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Biomedical subjects

M Landthaler

Publications and source records attributed to M Landthaler.

At least 73 records · Page 4Linked to original sources
PubMed2001

[Treatment of therapy refractory verrucae vulgares with a ciclopirox-containing lacquer].

BACKGROUND AND OBJECTIVE: Anti-inflammatory actions of ciclopirox, an antifungal agent, have been described previously. We assessed the effectiveness of ciclopirox in the treatment of viral warts. PATIENTS/METHODS: Twenty-three immunocompetent patients (age 9-61 years) with common warts at the hands, feet and in the face resistant to conventional therapy were treated. Following keratolysis with a salicylic acid-containing patch, an 8% ciclopirox lacquer was applied 1-2 times daily. At the beginning and the end of the treatment lesions were photographed and the time span (minimum 4 weeks) until complete resolution was documented. RESULTS: In 7 patients complete remission, and in 12 patients partial remission was achieved. Only 4 patients did not show any effect under topical ciclopirox treatment (mean duration of therapy 3.2 +/- 2.1 months). The overall response rate was 82.6%. Local side effects like erythema or pruritus were not reported. CONCLUSION: Our data suggest that a ciclopirox lacquer may be helpful in the treatment of common warts. However, the data have to be confirmed in a randomized controlled trial in the future.

Administration, Topical↗
PubMed2001

[Treatment of port-wine stains with the flash lamp pumped dye laser. 5 years of clinical experience].

BACKGROUND AND OBJECTIVE: Portwine stains are reported to occur in 2.8% of the newborn. Depending on the location and size, portwine stains can be disfiguring and may lead to psychosocial complications. They can be safely and successfully treated with the flashlamp pumped pulsed dye laser (FPDL). Our objective was to evaluate retrospectively the efficacy of the FPDL (450 microseconds, 585 nm, 5 and 7 mm) after five years of clinical experience with this laser. PATIENTS/METHODS: Between 1993-1998 in 961 patients with port-wine stains laser treatment was performed in the department of dermatology of the university of Regensburg. RESULTS: Total clearance of the portwine stain was recorded in 6.9% of the patients. In 40.4% of the patients 75-95% clearance and in 38.5% 50-75% clearance was observed. In 14.2% response was less than 50%. Laser therapy was more effective for lesions of the neck and trunk than for lesions on the head and extremities. Better results were found after laser therapy of light-red or red portwine stains compared to dark red and violaceus portwine stains. In children (less than 3 year old), clearance of more than 75% occurred significantly more often than in older patients. CONCLUSIONS: Since laser treatment in early childhood is more effective than treatment at a later age, a smaller number of treatment sessions is necessary and lower recurrence rates can be expected, laser treatment should be started in early childhood. Side effects were rare after FPDL treatment. This study underlines that the FPDL is a safe and successful treatment for portwine stains with rare side effects. But total clearance can only be reached in a small number of patients.

Adolescent↗
PubMed2001

[Transverse nasal groove. A rare embryological error in nature].

Two patients presented with a transverse groove located between the lower third and upper two-thirds of the nose since birth. The alar and triangular cartilage attach themselves in a linear transverse fashion, the so called nasal line. It is important to recognize the nasal line as a localizing factor for milia, cysts and comedones. The nasal line is rather easily overlooked but awareness of its existence allows one to quickly confirm that it is not a rarity. We propose an embryological origin.

Aged↗
PubMed2001

[Treatment of therapy-resistant verruca vulgaris with long-pulsed tunable dye laser].

BACKGROUND: Common warts are induced by human papilloma virus (HPV) types 1-4, 26-29, 38, 41, 49, 57, 63, and 65 and can be found in up to 10% of adults and children. Many treatment modalities have been used to destroy the infected viral cells. These include the use of various methods such as salicylic acids, cryosurgery, curettage, and electrocautery. PATIENTS/METHODS: The purpose of this study was to examine the efficacy of the long-pulsed tunable dye laser (LPTDL) in the treatment of verrucae vulgares. Twenty-four patients with recalcitrant warts were included in the study. Thirty-one warts were treated in these patients. RESULTS: Two patients (6.5%) were completely freed of their warts, and a reduction of > 75% was attained in 12.9%. Nine patients (29%) experienced a reduction of < 50%. CONCLUSIONS: The LPTDL represents another quick treatment modality with low side effects, but only low clearance rates could be found in this study.

Humans↗
PubMed2001

Differences in efficacy between intention-to-treat and per-protocol analyses for patients with psoriasis vulgaris and atopic dermatitis: clinical and pharmacoeconomic implications.

BACKGROUND: Pharmacoeconomic outcome research is based on three criteria: (i) evaluation of objective therapeutic effects; (ii) quality of life; and (iii) treatment costs. Evaluation of therapeutic effect is mainly based on the results of clinical trials using objective clinical measures, e.g: Psoriasis Area and Severity Index (PASI) (score for psoriasis vulgaris) and the Severity Scoring of Atopic Dermatitis (SCORAD) (score for atopic dermatitis). In most studies, only results for a treatment-optimized subpopulation (patients treated according to the protocol) are presented in publications. The relevance of such data for daily routine therapy is doubtful. OBJECTIVES: Our purpose was to investigate the expected loss of effectiveness of switching from a clinical trial to daily routine therapy for the synchronous application of narrow-band ultraviolet (UV) B phototherapy (311 nm) and bathing in 10% Dead Sea salt solution (synchronous balneophototherapy) for patients with psoriasis vulgaris and atopic dermatitis. METHODS: We conducted a multicentre, uncontrolled observational study of outpatients. To achieve data for 'clinical trial' and 'daily routine' situations, two populations were compared: (i) all patients strictly treated according to the protocol (ATP) with no protocol deviations (data published in clinical trials), and (ii) all patients participating in the study who received active treatment at least once, despite treatment irregularities, non-compliance, early withdrawal or other protocol violations [intention-to-treat-population (ITT), model for 'daily routine']. RESULTS: A total of 2526 patients were included in the ITT analysis for psoriasis vulgaris (n = 487 for atopic dermatitis), of which 818 patients could be analysed according to protocol (n = 104 for atopic dermatitis). Striking differences in the therapeutic effect between both groups (ITT and ATP) were found using relative PASI and SCORAD score improvement: 11% (57% 'daily routine' vs. 68% in 'clinical trial') for psoriasis vulgaris and 16% (39% 'daily routine' vs. 55% 'clinical trial') for atopic dermatitis. The main reasons for excluding patients from the 'clinical trial' group were early study withdrawal in 29% (atopic dermatitis, 47%) of patients and fewer treatments per week than planned in the protocol in 24% (atopic dermatitis, 52%). CONCLUSIONS: Our data clearly indicate that for the prediction of the therapeutic effect for daily routine therapy the ITT data appear to be more relevant than the ATP results (i.e. those presented in clinical trials). Although these data are only a first step for evaluating the 'real' therapeutic effect of a treatment modality in daily routine, they seem to support the requirements for ITT analyses in efficacy studies and demonstrate the necessity of ITT data for pharmacoeconomic evaluation.

Adult↗
PubMed2001

Both the flashlamp-pumped dye laser and the long-pulsed tunable dye laser can improve results in port-wine stain therapy.

BACKGROUND: At present, laser therapy of port-wine stains (PWS) using the flashlamp-pumped dye laser (FPDL) at 450 micros is accepted as the optimal approach. A few years ago, a new long-pulsed tunable dye laser (LPTDL, 1.5 ms) was introduced for the treatment of leg veins. OBJECTIVES: To investigate the efficacy and side-effects of FPDL vs. LPTDL therapy of PWS. METHODS: Sixty-two patients with untreated PWS underwent test treatments with the FPDL (585 nm; 7-mm spot size; 5.75--7.0 J cm(-2) fluence) and LPTDL (585, 590, 595, 600 nm; 5-mm spot size; 11--20 J cm(-2) fluence). With the LPTDL, the epidermis was additionally cooled (Spray cooling device). The fading was evaluated clinically 6 weeks after the test treatments. RESULTS: Optimal fading was achieved by the LPTDL (> or = 585 nm) in 30 patients and by the FPDL in 12 patients. No difference was found in 20 patients. At 585 nm, the lasers worked equally well in 12 (FPDL) and 13 (LPTDL) patients, respectively. Results were independent of the localization of the PWS and of the patient's age. In spite of the longer pulse duration, the LPTDL treatment did not result in more side-effects as long as sufficient cooling was provided. CONCLUSIONS: The results provide evidence that wavelengths longer than 585 nm can increase the efficacy of treatment in some PWS. Owing to the reduced light absorption by haemoglobin at longer wavelengths and consequently increased depth of the vascular injury, larger vessels can be damaged more adequately using an increased fluence. The LPTDL at 585 nm seemed to be slightly superior to the FPDL, while accepting that due to technical reasons the laser parameters were not directly comparable. Availability of both lasers increases the therapeutic possibilities in PWS.

Adolescent↗
PubMed2001

Detection of differentially regulated genes in keratinocytes by cDNA array hybridization: Hsp27 and other novel players in response to artificial ultraviolet radiation.

cDNA array technology was used to identify novel genes participating in the ultraviolet response of cultured human keratinocytes. cDNA arrays representing more than 50,000 different cDNA clones were hybridized with complex probes generated by SMART-polymerase chain reaction amplification of 150 ng of total RNA extracted 24 h after ultraviolet irradiation. Fifty-one clones with differential hybridization signals were detected, representing 19 different sequences; 10 known genes (seven ultraviolet induced, three ultraviolet suppressed) and further nine expressed sequence tags of unknown genes. In seven of 10 genes the data from cDNA arrays probed with SMART-cDNA could be confirmed by northern blot analysis. The 27 kDa heat shock protein mRNA was induced. Keratins 6 and 17, markers for the hyperproliferative status of keratinocytes, were among the ultraviolet suppressed genes. The change of expression profile of keratins indicates a differentiation towards a phenotype of keratinocytes present in the suprabasal layers of the epidermis. These mechanisms may contribute to the ultraviolet protective function of the epidermis and to the anti-proliferative action of ultraviolet in the therapy of psoriasis. We also detected an induction of adenylyl cyclase associated protein and the suppression of G(s)alpha (a stimulating subunit of the trimeric membrane bound GTPase).

Blotting, Northern↗
PubMed2001

Progression and NSAID-induced apoptosis in malignant melanomas are independent of cyclooxygenase II.

Cyclooxygenase-II (Cox-II) overexpression is involved in the progression of various subtypes of cancer. We investigated the significance of Cox-II in the progression of malignant melanomas (MMs). Using immunohistology we determined that Cox-II is not expressed in 70 benign and malignant melanocytic tumours. Basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) were also analysed as controls: the BCCs were consistently Cox-II negative (n = 11), whereas the SCCs showed moderate to strong Cox-II expression in 53% (n = 17). Reverse transcription-polymerase chain reaction and Western blotting of MM cell lines and MM tissues confirmed the lack of Cox-II expression in MM. However, in vitro the Cox-inhibiting non-steroidal anti-inflammatory drug (NSAID) sulindac sulphide (SIS) was significantly more effective in inducing apoptosis than sulindac sulphone (SOS), a derivative with a negligible effect on Cox (P < 0.01). The SIS doses needed for the induction of apoptosis were not significantly different in MM cell lines versus a Cox-II-positive colon carcinoma cell line (HT29). Furthermore, add-back experiments with high doses of the prostaglandins PGE2 and PGF2beta, major Cox-II products, did not abrogate this effect. We conclude that Cox-II expression is not involved in the progression of MM, and NSAID-induced apoptosis in MM cell lines seems to follow pathways independent of Cox-II. Nevertheless, Cox-II inhibitors are still candidates for therapy, though they act via an unknown mechanism.

Adolescent↗
PubMed2001

Phototherapy of psoriasis: comparative experience of different phototherapeutic approaches.

BACKGROUND: Broad-band UVB alone or in combination with different topical drugs (anthralin, calcipotriol), systemic PUVA and bath-PUVA therapy are very effective and well-established treatment modalities for psoriasis. OBJECTIVE: The aim of this retrospective study was to assess which of these routinely applied phototherapeutic modalities might be most effective and safe for the treatment of plaque-type psoriasis. METHODS: Patients (n = 203) with moderate to severe (pretreatment Psoriasis Area and Severity Index score between 12 and 35) chronic plaque-type psoriasis treated between 1992 and 1998 at our department with either UVB (with/without anthralin or calcipotriol; n = 97), systemic PUVA (n = 19) or bath-PUVA therapy (n = 87) were evaluated for efficacy, duration of treatment, number of treatments necessary for complete remission (CR), cumulative light dose, side effects of therapy and duration of remission after therapy. RESULTS: No statistically significant difference comparing the efficacy of bath-PUVA (CR in 72.4%), PUVA (CR in 89.5%) and UVB phototherapy (CR in 69.1%) was found. Although the duration of therapy was significantly longer for bath-PUVA (66 +/- 42 days) as compared to UVB treatment (50 +/- 27 days), the mean number of treatments did not differ significantly between bath-PUVA (28 +/- 12), UVB therapy (30 +/- 12) and PUVA (26 +/- 13). Significantly fewer side effects of phototherapy were observed with bath-PUVA (14.9%) therapy compared to UVB treatment (30.9%). Also, the duration of remission after successful therapy was significantly longer for bath-PUVA (8.4 +/- 3.5 months) as compared to UVB phototherapy (5.1 +/- 4.2 months). CONCLUSION: Bath-PUVA therapy has some advantages over UVB phototherapy in the treatment of psoriasis: fewer UV-related acute side effects and a longer period of remission after therapy. However, the choice of treatment with either UVB, bath-PUVA or systemic PUVA should also be based on a history of previous response to treatment and patient considerations, including compliance and responsibility for following the precautions to avoid potential side effects.

Administration, Topical↗
PubMed2001

Transient and partial effect of high-dose intravenous immunoglobulin in polyarteritis nodosa.

A 57-year-old male patient suffered from polyarteritis nodosa. He presented with articular pain, polyneuropathy, subcutaneous nodules and nodes on the lower legs. After several immunosuppressive agents (methotrexate, mycophenolate mofetil and prednisolone) had proven to be ineffective, 2 g intravenous immunoglobulin (IVIG) per kilogram body weight were administered within 2 days in combination with 10 mg prednisolone per day. Subsequently, 6 cycles of IVIG were applied in increasing intervals from 4 to 6 weeks resulting in a minimum dosage of 0.33 g/kg/week IVIG. The polyarteritis improved within a few days after the first IVIG application. The intensity of polyneuropathy and arthralgia of polyarteritis decreased during the period of IVIG treatment. Finally, a dose reduction of less than 0.25 g/kg/week IVIG resulted in recurring polyarteritis nodosa, which could not be controlled by further administration of IVIG. Therefore, our data indicate that: (1) IVIG is partially effective in cases of polyarteritis nodosa, but the therapeutic effect is only transient; (2) the success of treatment may be correlated with the dose of IVIG per body weight and week; (3) the efficacy/cost ratio of IVIG in polyarteritis nodosa appears to be low.

Dose-Response Relationship, Drug↗
PubMed2001

Role of lasers and photodynamic therapy in the treatment of cutaneous malignancy.

Tumor therapy is not a common indication for the use of lasers, as it is in the treatment of benign vascular skin lesions, since many alternative treatment modalities exist. However, certain patients may benefit from laser therapy of premalignant and malignant skin tumors. Skin tumors can be treated by laser excision, laser coagulation, laser vaporization, or photodynamic therapy (PDT). For these purposes, the carbon dioxide laser, the neodymium:yttrium aluminum garnet laser and the argon laser are particularly suitable. PDT is a therapeutic approach based on the photosensitization of the target tissue by topical or systemic photosensitizers and subsequent irradiation with light from a laser or a lamp inducing cell death via generation of reactive oxygen species. Laser therapy and PDT have shown good results in the curative treatment of actinic keratoses, superficial basal cell carcinoma, Bowen's disease and cheilitis actinica. However, they are not recommended for primary malignant melanoma and invasive squamous cell carcinoma. In some patients, lasers and PDT might also be used effectively for the palliative treatment of cutaneous metastases. In selected patients, lasers and PDT may offer some advantages over routine procedures, e.g. reduction of scarring and better cosmetic results. However, when treating invasive tumors with curative intention, one has to bear in mind the lack of histologic control and the limited depth of tissue penetration of most laser and PDT therapies.

Aged↗
PubMed2001

[Truss-induced macular amyloidosis].

A 80-year-old male presented with a long time history of a localized red-brown macule with superficial lichenification and slight scaling in the right groin. An earlier skin biopsy revealed the presence of amyloid deposits. The patient therefore had a complete internal checkup including a rectal biopsy for exclusion of systemic amyloidosis. However, the laboratory data did not reveal any specific abnormalities including immunoglobulins and Bence-Jones protein. The rectal biopsy was also nonspecific. After skin examination, a rebiopsy was performed at our department showing acanthosis and spongiosis of the epidermis with parakeratosis. A homogenous eosinophilic deposit was present in the upper dermis and stained positive with thioflavine. At the second visit the patient wore a truss for a right inguinal hernia, perfectly matching the area of the skin lesion. Thus, the diagnosis of a localized macular amyloidosis was confirmed very likely due to permanent local friction. The classification of localized cutaneous amyloidoses should include local trauma as a cause to avoid unnecessary and exhausting internal checkups to exclude systemic involvement.

Aged↗
PubMed2000

Q-switch laser and tattoo pigments: first results of the chemical and photophysical analysis of 41 compounds.

BACKGROUND AND OBJECTIVE: In the Western world, there are at least 20-30 million people with tattoos. Improved self-image and social stigmatization are the main reasons for removing tattoos from skin. Q-switched lasers are applied to destroy the tattoo compounds in the skin. The treatment of tattoos containing ink often gives excellent results, whereas the results of treatments for coloured tattoos are not predictable and usually are worse. The chemical structure and the absorption spectra of the tattoo pigments are usually unknown. However, the efficacy of the treatment by using light of different Q-switched lasers (wavelengths 510, 532, 694, 755, 1064 nm) is correlated to both the chemical structure of the tattooed compounds yielding specific absorption spectra and the laser wavelength used. STUDY DESIGN/MATERIALS AND METHODS: A structural and spectroscopic analysis of 41 coloured pigments was performed. RESULTS: The 41 substances were identified, and they consist of 16 individual chemicals of different structured well-known industrial organic pigments. The absorption spectra of the 16 pigments were measured quantitatively. CONCLUSION: The results of the present analysis explain to some extent the outcome of clinical studies regarding laser therapy of coloured tattoos. Because the laser energy used produces a high temperature in the azo or polycyclic pigments, it is necessary to investigate whether that change causes possibly toxic or cancerogenic compounds.

Coloring Agents↗