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Biomedical subjects

E Haneke

Publications and source records attributed to E Haneke.

At least 37 records · Page 2Linked to original sources
PubMed1998

Safety and efficacy of intermittent therapy with itraconazole in finger- and toenail onychomycosis: a multicentre trial.

The efficacy and safety of intermittent itraconazole therapy were investigated in patients with onychomycosis. Patients were divided into two groups according to site and extent of infection. Group A comprised 635 patients with toenail onychomycosis (at least one nail with > or = 20% involvement; n = 560) or fingernail onychomycosis (at least one nail with > 75% involvement; n = 63) or both (n = 12). These patients received itraconazole 400 mg day-1 for 1 week per month for 3 months. Group B comprised 48 patients with fingernail onychomycosis (at least one nail with > or = 20% involvement but no nail with > 75% involvement) who received itraconazole 400 mg day-1 for 1 week per month for 2 months. Patients were followed for a further 18 weeks without treatment, and received another treatment cycle if not cured or markedly improved 6 weeks after the end of the last cycle. An additional cycle was administered to 76 patients with fingernail onychomycosis (group A, n = 43; group B, n = 28) and to 316 patients with toenail onychomycosis. Clinical response rates and mycological cure rates at study end point were 89.0% and 68.4% respectively for toenails, 91.4% and 85.3% respectively for group A fingernails and 84.4% and 77.1% respectively for group B fingernails. Most adverse events occurred infrequently; major changes in liver function tests were not noted. In conclusion, intermittent itraconazole therapy is highly effective and safe in patients with onychomycosis.

Adult↗
PubMed1998

Surgical treatment of defects on the tip of the nose.

BACKGROUND: Malignant tumors frequently occur on the tip of the nose and may represent considerable therapeutic challenges. OBJECTIVE: Dermatologic surgical approaches are outlined to achieve maximum cure rates with optimal cosmesis. METHODS: Different excision techniques are shown to remove basal and squamous cell carcinomas as well as other malignant lesions on the tip of the nose. All operations can be performed under local anesthesia in a dermatologic surgical setting. RESULTS: Excisions with direct wound closure are sufficient for small tumors and may even enhance the appearance off the nose. Large tumors may require full-thickness skin grafts after extensive removal yielding acceptable cosmetic results. Multiple different local flaps are available for medium sized defects whereas large wounds including the nasal skeleton require loco-regional flap repair. CONCLUSIONS: Selection of the best defect repair allows the majority of nasal tip defects to be repaired with excellent functional and cosmetic results.

Anesthesia, Local↗
PubMed1998

Etiology and treatment of nail malalignment.

BACKGROUND: There are three main types of nail malalignment. These are: congenital nail malalignment of the big toenail, traumatic nail malalignment, and iatrogenic malalignment of the nail plate. OBJECTIVE: Treatment is only of benefit in the first two conditions, and specific surgical approach to each condition is outlined. The probable mechanism of iatrogenic malalignment is discussed. RESULTS: Nail rotation for congenital malalignment produces its best results in early childhood. CONCLUSION: Surgery is of benefit in congenital malalignment and traumatic malalignment and is worthwhile in selected cases. Iatrogenic malalignment that is the consequence of wide lateral nail biopsies or similar excisions does not respond to treatment.

Biopsy↗
PubMed1998

Itraconazole in the treatment of onychomycosis: a double-blind comparison with miconazole.

BACKGROUND: In recent years, itraconazole pulse therapy for onychomycosis has been developed [three 1-week pulses with itraconazole 400 (2 x 200) mg daily every month]. This has proved an effective and safe regimen which requires only 50% of the medication used for continuous dosing schedules. Parallel to the development of the new dosage schedule, additional studies were conducted to further document the safety and efficacy of itraconazole 200 mg once daily for 3 months to treat onychomycosis. OBJECTIVE: To compare the safety of itraconazole 200 mg once daily for 3 months, with or without itraconazole 200 mg once weekly for a further 3 months, with that of miconazole cream twice daily for 6 months, in the treatment of onychomycosis. Treatment efficacy was compared as a secondary objective. METHODS: In this multicenter, double-blind study, patients were randomized to receive itraconazole 200 mg once daily for 3 months followed by either itraconazole 200 mg once weekly for 3 months (ITR-ITR group, n = 599) or oral placebo once weekly for 3 months (ITR-PLAC group, n = 613), or to receive miconazole cream twice daily for 6 months (MIC-MIC group, n = 396). The primary variable was elevation of alanine amino-transferase (ALT) concentration above 50 U/I. RESULTS: Overall incidence of elevation of ALT concentration above 50 U/I, adverse events and rate of withdrawal because of adverse events were low and similar in the three treatment groups. Efficacy was significantly greater in the ITR groups than the MIC-MIC group. CONCLUSION: Itraconazole and miconazole were well tolerated and had no significant effect on liver function, but itraconazole was significantly more effective.

Administration, Oral↗
PubMed1996

Economic evaluation of antifungal agents in the treatment of toenail onychomycosis in Germany.

BACKGROUND: The strategies for the management of onychomycosis have changed since the availability of the newer generation of antifungal agents, particularly, itraconazole and terbinafine. Itraconazole (1-week pulse) therapy may have higher efficacy and an improved adverse-effects profile compared to the continuous therapy regimen. OBJECTIVE: We performed a pharmacoeconomic evaluation of the most commonly used treatments in Germany for toenail onychomycosis from a health care payer perspective. METHODS: A 5-step approach was used. Firstly, the purpose of the study, the comparator drugs, their dosage regimens and the time frame of the analysis were defined. Next, the medical practice and resource consumption patterns associated with the treatment of onychomycosis were identified. In step III, a meta-analysis was used to determine the relative efficacy of the comparator drugs. In step IV, a decision tree of the treatment algorithms was constructed for each comparator. The expected cost analysis and cost-effectiveness analysis were also performed. Finally, a sensitivity analysis was carried out. RESULTS: For the four main comparator drugs used to treat toenail onychomycosis in Germany, the clinical response rates (clinical cure plus marked improvement) at the end of the follow-up period (month 12 after starting therapy) were, for itraconazole (1-week pulse dosing): 89.8 +/- 3% (mean +/- SE), terbinafine: 79.4 +/- 10%, itraconazole (continuous dosing): 77.5 +/- 9%, and ciclopirox nail varnish: 55 +/- 5%. Itraconazole (1-week pulse dosing) was most cost-effective at DM 1,107 per successful treatment, followed by oral terbinafine at DM 1,224, ciclopirox nail varnish and itraconazole (continuous dosing). Sensitivity analyses indicated that itraconazole (1-week pulse dosing) and terbinafine had similar cost-effectiveness ratios. CONCLUSION: Itraconazole is an effective, broad-spectrum triazole used as continuous or pulse therapy in the treatment of onychomycosis. Itraconazole (1-week pulse) and terbinafine are the most cost-effective therapies for toenail onychomycosis.

Algorithms↗
PubMed1996

Sea urchin granuloma of the nail apparatus: report of 2 cases.

The authors report 2 cases of sea urchin granuloma of the nail apparatus resulting in permanent nail deformity. Both patients developed periungual and subungual nodular lesions 1-2 months after sea urchin spine injuries in the Mediterranean sea. The affected nails showed periungual nodules associated with splitting of the nail plate distal to the nodules. Surgical excision of the nail lesions required the removal of a large amount of nail matrix that resulted in permanent nail plate dystrophy. Histopathology revealed typical foreign-body granulomas in the nail dermis.

Adult↗
PubMed1995

[Mycosis fungoides bullosa].

We report on a male patient with mycosis fungoides (MF) with blisters mainly occurring on clinically uninvolved skin. This rare association has to be differentiated from other bullous diseases of the skin. The clinical picture has been known since the end of the last century and has been described as mycosis fungoides bullosa. The pathomechanism, however, has not yet been exactly identified. The different clinical and histological features of the disease are discussed.

Aged↗
PubMed1995

Short-duration treatment of fingernail dermatophytosis: a randomized, double-blind study with terbinafine and griseofulvin. LAGOS III Study Group.

BACKGROUND: Dermatophytic infections of the fingernail can be effectively treated with oral antifungal agents; however, a long duration of treatment, generally several months, is required for cure. OBJECTIVE: Our purpose was to compare the efficacies of short-duration treatment with terbinafine and griseofulvin in the management of fingernail dermatophytosis. METHODS: In this randomized, double-blind study 180 patients with fingernail dermatophytosis were treated with daily doses of either terbinafine, 250 mg/day, or microsized griseofulvin, 500 mg/day, for 12 weeks. Patients subsequently received placebo for 12 weeks and were observed for an additional 24 weeks. Drug efficacy was assessed by mycologic examination and measurement of the growth of unaffected nail. RESULTS: At the end of the study 76% of the group who received terbinafine and 39% of those who received griseofulvin were found to be completely cured (p = 0.001). Drug tolerability was equally good in both treatment groups, without any clinically relevant changes in laboratory biochemical values. CONCLUSION: Short-duration treatment (3 months) for fingernail dermatophytosis with terbinafine and griseofulvin is well tolerated. However, terbinafine was associated with a higher cure rate.

Adolescent↗
PubMed1995

Onychomatricoma.

BACKGROUND: Onychomatricoma is a rare benign tumor originating in the nail matrix. Only eight cases have been reported until now. OBJECTIVE: The clinical and histopathological features of this recently reported tumor will be described and its differential diagnoses outlined. A typical case of onychomatricoma is described in a 62-year-old white man. RESULTS: Clinically, onychomatricoma is characterized by: 1) a yellowish discoloration of a longitudinal segment of the nail plate with small splinter hemorrhages within the proximal portion of the nail; 2) a thickening with increased transversal curvature of the involved nail plate positively corresponding with the yellow discoloration; and 3) a matrix tumor consisting of multiple fine filiform projections that extend into the thickened nail plate. The treatment of onychomatricoma is complete excision of the tumor. CONCLUSION: Onychomatricoma is a new entity with clinical and histopathological features that are characteristic enough to make the correct diagnosis.

Diagnosis, Differential↗
PubMed1994

[Pyoderma gangrenosum vegetans. An overview of chronic pyoderma vegetans and pyoderma gangrenosum].

A case simulating extraordinarily extensive chronic vegetating pyoderma revealed itself in its course to be pyoderma gangrenosum. The bacterial flora varied due to a secondary colonization; there was no response to antibiotics but there was to corticosteroid, azathioprine and clofazimine therapy. IgA-paraproteinemia was found. Pyoderma gangrenosum has historically been considered to be a chronic ulcerous pyoderma and is not a disease of bacterial origin. Reviewing the literature available since the turn of this century, chronic vegetating pyoderma is compared with the latter from the viewpoint of clinical features, histopathology, immunology, course and treatment. There are so many convincing parallels between the two conditions that we would like to propose that we stop regarding them as distinct entities and instead view them as parts of a spectrum of the same immunopathological process.

Adult↗
PubMed1993

Immunohistochemical and immunoelectron microscopic demonstration of chromogranin A in formalin-fixed tissue of Merkel cell carcinoma.

BACKGROUND: Chromogranin A (CGA) is the major protein of neurosecretory granules (NSG) of cells of the diffuse neuroendocrine system, and the amount of CGA corresponds to the number of NSGs. OBJECTIVE: Because formalin fixation may destroy NSGs, a study was performed to examine the presence of CGA in Merkel cell carcinoma (MCC) to determine whether CGA depends on the presence of intact NSGs. METHODS: Formalin-fixed, paraffin-embedded tissue of 15 MCCs was investigated by immunohistochemistry and immunoelectron microscopy for the presence of CGA and NSGs. RESULTS: CGA was demonstrated in 12 of 15 MCCs by immunochemistry and in 6 of 10 MCCs by immunoelectron microscopy although intact NSGs could not be discerned in all cases. CONCLUSION: CGA remains demonstrable even when no morphologically intact NSGs are present, which suggests that CGA is not exclusively responsible for the electron density of NSGs.

Adult↗
PubMed1991

[Delayed hypersensitivity to protamine and immediate hypersensitivity to insulin].

A 63-year-old female, with type II diabetes mellitus, diagnosed in 1967, was started on combination therapy with sulphonylureas and human depot insulin in May 1989, because of inadequate blood sugar control with sulphonylureas alone. Within 3 months she began to develop nodular skin reactions at the site of injection, 12-24 hours after insulin injections. Intradermal testing demonstrated delayed (Gell and Coombs type IV) hypersensitivity to protamine. No specific IgE or IgG antibodies were demonstrable. She was changed to protamine-free human delayed action insulin. After an initial reaction-free period, red urticarial lesions, attributable to immediate (Gell and Coombs type I) hypersensitivity to human insulin, appeared at the injection sites. There were no other complications with continued insulin therapy, and after about 6 weeks no further local reactions were detectable. When an allergic reaction to an insulin preparation is suspected, careful immunological investigation should be performed, to ensure adequate treatment without risk to the patient.

Delayed-Action Preparations↗
PubMed1991

Phenotyping of immunocompetent cells in normal labial and palatal salivary glands and in non-autoimmune sialadenitis.

Different types of inflammatory cells in healthy major and minor salivary glands (SG), including those in labial and palatal non-autoimmune sialadenitis, were quantified immunohistochemically. Plasma cells, mainly IgA type predominated in all SG types, with the smallest number seen in the palatal glands. The numbers of common leukocyte antigen (CLA) reactive lymphocytes were greater in major SGs than in minor ones and were predominantly UCHL1 positive T cell type. Macrophages and neutrophils were absent in palatal glands, rarely present in labial ones and usually present in major SGs. Increases in the number of IgG and IgM plasma cells and lymphocytes (CLA+) which include both UCHL1+ T and L26+ B cell types, were found in non-autoimmune labial and palatal sialadenitis. There was no significant correlation between the number of the inflammatory cells and the degree of glandular atrophy in both labial and palatal non-autoimmune sialadenitis. Increase in their number represents a protective response of these glands in contrast to the inflammatory cells in major autoimmune sialadenitis playing there a pathogenetic role.

Antigens, Differentiation↗