The dominant alopecia phenotypes Bareskin, Rex-denuded, and Reduced Coat 2 are caused by mutations in gasdermin 3

Reduced Coat 2 (Rco2) is an ENU-induced mutation affecting hair follicle morphogenesis by an abnormal and protracted catagen. We describe chromosomal mapping and molecular identification of the autosomal dominant Rco2 mutation. The Rco2 critical region on mouse chromosome 11 encompasses the alopecia loci, Bareskin (Bsk), Rex-denuded (Re(den)), Recombination induced mutation 3 (Rim3), and Defolliculated (Dfl). Recently, the gasdermin (Gsdm) gene was described as predominantly expressed in skin and gastric tissues. We provide evidence for a murine-specific gene cluster consisting of Gsdm and two closely related genes which we designate as Gsdm2 and Gsdm3. We show that Gsdm3 reflects a mutation hotspot and that Gsdm3 mutations cause alopecia in Rco2, Re(den), and Bsk mice. We infer a role of Gsdm3 during the catagen to telogen transition at the end of hair follicle morphogenesis and the formation of hair follicle-associated sebaceous glands.

Alopecia in a novel mouse model RCO3 is caused by mK6irs1 deficiency

Reduced coat 3 (Rco3) is a new spontaneous autosomal recessive mutation with defects in hair structure and progressive alopecia. Here we describe chromosomal mapping and molecular identification of the Rco3 mutation. The murine Rco3 locus maps to a 2-Mb interval on chromosome 15 encompassing the keratin type II gene cluster. Recently, mK6irs1 was described as a type II keratin expressed in Henle's and Huxley's layer of the murine inner root sheath. Genomic sequencing revealed a 10-bp deletion in exon 1 of mK6irs1 resulting in a frameshift after 58 amino acid residues and, therefore, the absence of 422 carboxy-terminal amino acid residues containing the complete alpha-helical rod domain. Henle's and Huxley's layers show no immunoreactivity with mK6irs1-specific antibodies and the absence of intermediate filament formation in electron microscopic images. These results indicate that the expression of functional mK6irs1 is indispensable for intermediate filament formation in the inner root sheath and highlights the importance of the keratinization of the inner root sheath in the normal formation of the hair shaft.

Psychosomatic liaison service in dermatology. Need for psychotherapeutic interventions and their realization

BACKGROUND

Empirical investigations examining the psychosocial distress and need for care of dermatology patients are rare. Little is known about the use of psychotherapeutic interventions in routine care.

OBJECTIVE

To evaluate the psychosocial distress of dermatological inpatients, the need for psychotherapeutic interventions and their realization in the framework of a psychosomatic liaison service.

METHODS

86 patients from one unit at the University Dermatology Clinic in Freiburg underwent psychodiagnostic interviews and completed self-rating instruments, elucidating mental disorders, psychosocial distress, coping methods, quality of life, treatment motivation and psychotherapeutic interventions.

RESULTS

Using ICD-10 criteria, mental and behavioral disorders were diagnosed in 46%; most frequent were mood and anxiety disorders. Professional assessment indicated a need for psychotherapeutic treatment in 51%, while 28% of the patients wished for psychotherapy; actual intervention occurred in 38%.

CONCLUSIONS

The need for psychotherapeutic treatment can only be handled within the framework of a liaison service in close collaboration with care givers.

Improved diffusion-weighted single-shot echo-planar imaging (EPI) in stroke using sensitivity encoding (SENSE)

Diffusion-weighted single-shot EPI (sshEPI) is one of the most important tools for the diagnostic assessment of stroke patients, but it suffers from well known artifacts. Therefore, sshEPI was combined with SENSitivity Encoding (SENSE) to further increase EPI's potential for stroke imaging. Eight healthy volunteers and a consecutive series of patients (N = 8) with suspected stroke were examined with diffusion-weighted SENSE-sshEPI using different reduction factors (1.0 < or = R < or = 3.0). Additionally, a high-resolution diffusion-weighted SENSE-sshEPI scan was included. All examinations were diagnostic and of better quality than conventional sshEPI. No ghostings or aliasing artifacts were discernible, and EPI-related image distortions were markedly diminished. Chemical shift artifacts and eddy current-induced image warping were still present, although to a markedly smaller extent. Measured direction-dependent diffusion-coefficients and isotropic diffusion values were comparable to previous findings but showed less fluctuation. We have demonstrated the technical feasibility and clinical applicability of diffusion-weighted SENSE-sshEPI in patients with subacute stroke. Because of the faster k-space traversal, this novel technique is able to reduce typical EPI artifacts and increase spatial resolution while simultaneously remaining insensitive to bulk motion.

Maternal versus paternal expression of a LacZ transgene in preimplantation mouse embryos: effects of genetic background and 2-cell block

The expression of a transgene NI-ROSA LacZ (LacZtg) trapped into the genes for two presumably untranslated, ubiquitously expressed RNAs, was studied in preimplantation mouse embryos with respect to penetrance (fraction of expressing embryos) and to localisation of beta-galactosidase activity. With maternal origin in NMRI mice beta-galactosidase was first detected within one dot in the cytoplasm of zygotes at 30 h post-hCG. The staining pattern progressed to small clusters and to dense, homogeneous staining of the entire cytoplasm during further development. Within the NMRI background, penetrance in utero was delayed by at least 6 h when the transgene was of paternal as compared with maternal origin. Paternal transgene expression increased marginally during culture to 50 h after explantation of embryos at 30-48 h post-hCG and remained low or decreased in the '2-cell block'. Expression of a paternal transgene in preimplantation embryos developing in utero was further delayed in the maternal MF1 as compared with the NMRI background. In contrast to NMRI x NMRI embryos with paternally derived transgene, expression increased with time during the 2-cell block in MF1 x NMRI embryos. Thus, in the earliest phase of mammalian development expression of this LacZtg is influenced by parental origin, maternal genetic background and environment. The spatial distribution of the gene product is developmentally controlled.

A new rating scale for age-related white matter changes applicable to MRI and CT

BACKGROUND AND PURPOSE

MRI is more sensitive than CT for detection of age-related white matter changes (ARWMC). Most rating scales estimate the degree and distribution of ARWMC either on CT or on MRI, and they differ in many aspects. This makes it difficult to compare CT and MRI studies. To be able to study the evolution and possible effect of drug treatment on ARWMC in large patient samples, it is necessary to have a rating scale constructed for both MRI and CT. We have developed and evaluated a new scale and studied ARWMC in a large number of patients examined with both MRI and CT.

METHODS

Seventy-seven patients with ARWMC on either CT or MRI were recruited and a complementary examination (MRI or CT) performed. The patients came from 4 centers in Europe, and the scans were rated by 4 raters on 1 occasion with the new ARWMC rating scale. The interrater reliability was evaluated by using kappa statistics. The degree and distribution of ARWMC in CT and MRI scans were compared in different brain areas.

RESULTS

Interrater reliability was good for MRI (kappa=0.67) and moderate for CT (kappa=0.48). MRI was superior in detection of small ARWMC, whereas larger lesions were detected equally well with both CT and MRI. In the parieto-occipital and infratentorial areas, MRI detected significantly more ARWMC than did CT. In the frontal area and basal ganglia, no differences between modalities were found. When a fluid-attenuated inversion recovery sequence was used, MRI detected significantly more lesions than CT in frontal and parieto-occipital areas. No differences were found in basal ganglia and infratentorial areas.

CONCLUSIONS

We present a new ARWMC scale applicable to both CT and MRI that has almost equal sensitivity, except for certain regions. The interrater reliability was slightly better for MRI, as was the detectability of small lesions.

[The validity of the Hornheide questionnaire for psychosocial support in skin tumor patients: a survey in an Austrian and German outpatient population with melanoma]

Tumour patients are subject to different degrees of psychosocial distress depending on the course of disease, personality variables and amount of social support available. Often patients do not spontaneously talk about their distress and attending physicians fail to detect it. Therefore, it is important that the presence of distress is ascertained by specific screening instruments so that appropriate supportive measures can be instituted. The Hornheide Questionnaire (HQ) employed for investigating the need for psychosocial support in the case of patients with skin tumours and with tumours in the head and neck region represents such a specific screening instrument. The present study investigates the validity of the HQ on the basis of two representative samples from two different University Clinics for treatment and follow-ups of melanoma patients. With the help of the HQ, 215 patients at the Dermatology Out-patient Unit of the University of Innsbruck and 223 patients at the University of Freiburg were investigated with regard to their subjective experience of distress. The external constructive validity criteria were established on the basis of the Freiburg Questionnaire of Disease-Coping, the questionnaire of social support and Beck's Depression Inventory. There were significant differences between individuals in the severity of distress in different age groups and in patients in different tumour stages. The internal consistency of the HQ and its subscales proved to be satisfactory demarcation from other psychosocial dimensions and an adequate correlation with similar dimensions (depression, depressive illness coping, social support, compliance). The HQ appears to be an economical and valid screening instrument for detecting the need for psychosocial support in melanoma patients in the out-patient follow-up stage.

TIA1 and mast cell tryptase in food allergy of children: increase of intraepithelial lymphocytes expressing TIA1 associates with allergy

BACKGROUND

Variability of symptoms and signs make the diagnosis of children's food allergy (FA) difficult. In addition, mechanisms and antigens involved vary with age. In young infants, cow's milk protein allergy is associated with an increase of cytotoxic intraepithelial lymphocytes (IELs) expressing T-cell-restricted intracellular antigen (TIA1). In the current study, the significance of TIA1 in FA in older children of mainly preschool and school age was analyzed and the findings correlated the with a detailed clinical, endoscopic, and histopathologic analysis.

METHODS

The subjects of this study were 66 children (mean age, 7.9 years; range, 1-15), including 27 with untreated and 15 with treated FA, and 24 control subjects. The morphology of duodenal and antral biopsy specimens was evaluated, and the proportion of TIA1-positive IELs was counted from immunostained sections. Quantification of mast cells with immunostaining for mast cell tryptase (MCT) was completed, with the estimation of diffuse extracellular staining considered to indicate degranulation.

RESULTS

Patients with untreated FA showed an increase in the total number of TIA1-positive cells and IELs and of the TIA1/IEL ratio. The number of mast cells in duodenal mucosa was decreased in children with FA, but no association with degranulation was observed. Endoscopic abnormalities were common in FA, but conventional histopathology showed no informative differences.

CONCLUSIONS

The significant increase of TIA1-positive IELs in duodenal tissue specimens is associated with FA. The cytotoxicity of T lymphocytes seems to play a role in the pathogenesis of gastrointestinal FA. Activation and mechanisms of action should be studied further.

Parkin expression in the adult mouse brain

Mutations in a protein designated Parkin were shown to be involved in the pathogenesis of autosomal recessive juvenile parkinsonism. Nothing is known about its regional and subcellular distribution in the mouse. In order to elucidate the Parkin mRNA and protein distribution in the adult mouse, the mouse cDNA was cloned and polyclonal antisera were generated against the N-terminal part of mouse Parkin. The antibodies were shown to be specific using Western blot analysis, immunostaining of cells transfected with mouse Parkin and pre-absorption tests. The Parkin protein expression profile was studied using immunohistochemistry and Western blot analysis and was compared with that of the mRNA yielded by in situ hybridization and RT-PCR analysis. Parkin protein was widely distributed in all subdivisions of the mouse brain. Low levels were found in the telencephalon and diencephalon, while the brainstem contained a large number of cells heavily expressing Parkin. Ultrastructural analysis and double immunohistochemistry revealed that the majority of Parkin-expressing cells were neurons, while only single glial cells exhibited immunostaining. The protein was distributed nonhomogeneously throughout the entire cytoplasm. A subpopulation of Parkin-immunopositive cells displayed speckled immunodeposits in the nucleus. Dopaminergic cells of the substantia nigra pars compacta exhibited high levels of Parkin mRNA but no Parkin protein, while the striatum contained immunopositive profiles but no mRNA signals. Our data indicate that Parkin is neither restricted to a single functional system nor associated with a particular transmitter system. The speckled nuclear distribution of Parkin immunoreactivity strongly suggests a role for Parkin in gene expression.

A comparison of magnetization transfer ratio, magnetization transfer rate, and the native relaxation time of water protons related to relapsing-remitting multiple sclerosis

BACKGROUND AND PURPOSE

Magnetization transfer (MT) imaging and measurements of the magnetization transfer ratio (MTR) have extended our capability to depict and characterize pathologic changes associated with multiple sclerosis (MS). We wanted to investigate whether the analysis of other MT parameters, such as magnetization transfer rate (k(for)) and relative measure of water content (T1(free)), adds insight into MS-related tissue changes.

METHODS

Quantitative MT imaging by use of phase acquisition of composite echoes was performed in nine patients with clinically definite relapsing-remitting MS and eight healthy control subjects on a 1.5-T MR system. We analyzed a total of 360 regions of interest and compared control white matter with various types of lesions and normal-appearing white matter in MS.

RESULTS

We found a strong correlation between the MTR and k(for), but this relation was non-linear. A slight but significant reduction of the MTR in normal-appearing white matter of patients with MS was attributable to a reduced transfer rate only, whereas a lower MTR was associated with both a reduction of k(for) and an increase of T1(free) in regions of dirty white matter. Moreover, areas such as edema and T1-isointense lesions had a similar MTR but could be differentiated on the basis of Tl(free).

CONCLUSION

Estimates of k(for) and T1(free) appear to complement MTR measurements for the understanding of MT changes that occur with different types of MS abnormalities in the brain.

Magnetic resonance diffusion tensor imaging for characterizing diffuse and focal white matter abnormalities in multiple sclerosis

High-resolution diffusion tensor imaging (DTI) was performed in 14 patients with clinically definite multiple sclerosis (MS) and the trace of the diffusion tensor (<D>) and the fractional anisotropy (FA) were determined in normal appearing white matter (NAWM) and in different types of focal MS lesions. A small but significant increase of the <D> in NAWM compared to control white matter ((840 +/- 85) x 10(-6) mm(2)/sec vs. (812 +/- 59) x 10(-6) mm(2)/sec; P < 0.01) was found. In addition, there was a significant decrease in the FA of normal-appearing regions containing well-defined white matter tracts, such as the genu of the internal capsule. In non-acute lesions, the <D> of T(1)-hypointense areas was significantly higher than that of T(1)-isointense lesions ((1198 +/- 248) x 10(-6) mm(2)/sec vs. (1006 +/- 142) x 10(-6) mm(2)/sec; P < 0. 001), and there was a corresponding inverse relation of FA. Diffusion characteristics of active lesions with different enhancement patterns were also significantly different. DTI with a phase navigated interleaved echo planar imaging technique may be used to detect abnormalities of isotropic and anisotropic diffusion in the NAWM and selected fiber tracts of patients with MS throughout the entire brain, and it demonstrates substantial differences between various types of focal lesions.

Diffusion-weighted imaging of patients with subacute cerebral ischemia: comparison with conventional and contrast-enhanced MR imaging

BACKGROUND AND PURPOSE

The importance of diffusion-weighted imaging (DWI) for delineating acute ischemic lesions has been investigated extensively; however, few studies have investigated the role of DWI in the subacute stage of stroke. Because these lesions tend to appear bright throughout the first days of ischemia, owing to restricted diffusion, we speculated that DWI could also improve the detection of subacute infarcts as compared with conventional and contrast-enhanced MR imaging.

METHODS

Interleaved echo-planar DWI with phase navigation was performed on a 1.5-T MR unit in a consecutive series of 53 patients (mean age, 66 +/- 14 years) with suspected recent cerebral ischemia. The interval between onset of clinical symptoms and MR imaging ranged from 1 to 14 days (mean, 6 +/- 4 days). Contrast material was given to 28 patients in a dose of 0.1 mmol/kg.

RESULTS

DWI clearly delineated recent ischemic damage in 39 patients (74%) as compared with 33 (62%) in whom lesions were identified or suspected on conventional T2-weighted images. DWI provided information not accessible with T2-weighted imaging in 17 patients when evidence of lesion multiplicity or detection of clinically unrelated recent lesions was included for comparison. Subacute ischemic lesions were also seen more frequently on DWI sequences than on contrast-enhanced images (20 versus 13 patients). DWI was more likely to make a diagnostic contribution in the first week of stroke and in patients with small lesions or preexisting ischemic cerebral damage than was conventional MR imaging.

CONCLUSION

Recent ischemic damage is better shown on DWI sequences than on conventional and contrast-enhanced MR images throughout the first days after stroke and may provide further information about the origin of clinical symptoms. Adding DWI to imaging protocols for patients with subacute cerebral ischemia is recommended.

Psychosocial stress of patients with port wine stains and expectations of dye laser treatment

BACKGROUND

Port wine stains can be treated successfully with the dye laser in most cases. The indication for treatment is made on the basis of the emotional stress arising from the port wine stain. Studies of the extent of psychosocial stress to date have led to contradictory results.

OBJECTIVE

To address the question how many patients with port wine stain suffer psychosocial stress and how this group can further be characterized. Moreover, the specific expectations of treatment were to be elucidated.

METHODS

During dye laser treatment, 76 patients with port wine stains were evaluated by questionnaires regarding (a) emotional well-being, (b) quality of life, (c) body perception and (d) disease-specific stress and expectations of therapy.

RESULTS

Patients with port wine stains showed significantly higher emotional stress than healthy controls. They were particularly impaired in quality of life with respect to their social life and felt less attractive than a healthy control group. Patients with high emotional stress placed high hopes on the laser therapy with regard to chances of employment and social contacts.

CONCLUSION

The data point to the need for thorough patient consultation prior to laser therapy in order to avoid excessive expectations. Psychological consultation is recommended for emotionally labile PWS patients.

Diffusion-weighted MR imaging of the spinal cord

Diffusion-weighted MR imaging may increase the sensitivity and specificity of MR imaging for certain pathologic conditions of the spinal cord but is rarely performed because of several technical issues. We therefore tested a novel phase-navigated spin-echo diffusion-weighted interleaved echo-planar imaging sequence in seven healthy volunteers and six patients with intramedullary lesions. We performed diffusion-weighted MR imaging of the spinal cord with high spatial resolution. Different patterns of diffusion abnormalities observed in patient studies support the possible diagnostic impact of diffusion-weighted MR imaging for diseases of the spinal cord.

[Effects of combined dermatological and behavioural medicine therapy in hospitalized patients with psoriasis and atopic dermatitis]

The present study examined the effectiveness of combined dermatological and behavioural medicine therapy on the skin status and disease-specific stress of eighty-six patients with psoriasis and fifty-eight patients with atopic dermatitis who were hospitalized in the PsoriSol Clinic, Hersbruck, Germany. In addition to receiving instruction about their stain disease, the patients were offered, practice in relaxation techniques, social contacts and scratching control as well as individual psychological counselling. The clinical change was assessed by PASI and SCORAD, respectively. The Marburg questionnaire for coping with skin diseases (MHF) and a questionnaire for health-related control attributes (GKU-S) served as psychometric measures. Patients showed significant improvement in skin status and psychosocial parameters in pre-post comparison. Social fears, avoidance and helplessness were reduced by significant improvement of the emotional status in both groups. Patients with psoriasis also showed an increase in internal control attributes. Dermatological treatment combined with behavioural medicine therapy can be considered an effective method in patients with atopic dermatitis and psoriasis.

Skin surgery under local anesthesia leads to stress-induced alterations of psychological, physical, and immune functions

BACKGROUND

Although excision of nevi under local anesthesia is a frequent and harmless operation, it apparently causes increased stress in many patients. However, thus far no studies have focused on the question of whether there are measurable effects on psychological, physiological, and immunological parameters.

OBJECTIVE

To assess the perioperative stress reactions of patients undergoing skin surgery under local anesthesia for nevocellular nevi.

METHODS

Fifty consecutive patients with pigmented nevi were examined at five points of measurement: 1 week and 30 minutes before the operation, during the operation, 30 minutes and 1 week after the operation. Somatic parameters included blood pressure, pulse, respiratory rate, and the level of pain. Lymphocyte subpopulations, white blood cell count, and cortisol in saliva were determined. Anxiety and general psychological distress were evaluated with validated questionnaires.

RESULTS

There was a significant increase in anxiety at the time of surgery. In parallel, the physiological parameters as well as the CD56+ lymphocytes changed significantly. Preoperation anxiety and intraoperation pain were significantly higher in women (P <.001), but did not depend on age.

CONCLUSION

There appears to be an interaction between physiological and emotional components in the operative stress reaction under local anesthesia. In patients with skin cancer, the perioperative stress may lead to transient impairment of immune function.

[Quality of life in skin diseases: methodological and practical comparison of different quality of life questionnaires in psoriasis and atopic dermatitis]

Aim of the present study was a comparison of four quality of life (QoL) questionnaires in 228 patients with psoriasis (PSO, n = 148) and atopic dermatitis (AD, n = 80) regarding feasibility, discriminant validity and sensitivity to change. Evaluating were performed before and after treatment in clinic. The following questionnaires were compared. 1) Freiburg Quality of Life Assessment for Dermatoses (FLQA-d), 2) Dermatology Life Quality Index (DLQI), 3) Chronic Skin Disease Questionnaire (CSDQ) and 4) questionnaire on everyday life (ALLTAG). All questionnaires were able to discriminate significant reductions of QoL in PSO and AD, as compared to controls. In parallel to the clinical improvement, all questionnaires showed QoL improvements as well, i.e. the questionnaires were sensitive to change. However, not all of the DLQI and ALLTAG scales were sensitive to change. Also, in some cases part of the scales of these questionnaires could not be calculated due to missing data. Otherwise, all questionnaires were valid and easy to handle. Thus, QoL of patients with PSO and AD can reliably be assessed by various questionnaires. Decisive for selection are the aim and the design of the study.

[Psychological status and motivation for psychosocial intervention in patients with allergic disorders]

The aim of this study was to compare the psychological stress of patients with different forms of immediate type hypersensitivity and urticaria. Moreover, the patients' motivation for different forms of psychological treatment was assessed and an indication for psychosocial support was defined. 228 consecutive inpatients with insect venom allergies (ins), food intolerance (food), drug hypersensitivities (dru) and urticaria (urt) were evaluated by validated questionnaires regarding psychological strain and motivation for psychosocial treatments. Patients with food intolerance and urticaria showed significantly elevated psychological stress and higher motivation for psychosocial support as compared to those with insect venom allergies and drug intolerance. Patient education was the favourite technique for the patients (food 78%, urt 57%, dru 24%, ins 17%), followed by relaxation treatment. The most important predictors for the motivation were the wish for self-responsibility, a feeling of helplessness and social limitations. If strong indication criteria are applied, psychosocial support is indicated in only small subgroups of each patient group. In spite of that, the management of allergic disease should consider the potential need for psychosocial support.

Diffusion-weighted imaging with navigated interleaved echo-planar imaging and a conventional gradient system

PURPOSE

To demonstrate the technical feasibility and precision of a navigated diffusion-weighted (DW) MR imaging method with interleaved echo-planar imaging and test its diagnostic sensitivity for detection of ischemic stroke.

MATERIALS AND METHODS

Apparent diffusion coefficient (ADC) measurements were performed in phantoms, and six healthy adult volunteers were examined to determine intrasubject (precision) and intersubject (reference range) variations in absolute ADC and relative ADC (rADC) measurements. DW imaging maps and lesion rADC values were also obtained in 34 consecutive stroke patients to evaluate the sensitivity and reliability of DW-interleaved echo-planar imaging for detection of ischemic brain damage.

RESULTS

Phantom and volunteer ADC values were in excellent agreement with published data. The intrasubject variation of rADC was 6.2%. The ADC precision ranged from 6.5% in the subcortical white matter in the frontal lobe to 12.9% in the head of the caudate nucleus. Interleaved echo-planar imaging enabled rapid acquisition of high-quality images of the entire brain without substantial artifacts. Within the 1st week, the sensitivity of DW-interleaved echo-planar imaging for detection of acute infarction was 90% (18 of 20 true-positive studies) and independent of lesion location.

CONCLUSION

DW-interleaved echo-planar imaging with phase navigation and cardiac triggering is robust, reliable, and fast. With high sensitivity for detection of early ischemic infarction, it is useful for examining stroke patients by using MR systems with conventional gradient hardware.

Sociodemographic profile and satisfaction with treatment of patients undergoing liposuction in tumescent local anesthesia

OBJECTIVE

To assess patient satisfaction with liposuction in tumescent local anesthesia (TLA) and to define a patient profile regarding sociodemographic data.

METHODS

Three hundred randomly selected patients were asked by mail to complete a standardized questionnaire on aesthetic dermatology and cosmetic surgery 3-25 months after liposuction. The 64 items addressed treatment satisfaction, treatment effects on body, social, and professional life as well as self-confidence, body feeling, and social contacts.

RESULTS

One hundred fifty-nine (53.0%) of 300 patients returned complete questionnaires. Ninety-two percent of the patients were female and the mean age was 45.3 +/- 11.8 years. The mean body mass index (BMI) was 24.5 +/- 3.7, and 61.7% of the patients had a normal BMI. Satisfaction with the liposuction was high (about 85% mostly or completely satisfied). The procedure was regarded by most patients as a nonstressful event (>80%). About 40% reported positive effects on social life, about 91% on body feeling, 57% on attractiveness, and 20% on their profession.

CONCLUSION

Liposuction in TLA is a satisfying and well-tolerated treatment for most patients.

A multicopy c-Myc transgene as a nuclear label: overgrowth of Myctg50 cells in allophenic mice

To trace cell lineages and the origin and fate of cells in transplantation and embryo chimeras, a DNA/DNA in situ hybridization cell labelling system was developed, based on a 50-copy murine c-myc transgene on mouse chromosome 8. Elevated levels of cMyc mRNA were found in Myc*tg50 (Myctg50/0 and Myctg50/Myctg50) transgenic tissues, but adult transgenic NMRI mice were anatomically and histologically indistinguishable from control NMRI mice and did not develop tumours on a wild-type or nude (nu/nu) background. The hybridization label detected transgenic nuclei with an efficiency of approximately 80%. In muscle grafts, this transgene label was successfully applied to trace donor cells in a labelled host and to study the invasion of a graft by host cells. When the cMyc hybridization was used in allophenic mice of the control<-->NMRI-Myctg50/? (nu/+ or +/+) type, an up to a three-fold excess of MYC*tg50 positive over control nuclei was found in all organs examined (ventricle, skeletal muscle, liver, small intestine). This overgrowth of MYC*tg50 cells is probably due to transgene expression. Four out of seven (C57BL/6xBALB/c) or (C57BL/6xNMRI)<-->MYC*tg50 allophenic mice displayed anatomical abnormalities, e.g. an enlarged thymus and a tumour in the groin region. As these abnormalities were only observed in allophenic mice, they might be due to the imbalance of growth potential between MYC*tg50 transgenic and normal cells in the same individual.

Interactive patterns of social support and individual coping strategies in melanoma patients and their correlations with adjustment to illness

Combined patterns of social support and coping style and correlations with adjustment to cancer were investigated in early-stage melanoma patients. The authors studied 358 consecutive patients attending regular follow-up who answered standardized instruments that assess social support, coping behavior, and tumor-related distress. Regression analyses identified high active and low depressive coping behavior as stronger predictors for perceived support than sociodemographic and clinical variables. Cluster analyses yielded four coping-support patterns. High social support, combined either with active coping or with stoicism, was associated with good adjustment, whereas low perceived support in the subjects living alone or in the patients exhibiting depressive coping behavior was associated with poor adjustment.

[Regulative therapy: treatment with nonspecific stimulants in dermatology in traditional and modern perspectives]

Stimulation or regulation therapies are old therapeutic procedures based on models reaching back to traditional medical faculties in ancient times and in the Middle Ages. Among this heterogeneous group are acupuncture, purgative procedures (especially the Aschner methods), autohemotherapy, fasting therapy, homeopathy, microbiological and physical therapies. The basic principle underlying all of these procedures is that stimulants applied in proper doses to the organism elicit counterregulation. The counterregulation stimulates 'self-healing processes' within the organism. The efficacy of stimulation therapies was originally deduced mostly from traditional explanatory models which have lost their relevance for modern medicine. However, it has been found in applications in dermatology that many of these stimulation therapies can lead to clinical improvement in selected indications and that modern explanatory models can be found for these effects. This presentation reports on exemplary applications of stimulation therapies in dermatology. Traditional and modern concepts of action are compared.

[Alternative medicine therapy in dermatology: dimensions, chances and approaches to an integrative understanding]

Skin diseases may bring considerable psychosocial stress for the affected patients. The therapist must strive to relieve the symptoms and also to provide long-lasting prevention of recurrences, especially in chronic skin diseases. Clinical experience has shown complementary procedures, especially the classical naturopathy, to be promising supplements to conventinal therapy. Proof of efficacy in dermatological applications has been found in controlled studies for some of these procedures. By far the majority of these applications in dermatology still require controlled investigation. The required efficacy studies should orient to internationally accepted criteria for clinical studies and record not only clinical efficacy but also quality of life factors and cost of treatment in a therapy comparison. Psychosomatic relationships play a particular role in dermatological treatment. In addition to their importance as occasional originators or potentiaters of skin disease, emotional factors are crucial in the secondary stress associated with the disease due to the numerous visible effects on the skin. An integrative dermatological therapy makes the attempt both to determine and to treat the co-eliciting emotional factors and to support the patient's mode of coping with the disease. The doctor-patient relationship is especially important here. In summary, conventional, complementary and psychosomatic procedures can be mutually beneficial in dermatological therapy.

Attitudes and prior experience with respect to alternative medicine among dermatological patients: the Freiburg questionnaire on attitudes to naturopathy (FAN)

OBJECTIVES

1) Development and validation of a questionnaire on the attitudes and prior therapies with respect to naturopathy. 2) Clinical application in patients with atopic dermatitis in conventional and unconventional inhospital therapy.

METHODS

A questionnaire for patients with skin diseases was developed, which includes the following areas: 1. prior therapies (conventional, unconventional, and psychotherapeutic procedures), 2. attitudes to the procedures, 3. previous therapists, 4. sources of information about the disease. The questionnaire was validated on 1,288 inpatients and outpatients in three clinics. A comparison study using the questionnaire was performed with 73 inpatients with atopic dermatitis under conventional therapy and 59 inpatients under alternative-medical therapy.

RESULTS

The patients undergoing alternative-medical therapy reported significantly more prior experience in both conventional and unconventional procedures. The unconventional procedures were rated significantly higher by these patients, while the patients under conventional treatment rated several conventional procedures significantly higher. With respect to previous therapists, patients under unconventional treatment had been treated significantly more frequently by physicians oriented toward naturopathy and nonmedical practitioners. Prior information concerning the disease had been obtained significantly more frequently by the patients under alternative-medical treatment.

DISCUSSION

Patients with atopic dermatitis under conventional or alternative medical treatment differ widely from one another with respect to previous therapies and prior experience and attitudes to conventional and unconventional procedures. These selection effects must be taken into consideration when comparing various therapeutic approaches, e. g. in multicenter studies.

[Linear IgA dermatosis in an adult with clinical signs of Stevens-Johnson syndrome]

Immunohistologically linear IgA disease presents with unambiguous features, whereas clinical manifestations are variable. It sometimes shows similarity to other bullous dermatoses such as bullous pemphigoid and dermatitis herpetiformis. A 73 year old female patient was referred with the diagnosis of bullous pemphigoid. One day after admission clinical examination revealed the classical features of Stevens-Johnson syndrome (SJS): widespread confluent atypical target lesions, partly raised, partly flat with central blisters, and erythematous spots, but few typical targets, as well as blisters and large areas of skin detachment on her back and buttocks, accompanied by erosions of the oral and genital mucosa. Direct immunofluorescence performed on peri-lesional skin showed linear deposition of IgA along the basement membrane zone, leading to the diagnosis of linear IgA disease of adults. Our case report shows that linear IgA disease may present with the clinical pattern of SJS.

[Phytotherapy in chronic dermatoses and wounds: what is the evidence?]

Phytotherapeutic preparations and synthetic derivatives of plant origin have been used in conventional dermatology for a long time. A further spectrum of phytotherapeutic agents for the treatment of dermatological diseases and wounds is known from alternative medical treatment. To the efficacy of these phytotherapeutic agents only few data from studies are available. Own studies and studies published in the specialist literature, especially on chamomile, arnica, calendula, hamamelis, Aloe vera, cardiospermum, Mahonia aquifolium, oak bark, bittersweet stalk, and capsaicin indicate that these plants may be of value in selected dermatological indications. Other controlled clinical efficacy studies and pharmacological studies are needed to prove the assumed effects, to record the spectrum of side effects, and to clarify the mechanisms of action.

Psychosocial characterization of patients with atopic dermatitis in conventional versus alternative-medical therapy

OBJECTIVE

Recording of psychosocial differences between patients with atopic dermatitis (AD) undergoing conventional versus alternative-medical treatment as indication of a center-related selection effect.

STUDY DESIGN

In this prospective comparative study, inpatients of an alternative-medical clinic and of the University Dermatology Clinic Freiburg were given standardized questionnaires on psychosocial characteristics in the areas of disease-specific stress, social support, and coping with the disease.

PATIENTS

Fifty-nine consecutive AD patients were recruited at the alternative-medical clinic and 79 AD patients at the University Dermatology Clinic. Fifty-five (93.2%) and 73 (92.4%) patients respectively returned completed questionnaires.

RESULTS

The two treatment groups differed markedly from one another with respect to psychosocial parameters. Patients of the alternative-medical clinic showed greater disease-specific stress, lower social integration, and higher values in the coping scales 'depressive coping' and 'religious conviction and search for meaning'. Compared to patients with acne vulgaris, both patient groups were under significantly greater disease-specific stress. The factor 'social integration' was determined by logistical regression analysis to be the most important differentiation characteristic between the groups.

CONCLUSIONS

Patients under alternative-medical treatment may show significant psychosocial differences in comparison with conventionally treated patients. In comparative studies between conventional and alternative-medical therapy centers, selection effects must be assumed and taken into account when evaluating the study.

Effects of Mahonia aquifolium ointment on the expression of adhesion, proliferation, and activation markers in the skin of patients with psoriasis

OBJECTIVE

To examine the effects of topical therapy with Mahonia aquifolium on the expression of pathogenetically relevant molecules in psoriatic skin by immunohistochemistry.

STUDY DESIGN

Prospective-randomized, half-side comparison study with subsequent immunohistochemical assessment of biopsies.

METHODS

The study areas were treated with Mahonia aquifolium ointment 3( daily and with dithranol in rising concentrations 1( daily, respectively. Biopsies of lesional skin from the test areas were carried out in 49 patients a) prior to therapy and b) 4 weeks after the start of therapy. Immunohistochemical stainings were performed with the following monoclonal antibodies: anti-ICAM-1, -CD3, -HLA-DR, -keratin 6, -keratin 16, -Ki-67. Evaluation of staining was made by two independent examiners using established semiquantitative scores.

RESULTS

Marked staining with all of the cited monoclonal antibodies was observed in the lesional skin prior to therapy. After 4 weeks of therapy there was a marked reduction in the expressions of ICAM-1, CD 3, HLA-DR and keratin 6 and 16. There were significantly greater reductions of ICAM-1, CD3, and HLA-DR at sites treated with dithranol. The expression of Ki-67 was not reduced by either therapy.

CONCLUSIONS

These results indicate efficacy of Mahonia aquifolium and dithranol in psoriatic skin both on cellular cutaneous immune mechanisms and on the hyperproliferation of keratinocytes. The effect of dithranol appears to be more potent than that of Mahonia aquifolium.

[Tumescent technique for local anesthesia. Use and prospectives of aa new anesthetic method]

The tumescent technique for local anesthesia (TLA) involves the infiltration of the subcutaneous fatty tissue with a large volume of a diluted local anesthetic. This large added volume increases the tension in the tissue, creating more favorable conditions for the action of the analgesic and for dermatological operative measures. Originally developed for use in the area of liposuction, TLA has since proved to have advantages over other forms of analgesia in numerous other dermatological indications. Overall, TLA is an effective and practical analgesic technique associated with comparatively few side effects that has been shown to be very useful in surgery of the skin.