bluuebunny/crossref_metadata_2025 huggingface dataset:
Micrographic Surgery (‘Slow Mohs’) in Cutaneous Sarcomas
Authors: Hafner J. , Schütz K. , Morgenthaler W. , Steiger E. , Meyer V. , Burg G.
Published: April 2003

Background: Micrographic surgery (MS) results in very low local recurrence rates in all sorts of skin tumours that grow by extensive subclinical infiltration. Therefore, MS should prove useful in the treatment of cutaneous sarcomas. Objective: To treat cutaneous sarcoma with MS in order to minimize local recurrence rates. Methods: We treated 5 cases of dermatofibrosarcoma protuberans and 5 cases of cutaneous sarcomas of different origin (atypical fibroxanthoma, malignant fibrous histiocytoma, malignant peripheral nerve tumour) with micrographic surgery using paraffin-embedded sections. In primary cutaneous sarcomas, tumour extensions were readily detected in HE sections. In recurrent tumours, special stains were needed to distinguish tumour extensions from scar tissue. Results: All patients were treated successfully and have remained free of local recurrences as of yet. Solitary pulmonary metastasis occurred in 1 patient with high-grade malignant peripheral nerve tumour. Conclusion: MS is an excellent procedure to minimize local recurrence in cutaneous sarcomas. Cutaneous sarcomas with low metastatic potential can be cured with MS.
Identification of DNA Sequences of Both Genital and Cutaneous HPV Types in a Small Number of Keratoacanthomas of Nonimmunosuppressed Patients
Authors: Stockfleth E. , Meinke B. , Arndt R. , Christophers E. , Meyer T.
Published: April 2003

Background: Viral infection was suggested to be etiologically involved in skin tumor development. Data on the association of human papillomavirus (HPV) with keratoacanthomas are still conflicting. Objective: Analysis of HPV infection in keratoacanthomas of the general population. Methods: HPV DNA was detected by nested PCR. To include a broad range of both cutaneous and mucosal HPV types, HPV PCR was performed with two sets of degenerate primers. Results: Considering only β-globin-positive specimens, HPV DNA was detected in 20% of the specimens obtained from 18% of the patients. The spectrum of HPV types detected contains HPV types 6, 14, 16, 35, 58 and 61. In 1 case, the underlying HPV type was not identified. In 1 specimen with transition towards squamous-cell carcinoma, HPV 16 was detected. Conclusions: HPV is probably not generally associated with the etiology of keratoacanthoma but may be relevant in individual cases. Oncogenic HPV types may be cofactors for malignant transformation of initially benign skin lesions like keratoacanthomas.
Absence of Male-Pattern Baldness in Men with X-Linked Recessive Ichthyosis?
Authors: Happle R. , Hoffmann R.
Published: April 2003

X-linked recessive ichthyosis (XRI) is caused by a deficiency of steroid sulfatase. Because this enzyme plays an important role in androgen metabolism, we advance the hypothesis that men with XRI do not show androgenetic alopecia or develop only mild forms of this common type of hair loss. Clinical studies should show whether this hypothesis can be supported.
Antibacterial Efficacy of Benzoyl Peroxide in Phospholipid Liposomes
Authors: Fluhr J.W. , Barsom O. , Gehring W. , Gloor M.
Published: April 2003

Background: Literature reports indicate that phospholipid liposomes facilitate the accumulation of active agents in the infundibulum. Objective: The study hypothesis of an improved antibacterial efficacy of benzoyl peroxide (BPO) in phospholipid liposomes was tested in comparison with a commercial and a pharmacopoeial BPO preparation. Methods: The infundibular bacterial samples were obtained with the Permabond technique from 20 acne patients who had been treated with the test substances (vehicle-controlled) for 2 weeks twice per day in a single-blinded, comparative study on the upper back. Results: A significant antibacterial effect in the infundibula (Propionibacteria and Micrococcaceae, both: p < 0.001) for a BPO phospholipid liposome formulation could be demonstrated. In comparison to the other significantly efficacious BPO formulations which were also tested (commercial product and pharmacopoeial formulation), the BPO phospholipid liposome formulation showed a significantly greater antibacterial efficacy for Propionibacteria and Micrococcaceae (both: p < 0.01). Conclusion: A BPO formulation in phospholipid liposomes may represent an improvement of the conventional external BPO treatment of acne.
Vegetating Iododerma with Fatal Outcome
Authors: Miranda-Romero A. , Sánchez-Sambucety P. , Esquivias Gómez J.I. , Martínez Fernández M. , Bajo del Pozo C. , Aragoneses Fraile H. , Garcia-Muñoz M.
Published: April 2003

A 65-year-old woman on whom a cardiac catherization using iodine contrast had been performed developed 5 days later acute renal failure, respiratory insufficiency and cutaneous lesions consisting of two great vegetating masses located on both cheeks and pustular vesicular lesions on the extremities. A fortnight later, the patient died. We would like to stress this case because of the exceptional nature of vegetating iododerma at present, and the importance of recognizing a possibly fatal disease.
Sjögren-Larsson Syndrome: Early Diagnosis, Dietary Management and Biochemical Studies in Two Cases
Authors: Taube B. , Billeaud C. , Labrèze C. , Entressangles B. , Fontan D. , Taïeb A.
Published: April 2003

Background: Sjögren-Larsson syndrome (SLS) is a rare autosomal recessive disorder with worldwide distribution. It consists of ichthyosis, spastic diplegia and mental retardation caused by an enzymatic defect in fatty alcohol oxidation. Objective: To study the effects of dietary management on clinical outcome and plasma/red blood cell fatty alcohol and plasmalogen concentrations. Methods: To reduce fatty alcohol production, we reduced total fat intake to 30% of total intake of calories. To correct d 6 desaturase deficiency, we supplemented the diet with both n–3 and n–6 fatty acids to obtain a linoleic/linolenic acid ratio of 6 with low erucic acid rapeseed oil, plus high unsaturated fatty acids. We used gas liquid chromatography to assay blood cell membranes and plasma fatty alcohols/plasmalogens. Results: Two SLS infants with proven fatty alcohol/NAD+ oxidoreductase deficiency were studied. Good clinical results were obtained in one of the patients when dietary intervention was started in early infancy and correlated well with plasma fatty alcohol decrease. However, no clinical improvement was seen in the other patient who started later with low compliance. Acitretin therapy was necessary to control skin symptoms in this second patient. Conclusion: Dietary intervention using the combined approach described here may improve fatty alcohol metabolism in SLS. However, only very early intervention seems clinically beneficial.
Therapeutic Efficacy and Safety of One-Week Intermittent Therapy with Itraconazole for Onychomycosis in a Chinese Patient Population
Authors: Wang D.L. , Wang A.P. , Li R.Y. , Wang R.
Published: April 2003

Objective: To evaluate the efficacy and safety of a 1-week intermittent itraconazole dosing schedule for onychomycosis. Methods: In this multicenter, open-label study, 646 patients received itraconazole 200 mg twice daily for 1 week/month, followed by 3 weeks without therapy. Patients with fingernail infections received 2 treatment cycles, patients with toenail or combined toenail and fingernail infections received 3 cycles. Efficacy was evaluated at week 9 (2-month regimen), week 13 (3-month regimen) and 3, 6 or 9 (toenails only) months after completion of therapy. Results: Clinical and mycologic cure rates for fingernails were greater than 90% 6 months after completion of 2 treatment cycles. Clinical and mycologic cure rates for toenails were 84 and 98%, respectively, 9 months after completion of 3 cycles. Treatment was well tolerated; adverse events (mostly mild) occurred in 4.6% of patients. Conclusion: A 1-week intermittent itraconazole dosing regimen is a safe and effective treatment for onychomycosis.
Self-Healing Juvenile Cutaneous Mucinosis
Authors: Aydingöz İ.E. , Candan İ. , Dervent B.
Published: April 2003

Self-healing juvenile cutaneous mucinosis was encountered in a 15-year-old boy who presented with characteristic cutaneous findings and a clinical course of final spontaneous resolution. The interesting point is the presence of numerous nodules found in unusual locations. To date, nodules occurring on the long axis of the extremities have not been reported.
Pseudoxanthoma elasticum: An Update
Authors: Sherer D.W. , Sapadin Allen N. , Lebwohl M.G.
Published: April 2003

Pseudoxanthoma elasticum (PXE) is an inherited disorder of elastic tissue with many systemic manifestations. The disease varies widely in its degree of expression and inheritance patterns and is believed to be considerably underdiagnosed due to lack of familiarity with the condition among physicians. The purpose of this article was to provide an update on important topics in PXE. Common presentations of the disease as well as the histopathology are discussed. The genetics of PXE as well as the importance of early diagnosis and genetic counseling are addressed. Special areas of concern, such as PXE in childhood, are reviewed. Finally, the article concludes with management of the disease and current areas of research.
Carcinogenic Risk of Bath PUVA in Comparison to Oral PUVA Therapy
Authors: Shephard S.E. , Panizzon R.G.
Published: April 2003

The potential carcinogenic risk of bath PUVA therapy was compared to that of systemic (oral) PUVA. An analysis of the epidemiological data on cancer risk following bath PUVA with trimethylpsoralen does not support the conclusion that bath PUVA per se is less carcinogenic than systemic PUVA with 8-methoxypsoralen (8-MOP). Pharmacokinetic studies indicate that both the concentration of 8-MOP in the target organ for PUVA carcinogenicity (skin) at the relevant time point (time point of UVA irradiation) and the extents of biological effects in the skin are comparable following bathwater or systemic 8-MOP administration. Furthermore, the therapeutic effects of PUVA arise from the same photochemical reaction mechanisms as do the carcinogenic effects. Theoretically, the ratio of (desired) cytotoxic versus (undesired) mutagenic effects could increase with increasing efficiency of the PUVA therapy itself. On the basis of the available evidence, it is concluded that all forms of PUVA therapy, independently of the route of 8-MOP administration, contribute to a small but dose-dependent increase in nonmelanoma skin cancer risk.
Excessive Concern with Physical Appearance Leading to a Diagnosis of Adrenal Adenoma
Authors: Granel B. , Serratrice J. , Berbis P. , Rey J. , Denizot A. , Disdier P. , Weiller P.J.
Published: April 2003

We report an unusual case of Cushing’s syndrome manifested by anxiety over body image in a 26-year-old nurse. Initial presentation was a ‘dermatological nondisease’. Clinical signs became increasingly evident during the course of the disease, justifying an adrenal gland evaluation which showed a secreting adrenocortical adenoma. Surgical treatment led to recovery with return to normal appearance and cessation of her aesthetic complaints. Our observation shows that persistent aesthetic complaints may sometimes reveal early hypercorticism.
Interdigital Intertrigo of the Feet due to Therapy-Resistant Fusarium solani
Authors: Romano C. , Presenti L. , Massai L.
Published: April 2003

We report a case of bilateral intertrigo of the third and fourth interdigital spaces of the feet in a 34-year-old immunocompetent Senegalese male. A diagnosis of Fusarium solani infection was made. Systemic and topical therapy with terbinafine led to clinical but not mycological recovery. As this mould is potentially dangerous for immunodepressed subjects, early diagnosis and rigorous follow-up of skin diseases caused by this agent are advisable.
Cryptococcosis during Systemic Glucocorticosteroid Treatment
Authors: Lauerma Antti I. , Jeskanen Leila , Rantanen Tapio , Stubb Sakari , Kariniemi Arja-Leena
Published: April 2003

Cryptococcosis is an opportunistic infection caused by a fungus, Cryptococcus neoformans. It is usually seen in immunocompromised patients with AIDS, leukaemia, lymphoma, sarcoidosis or immunosuppressive treatments. We describe a patient who was treated with systemic glucocorticosteroids for 4 years because of lung sarcoidosis. During the last year of treatment, a papular eruption developed which later became ulcerative. In a histopathological examination of a skin biopsy, there was granulomatous inflammation, and the disease was treated as sarcoidosis without success. After 1 year’s unsuccessful treatment, another skin biopsy and skin fungal culture revealed C. neoformans. Cryptococcal antigen was found in blood and cerebrospinal fluid, too. The patient was successfully treated first with an amphotericin-B-flucytosine combination and later with fluconazole.
Personal UV Dosimetry by Bacillus subtilis Spore Films
Authors: Moehrle Matthias , Garbe Claus
Published: April 2003

Background: Ultraviolet radiation (UVR) is known to be the most important risk factor for melanoma and non-melanoma skin cancers. Until today it has been impossible to measure reliably UVR in the frame of epidemiological studies. The recent development of a spore film containing spores of Bacillus subtilis resulted in a new method of UV measurement by personal dosimetry. Methods: The practical application of dosimeters was tested in 18 study persons under different circumstances of UV exposure and in 4 different geographical regions. Results: Eleven children carried dosimeters on their shoulders for 1 day, playing in- and outdoors on a sunny day in summertime. Their whole-day values ranged from 0.1 to 1.5 minimal erythema doses (MED) per day with a mean of 0.71 MED (±0.44). Four lifeguards in a public swimming-pool carried dosimeters on their shoulders for 11 days and received UV exposures ranging from 3.6 to 9.5 MED (mean 5.9 ± 1.88). Three mountain guides with dosimeters attached to the lateral head in different mountain regions at 23 mountaineering activities received daily exposures of 4.44–17.07 MED (mean 11.9 ± 3.8). Conclusion: B. subtilis spore film dosimeters can be applied to different study persons including children and mountain guides under different climatic conditions. A broad range of UV exposures can reliably be measured with this method.
Generalized Granuloma annulare Associated with Granulomatous Mycosis fungoides
Authors: Wong Wen-Rou , Yang Lih-Jen , Kuo Tseng-tong , Chan Heng-Leong
Published: April 2003

We describe a 68-year-old man with plaque stage mycosis fungoides (MF) for 8 years. He developed tumorous lesions of granulomatous MF (GrMF) and generalized granuloma annulare (GA) after a previously indolent clinical course. Since then, the clinical course was aggressive with involvement of the bone marrow and lymph nodes, and leukemic change occurred. Systemic chemotherapy was given, but the patient died 9 months later due to neutropenic fever and septic shock. GA in malignant lymphoma has been reported most frequently in association with Hodgkin’s disease. To the best of our knowledge, GA associated with GrMF has never been reported in the English language literature. The prognostic significance of the association of granulomatous inflammation and malignancy is reviewed.
From Axioms to New Insights into Dandruff
Authors: Piérard-Franchimont C. , Hermanns J.F. , Degreef H. , Piérard G.E.
Published: April 2003

This review addresses the current concepts about dandruff. The nature, origin and treatments of such skin conditions are scrutinized. The role of Malassezia spp. and other triggering factors is highlighted.
Penicillin G Does Not Alter Collagen Type I Metabolism of Dermal Fibroblasts in Culture
Authors: Anderegg Ulf , Wilczek Agnes , Haustein Uwe-Frithjof
Published: April 2003

Background: Penicillin G (PenG) has successfully been used for therapy of dermal fibrosis in patients suffering from systemic sclerosis (SSc). However, there is little knowledge on the mechanism of the antifibrotic action of PenG. Objective: We studied the effects of PenG on dermal fibroblasts by analysing the influence of various amounts of PenG on the proliferation, synthesis and degradation of collagen by human dermal fibroblasts from healthy donors and 1 SSc patient (collagen high producer). Methods: Collagen metabolism of cultured dermal fibroblasts was studied by Northern hybridisation for mRNA of collagen I, proline-4-hydroxylase, lysyl hydroxylase, matrix metalloproteinase I and determination of collagen content in culture supernatants. Results: PenG did not alter the expression of the investigated mRNA, independently of the dosage and the incubation times used. The amount of collagen I protein was not influenced. Conclusion: There is no evidence of a direct antifibrotic effect of PenG on dermal fibroblasts; therefore, other mechanisms might be responsible for its effect in the treatment of SSc patients.
Blisters on Psoriatic Lesions Treated with TL-01 Lamps
Authors: Calzavara-Pinton P.G. , Zane C. , Candiago E. , Facchetti F.
Published: April 2003

Background: Asymptomatic blisters on psoriatic plaques are an uncommon adverse effect of TL-01 (UVB narrow-band 312 nm) phototherapy. Objective: We report 7 new cases aiming to clarify the pathogenesis. Methods: Blisters were biopsied at different times after onset. Blood porphyrins and antibodies to nuclear antigens and the cell surface of keratinocytes were investigated. Results: We observed 7 asymptomatic blistering eruptions strictly limited to recovering psoriatic plaques. Biopsies taken within 24 h showed junctional detachment and apoptotic necrosis of basal keratinocytes. After 48 and 72 h, the blisters were intraepithelial, due to basal cell regeneration, and were no longer evident at 96 and 120 h. Dermal inflammation was always mild. Direct immunofluorescence tests as well as stainings for p53 protein did not show substantial changes. Blood investigations were negative. Conclusions: TL-01 blisters are caused by the quick reduction of acanthosis and desquamation before defensive mechanisms, i.e. the increase in the thickness of the stratum corneum and pigmentation, develop. However, the pathogenetic mechanisms of apoptosis of keratinocytes remain unknown.
Treatment of Old World Cutaneous Leishmaniasis by Pentamidine Isethionate
Authors: Hellier Isabelle , Dereure Olivier , Tournillac Isabelle , Pratlong Francine , Guillot Bernard , Dedet Jean-Pierre , Guilhou Jean-Jacques
Published: April 2003

Background: Pentavalent antimonial derivatives (PAD), especially meglumine antimoniate (Glucantime®), are usually considered as the first-line drugs for Old World leishmaniasis, but their potential toxicity and the number of required injection, either intralesional or intramuscular, prompt to search for alternative treatments. Objective: To evaluate the efficiency and tolerance of pentamidine isethionate in Old World leishmaniasis. Methods: An open pilot study included 11 patients from two regional academic centers, with varied parasitological forms of Old World leishmaniasis, treated with three strictly intramuscular injections of 4 mg/kg of base-pentamidine every other day. Results: Tolerance was good overal, and 8/11 (73%) of patients responded well with a quick healing of their lesions, little scarring and no relapse. Conclusion: Pentamidine isethionate is a safe and effective first-line treatment for Old World leishmaniasis. Larger-scale prospective studies comparing several dosage regimens of pentamidine and pentamidine isethionate to PAD are warranted.
A Case of Symptomatic Heterozygous Female Fabry’s Disease without Detectable Mutation in the Alpha-Galactosidase Gene
Authors: Handa Yoshihiro , Yotsumoto Shinichi , Isobe Eiichi , Sai Yoshiyuki , Yoshii Noriko , Nakao Shoichiro , Fujita Naoaki , Hamaguchi Satoshi , Kanzaki Tamotsu
Published: April 2003

We report a case of symptomatic heterozygous female Fabry’s disease with low α-galactosidase blood activity. We could not find any mutations in the coding regions of either the signal peptide or the enzyme subunit in our case.
Cutaneous Monomorphous CD4- and CD56-Positive Large-Cell Lymphoma
Authors: Nagatani Tetsuo , Okazawa Hiromi , Kambara Tsuyoshi , Satoh Kasumi , Tokura Hirokazu , Miyazawa Megumi , Yamada Rie , Baba Naoko , Nakajima Hiroshi , Yamazaki Etsuko , Kanamori Heiwa , Mohri Hiroshi
Published: April 2003

Background: Recently, CD56 (NCAM)-positive lymphomas, such as nasal and nasal-type angiocentric NK/T cell lymphoma, aggressive NK cell leukemia/lymphoma and blastic NK cell lymphoma, were described by several authors as a unique group of lymphoma. Objective: In this study, we intend to clarify the clinicopathological features of cutaneous CD4+ and CD56+ lymphoma. Methods: Four patients with cutaneous CD4+ and CD56+ lymphoma were studied. Results: Age at the first examination ranged from 71 to 89 years (mean = 81.2 years). One patient was female and 3 were males. The organ mainly involved at presentation was the skin. Lymphadenopathy, splenomegaly, leukemic spread and central nervous system involvement were observed as the disease progressed. The mean survival time was 12.2 months. Epstein-Barr virus was not detected within the tumor cells. Conclusion: This peculiar lymphoma is different from nasal and nasal-type angiocentric NK/T cell lymphoma and aggressive NK cell leukemia/lymphoma. Similar cases have been reported as blastic NK cell lymphoma/leukemia.
Renal Amyloidosis in Recessive Dystrophic Epidermolysis bullosa
Authors: Kaneko Kazunari , Kakuta Mie , Ohtomo Yoshiyuki , Shimizu Toshiaki , Yamashiro Yuichiro , Ogawa Hideoki , Manabe Motomu
Published: April 2003

Background: Although it is known that renal amyloidosis may complicate several dermatoses, recessive dystrophic epidermolysis bullosa (RDEB) complicated by nephropathy has been thought to be rare. We, however, had seen a young adult with RDEB who died of renal failure due to systemic amyloidosis. Objective: A retrospective study was performed in order to investigate the incidence and etiology of renal amyloidosis in RDEB. Methods: Routine urinalysis, serum amyloid A protein (SAA) and creatinine levels were repeatedly determined in 11 patients with RDEB (mean age 17.7 years, range 5–28, 7 males, 4 females). Nephropathy was defined as the presence of both proteinuria and hematuria with red blood cell casts. Results: Seven out of 9 generalized RDEB patients had nephropathy including 3 cases with end-stage renal disease (2 died within 2 years from the onset of nephropathy), while 2 patients with localized RDEB did not. Levels of SAA were significantly higher in patients with nephropathy than those in patients without nephropathy (p < 0.05). Conclusion: Nephropathy is a common and serious complication of RDEB. Renal amyloidosis may play an important role in its etiology. We recommend that patients with RDEB should be periodically screened for nephropathy due to amyloidosis by urinalysis and measuring SAA levels.
Three Cases of Pityriasis rubra pilaris Successfully Treated with Cyclosporin A
Authors: Usuki Kazunari , Sekiyama Mitsuhiro , Shimada Tokihiko , Shimada Shoko , Kanzaki Tamotsu
Published: April 2003

Background: Pityriasis rubra pilaris (PRP) is reported to respond poorly to cyclosporin A (CsA). Objective: We attempted to determine the efficacy of CsA in the treatment of classic adult-type PRP. Methods: Three patients with classic adult-type PRP were treated with 5 mg/kg/day CsA. Results: A sustained clinical response was achieved within 2–4 weeks of therapy. Relapses were noted when the CsA dose was decreased to 1.2 mg/kg/day. Conclusion: CsA should be considered in the treatment of classical adult-type PRP.
Topical Colchicine Therapy for Actinic Keratoses
Authors: Grimaître M. , Etienne A. , Fathi M. , Piletta P.-A. , Saurat J.-H.
Published: April 2003

Background: The beneficial effect of topical colchicine therapy for actinic keratoses has already been described in 1968. Objective: To confirm that the application of a 1% colchicine gel is a safe and effective treatment for actinic keratoses. Methods: Twenty patients were included in a double-blinded protocol. They all had actinic keratoses on the scalp, most of which had been previously treated with 5-fluorouracil or cryotherapy. Ten patients applied twice daily on the forehead a hydrophilic gel (placebo group), while the other 10 where treated with the same gel containing 1% of colchicine (colchicine group). Erythema and efficacy were evaluated at each control on days 7, 30 and 60, with repetitive blood tests to exclude a possible systemic absorption. Results: A complete healing of the solar keratoses was observed in 7 out of the 10 patients treated with 1% colchicine gel; these showed no recurrence after 2 months of follow-up. Burning and itching occurred only in the colchicine group after 2 or 3 days of application, with an inflammatory reaction on the areas where the gel was applied, while pustules and crusts were located specifically on the actinic keratoses. Repeated blood controls showed that there was no systemic absorption. Conclusions: This double-blind placebo-controlled study confirms the activity of colchicine for the treatment of actinic keratosis. A comparison with other topical treatments in terms of efficacy and practicability is needed.
The Dąbska Tumor: A Thirty-Year Retrospect
Authors: Schwartz R.A. , Dabski C. , Dąbska M.
Published: April 2003

The Dąbska tumor is a rare low-grade angiosarcoma also known as malignant endovascular papillary angioendothelioma of childhood. It primarily affects the skin of children and has a distinctive histologic pattern of anastomosing vascular channels with intravascular papillary outpouchings projecting, sometimes, in a glomerulus-like pattern, into a lumen lined by atypical columnar endothelial cells. Since its original description 30 years ago by one of us, knowledge in this area has expanded.
No Correlation of Tyrosinase mRNA in Bone Marrow with Prognosis of Metastatic Melanoma
Authors: Waldmann Volker , Wacker Jörg , Deichmann Martin , Näher Helmut
Published: April 2003

Background: Recent publications suggest that tyrosinase mRNA in blood as well as in bone marrow is detectable only in a subgroup of patients with metastatic melanoma. Objective: We addressed the question, whether patients with metastatic melanoma and with RT-PCR-detectable tyrosinase mRNA in blood or bone marrow have a different prognosis compared to tyrosinase mRNA-negative patients. Methods: 20 melanoma patients with widespread clinical metastases were enrolled and the survival time after first diagnosis of visceral metastases was correlated to tyrosinase mRNA presence in blood and bone marrow samples. Results: The time of survival of 8 patients with metastatic melanoma and detectable tyrosinase mRNA in either blood or bone marrow was not different from the prognosis of 12 patients without detectable tyrosinase mRNA in either blood or bone marrow. Conclusion: Although based on a limited number of patients our results suggest that detection of tyrosinase mRNA in blood or bone marrow samples of melanoma patients with advanced disease seems to have no substantial relevance for survival time and outcome of disease. For this purpose, detection of tyrosinase mRNA by RT-PCR is not a valid tumor marker. Nevertheless, tyrosinase positivity in bone marrow in earlier tumor stages might indicate increased risk for the development of distant metastases. This should be addressed in further studies.
Occupational Skin Injury by Hydrogen Peroxide
Authors: Izu Kunio , Yamamoto Osamu , Asahi Masakazu
Published: April 2003

Hydrogen peroxide is widely used in products such as rocket fuel, bleaching preparations and topical disinfectants. Contact of hydrogen peroxide with the skin can cause severe skin damage. In this report, we describe a case of skin injury induced by hydrogen peroxide. The patient was a 34-year-old man working in a dry cleaning shop. While he was pouring 35% hydrogen peroxide, some of it accidentally splashed over his left shoulder and back, and then an erythema, purpura and vacuolar eruption, similar to bubble wrap, appeared on his left shoulder and down the left side of his back. Histologically, numerous vacuolar structures were observed in the epidermis, dermis and subcutaneous tissue. Coupled with the clinical features, these vacuolar structures were considered as ‘oxygen bubbles’. Subcutaneous emphysema was detected by chest X-ray examination. All skin eruptions rapidly healed without scarring by using a steroid ointment. As far as we know, this is the first time such clinical and histological features have been described
Pemphigus foliaceus Induced by Exposure to Sunlight
Authors: Kano Yoko , Shimosegawa Masako , Mizukawa Yoshiko , Shiohara Tetsuo
Published: April 2003

Background: Although there are many reports on photo-induced pemphigus, careful analysis in the development of acantholytic blister have rarely been performed in the lesions induced by photochallenge. Objective: The study was intended to elucidate the mechanisms by which ultraviolet light (UV) radiation causes the skin lesions of pemphigus foliaceus. Methods: Photochallenge-induced lesions were examined histologically and immunohistochemically over the time course with three biopsy specimens. Neutrophil adhesion assay was performed using the specimens prepared from the photochallenged lesions as substrates. Results: A small number of neutrophils were seen at 5 h after photochallenge in the dermis and epidermis, and slight acantholysis was detected at 72 h. In neutrophil adhesion assay, greater numbers of neutrophils adhered to the upper epidermis of the skin obtained at 5 h after challenge. Conclusions: Our results suggest that both enhanced binding of autoantibodies to the epidermis after UV radiation and preferential adhesion of neutrophils to the UV-irradiated epidermis contribute to the development of acantholysis in photo- induced pemphigus foliaceus. Intercellular adhesion molecule-1 (ICAM-1) expression on keratinocytes is not primarily responsible for the epidermal migration of neutrophils.
Lack of TP53 Mutations in a Case of Porokeratosis palmaris, plantaris et disseminata
Authors: Özkan Şebnem , Fetil Emel , Aydoğan Turna , Atabey Neşe , Erkizan Verda , Pabuçcuoğlu Uğur , Güneş Ali Tahsin
Published: April 2003

A 73-year-old man with porokeratosis palmaris, plantaris et disseminata is presented. He had punctate, guttate and annular hyperkeratotic papular lesions widespread on his body with thorn-like hyperkeratosis on the palms and soles. Lesional skin did not show mutations of TP53 exons 5–6, 7, 8.
Two Cases of Kimura’s Disease with Unusual Clinical Manifestations
Authors: Lee Jeong Heon , Park Hyang Joon , Kim You Chan , Cinn Yong Woo
Published: April 2003

We report 2 cases of Kimura’s disease with unusual clinical presentation. Lesions were itching nodules located at the elbow and the dorsum of the hand, and were associated with unusual laboratory values. These features may lead to problems in clinical differential diagnosis.
Novel Unconventional Therapeutic Approaches to Atopic Eczema
Authors: Worm Margitta , Henz Beate M.
Published: April 2003

Atopic eczema is a chronic, recurrent, multifactorial skin disease, and, accordingly, there are numerous therapeutic options for its symptomatic treatment. Conventional medications are however often unsatisfactory for many patients because of adverse effects on long-term use. For this reason, patients often readily welcome unconventional therapeutic approaches. We present here a selected number of such treatment modalities, namely γ-linolenic acid, Chinese herbal tea, diets eliminating allergens, pseudoallergens, metal salts and sodium, and bioresonance. When stringent scientific criteria are applied in the evaluation of such study results, none of the reviewed alternative treatments provides unequivocal, convincing evidence of its efficacy, even when double-blind, placebo-controlled studies are available. With Chinese herbal tea, potentially serious adverse effects should be considered as well. Any new type of unconventional therapy should thus be thoroughly evaluated and shown to be equal or superior to conventional treatments with regard to both efficacy and tolerability before it is recommended for use in clinical practice.
Frequency and Spectrum of HPV Types Detected in Cutaneous Squamous-Cell Carcinomas Depend on the HPV Detection System: A Comparison of Four PCR Assays
Authors: Meyer Thomas , Arndt Rüdiger , Christophers Enno , Stockfleth Eggert
Published: April 2003

Background: The association of human papillomavirus (HPV) with cutaneous squamous-cell carcinomas (SCCs) has been described recently, but the frequency and spectrum of HPV types identified differed substantially in distinct studies. Objective: Comparison of different PCR assays with respect to sensitivity and range of HPV types detected. Method: Cutaneous SCC were analyzed for HPV DNA using both consensus PCR assays with degenerate primers and PCR assays with nondegenerate primers derived from HPV types 5 and 8. Results: HPV DNA was found in 50% of SCC specimens using degenerate primers. The rate of HPV-DNA-positive specimens increased to 69% when PCR assays with nondegenerate primers were applied in addition. The spectrum of HPV types detected with each of the PCR assays differed considerably. Conclusions: The frequency and spectrum of HPV types detected in cutaneous SCC strongly depends on the HPV detection system used and urges the need for standardization of HPV detection and typing in skin lesions in order to characterize HPV types predominating in distinct tumors.
Truncal Vagotomy, Antrectomy and Roux-en-Y Gastrojejunostomy in the Treatment of Duodenogastric Reflux Disease
Authors: Civello Ignazio Massimo , Brisinda Giuseppe , Palermo Alessandra , Agresti Maria , Minelli Stefano , Sganga Gabriele , Maria Giorgio
Published: April 2003

Background/Aims: The surgical treatment of duodenogastric reflux (DGR), resistant to medical therapy, in patients with intact stomach is difficult to standardize. The aim of this study is to present our experience on 5 patients, all cholecystectomized, with severe DGR disease treated surgically. Methods: Out of a group of 223 patients suffering from nonulcerous dispeptic pathology presenting to our department, we selected 5 patients suffering from alkaline reflux gastritis in intact stomach. The diagnosis of primary DGR was made using Wilson’s criteria. The surgical procedure adopted consisted of a truncal vagotomy, antrectomy, and a Roux-en-Y gastrojejunostomy. Results: No perioperative mortality was observed. Twelve months after surgery all patients expressed satisfaction with the result of the operation and complained of no severe disturbances. A sense of postprandial fullness with a sense of pain in the left shoulder persisted in one case only, requiring the consumption of small and frequent meals. Radiological examination of the upper gastrointestinal tract of these patients showed notably delayed emptying of the gastric stump, while the endoscopic picture was completely normal. Conclusion: The antrectomy and Roux-en-Y gastrojejunostomy is a better known operation, easily executed, and has the advantage that it can be performed on patients previously operated on for gastric resection and therefore suffering from secondary reflux. It also has the advantage of removing the gastric antrum where mucous atrophy is more frequent and is susceptible to neoplastic degeneration. However, at the present time the choice between different types of operation depends exclusively on the personal conviction and experience of the surgeon.
Intestinal Leiomyosarcoma as the Cause of Severe Hemoperitoneum
Authors: Reina Angel J. , Fuentes Orlando , García Ana , González Cristina , Sánchez Belén , López-Cantarero Manuel , Bravo Francisco , Torné Pablo
Published: April 2003

Leiomyosarcomas represent 10–20% of malignant tumors in the small bowel and 1% of those located in the large bowel. These tumors have aspecific symptoms depending on their size, location and histology. Intestinal leiomyosarcomas may be the cause of numerous types of surgical emergency. We report 2 cases of intestinal leiomyosarcoma in the jejunum and transverse colon. Both were diagnosed during an emergency exploratory celiotomy. The clinical features on admission were similar to those of acute abdomen. The main cause of surgical emergency was an extremely rare complication of gastrointestinal leiomyosarcoma: a severe hemoperitoneum. We briefly describe the surgical emergencies caused by intestinal leiomyosarcomas as well as the surgical methods employed in these cases.
Laparoscopic Partial Hepatectomy in the Rat: A New Resectional Technique
Authors: Krähenbühl Lukas , Feodorovici Michael , Renzulli Pietro , Schäfer Markus , Abou-Shady Mohamed , Baer Hans U.
Published: April 2003

Background: Rats are widely used for basic research in laparoscopic surgery. We have developed a new technique of laparoscopic partial hepatectomy in the rat. Methods: 40 American Cancer Institute rats were randomized into 3 groups. Group A (n = 14) underwent laparoscopic liver resection using a CO2 pneumoperitoneum. Group B (n = 14) was operated on with a gasless laparoscopic technique using a lifting device. A control group C (n = 12) underwent conventional open liver resection. In each group half of the animals underwent single lobectomy and the other half bilobectomy. Results: The liver resection was performed successfully in all 40 rats. No conversion to open surgery was necessary. No mortality or morbidity was observed. Conclusions: This new technique of laparoscopic partial hepatectomy proved to be feasible and safe. It is the first description of a laparoscopic hepatic resection in the rat that could prove valuable in further investigations of liver physiology and pathology.
Impact of Early Operation on the Mortality from Bleeding Peptic Ulcer – Ten Years’ Experience
Authors: Imhof M. , Schröders C. , Ohmann C. , Röher H.-D.
Published: April 2003

In 1984, a risk-dependent combined endoscopic and operative approach for the treatment of bleeding peptic ulcer was developed. This treatment policy has as its major feature an early elective operation in patients with arterial bleeding and a visible vessel, providing that endoscopic control of the bleeding could be achieved. Using this concept in a prospective series resulted in a mortality of 5% compared to a mortality of 14% in a historical control group, where an operation was performed only on demand in case of recurrent bleeding. In 1986, the treatment policy was introduced into clinical routine circumstances at the University Hospital of Düsseldorf. In this paper the results of routine clinical application are presented. The treatment policy was followed in 47% of patients treated respectively primarily transferred to the surgical department. Mortality in arterial bleeding and visible vessel in the conservatively treated group was double the mortality in the early elective operated group (14 vs. 7%). The mortality in patients treated primarily in the department of internal medicine was double the mortality of patients treated at the surgical department (18 vs. 9%). The differences in mortality are mainly due to the procedure in the elderly patients. In patients aged 70 years or more, the mortality rate of patients treated in internal medicine was 31% compared to 16% in the surgery department. Younger patients do not seem to benefit from early elective operation. Our study clearly demonstrates the importance of avoiding late recurrent bleeding. Patients at high risk of this complication should therefore be identified as early as possible and early surgical intervention should be considered by agreed interdisciplinary and evaluated treatment concepts.
Spontaneous Perforation of the Hepatic Duct in Adults
Authors: Paladugu Ramesh , Rau Anjan , Schein Moshe , Wise Leslie
Published: April 2003

Background: Nontraumatic perforations of the extrahepatic biliary ductal system are a rare albeit recognized occurrence in the cystic duct, choledochus and main hepatic duct; the latter appears to be the rarest. Methods: Recent experience with such a case prompted a thorough review of 26 similar cases previously reported. Results: It appears that obstruction of the biliary tract by gallstones results in raised intraductal pressure leading to dilatation of the biliary tree, subsequent stasis and infection, causing ascending cholangitis and thrombosis of intramural vessels, leading to necrosis and perforation of the duct wall. Most patients present with an acute abdomen and are operated upon. Conclusions: The goals of operation, which should be tailored to the individual patient, are to stop the bile leak, cure choledocholithiasis and cholangitis and reconstruct the bile duct.
A Comparison of Stapled and Hand-Sewn Anastomoses in Crohn’s Disease
Authors: Kusunoki Masato , Ikeuchi Hiroki , Yanagi Hidenori , Shoji Yasutsugu , Yamamura Takehira
Published: April 2003

Sixty-eight patients with Crohn’s disease who underwent intestinal resection were randomly divided into 2 groups: the stapled group (32 patients, 40 anastomoses) with functional end-to-end anastomoses made with linear staplers and with circular stapling anastomoses, and the hand-sewn group (36 patients, 48 anastomoses), with anastomoses achieved by layer-to-layer suturing. There were no significant differences in operative indications, age, sex, blood loss, or length of hospital stay between the groups. The operation times for right hemicolectomy and total colectomy in the stapled group were significantly shorter than those in the hand-sewn group. There were no significant differences in anastomotic dehiscence or recurrence between the stapling and hand-sewn procedures. These results indicate that these stapling techniques, even though producing an everted anastomosis, are not an adverse procedure for Crohn’s disease.
Pseudomyxoma peritonei:Sudden Cardiac Death Complicating Post operative Intraperitoneal Treatment with 5-Fluorouracil
Authors: El-Attar Ayman F. , Skeel Roland T. , Howard John M.
Published: April 2003

Background: Pseudomyxoma peritonei, a tumor which spreads chiefly along peritoneal surfaces, has recently been treated by resection followed by intraperitoneal infusion of 5-fluorouracil (5-FU). Reports on the cardiotoxicity of this drug, given intravenously, indicate an incidence of 1.4–2.9%. Although several deaths have been reported following 5-FU therapy by continuous intravenous infusion, none has apparently been reported following bolus intravenous injection. Method: Radical resection of an extensive pseudomyxoma peritonei was performed. Following convalescence, intraperitoneal infusion of 5-FU was initiated in a daily dose of 20 mg/kg body weight (1,440 mg), planned for administration in multiple 5-day cycles. Results: After three uneventful daily infusions of 5-FU, the patient suddenly died, apparently of a sudden cardiac event. Autopsy provided no explanation for his death. The coronary arteries were free of disease and no residual tumor was found. A review of the literature reveals no report of a cardiac death from 5-FU following its intraperitoneal administration. Conclusions: The fatality suggests the potential toxicity of 5- FU when administered intraperitoneally, a factor to be considered in decisions to use this drug intraperitoneally.
Duodenal Leiomyosarcoma
Authors: Petralia G.A. , Hansen P.D. , Bowyer R.C. , Williamson R.C.N.
Published: April 2003

Malignant stromal tumours of the duodenum are rare. The efficacy of surgical resection for duodenal leiomyosarcoma was assessed in 5 patients treated over an 11-year period, probably the largest series treated by a single surgeon. There were 3 women and 2 men with an age range of 27–52 years. Tumours were large (8.5–21 cm diameter) and partly cystic (4 cases). They arose from the second (2), third (2) and fourth parts of the duodenum. Resection was a major undertaking and comprised either partial duodenectomy (n = 4) or Whipple resection. Two patients required a right hemicolectomy in addition. Two patients with positive resection margins had adjuvant radiotherapy. Operative time ranged from 4.0 to 6.25 h and blood loss from 1.8 to 4.5 litres. Two patients developed complications: a transient low-output biliary fistula and an infected haematoma requiring percutaneous drainage. The 2 patients with incomplete resection died of recurrent disease at 3 and 15 months. The 3 survivors are free of disease at 24, 60 and 66 months. The results support a policy of aggressive resection despite the technical difficulties posed by these large and vascular tumours.
Arterial Ring Encircling the Bile Duct with Coexisting Anomalous Liver Irrigation
Authors: Dušanović Aleksandar M. , Ignjatović Dejan M. , Knežević Paja A. , Todorović Milorad , Krgović Ksenija Lj. , Filipović Branislav R.
Published: April 2003

Analysis of the arterial system of the liver in a 64-year-old male cadaver revealed an anomaly of the branching of the proper hepatic artery. The right branch of the hepatic artery was missing, replaced by two segmental arteries, so that a ‘trifurcation’ occurred, consisting of two segmental arteries, anterior segmental and posterior segmental, and the left branch of the hepatic artery. These segmental arteries formed an arterial ring around the common hepatic duct, completely encircling it. A single cystic artery unusually originated from the posterior segmental artery. An extremely rare anatomical variation of the dorsal liver segment irrigation proves the fact that anatomical anomalies are usually multiple. The arterial blood supply for the dorsal liver segment is through four separate vessels (‘quadruple type’), two originating from the left branch of the hepatic artery and two from the posterior segmental artery. These four arteries presented numerous anastomotic bridges among themselves.
Adjustable Silicone Gastric Banding: Can We Continue the Original Technique of Kuzmak?
Authors: van Eerten P.V.van , Hunfeld M.A.J.M. , Tuinebreijer W.E. , Cuesta M.A.
Published: April 2003

Background: Kuzmak developed a horizontal gastroplasty for morbid obesity using his adjustable silicone gastric banding (ASGB). The aim of this study was to evaluate the efficiency at weight loss, early and late morbidity and mortality. Method: The records of 44 patients (mean age 36 years) were reviewed. The indication for ASGB was a BMI >40 (group A = 37 patients) or a BMI between 35 and 40 with obesity-related morbidity (group B = 7 patients). The mean preoperative BMI was 44 (±5). The paired t test was used to evaluate the BMI. Results. Early complications occurred in 5 patients: splenic injury (n = 1), aspiration pneumonia (n = 1), wound infection (n = 1), gastric perforation (n = 2); mortality was 2%. Late complications occurred in 19 patients: 17 patients (39%) had a functional stenosis with pouch dilatation (FSPD) and 6 patients had an injection port leakage (14%). At the 1-year follow-up, the mean BMI (of the 39 patients available) was 30 (±5) and remained stable. At 36 months, 54% of group A and 100% of group B had a BMI <30. Conclusion: The original technique of Kuzmak is effective to lose weight. However the technique must be adjusted in order to decrease the unacceptable high incidence of FSPD.