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Biomedical subjects

D Metze

Publications and source records attributed to D Metze.

At least 55 records · Page 3Linked to original sources
PubMed2000

[Hydroxyethyl starch accumulation in the skin with special reference to hydroxyethyl starch-associated pruritus].

BACKGROUND AND OBJECTIVE: Hydroxyethyl starch (HES) is a colloidal infusion fluid that has for a long time been used in emergency situations and to improve impaired blood perfusion. In the last few years there have been numerous reports about treatment resistant pruritus, often persisting for months, after HES infusion. We investigated the intracellular uptake of HES in the skin, special attention being focused on associated pruritus. PATIENTS AND METHODS: Skin biopsies were obtained from 120 patients (120 men, 35 women) and examined immunohistochemically and for their ultrastructure. Three patients had received various HES preparations, while 22 had been given dextran. Five patients who had received no infusions served as controls. RESULTS: All patients given HES had lysosomal deposits in the histiocytes, some of them also in cutaneous epithelium and endothelium. The extent of lysosomal storage correlated with the amount of infused HES and the interval between biopsy and last HES infusion. Consecutive biopsies in some cases demonstrated a definite decrease over the years of HES deposits in the vacuoles. This suggests that HES is regularly metabolized in the skin. Pruritus after high cumulative doses of HES was closely correlated with HES deposition in cutaneous nerves. CONCLUSIONS: These results emphasize the need for starch derivatives that can be better metabolized and for better adapted infusion schedules to reduce the high incidence of pruritus.

Adolescent↗
PubMed2000

[Hyperkeratosis lenticularis perstans (Flegel's disease) - a complex disorder of epidermal differentiation with good response to a synthetic vitamin D3 derivate].

Hyperkeratosis lenticularis perstans (Flegel's disease) is a rare but clinically and histologically highly characteristic genodermatosis. We report on new immunohistochemical and ultrastructural findings suggesting a complex disorder of epidermal differentiation. In this context, a good response to calcipotriol, a synthetic vitamin D3 derivative is of particular interest.

Aged↗
PubMed2000

[Topical administration of capsaicin in dermatology for treatment of itching and pain].

BACKGROUND AND OBJECTIVES: Treatment of pruritus as observed in many dermatological and internal diseases may be very often disappointing. There are many reports describing the topical use of capsaicin, the pungent agent in red pepper. Long term administration of capsaicin depletes neuropeptides in unmyelinated, polymodal C-type and small myelinated A delta-type cutaneous nerves that conduct pruritus and pain. PATIENTS/METHODS: The aim of this study was to evaluate the efficacy, safety and practicability of capsaicin in the treatment of pruritus and pain of different origin in a total of 40 patients. RESULTS: Capsaicin suppressed completely itch in all patients. CONCLUSIONS: In addition to its excellent antipruritic and analgetic effect, capsaicin significantly contributed to healing of some dermatoses, such as prurigo nodularis and psoriasis.

Administration, Topical↗
PubMed2000

[Specific skin infiltration of extracutaneous B-cell lymphoma in healing herpes simplex skin].

Both herpes simplex and herpes zoster are not uncommon in patients affected by malignant lymphoma or leukemia. Of particular interest, the herpetic lesions may be followed by specific cutaneous infiltrates. We report on a patient with a centrocytic-centroblastic non-Hodgkin lymphoma who showed primary skin infiltrates within the area affected by herpes simplex. After effective therapy with aciclovir, papules and plaques developed at the site of the herpetic scars. Histologic investigation confirmed dense B-lymphocytic infiltrates with immunoglobulin light chain restriction and a granulomatous reaction. Although the chemotherapeutical regiment was modified, the patient died one month later of a lethal blast crisis. The occurrence of so called isotopic skin reactions and their prognostic significance is discussed.

Blast Crisis↗
PubMed2000

[Unilateral eyelid swelling as an initial manifestation of angiosarcoma].

Cutaneous angiosarcomas mainly arise on the scalp and face of older patients. They present with reddish nodules or plaques and tend to bleed and ulcerate. Angiosarcomas show an aggressive and recurrent course and have a high potential for metastasis. We report on a 48-year-old patient with unilateral eyelid edema as the first manifestation of an angiosarcoma. The clinical presentation, the history of contact allergy, the presence of antinuclear antibodies, and abnormal thyroid function tests favoured a non-neoplastic disease. However, multiple biopsies confirmed the diagnosis of a highly differentiated angiosarcoma. Staging of the patient revealed no metastasis. After radical surgery including orbital exenteration and postoperative radiation therapy, no recurrence was observed with a follow up of 26 months. This case underlines the importance of including angiosarcoma in the differential diagnosis of unilateral eyelid edema.

Biopsy↗
PubMed2000

[Control of section margins without any gaps in paraffin sections of melanoma of the face].

BACKGROUND AND OBJECTIVE: Malignant melanomas on sun-exposed skin are often poorly circumscribed and thus recur frequently. The aim of our clinical trial was to compare conventional to a modified micrographic surgery of primary melanoma. PATIENTS/METHODS: 28 patients with in-situ (n = 7) and invasive (n = 21) melanoma were treated with conventional surgical excision with wide margins; eight of these patients developed a local recurrence. In comparison, 20 patients with primary in-situ (n = 7) and invasive (n = 13) melanoma as well as four patients with recurrence after conventional surgery underwent modified micrographic surgery with delayed closure of the wound. RESULTS: Paraffin specimens of the margins revealed in half of the patients remnants of melanoma although excision was extended to non-lesional skin. Within a mean follow-up period of 21.3 months, none of our patients treated by modified surgery developed a recurrence. CONCLUSIONS: Local recurrencies of melanoma on sun exposed skin may be avoided by means of a modified micrographic surgery using permanent histologic sections.

Adult↗
PubMed1999

Reduced ultraviolet-induced carcinogenesis in mice with a functional disruption in B7-mediated costimulation.

Immunosuppression by UV light contributes significantly to the induction of skin cancer by suppressing the cell-mediated immune responses which control the development of carcinogenesis. The B7/CD28-CTLA-4 signaling pathway provides costimulatory signals essential for Ag-specific T cell activation. To investigate the role of this pathway in photocarcinogenesis, we utilized transgenic (Tg) mice which constitutively express CTLA-4Ig, a high-affinity CD28/CTLA-4 antagonist that binds to both B7-1 and B7-2. The transgene is driven by a skin-specific promoter yielding high levels of CTLA-4Ig in the skin and serum. Chronic UV exposure of CTLA-4Ig Tg mice resulted in significantly reduced numbers of skin tumors, when compared to control mice. In addition, Tg mice were resistant to UV-induced suppression of delayed-type hypersensitivity responses to alloantigens. Most importantly, upon stimulation with mitogens and alloantigens, T cells isolated from CTLA-4Ig Tg mice produced significantly less IL-4 but more IFN-gamma compared to control T cells, suggesting an impaired Th2 response and a relative increase of Th1-type immunity. Together, these data show that overall B7 engagement directs immune responses toward the Th2 pathway. Moreover, they point out the crucial role of Th1 immune reactions in the protection against photocarcinogenesis.

Abatacept↗
PubMed1999

Irradiation induces increase of adhesion molecules and accumulation of beta2-integrin-expressing cells in humans.

PURPOSE: The purpose of our investigation was to describe the dose- and time-dependent histomorphologic alterations of the irradiated tissue, the composition of the infiltrate, and the expression patterns of various adhesion molecules. METHODS AND MATERIALS: We analyzed immunohistochemically alterations in oral mucosa in 13 head and neck cancer patients before radiotherapy and with 30 Gy and 60 Gy. All had oral mucosa irradiation, with a final dose of 60 Gy using conventional fractionation. Snap-frozen specimens were stained using the indirect immunperoxidase technique. Histomorphology was studied in paraffin-embedded sections. In addition, we determined the clinical degree of oral mucositis. RESULTS: Histomorphologic evaluation showed no vascular damage. Irradiation caused a steep increase of beta2-integrin-bearing cells (p < 0.01), whereas the percentage of beta1-integrin-positive cells remained at low levels. Additionally we found an increase in the expression of endothelial intercellular adhesion molecule-1 (ICAM-1) (p < 0.01) and E-selectin (p < 0.05), while endothelial vascular cell adhesion molecule-1 (VCAM-1) expression remained at very low levels. CONCLUSION: Our findings indicate that in radiation-induced oral mucositis there is no marked vascular damage until the end of radiotherapy. For recruitment of leukocytes, beta2 is more involved than beta1. Pharmaceuticals that block leukocyte adhesion to E-selectin or ICAM-1 may prevent radiation-mediated inflammation in oral mucosa.

Aged↗
PubMed1999

[Proliferating trichilemmal cyst with focal segments of metastatic squamous epithelial carcinoma].

A large ulcerated tumor covered the right hemisphere of the scalp of a 77 year old woman. By histological, immunohistological, and electronmicroscopical examination, a proliferating trichilemmal cyst with focal areas of a poorly differentiated squamous cell carcinoma was identified. Six months after extirpation of the entire tumor and dissection of supraomohyoidal lymph nodes, metastases in nuchal and supraclavicular lymph nodes and soft tissue of the neck became apparent. The present case underlines the necessity of a preoperative diagnostic evaluation and of radical surgical treatment for proliferating trichilemmal cysts.

Aged↗
PubMed1999

[Cutaneous myiasis--a vacation souvenir].

Cutaneous myiasis is a temporary infestation of the skin with fly larvae. Travelling to subtropical areas accounts for a higher risk and increasing incidence in Europeans. In Middle- and South American myiasis is mainly caused by the botfly (Dermatobia hominis). Blood-suckling arthropods, usually mosquitoes, transmit the larvae of the botfly via phoresis, a unique mechanism of egg deposition. In Africa cutaneous myiasis is mostly due to the tumbu fly (Cordylobia anthropophaga). Infection with the tumbu fly larvae occurs after direct contact with the eggs that are often deposited in clothes and towels. Clinically an abscess-like lesion develops. Creeping sensations of movement under the skin are occasionally described. Following hatching, spontaneous healing can normally be expected, although extraction of the larvae is recommended to prevent abscess formation and superinfection.

Adult↗
PubMed1999

[Embolia cutis medicamentosa (Nicolau syndrome) after intra-articular injection].

Embolia cutis medicamentosa (Nicolau Syndrome) is a very rare complication of intramuscular injections which presents with extensive necrosis of the injected skin area. Intra-arteria and/or para-arterial injections after prior perforation of certain vessels are discussed as possible pathogenetic mechanisms. We describe the occurrence of embolia cutis medicamentosa after intra-articular injections into the knee.

Anti-Inflammatory Agents↗
PubMed1999

[Localized reticulate hyperpigmentation].

34 year-old pregnant woman presented with reticulate pigmentation of the flexures, the dorsum of the hands and the genitoperianal region. She was in good health and her family history was unremarkable. Histologic examination of the hyperpigmented patches revealed pigmented filiform downgrowths of the interfollicular epidermis and follicular infundibula, as well as small epithelial cysts. Upon immunohistochemical and ultrastructural studies, the number of melanocytes appeared normal. The elongated dendritic processes of the melanocytes contained many mature melanosomes. In the adjacent keratinocytes large melanosomes did not aggregate into complexes. The diagnosis of localized reticulate pigmentary disorder was established. The knowledge of the broad clinical spectrum of localized reticulate hyperpigmentations with its favorable prognosis is of practical importance. Genital or flexural pigmented lesions have to be differentiated from melanosis of the vulva or acanthosis nigricans. The presented case gives further evidence that many of the proposed entities characterized clinically by reticulate pigmented macules and hyperkeratotic follicular lesions are different phenotypic expressions of the same autosomal dominant genodermatosis.

Adult↗
PubMed1999

[Acanthosis nigricans associated with transitional cell carcinoma of the bladder--symptomatic treatment with calcipotriol].

Acanthosis nigricans is a hyperkeratotic mucocutaneous eruption of heterogenous etiology which is characterized by hyperpigmentation, velvety cutaneous thickening, intensified skin markings and development of verrucous excrescences typically involving the intertriginous areas. Malignant acanthosis nigricans is most often associated with an abdominal adenocarcinoma frequently unresectable at the time of diagnosis. We report on the rare association of acanthosis nigricans with a transitional cell carcinoma of the urinary bladder. Symptomatic treatment with topical calcipotriol significantly reduced the hyperkeratotic and papillomatous skin changes.

Acanthosis Nigricans↗
PubMed1999

[Buschke adult scleroderma as a rare differential stiff-man syndrome diagnosis].

Stiff-man syndrome is a rare disorder of the central nervous system characterized by muscular rigidity and superimposed spasms. The etiology is still unknown and an autoimmune cause is discussed. Many differential diagnoses of muscular rigidity and of induration of the skin have to be considered. A 22 year old patient was admitted under suspicion of a stiff-man syndrome. He has had developed a painful rigidity of the trunk, starting in the neck. Massive stiffness of the trunk with pale appearance of the skin and a beginning disorder of swallowing and respiration were observed. Clinical investigation, EMG, cerebrospinal fluid and laboratory findings were all normal, thus excluding a stiff-man syndrome and other neuromuscular diseases. Skin biopsy showed typical changes of Buschke's scleredema adultorum, a rare connective tissue disorder of unknown etiology. Therapy with corticosteroide and ciclosporin led to a mild improvement of symptoms. Although rare, Buschke's scleredema adultorum should be regarded as a differential diagnosis of the stiff man syndrome.

Adult↗
PubMed1999

Reactive angioendotheliomatosis or intravascular histiocytosis? An immunohistochemical and ultrastructural study in two cases of intravascular histiocytic cell proliferation.

Two elderly women with complex medical histories presented with erythematous patches, in one case involving the face and forearms, and in the other both elbows. Punch biopsies from both patients revealed intravascular proliferations of medium-sized and large cells with luminal occlusion typical of angioendotheliomatosis. Immunostaining did not show either lymphocytic or endothelial cell antigens but was consistent with a histiocytic differentiation of the intravascular cells in both cases, and was further substantiated by ultrastructural examination in one case. One patient received a course of cyclophosphamide therapy over 15 days. Skin lesions faded but did not disappear. The patient died 10 months later from cardiac and renal failure, which was most probably unrelated to the skin lesions. In the other case, lesions diminished but did not entirely resolve with treatment with low doses of oral prednisone. Angioendotheliomatosis can be divided into a malignant variant, which is an angiotropic lymphoma mostly of B-cell phenotype, and a benign, reactive variant, which is characterized by a proliferation of cells expressing endothelial cell markers. Only one case of angioendotheliomatosis with cells of histiocytic differentiation has been published previously under the name of intravascular histiocytosis. Our cases are very similar to the latter. The question arises as to whether intravascular histiocytic cell proliferation is a neoplastic proliferation of histiocytes or an early stage of classic reactive angioendotheliomatosis representing the residual cells associated with organization of microthrombi, which will be later followed by endothelial cell proliferation.

Aged↗
PubMed1999

Lipodystrophia centrifugalis abdominalis infantilis in a 4-year-old Caucasian girl: association with partial IgA deficiency and autoantibodies.

We report the third case of lipodystrophia centrifugalis abdominalis outside East Asia. A 4-year-old Caucasian girl developed an area of bluish erythema on the left side of the lower abdomen which spread centrifugally to the umbilical and inguinal areas with depression of the skin resulting from the loss of subcutaneous fat, surrounded by an erythematous border. This unusual skin disease was characterized by clinical and histological examination. Laboratory tests revealed a partial IgA deficiency, antinuclear antibodies and IgG antibodies against gliadin.

Abdomen↗
PubMed1999

A child with localized vulval pemphigoid and IgG autoantibodies targeting the C-terminus of collagen XVII/BP180.

Localized vulval pemphigoid of childhood (LVPC) has previously been reported in six girls. Clinical features and immunopathological data have suggested it to be a morphological variant of bullous pemphigoid. Epitope targets of the autoantibodies of these patients have not been defined in detail. We describe a 9-year-old girl with possible cicatricial LVPC and circulating IgG antibodies directed against native collagen XVII/BP180, its 120-kDa soluble ectodomain and against the C-terminus of collagen XVII/BP180. No reactivity was detected towards the NC16A domain of collagen XVII/BP180. Linear IgG and C3 deposits were found along the cutaneous basement membrane zone. On 1 mol/L salt-split skin, IgG autoantibodies were shown to bind to the epidermis, and the HLA type II allele DQB1*0301, a marker with significantly increased occurrence in patients with ocular and oral cicatricial pemphigoid, was identified in this patient. Our data suggest that LVPC is a variant of bullous pemphigoid in which direct immunofluorescence microscopy combined with immunoblot analysis can deliver valuable diagnostic information for differential diagnosis. However, differentiation between the scarring and non-scarring course of the disease cannot be made with the present diagnostic markers and therefore careful follow-up of patients with LVPC is required.

Autoantibodies↗