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Biomedical subjects

H A Neumann

Publications and source records attributed to H A Neumann.

At least 73 records · Page 4Linked to original sources
PubMed1995

Skin cancer screening focusing on melanoma yields more selective attendance.

BACKGROUND: Screening theoretically reduces death and morbidity from malignant melanoma. The rationale of screening for nonmelanoma skin cancer is more debatable, since mortality is very low. METHODS: We organized a screening campaign in Southern Limburg, the Netherlands, in 1993. Press releases and public announcements referred only to melanoma. The results were compared with similar campaigns in Arnhem and Eindhoven, the Netherlands, in 1990; these, however, addressed skin cancer in general. RESULTS: There were 4146 people attending the 1993 screenings, compared with 2463 in 1990. The proportion of screenees with lesions suggestive of melanoma increased from 1.1% in 1990 to 1.7% during the 1993 campaign (P = .04). The proportion of dysplastic nevi rose from 2.1% to 7.7% (P < .001). Nonmelanoma skin cancers were less often encountered (3.7% in 1990 vs 2.6% in 1993; P = .009). Actinic keratoses were also less numerous (6.3% vs 1.5%; P < .001). CONCLUSION: Screening concentrating on melanoma increases the rates of lesions suggestive of melanoma and dysplastic nevi, whereas the proportions of basal and squamous cell carcinomas and actinic keratoses decrease. These findings may have important implications with regard to the cost-effectiveness of skin cancer screening efforts.

Adult↗
PubMed1995

[Effect of colloidal plasma substitutes on liberation of tumor necrosis factor-alpha (TNF-alpha) in human whole blood in vitro].

OBJECTIVE: To investigate the influence of colloidal plasma substitutes on human cytokine network, especially of tumor necrosis factor alpha (TNF-alpha), in vitro. DESIGN: Heparinized whole blood samples from 8 healthy volunteers were divided and set on various concentrations of artificial colloidal plasma substitutes (native = 0 mg/ml; 5 mg/ml; 15 mg/ml). As colloids were used hydroxyethyl starch 200/0.5 (HES), dextran 60 (DX), urea-linked gelatin (GEL) and human albumin solution (HA). After incubation (24 h; 5% CO2; 37 degrees C; with and without concomitant stimulation of blood cells with phytohemagglutinin [PHA]) measurement of TNF-alpha release was performed via ELISA by the method described by Gallati. For the statistical evaluation a repeated measures analysis of variance was used. RESULTS: Basic level of TNF-alpha was found between 226 and 273 pg/ml (0 mg of each colloid/ml), stimulation with PHA without any colloid increased the TNF-alpha level about fourfold (1,066-1,260 pg/ml; 0 mg of each colloid/ml). At 5 mg/ml and 15 mg/ml without PHA all 3 artificial colloids rose the level of TNF-alpha (up to 50%). Under concomitant stimulation each colloid induced additional TNF-alpha release in comparison to PHA alone. The changes elicited by DX and GEL were statistically significant (p < 0.001 and p = 0.005, respectively) in contrast to those induced by human albumin solution or HES. CONCLUSION: In relation to TNF-alpha plasma substitutes are not inert substances as perhaps suspected. The questions whether the observed effects exist in vivo how far other cytokines are influenced and the question about the clinical importance are subject of ongoing studies.

Colloids↗
PubMed1994

[Is dopaminergic therapy immunologically rejuvinating? Increased interferon-gamma production with the dopaminergic agent lisuride].

Eighteen patients with advanced Parkinson's disease (n = 13) or dopamine-sensitive dystonia (n = 5) were treated with the dopaminergic agent, lisuride, applied as a long-term subcutaneous infusion. The results were compared with those obtained in a group of younger, and a group of older, healthy volunteers. The liberation of gamma-interferon (gamma-IFN) following mitogenic stimulation of whole blood with phytohemagglutinin (PHA) was highly significantly elevated in comparison with the group of older healthy volunteers, and clearly, but not significantly, elevated in comparison with the younger group. There was no difference between patients with dystonia and those with Parkinson's disease. The effect observed is thus probably due to lisuride. This effect might explain the longer life expectancy and reduced proclivity for infection shown by patients with Parkinson's disease. It needs to be determined whether, on the basis of these initial data, a therapeutic principle for the treatment of diseases that can be directly influenced by gamma-IFN can be derived.

Adult↗
PubMed1994

[Leg ulcers with hyperpigmented maculae and white atrophy as manifestation of Klinefelter syndrome].

Two patients, men of 38 and 32 years old, had Klinefelter's syndrome in combination with recurrent lower leg ulcers and hyperpigmentations. For the ulcers no venous insufficiency or other underlying cause could be found. Klinefelter's syndrome is characterised by the existence of at least one extra X-chromosome in phenotypical men. Clinical findings are eunochoid body proportions, scanty facial and body hair, gynaecomastia and small testicles. Plasma follicle-stimulating hormone is usually high and testosterone is reduced in about 50% of the patients. Leg ulcers, especially in combination with hyperpigmentation or atrophie blanche of the surrounding skin, can be a symptom of Klinefelter's syndrome and are not necessarily to be attributed to venous insufficiency.

Adult↗
PubMed1994

[Bilateral linear temporoparietal scleroderma en coup de sabre].

Bilateral linear frontoparietal scleroderma en coup de sabre is an extremely rare form of localized linear scleroderma. In this paper the case of a 35-year-old woman with bilateral linear temporoparietal scleroderma en coup de sabre is presented. The manifestations that can be associated with linear scleroderma and the serologic abnormalities it involves are briefly discussed.

Adult↗
PubMed1994

Congenital atrichia, palmoplantar hyperkeratosis, mental retardation, and early loss of teeth in four siblings: a new syndrome?

A syndrome of congenital atrichia, palmoplantar hyperkeratosis, mental retardation, and early loss of teeth was observed in four siblings (three women and one man). The pedigree is suggestive of either an autosomal recessive mode of inheritance or the inheritance of a (small) chromosomal translocation. This combination of findings has not been previously reported and is therefore considered to be a new genetic entity.

Adult↗
PubMed1994

Increased plasma activity of plasminogen activator inhibitor 1 (PAI-1) in two patients with Klinefelter's syndrome complicated by leg ulcers.

Klinefelter's syndrome is the most frequent major abnormality of sexual differentiation in men with two or more X-chromosomes, and affects one in 500 males. The syndrome is characterized by eunuchoid body proportions, scanty facial and body hair, gynaecomastia, and small firm testes. Leg ulcers, especially in combination with hyperpigmentation, have been reported in association with Klinefelter's syndrome. Thromboembolic processes are also frequently observed. The leg ulcers in patients with Klinefelter's syndrome are usually attributed to venous insufficiency. We describe two patients with Klinefelter's syndrome associated with recurrent ulcers and hyperpigmentation on both legs, in whom no venous or other underlying cause could be found. The patients were not taking any drugs, in particular no supplemental androgen therapy. Both had normal plasma testosterone values. We detected increased activity of plasminogen activator inhibitor 1 (PAI-1), with only a partial decrease upon venous occlusion. A possible role for this inhibitor of fibrinolysis in the pathogenesis of ulceration is discussed.

Adult↗
PubMed1994

Traumatic neuroma. A rare complication following Muller's phlebectomy.

BACKGROUND: Complications following ambulatory surgical phlebectomy are rare, and to our knowledge, traumatic neuromas have never been reported. OBJECTIVE: To present a case of traumatic neuroma in a 48-year-old woman after ambulatory minisurgical phlebectomy. METHODS: The ambulatory minisurgical phlebectomy as described by Muller. RESULTS: In a 48-year-old woman who developed persisting nodules after phlebectomy, histopathology confirmed the clinical diagnosis of traumatic neuroma.

Ambulatory Surgical Procedures↗
PubMed1994

Digital photoplethysmography and light reflection rheography. A clinical comparison.

BACKGROUND: Light reflection rheography (LRR) is appropriate for the global assessment of calf-pump insufficiency regardless of whether it is caused by varicosity, the post-phlebitic syndrome, or deep venous thrombosis. The instrument has been increasingly used by many phlebologists. Digital photoplethysmography (D-PPG) is a further development of this well-established LRR. With this D-PPG instrument it is possible, in contrast to LRR, to calibrate the reflected light. OBJECTIVE AND METHODS: To compare the venous refilling times of both the LRR and the D-PPG when measured at the same time on the same leg. We also evaluated the practical use of both instruments. In total we performed 152 simultaneous measurements with both instruments. RESULTS: We found a statistically significant correlation when we compared the venous refilling time of both LRR and D-PPG (r = .664; P < .001). The observed agreement between both instruments for detecting a disturbed venous refilling time (< or = 25 seconds) is 92%. CONCLUSION: Both instruments seems to correlate as has been shown in this and other studies. The D-PPG has the advantage of being more handy. Furthermore the reflected light is calibrated, which enables to compare intra- and interindividual measurements.

Humans↗
PubMed1994

Morphological and functional skin changes in postthrombotic syndrome.

After a period of deep venous thrombosis a lot of patients will develop chronic venous insufficiency. In time different skin alteration will occur. Several hypothesis have been proposed to explain the pathogenesis behind these skin changes. In this paper we will briefly discuss the most important theories. We concentrate on microcirculation and the different skin changes.

Atrophy↗
PubMed1994

Klinefelter's syndrome as a model for skin changes in venous insufficiency.

Chronic venous insufficiency is a common disease with skin changes, varicosity and leg ulceration. Several theories have been proposed to explain all the changes that occur. We recently saw several patients with Klinefelter's syndrome complicated by leg ulceration and all the typical skin changes of venous insufficiency. The underlying disease was however lacking. They all showed disturbances in their fibrinolytic parameters. In this article we discuss (local) fibrinolytic disturbances as a possible factor in the pathogenesis of the skin changes in chronic venous insufficiency.

Fibrinolysis↗
PubMed1993

Adhesion molecule expression in venous leg ulcers.

The final stage of chronic venous insufficiency (CVI) is ulceration. Several theories have been suggested to explain the skin changes and ulcerations. However, none of these can fully account for all the alterations which occur. Adhesion molecules are considered to play an important role in inflammatory reactions and in the process of wound healing. The aim of our study was to investigate the expression of intercellular adhesion molecule-1 (ICAM-1), endothelial leucocyte adhesion molecule-1 (ELAM-1), and vascular cellular adhesion molecule-1 (VCAM-1) in venous leg ulcers. Skin biopsies from 8 patients were taken from the surrounding skin of venous ulcers. ICAM-1 showed a weak to moderate expression on the endothelium of capillaries directly below the venous ulcer. A moderate expression of ICAM-1 was found on capillaries in the papillary dermis around the ulcus, similar to that of normal controls. A strong expression of ELAM-1 was only found on capillaries in the infiltrate directly under the ulcer. Some specimens also showed a moderate expression of ELAM-1 around the ulcus. Expression of VCAM-1 was subsequently found to be negative in all patients. The results suggest a disturbed inflammatory reaction in venous leg ulcers. In the area around the ulcer, where healing should initiate, the adhesion of monocytes and lymphocytes to the endothelium and the migration of these cells to the wound area were found to be insufficient.

Adult↗
PubMed1992

Uptake and localisation of O-(beta-hydroxyethyl)-rutosides in the venous wall, measured by laser scanning microscopy.

The uptake and localisation of O-(beta-hydroxyethyl)-rutosides (HR) in the venous wall was studied in 8 patients undergoing crossectomy for a varicose long saphenous vein. The fluorescence of cross-sections of the vein wall was measured by laser scanning microscopy, based on the autofluorescence of HR. Four patients (treated group) received 2 x 1.5 g HR IV before surgery, and four (untreated patients) served as controls. Uptake of HR into the veins from treated patients was seen, with a mean fluorescence intensity of 80.9 units compared to 49.4 units in the untreated veins. The increase in fluorescence was clearly demarcated on the endothelial side of the vein wall. It is concluded that HR passes into the vascular wall, where it is localised in the endothelial and sub-endothelial areas.

Adult↗
PubMed1992

Fundamentals of skin cancer/melanoma screening campaigns.

There is increased world-wide concern about the rising incidence of melanoma and non-melanoma skin cancer. Screening theoretically reduces death and morbidity from skin cancer/melanoma. Visual examination of the skin is a rapid, safe and inexpensive screening tool. In this review the fundamentals of early disease detection before implementation of a public-health screening programme are critically analysed with reference to the skin cancer/melanoma, epidemic. It is concluded that skin cancer/melanoma fulfils, for the most part, the criteria enunciated by Wilson and Jungner in 1968. However, information about the effect of screening on reducing incidence and mortality is still lacking. Future research should focus on methods of improving compliance and on the costs and benefits of such screening programmes.

Mass Screening↗