Biomedical subjects
Publications and source records attributed to M Hundeiker.
Investigation of anamnestic development, Tumor types, levels of invasion (Clark), tumor thickness (Breslow), mitotic index (Schmoeckel and Braun-Falco) in 407 (without lentigo maligna and preinvasive superficial spreading melanoma 317) cases revealed an interdependence between thickness and mitotic index. This is a theoretical argument against the "prognostic index" as a product of both these parameters.
Fifty-two congenital melanocytic nevi (CMN) as precursors to melanoma or severe melanocytic dysplasia were reviewed macroscopically and microscopically. Forty-eight "small" CMN measured less than 10 cm in diameter. Histologically, only five reached to the lower third of the dermis or subcutis ("deep type"); the remaining 47 were limited to the upper two thirds of the corium ("superficial type"). There were 47 invasive melanomas, two in situ melanomas, and three severe focal melanocytic dysplasias. All melanomas were of "epidermal" origin and primarily of the superficial spreading type. The age at diagnosis ranged from 18 to 79 years. Prepubertal melanomas were not observed. Melanoma may also arise on small CMN. The most frequent origin of the melanomas in small CMN and the preferred age at manifestation seem to be different from that for giant nevi.
Previous analyses of possible associations between MHC determinants and cutaneous malignant melanoma (MM) have been inconclusive. We have investigated 98 patients with special emphasis on histologically determined subtypes of MM, and 5 multiple-case families. In addition to HLA-ABC and DR typing, complement allotypes of C2, C4A, C4B, BF were determined. Among the unrelated patients HLA-DR5 and, secondarily, B49 were observed to be associated with superficial spreading (SSM) but not with nodular (NM) or lentigo maligna melanoma (LMM). In families with MM, no definite segregation of the disease according to HLA and complement haplotypes was discernible. Moreover, no coincidence of haplotypes occurred in patients of the different families. HLA region recombinations including B/DR and/or DR/GLO were found in all the families investigated.
The diagnosis of malignant melanoma in the head and neck region is often difficult. Electron microscopy and immunhistochemistry can facilitate the pathological investigation of amelanotic malignant melanoma.
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In 22 patients isolated extremity perfusion with cis-platinum for treatment of malignant melanoma was performed; 18 had local metastastic disease (M. D. Anderson stages II and III A, B, AB) and four were stage I. A further five patients were submitted to isolated DTIC perfusion. DTIC-perfused tumors showed regression rates of 30%-80%, followed by recurrences within 4 months. After cis-platinum perfusion stage-III AB cases tended to show tumor recurrence within 4 months, while to date stage-III A and stage-II cases have reached disease-free survival times of 17 and 20 months respectively. While in DTIC perfusion the tissue temperature may range between 40 degrees and 41 degrees C, in cis-platinum perfusions 40 degrees C should not be exceeded; otherwise neural damage will occur.
Adriamycin is known as an antineoplastic agent with a broad spectrum of activity for human malignancies. To determine the highest tolerable concentrations of adriamycin in isolated perfusion of the extremities the hind legs of 12 dogs were isolated in an extracorporeal circuit and perfused under normothermic conditions. Dosages of about 10 mg/l perfused extremity were well tolerated by the animals, and lower concentrations did not result in any side effects. However, in most cases, dosages higher than 10 mg adriamycin/l extremity volume induced severe edema, pain, and histological changes.
In 119 patients a "delayed skin flap transplantation" was carried out after excision of malignant melanomas. The skin graft can be stored in a refrigerator at 4 degrees C up to two weeks without damage to the transplant. The transplantation may be accomplished at any time, but is usually due 3 to 4 days postoperatively. Advantages of this method are decreased risk of local infection, early mobilisation of the patient and generally good cosmetic results.
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Hyperthermic isolated extremity perfusion has been undertaken in 117 patients with advanced melanoma of the extremities from october 1979 to may 1981. Perfusion is indicated in cases above level III and tumor thickness above 1,5 mm. Among the cytostatic agents used were melphalane, melphalane and dactinomycin, nitrogen mustard/dactinomycin, as well as DTIC, cis-platinum and the combination of cis-platinum and dactinomycin. All cytostatics lead to tumor regression, as observed on tumors left in situ. Longterm results have yet to be awaited. While melphalane may be perfused at 42 degrees C, the cisplatinum perfused extremity should not be heated to above 40 degrees C because permanent neurological damage may be induced. For this reason maximal hyperthermia is reached before the cytostatic agent is introduced and has to be lowered when the drug is added.
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Report on a 58-year-old woman with eczema-like lesions in both axillae. The lesions had been treated as a mycotic infection, but no fungi grew in the cultures. There was massive growth of pseudomonas aeruginosa, and some few colonies of B-streptococci were found. The lesions disappeared two weeks after treatment with gentamycin and water dressings. The disease is reported as "gram-negative infection of the axillae" because its clinical and anamnestic features are similar to those of the so-called "gram negative infection of the feet".
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This disease is discussed in the past mostly in the dermatological literature, the ENT specialist is little aware of its existence. The condition is characterized by subcutaneous, painless nodules occurring most frequently in the region of the ear, parotid gland, cheek and lateral neck. The lesion must be differentiated from disease of the lymph nodes, especially malignant tumours. The pathologic diagnosis is based upon a hyperplasia of angiolymphatic tissue and marked blood eosinophilia. The prognosis appears to be favourable. A case is presented together with the clinical picture and histopathological findings. The differential diagnosis and treatment are discussed.