Biomedical subjects
Publications and source records attributed to E Diem.
24 patients with metastatic malignant melanoma were treated with DTIC applied alone or in combination with other cytotoxic agents (Oncovin, Bleomycin, Adriblastin). Treatment resulted in objective improvement (3 patients), subjective improvement (2 patients), stable state (5 patients). The other patients showed further progression of their disease.
This paper deals with the working plan of immediate care, parenteral nutrition and surgery in burned children according to experience gained in the treatment of these children at the specialist Burns Unit of the Department of Dermatology (I) of the University of Vienna. Features peculiar to this age group lie in the appropriate recommendations for shock therapy and prophylaxis as well as parenteral nutrition. The guidelines for surgical treatment of burns are basically similar in adults and children.
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A 44-year-old white man presented with an erythemato-squamous rash in the supra-orbital and preauricular regions of the face. The diagnosis systemic lupus erythematosus was confirmed by histopathology, immunofluorescence (circulating antinuclear antibodies and a positive lupus band test), and by immunoelectron microscopy. Further examinations disclosed a multiple myeloma of the IgG type without cutaneous involvement. The coexistence of these two disorders has not been reported previously.
Immunologic membrane markers have been utilized for the in situ identification of lymphoreticular cells within lymphoreticular tissues and in inflammatory and neoplastic lymphoreticular infiltrates of the skin. Frozen sections were layered with untreated sheep red blood cells (SRBC) for the detection of the E receptor on T cells, SRBC coated with 7S antibody for the detection of the Fc receptor (IgGEA) and SRBC coated with 19S antibody and complement (IgMEAC) for the detection of the C3 receptor. In normal lymphoreticular tissue, IgGEA selectively bound to areas colonized by macrophages, IgMEAC to B-dependent areas, whereas E showed no adherence. In chronic lymphatic leukemia, a predominant and selective adherence of IgMEAC was found in lymphoreticular organs which supports the B-cell nature of the neoplastic cells; in leukemic reticuloendotheliosis a selective IgMEAC adherence was observed and this favors a monocytoid origin of the hairy cells. Adherence of any indicator cell was practically absent from skin infiltrates of mycosis fungoides, which represents an additional piece of evidence for the T-cell nature of this disease process. In psoriasis, a considerable binding of IgGEA was observed, whereas IgMEAC did not adhere at all. This result indicates that the lymphocytic part of the infiltrate in this disease consists mainly of T cells.
A subcutaneous pedicled island flap for closing skin defects in face tumor surgery is presented. Simple design and operative technique of these flaps make them interesting for closing excisional face skin defects especially in the elderly.
This paper is intended to present an approach to the modern care of burns out of the experience of a dermatological burn unit for the dermatologist in the outpatient clinic. It is the first burn unit in Austria.
Contact thermography in diagnosis of cutaneous melanomas is only a complementary method of investigation. Positive thermograms should lead to a diagnosis of malignancy without being pathonomic of malignancy.
As a result of progress in the modern treatment of burns, systemic candidosis (CA), in the sense of "surviving mycoses", has become increasingly frequent. The site of entry is not usually the wound, but the intestinal tract, which becomes overgrown by the yeasts as a consequence of the requisite therapy with antibacterial antibiotics in high dosage. Passage of the organism into the circulation occurs by persorption. In view of the bad prognosis of systemic CA, it is essential to recognize its incipient development and counteract by timely prophylactic measures, primarily sterilization of the intestine. In a developed case os systemic CA, the chances of cure improve with rapidity of recognition of the infection and initiation of treatment. Early diagnosis of the infection is achieved by the regular quantitative determination of the organism in the faeces, in urine and blood, as well as in swabs of mucous membranes and the wounds and, above all, by serological examination (movement of titre). The practical problems of the disease are demonstrated and discussed on the basis of 2 cases treated in this department.
A case is reported of the successful treatment of severe, third-degree burns by early limited, but repeated electrocautery excision and immediate meshed autografting. The concept of such attempts to convert large areas of full-thickness burns into a clean closed wound by means of the described techniques if discussed. A decrease in morbidity and mortality can be anticipated when this procedure is carried out for the correct indications by an experienced specialist team. Particular attention must be paid to the optimum, patient-geared timing of each surgical stage.
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Basic techniques and indications for free split and full-thickness grafts are outlined on the basis of experience gained in surgical management of selected cases at the First Department of Dermatology, University of Vienna. A well-prepared wound bed, correct choice of procedure, good operative and dressing technique and careful follow-up therapy lead to good results which are also aesthetically acceptable to the patient.
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The radiological and scintigraphic findings in the skeletons of patients with psoriasis and psoriatic arthropathy are described. The results indicate that is it possible to detect inflammatory disease in joints by scintigraphy in patients who have not yet developed symptoms. The effect of treatment can be satisfactorily followed by serial scans. Further investigations and observations will be required to show whether the paravertebral calcification and syndesmophyte formation which has been described is really pathognomonic for psoriatic arthropathy.
The evaluation by contact-thermography (with heat sensitive cholesterinester crystals) of patch tests for contact dermatitis is an important aid to detect weak positive or false negative reactions. In addition, it facilitates the interpretation of patch tests in dark skin persons. The number of diagnosed cases of contact dermatitis can be increased by about 10% without increasing the expenditure of time on the part of the patient or the physician.
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