[Development of an ivermectin-containing syrup as an extemporaneous preparation for treatment of scabies in children]

BACKGROUND

Oral ivermectin can be used to treat scabies. Evidence for safe and effective use in young children in individual treatment situations has been developed and published. In order to also ensure a body weight-adapted dosage for children, an ivermectin-containing syrup was developed as an extemporaneous preparation.

MATERIALS AND METHODS

Since ivermectin is not available as a pure substance for the formulation, tablets containing active ingredient were used as a basic material for development. The formulation was designed according to pharmaceutical, regulatory and use-oriented criteria. An HPLC (high-pressure liquid chromatography) method was developed and validated to demonstrate chemical stability. In order to facilitate the practical implementation, information on suitable packaging material and application aids was also developed and the formulation was evaluated.

RESULTS

It has been demonstrated that the final formulation produced in the pharmacy was stable and can be stored for 3 weeks. No concerns were raised regarding the tolerability of the syrup formulation. The physicochemical properties and the taste of the formulation allow the intended use as a well-dosed syrup for children.

CONCLUSION

The developed formulation meets the requirements of the Apothekenbetriebsordnung (Pharmacy Work Rules; Section 7 ApBetrO) and enables an exact, body weight-adapted dosage of oral ivermectin in young children. Studies on human pharmacokinetics or clinical studies to demonstrate tolerability and/or efficacy are not available for the formulation.

A phase I clinical trial testing the safety of IL-21-expanded, off-the-shelf, natural killer cells for relapsed/refractory acute myeloid leukemia and myelodysplastic syndrome

TPS7562

Background: Allogeneic transplantation (Allo-HCT) demonstrates the enduring and potent role of the immune system in the control and eradication of acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). However, patients with relapsed, refractory (R/R) disease or comorbidities are not eligible for Allo-HCT. We sought to develop an allogeneic Natural killer (NK) cell-based immunotherapy approach to induce remission for these patients. The efficacy of haploidentical NK cells expanded ex vivo using a K562 feeder-cell line transfected with IL-21 and 41BBL has been established in R/R AML patients. However, haploidentical donor-derived NK cell manufacturing exceeds three weeks with the possibility of fulminant malignancy rendering patients ineligible for cellular therapy. To address this limitation we established a third-party NK cell bank derived from KIR and HLA-mismatched ‘ideal’ donors that allows scalable, affordable mass-production of large numbers of NK cells suitable for banking and immediate ‘off-the-shelf’ (OTS) administration to a broad population of recipients. Methods: This phase I study follows a 3+3 design to investigate the safety of mIL-21-expanded, third-party, OTS NK cells for treatment of R/R AML and MDS patients. Patients aged ≥18 or ≤80 years are enrolled into two cohorts: those <60 years and able to tolerate intensive chemo will receive Fludarabine 30mg/m2/day (days -6 to -2) and Cytarabine 2g/m2/day (days -6 to -2). Patients >60 years or <60 years and unable/unwilling to tolerate intensive chemo will receive Fludarabine 30mg/m2/day (days -5 to -2) and Decitabine 20mg/m2/day (days -6 to -2). All patients subsequently receive a total of 6 infusions of NK cells administered thrice weekly for two weeks (between days 0-21) and will be followed up to day 56 from first NK cell infusion. Three NK cell dose-levels: 1x107, 3x107 and 1x108 cells/kg/dose will be explored to determine maximum tolerated dose (MTD). 3-18 patients/cohort/dose may be enrolled for MTD determination plus an additional 10 patients/dose in an expansion phase (maximum 28/cohort = 56 total subjects). Primary objective is to determine safety and feasibility of NK cell infusions. Secondary objectives will explore rates of remission PFS, overall survival and measurable residual disease negativity, cell counts, infectious complications, and patients proceeding to transplant. Enrollment in dose level 1 has started. Clinical trial information: NCT04220684 .

Isolated recessive nail dysplasia caused by FZD6 mutations: report of three families and review of the literature

Congenital abnormalities of the nail are rare conditions that are most frequently associated with congenital ectodermal syndromes involving several of the epidermal appendages including the skin, teeth, hair and nails. Isolated recessive nail dysplasia (IRND) is much rarer but has recently been recognized as a condition resulting in 20‐nail dystrophy in the absence of other cutaneous or extracutaneous findings. A few case reports have identified mutations in the Frizzled 6 (FZD6) gene in families presenting with abnormal nails consistent with IRND. These reports have highlighted the role of Wnt–FZD signalling in the process of nail formation. We report three families presenting with features of IRND, in whom we identified mutations in FZD6, including one previously unreported mutation.

Utilization of Whole Exome Sequencing to Identify Causative Mutations in Familial Congenital Heart Disease

BACKGROUND

Congenital heart disease (CHD) is the most common type of birth defect with family- and population-based studies supporting a strong genetic cause for CHD. The goal of this study was to determine whether a whole exome sequencing (WES) approach could identify pathogenic-segregating variants in multiplex CHD families.

METHODS AND RESULTS

WES was performed on 9 kindreds with familial CHD, 4 with atrial septal defects, 2 with patent ductus arteriosus, 2 with tetralogy of Fallot, and 1 with pulmonary valve dysplasia. Rare variants (<1% minor allele frequency) that segregated with disease were identified by WES, and variants in 69 CHD candidate genes were further analyzed. These selected variants were subjected to in silico analysis to predict pathogenicity and resulted in the discovery of likely pathogenic mutations in 3 of 9 (33%) families. A GATA4 mutation in the transactivation domain, p.G115W, was identified in familial atrial septal defects and demonstrated decreased transactivation ability in vitro. A p.I263V mutation in TLL1 was identified in an atrial septal defects kindred and is predicted to affect the enzymatic functionality of TLL1. A disease-segregating splice donor site mutation in MYH11 (c.4599+1delG) was identified in familial patent ductus arteriosus and found to disrupt normal splicing of MYH11 mRNA in the affected individual.

CONCLUSIONS

Our findings demonstrate the clinical utility of WES to identify causative mutations in familial CHD and demonstrate the successful use of a CHD candidate gene list to allow for a more streamlined approach enabling rapid prioritization and identification of likely pathogenic variants from large WES data sets.

CLINICAL TRIAL REGISTRATION

URL: https://clinicaltrials.gov; Unique Identifier: NCT0112048.

Endothelial Notch1 Is Required for Proper Development of the Semilunar Valves and Cardiac Outflow Tract

Background

Congenital heart disease is the most common type of birth defect, affecting ≈2% of the population. Malformations involving the cardiac outflow tract and semilunar valves account for >50% of these cases predominantly because of a bicuspid aortic valve, which has an estimated prevalence of 1% in the population. We previously reported that mutations in NOTCH1 were a cause of bicuspid aortic valve in nonsyndromic autosomal‐dominant human pedigrees. Subsequently, we described a highly penetrant mouse model of aortic valve disease, consisting of a bicuspid aortic valve with thickened cusps and associated stenosis and regurgitation, in Notch1‐haploinsufficient adult mice backcrossed into a Nos3‐null background.

Methods and Results

Here, we described the congenital cardiac abnormalities in Notch1^+/−;Nos3^−/− embryos that led to ≈65% lethality by postnatal day 10. Although expected Mendelian ratios of Notch1^+/−;Nos3^−/− embryos were found at embryonic day 18.5, histological examination revealed thickened, malformed semilunar valve leaflets accompanied by additional anomalies of the cardiac outflow tract including ventricular septal defects and overriding aorta. The aortic valve leaflets of Notch1^+/−;Nos3^−/− embryos at embryonic day 15.5 were significantly thicker than controls, consistent with a defect in remodeling of the semilunar valve cushions. In addition, we generated mice haploinsufficient for Notch1 specifically in endothelial and endothelial‐derived cells in a Nos3‐null background and found that Notch1^fl/+;Tie2‐Cre^+/−;Nos3^−/− mice recapitulate the congenital cardiac phenotype of Notch1^+/−;Nos3^−/− embryos.

Conclusions

Our data demonstrate the role of endothelial Notch1 in the proper development of the semilunar valves and cardiac outflow tract.

23-Year-Old Female with an Inflammatory Myofibroblastic Tumour of the Breast: A Case Report and a Review of the Literature

Purpose: Inflammatory myofibroblastic tumours (IMT) are a subcategory of inflammatory pseudotumours (IPT). They arise most commonly in the abdominopelvic region, lung and retroperitoneum, but virtually any anatomical site may be involved. Predominantly children and adolescents are affected and there is a tendency for local recurrence. In the literature up to the present, 20 patients have been reported with an IPT/IMT of the breast. We would like to present another patient with this unusual tumour entity of the breast and discuss the literature. Patient and Examinations: A 23-year-old woman presented with a painless lump in her left breast. There was no history of breast cancer in her family. Sonography showed a hypoechoic heterogeneous solid mass with irregular margins. A core needle biopsy revealed a tumour of high cellularity and a densely collagenous background. Immunohistochemically, the spindle-shaped cells were immunoreactive to smooth muscle actin and ALK-1 protein. Additional FISH analysis proved ALK rearrangements on chromosome 2p23 leading to the diagnosis of an IMT. Wide surgical excision was performed with no evidence of local recurrence after 12 months. Conclusion: Three of the above mentioned 20 patients with IMT/IPT of the breast developed a recurrent tumour, none presented with distant metastasis. A significant recurrence rate of 15 % leads to a clinically and sonographically close follow-up in these patients.

Endothelial nitric oxide signaling regulates Notch1 in aortic valve disease

The mature aortic valve is composed of a structured trilaminar extracellular matrix that is interspersed with aortic valve interstitial cells (AVICs) and covered by endothelium. Dysfunction of the valvular endothelium initiates calcification of neighboring AVICs leading to calcific aortic valve disease (CAVD). The molecular mechanism by which endothelial cells communicate with AVICs and cause disease is not well understood. Using a co-culture assay, we show that endothelial cells secrete a signal to inhibit calcification of AVICs. Gain or loss of nitric oxide (NO) prevents or accelerates calcification of AVICs, respectively, suggesting that the endothelial cell-derived signal is NO. Overexpression of Notch1, which is genetically linked to human CAVD, retards the calcification of AVICs that occurs with NO inhibition. In AVICs, NO regulates the expression of Hey1, a downstream target of Notch1, and alters nuclear localization of Notch1 intracellular domain. Finally, Notch1 and NOS3 (endothelial NO synthase) display an in vivo genetic interaction critical for proper valve morphogenesis and the development of aortic valve disease. Our data suggests that endothelial cell-derived NO is a regulator of Notch1 signaling in AVICs in the development of the aortic valve and adult aortic valve disease.

The Value of Breast Ultrasound in BRCA1 and BRCA2 Mutation Carriers

OBJECTIVE: BRCA1/2 mutations carriers face a lifetime risk for breast cancer of 60 to 80%. Typically, tumor incidence is high at young age and tumor growth rates are significantly elevated. On ultrasound investigation the malignancies often mimic fibroadenomas with round shape, circumscribed margins and a homogeneous internal structure leading to a BIRADS 3 classification. On this background we evaluated the efficacy of ultrasound for the early detection of breast cancer in this high risk group.METHODS: Between 01/1997-07/2008 223 BRCA1/2 mutation carriers participated in a breast cancer screening program which included semi-annual ultrasound (US) and annual mammography (MG) and MR imaging (MRI).Screening procedures started from age 25, MG at age 30. As patients consecutively joint the study women underwent 5 (median) screening rounds with a range of 1 to 22 appointments, totaling 1855 rounds of screening. All three imaging modalities were coded according to the American College of Radiology (BI-RADS classification).RESULTS: We detected 15 primary and 14 secondary contralateral BRCA-associated tumors in 27 patients. Age at diagnosis ranged from 29 to 66 years (median 41 years). BI-RADS classification IV and V enabled the detection of 9 (32%) cancers by mammography, 21 (87,5%) by US and 27 (96%) by MRI scan. Specificity added up to 100%. Three (11%) tumors were detected by the semi-annual ultrasound screen and two patients presented with interval carcinomas (16 and 8 mm in diameter) between two screening appointments. Thus, the proportion of interval cancers was 7%.CONCLUSION: Semi-annual sonography as a supplementary examination enabled us to reveal 3 additional invasive cancers (two stage pT1b, one stage pT1c). Due to the specific tumor morphology and the considerably elevated tumor doubling time mutation carriers may benefit from the addition of semi-annual ultrasound as a highly sensitive and cost-effective method.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4004.

Combination of oncolytic adenoviral therapy with chemotherapy for enhanced breast cancer cell killing

Abstract #2129

Oncolytic adenoviruses are emerging agents for treatment of cancer by tumor-restricted virus replication, cell lysis and virus spread. A promising oncolytic adenovirus agent, known as Ad5-24-RGD, harbors a 24-bp deletion in the E1A gene that abrogates the binding of E1A to the retinoblastoma tumor suppressor (Rb) and presents enhanced infectivity of primary cancer cells due to insertion of an Arg-Gly-Asp (RGD) motif into the fiber knob. Thus, Ad5-24-RGD has improved cancer cell infection efficiency due to expanded tropism toward alpha-v integrins. It also replicates selectively in cancer cells with Rb/p16 mutations. As with conventional therapy regimes, oncolytic virotherapy, by itself, has limited success in complete tumor eradication in both preclinical animal models and clinical studies. Combination of anticancer agents with different modes of action remains a mainstay in cancer treatment. We undertook one approach towards this end by combining oncolytic adenoviral therapy with chemotherapy. In this study, we investigated a combination treatment of breast cancer cells with Ad5-4-RGD and Docetaxel, a microtubule-stabilizing taxane that is being used in the clinic for the treatment of breast and prostate cancers and small cell carcinoma of the lung. Our results indicate a synergistic effect between Docetaxel and Ad5-24-RGD in breast cancer cell killing at a lower dose than either agent alone. These results suggest that viral replication was not inhibited by this chemotherapy treatment and that chemotherapy could reduce the amount of viral particles needed to help eradicate the tumor. Administration of lower viral loads would simultaneously improve safety and decrease immunogenicity of the vector. Likewise lower doses of chemotherapy agents would decrease toxicity and side effects. The inclusion of oncolytic adenoviruses into multimodal cancer treatment together with chemotherapy has a potential to become powerful therapeutic regimen.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2129.

Increased risk of cervical cancer in high-risk families with and without mutations in the BRCA1 and BRCA2 genes

5588

Background: In BRCA germline mutation carriers increased risks for cancer at other sites than breast and ovary have been reported. Methods: To evaluate the risk of BRCA-associated cancers, we conducted a cross-section analysis in 4405 individuals from 409 families with BRCA1 (n=86) or BRCA2 mutations (n=53) and 270 high risk BRCA1/2 negative families ascertained by the Familial Breast and Ovarian Cancer Center Cologne. We considered proven mutation carriers, individuals affected by breast and ovarian cancer and their first degree relatives and identified 921 individuals from BRCA1 (604 female; 317 male), 571 from BRCA2 (365 female; 206 male) and 2913 from BRCA1/2 negative (1938 female; 975 male) families that suffered from 677 cancers other than breast and ovarian cancers. Relative risks (RR) of the study group compared to the general population were evaluated by the standardized incidence ratio (SIR), using data from two German Cancer Registries. Results: The risk for cervical cancer is significantly increased in women from BRCA1 and BRCA2 positive (RR=4.59, 95% CI=2.20 to 8.44, and RR=3.69, 95% CI=1.20 to 8.61; p=<0.001) and from BRCA1/2 negative families (RR=2.97, 95% CI=1.88 to 4.45). Moreover, the risk for pancreatic cancer in women from BRCA2 positive and BRCA1/2 negative families as well as the risk for prostate cancer in men from BRCA2 positive families is increased (RR=5.10, 95% CI=1.65 to 11.90; RR=1.98, 95% CI=1.02 to 3.46; RR=2.09; 95% CI=1.00 to 3.84). Conclusions: We here report an increased risk of cervical cancer for women from BRCA1 and BRCA2 positive and from BRCA1/2 negative high risk families, respectively. These results are in line with other studies in BRCA1 and 2 positive individuals and should be considered in the clinical risk management of these individuals.

No significant financial relationships to disclose.

Breast cancer growth rates in BRCA1/2 mutation carriers

10575

Background: 1. Recent investigations suggest an accelerated growth rate in BRCA1/2-associated breast cancer. 2. This characteristic may have influence on screening policy. Patients and Methods: BRCA1/2 mutation carriers are regularly observed in a structured surveillance program that comprises annual mammography and MRI-scan in addition to sonography undertaken every six months. We performed a prospective study in approx. 2035 women participating in a breast cancer screening program from 01/1997 until 12/2006. In 9 carriers 10 BRCA-associated breast cancer cases were diagnosed of whom at least one previous examination was available. A calculation of the tumor volume doubling time was performed according to the following algorithm: VDT= log2 × (t2-t1)/logm2 - logm1 (VDT= Volume doubling time; t1 and t2 at the beginning and at the end of the observation period; m1 and m2 size of the tumor at point in time t1 and t2). Results: The 10 cases shown in table 1 prove both high growth rates with VDTs measuring on average 48 days and benign morphologic criteria in early stage disease by all 3 imaging procedures. The VDT for BRCA1-associated tumors was in average 42 days, while the single BRCA2 associated case had a VDT of 102 days. Conclusions: Our data demonstrate a short VDT of 48 days in BRCA1/2 mutation carriers. This is in line with another observational study which identified a tumor doubling time of 45 days for familial tumors in comparison to sporadic tumors with 82 days (Tilanus-Linthorst et al., 2005). These data underline the necessity for a closely meshed screening interval of 6 months. Lit: Tilanus- Linthorst et al., Eur J Cancer. 2005. Jul.41(11):1610–17

[Table: see text]

No significant financial relationships to disclose.

DNA microarray analysis identifies candidate regions and genes in unexplained mental retardation

OBJECTIVE

Because in most patients with mental retardation (MR), who constitute 2 to 3% of the population, the etiology remains unknown, we wanted to identify novel chromosomal candidate regions and genes associated with the MR phenotype.

METHODS

We screened for microimbalances in 60 clinically well-characterized patients with unexplained MR mostly combined with congenital anomalies. Genome-wide array-based comparative genomic hybridization was performed on DNA microarrays with an average resolution of <0.5 Mb. We verified every nonpolymorphic array clone outside the diagnostic thresholds by fluorescence in situ hybridization and performed breakpoint analyses on confirmed imbalances.

RESULTS

Six presumably causal microimbalances were detected, five of which have not been reported. Microdeletions were found in five patients with MR and distinctive facial features, who also had neurologic findings (three cases), brain anomalies (two cases), and growth retardation (two cases), in chromosomal bands 6q11.1-q13 (10.8 Mb), Xq21.31-q21.33 (4.0 Mb), 1q24.1-q24.2 (3.8 Mb), 19p13.12 (2.1 Mb), and 4p12-p13 (1.1 Mb). One microduplication was detected in 22q11.2 (2.8 Mb) including the DiGeorge syndrome critical region in a patient with mild MR, microcephaly at birth, and dysmorphisms. Three imbalances were shown to be de novo and two inherited. The Xq21 microdeletion in a boy with borderline intellectual functioning was inherited from a normal mother; the 22q11.2 microduplication was inherited from a normal father and was present in two affected siblings.

CONCLUSION

We could identify novel microimbalances as the probable cause of mental retardation in 10% of patients with unclear etiology. The gene content of the microimbalances was found to correlate with phenotype severity. Precise breakpoint analyses allowed the identification of deleted genes presumably causing mental retardation.

Neoadjuvant, biweekly, dose-dense chemotherapy with epirubicin (E) and cyclophosphamide (C) followed by docetaxel (T) in primary breast cancer (BC)

10656

Background: Primary chemotherapy is established in the treatment of local advanced BC. Two important advances are the chance to detect the clinical responders during the chemotherapy and an increasing rate of breast conserving surgery (BCS). According to the promissing results of dose-dense chemotherapy schedules in the adjuvant setting we tested the benefit of this approach in a primary chemotherapy protocol. Methods: This clinical trial (01/2003–11/2005) enrolled 93 females with advanced (cT2-cT4), non metastatic BC. The pts received four courses of E (90 mg/m2) and C (600 mg/m2) q2w, followed by four courses of T (100/75 mg/m2) q2w. The severe hand-foot-skin reaction NCI-CTG grade 3 during the T courses of the first pts (G1: n = 19) lead to a dose reduction of T to 75 mg/m2 for the following pts (G2: n = 73). During the first four cycles Pegfilgrastim was applied to prevent neutropenic complications. After every two cycles the actual tumor size was measured by clinical and sonographical examination. The clinical and pathological response, the toxicity and the rate of BCS were evaluated. Results: Pathological complete remission (pCR) of the invasive tumors was observed in 7/19 pts (G1) and 17/73 (G2), pathological partial remission (pPR) in 7/19 pts (G1) and 28/73 (G2), minimal response (pMR) in 3/19 pts (G1) and 14/73 (G2), a stable disease in 2/19 pts (G1) and 11/73 (G2). Two pts in group two showed a progressive disease (pPD). Three pts developed neutropenic fever and stopped the chemotherapy after the 5th and 6th cycle, respectively. One patient died after the 8th cycle in neutropenic sepsis. During this trial the main side effect of T was a hand-foot-skin reaction. Conclusions: This neoadjuvant dose-dense chemotherapy is a potent schedule for the treatment of primary BC. Using T with 75 mg/m2 instead of 100 g/m2 is generally better tolerated. The first group of pts treated with T 100 mg/m2 exhibited a higher frequency of pCR (36.8%) compared to the pts treated with 75 mg/m2 (pCR 23.3%), (p = 0.23). But the increased rate of severe side effects lead to an early dose reduction to 75 mg/m2 in this clinical trial.These first promissing results will be improved in an enlarged number of pts.

No significant financial relationships to disclose.

Unbalanced translocation 8;Y (45,X,dic(Y;8)(q11.23;p23.1)): case report and review of terminal 8p deletions

A boy with a rare unbalanced de novo Y/autosome translocation is presented. Main clinical features in the boy comprised a psychomotor delay, talipes planus, a dolichocephalus, low set and retroverted ears, supraorbital fullness of subcutaneous tissue and a bulbous nasal tip. Chromosomal analysis on amniocytes showed a single X chromosome and a derivative 8p (Karyotype: 45,X,der(8)GTG). The following DAPI staining revealed the inactivated centromere of the chromosome Y located on 8p and the absence of heterochromatic material Yq. Microsatellite analysis on fetal blood DNA using markers between SRY on Yp and DYS 240 on Yq proved presence of the spermatogenetic relevant factors. A terminal deletion of 8p was confirmed by FISH postnatally. Molecular genetic reassessment revealed the monosomy 8p to be of maternal origin; the translocation can thus be proven to have occurred in the zygote. The breakpoint in 8p was localised distal to GATA4, a gene which is involved in heart development; the finding that our patient did not suffer from cardiac problems agrees with the disomic presence of GATA4. Only the application of FISH combined with microsatellite analysis allowed a precise correlation between clinical phenotype and a subtle deletion of terminal 8p; furthermore, a recurrence risk for the parents could be excluded.

[Psychosomatic medicine in dermatologic education]

Ten years' experience in handling psychosomatic aspects as part of dermatology courses in Göttingen have revealed an unexpected need for such courses among students. Our program includes lectures as well as work in small groups.

[Short-term discharge as a diagnostic and therapeutic possibility in psychosomatically oriented treatment of the atopic eczema patient]

70 patients suffering from atopic dermatitis and receiving in-patient care were discharged for one or two days upon achieving an improved and stable dermatological state. Back in hospital after their short-term demission, two thirds of these patients showed a deterioration of their cutaneous condition. The majority of them were able to perceive a connection between their worsened skin condition and the acute psychosocial constellation during their brief stay at home. A second short-term demission brought about more acceptable and steady skin conditions, especially in patients treated psychosomatically. Some of the patients declared definite changes in their own modes of behavior to be responsible for this stabilized improvement.

[The disease course and psychosocial events in inpatient treatment of atopic eczema patients--a pilot study]

Our pilot study deals with the systematic investigation of the clinical experience that, in correlation with psychosocial events, atopic dermatitis may take an unexpected course (deterioration or improvement) during hospitalization. We describe our procedures regarding the proposal of hypotheses, the operationalization of the variables "deterioration of eczema" and "psychosocial factor", and our methods in gaining the data required. In the evaluation of 19 courses of treatment, we first checked the possible correlations between individual deterioration of eczema and various psychosocial events. We had to rule out, however, that a positive reaction like this was purely coincidental. In this respect, the event "confrontation with every day life" has significantly been confirmed. We discuss possible further studies which may ensue from our psychosomatic research concept.

[Change in therapy as a model for interaction problems between dermatologists, nurses and patients]

We studied both the frequency of changes in the therapeutic management regarding in-patients with skin diseases and the estimation of these changes by dermatologists, nurses, and the patients concerned. Changing the procedures of topical treatment have been found a special source of conflict between doctors, nurses, and patients.

[Confronting the artefact patient with manipulative behavior]

Patients with self-inflicted skin disorders form a rather heterogeneous group. Our paper is intended to provide the practitioner with some orientation concerning interaction and therapeutic procedure in patients with artefactual skin diseases. Basically, these patients should be differentiated according to what extent they are aware of their manipulations. This degree of awareness should then be the guideline for a well-dosed and sensitive confrontation with their manipulative behavior. In any case, a positive result of the confrontation largely depends on the confidential relationship between physician and patient.

[Psychosomatic criteria in the treatment of atopic neurodermatitis]

We report on psychosomatic aspects regarding out-patient and hospital treatment of atopic dermatitis, including information concerning the disease, motivation for psychotherapeutic forms of treatment (relaxation, diagnostic and therapeutic conversation), as well as psychosomatic indicators for the discharge from hospital.

[Amiodarone therapy--behavior of serum and fatty tissue concentrations]

Thirty-eight patients with refractory supraventricular and ventricular tachyarrhythmias were administered a mean oral dosage of 400 mg amiodarone daily (200-600 mg). A high-pressure liquid chromatography method was used to measure serum concentrations of amiodarone and its metabolite desethylamiodarone after one week, one month, three months, and then at 6-month intervals. In 24 patients subcutaneous fatty tissue concentrations were also measured. The mean follow-up was 9 months (4 days to 29 months). A linear correlation was found between amiodarone and its metabolite in serum (r = 0.56, p less than 0.001) as well as in subcutaneous fatty tissue (r = 0.67, p less than 0.001). While serum concentrations were dose dependent, tissue concentrations accumulated during chronic therapy (p less than 0.01, both). Clinical efficacy was achieved in 84% of the patients. No statistically significant difference was found between responders and non-responders as regards serum and subcutaneous fatty tissue concentrations. Side effects of amiodarone occurred in 63%. The incidence of adverse effects was related to significantly higher serum and subcutaneous fatty tissue concentrations of amiodarone and its metabolite (p less than 0.001, both). Thus, although the determination of serum and subcutaneous fatty tissue concentrations does not seem to be helpful for assessing clinical efficacy of this antiarrhythmic drug, these values may predict the occurrence of adverse effects.

[Dysmorphophobia as casus pro diagnosi]

Our psychodiagnostic studies were concerned with two female patients considering themselves disfigured although their residual somatic findings were only minimal. Two main factors could be derived from analysis: "feelings of anxiety and insecurity" and "obsessive-compulsiveness". The compulsive and sometimes paranoid ideas of the patients suffering from dysmorphophobia require differentiated conclusions by the doctor.

[The pruritus of endogenous eczema patients (author's transl)]

The psychosomatic aspects of the pruritus symptom of endogenous eczema patients are presented. The phenomenon of "scratching" is analysed descriptively from observations of the behavior of the patient and his family. Psychotherapeutic approaches as a supplement to the dermatological therapy of endogenous eczema are described.

[Oxygen consumption of the spontaneous and artificially induced skincycle at different times of day (author's transl)]

In the "clean" rat skin purified from the panniculus carnosus the oxygen consumption of the spontaneous and artificially induced skincycle was measured at different times of day. The level of oxygen consumption correlated to diurnal and nocturnal periods. During the skincycle the oxygen consumption showed fluctuations. There were indications that the value of oxygen consumption of the early anagen is influenced by that phase of the cycle at which the new cycle is artificially induced. Furthermore, it was found that a certain decrease of oxygen consumption stimulates the quiescent hair follicles to spontaneous proliferation. During the katagen the peak value of the oxygen consumption seemed to be correlated with specially morphofunctional perifollicular changes. The application of these findings to the pathophysiology of human hair growth disturbances is discussed.

[Skincycle of a new spontaneous mutant (Nackig) with abnormal hair keratinization in the mouse (author's transl)]

The pathomorphological and pathophysiological reactions of the first skincycle of the mutant (Ng) were histologically investigated. 1. During the hair growth disturbances as the result of imperfect keratinisation changes of the morphology and function of different skin areas could be observed. 2. The developments of abnormal thinner hair growth were correlated to hyperorthokeratotic, inter-respectively intrafollicular hyperplasia of the epidermis and to infraseboglandular hypoplasia of the follicles. 3. The hyper- and hypoplasia of the epidermis corresponded with a functional pseudohypo- and pseudohypertrophy of the cutis. 4. During the skincycle the perifollicular epithelium ranged from the inter- to intrafollicular skin areas. The inter- and intrafollicular epidermal sections varied simultaneously. 5. These results are important for the understanding of some pathomorphological and pathophysiological reactions of skin compartments of man.

[Biographical information from patients with endogenous eczema]

Based on psychoanalytical biographies of 25 patients with atopic dermatitis, striking anamnestic facts concerning especially social contact of the patients are described and discussed.

[Social situation of persons with dermatoses as a phenomena of interpersonal perception (author's transl)]

Discussing the medical importance of the topic, the necessity of cooperation with social-scientific disciplines is demonstrated. Reflecting some relevant psychological theories, an experimental concept for analysing the interpersonal communication with persons suffering from skin-diseases is developed. It is a purpose of this investigation, not only to get the estimations of persons with and without skin-diseases but also the opinion which the other group is supposed to have. It was assumed that the state of health in persons with dermatoses is depending on these supposed estimations by the social environment. After describing the experimental setting, the results which were received from the answers of 465 persons (mean and women with and without dermatoses) are referred. Finally the findings are discussed from different points of view (methodical, cognition-theoretical, learning-psychological, psychoanalytical and last not least medical).

[Effect of pregnancy and lactation on hair growth in mice (author's transl)]

The influence of pregnancy and suckling in mice on spontaneous, induced hair growth and on body weight was examined. 1. An inhibition of spontaneous and induced growth of hair some days before delivery was found. 2. The initiation of hair growth was found not to be wave-like as usually, but nearly simulatneously. 3. Inhibition and initiation of hair growth seem to be related to body weight. 4. The influences on hair growth in mice are compared with known effects of pregnancy on hair growth in women.

[Possibility of thermography to differentiate pigmental skin tumors (author's transl)]

Problems and criteria to evaluate thermographic profiles and the differentiation of pigmental skin tumors are discussed.