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Biomedical subjects

G Rassner

Publications and source records attributed to G Rassner.

At least 109 records · Page 6Linked to original sources
PubMed1991

[Standardized epiluminescent microscopy for differentiating melanocytic and non-melanocytic pigment nevi].

Epiluminescent microscopy (ELM) has been widely accepted as a non-invasive, rapid technique for the differentiation of pigmented skin lesions. The method is valuable for distinguishing melanocytic and non-melanocytic tumors, as well as for identifying malignant melanoma. Due to great morphological variability of pigmented lesions considerable experience is required. Based on a morphological analysis of 600 pigmented skin lesions, a diagnostic procedure was developed that permits a reproducible description and diagnosis of a given lesion and facilitates training in ELM.

Basal Cell Carcinoma↗
PubMed1991

[Locally infiltrative growth of squamous cell carcinoma of the skin and treatment guidelines resulting from it].

The infiltrative growth behaviour of squamous cell of the skin carcinomas is characterized by subclinical outgrowths, very frequently extending horizontally and sometimes over long distances. They are presented in the form of a negative exponential function. These outgrowths have an irregular pattern. It is much more extensive in the case of tumours with a clinical diameter of more than 20 nm. All types of "blind" therapy such as cryopexy, irradiation, laser, and surgery monitored in only two dimensions involve an inevitable risk of recurrences, which can be calculated statistically from the results available. Routine histographical surgery of skin carcinomas in the form of continuous, 3-dimensional histology can dramatically reduce the risk of local relapse, especially in the case of small and medium-sized carcinomas. The test group presented here (411 carcinomas) was treated with histographic surgery using the paraffin section method; during the follow-up period (maximum: 7 years, minimum: 3 years) the danger of recurrence was 2.2% for all carcinomas but only 0.6% for those up to 20 mm in diameter (n = 340). Carcinomas with a diameter of more than 20 mm (n = 71) involved a much higher risk of recurrence with 9.8%. This is probably because of local micrometastases, which require more generous local excision with a safety margin of about 10 mm.

Carcinoma, Squamous Cell↗
PubMed1990

Microstaging of squamous cell carcinomas.

The clinical classification of squamous cell carcinoma, which was established primarily by the International Union Against Cancer (UICC), does not permit optimal estimation of expected metastasis. The authors' results indicate that metastasis can be more accurately estimated on the basis of invasion depth, histopathologic grading, and especially tumor thickness. One essential advantage of these criteria is that they can be established by a histopathologist. It is interesting to note that in the authors' collective no carcinoma less than 2 mm thick metastasized, that is, a relatively high percentage of carcinomas (48%) can be graded as no-risk carcinomas. The risk of metastasis for undifferentiated carcinomas greater than 6 mm thick that have infiltrated the musculature, the perichondrium, or the periosteum, however, is quite high. Tumors between 2 and 6 mm thick with moderate differentiation and a depth of invasion that does not extend beyond the subcutis can be classified as low-risk carcinomas.

Carcinoma, Squamous Cell↗
PubMed1990

Treatment of psoriasis and psoriatic arthritis with interferon gamma.

In a placebo-controlled double-blind randomized study, 24 patients with psoriatic arthritis were given 28 d of treatment, and in an open study, 56 patients were treated for 9 months. We treated patients with 100 micrograms IFN gamma per subcutaneous injections, which were given daily for the first 2 weeks and then 3 times per week. The principal criterion for evaluation of therapeutic success on arthritis was improvement of the Ritchie joint pain index by at least 25% in the double-blind and 30% in the long-term study. In the double-blind study, the interferon arm was superior to the placebo arm with a statistically significant, one-side error probability of less than 5% in the chi-square test. In the long-term study, IFN gamma caused an improvement in a portion of patients in the first 3 months of therapy. No further improvement was observed after the third month, and patients classified as responders in the first months showed a deterioration of the disease by continuing treatment. The humoral inflammatory parameters did not normalize during therapy. Regression of the skin manifestations could not be observed. IFN gamma is evidently capable of inducing a psoriasis on the injection site. Investigations of IFN gamma serum levels, IFN antibodies, 2'-5' A synthetase levels in serum, and mononuclear blood cells and NK cell activity under long-term therapy showed no explanation for the loss of efficacy after 3 months treatment.

Arthritis, Psoriatic↗
PubMed1990

Psoriasis induced at the injection site of recombinant interferon gamma. Results of immunohistologic investigations.

Recombinant human interferon gamma used for treatment of psoriatic arthritis was found to induce expression of HLA-DR, but not HLA-DP or HLA-DQ, on keratinocytes at the site of injection. Some patients showed an improvement of their joint symptoms, but the cutaneous manifestations remained unaffected. In 10 of 42 patients, punctiform psoriatic foci could be induced at the site of injection of interferon gamma. For this presentation, we selected a female patient with psoriatic arthropathy and type II diabetes mellitus in whom psoriasis was induced at the site of application of interferon gamma, but not after subcutaneous injection of insulin or placebo. We conclude that interferon gamma is an important lymphokine in the development of psoriasis.

Abdomen↗
PubMed1990

[Structural analysis of melanocytic pigment nevi using epiluminescence microscopy. Review and personal experiences].

Epiluminescent microscopy is now used frequently for the differential diagnosis of pigmented skin lesions. In order to improve the distinction between benign and malignant melanocytic tumours it seemed advisable to develop a standardized pathway of epiluminescent microscopical analysis and to determine the frequency of structures recognizable with the microscope. A total of 600 melanocytic lesions were examined by epiluminescent microscopy, photographed and classified histologically after excision, revealing 426 naevocellular naevi and 174 melanoma. The experience achieved during the course of the investigation was used as the basis of a procedure for stepwise analysis of keratin layer, pigment structures and blood vessels. The most important findings are described and referred to malignancy. The photographs were analysed for the frequency of occurrence of various pigment structures in different types of lesions. The results differ in several aspects from previous findings.

Diagnosis, Differential↗
PubMed1990

[The subclinical portion in the periphery of lentigo maligna and lentigo maligna melanoma].

Lentigo maligna is a precancerosis or a melanoma in situ, whose level of malignancy has not yet been definitively clarified. Recurrences are not rare after excision, even when an ample safe margin is observed. One reason for this is the existence of a subclinical ramification in the marginal area of the lentigo maligna. Such subclinical ramifications were investigated by means of excision with histological monitoring of the margins by the paraffin section technique. There was a clear relationship between the frequency of these ramifications and the clinical safe margin left in 64 excisions. With the aid of parametric evaluation methods the distribution of the subclinical portion referred to the distance from the clinical margin could be determined with a special formula. If an invasion, in the form of a lentigo maligna melanoma had already taken place, then the subclinical portion within the marginal area was significantly more extensive. For the treatment of lentigo maligna, and especially of lentigo maligna melanoma, we therefore recommend excision with histological monitoring of the margins. There were no local recurrences within an average follow-up period of about 2 1/2 years.

Adult↗
PubMed1990

[Epiluminescence image of lentiginous junctional nevi].

Occasionally, in patients with pigmented skin lesions referred for epiluminescence microscopy (ELM) the lesions are deep black naevi that even experienced dermatologists suspect might be malignant melanomas. The surface of these lesions is abnormal, often scaly, but their general aspect is regular and not characterized by any gross asymmetry. Inspection by ELM reveals additional features, which, if present in a typical combination, indicate a benign lesion. One simple examination can be enough to exclude malignancy. Histological examination allows the diagnosis of lentiginous junctional naevocytic naevi. Two typical cases are presented.

Adult↗
PubMed1990

[Virus-induced papilloma of the conjunctiva. Detection of HPV 6a DNA].

By means of hybridization of nucleic acid, we detected DNA specific for papilloma virus, type 6a, in a caruncle papilloma of a 45-year-old female patient suffering from genital warts. These findings show that papilloma viruses, which are usually responsible for genital warts, may also induce conjunctival papilloma.

Condylomata Acuminata↗
PubMed1989

[Depth of invasion of basaliomas].

The infiltration depths of 1421 basal cell carcinomas (BCC) were determined by means of the mid and basic sections of excised tumor specimens. According to our findings, BCC shows peripheral spreading in the majority of the cases. Deep infiltration primarily occurs in large tumors, scirrhous forms, tumors with exophytic growth or ulceration, and particularly in recurrent BCC. Because of the asymmetric infiltrative growth in depth, conventional evaluation of the mid-section does not provide satisfactory information on the question of radical removal in depth. Therefore, histological control of excisional margins is absolutely essential at least in the tumors mentioned above. The proportion of the tumors with subtotal excision in depth at the first operation was 5.9% for primary BCC and 14.8% for recurrent BCC. In almost all these cases, radical removal could be achieved by re-excision into a deeper layer.

Basal Cell Carcinoma↗
PubMed1989

[Condylomata acuminata gigantea with detection of HPV-6-DNA. A case report with adjuvant systemic IFN-gamma therapy].

A case history of a 65-year-old man with giant condylomata (Buschke-Loewenstein tumour) of 30 years' duration is presented. The lesions were histologically confirmed, there were no signs of metastatic spread. HPV 6a DNA has been identified in Buschke-Loewenstein tumours and in different types of papilloma. After surgical removal in several sessions and treatment with gamma interferon by subcutaneous injection into the abdominal skin the patient has remained almost free of lesions.

Aged↗
PubMed1989

[The margin of safety and depth of excision in surgical treatment of basalioma. Use of 3-dimensional histologic study of 2,016 tumors].

During the treatment of 2016 basal cell carcinomas (BCC), 1757 of which were primary tumours and 259, recurrences, every operation was followed by a check on radicality by means of histological evaluation of the margins of the excised tissue (three-dimensional histology). The average safe margin at first excision was 3.8 mm, and excision normally extended to the lower subcuticular border in depth. After first excisions, tumour tissue was found in 31.6% of histological sections prepared from the marginal sections at the circumference and/or on the underside of the excised material. Tumour material was far more frequent in the marginal area (28.3%) than on the underside (7%). With a 2-mm safe margin around the primary BCC there were still 46.7% tumour-positive marginal sections; with 4 mm, 20.3%; and with 6-8 mm, 14.7%. Fibrosing BCC and tumours with diameters over 20 mm, and recurrent BCC in particular had a significantly larger share of tumour-positive marginal sections and considerably more frequently required two or more reoperations until the final radical excision than did the solid and superficial types of BCC. An average safe margin of 4.5 mm plus standard deviation to give 7 mm (standard deviation 2.5 mm) was necessary for radical excision of primary BCC, but often even larger margins, up to a maximum of 3.2 mm were necessary. Hence, when surgical treatment of BCC does not include three-dimensional histological evaluation generous safe margins are necessary. Surgery with histological monitoring is the only justifiable method of treating tumours of the fibrosing type, recurrent BCC and BCC over 10 mm in diameter.(ABSTRACT TRUNCATED AT 250 WORDS)

Basal Cell Carcinoma↗
PubMed1989

[Long-term experiences with histologic control of the incision margin (3-D histology)].

In order to make sure that malignant tumors of the skin are excised completely, excisional margin control has been performed in our department for 8 years. For this purpose, tissue is excised, fixed in formalin and embedded in paraffin. The tumor and the excisional margins are examined separately. A total of 2016 basal cell carcinomas have been followed up for up to 4 years. If histological examination of the excised margins still show evidence of the tumor, re-excision is performed until the excised margins are free of the lesion. This procedure has proven to be very successful, with a recurrence rate of only 0.35%. The tissue is processed in a routine histology laboratory according to standard procedures.

Basal Cell Carcinoma↗
PubMed1989

[A comparison of immunohistologic technics in dermatopathology].

With the increasing use of immunohistological techniques in the diagnosis of skin diseases, the question of appropriate techniques becomes more and more important. In this study the ABC (avidin-biotin-peroxidase-complex)-technique, the IGSS (immunogold-silver-staining)-technique and the APAAP (alkaline phosphatase anti-alkaline phosphatase)-technique are described. Antigenic determinants are demonstrated in frozen and paraffin-embedded sections with monoclonal and polyclonal antibodies, lectins and protein A. Sensitivity, reliability, application and handling of these techniques and their suitability for double labelling are compared. The ABC-technique is easy to handle, as sensitive as the other techniques, and gives good results with mono- and polyclonal antibodies, lectins and protein A in paraffin-embedded sections. The APAAP-technique yields good results when monoclonal antibodies are used in frozen sections. Similar results are obtained with the IGSS-technique, which also gives good results with polyclonal antibodies, lectins and protein A.

Antibodies, Monoclonal↗
PubMed1989

[Demonstration of S 100 protein in malignant melanoma of the skin. Pattern of distribution and significance for determination of tumor thickness].

Paraffin sections of 110 histologically proven malignant melanomas were incubated with a polyclonal antibody against S-100-protein. The avidin-biotin-peroxidase technique was used. A positive reaction was found in 109 cases. The staining pattern was inhomogeneous, suggesting heterogeneity within the tumor. The tumor thickness was measured in HE sections and corresponding sections that had been incubated with an antibody against S-100 protein. The results were as follows: 48.5% of the melanomas incubated with anti-S-100 protein showed a greater tumor thickness than the HE sections. The deviation between the two criteria was 15%. Four cases with the histological diagnosis of "melanoma in situ" showed S-100-positive cells within the subepidermal inflammatory infiltrate. Incubating sections of malignant melanoma with anti-S-100-protein facilitates the recognition of neoplastic cells within the inflammatory infiltrate.

Humans↗
PubMed1989

[Lymph node sonography in the after care of malignant melanoma].

Sonographic and palpatory lymph node findings were compared with the results of surgery or regular examination in a retrospective study of 167 melanoma patients. Sonography proved highly advantageous for diagnosis: whereas palpation indicated tumors at 83 of 277 lymph node locations, sonography showed 36 of the 83 to be false-positive. Moreover, sonography allowed the correct diagnosis of 6 non-palpable lymph node metastases. Sonographic diagnosis was initially uncertain in only 15 cases. Differential diagnoses and the limitations of lymph node sonography are described, and suggestions made for the application of this method in the postoperative care of melanoma patients.

Humans↗
PubMed1988

[The pretherapeutic phase of malignant melanoma of the skin. Analysis and suggestions for improvements in early diagnosis].

138 patients suffering from histologically proven malignant melanoma of the skin were questioned about the period of time that had elapsed between recognizing the tumor and seeing a doctor. The average time was 331 days, but there was considerable variation. The main reason for the delay in seeking medical advice was a lack of knowledge concerning the nature of malignant melanoma. The patient's social background was the determining factor in how much time went by until he saw a physician. 20% of the melanomas were coincidental findings. The time which elapsed between seeing a doctor and initiation of therapy was 179 days on the average. This period largely depended on the specialization of the physician and the kind of evaluation given. Our analysis should help to shorten the time which elapses between recognition of the tumor by the patient and initiation of treatment by the physician. A reduction of this period should improve the prognosis of malignant melanoma.

Adult↗