Biomedical subjects
Publications and source records attributed to H Zachariae.
We report the observation of delayed wound healing and keloid formation in three patients, following dermabrasion or Argon laser treatment administered while they were receiving isotretinoin for acne or rosacea.
Eleven patients with mycosis fungoides (MF) were treated with recombinant alpha-interferon (rIFN-alpha 2a2) in combination with etretinate (seven patients) or alone. One patient, who also received etretinate, went into complete remission and remained without signs of MF after 18 months. Six patients experienced partial remission; one of these was treated with rIFN-alpha 2a alone and was clinically in complete remission, but had still a pleomorphic skin infiltrate. Two patients were non-evaluable, and two stopped therapy due to progressive disease. Five patients discontinued therapy due to side-effects although three had partial remission of their disease. Only four patients received 12 months therapy. The study shows that rIFN-alpha 2a in combination with etretinate or alone can induce remission of MF.
Twenty-four psoriatic patients on methotrexate were studied with liver biopsies and serum measurements of aminoterminal propeptide of type III procollagen (PIII NP). All but one of nine patients with serum levels of PIII NP above the normal range had liver fibrosis or cirrhosis and no normal liver biopsies were obtained in this group. In contrast, nine normal liver biopsies and two biopsies with minimal fibrosis were found among the 15 patients with normal serum levels of PIII NP. The study indicates that aminoterminal propeptide of type III procollagen can be utilized as a valuable non-invasive marker of fibrogenesis in the liver. This analysis is not specific for the liver, but it seems that the number of liver biopsies probably can be reduced in psoriatics on methotrexate who have normal levels of PIII NP.
A case is presented of a 63-year-old female suffering from Buschke-Löwenstein giant condyloma acuminatum of more than 12 years' duration. The lesions had spread from portio and vagina to the bladder and the right ureter resulting in hydronephrosis of the right kidney leading to subsequent surgical procedures including the establishment of an ilealbladder and exstirpation of the right ureter and nephrectomy of the right kidney. Treatment with recombinant interferon alpha-2A 1.8 mU for 5 days a week resulted in steady regression of all tumor masses. After 6 months of treatment the tumors which had covered the whole of vagina and portio and filled out the whole vagina cavity were reduced to 5 small pin-size lesions at the introitus. Initial side effects of flu-like symptoms disappeared spontaneously without discontinuation of treatment.
Two patients with juvenile dermatomyositis, 5 with chronic discoid lupus erythematosus, and one with Rothmund-Thomson's Syndrome were treated for their teleangiectasias of the face with argon laser. The results were highly satisfactory with an almost normal appearance of treated skin in 4 patients. Two patients showed satisfactory results with 60-70% blanching, while 2 patients showed some improvement, but not a completely cosmetically satisfactory result. The most impressive results were in the patients with juvenile dermatomyositis and Rothmund-Thomson's Syndrome. The only side effects observed were a slight scarring and an insignificant pigmentation. No patient displayed any signs of disease activation.
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A case is presented of a 58-year-old female exhibiting a severe pustular psoriasis of the acrodermatitis continua type treated with ciclosporin A. The disease which had lasted for 10 years and had lead to 14 hospitalizations had previously been treated with methotrexate, systemic steroids, etretinate, colchicine, hydroxyurea and PUVA, or combinations of some of these drugs without producing complete remissions. Ciclosporin A (14 mg/kg/day/reduced to 7.5 mg/kg/day) produced complete remission in three weeks. Whether the patient can be maintained on low-dose ciclosporin A without toxicity remains to be seen. The drug, however, seems to be effective in bringing the disease under control.
Studies on serial liver biopsies from 25 patients with methotrexate-induced liver cirrhosis, taken from 1 to 13 years after cirrhosis was established, confirm that this type is not of aggressive nature. When evaluated blind no progression was found in most of the later biopsies. Alcohol and previous use of hepatotoxic drugs such as the combination of arsenics and vitamin A seem to have been contributing factors to cirrhosis formation.
A prospective study was carried out over 12 months involving twenty-eight patients with psoriatic arthritis. Almost all patients improved dramatically with regard to both pain and function. Clinical assessment including evaluation of number of swollen joints, joint tenderness score, and morning stiffness was performed by external observer without any knowledge of previous evaluation data. These data together with patients' assessment of pain and assessment of general condition, consumption of analgetics, and sedimentation rate improved significantly after three and six or twelve months. Apart from transient increases in serum transaminases no other abnormalities developed during the study.
Assessment of folate and methotrexate concentrations in erythrocytes has been suggested as criterion for when to institute liver biopsy surveillance during methotrexate treatment of psoriasis. We report an investigation of these parameters in thirty psoriatics on long-term methotrexate treatment. The patients were six psoriatics with histologically verified methotrexate-induced liver cirrhosis, eleven patients in which a blind histological evaluation had established a liver fibrosis in progression during treatment, and thirteen patients, who either had no liver fibrosis or no progression in the degree of fibrosis. There was no statistically significant difference in erythrocyte folate between the groups. When the two groups with progression were combined and compared with the group without progressive hepatic disease, erythrocyte methotrexate was found significantly higher in the patients with progression. Individual data, however, did not support the idea that assessment of folate and methotrexate in erythrocytes can limit the number of necessary liver biopsies during methotrexate treatment.
A six-year experience in 20 patients with advanced mycosis fungoides treated with combination chemotherapy with bleomycin, cyclophosphamide, prednisone and etretinate (BCPE) in advanced mycosis fungoides showed initial complete remissions in 16 patients (85%). The initial complete remissions lasted in average 8 months. A second complete remission was obtained in seven patients. The overall survival after 2 years was 50% and 30% after 4 years. At the time of the investigation six patients are alive, three in complete remission and three in partial remission. Two patients are in partial remission after 6 years, one of these had additional therapy with alfa-interferon. Patients entering the study until 1982 also received transfer factor, an immune stimulating agent. Since in 1982 a double-blind study revealed no differences between patients given the active--and patients given the inactive medication, no new patients since then had transfer factor. BCPE compares favourable with other chemotherapeutic regimes. The data presented seem to justify the use of retinoids as a part of combination chemotherapy in mycosis fungoides.
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Ten patients with systemic sclerosis were treated with benoxaprofen, a potent lipoxygenase inhibitor, for a period of 6 months. In an attempt to evaluate the efficacy a number of physical disease parameters were followed during the trial. None of these parameters revealed any significant differences. There was, however, a trend for a change towards normalisation of a defect monocyte chemotaxis. In view of the slow and progressive nature of systemic sclerosis the present study leaves undetermined whether benoxaprofen exerts a beneficial effect on systemic sclerosis.
Five patients were treated with either 0.25% methotrexate cream or placebo in a double blind trial. The evaluation showed no clinical or histological effect although the drug was absorbed from the skin. Methotrexate (MTX) accumulated in locally treated psoriasis plaques as well as in untreated plaques. The psoriatic skin concentrations were increased by a factor of 119 and 4, respectively. This observation is discussed in relation to the possible role of action of methotrexate in psoriasis. We suggest that methotrexate inhibits the chemotaxis of neutrophil leukocytes systemically and not primarily in the skin, thereby preventing development of the early stages in the psoriatic lesions.
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