Biomedical subjects

P Altmeyer

Publications and source records attributed to P Altmeyer.

At least 235 records · Page 13Linked to original sources

PubMed1994

[Schimmelpenning-Feuerstein-Mims syndrome (SFM syndrome)].

We report on the case of a 70-year-old caucasian woman with a large linear sebaceous naevus with multifocal intralesional basaliomas and a lipodermoid of the left eye. This rare finding has been preserved because of the special history of the patient. The naevus spread on the left side from parietal to retroauricular, nuchal and sternal. Because of the patient's cardio-pulmonary insufficiency we excised the basaliomas under local anaesthesia. We also made a partial stripped excision of the left-sided parietal parts of the naevus.

Aged↗

PubMed1994

Contact allergy to 8-methoxypsoralen.

A 36-year-old female patient was treated with PUVA for dyshidrotic eczema that had not shown sufficient response to topical therapy over the previous months. PUVA therapy caused acute aggravation of the eczema. Patch testing demonstrated Type IV sensitization to 8-methoxypsoralen in Meladinine solution.

Adult↗

PubMed1994

Sonographic quantification of the type IV reaction after intradermal application of recall antigens.

20-MHz B-scan high-resolution sonography permits non-invasive, two-dimensional visualisation of micromorphological structures in vivo, and allows precise measurement of the depth and extent of inflammatory skin lesions. In 50 patients, the reactions following intradermal application of 8 recall antigens to the volar forearm were evaluated clinically and sonographically at various times (0, 24, 48, 72 h). In 30 patients, one of the inflammatory papules was excised after 48 h for complete histological work-up (serial sections) and subsequent comparison with the sonographic image. Infiltrates were characterised in the ultrasound scans by the almost regular occurrence of convexity of the skin surface, by a loosened structure (loss of echogenicity) of the corium and by protrusion of the corium into the subcutaneous fatty tissue. It was also possible to follow the dynamics of the type IV reaction with the measurement of echogenicity (densitometry). High-frequency ultrasound is an objective, exact and very sensitive tool for the measurement of type IV reactions after intradermal application of recall antigens and therefore superior to clinical evaluation. The B-scan was superior to the A-scan. However, for routine evaluation of tuberculin-like reactions, sonography is too time-consuming. Our results suggest that densitometry provides no additional or necessary information compared to sonometry.

Adult↗

PubMed1994

Evaluation of the efficacy of H1 blockers by noninvasive measurement techniques.

BACKGROUND: Evaluation techniques for determining the strength of action and the onset of activity of H1 receptor blockers have not yet been sufficiently standardized. OBJECTIVE: The clinical efficacy of the H1 receptor blocker loratadine was to be measured upon a wheal response subsequent to an intracutaneous injection of 0.1 ml histamine (0.1%). METHODS: In a pilot study, 10 patients were treated with the H1 receptor blocker loratadine for a period of 7 days. Various noninvasive measurement techniques, i.e. 20-MHz sonography, laser-Doppler flowmetry, chromatometry using the Lab* system and computer-assisted planimetry, were applied to provide a quantitative evaluation of the wheal and the marginal erythema. Using these quantification methods, the development of the urticarial reaction 20 min after injection and its decline were evaluated. RESULTS: The urticarial reaction was reduced substantially under treatment with 10 mg loratadine over a period of 7 days. The methods we used could accurately quantify different aspects of the urticarial reaction noninvasively. CONCLUSIONS: All of the chosen measurement techniques are widely recognized. For objective assessment of the urticarial reaction with high-frequency ultrasound, we recommend the measurement of the distance between skin entrance echo and fascia since the demarcation of the wheal is often impossible by ultrasound. In order to improve comparison of results of various workgroups in the future, we therefore suggest the use of the selected combination of noninvasive procedures as a standard for evaluating the efficacy of H1 receptor blockers.

Administration, Oral↗

PubMed1994

Fumaric acid esters (FAEs) suppress CD 15- and ODP 4-positive cells in psoriasis.

A histological-immunohistological study was conducted to investigate the effect of systemically administered fumaric acid esters (FAEs) on epidermal thickness and composition of the inflammatory infiltrate in psoriatic plaques. The very first effect of systemic therapy with FAEs is the disappearance of CD 15-positive cells in the beneath the epidermis, accompanied by a significant reduction in T-helper cells beneath the epidermis, pointing to an immunosuppressive effect. This is followed after some delay by a reduction in acanthosis and hyperkeratosis. The reduction in infiltrating T-lymphocytes corresponds to that seen after systemic or intralesional therapy with cyclosporin. However, the normalization of the psoriatic plaques takes longer under the influence of FAEs than under cyclosporin.

Adult↗

PubMed1994

Assessment of actinic skin damage by 20-MHz sonography.

Ninety people were evaluated on age-related changes of the dermal connective tissue in light-exposed and protected skin areas non-invasively by 20-MHz sonography. The method allows sonographic structures to be measured and densitometric values to be quantified in a region of interest. Sonography of sun-exposed skin regions shows an echo-poor band in the upper dermis, which corresponds to actinic elastosis in the histological picture. The band is sharply demarcated from the entry echo. The border towards the non-actinically altered dermis below is often serrated. The sonographic phenomena can be explained by the micromorphological changes that develop in the upper dermis in actinic elastosis. An increased amount of elastic material and the destruction of the fiber architecture as well as an increase in ground substance and a mild inflammatory reaction cause a reduction in echogenicity. The extent of elastotic alterations and their progression is expressed in the densitometric values. These are low in areas of high sun exposure (the forehead and the infraorbital region). The echogenicity of the echolucent band (ELB) diminishes with increasing age. In highly exposed regions we found the lowest densitometric values already in the 41- to 50-year-olds. However, the width of the ELB remains relatively constant, extending in all locations to the middle dermis. This finding differs from earlier publications. On the buttock skin as a nonexposed area, an ELB could only be found in 6.7% of the cases.

Adipose Tissue↗

PubMed1994

The pseudo-elongation of capillaries in psoriatic plaques.

The intrapapillary vessels in the psoriatic plaque are described as elongated, twisted and multiplied. However there is neither proliferation nor necrosis of vessels in growing and dissolving psoriatic plaques. In 120 patients suffering from psoriasis vulgaris, computer-supported image analysis and in 8 patients additionally 3D reconstructions were made to investigate the regression process of the intrapapillary capillaries in the active and resolving psoriatic plaque. In acanthotic epidermis with a thickness of > 400 microns the first subpapillary horizontally oriented plexus is included in the papilla due to the down-growing of the epidermal rete pegs. In the evaluation of the computer-supported image analysis there is only little variation in the levels of the different vascular plexuses within the dermis, while the epidermis is decreasing from > 600 microns to > 100 microns. In the 3D reconstruction of the transition of a psoriatic lesion into adjacent non-involved skin it could be proved that, apart from the epidermal alterations, there is virtually no difference in the arrangement of the vessels between the psoriatic lesion and the adjacent non-involved skin. In psoriasis the vessels do not proliferate, they rest as resident structures and are embraced by the down-growing rete pegs.

Capillaries↗

PubMed1994

Psoriasis vulgaris in 50 MHz B-scan ultrasound--characteristic features of stratum corneum, epidermis and dermis.

One hundred and forty fully developed, non-treated plaques of psoriasis vulgaris from the arms and legs of 22 patients were examined using 50 MHz B-scan ultrasound and compared with the images from adjacent, clinically normal skin. To visualize the dermis, high pre-amplification (digitization range 200 mV) was used, determined according to A-scan images. For evaluation of epidermal phenomena, low pre-amplification (digitization range 380 mV) was chosen in order to avoid overmodulation of the skin entry echo. In 10 patients, sonographic images were compared with histological sections from the exact same planes at the same magnification. At low pre-amplification, the skin entry echo is displayed as a markedly widened, frequently interrupted band composed of spots varying in thickness, height and echo density. Within these spots, several lamellae can be observed, represented as fine, echo-rich lines stacked one upon another. These phenomena correspond histologically to focal hyperparakeratosis, scaling and cracking of the stratum corneum. Due to the low amplification of the echo-signal the dermis is not visible. High pre-amplification allows evaluation of dermal changes. Below the entry echo there is an echopoor band (EPB) corresponding to the sum of acanthosis and infiltrate in the upper dermis. Underneath the EPB the dermis is represented as a zone with scattered internal echoes which are less intense than in normal skin. Dorsal shadows are typically present. They are artifacts emanating from epidermal regions with marked hyperkeratosis and disappear when the sonographic characteristics of the epidermis are changed, for instance by application of ointments prior to sonographic examination.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1994

The hyperperfusion of the psoriatic plaque correlates histologically with dilatation of vessels.

We examined psoriatic lesions on the upper legs in 20 patients, using a two-dimensional Laser-Doppler-Scanner (Laser Doppler Perfusion Imager LDI, Lisca Development, Linköping/Sweden). The plaques were evaluated weekly during therapy with dithranol. Five plaques were reconstructed three-dimensionally before and after therapy (reconstruction program ANAT 3D, SIS, Münster, Germany). The psoriatic plaque was represented in the Laser Doppler Perfusion image as a sharply demarcated, hyperperfused area. The perfusion of the plaques dropped during therapy with dithranol to just slightly increased values, compared with normal skin (2.04 arbitrary units AU, healthy skin 1.1 AU). Using three-dimensional reconstruction, we investigated the volume of dermal vessels and the density of papillae. When compared, the volume of papillary vessels was twice as large in psoriatic as in healthy skin. The number of the papillae per square millimetre, detected by three-dimensional reconstruction, was not reduced significantly during therapy. We think that the increased perfusion of the psoriatic plaque is due to the combination of morphological (dilatation of vessels), dynamic (increased blood flow) and optical effects (reduced scattering and increased sampling depth of the laser-beam in acanthotic tissue).

Anthralin↗

PubMed1993

A local education campaign on early diagnosis of malignant melanoma.

The growing incidence of all kinds of skin cancer is a worldwide phenomenon observed in the last decades. Malignant melanoma is of special concern because of its high death rate when in an advanced stage, poor therapeutic response and fast growing incidence. Malignant melanoma is primarily located on the skin and therefore well suited for early cancer detection. The "Deutsche Dermatologische Gesellschaft" carried out a highly successful information campaign in Germany. Under this roof we organised different campaigns. Following considerable success in a campaign in 1989, a total of 1467 patients were examined and advised in the course of a local initiative (Education Campaign "Black cancer") in the city of Bochum (approximately 400,000 inhabitants) in the summer of 1991. In addition to full body examinations, important data were collected concerning the degree of knowledge about skin cancer, epidemiology, and the risk of skin cancer in general. As a result of the clinical examinations, 73 patients with strongly suspected skin cancer have been treated. Within this group, 14 malignant melanomas (1.0%) as well as 34 basal cell carcinomas (1.9%) were diagnosed. These numbers highly exceed the assumed risk incidence of skin cancer in Germany. Even on the assumption that the population was selective it is to be feared that a high number of individuals with skin cancer remain undetected and untreated. The majority of persons seeking advice had been motivated by the local media. The response and results of this local campaign indicate that further preventive measures for the general population in Europe are conceivable, meaningful and urgently needed.

Adolescent↗

PubMed1993

A wound healing model with sonographic monitoring.

The methods used hitherto for quantification of skin repair processes only allow an examiner a two-dimensional assessment of superficial wound healing. With the recent advent of high frequency B-scan ultrasonography in dermatology it has become possible to follow the course of healing and evaluate the healing processes in deeper layers of the skin. In this investigation 80 patients received cryosurgery for treatment of basal cell carcinomas on the face or neck region. As the size of cryosurgical defects can be precisely controlled they are potentially useful as standardized wound healing models. The course of wound healing after cryosurgery using a digital ultrasound scanner (DUB 20, Taberna pro medicum, Lüneburg, Germany) was monitored. The usable depth of penetration of the echo signal is approximately 7 mm. The lateral resolution is approximately 200 microns, the axial resolution approximately 80 microns. The cryolesion and the repair processes were examined ultrasonographically and clinically over a period of at least 3 weeks or until the wound had completely healed. The depth of invasion and lateral extent of the basal cell carcinoma as well as the size of the induced cryolesion can be determined by ultrasound. The exudative phase after cryosurgery, with developing oedema and necrosis, can be quantified on the basis of the reduced reflectivity in the corium. The repair processes taking place in the region of necrosis can be visualized in the ultrasound scan. The ultrasonically monitored wound healing model which we have demonstrated is particularly suitable for investigating the efficacy of drugs which promote healing.

Aged↗

PubMed1993

Altered muscle metabolism in pustular psoriasis (Zumbusch type): demonstration by 31P magnetic resonance spectroscopy.

We report a patient with pustular psoriasis (Zumbusch type) with diffuse muscle pain. Evaluation of skeletal muscle metabolism during rest, graded levels of exercise and recovery was performed using 31phosphor magnetic resonance spectroscopy (31P MRS). Our results underline the systemic character of severe pustular psoriasis. The clinical improvement after drug therapy (prednisolone and etretinate) correlated well with the measurable changes in vivo of several metabolites and indices important in muscle contraction, such as phosphocreatine (PCr), inorganic phosphate (P(i)), intramuscular pH and the phosphorylation potential (PCr/Pi). Abnormal accumulation of sugar phosphates (phosphomonoester) as well as their slow resolution during recovery reflect profound alteration of metabolism in the sense of block in glycolysis. Our results show that 31P MRS is well suited to identify and measure subtle changes in the muscle metabolism occurring in pustular psoriasis.

Adenosine Triphosphate↗

PubMed1993

[Successful conservative therapy of pincer nail syndrome].

We report on a 39-year-old female patient who has had a pincer-nail syndrome affecting most of the toenails and all her fingernails since early childhood. A conservative treatment with uric acid ointment under occlusion was used to dissolve the central part of the curved nail. With this therapy, the growing nail slowly curved back into its normal shape and all clinical symptoms of the pincer-nail syndrome disappeared.

Adult↗

PubMed1993

[The pustular bacterid (Andrews). Are there clinical criteria for differentiating from psoriasis pustulosa palmaris et plantaris?].

A case report on the rare entity of "true" Andrews bacterid and a review of the literature are used to illustrate clinical and morphological criteria that allow discrimination between Andrews bacterid and psoriasis pustulosa palmaris et plantaris. The patient noted the eruption of sterile pustules on palms and soles for the first time in his life at the age of 73 during an attack of acute tonsillitis. He had no history of psoriasis and it was also unknown in the family history. In contrast to psoriasis pustulosa palmaris et plantaris, Andrews bacterid becomes manifest as isolated pustules with an erythematous rim, which do not destroy the ridged skin. On the rest of the integument disseminated pustules are seen but no psoriatic stigmata. Thus, apart from the criterion of coincidence with an infection and the short course, we can also differentiate between Andrews bacterid and psoriasis pustulosa palmaris et plantaris on the basis of clinical criteria.

Aged↗

PubMed1993

[Symmetrical cyanosis circumscripta e lipomate].

We report the case of a 78-year-old woman with a symmetrical type of cyanosis circumscripta e lipomate above both knees. Clinical symptoms, pathogenesis and possible treatments are presented.

Aged↗

PubMed1992

Malignant melanoma in 20-MHz B scan sonography.

In order to assess the value of 20-MHz sonography in the pre-operative diagnosis of malignant melanomas, 54 melanomas were examined. The pre-operative ultrasound scans were compared with corresponding histological sections from the excised tumours. A computer-aided measurement of the tumour thickness (sonometry) and the internal echo density (densitometry) was performed in the ultrasound scans. The melanomas appeared as largely echolucent zones. There was a significant correlation between the tumour thickness measured in the ultrasound scan and those measured in the histological sections (r = 0.938, p less than 0.001). As a rule the tumour thickness determined by sonometry were greater than the histometrically determined values. Subtumoral inflammatory infiltrate and other hypo-echoic structures in the region of the tumour are possible causes of the discrepancies. Some of those hypo-echoic structures can be identified and disregarded in B scan measurement. Even if a definite differential diagnosis is not possible on the basis of the ultrasound scan alone, 20-MHz sonography provides additional information which can be of use in surgical planning.

Adolescent↗

PubMed1992

The pustule in palmoplantar psoriasis: transformed vesicle or mature microabscess? A three-dimensional study.

Psoriasis on the palms and soles is characterized by pustules, vesicles and hyperkeratotic plaques. Several studies have postulated that the pustules and vesicles are round or egg-shaped. This three-dimensional study reveals that neither pustules nor vesicles have a regular spherical morphology. The vesicles are located in the upper and middle layers of the epidermis and may exhibit dumb-bell- or banana-shaped lumina. The pustules consist of different compartments combining characteristics of a dyshidrotic vesicle with those of a microabscess of Munro.

Abscess↗

PubMed1992

[Immunogenetic studies of familial occurrence of progressive systemic scleroderma and circumscribed scleroderma].

Two different forms of scleroderma in one family are described: the mother suffers from systemic sclerosis and her daughter from linear morphoea. The observed HLA antigens indicate that systemic sclerosis and morphoea have various features in common. The immunogenetic data can be used to calculate the aetiological and preventive fractions, which together with environmental hazards and other risk factors describe the HLA-associated potential for provocation of scleroderma.

Adolescent↗