A 33-year-old white female presented to dermatology clinic with a three-month history of swelling and itching of blue-ink tattoos over each of her deltoid muscles. These symptoms began within one week of receiving intramuscular H1N1 vaccine (Sanofi-Pasteur, multidose vial containing 0.01% thimerosal, lot number UP005AA with expiration date March 15th 2011) into the right deltoid muscle superior to the tattoo on the right deltoid. These tattoos were placed eight years prior at different tattoo parlors. The patient denied past cutaneous eruptions or history of sarcoidosis or other vaccines or tattoos during this period. Past medical history included depression treated with depakote and haloperidol; hysterectomy with right oophorectomy and obesity. No medications had changed in the previous four months. Social history included occasional alcohol use but no tobacco or intravenous drug abuse. Physical examination showed induration confined to the blue-ink containing skin of two tattoos over the patient's deltoid muscles ( Figure 1). Other tattoos containing black, red and yellow ink were not affected.Histology of the punch biopsy specimen revealed noncaseating granulomas containing fine black granules (Figure 2). Staining revealed no evidence of acid-fast bacilli or fungi. Pathohistological differential diagnosis was sarcoidosis versus granulomatous reaction to pigment granules.Workup for sarcoidosis included chest X-rays, pulmonary function testing, ophthalmological examination and angiotensin converting enzyme serum levels. All studies were within normal limits except for pulmonary function testing which revealed a moderate restrictive lung defect. The patient declined further workup, as well as referral to a pulmonologist. A diagnosis was made of granulomatous reaction confined to blue-ink tattoos possibly triggered by H1N1 vaccine. After failing a trial of clobetasol ointment twice daily the patient is currently well-controlled with intralesional injections of triamcinolone acetonide. CommentNoncaseating granulomas in patients with edema and pruritus of tattoos have been attributed to both sarcoidosis and delayed type hypersensitivity reactions.1 Sarcoidosis cannot be excluded even if foreign pigment is found in a biopsy site [1].Sarcoidosis is a common disorder of the lungs and skin with AbstractNoncaseating granulomas occur due to a hypersensitivity reaction to an exogenous antigen. The introduction of the H1N1 vaccine has been successful in disease prevention but we expand the current literature on possible adverse reactions to the vaccine to include granulomatous reactions.

Neurofibromatosis, being found as one incident in 2500-3000 births, is a genetic disease that involves either skin system, nervous system or both systems simultaneously and that leads to important cosmetic and functional disorders. Although, cervical cord compression is not frequently found in nervous system compression, nevertheless, it takes a very important place since it may lead to severe neurological deficits and it may be treated by combination of surgical intervention with physical medicine and rehabilitation in early stage. There are not many treatment options in the advanced cases. In our study, we aimed to discuss treatment approaches by evaluating a patient with complex case of neurofibromatosis in whom whole spinal cord is full of neurofibromas accompanied by cervical cord compression.

We present a possibly simple and effective way to identify living specimens of the various species of Nepenthes. The volume and height of the pitchers are closely correlated variables of which the mathematical relationship between them can be expressed in a simple formula. These formulas, preferably of the upper pitchers when available, are slightly different for most species investigated, especially for the largest pitchers on specimens. This method is easily applicable in Botanical Gardens, which generally have a small, highly similar set of species. However, the results are based on few data (few specimens per species, only from two botanical gardens). Thus, please help, by providing more data, especially of hybrids, to further test the method.

Biomacromolecules offer complex and precise functions embedded in their monomer sequence such as enzymatic activity or specific interactions towards other molecules. Their informational content and capability to organize in higher ordered structures is superior to those of synthetic molecules. In comparison, synthetic polymers are easy to access even at large production scales and they are chemically more diverse. Solubilization, shielding against enzymatic degradation to more advanced functions like switchability or protein mimicry, etc., are accessible through the world of polymer chemistry. Bio-inspired hybrid materials consisting of peptides or proteins and synthetic polymers thereby combine the properties of both molecules to give rise to a new class of materials with unique characteristics and performance. To obtain well-defined bioconjugate materials, high yielding and site-specific as well as biorthogonal ligation techniques are mandatory. Since the first attempts of protein PEGylation in the 1970s and the concept of “click” chemistry arising in 2001, continuous progress in the field of peptide– and protein–polymer conjugate preparation has been gained. Herein, we provide an overview on ligation techniques to prepare functional bioconjugates published in the last decade, also referred to as “post-click” methods. Furthermore, chemoenzymatic approaches and biotransformation reactions used in peptide or protein modification, as well as highly site-specific and efficient reactions originated in synthetic macromolecular chemistry, which could potentially be adapted for bioconjugation, are presented. Finally, future perspectives for the preparation and application of bioconjugates at the interface between biology and synthetic materials are given.