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Biomedical subjects

E Held

Publications and source records attributed to E Held.

At least 19 recordsLinked to original sources
PubMed2005

The hand eczema severity index (HECSI): a scoring system for clinical assessment of hand eczema. A study of inter- and intraobserver reliability.

BACKGROUND: There is a need for a standardized clinical grading system for a more objective and accurate assessment of the severity of hand eczema (HE). OBJECTIVES: To develop and validate a scoring system called the hand eczema severity index (HECSI) designed for clinical assessment of HE. METHODS: Twelve dermatologists (observers) assessed 15 HE patients twice, with an interval of 30 min. The study was performed blinded for the observers, and only the hands and wrists of the patients were visible to the observers. Agreement between the observers was determined by using the intraclass correlation coefficient (ICC), which is the correlation between (single) ratings of the same patient. RESULTS: ICC for total HECSI score was 0.79 at the first assessment and 0.84 at the second assessment. ICC for intraobserver agreement was 0.90. CONCLUSIONS: Overall excellent agreement existed for both inter- and intraobserver reliability and the scoring system is suggested for use in future clinical studies on HE. Because HECSI is an entirely objective assessment of clinical signs, in addition, inclusion of patient-rated symptoms should be considered.

Adolescent↗
PubMed2005

Less skin irritation from alcohol-based disinfectant than from detergent used for hand disinfection.

BACKGROUND: The benefit of alcohol-based disinfectant used on normal skin has been debated. OBJECTIVES: The objective of the present study was to compare the effects of repeated exposure to an alcohol-based disinfectant, a detergent and an alcohol-based disinfectant/detergent alternately for 10 days, including noninvasive measurements in the evaluation. Skin reactivity in irritated skin after a 4-week interval was also evaluated. MATERIALS AND METHODS: Detergent, disinfectant and alternate disinfectant and detergent were applied twice daily every 10 min for 1 h to the ventral upper arms and forearms of 17 healthy volunteers. A control area was included. After 4 weeks an SLS patch was applied to each area. Irritant reactions were quantified with a visual score recording and measurements of transepidermal water loss (TEWL) and skin colour were performed on days 1, 5, 11, 38 and 40. RESULTS: On day 5 the detergent caused a higher visual score than either disinfectant applied alone or alternate disinfectant and detergent, P < 0.05. On day 11 detergent and alternate disinfectant and detergent caused a higher score than disinfectant, P < 0.05. An increased irritant response for detergent compared with disinfectant alone and alternate disinfectant and detergent was confirmed by TEWL evaluations on days 5 and 11, P < 0.001, while no significant difference was found by colour measurement. After 4 weeks, when evaluated by colour measurement, significantly less response to the SLS patch was found on the disinfectant-treated area compared with the control area and detergent area, and a similar trend was found for TEWL, although it was not statistically significant. CONCLUSION: Alcohol-based disinfectant caused less visible skin irritation and less skin barrier disruption than the use of detergent. The alternate use of detergent and disinfectant caused less irritation than the use of detergent, and a possible interaction between the two irritants was not indicated. After 4 weeks there was a tendency for decreased skin reactivity in the skin areas which had 4 weeks previously been exposed to disinfectant.

Adult↗
PubMed2004

Methyldibromoglutaronitrile in leave-on products elicits contact allergy at low concentration.

BACKGROUND: The rapidly increasing level of contact allergy to methyldibromoglutaronitrile (MDBGN) in Europe is of concern. In April 2003, the EU Commission prohibited the use of MDBGN in leave-on cosmetic products, such as creams and lotions, until a level of safe use can be defined. Industry risk assessment has indicated that such a safe level could be 50-100 p.p.m. OBJECTIVES: To determine whether 50 p.p.m. or 100 p.p.m. could be tolerated by MDBGN-sensitized individuals, and to evaluate if the risk for elicitation of MDBGN allergy is higher for a leave-on product with a high lipid content than for a product with a low lipid content. METHODS: Eighteen volunteers with contact allergy to MDBGN and 10 healthy controls were exposed to repeated open application tests (ROATs) with two moisturizers with a high and a low lipid content, respectively, both containing MDBGN at a concentration of 50 p.p.m. The ROATs were performed on the left and the right side of the neck for 14 days, or until a positive reaction was seen. If a positive reaction did not develop within the first 14 days, two analogous moisturizers containing 100 p.p.m. MDBGN were applied for a further 14 days. Clinical assessments were done on days 2, 3, 7, 14, 21 and 28 or when a reaction developed. RESULTS: Eleven of 18 (61%) subjects developed dermatitis on the test area, of whom 10 developed a positive reaction to the 50 p.p.m. moisturizer, seven having a positive reaction on day 2 or 3. Reactions to the low-lipid moisturizer were the more frequent. All participants used more of the low-lipid moisturizer than the high-lipid moisturizer. The controls all had negative ROATs. CONCLUSIONS: Even 50 p.p.m. cannot be regarded as a safe concentration for use and the prohibition of MDBGN is scientifically well founded.

Adult↗
PubMed2002

Prevention of work related skin problems: an intervention study in wet work employees.

AIMS: To evaluate the effect of implementation of an evidence based skin care programme for wet work employees as part of an occupational health and safety management system. METHODS: 375 wet work employees were included in a prospective randomised controlled trial, allocated to either intervention (n = 207) or control (n = 168). The intervention group was exposed to a skin care programme during the five month study period. The intervention included an educational programme for a group of frontline employees, who underwent formalised training, and subsequently introduced the information to their colleagues. As part of the intervention a skin care policy including written instructions was established at each workplace. Both groups answered a test quiz, completed questionnaires on behaviour and symptoms, and underwent clinical examination of their hands before and after the five month period. RESULTS: No difference between the intervention and the control group was found at baseline with respect to clinical symptoms or behaviour. Evaluation after the five months of intervention revealed a significantly higher information level on skin care in the intervention group compared to the control group, a significant change in behaviour in the intervention group but not in the control group, and significantly less skin symptoms as evaluated clinically in the intervention group but not in the control group. No significant difference was found for self reported skin problems. CONCLUSIONS: The intervention was successful with respect to information level (knowledge), behaviour, and clinical symptoms. Implementation of a skin care programme as part of an occupational health and safety management system is recommended as a prophylactic measure for employees in wet occupations.

Adult↗
PubMed2001

[Acute renal failure due to rhabdomyolysis in McArdle's disease following binge drinking with seizures].

HISTORY AND ADMISSION FINDINGS: A 36-year-old gardener was admitted for tonic-clonic seizures after binge drinking. The next days he developed massive rhabdomyolysis with acute renal failure. Past medical history was unremarkable except for a similar episode of acute renal failure 14 years ago. At that time he had consumed alcohol as well. Furthermore, the patient complained of exercise-related painful muscle cramping and swelling. INVESTIGATIONS: The serum creatinine peaked at 8.5 mg/dl, blood urea at 126 mg/dl and the maximal level of serum creatinine kinase was 108 300 U/l. Because of the massive rhabdomyolysis and the patient inverted question marks past medical history a metabolic myopathy was suspected and a muscle biopsy was performed. Histochemical staining of muscle frozen sections for phosphorylase revealed no activity which is typical for myophosphorylase deficiency (McArdle inverted question marks disease). Additional biochemical analysis of the muscle biopsy specimen confirmed the diagnosis. TREATMENT AND COURSE: By vigorous intravenous hydration and forced alkaline diuresis, the patient had a sufficient urinary output and lacked uremic signs. The serum creatinine and urea fell continuously and reached normal levels after 6 weeks. At that time serum creatinine kinase was still elevated (867 U/l), which is typical for McArdle inverted question marks disease. Avoiding alcohol, a new episode of rhabdomyolysis and acute renal failure did not occur. CONCLUSIONS: Besides exercise alcohol is likely to be a further possible trigger of rhabdomyolysis and acute renal failure in McArdle inverted question marks disease. Postulated mechanisms by which alcohol induces muscle injury include direct muscle toxicity and inhibition of gluconeogenesis, as these patients are probably more dependent on the gluconeogenetic pathway for muscle cell metabolism.

Acute Kidney Injury↗
PubMed2001

Effect of different moisturizers on SLS-irritated human skin.

Moisturizers are widely used to treat irritant contact dermatitis (ICD). Their use is, however, not well-documented and standardized models for testing skin care products are needed to acquire documentation of their efficacy. The present study was undertaken to evaluate the effect of 6 commonly-used moisturizers on the recovery of irritated human skin. No commercial interests were involved in the study. 36 healthy volunteers had patch tests with SLS 0.5% applied on their forearms/upper arms for 24 h. After irritation of the skin, all volunteers had a moisturizer applied on one forearm/upper arm, respectively, 3 x daily for the following 5 days. The other forearm/upper arm served as an untreated control. Each moisturizer was tested on 12 volunteers and each volunteer tested 2 moisturizers at the same time. Evaluation was done on days 1, 3 and 8 by transepidermal water loss, electrical capacitance, laser Doppler flowmetry, DermaSpectrometry and clinical scoring. All 6 moisturizers were found to accelerate regeneration of the skin barrier function when compared to irritated non-treated skin. The most lipid-rich moisturizers improved barrier restoration more rapidly than the less lipid-rich moisturizers. We suggest this experimental model for further moisturizer efficacy testing.

Dermatitis, Contact↗
PubMed2001

Prevention of work-related skin problems in student auxiliary nurses: an intervention study.

The present study was designed as an intervention study to investigate whether an educational programme was efficient in preventing work-related skin problems on the hands. 107 student auxiliary nurses (61 in the intervention group and 46 in the control group) were followed during the first 10 weeks of their initial practical training in county hospitals. The intervention group was given an educational programme before the practical training started. For evaluation the participants had questionnaires, clinical examination of the hands, measurement of transepidermal water loss (TEWL) and patch testing. The use of hand disinfectants, which was discouraged in the educational programme, was significantly lower in the intervention group as compared to the control group (p=0.002). 48% of the intervention group and 58% of the control group had aggravation of skin problems during practical training (p>0.05). Use of hand disinfectant agents was significantly associated with aggravation of skin problems (p=0.016). A significant increase in TEWL for the control group (p<0.005), but not for the intervention group, was seen after 10 weeks of practical training. In conclusion, the present intervention study shows promising results from the use of an educational programme.

Adult↗
PubMed2001

[Clinic admission?--but not without my child!].

Since the end of the 1990s the Westfälische Klinik Lengerich has offered an inpatient psychiatric treatment of an psychiatric ill parent--combined with a pedagogic attendance of the child taken along. The following article describes our experience in that matter, from a ward concentrated on psychotherapy. In selected examples supposed patterns of interaction--following the specific disease--are represented from both the psychotherapeutic und the pedagogic point of view. In practice our plan of treatment and attendance has proved successful for the wellbeing of the patients and their children. Remains to be hoped that--despite difficulties in organisation which will have to be overcome--similar offers can be made in regional psychiatric attendance.

Adult↗
PubMed2001

Effect of moisturizers on skin susceptibility to irritants.

Moisturizers are used for the treatment of dry and irritated skin. The benefit of moisturizers when used on normal skin has recently been challenged, since an earlier study indicated that the increased hydration that follows long-term use of moisturizers on normal skin may facilitate penetration of irritants. The aim of the present study was to evaluate short-term use of 2 different moisturizers used on normal skin: cream A (high lipid content) and B (moderate/low lipid content). Nineteen healthy volunteers applied the moisturizers on the upper arm/forearm 3 times daily for 5 days, while the other upper arm/forearm served as symmetrical control. The day after moisturizer treatment was stopped the skin was challenged with a patch test of sodium lauryl sulphate. Skin reactions were evaluated by bioengineering measuring methods and clinical scoring. Skin response to sodium lauryl sulphate was increased on moisturizer-treated arms compared to controls for one of the moisturizer (cream A), while this was not statistically significant for the other moisturizer (cream B). Data confirm previous indications that some moisturizers when used on normal skin may increase skin susceptibility to irritants.

Administration, Topical↗
PubMed2001

Binocular vision recovery in bilateral keratoplasty.

PURPOSE: To determine the benefit of bilateral penetrating keratoplasty with regard to binocular vision. METHODS: We compared patients who underwent corneal transplantation bilaterally with patients who had successful corneal transplantation in one eye and corneal disease in the other eye. Specifically, changes in fusion, stereopsis, and binocular vision function were analyzed. A questionnaire regarding performance of daily tasks was given. RESULTS: Patients with bilateral keratoplasty performed better in all the analyzed functions. Fusion was achieved by 81.25% in the unilateral group versus 100% in the bilateral group (p = 0.15). Stereopsis was present more in the bilateral group (100% vs. 62.5%, p = 0.008) and the quantity of stereopsis was significantly better in the bilateral group (121 seconds of arc vs. 1,284 seconds of arc, p = 0.014). 88.8% of the patients subjectively improved in daily activities after second eye surgery. CONCLUSION: There are objective and subjective improvements after bilateral penetrating keratoplasty.

Activities of Daily Living↗
PubMed1999

[Skin necrosis in the front foot area during anticoagulation with phenprocoumon].

HISTORY AND ADMISSION FINDINGS: A 52-year-old woman was admitted because of pain for several days in the lower left leg and increasing pretibial swelling with livid discoloration. Six months before she had undergone a bilateral adnexectomy with removal of the omentum and subsequent chemotherapy for ovarian cancer. INVESTIGATIONS: Duplex sonography on the day of admission revealed thrombosis of the left popliteal vein with an unobstructed femoral vein. Both the quick value (89%) and partial thromboplastin time (PTT, 35.9 s) were within normal limits. Computed tomography and sonography were highly suspicious of a local recurrence of the ovarian cancer with peritoneal carcinomatosis. TREATMENT AND COURSE: PTT-effective heparinization (heparin-Na) was initiated together with overlapping anticoagulation with phenprocoumon (thromboplastin time 20-30%). On the 9th day after starting phenprocoumon painful, black necrotic changes began to appear on the skin of the left first to fourth toes. Assuming these to be due to phenprocoumon, anticoagulation was switched to low-molecular heparin (Enoxaparin), and antithrombin III and protein C were administered. A few days later thrombosis of the right iliac vein occurred, probably caused by local recurrence of the ovarian cancer. No palliative chemotherapy was undertaken in view of the thrombotic complications. The patient died a few months later from the cancer. CONCLUSION: If there is an underlying malignancy, chemotherapy and therapeutic vitamin-K antagonism in the presence of thromboembolic complications increases the risk of lowering protein C activity and may cause the rare complication of skin necrosis, induced by phenprocoumon.

Anticoagulants↗
PubMed1999

[Investigation of malignant melanoma in an "open house" setting].

Individuals with a self-evaluated risk of malignant melanoma were invited to an "open house" where trained dermatologists examined suspected lesions. The attendants filled in a short questionnaire relating to skin cancer risk factors. Persons with skin changes suspected for malignancy were referred for excision in the dermatological department. The clinical evaluation included dermatoscopy. Nine hundred and eleven individuals attended. Among 16 individuals referred for excision one malignant melanoma, one lentigo maligna melanoma and two in situ melanomas were histologically verified. Furthermore, 21 basal cell carcinomas were identified clinically. The most frequent clinical diagnoses were melanocytic naevi and seborrhoic keratoses.

Adult↗
PubMed1999

The combined use of moisturizers and occlusive gloves: an experimental study.

BACKGROUND: Protective gloves are used in the workplace to protect the hands from occupational hazards, but side effects from glove use are frequently reported. Among these side effects, irritant skin reactions are common. OBJECTIVE: The present study was undertaken to investigate whether applying a moisturizer to compromised skin before wearing an occlusive glove could reduce skin irritation. METHODS: Healthy volunteers had both hands immersed in a sodium lauryl sulfate solution twice daily for 2 days. After each immersion, one hand had a moisturizer applied and both hands were put in occlusive gloves for 2 hours. Skin barrier function was evaluated by transepidermal water loss, skin hydration was measured by electrical capacitance and inflammation was evaluated by colorimetry. RESULTS: The moisturizer had a statistically significant positive effect on both the water barrier function and the hydration level of the skin. Although not statistically significant, less inflammation was observed on the moisturizer-treated hand. CONCLUSION: The findings suggest that use of a moisturizer under an occlusive glove may diminish irritation from exposure to a detergent followed by glove wearing.

Adult↗
PubMed1999

Paraneoplastic pemphigus with fatal pulmonary involvement in a woman with a mesenteric Castleman tumour.

A 42-year-old woman presented with oral and labial erosions, conjunctivitis, facial rash and lichenoid erythematous papules on the trunk. Paraneoplastic pemphigus (PNP) was suspected, and a search for a neoplasm revealed an intra-abdominal Castleman tumour sized 7 x 5 x 6 cm. After removal of the Castleman tumour, the skin and mucosal inflammation gradually subsided over the next 12 months. However, due to irreversible pulmonary involvement the patient died of intractable respiratory distress 2 years after the onset of the disease. Systemic corticosteroids, azathioprine, cyclophosphamide, high-dose intravenous immunoglobulins and thalidomide were ineffective. The diagnosis of PNP was confirmed by keratinocyte antigen immunoprecipitation with the patient's serum.

Adult↗