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Biomedical subjects

H A M Neumann

Publications and source records attributed to H A M Neumann.

17 recordsLinked to original sources
PubMed2004

[Diagnosis of pigmented skin lesions: how to recognize a malignant melanoma].

An accurate answer to the clinical question of whether a pigmented skin lesion has become a malignant melanoma or not is difficult because of the clinical variability of this lesion. Because of the low incidence of 2400 new melanoma cases each year in The Netherlands, a general practitioner only sees one new case every 3-4 years. The best way to distinguish between a benign lesion and a malignant melanoma is the combined use of several criteria, such as in the ABCD-formula: asymmetry, border irregularity, colour variation and a diameter > 6 mm. Dermatoscopical examination, provided that the technique is used by well-trained and experienced physicians, is a valuable adjunct to clinical examination. A pigmented lesion should always be excised if there is not enough convincing evidence to exclude its malignant nature. Histological classification of pigmented lesions may prove difficult because of morphological overlap between benign and malignant melanocytic tumours.

Diagnosis, Differential↗
PubMed2004

Non-pharmaceutical measures for prevention of post-thrombotic syndrome.

BACKGROUND: Post-thrombotic syndrome (PTS) is a long-term complication of deep vein thrombosis (DVT) characterised by chronic pain, swelling and skin changes in the affected limb. One in every three patients with DVT will develop post-thrombotic complications within five years. OBJECTIVES: To determine the relative effectiveness of, and the rate of complications using non-pharmaceutical interventions in patients with DVT in the prevention of PTS. SEARCH STRATEGY: The reviewers searched the Cochrane Peripheral Vascular Diseases Group Specialised Trials Register (last searched January 2003), and the Cochrane Central Register of Controlled Trials (CENTRAL) (last searched Issue 4, 2002). In addition, hand searching of non-listed journals and personal communications with researchers was undertaken. SELECTION CRITERIA: Randomised controlled trials (RCTs) of non-pharmaceutical interventions, such as bandaging and elastic stockings in patients with clinically confirmed DVT. The primary outcome was the occurrence of PTS. There was no restriction on date or language. One reviewer (DNK) identified and assessed titles and abstracts for relevance. This was verified independently by a second reviewer (RS). DATA COLLECTION AND ANALYSIS: Data extraction was undertaken independently by two reviewers (DNK, RS), using data extraction sheets. MAIN RESULTS: Three RCTs that evaluated compression therapy were identified. Two studies compared elastic compression stockings with a pressure of 30-40 mm Hg at the ankle with no intervention applied directly after an episode of DVT. The other small study compared elastic compression stockings (pressure 20-30 mm Hg) with stockings that were one to two sizes too large in patients one year after DVT. Overall, in the treatment group at two years, the use of elastic compression stockings was associated with a highly statistically significant reduction in the incidence of PTS with odds ratio (OR) 0.31 (95% confidence interval (CI) 0.20 to 0.48). In addition, the incidence of severe PTS was reduced from OR 0.39 (95% CI 0.20 to 0.76). In another RCT that considered the first nine days post DVT, no difference in the incidence of pulmonary embolism and size of thrombus in the femoral vein was found. A statistically significant reduction (p <0.05) was found in pain, swelling and clinical scores, favouring the compression group. REVIEWER'S CONCLUSIONS: There is substantial evidence that elastic compression stockings reduce the occurrence of PTS after DVT. No serious adverse effects were mentioned in the studies. Hence, elastic compression stockings should be added to the treatment of DVT to prevent the development of post-thrombotic syndrome.

Bandages↗
PubMed2004

Human follicular stem cells: their presence in plucked hair and follicular cell culture.

BACKGROUND AND OBJECTIVES: A considerable portion of the hair follicle remains attached to plucked hair and can be used for follicle cell culture. In this study we have phenotyped these cells in an attempt to identify the stem cell fraction. Reports in the literature have indicated that this cell population may be positive for cytokeratin (CK) 19. Because stem cells in general need to be protected from apoptosis, the presence of the apoptosis-suppressing Bcl-2 protein, together with the absence of the apoptosis-promoting Bax and the CK profile may be used as an indicator of the stem cell population in the hair follicle, and in cultures of hair follicle cells. METHODS: Hair follicles from skin biopsies and plucked hair were derived from the scalps of healthy volunteers. Follicular cells were cultured from the plucked hairs. These hair follicles, plucked hairs and cultured cells were examined for their CK profiles, which are indicative of the type of cell (basal/stem cells) and for their status with respect to the proliferation marker Ki-67, Bax and Bcl-2. RESULTS: We found coexpression for CK19 and Bcl-2, but not Bax in two distinct areas, localized in the upper and lower third of the follicle from both skin biopsies and plucked hairs, while proliferation markers were negative in these areas. CK19 and Bcl-2 were also coexpressed in combination in a fraction of the follicular cell culture. The skin basal cell marker CK14 could be found throughout the outer root sheath of the hair follicle from both skin biopsies and plucked hairs, as well as in the follicular cell culture. CONCLUSIONS: Thus, CK19/Bcl-2-positive and Bax-negative cells can be obtained from cells derived from plucked hair and are retained in cultures made from these cells. If this phenotype represents follicular stem cells, our finding endorses the assumption that stem cells are located in the bulge area of the hair follicle, as we did not find them in or near the dermal papilla.

Adult↗
PubMed2004

Mohs' micrographic surgery for treatment of basal cell carcinoma of the face--results of a retrospective study and review of the literature.

BACKGROUND: The incidence of skin cancer and especially basal cell carcinoma (BCC) has increased in the last decade and is still increasing. Many treatment modalities can be used to treat BCC; surgical excision is the most frequently used. Mohs' micrographic surgery (MMS) is an advanced excision technique which is often used to treat BCC in the U.S.A. In Europe it is practised less frequently. OBJECTIVE: The aim of this article was to evaluate the efficiency of MMS for the treatment of facial BCC. METHODS: In a retrospective study recurrence rates after the treatment of facial BCC by MMS were estimated by reviewing the records of all patients with BCCs (620 patients with 720 BCCs) treated by MMS in our department from April 1992 until December 1999. RESULTS: The 5-year recurrence rates estimated from this study were 3.2% for primary BCC and 6.7% for recurrent BCC. Prognostic factors for recurrence are: an aggressive histopathological subtype, more than four Mohs' stages, a large defect size and a recurrent BCC. CONCLUSION: Based on the fact that MMS provides the lowest recurrence rates, it is the treatment of first choice for primary facial BCCs with an aggressive histopathological subtype and for recurrent BCCs in the face.

Adult↗
PubMed2004

A method for measuring the dynamic behavior of medical compression hosiery during walking.

BACKGROUND: . Compression therapy is effective in patients suffering from venous disease. This therapy has proven to be especially effective in the ambulant patient. Therefore, the dynamic behavior of the medical compression hosiery (MCH) is more important than the static one in the treatment of patients. OBJECTIVE: . The objective of this study was to develop a method for investigating the dynamic behavior of MCH during walking. METHODS: . The changes in the circumference of the lower leg equipped with a MCH are registered on a treadmill. The dynamic movement is then exactly simulated using an artificial leg-segment model equipped with the same MCH. The dynamic behavior of the MCH can thus be investigated using this artificial leg-segment model. The dynamic stiffness index can be calculated from the dynamic pressure and circumference signals. RESULTS: The expansion of the MCH was only limited to the area underlying the expanding muscles and did not spread circularly. This resulted in relatively high pressure exerted by the MCH on the underlying tissues during walking. Insertion of nonelastic material into the MCH overlying the expanding muscles increased the dynamic pressure. CONCLUSIONS: The active behavior of the MCH during normal walking differed considerably from its passive behavior. We defined a new characteristic of the MCH: the dynamic stiffness index based on the dynamic pressure profile. Insertion of nonelastic materials into the MCH covering overlying the expanding muscles increased the dynamic stiffness index.

Adult↗
PubMed2003

The garlic-derived organosulfur component ajoene decreases basal cell carcinoma tumor size by inducing apoptosis.

Although the therapeutic role of ajoene, an organosulfur compound of garlic, in cardiovascular diseases and mycology has been established, its usefulness in cancer treatment has only recently been suggested. We applied ajoene topically to the tumors of 21 patients with either nodular or superficial basal cell carcinoma (BCC). A reduction in tumor size was seen in 17 patients. Immunohistochemical assays for Bcl-2 expression in a selection of these tumors before and after treatment showed a significant decrease in this apoptosis-suppressing protein. On average, the percentage of tumor cells expressing the proliferation marker Ki-67 was not decreased, which suggests that the action of ajoene is not explained by a cytostatic effect. To obtain further insight into the mode of action of ajoene, the BCC cell line TE354T and a short-term primary culture of BCC were analyzed for apoptosis induction after treatment with the drug. Apoptosis was detected by morphology of the cells and by flow cytometry. Ajoene induced apoptosis in a dose- and time-dependent manner in these cultures. Taking together the results of the in vivo and in vitro studies, we conclude that ajoene can reduce BCC tumor size, mainly by inducing the mitochondria-dependent route of apoptosis.

Aged↗
PubMed2003

Compression therapy for treating stage I and II (Widmer) post-thrombotic syndrome.

BACKGROUND: Post-thrombotic syndrome (PTS) is a long-term complication of deep vein thrombosis characterised by chronic complaints, swelling, and skin changes in the affected limb. One in every three patients with deep vein thrombosis develops post-thrombotic complications within five years. OBJECTIVES: To assess the effectiveness of compression therapy in patients with stage I and II post-thrombotic syndrome according to the classification of Widmer. Interventions of interest included elastic compression stockings and mechanical devices, compared with no intervention and with each other. SEARCH STRATEGY: The reviewers searched the Cochrane Peripheral Vascular Diseases Specialised Trials Register (last searched April 2003), and the Cochrane Central Register of Controlled Trials (CENTRAL) (last searched Issue 1, 2003). In addition, journals, conference proceedings and bibliographies were hand searched. Personal contact with other investigators involved in the clinical area was sought to get information about missed or unpublished studies. SELECTION CRITERIA: Trials that evaluated compression therapy for stage I and II (Widmer) post-thrombotic syndrome. Primary outcomes were leg ulceration, or deterioration of post-thrombotic syndrome. There were no restrictions on date or language. One reviewer (DNK) assessed titles and abstracts for relevance. This was verified independently by a second reviewer (MWCS). DATA COLLECTION AND ANALYSIS: Details of eligible studies were extracted and summarised using data extraction sheets. Data extraction was undertaken by one reviewer (DNK) and verified by a second reviewer (MHP). MAIN RESULTS: Only two trials were identified that addressed physical treatment of post-thrombotic syndrome. Both trials were initiated by the same group of investigators. A cross-over study lasting two months compared low and high pressure with intermittent compression units for severe post-thrombotic syndrome. This showed a beneficial effect of higher pressures. The second study, in patients with mild to moderate post-thrombotic symptoms, showed no effect of elastic compression stockings (30-40 mm Hg at the ankle region) when compared to 'placebo' stockings that were one to two sizes too large. REVIEWER'S CONCLUSIONS: There is some evidence of a beneficial effect of intermittent pneumatic compression units, but the study was too small and of too short a duration to draw strong conclusions. Further research is needed in order to assess whether intermittent pneumatic compression units give long term reduction and relief of the symptoms caused by post-thrombotic syndrome, and prevent deterioration and leg ulceration. The use of elastic compression stockings to treat post-thrombotic syndrome cannot be supported on the basis of the currently available data.

Bandages↗
PubMed2003

Lamin expression in normal human skin, actinic keratosis, squamous cell carcinoma and basal cell carcinoma.

BACKGROUND: Aberrant expression patterns of nuclear lamins have been described in various types of cancer depending on the subtype of cancer, its aggressiveness, proliferative capacity and degree of differentiation. In general, the expression of A-type lamins (lamins A and C) has been correlated with a non-proliferating, differentiated state of cells and tissues. OBJECTIVES: To establish and compare the expression patterns of lamins in normal human skin, actinic keratosis (AK), squamous cell carcinoma (SCC) and basal cell carcinoma (BCC). METHODS: Expression patterns of the individual lamin subtypes were studied immunohistochemically. The proliferation capacity of the tumour cells was detected using a specific antibody to Ki-67, and was related to the A-type lamin expression patterns. RESULTS: In normal skin, lamin A was expressed in the suprabasal cell compartment of the epidermis, whereas the basal cells were mostly unstained. BCCs and SCCs stained positive in most cells, while the epidermis overlying BCC and SCC and the epidermis in AK stained homogeneously and strongly in the basal cells in addition to the suprabasal cells. Lamin C was expressed in some basal cells of normal epidermis while the suprabasal cells stained strongly positive. Both BCCs and SCCs stained strongly positive for lamin C, with the difference that in BCC the staining was predominantly present in nucleolar structures with occasional staining of the nuclear envelope. The epidermis overlying SCC showed strong positivity in the lamina of virtually all cells. The expression of lamin C in the basal cells of AK resembled the expression pattern seen in the epidermis overlying BCC, i.e. a nucleolar staining next to nuclear envelope staining. Lamin B1 and B2 were found in virtually all cells in normal epidermis, AK, BCC, SCC and the epidermis overlying cancer. The percentage of Ki-67-expressing cells was highest in BCC (45%), and gradually decreased via epidermis overlying BCC, AK, SCC, and epidermis overlying SCC, to normal skin (11%). Simultaneous expression of A-type lamins and Ki-67 occurred in approximately 50% of the proliferating (Ki-67 positive) cells in BCC and SCC. CONCLUSIONS: Significant changes occur in the expression patterns of A-type lamins in both premalignant and malignant lesions of the skin. The profound overlap of lamin A and Ki-67 staining patterns indicates that the proliferating tumour cells may obtain a certain degree of differentiation. Finally, lamin A expression in the basal cell layer of the apparently normal epidermis overlying BCC may suggest its involvement in the primary process.

Basal Cell Carcinoma↗
PubMed2003

Unusual presentation of early lymphogranuloma venereum in an HIV-1 infected patient: effective treatment with 1 g azithromycin.

The incidence of lymphogranuloma venereum (LGV) is low in the western world. Early LGV is characterised by bubonic disease following a painless papule or small ulcer. We report a white bisexual male who presented with a painful perianal ulcer, inguinal lymphadenitis, and concomitant infection with human immunodeficiency virus 1 (HIV-1). Chlamydia trachomatis serovar L2 was identified as the cause after polymerase chain reaction and genotyping the major outer membrane protein by restricted fragment length polymorphism. Treatment with a single dose of 1 g azithromycin was effective. This case illustrates that early LGV may mimic other genital ulcer diseases, such as genital herpes or chancroid, especially in HIV infected patients. In the western world, LGV must still be included in the differential diagnosis of bubonic disease with or without sexually acquired ulcers.

AIDS-Related Opportunistic Infections↗
PubMed2003

The reliability of diagnosis using store-and-forward teledermatology.

We compared diagnoses made by a teledermatologist from digital photographs and patient histories sent from general practitioners using a store-and-forward technique and those made by another dermatologist in a face-to-face consultation with the same patients. A total of 117 patients (mean age 47 years) were referred by 18 general practitioners for diagnosis of a skin condition. Between one and seven digital images were transmitted per case. In 31% of the cases, three images were transmitted. There was full concordance between store-and-forward and face-to-face diagnoses in 57 of 106 cases (54%); in 10 cases (9%) there was overlap between the differential diagnoses provided by the teledermatologist and the face-to-face consultant. Diagnostic categories with relatively high concordances were eczema and follicular eruptions. General practitioners need to be trained in the making of digital images and in giving a good patient history.

Diagnosis, Differential↗
PubMed2002

Treatment of necrobiosis lipoidica with topical psoralen plus ultraviolet A.

BACKGROUND: Necrobiosis lipoidica (NL) is a rare skin disease, mostly seen on the legs and often occurring in patients with diabetes mellitus. The disease belongs to the idiopathic cutaneous palisading granulomatous dermatitides associated with a degeneration of collagen, thus leading to skin atrophy. Application of topical corticosteroids is the most widely used treatment but the results are not always satisfactory and may worsen skin atrophy. Preliminary studies in patients with NL have shown a clinical response with psoralen plus ultraviolet (UV) A (PUVA). Objectives To study the effect of topical PUVA on NL in a multicentre prospective study. METHODS: Thirty patients (27 women and three men) including 13 with insulin-dependent diabetes mellitus, with a diagnosis of NL proven by histopathology, were included. All patients had been unsuccessfully treated with topical and/or intralesional corticosteroids. Patients were treated twice weekly with an aqueous gel containing 0.005% psoralen followed by irradiation with UVA. Clinical photographs were taken for evaluation. In addition, 20-MHz high-frequency ultrasound analysis was performed in 10 patients to evaluate the thickness and density of the dermis during topical PUVA therapy. RESULTS: Five patients (17%) showed complete clearing (healing of ulceration and disappearance of erythema) after a mean of 22 exposures (range 15-30). Eleven patients (37%) showed improvement, defined as healing of ulceration and/or reduction of erythema, after a mean of 23 exposures (range 11-42). Ten patients (33%) showed no effect and four patients (13%) worsened during topical PUVA therapy. The treatment results of the patients who suffered from diabetes mellitus were not different from those who did not have diabetes mellitus. No difference was seen in mean dermal thickness (1666 vs. 1706 micro m) and density (17 vs. 16 units) before and after topical PUVA therapy. Side-effects were seen in 10 patients: hyperpigmentation (n = 4), blistering (n = 4) and bacterial infection (n = 2). CONCLUSIONS: Topical PUVA may be a useful treatment modality for NL in patients not responding to topical or intralesional corticosteroids.

Adolescent↗
PubMed2002

Cerebriform intradermal naevus (a rare form of secondary cutis verticis gyrata).

BACKGROUND: Acquired cerebriform intradermal naevus (CIN) is a rare form of pseudo cutis verticis gyrata. CASE REPORT: A case of acquired CIN of the scalp in a 46-year-old male patient is presented. The clinical and histopathological presentations of CIN are described and the therapeutic possibilities are discussed. CONCLUSIONS: In each individual case the physician must decide whether to do surgery or follow a wait-and-see policy. There is little risk of malignant change of CIN, and surgical excision of such lesions often involves evident mutilation.

Diagnosis, Differential↗
PubMed2002

Hypertrophic scars after therapy with CO2 laser for treatment of multiple cutaneous neurofibromas.

BACKGROUND: CO2 laser surgery is a treatment modality for cutaneous neurofibromas. OBJECTIVE: Hypertrophic and atrophic scars can result from treatment with CO2 laser surgery. We present a case of cutaneous neurofibromatosis that developed hypertrophic scars postoperatively. METHODS: Continuous wave CO2 laser surgery therapy was applied to the patient. RESULTS: Hypertrophic scars developed 2 months after therapy. CONCLUSION: With a preliminary test treatment the patient is able to see the expected result.

Cicatrix, Hypertrophic↗
PubMed2002

Recurrent leg ulcers in a young man with hyperhomocysteinemia, factor V Leiden and impaired fibrinolysis.

We present a young male patient referred to our hospital with leg ulcers on both legs that were more than 3 years refractory to standard treatment with compression therapy. By thrombophilia screening factor V Leiden mutation, hyperhomocysteinemia and evidence for impaired fibrinolysis were found. Treatment with folic acid in combination with long-term oral anticoagulant therapy was added to non-elastic compression therapy. The leg ulcers showed slow improvement and complete healing within 3 years. During a 6-year follow-up period neither new thrombo-embolic events occurred nor recurrence of ulcerations. This case suggests a potential synergistic pathogenic role of factor V Leiden, hyperhomocysteinemia and impaired fibrinolysis in the development of postthrombotic syndrome and his sequelae. We postulate that increased formation of thrombi in the microcirculation of the skin in combination with ambulatory venous hypertension due to recurrent deep venous thrombosis might explain our observation.

Adrenal Cortex Hormones↗