Oral retinoids, synthetic derivatives of vitamin A, have been used in the treatment of various dermatoses over the last decade. The most useful drugs have been isotretinoin (13-cis-retinoic acid) for nodulocystic acne and etretinate for psoriasis vulgaris. Retinoids are also effective in the treatment of papulosquamous dermatoses other than psoriasis (i.e. inherited disorders of keratinisation), cutaneous T-cell lymphoma and in chemotherapy and chemoprevention of cancer. However, systemic administration of these compounds is frequently associated with mucocutaneous side effects, liver toxicity and abnormalities of serum lipid profiles, which might be related to an increased risk of coronary heart disease. Of particular concern is the teratogenic effect of all retinoids, which limits their use in women of child-bearing potential. Chronic toxicities from long term therapy with retinoids may result in skeletal abnormalities, usually mimicking diffuse idiopathic hyperostosis syndrome. Furthermore, the chronic use of retinoids in children may inhibit their growth due to premature epiphyseal closure. In contrast to other side effects of retinoids which are dose dependent and reversible upon withdrawal of the drug, it seems unlikely that bone abnormalities will resolve after discontinuation of the medication. In view of the wide spectrum of toxicities, treatment with retinoids requires appropriate selection of patients, careful consideration of the benefit to risk ratio for each individual, periodic monitoring of clinical response and laboratory tests. Clinicians should use special management techniques in order to prevent or minimize slide effects. Extensive investigations are currently being conducted in an attempt to develop new retinoids which will improve the therapeutic efficacy and reduce unwanted reactions.

Humans↗

PubMedDate not supplied

[Anatomical research on intracranial arterial aneurysms].

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Adult↗

PubMedDate not supplied

Heparin-like inhibitory activity to fibroblast growth factor-2 in wound fluids of patients with chronic skin ulcers and its modulation during wound healing.

Fibroblast growth factors are potent mitogens and angiogenic factors which play a critical role in wound healing. Fibroblast growth factors require heparan sulfates as cofactors in order to activate their cognate receptors and exert their cellular and biological effects. Heparan sulfates were extracted from wound fluids of 5 patients with chronic diabetic foot ulcers or chronic venous stasis ulcers and tested for their capacity to modulate fibroblast growth factor-receptor binding, during the course of the ulcers' resolution, until complete healing (3-8 months). Total heparan sulfates concentration measured as iduronic acid equivalents, decreased in wound fluids from 1.1 +/-0.3 microg/ml to 0.26 +/-0.1 microg/ml as wound healing progressed. These heparan sulfates exhibited a predominant inhibitory effect on fibroblast growth factor-2 binding to fibroblast growth factor receptor-1, when tested in cells deficient in cell surface heparan sulfates. During wound healing, there was a marked decrease in the relative inhibitory activity of the extracted heparan sulfates on fibroblast growth factor-2-receptor binding. Heparan sulfates extracted from chronic skin ulcers of different etiologies such as diabetic foot or chronic venous stasis ulcers showed the same pattern of alternating balance in heparan sulfates mediated activity. The presence of fibroblast growth factor inhibitory factors which possess heparin-like activity in fluids of chronic skin ulcers and their ability to modulate fibroblast growth factor-receptor activity throughout the process of wound healing, may significantly contribute to the mechanism of chronicity. Treatments to counter this inhibition may offer new possibilities for healing chronic wounds.

Body Fluids↗

PubMedDate not supplied

[Preventive intravenous nitroglycerin administration in cesarean section to facilitate fetal extraction of infants between 500 and 1500 g--are there negative effects on the newborn infant?].

BACKGROUND: Preterm infants should be delivered with as little trauma as possible. Fetal extraction during cesarean delivery can be facilitated by modification of the incision or by use of short-term tocolytic agents. A possible alternative to intravenous administration of beta-mimetics is i.v. application of nitroglycerin to induce rapid uterine relaxation. This has been recommended by various clinical teams, but with relatively little experience being available regarding preterm births. PATIENTS AND METHODS: Retrospective analysis of the perinatal data for all single neonates weighing 500 to 1500 g delivered by cesarean section at the Berlin-Neukölln Hospital in the period from 6/1995 to 9/1999 following prophylactic intraoperative i.v. application to the mother of 0.2 mg nitroglycerin (n = 55). Control groups: 1. All infants weighing 500 to 1500 g delivered by cesarean section at the Berlin-Neukölln Hospital with no intraoperative application of nitroglycerin (n = 38); 2. All infants weighing 500 to 1500 g delivered by cesarean section included in Berlin perinatal statistics (BePE) 1993-1998 (n = 715). RESULTS: There were no differences between the groups in terms of Apgar scores or the incidence of arterial umbilical pH values < or = 7.10 or of maternal blood loss > 1000 ml. Within the nitroglycerin group, in a shorter interval between nitroglycerin application and cutting of umbilical cord (< or = 3 min: n = 42; > 3 min: n = 13) 1-minute Apgar scores < 7 were observed more rarely, but no differences in arterial umbilical pH values < or = 7.10. CONCLUSIONS: 1. Intraoperative nitroglycerin application during cesarean section has no unfavorable effect on the condition of newborns < 32 SSW or between 500 and 1500 g. 2. The incidence of intraoperative maternal blood loss > 1000 ml was not increased. 3. Differences in the interval between nitroglycerin application and cutting of the umbilical cord have no clinically relevant effects on Apgar scores or arterial umbilical pH.

Acid-Base Equilibrium↗

PubMedDate not supplied

[What Turkish-speaking women expect in a German hospital and how satisfied they are with health care during their stay in a gynaecological hospital in Berlin - a comparative approach].

Although cultural diversity in German metropolises is rapidly increasing, immigrant patients are rarely included in clinical studies. Specific needs of these patients are hardly known. In a comparative study, 320 German and 262 Turkish immigrant women, respectively, were interviewed via bilingual questionnaires to assess their expectations from and their satisfaction with provided health care services. While no significant differences could be found between basic expectations concerning anticipated health care standards between the two study groups, women of Turkish origin were markedly less satisfied with provided health care services. High expectations of immigrant patients towards information during their stay, communication with doctors and nurses and psychosocial services were only insufficiently met. The results indicate that specific health-relevant factors, such as social and educational status, knowledge of German language and health knowledge together with structural deficiencies of a health care service that is not prepared to correspond properly to patients of different social and cultural backgrounds, have a negative impact on patient satisfaction for migrant women.

Adult↗