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Biomedical subjects

M Landthaler

Publications and source records attributed to M Landthaler.

At least 127 records · Page 7Linked to original sources

[Therapeutic use of lasers in dermatology].

In recent years, lasers have become an indispensable part of dermatotherapy. Multiple lasers allow the treatment of the most contrasting indications. Port wine stains, childhood hemangiomas, telangiectasias as well as other vascular malformations and neoplasms represent the most significant indications for laser therapy. Furthermore, modern lasers are used not only for the removal of non-professional tattoos but also for removing solar lentigines and ephelides. In principle, laser therapy of wrinkles, rhytides and actinically damaged skin is possible, but exact diagnosing and excellent treatment techniques are vital because of the possibility of severe side effects.

Cosmetic Techniques↗

Photo-oxidative killing of human colonic cancer cells using indocyanine green and infrared light.

Despite of the approval of Photofrin in various countries, chemically defined sensitizers for photodynamic therapy (PDT) are still needed for the absorption of light in the infrared spectrum, which provides a maximal penetration of light into tissue. Therefore, both the efficacy and the mechanism of action of the clinically approved dye indocyanine green (ICG) and laser irradiation were investigated in vitro. For the investigation of phototoxic effects, HT-29 cells were incubated 24 h prior to irradiation by using different concentrations of ICG (10-500 microM). In each experiment, cells were irradiated using a continuous wave (cw)-diode laser (lambda(ex) = 805 nm, 30 J cm(-2), 40 mW cm(-2)). After laser irradiation, cell viability of dark control and of cells incubated with 500 microM ICG was 1.27+/-0.11 or 0.28+/-0.05 respectively. Using 100 microM ICG and D2O, cell viability was further decreased from 0.46+/-0.03 (H2O) to 0.11+/-0.01 (D2O). Using D2O and 100 microM ICG, the concentration of malondialdehyde, a marker of lipid peroxidation, increased from 0.89+/-0.10 nmol 10(-6) cells to 11.14+/-0.11 nmol 10(-6) cells. Using 100 microM ICG and laser irradiation sodium azide or histidine (50 mM), quenchers of singlet oxygen reduced the cell killing significantly. In contrast, when using mannitol, a quencher of superoxide anion and hydroxyl radical, cell killing was not inhibited. According to the present results, photoactivated ICG seems to kill colonic cancer cells due to the generation of singlet oxygen and the subsequent formation of lipid peroxides. Therefore, ICG might present a promising photosensitizer for PDT; first clinical results confirm these findings.

Cell Death↗

Epidermodysplasia verruciformis treated using topical 5-aminolaevulinic acid photodynamic therapy.

We describe a 65-year-old woman who had had wart-like lesions on the hands, lower arms and forehead for about 45 years. She had already had several basal cell carcinomas excised. Histological study, electron microscopy and in situ hybridization [human papilloma virus (HPV)-types 5/8/12/14/19-23/25/36] of skin biopsies confirmed a diagnosis of epidermodysplasia verruciformis (EV). Photodynamic therapy (PDT) was performed using a 20% 5-aminolaevulinic acid ointment applied for 6 h to the lesions and irradiating using an incoherent light source (lambda = 580-740 nm, 160 mW/cm2, 160 J/cm2). Following PDT, blistering and crusting of the lesions occurred, but these healed completely within 2-3 weeks without scarring, and the cosmetic result was excellent. Six months after PDT a skin biopsy was taken. In situ hybridization was positive for HPV type 8 in skin which was clinically and histologically normal. Twelve months after PDT a few lesions had recurred on the hands. Although permanent cure of EV cannot be achieved by any therapy at present and single lesions continue to appear in this patient, topical PDT might result in better control of HPV-induced lesions.

Administration, Topical↗

Treatment of digital mucous cysts with a carbon dioxide laser.

Digital mucous cysts are common tumours of the distal interphalangeal joint, causing pain, cosmetic disfigurement and nail deformities. This study describes six patients suffering from digital mucous cysts, some of which recurred after surgery. Carbon dioxide laser vaporization was performed under local anaesthesia, resulting in complete remission in four out of six patients. In two patients, the mucous cyst recurred within 3 weeks and 11 months, respectively, after laser therapy. Although complete remission cannot be achieved in all patients, carbon dioxide laser vaporization of mucous cysts is fast and easy to perform. No side-effects of therapy, such as nail deformities, pain or infection, occurred. For this reason, more aggressive treatments, such as radical excision of the cyst, could be restricted to cases in which carbon dioxide laser therapy fails.

Aged↗

Percutaneous and combined percutaneous and intralesional Nd:YAG-laser therapy for vascular malformations.

The numerous types of vascular abnormality are classified in groups according to their pathological and anatomical features. We present case histories of 2 patients who had vascular malformations of the face since birth or early childhood. Application methods, side-effects and complications of percutaneous and intra-lesional Nd:YAG-laser therapy are reviewed for these patients. A 54-year-old woman was treated percutaneously with the Nd: YAG-laser at 1064 nm, with 20 30 W, cw 1-5 s pulses and 2 - 3 mm spot size. A 59-year-old woman was treated with the combined percutaneous and intralesional laser therapy with 30 W, cw 1-5 s pulses and 2-3 mm spot size. In both cases, percutaneous or combined percutaneous and intra-lesional Nd: YAG-laser application resulted in a significant shrinking of the lesion. The Nd:YAG-laser radiation at 1064 nm presents an effective treatment of vascular malformations due to its deep penetration into the tissue. No standardized guidelines for Nd: YAG-laser therapy exist and the treatment parameters should be chosen individually according to the type of vascular malformation.

Arteriovenous Malformations↗

Detection of melanoma cells in the blood of melanoma patients by melanoma-inhibitory activity (MIA) reverse transcription-PCR.

The detection of tumor-specific mRNA transcripts in the blood of patients by reverse transcription (RT)-PCR has been used as a very sensitive technique for determining systemically disseminated tumor cells. On the basis of previous expression studies, we aimed to trace melanoma cells in the blood of melanoma patients by RT-PCR of melanoma-inhibitory activity (MIA) mRNA. To detect sensitively MIA transcripts in total RNA isolated from peripheral blood mononuclear cells (PBMCs), we established a sensitive PCR-ELISA system. With this assay, we detected one melanoma cell in 2 ml of blood by a single round of 32 PCR cycles. A total of 295 PBMC samples isolated from 166 patients with melanocytic tumors were tested with the MIA RT-PCR-ELISA: (a) 58 patients (99 samples) with malignant melanomas in stage I; (b) 49 patients (65 samples) with malignant melanomas in stage II; and (c) 47 patients (116 samples) with metastasized melanomas (stages III and IV), with an additional 12 patients (15 samples) with benign melanocytic nevi. Forty-four (26.8%) of 164 samples isolated from patients with melanomas in stages I and II were positive for MIA mRNA; in stages III/IV, 33 (28.4%) of 116 samples of patients, irrespective of clinically evident disease, were positive. Eleven (84.6%) of 13 PBMC samples from patients with metastasized melanoma and clinically evident disease without treatment were MIA mRNA-positive in contrast to only 19 (25.7%) of 74 samples isolated from patients in stage IV with metastasis during chemotherapy. Furthermore, none of the 16 PBMC samples of patients in stage IV without clinically detectable metastases at that time point during chemotherapy was MIA mRNA-positive. Interestingly, of the 44 positive samples (26.8%) isolated from patients with melanomas in stages I and II, 20 were still positive when retested after complete excision of the tumor. Our results reveal that amplification of MIA mRNA from the PBMCs of patients with malignant melanomas by PCR-ELISA provides a useful means to detect tumor cells in the systemic blood circulation. A correlation between positive blood samples and tumor burden in stages III and IV was detected, and, in addition, a significant effect of chemotherapy with respect to the reduction of the number of systemically spread tumor cells was observed. However, MIA amplification seems to be of little value as a surrogate marker for clinical staging or the detection of metastatic disease.

Adult↗

Deficiency of a novel retinoblastoma binding protein 2-homolog is a consistent feature of sporadic human melanoma skin cancer.

Using RNA arbitrarily primed PCR, the authors selected for transcripts with cell cycle-related differential expression in cultured human melanocytes. Among the partial cDNAs cloned, a novel cDNA was identified, which showed 54% identity to the recently cloned cDNA of the retinoblastoma binding protein-2 (RBP2). The 6.5-kB full-length cDNA of this RBP2-related gene, termed RBP2 homolog 1 (RBP2-H1), was obtained from a human teratocarcinoma cDNA library. Two independent libraries from human malignant melanomas were negative. A computerized sequence analysis revealed highly conserved motifs with possible functional meaning: two domains that, in the RBP2 homolog, mediate the binding and interaction with the proteins encoded by the retinoblastoma susceptibility gene, the TATA-binding protein, and the oncoprotein rhombotin 2; in addition, two DNA-binding zinc finger/leukemia-associated protein motifs were detected. Because a functional role in cell-cycle control and transcriptional activation can be envisioned, we investigated the expression of this novel transcript in normal fetal and adult tissues, as well as tissues of benign and malignant melanocytic tumors. By conducting multiple Northern blot, RT-PCR, and in situ hybridization analyses, the authors showed that the corresponding mRNA is expressed in virtually all normal tissues. Accordingly, they found RBP2-H1 expression in microdissected tissue samples from benign melanocytic nevi (n = 10). In contrast, the transcript is significantly down-regulated or even lost in tissue samples from human malignant melanomas (n = 13), melanoma metastases (n = 10), and melanoma cell lines (n = 7). The authors concluded that the loss or down-regulation of RBP2-H1 expression could be a useful molecular marker for a transformed phenotype in the human melanocytic system.

Amino Acid Sequence↗

Are dermatologists in private practice interested in teledermatological services?

Diagnosing dermatologic skin conditions can be difficult, especially in pigmented skin lesions. Therefore, the consultation of an expert via teledermatology could prove vital. For this purpose, a rapid transfer of medical data including high resolution images is essential. This transfer can be performed with a variety of modern telecommunication technologies, including ISDN, highspeed-ISDN, Internet, and Intranet. As the levels of both communication software and camera-systems can be quite different, our survey investigated the equipment of 84 dermatologists in private practice. A questionnaire was distributed on computer equipment, operating system software, and any image documentation systems used, as well as required telecommunications equipment and possible applications of tele-dermatology. This survey showed a response rate of 54% and proves that dermatologists in private practice are interested in telemedicine services. Most dermatologists surveyed use Windows 95 operating software and 74% have access to modern ISDN modems or PC-cards. Dermatologists currently prefer applications with low-tech communication hardware and software requirements. Consultation of dermatological centers was the favored application with 59%. Our survey clearly demonstrates that a high percentage of dermatologists in private practice would use tele-dermatology. In our experience, for the excellence of this service an image documentation system is essential to provide the tele-dermatological expert with standardized images with constant illumination.

Dermatology↗

[Sebaceous gland hyperplasia as a side effect of cyclosporin A. Treatment with the CO2 laser].

HISTORY AND CLINICAL FINDINGS: After renal transplantation 11 years previously followed by immunosuppression with cyclosporin A, a 59-year-old man developed, shortly after starting the medication, skin-coloured nodules in the region of both ears and the forehead. In the subsequent years the skin changes spread throughout the entire face. The nodes (up to 2 cm in diameter) and nodules were soft and yellowish-white in colour. In addition there were numerous distinct telangiectasias over the whole face. INVESTIGATIONS: Several skin biopsies were taken. They showed largely unremarkable epidermis but marked enlargement and multiplication of the sebaceous glands. DIAGNOSIS, TREATMENT AND COURSE: In view of the histological findings the diagnosis of sebaceous hyperplasia was established. After a trial with carbon dioxide laser, treatment over the entire surface of the two auricles was undertaken under full anaesthesia. The normal auricular contour was reconstituted by removal of the papules and nodes, without any scar formation. CONCLUSION: In the absence of an alternative medication and if the very marked skin changes show no sign of regression, "shaving off" by scalpel of the nodes and nodules or conventional surgery has been the available treatment. However, removal by carbon dioxide laser has the advantage of fewer side effect, is less stressful to the patient and provides a dry operative field.

Biopsy↗

[Acne comedonica following radiation therapy].

HISTORY AND CLINICAL FINDINGS: A 50-year-old female patient underwent extirpation of a moderately differentiated, partially tubular ductal carcinoma of the left mamma and dissection of the left axilla followed by postoperative radiation therapy (total dose 58/48 gy). 2 weeks after the radiation therapy was stopped, treatment with goserelin subcutaneously was started. 6 weeks later numerous open and closed comedons appeared which were sharply confined to the radiation areas of left mamma and sternum. DIAGNOSIS, TREATMENT AND COURSE: Because of the clinical diagnosis of acne comedonica following radiation therapy a local treatment with benzoyl-peroxide gel 5% and erythromycin cream 2% was performed, which led to improvement of the skin lesions within a few weeks and total restitution within 3 months. During one year no comedons have occurred although the local therapeutics are not applied constantly anymore. CONCLUSION: Acne comedonica in the radiation area is a rarely known side effect of radiation therapy. Although the skin lesions cause no pain or itching they can affect the patient due to cosmetic changes. Local treatment with comedolytic acne therapeutics is effective.

Acne Vulgaris↗

Leg telangiectasia treatment with a 1.5 ms pulsed dye laser, ice cube cooling of the skin and 595 vs 600 nm: preliminary results.

BACKGROUND AND OBJECTIVE: Preliminary results indicate that pulsed dye lasers (PDL) with 1.5 ms pulsewidth and 595 nm wavelength are effective in the treatment of leg telangiectasia. The aim of this study was to evaluate if the clinical results could be improved by a) an effective skin cooling with ice cubes and b) the longer wavelength of 600 nm. STUDY DESIGN/MATERIALS AND METHODS: In 87 patients with vessels up to 1 mm in diameter, 257 single test treatments were performed using wavelengths of 595 and 600 nm, fluences of 16, 18, and 20 J/cm2, a 1.5 ms pulse duration, and an elliptical spot of 2 x 7 mm. In 7 patients, the skin surface temperature curve was measured after cooling with ice cubes vs hydrogel dressings, and spot geometry and fluence were investigated with and without the gel dressing. RESULTS: Vessel clearance was evaluated 6-8 weeks after treatment. 20 J/cm2 were most effective (80% clearance >50%), and 18 J/cm2 were more effective than 16 J/cm2 (66.2 vs 52.5% clearance >50%). There was a tendency towards better results with 595 nm, but the differences were not significant. Vessels with a diameter <0.5 mm cleared significantly better than those with 0.5-1 mm (69.1 vs 31.9% clearance >50%). Hypo- and hyperpigmentation were seen in 32% of the patients. Cooling with ice cubes proved to be far more effective than with hydrogel dressings (temperature decrease approx 15 vs 5 degrees C). Additionally, the gel dressing caused an energy loss of approx 35% and an irregular spot geometry as shown on burn paper. CONCLUSIONS: Treatment of leg telangiectasia with the 1.5 ms-PDL is safe and effective, especially in vessels smaller than 0.5 mm in diameter; 595 nm and 18 J/cm2 seem to be somewhat more effective as 600 nm and 16 J/cm2; and 20 J/cm2 are even more effective, but persistent hyperpigmentation cannot yet be excluded due to insufficient follow-up time. Cooling with ice cubes is more effective and less expensive than gel dressings, and the short term clinical results are equivalent, even if the frequency of transient pigmentary changes is increased.

Bandages↗

[On the color black].

The colour black often has a negative symbolic connotation. However, our synopsis of its occurrence in dermatology, and the historical changes and sociocultural differences in the way it is viewed, highlight the diversity of its potential meaning. Unlike any other colour, black requires personal confrontation.

Adult↗

[p16(INK4A)/CDKN2--the "melanoma gene"? Status of research and outlook].

The gene of the cyclin-dependent kinase 4 (CDK4)-inhibitor p16INK4A (CDKN2/MTS1) has been proposed as a candidate for a tumor-suppressor gene located on chromosome 9p21, a frequently deleted region in a series of human cancers including malignant melanoma. An increasing and sometimes conflicting body of data has accumulated regarding the frequency of homozygous deletions and mutations as well as the importance of p16INK4A in malignant melanoma. The purpose of this review is therefore to summarize the current knowledge on p16INK4A and to discuss its biologic significance in the pathogenesis of melanocytic tumors.

Cell Cycle↗

[Laser and cryotherapy of hemangioma in infants in a direct comparison].

In our comparative study, 40 infants ranging in age from 1 week to six months, were treated for their hemangiomas. Cryosurgery was performed on 20 hemangiomas whereas the others were treated with flash lamp-pumped pulsed dye laser (FPDL). In 72% of initial macular, flat-topped, superficial hemangiomas a predominant (> 75%) or complete regression could be achieved. In 68% of cutaneous-exophytic lesions, both therapeutical modalities showed a sufficient regression (> 50%) or marked growth inhibition after two sessions with further improvement after additional treatment. Cutaneous hemangiomas and the cutaneous part of combined hemangiomas responded well to both therapies whereas subcutaneous hemangiomas were predominantly influenced by cryotherapy. Our data emphasise the efficiency of early treatment of childhood hemangiomas. Since FPDL therapy is easy to perform, less time-consuming and reduces post-therapeutic exsudation, this treatment is preferable in initial macular, flat-topped and superficial lesions while cryotherapy is considered to be superior in lesions with marked elevated and/or subcutaneous parts.

Cryosurgery↗

[Allopurinol in treatment of cutaneous sarcoidosis].

Several reports more than ten years ago provided evidence that allopurinol may be effective for cutaneous sarcoidosis. We therefore treated two patients with histologically confirmed scar sarcoidosis and two with nodular sarcoidosis. A daily dosage of 300 mg allopurinol was given over a period of 4-7 months as single drug therapy. In both patients with scar sarcoidosis, the skin manifestations completely regressed while in the patients with nodular sarcoidosis there was significant improvement. The concomittant pulmonary involvement in two patients was unpredictable, in one patient improved while the other was deteriorated, The mode of action is still unclear but because of the positive results and the low rate of side effects, allopurinol seems a reasonable agent for treating cutaneous sarcoidosis.

Administration, Oral↗

[Minocycline-induced hyperpigmentation].

A common adverse effect of minocycline therapy is cutaneous pigmentation. We describe two patients who presented with hyperpigmentation caused by minocycline. One patient, aged 54 years, had taken minocycline due to lung silicosis for 3 years before black pigmentation of the face occurred. The other 49 year-old patient developed grey-black hyperpigmentation on both lower legs after a 6-month therapy with minocycline for folliculitis. This patient was treated with the Q-switched ruby laser and the pigmentation resolved in the treated area. The different clinical and histological forms of minocycline-induced hyperpigmentation are discussed.

Administration, Oral↗