1
|
Reich-Schupke S, Alm J, Altmeyer P, Bachter D, Bayerl C, Beissert S, Bieber T, Böhmer J, Dill D, Dippel E, Dücker P, Effendy I, El Gammal S, Elsner P, Enk A, Feldmann-Böddeker I, Frank H, Gehring W, Gieler U, Goebeler M, Görge T, Gollnick H, Grabbe S, Gross G, Gudat W, Happ A, Herbst R, Hermes B, Hoff NP, John SM, Jungelhülsing M, Jünger M, Kaatz M, Kapp A, Kaufmann R, Klode J, Knaber K, König A, Krieg T, Kohl P, Kowalzick L, Lehmann P, Löffler H, Maschke J, Marsch W, Mechtel D, Mohr P, Moll I, Müller M, Nashan D, Ockenfels HM, Peter RU, Pillekamp H, Rompel R, Ruzicka T, Salfeld K, Sander C, Schaller J, Scharffetter-Kochanek K, Schuler G, Schulze HJ, Schwarz T, Splieth B, Stege H, Stolz W, Strölin A, Tran H, Tronnier M, Ulrich J, Vogt T, Wagner G, Welzel J, Willgeroth T, Wollina U, Zillikens D, Zouboulis CC, Zuberbier T, Zutt M, Stücker M. [Phlebology in German departments of dermatology. An analysis on behalf of the German Society of Phlebology]. Hautarzt 2013; 64:685-94. [PMID: 24022632 DOI: 10.1007/s00105-013-2623-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Phlebologic diseases have become extremely common and have major socio-economic impact. However, the percentage of dermatologists working in phlebology appears to be decreasing according to the data of the German Society of Phlebology (DGP). METHODS To investigate the reasons for this development, we--on behalf of the DGP--sent a questionnaire to 120 German Departments of Dermatology in autumn 2012. RESULTS In 76 returned questionnaires, the number of physicians with additional fellowship training in phlebology averaged 1.5; the average number of those who fulfill the criteria for training fellows in phlebology was 0.9. In 71.1 % of the departments there was a phlebologist. A special phlebologic outpatient clinic existed in 73.7 % of the departments. Sonography with Doppler (89.5 %) and duplex (86.8 %) was used as the most frequent diagnostic tool. For therapy, compression (94.7 %), sclerotherapy (liquid 78.9 %, foam 63.2 %, catheter 18.4 %), endoluminal thermic procedures (radio wave 28.9 %, laser 17.1 %) and surgery (especially crossectomy and stripping 67.1 %, phlebectomy of tributaries 75 %) were used. The average number of treatments was very heterogenous in the different departments. CONCLUSIONS Phlebology definitely plays an important role in dermatology. Most departments fulfill the formal criteria for the license to conduct advanced training in phlebology. A wide spectrum of phlebological diagnostic and therapeutic procedures is available.
Collapse
Affiliation(s)
- S Reich-Schupke
- Klinik für Dermatologie, Venerologie und Allergologie, Venenzentrum der Dermatologischen und Gefäßchirurgischen Kliniken, Ruhr-Universität Bochum, Hiltroper Landwehr 11-13, 44805, Bochum, Deutschland,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Brockow T, Schiener R, Franke A, Resch KL, Peter RU. A pragmatic randomized controlled trial on the effectiveness of low concentrated saline spa water baths followed by ultraviolet B (UVB) compared to UVB only in moderate to severe psoriasis. J Eur Acad Dermatol Venereol 2007; 21:1027-37. [PMID: 17714121 DOI: 10.1111/j.1468-3083.2007.02152.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate whether low concentrated saline spa water baths followed by ultraviolet B (LC-SSW-UVB) are superior to UVB alone in moderate to severe psoriasis. BACKGROUND There is a lack of sufficiently large randomized controlled clinical trial evaluating the additional benefit of saltwater baths followed by UVB compared to UVB only in psoriasis. STUDY DESIGN Partly evaluator blind, multicentre, pragmatic, randomized controlled trial. SETTING Five German spa centres. SUBJECTS One hundred and forty-three adults with stable psoriasis during the last month and a Psoriasis Area and Severity Index (PASI) of > 10 and/or an affected body surface area of > 15%. INTERVENTIONS LC-SSW-UVB or UVB thrice a week until remission (PASI < 5) or for a maximum of 6 weeks. Sodium chloride concentrations of natural springs varied between 4.5% and 12%. Conventional UVB (broadband UVB or selective UVB phototherapy) was used as irradiation source. MAIN OUTCOME Reduction of PASI and/or affected body surface area of 50% at the end of the intervention period (PASI-50). Only participants receiving at least one intervention were included in the primary analysis. RESULTS Patients allocated to LC-SSP-UVB attained a statistically significantly higher rate of PASI-50 at the end of the intervention period than patients allocated to UVB [58/79 (73%) vs. 32/64 (50%); P = 0.01; NNT, 4.3, 95% CI, 2.4-18.1]. Benefit persisted until 3 months only for one of two secondary outcomes considered. CONCLUSIONS In routine clinical practice balneophototherapy using conventional UVB is superior to conventional UVB only at the end of a 6-week treatment course.
Collapse
Affiliation(s)
- T Brockow
- Spa Medicine Research Institute, Bad Elster, Germany.
| | | | | | | | | |
Collapse
|
3
|
Horch RE, Gerngross H, Lang W, Mauckner P, Nord D, Peter RU, Vogt PM, Wetzel-Roth W, Willy C. [Indications and safety aspects of vacuum-assisted wound closure]. MMW Fortschr Med 2005; 147 Suppl 1:1-5. [PMID: 16739365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Problem wounds continue to challenge medical care. In recent times, good results have been achieved through the application of negative pressure wound therapy. This approach, known as vacuum-assisted wound closure (VAC) involves the use of a defined,controlled negative pressure over a polyurethane or polyvinyl sponge placed in the wound. The wound effluent is evacuated continuously. The result is an improvement of microcirculation, and wound healing is enhanced. Animal experiments have confirmed an increase in cell growth. The basis for surgical wound management continues to be appropriate debridement. In this connection, negative pressure therapy, as a supportive measure, has proved to have major advantages over traditional methods of wound management, advantages that need to be further investigated clinically and experimentally. Consideration of the safety aspects and risk factors associated with the procedure can contribute to the optimization of therapeutic safety.
Collapse
Affiliation(s)
- R E Horch
- Universitätsklinikum Erlangen, Krankenhausstrasse 12, D-91054 Erlangen.
| | | | | | | | | | | | | | | | | |
Collapse
|
4
|
|
5
|
Walther U, Kron M, Sander S, Sebastian G, Sander R, Peter RU, Meurer M, Krähn G, Kaskel P. Risk and protective factors for sporadic basal cell carcinoma: results of a two-centre case-control study in southern Germany. Clinical actinic elastosis may be a protective factor. Br J Dermatol 2004; 151:170-8. [PMID: 15270887 DOI: 10.1111/j.1365-2133.2004.06030.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND There are very few data regarding sun exposure behaviour of patients with basal cell carcinoma (BCC) in central Europe. OBJECTIVES A case-control study of patients with sporadic BCC was conducted to assess the risk of occupational and leisure-time sun exposure behaviour, precursor lesions for skin cancer and phenotypic factors on the development of sporadic BCC in Ulm and Dresden, Germany. METHODS A comparison was made of 213 patients with BCC (128 from Ulm, 85 from Dresden; 103 men and 110 women; median age at diagnosis 69 years) and 411 controls (237 from Ulm, 174 from Dresden; 197 men and 214 women; median age 58 years). Crude odds ratios (ORs) and corresponding 95% confidence intervals for all of 64 possible risk factors revealed strong associations in 33 items. Selection of important risk factors was performed in a multiple logistic regression. RESULTS For sporadic BCC, an increased risk was shown for persons with actinic cheilitis (OR 7.1), actinic keratosis (OR 2.7) and solar lentigo (OR 2.5). The only phenotypic factor indicating risk of sporadic BCC was hair colour, with a higher risk for red/fair than brown/black hair (OR 4.3). There was an increased risk for persons with BCC in first-degree relatives (OR 5.1) and those with sunburn 20 years before sporadic BCC was diagnosed (OR 3.6). Additionally, occupational ultraviolet (UV) exposure appeared to be a risk factor (OR 2.4). In contrast, clinical actinic elastosis showed a protective effect (OR 0.1). CONCLUSIONS In contrast to earlier reports, clinical actinic elastosis turned out to be the only protective factor for sporadic BCC. A special relationship between wrinkling and BCC risk could not be shown. For basic research, future work should be aimed at elucidating further the different forms of collagen repair processes after intermittent and/or chronic UV exposure. The data strongly support the recommendation that a change in recreational UV exposure habits in individuals, and sunburn avoidance in particular, are necessary not only because of the increased long-term risk of melanoma, but also because of the risk of other skin cancers such as sporadic BCC.
Collapse
Affiliation(s)
- U Walther
- Department of Dermatology, Technical University of Dresden, Dresden, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Abstract
We determined whether digital photographs of skin lesions could enhance diagnostic accuracy in dermatohistological evaluations. Two dermatohistopathologists examined 375 unsorted consecutive cases. On a standardized questionnaire they recorded whether the final diagnostic interpretation would be improved by the availability of digital images of the skin lesions. In 101 cases (27%) they said that digital photographs would be helpful. Subsequently, 30 histological analyses were performed with and without digital photographs of the skin lesions. Presentation of digital photographs reduced the number of differential diagnoses significantly, from a median of 3 to 2. Ratings of ability to make a single definitive diagnosis increased significantly with the presentation of digital photographs. Enhancement of information given by the digital images was scored a median of 6 (on a scale of 0-10, with higher scores reflecting greater enhancement). Digital photographs of skin lesions are likely to refine diagnostic accuracy in histopathology.
Collapse
Affiliation(s)
- R Schiener
- Department of Dermatology, Armed Forces Hospital Ulm, Germany.
| | | | | | | | | |
Collapse
|
7
|
Gottlöber P, Leiter U, Friedrich W, Bunjes D, Schulz A, Kerscher M, Peter RU. Chronic cutaneous sclerodermoid graft-versus-host disease: evaluation by 20-MHz sonography. J Eur Acad Dermatol Venereol 2003; 17:402-7. [PMID: 12834449 DOI: 10.1046/j.1468-3083.2003.00516.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Chronic graft-versus-host disease (GVHD) is an immunological disorder frequently occurring as a late consequence of allogeneic bone marrow transplantation. Two variants, cutaneous lichenoid and sclerodermoid, have been described, based on clinical and histopathological examinations. It is, however, difficult to determine non-invasively the degree of cutaneous GVHD in vivo. Ultrasonographic methods have recently provided us with the means for objective and non-invasive monitoring of the dynamics of many chronic skin diseases. AIM, PATIENTS AND METHODS In five patients with chronic cutaneous sclerodermoid GVHD skin thickness was measured with a 20-MHz B-mode ultrasound scanner (DUB 20S, taberna pro medicum, Lüneburg, Germany) in a clinically well-defined target skin lesion. Additionally cutaneous GVHD was assessed histologically before and after treatment. RESULTS In all patients before treatment the corium of sclerotic skin was thicker than the corresponding areas of healthy skin. The skin thickness was increased from 45% to 83%. In the subcutaneous tissue proper echo-rich reflexes were prominent, representing the correlate of subcutaneous fibrotic trabeculae. In all patients ultrasonographic evidence of regression was shown (decrease of skin thickness by 18-83%). Moreover, it was demonstrated that quantitative assessment of skin thickness is feasible. CONCLUSIONS In this paper we describe the detailed sonographic features of cutaneous sclerodermoid GVHD for the first time. As the method is simple and non-invasive, repeated examinations are possible. This provides the basis for monitoring treatment effects and efficient follow-up in these chronically progressive clinical conditions after bone marrow transplantation.
Collapse
Affiliation(s)
- P Gottlöber
- Department of Dermatology, University of Ulm, Oberer Eselsberg, Ulm, Germany.
| | | | | | | | | | | | | |
Collapse
|
8
|
Abstract
BACKGROUND Detection of cutaneous infections with herpes simplex virus (HSV) has proven difficult, as serum antibody tests sometimes are not sensitive and specific enough for that purpose. OBJECTIVE This study was conducted to compare the sensitivity for detection of HSV of an immunofluorescence method (Syva Microtrak) and an internally controlled PCR. METHODS Cutaneous swabs from skin lesions were analysed by immunofluorescence separately for HSV types 1 and 2 and by competitive PCR. Detection of PCR products was done by ELISA, if positive additionally by agarose gel electrophoresis. RESULTS Of 79 samples 34 were PCR-positive by ELISA (34 = 100%), of which 23 (68%) were also positive on the agarose gel. Eleven samples (32%) were positive by immunofluorescence. No sample was positive by immunofluorescence and negative by PCR. CONCLUSIONS These results demonstrate that immunofluorescence using Syva Microtrak is not suitable for exclusion of herpes simplex virus infection as sensitivity was only 32%. However, as immunofluorescence is cheaper and faster than PCR, first screening can be done with immunofluorescence, and negative samples can be investigated by PCR to finally prove or exclude the presence of HSV DNA.
Collapse
Affiliation(s)
- G Bezold
- Department of Dermatology, University of Ulm, Ulm, Germany
| | | | | | | | | |
Collapse
|
9
|
Nowak R, Gottlöber P, Peter RU. [Death after bee-sting]. Hautarzt 2003; 54:348-50. [PMID: 12669207 DOI: 10.1007/s00105-002-0420-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A ten-year-old girl collapsed on the street with the signs of acute anaphylaxis. Cardiopulmonary resuscitation was unsuccessful. At the autopsy a thorn-like object was found sticking in the tongue and was later identified as the stinger of a honey bee. Witnesses reported that the girl had drunk some ice tea from a box and then had complained about pains in the mouth. Postmortem blood tests revealed increased total IgE level as well as increased levels of specific IgE against bee and wasp poisons. Cause of death was a bronchospasm caused by an allergic reaction due to a sting of a honey bee.
Collapse
Affiliation(s)
- R Nowak
- Abteilung für Rechtsmedizin, Universitätsklinikum Ulm
| | | | | |
Collapse
|
10
|
Schiener R, Pillekamp H, Kerscher M, Peter RU. [Phototherapy and photochemotherapy of inflammatory dermatoses]. MMW Fortschr Med 2003; 145:45-7. [PMID: 12661442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Stubborn and extensive dermatoses, such as psoriasis vulgaris or atopic dermatitis (eczema), are indications for phototherapeutic methods. These include UVB phototherapy, UVA photochemotherapy (PUVA), UVA irradiation following prior photosensitization, UVA, treatment and combination treatments. Phototherapy is contraindicated in the case of light-induced dermatoses. Caution must also be exercised in patients receiving photosensitizing medications. When establishing the indication, consideration must be given to the treatment-related increased risk of developing skin cancer. The patient must also be informed of such undesired potential side effects as burns and premature aging of the skin.
Collapse
Affiliation(s)
- R Schiener
- Abteilung Dermatologie, Venerologie und Allergologie, Bundeswehrkrankenhaus Ulm
| | | | | | | |
Collapse
|
11
|
Abstract
BACKGROUND Psoriatic arthritis concerns both the skin and the joints. Therapeutic interventions should therefore ideally improve both symptoms. Current disease modifying drugs are effective; however, they are usually limited to either psoriasis or arthritis. AIM OF THE STUDY The aim of this study was to analyze the therapeutic effects of a new immunosuppressive drug (Mycophenolate mofetil) in the treatment of psoriatic arthritis. METHODS Six patients with psoriatic arthritis were treated with Mycophenolate mofetil for a period of 12 weeks and examined every 14 days (range of motion, joint swelling, joint deformity, PASI score (Psoriasis Area and Severity Index). In addition, a life quality assessment (SF-36 Health Survey) was performed. White and red blood count as well as inflammation parameter were controlled regularly. RESULTS 6 patients could be included in a complete follow-up (5 men, 1 woman, average age 50.3 years, average duration of psoriasis 8.3 years, average duration of arthritis 5.7 years). Four of 6 patients showed relevant improvement in pain, mobility and degree of psoriatic skin effluorescences. Only 3 of 6 showed relevant improvement in life quality. CONCLUSION For the first time results of treatment of psoriatic arthritis with a new immunosuppressive drug (Mycophenolate mofetil) were presented. A positive influence on both, the arthritis and the psoriasis could be shown. These first observations warrant controlled, randomized clinical trials.
Collapse
Affiliation(s)
- P Schräder
- Orthopädische Universitätsklinik Theodor-Kutzer-Ufer 1-3 68167 Mannheim, Germany
| | | | | | | |
Collapse
|
12
|
Mühlmeier G, Tisch M, Bredlich RO, Peter RU, Maier H. [Erosions of the mouth mucosa]. HNO 2002; 50:762-3. [PMID: 12243034 DOI: 10.1007/s00106-002-0628-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- G Mühlmeier
- Abteilung Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Bundeswehrkrankenhaus Ulm.
| | | | | | | | | |
Collapse
|
13
|
Abstract
BACKGROUND Shingles are caused by an endogenous or exogenous reinfection with varicella zoster virus (VZV). Up to 50% of individuals with Hodgkin's disease develop herpes zoster; however, no association could be shown between the occurrence of herpes zoster and underlying subclinical malignancies. OBJECTIVE This study was conducted to investigate whether VZV DNA could be detected by polymerase chain reaction (PCR) in the blood of herpes zoster patients and whether there was an association between VZV viraemia and previous or concurrent neoplasias. METHODS At least five blood samples from 28 patients with herpes zoster were investigated by internally controlled PCR enzyme-linked immunosorbent assay prior to and during therapy with aciclovir. RESULTS None of 13 patients, two with a history of neoplasia and two with a neoplasia at the time of the study, showed any signs of viraemia with VZV, and 14 patients had inconsistent viraemia, one with a history of neoplasia and two with neoplasia at the time of the study. In one patient VZV DNA was detected in the blood for 6 days. This patient died soon after from metastatic malignant melanoma. CONCLUSIONS VZV viraemia may occur during herpes zoster episodes, even in patients without evidence of immunosuppression; however, this viraemia is, in most cases, inconsistent and does not provide any specific information concerning underlying unrecognized malignancies.
Collapse
Affiliation(s)
- G Bezold
- Department of Dermatology, University of Ulm, Germany
| | | | | | | |
Collapse
|
14
|
Schiener R, Weidmann M, Kerscher M, Peter RU. Behandlung der fokalen Hyperhidrose der Stirn mit Botulinumtoxin. Akt Dermatol 2002. [DOI: 10.1055/s-2002-33487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
15
|
Kaskel P, Sander S, Kron M, Kind P, Peter RU, Krähn G. Outdoor activities in childhood: a protective factor for cutaneous melanoma? Results of a case-control study in 271 matched pairs. Br J Dermatol 2001; 145:602-9. [PMID: 11703287 DOI: 10.1046/j.1365-2133.2001.04432.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND A matched case-control study was performed in Munich, Germany, in 1996-97 to evaluate the risk of cutaneous melanoma due to ultraviolet (UV) exposure behaviour in Southern Bavaria, Germany. OBJECTIVES Patients with cutaneous melanoma and controls were investigated by two physicians using a standardized questionnaire to identify risk factors for the development of melanoma, such as professional and leisure sun exposure behaviour. In each person, a total body examination was performed to detect benign skin alterations, phenotypic characteristics and precursor lesions for skin cancer. PATIENTS/METHODS A total of 271 melanoma patients and 271 controls were individually matched for residence, age and gender. A multiple conditional logistic regression analysis was performed. RESULTS Of 56 factors, those risk factors with a strong effect on the development of melanoma were: the existence of melanoma in first degree relatives, solar lentigo, actinic keratosis, actinic cheilitis, skin phototype, immediate skin reaction to UV light at the start of the outdoor season, sunburn in childhood and sun exposure during holidays in sunny areas 20 years before melanoma was diagnosed; outdoor activities in childhood were found to be protective. CONCLUSIONS Sunburn in childhood and increased sun exposure during annual holidays in sunny areas should be avoided. In contrast, outdoor activities in childhood, including soccer and gardening, should be encouraged because they are associated with a lower risk of melanoma formation.
Collapse
Affiliation(s)
- P Kaskel
- Department of Dermatology, University of Ulm, 89070 Ulm/Donau, Germany.
| | | | | | | | | | | |
Collapse
|
16
|
Gottlöber P, Gall H, Peter RU. Allergic contact dermatitis from natural latex. Am J Contact Dermat 2001; 12:135-8. [PMID: 11526517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
BACKGROUND Reports on natural latex allergy have increased steadily during the last 10 years. Latex allergy generally refers to a type 1 reaction to natural rubber latex (NRL) proteins with clinical manifestations ranging from contact urticaria to asthma and anaphylaxis. Previous United States studies on NRL allergy largely have been reported by allergists with little detailed information on hand eczema, contact allergy, or on outcome. The present study was performed from March 1998 to November 1999 with the aim of finding out the prevalence of type IV hypersensitivity to latex in patients with suspected rubber allergy. MATERIALS AND METHODS A total of 167 patients with hand eczema and contact with rubber products underwent patch testing with the standard screening and rubber components (test series Deutsche Kontaktallergiegruppe), and NRL pure provided by Regent (liquid high ammonia 0.7% NRL, accelerator, and preservative-free latex) between March 1998 and November 1999. The charts of all NRL positive patients are reported with the results of history, prick, patch tests, total IgE, specific IgE to latex (FEIA) test and follow-up data (after 6 months). RESULTS Four patients (3 men) showed positive patch test results to NRL. One of these patients also reacted to the rubber chemical tetraethylthiuram monosulfide, and another one of these patients revealed a type 1 reaction to NRL, diagnosed by positive reaction to prick test. The other 3 patients with patch test reactions to NRL had negative reactions to prick tests to NRL extracts after 20 minutes. All 4 patients had a positive delayed prick test reaction to NRL. Latex FEIA test result was negative in all 4 patients. The contact eczema healed after elimination of the latex gloves and medical latex devices in all patients. Furthermore, 10 of the 167 patch testing patients (6%) were positive for tetramethylthiuram monosulfide 1%. CONCLUSION In the present study with 167 patients, the prevalence of type IV hypersensitivity to latex was 2.4%. We recommend that the patch test with NRL as well as with rubber additives should be performed in patients of suspected contact dermatitis caused by rubber products.
Collapse
Affiliation(s)
- P Gottlöber
- Department of Dermatology, University of Ulm, Ulm, Germany.
| | | | | |
Collapse
|
17
|
Schiener R, Behrens-Williams SC, Pillekamp H, Peter RU, Kerscher M. Does the minimal phototoxic dose after 8-methoxypsoralen baths correlate with the individual's skin phototype? Photodermatol Photoimmunol Photomed 2001; 17:156-8. [PMID: 11499535 DOI: 10.1034/j.1600-0781.2001.170402.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND/AIMS Up to now no data have been available concerning whether there is a significant correlation between skin phototypes and the minimum phototoxic dose (MPD) after bath water delivery of 8-MOP. METHODS The skin phototype of each of 46 patients was determined based on the individual past history of solar-induced burning and tanning. In addition, the MPD of each patient was assesed after photosensitization with a warm water bath (37 degrees C, 98.6 degrees F) containing 1.0 mg/l 8-methoxypsoralen (8-MOP). Statistical analysis was performed using a Mann-Whitney U-test and Spearman rank order correlation. RESULTS The median MPD in patients with skin phototype II was 2.0 J/cm2 (range < or =0.5 to > or =3.5) versus 1.5 J/cm2 (range 1.0 to > or =3.5) in patients with skin phototype III. There was a considerable overlap between both groups. No significant difference was detected comparing both groups (P=0.7326) and Spearman rank order correlation revealed no correlation between skin phototype and MPD. CONCLUSION Erythemal sensitivity in PUVA bath therapy, measured as MPD, is not correlated with sun-reactive skin phototype in skin types II and III. Thus skin phototype is not a suitable indicator for the initial UVA dose in PUVA bath photochemotherapy.
Collapse
Affiliation(s)
- R Schiener
- Department of Dermatology, University of Ulm, Germany
| | | | | | | | | |
Collapse
|
18
|
Bezold G, Schuster-Grusser A, Lange M, Gall H, Wolff H, Peter RU. Prevalence of human herpesvirus types 1-8 in the semen of infertility patients and correlation with semen parameters. Fertil Steril 2001; 76:416-8. [PMID: 11476803 DOI: 10.1016/s0015-0282(01)01920-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
19
|
Kaskel P, Rohwer H, Osterwalder U, Peter RU. [Prevention of skin cancer. Sunscreens from the washing machine]. MMW Fortschr Med 2001; 143:40. [PMID: 11499147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- P Kaskel
- Abt. Dermatologie, Universitätsklinikum Ulm, D-89070 Ulm/Donau
| | | | | | | |
Collapse
|
20
|
Kaskel P, Rohwer H, Osterwalder U, Peter RU. [Improving textile sun protection by regular washing of clothing]. Fortschr Med Orig 2001; 119 Suppl 2:91-4. [PMID: 15704362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
The highest priority in the prevention of malignant tumors of the skin is given to the avoidance of sun-induced reddening of the skin and sunburn at any age. The usual recommendation is to keep out of the sun between 11 am and 3 pm, wear a sun-hat and appropriate clothing, and use a sun screen (UV-A and UV-B) that doesn't wash off on exposed skin and when in the water. With regard to the wearing of clothing protecting against UV radiation, compliance must be expected to be low, since just such protective clothing (in particularthick, densely-woven materials) is unsuitable for the summer. Using detergents containing a UV absorber in the home wash, even light summer wear can be made to offer good UV protection.
Collapse
Affiliation(s)
- P Kaskel
- Dr. med. Peter Kaskel, Abt. Dermatologie, Universitätsklinikum Ulm, Ulm/Donau
| | | | | | | |
Collapse
|
21
|
Huber MA, Gall H, Gethöffer K, Mühlmeier G, Maier H, Peter RU. Successful prevention of recurrent nasal polyposis by means of systemic low-dose IFN-alpha2a. J Allergy Clin Immunol 2001; 108:141. [PMID: 11447396 DOI: 10.1067/mai.2001.116288] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
22
|
Bezold G, Lange M, Gethöffer K, Pillekamp H, Reindl H, Richter C, Schönian G, Weber L, Peter RU. Competitive polymerase chain reaction used to diagnose cutaneous leishmaniasis in German soldiers infected during military exercises in French Guiana. Eur J Clin Microbiol Infect Dis 2001; 20:421-4. [PMID: 11476445 DOI: 10.1007/s100960100519] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A competitive polymerase chain reaction (PCR) followed by enzyme-linked-immunoassay-based verification of PCR products has been developed, which facilitated the diagnosis of leishmaniasis in two German soldiers who underwent survival training in the jungle of French Guiana and returned with therapy-resistant pyoderma-like lesions. After treatment with liposomal amphotericin B, the skin manifestations disappeared, and leishmania DNA could no longer be detected by PCR. In the context of growing military involvement in areas where leishmaniasis is prevalent, this assay may help detect or, due to its internal controls, exclude cases of infection with this parasite.
Collapse
Affiliation(s)
- G Bezold
- Department of Dermatology, University of Ulm, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Schiener R, Behrens-Williams SC, Gottlöber P, Pillekamp H, Peter RU, Kerscher M. PUVA-Badtherapie bei Necrobiosis lipoidica. Akt Dermatol 2001. [DOI: 10.1055/s-2001-14532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
|
24
|
Abstract
The lack of p16 expression has been shown in cultured melanoma cells, however contradictory evidence for p16 expression in melanoma tissues exist. Ultraviolet (UV) C and UVB have been shown to affect p16 expression, which impairs cell cycle regulation in vitro and in vivo. In this study, p16/CDKN2A gene expression was determined by reverse transcription polymerase chain reaction in seven skin cancer patients, in one dysplastic nevus patient and in seven healthy individuals, prior to UVB exposure and at various times after application of one minimal erythema dose (MED). Five of the seven skin cancer patients showed a down-regulation of p16/CDKN2A expression after UVB exposure, while controls remained unaltered. The UVB-induced decline of p16/CDKN2A in skin cancer patients might offer new insights into photocarcinogenesis. The putative sequence of events could start with a down-regulation of p16/CDKN2A expression, which would lead to impaired cell cycle regulation. Altered expression patterns of p16/CDKN2A following UVB exposure could be of value for identifying people with an increased risk of UV-induced skin cancer.
Collapse
Affiliation(s)
- G Krähn
- Department of Dermatology, University of Munich, Germany.
| | | | | | | | | |
Collapse
|
25
|
Abstract
A 75-year-old female patient presented with late stage cutaneous radiation syndrome, following postoperative combined radiotherapy for cervical carcinoma administered 32 years ago. She was hospitalized because of a deep abscess in the radiation-exposed area on the sacrum. Extension into the subcutaneous fibrosis was verified by 7,5-MHz-sonography and nuclear magnetic resonance imaging. With intravenous cefotiam (Spizef) 2.0 g three times daily, the inflammation decreased, as seen clinically and with nuclear magnetic resonance imaging. As a secondary finding, an unusual distinctive subcutaneous calcification was diagnosed in the radiation-exposed area by means of 7,5-MHz-sonography, as well as computer- and nuclear magnetic resonance imaging. These subcutaneous calcifications are most likely to have been radiation-induced.
Collapse
Affiliation(s)
- M Steinert
- Abteilung Dermatologie, Universitätsklinikum Ulm, Oberer Eselsberg 40, 89081 Ulm
| | | | | | | |
Collapse
|
26
|
Mooser G, Gall H, Weber L, Peter RU. Cold panniculitis--an unusual differential diagnosis from aluminium allergy in a patient hyposensitized with aluminium-precipitated antigen extract. Contact Dermatitis 2001; 44:368. [PMID: 11380551 DOI: 10.1034/j.1600-0536.2001.440609-3.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- G Mooser
- Department of Dermatology, University of Ulm, Oberer Eselsberg 40, D-89081 Ulm, Germany
| | | | | | | |
Collapse
|
27
|
Abstract
Occupational contact dermatitis in hair dressers and beauticians has increased in importance in the past years. Type IV-allergies against glyceryl monothioglycate components of permanent waves are most common. Other occupational allergens include bleach components such as ammonium persulfate and hair dye ingredients such as p-phenylenediamine (PPD) and p-toluylene-diamine (PTD) base. Allergies to hair dyes in customers of hair dressers have rarely been observed. Two female patients developed allergic contact dermatitis of the scalp and face after repeated use of Polycolor intensivtönung schwarz and of Movida color. We also review the current literature on type IV-allergies to components of hair dressing products components.
Collapse
Affiliation(s)
- P Gottlöber
- Abteilung Dermatologie, Universitätsklinikum Ulm, Oberer Eselsberg 40, 89081 Ulm.
| | | | | | | |
Collapse
|
28
|
Weidmann MJ, Kunzi-Rapp K, Wortmann S, Peter RU. Tuberöse Sklerose: Kontrollierte Feinstablation der Angiofibrome im Gesichtsbereich mit einem modifizierten Erbium:YAG-Laser. Akt Dermatol 2001. [DOI: 10.1055/s-2001-13107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
29
|
Mooser G, Weber L, Kerscher M, Peter RU. [Circumscribed myxedema of the upper and lower extremities--a rate cutaneous manifestation of Basedow disease. Case report and review of the literature]. Hautarzt 2001; 52:439-43. [PMID: 11405164 DOI: 10.1007/s001050051339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A 63 year old man presented with circumscribed myxedema surprisingly involving both the arms and legs. He had a history of thyroiditis with hyperthyroidism and an infiltrative ophthalmopathy leading to the diagnosis of Graves disease. At the time of presentation the patient had already been treated with radioactive iodine and undergone endonasal orbital decompression. We review the pathogenesis and treatment of Graves disease and discuss the first therapeutic attempt with PUVA-bath therapy.
Collapse
Affiliation(s)
- G Mooser
- Abteilung Dermatologie der Universität Ulm, Oberer Eselsberg 40, 89081 Ulm
| | | | | | | |
Collapse
|
30
|
Udart M, Utikal J, Krähn GM, Peter RU. Chromosome 7 aneusomy. A marker for metastatic melanoma? Expression of the epidermal growth factor receptor gene and chromosome 7 aneusomy in nevi, primary malignant melanomas and metastases. Neoplasia 2001; 3:245-54. [PMID: 11494118 PMCID: PMC1505589 DOI: 10.1038/sj/neo/7900156] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2000] [Accepted: 01/15/2001] [Indexed: 11/09/2022]
Abstract
Receptor tyrosine kinases such as the epidermal growth factor receptor (EGFR) play an important role in a variety of malignant neoplasias, making the search for aberrations in the relevant chromosomes an important issue. Differential expression of the EGFR gene was investigated by reverse transcriptase (RT)-PCR on tissue samples of normal skin, nevi, primary melanomas, and melanoma metastases. The EGFR gene is located on chromosome 7p12.3-p12.1. To determine the number of chromosomes 7 in cell nuclei of the mentioned tissue samples we performed fluorescence in situ hybridization (FISH) on touch preparations, using a DNA probe that hybridizes specifically to the centromeric region of chromosome 7. Additionally, chromosome 7 number in interphase nuclei was determined in short-term primary cell cultures of nevi, primary melanomas, and metastases. The highest EGFR gene expression frequency was found in melanoma metastases. By FISH we detected the highest fraction of cell nuclei with more than two chromosomes 7 in the group of metastases. Our results suggest that overexpression of the EGFR gene might play an important role in metastasis of malignant melanoma. This is well reflected by polysomy 7, possibly accounting for an increased EGFR gene copy number.
Collapse
Affiliation(s)
- M Udart
- Department of Dermatology, University of Ulm, Ulm, Germany.
| | | | | | | |
Collapse
|
31
|
Gottlöber P, Steinert M, Bähren W, Weber L, Gerngross H, Peter RU. Interferon-gamma in 5 patients with cutaneous radiation syndrome after radiation therapy. Int J Radiat Oncol Biol Phys 2001; 50:159-66. [PMID: 11316559 DOI: 10.1016/s0360-3016(00)01542-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Irradiation can cause acute inflammatory responses as well as chronic fibrotic alterations of the skin. Cutaneous radiation fibrosis evokes a complex of therapeutic problems. However, therapeutic options, apart from surgical approaches, are limited. PATIENTS AND METHODS Five female patients suffering from severe cutaneous fibrosis were treated with interferon-gamma on a low-dose regimen, 3 x 100 microg/week subcutaneously for 6 months, then once per week for another 6 months. In 4 patients, skin thickness was measured with high-frequency (20 MHz) ultrasound in a clinically well-defined target skin lesion. In 1 patient, nuclear magnetic resonance imaging was performed to quantify the extent of cutaneous radiation fibrosis and to monitor the therapeutic outcome. RESULTS All patients suffered from radiation-induced cutaneous fibrosis. Additionally, in 1 patient, a fistula, as assessed by lymph vessel scintigraphy, and in another patient a radiation ulcer was diagnosed. In all patients, reduction of radiation-induced fibrosis could be documented. Both fistula and radiation ulcer regressed completely under interferon-gamma therapy. CONCLUSION Low-dose interferon-gamma therapy is a new and effective treatment modality for cutaneous radiation fibrosis caused by radiation therapy. The positive impact of interferon-gamma on our patients warrants randomized double-blind trials on therapy of radiation fibrosis.
Collapse
Affiliation(s)
- P Gottlöber
- Department of Dermatology, University of Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany.
| | | | | | | | | | | |
Collapse
|
32
|
|
33
|
Reinhold U, Berkin C, Bosserhoff AK, Deutschmann A, Garbe C, Gläser R, Hein R, Krähn G, Peter RU, Rappl G, Schittek B, Seiter S, Ugurel S, Volkenandt M, Tilgen W. Interlaboratory evaluation of a new reverse transcriptase polymerase chain reaction-based enzyme-linked immunosorbent assay for the detection of circulating melanoma cells: a multicenter study of the Dermatologic Cooperative Oncology Group. J Clin Oncol 2001; 19:1723-7. [PMID: 11251002 DOI: 10.1200/jco.2001.19.6.1723] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Reverse transcription-polymerase chain reaction (RT-PCR)-based detection of tyrosinase mRNA is the most frequently used laboratory method for the detection of circulating tumor cells in melanoma patients. However, previously published results showed considerable variability in the PCR positivity rates. MATERIALS AND METHODS We designed a collaborative study to assess the sensitivity, specificity, and clinical relevance of a new standardized RT-PCR-based enzyme-linked immunosorbent assay (ELISA) for the detection of circulating melanoma cells. Blood samples of healthy donors mixed with cells of a melanoma cell line were prepared in a blinded fashion, and aliquots were sent to seven participating laboratories experienced in RT-PCR. RESULTS The results demonstrate a high sensitivity (1 melanoma cell/mL blood) and specificity (no false-negatives and 7.4% [2 of 28] false-positives) of the assay and a satisfactory rate of interlaboratory reproducibility. The analysis of aliquots of blinded samples derived from 60 melanoma patients identified tyrosinase mRNA in 17 of 60 (28.3%): three (20%) of 15 stage I patients, two (13.3%) of 15 stage II patients, five (35.7%) of 14 stage III patients, and seven (43.8%) of 16 stage IV patients. The interlaboratory reproducibility of positive samples, however, was extremely low and indicates the presence of low amounts of target mRNA. CONCLUSION Reverse transcriptase-PCR ELISA has a high sensitivity and specificity for the detection of tyrosinase mRNA in peripheral blood cells. The low interlaboratory reproducibility for the detection of tumor cells in blood samples of melanoma patients, however, raises the question of relevance of this assay for clinical use.
Collapse
Affiliation(s)
- U Reinhold
- Department of Dermatology, The Saarland University Hospital, Homburg/Saar, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Bezold G, Gottlöber P, Leiter U, Kerscher M, Krähn G, Peter RU. Quantitation of herpes simplex DNA in blood during aciclovir therapy with competitive PCR ELISA. Dermatology 2001; 201:296-9. [PMID: 11146337 DOI: 10.1159/000051541] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Monitoring viral load in blood has already been introduced into clinical routine for human immunodeficiency virus and hepatitis C virus. OBJECTIVE This study was conducted to monitor the decline of herpes simplex (HSV) viral load in the blood of a patient with gingivostomatitis herpetica prior and during acyclovir therapy. METHODS Analysis was done by quantitative PCR ELISA using an internal quantitation standard. RESULTS Copy numbers were 66/microl blood prior to therapy, 60 during oral medication with valaciclovir, 97 and 72 copies/microl blood during the first 2 days of intravenous acyclovir therapy, followed by a sharp decline to 8 and 9 copies on days 3 and 4. During the following days, HSV was no longer detectable. CONCLUSION As this quantitative approach can be easily adjusted to any other PCR, it provides a reliable, easy-to-apply method for monitoring therapy, also during new antiviral clinical trials.
Collapse
Affiliation(s)
- G Bezold
- Department of Dermatology, University of Ulm, Germany
| | | | | | | | | | | |
Collapse
|
35
|
Krähn G, Kaskel P, Sander S, Waizenhöfer PJ, Wortmann S, Leiter U, Peter RU. S100 beta is a more reliable tumor marker in peripheral blood for patients with newly occurred melanoma metastases compared with MIA, albumin and lactate-dehydrogenase. Anticancer Res 2001; 21:1311-6. [PMID: 11396205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Lactate-dehydroxynase (LDH) has been described as a leading blood parameter in patients with melanoma metastases. However, recent data indicates that levels of S100 as well as melanoma inhibiting activity (MIA) in peripheral blood, correlate with melanoma progression. The aim of this study was to evaluate tumor markers S100, MIA, LDH and albumin in peripheral blood of 373 melanoma patients. 284 patients presented with in-situ or UICC stage I/II, and 89 with stage III/IV (54 tumor-free, 29 with newly occurred metastases). For newly occurred metastases, sensitivity was highest for S100 in peripheral blood (0.86), followed by MIA (0.80), LDH (0.48), and albumin (0.15). Specificity for albumin (0.99) and LDH (0.98) was higher than for S100 (0.91) and MIA (0.62). This data indicate that S100 in peripheral blood as compared to MIA, LDH and albumin appears to be the most appropriate tumor marker for newly occurred melanoma metastases.
Collapse
Affiliation(s)
- G Krähn
- Department of Dermatology, University of Ulm, 89070 Ulm/Donau, Germany.
| | | | | | | | | | | | | |
Collapse
|
36
|
Gottlöber P, Steinert M, Weiss M, Bebeshko V, Belyi D, Nadejina N, Stefani FH, Wagemaker G, Fliedner TM, Peter RU. The outcome of local radiation injuries: 14 years of follow-up after the Chernobyl accident. Radiat Res 2001; 155:409-16. [PMID: 11182791 DOI: 10.1667/0033-7587(2001)155[0409:toolri]2.0.co;2] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The Chernobyl nuclear power plant accident on April 26, 1986 was the largest in the history of the peaceful use of nuclear energy. Of the 237 individuals initially suspected to have been significantly exposed to radiation during or in the immediate aftermath of the accident, the diagnosis of acute radiation sickness (ARS) could be confirmed in 134 cases on the basis of clinical symptoms. Of these, 54 patients suffered from cutaneous radiation syndrome (CRS) to varying degrees. Among the 28 patients who died from the immediate consequences of accidental radiation exposure, acute hemopoietic syndrome due to bone marrow failure was the primary cause of death only in a minority. In 16 of these 28 deaths, the primary cause was attributed to CRS. This report describes the characteristic cutaneous sequelae as well as associated clinical symptoms and diseases of 15 survivors of the Chernobyl accident with severe localized exposure who were systematically followed up by our groups between 1991 and 2000. All patients presented with CRS of varying severity, showing xerosis, cutaneous telangiectasias and subungual splinter hemorrhages, hemangiomas and lymphangiomas, epidermal atrophy, disseminated keratoses, extensive dermal and subcutaneous fibrosis with partial ulcerations, and pigmentary changes including radiation lentigo. Surprisingly, no cutaneous malignancies have been detected so far in those areas that received large radiation exposures and that developed keratoses; however, two patients first presented in 1999 with basal cell carcinomas on the nape of the neck and the right lower eyelid, areas that received lower exposures. During the follow-up period, two patients were lost due to death from myelodysplastic syndrome in 1995 and acute myelogenous leukemia in 1998, respectively. Other radiation-induced diseases such as dry eye syndrome (3/15), radiation cataract (5/15), xerostomia (4/15) and increased FSH levels (7/15) indicating impaired fertility were also documented. This study, which analyzes 14 years in the clinical course of a cohort of patients with a unique exposure pattern, corroborates the requirement for long-term, if not life-long, follow-up not only in atomic bomb survivors, but also after predominantly local radiation exposure.
Collapse
Affiliation(s)
- P Gottlöber
- Department of Dermatology, University of Ulm, Ulm, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Bezold GD, Lange ME, Gall H, Peter RU. Detection of cutaneous varicella zoster virus infections by immunofluorescence versus PCR. Eur J Dermatol 2001; 11:108-11. [PMID: 11275804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Detection of localized, clinically atypical cutaneous infections with varicella zoster virus (VZV) has proven difficult, as serum antibody tests sometimes are not sensitive and specific enough for that purpose. Therefore immunofluorescence and an internally controlled PCR for VZV are compared for sensitivity. Detection of PCR products was done by ELISA, and if positive, additionally by agarose gel electrophoresis. Of 60 samples 44 were PCR-positive by ELISA (44 = 100%), of which 37 (84%) were also positive on the agarose gel. Thirty-four samples (77%) were positive by immunofluorescence. No sample was positive by immunofluorescence and negative by PCR. A combination of immunofluorescence and PCR with agarose gel analysis detected 42 samples out of 44 positive by PCR ELISA (95%). These results demonstrate that immunofluorescence is a suitable, fast and inexpensive method for routine diagnostics. Additional sensitivity can be achieved by screening immunofluorescence-negative samples by PCR, which is extremely sensitive but time-consuming and labor-intensive.
Collapse
Affiliation(s)
- G D Bezold
- Department of Dermatology, University of Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
| | | | | | | |
Collapse
|
38
|
Abstract
Diagnosis of scabies infection can be difficult as in many cases only few mites are present on an infected person, and in some cases the skin manifestations can be subtle or atypical. We describe the use of polymerase chain reaction (PCR) to amplify Sarcoptes scabiei DNA in a patient presenting with clinically atypical eczema. Cutaneous scales were PCR positive for S. scabiei DNA before, and negative 2 weeks after, therapy. This method facilitates fast and very sensitive diagnosis of clinically atypical or inapparent scabies infection and therapy control in severely affected patients and may help to identify previously unrecognized scabies cases.
Collapse
Affiliation(s)
- G Bezold
- Department of Dermatology, University of Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
| | | | | | | | | | | | | |
Collapse
|
39
|
Kunzi-Rapp K, Kaskel P, Steiner R, Peter RU, Krähn G. Increased blood levels of human S100 in melanoma chick embryo xenografts' circulation. Pigment Cell Res 2001; 14:9-13. [PMID: 11277496 DOI: 10.1034/j.1600-0749.2001.140103.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The chorioallantoic membrane (CAM) of the fertilized egg allows grafting of human melanomas for short-term investigations and offers the opportunity to investigate the behavior of metastasizing cells and the release of S100beta into peripheral blood. Tissue from one primary melanoma as well as cutaneous and subcutaneous metastases of 10 melanoma patients with elevated levels of S100 in the peripheral blood before surgery were transplanted onto the CAM of chick embryos at day 5/6 of development. Grafts were nourished by the host blood supply 2 days after transplantation. Histologically, 3 days after grafting, metastasizing melanoma cells could be found near the vessels of the host membrane, penetrating the endothelial layer and entering the blood system. Growth conditions remained stable for 6 days after transplantation. Blood samples were taken from a larger CAM vessel before collecting the xenografts 5 days after grafting. Measurement of human S100 in peripheral blood was performed in a blinded manner. No negative control showed elevated levels of human S100 protein. Samples deriving from melanoma xenografts contained highly elevated levels of S100 protein in 80% of cases. The data strongly support the concept of graft-host interaction concerning adherence of tumors and extravasation of human melanoma cells.
Collapse
Affiliation(s)
- K Kunzi-Rapp
- Institute for Laser Technologies and Metrology at the University of Ulm, Germany.
| | | | | | | | | |
Collapse
|
40
|
|
41
|
Behrens-Williams SC, Leiter U, Schiener R, Weidmann M, Peter RU, Kerscher M. The PUVA-turban as a new option of applying a dilute psoralen solution selectively to the scalp of patients with alopecia areata. J Am Acad Dermatol 2001; 44:248-52. [PMID: 11174382 DOI: 10.1067/mjd.2001.110060] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Alopecia areata is a burden for many patients and often resistant, even to extensive therapy. Orally administered PUVA therapy has been shown among numerous systemic and topical treatment modalities to be a therapeutic alternative. However, the clinical use of oral PUVA is often limited by systemic side effects. Bath-PUVA therapy offers an alternative solution because of the negligible systemic absorption of psoralen with this technique. Through use of a "PUVA-turban" it is now possible to administer a dilute bathwater solution containing 8-methoxypsoralen (8-MOP) to the scalp. OBJECTIVE The purpose of this study was to determine whether PUVA turban therapy is effective in treating alopecia areata in different clinical stages. METHODS We treated 9 patients with severe, rapidly progressing, treatment-resistant alopecia areata with PUVA-turban treatment as a modification of bath-PUVA therapy. At each treatment session a cotton towel was soaked with a 0.0001% 8-MOP solution (1 mg/L) at 37 degrees C, wrung gently to remove excess water, and wrapped around the patient's head in a turban fashion for 20 minutes. This was directly followed by UVA radiation. Treatment sessions were initially performed 3 to 4 times per week. RESULTS The cumulative UVA doses given over treatment periods of up to 24 weeks were 60.9 to 178.2 J/cm(2), with single doses ranging from 0.3 to 8.0 J/cm(2). After up to 10 weeks of treatment, hair regrowth could be noticed in 6 of 9 patients. Two patients did not respond to the treatment, and one patient showed only vellus hair regrowth. CONCLUSION PUVA-turban therapy can be considered a useful method of administering a dilute psoralen solution selectively to the scalp of patients. It has been shown to be a well-tolerated and, in some patients, efficient therapeutic alternative in the treatment of alopecia areata.
Collapse
|
42
|
Kraehn GM, Utikal J, Udart M, Greulich KM, Bezold G, Kaskel P, Leiter U, Peter RU. Extra c-myc oncogene copies in high risk cutaneous malignant melanoma and melanoma metastases. Br J Cancer 2001; 84:72-9. [PMID: 11139316 PMCID: PMC2363612 DOI: 10.1054/bjoc.2000.1535] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Amplification and overexpression of the c-myc gene have been associated with neoplastic transformation in a plethora of malignant tumours. We applied interphase fluorescence in situ hybridization (FISH) with a locus-specific probe for the c-myc gene (8q24) in combination with a corresponding chromosome 8 alpha-satellite probe to evaluate genetic alterations in 8 primary melanomas and 33 advanced melanomas and compared it to 12 melanocytic nevi, 7 safety margins and 2 cases of normal skin. Additionally, in metaphase spreads of 7 melanoma cell lines a whole chromosome 8 paint probe was used. We investigated the functionality of the c-myc gene by detecting c-myc RNA expression with RT-PCR and c-myc protein by immunohistochemistry. 4/8 primary melanomas and 11/33 melanoma metastases showed additional c-myc signals relative to the centromere of chromosome 8 copy number. None of the nevi, safety margins or normal skin samples demonstrated this gain. In 2/7 melanoma cell lines (C32 and WM 266-4) isochromosome 8q formation with a relative gain of c-myc copies and a loss of 8p was observed. The highest c-myc gene expression compared to GAPDH was found in melanoma metastases (17.5%). Nevi (6.6%) and primary melanomas (5.0%) expressed the c-myc gene on a lower level. 72.7% of the patients with c-myc extra copies had visceral melanoma metastases (UICC IV), patients without c-myc gain in 35.0% only. The collective with additional c-myc copies also expressed the gene on a significantly higher level. These results indicate that a c-myc gain in relation to the centromere 8 copy number might be associated with advanced cutaneous melanoma.
Collapse
Affiliation(s)
- G M Kraehn
- Department of Dermatology, University of Ulm, Ulm, Germany
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Abstract
BACKGROUND AND OBJECTIVE Rapid progress in computer and information technologies has led to an increased interest in the use of telemedicine during the past few years. Thus it should be clarified, whether teledermatology can achieve comparable results to conventional specialist examination and advice. PATIENTS/METHODS We initiated a pilot study, comparing teledermatology with conventional examination in a dermatology outpatient setting. 60 patients were included. RESULTS Out of 60 teledermatological examinations, remote clinicians were in agreement with face-to-face clinicians in 90%. Teledermatology was unable to make a useful diagnosis in 6 patients, however further diagnostic procedures were ordered, enabling teledermatologists to achieve correct diagnoses. Regarding need for further diagnostic tests, there was no difference between teledermatology and conventional examination. CONCLUSIONS Teledermatology appears suitable to transfer a dermatologist's expertise over large distances.
Collapse
Affiliation(s)
- R Schiener
- Bundeswehrkrankenhaus Ulm, Abteilung Dermatologie und Venerologie
| | | | | | | |
Collapse
|
44
|
Abstract
The receptor tyrosine kinases (RTKs) epidermal growth factor receptor (EGFR), HER2, HER3 and HER4 are involved in the pathogenesis of multiple human malignant neoplasias. However, their role in the carcinogenesis of basal cell carcinomas (BCC) and squamous cell carcinomas (SCC) remains to be elucidated. In order to further define the role of these RTKs, 56 human skin tissue samples of normal skin, BCC and SCC were studied by conventional and differential and quantitative reverse transcriptase-polymerase chain reaction (rtPCR). EGFR and HER3 were predominantly expressed in the BCCs and SCCs, while HER2 was ubiquitously expressed. HER4 was not expressed in any sample. Since in vitro studies have provided compelling evidence that heterodimer formation of these receptors are associated with different signal transduction processes, coexpression patterns might be decisive for the induction and maintenance of a malignant phenotype. These results confirm this concept: isolated HER2 expression and EGFR/HER2 were predominantly found in normal skin, while HER2/HER3 and the triple expression of EGFR/HER2/HER3 were seen more frequently in the BCCs and SCCs compared with normal skin (50% and 40% compared with 26%, respectively). The activation of HER3, in addition to EGFR and HER2, might therefore be associated with the malignant phenotype. However, due to the small numbers in this study, further confirmation of the patterns is needed.
Collapse
Affiliation(s)
- G Krähn
- Department of Dermatology, University of Ulm, Oberer Eselsberg 40, D-89081 Ulm, Germany.
| | | | | | | | | | | | | |
Collapse
|
45
|
Kunzi-Rapp K, Krähn GM, Wortmann S, Peter RU. Early treatment of traumatic tattoo by erbium-YAG laser. Br J Dermatol 2001; 144:219-21. [PMID: 11167731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
|
46
|
Schiener R, Behrens-Williams SC, Pillekamp H, Kaskel P, Peter RU, Kerscher M. Calcipotriol vs. tazarotene as combination therapy with narrowband ultraviolet B (311 nm): efficacy in patients with severe psoriasis. Br J Dermatol 2000; 143:1275-8. [PMID: 11122033 DOI: 10.1046/j.1365-2133.2000.03900.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Phototherapy has been shown to be one of the most effective treatment modalities for patients with psoriasis. Nevertheless, photocombination therapies capable both of reducing cumulative ultraviolet (UV) doses and of accelerating clearance of skin lesions are important and of high interest. There have been no published studies comparing the effect of narrowband UVB irradiation in combination with topical application of tazarotene vs. calcipotriol. OBJECTIVES To determine, in a half-side manner, whether a combination of UVB (311 nm) and tazarotene is superior to UVB (311 nm) plus calcipotriol or vice versa. METHODS Ten patients suffering from widespread symmetrical psoriasis were treated for at least 4 weeks with topical calcipotriol and tazarotene in a half-side distribution. Additionally, the whole body was irradiated with narrowband UVB (311 nm) four times a week. Before treatment and once weekly during therapy a modified Psoriasis Area and Severity Index was estimated for each body half. The total treatment time, number of treatment sessions and cumulative UVB dose necessary for clearance of skin lesions were determined in an observer-blind fashion for each patient. Furthermore, all patients completed a quality of life questionnaire. RESULTS Clearance of psoriasis was observed after a median of 19 treatment sessions (range 14-28) and a median cumulative UVB dose of 22.98 J cm-2 (range 9.24-58.22) simultaneously for both body halves. On the side treated with topical tazarotene gel, four patients complained of itching and dryness of the skin, and skin irritation was observed in three of them. Six patients preferred the application of tazarotene gel, while four preferred calcipotriol. CONCLUSIONS Our clinical comparison of narrowband UVB with either topical calcipotriol or topical tazarotene revealed no significant therapeutic difference between both regimens. Although these results need to be confirmed in larger patient groups, we feel that both photocombination therapies can broaden the therapeutic options for moderate to severe psoriasis vulgaris and may reduce the cumulative UVB dose during therapy.
Collapse
Affiliation(s)
- R Schiener
- Department of Dermatology, University of Ulm, Oberer Eselsberg 40, D-89081 Ulm, Germany
| | | | | | | | | | | |
Collapse
|
47
|
Panhans-Gross A, Gall H, Dziuk M, Peter RU. Contact dermatitis from estradiol in a transdermal therapeutic system. Contact Dermatitis 2000; 43:368-9. [PMID: 11140397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
|
48
|
Bezold G, Volkenandt M, Gottlöber P, Peter RU. Detection of herpes simplex virus and varicella-zoster virus in clinical swabs: frequent inhibition of PCR as determined by internal controls. Mol Diagn 2000; 5:279-84. [PMID: 11172491 DOI: 10.1007/bf03262088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
BACKGROUND PCR-based detection of microorganisms is widely used for diagnostic purposes. Most routine PCR applications do not control for inhibition of PCR, thus leading to false-negative results. METHODS AND RESULTS One hundred eighteen swab samples obtained from skin and mucosa were investigated for the presence of herpes simplex virus (HSV), varicella-zoster virus (VZV), and the control gene betaglobin by internally controlled PCR with purified and unpurified DNA in parallel. With unpurified DNA, inhibition of PCR was detected in 23% of betaglobin PCRs, 25% of VZV PCRs, and 16% of HSV PCRs versus 3% each for purified DNA. Approximately 20% of the samples with positive results for HSV or VZV had negative or inhibited results using unpurified DNA. CONCLUSION These results indicate that PCR from clinical swab specimens should be performed exclusively with internal controls because the positive control alone cannot exclude PCR inhibition in individual samples. Purification of DNA will decrease, but not exclude, PCR inhibition.
Collapse
Affiliation(s)
- G Bezold
- Department of Dermatology, University of Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
| | | | | | | |
Collapse
|
49
|
Beetz A, Peter RU, Oppel T, Kaffenberger W, Rupec RA, Meyer M, van Beuningen D, Kind P, Messer G. NF-kappaB and AP-1 are responsible for inducibility of the IL-6 promoter by ionizing radiation in HeLa cells. Int J Radiat Biol 2000; 76:1443-53. [PMID: 11098847 DOI: 10.1080/09553000050176207] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
PURPOSE To investigate the mechanisms leading to initiation by ionizing radiation of IL-6 transcription in HeLa cells. MATERIALS AND METHODS HeLa cells were irradiated with X-rays at a dose rate of approximately 1 Gy/min or treated with TPA (100 ng/ml). Transient transfection analysis with truncated IL-6 promoter CAT constructs was used to identify the radiation-sensitive region within the IL-6 promoter/enhancer. RESULTS For basal expression of the IL-6 gene in unirradiated control cells the presence of the binding site for the nuclear factor kappa B (NF-kappaB) and the multiple response elements (MRE) were necessary. After deletion of either the activator protein (AP)-1 or the MRE site, radiation-induced IL-6 promoter CAT activity was significantly reduced, whereas after deletion of the NF-kappaB site it was completely abolished. Maximal radiation-induced IL-6 promoter CAT activity was observed when the AP-1, NF-kappaB and MRE motifs were present. In electrophoretic mobility shift analyses (EMSA), X-ray-inducible activity was found for NF-kappaB and AP-1 at the MRE constitutive, but no inducible activities were detectable. The nuclear factor IL-6 (NF-IL6) element showed no specific radiation-responsive activity. CONCLUSIONS These results demonstrate that NF-kappaB plays a major role in X-ray-inducible IL-6 expression in HeLa cells. The fact that IL-6 promoter activity was dramatically enhanced in the presence of the MRE and distal AP-1 binding motif is indicative of a cooperative mode of transcriptional activation involving all three transcription factor systems. These data provide new insights into the prodromal events of radiation-induced inflammation of epithelial cells and putatively the cutaneous radiation syndrome.
Collapse
Affiliation(s)
- A Beetz
- Institute of Radiobiology, Federal Armed Forces Medical Academy, Munich, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Affiliation(s)
- H Gall
- Department of Dermatology, University of Ulm, Germany
| | | | | |
Collapse
|