Dermabrasion for the treatment of xeroderma pigmentosum.
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Carcinoma, Squamous Cell↗
Biomedical subjects
R Hoffmann
Publications and source records attributed to R Hoffmann.
Diagnostic value of duplex ultrasound and liquid crystal contact thermography in preclinical detection of deep vein thrombosis after proximal femur fractures.
During a prospective clinical study the diagnostic value of the two non-invasive examinations colour-coded duplex ultrasound (Duplex) and fluid crystal contact thermography (LCCT) was investigated in relation to phlebography, the standard examination for the diagnosis of deep vein thrombosis (DVT), in 112 patients with proximal femur fractures. In 19% of the patients, DVT was diagnosed by phlebography, with the main localisation in the lower leg in 19 of 21 (90%) thromboses. With a negative prediction value of 83%, Duplex is less suitable than LCCT under such difficult examination conditions as the early postoperative period. The specificity of Duplex is 95%, but the sensitivity only 18%. The specificity of LCCT is 85% and the sensitivity 75%. Considering the frequency of postoperative DVT after surgery on the legs, especially hip surgery, a postoperative screening for DVT should become mandatory. LCCT has proved to be a suitable, cheap, non-invasive examination with a negative prediction value of 94%.
Adult↗
Differential distribution of rat PDE-7 mRNA in embryonic and adult rat brain.
Currently not much is known about the distribution and function of the phosphodiesterase type 7 (PDE-7) enzyme. Therefore, we carried out an extensive distribution analysis of the rat and human PDE-7 by in situ hybridization as well as RT-PCR. We isolated a partial rat cDNA clone that is highly homologous to the sequence of the human PDE-7 gene. RT-PCR tissue distribution analyses revealed expression of the mRNA of the human and rat-enzymes in most of the examined tissues, like adult heart, lung, brain, and liver, as well as in several cell lines of the immune system. In situ hybridization with the rat PDE-7 showed a differential expression pattern during the late phases of the developing rat brain with higher levels of mRNA in cortical and telencephalic structures in d 16, 18, and 20 embryonic stages, whereas in adult rat brain, higher amounts of mRNA could only be detected in cerebellum and, to a lesser extent, in hippocampus and the olfactory system.
3',5'-Cyclic-AMP Phosphodiesterases↗
[Therapy of dislocated calcaneus joint fracture with the AO calcaneus plate].
From August 1992 to March 1997, 66 patients with 71 displaced intraarticular calcaneal fractures were prospectively examined after an operative treatment using an extended lateral approach and the ASIF calcaneal plate followed by early functional postoperative treatment (mean follow-up 25 months, retrieval rate 96%). To classify the type of fracture and to verify the results of reduction and of retention CT scans in the coronal and transverse plane were performed pre- and postoperatively and on the day of assessment. The Zwipp Score was used for clinical evaluation. After fractures with 5 to 8 points according to the calcaneal fracture scale, 97% of the patients had an anatomical or near anatomical reduction of the posterior facet and the clinical outcome in 82% of the patients was graded as good or excellent. In 70% of patients with a fracture rated 9 to 10 points a good reduction was demonstrated and clinically there were 67% good or excellent results. But in the fractures with 11 to 12 points, despite 40% good reductions, the clinical outcome was graded as good in 10% of the patients only. However, if the post-operative displacement of the posterior facet was more than 2 mm no patient had a good result independent of the type of fracture. Due to restoration of the geometry of the most comminuted fracture types and the immediate partial weight bearing secondary soft tissue problems could be minimized without any loss of articular reduction. Anatomical reduction and stable internal fixation together with adequate physical therapy are apparently preconditions but not a guarantee for a good clinical result after displaced calcaneal fractures.
Adult↗
[Neonatal lupus erythematosus and maternal HELLP syndrome: is there a pathogenetic link?].
A newborn boy developed annular erythematous lesions on his entire body. Histopathological examination showed typical features of lupus erythematosus. His mother was positive for anti-Ro/SSa and anti-La/SSb antibodies. Neonatal lupus erythematosus was diagnosed. During pregnancy the mother had suffered from HELLP syndrome. The reported case points out the necessity to differentiate HELLP syndrome from first manifestation of lupus erythematosus during pregnancy. A direct causal relationship between neonatal lupus erythematosus and HELLP syndrome of the mother seems to be unlikely.
Adult↗
[Dorsal removal and stabilization of giant cell tumor of the thoracic spine].
The incidence of giant cell tumors accounts for less than 5% of all bone tumors. In the thoracic spine these tumors are extremely rare (1-1.5% of the giant-cell tumors). The potential malignant character of giant cell tumors of the spine usually leads to wide surgical extirpation by ventral approach. The filling of bone defects with palacos cement after tumor resection is sufficient in the metaphysis of long bones. The case presented here is a giant cell tumor of the upper thoracic spine with primarily posterior destruction of the vertebral body and left arch. A single dorsal approach allowed for intralesional resection and filling of the defect with bone cement. This procedure was sufficient to achieve a solid fixation without recurrence of the giant cell tumor.
Adolescent↗
Anterior cruciate ligament reconstruction: the diagnostic value of MRI.
A prospective study was carried out in order to evaluate the predictive value of MRI in the early postoperative course after cruciate ligament replacement. Twenty patients who had undergone anterior cruciate ligament reconstruction using autologous patellar tendon/bone grafts were examined clinically and with contrast enhanced MRI at 2, 12 and 24 weeks, and 1 and 2 years after operation. The clinical findings were evaluated according to the scores established by Lysholm, OAK and IKDC. The MRI scans (SP 63, 1.5 Tesla) were assessed in terms of the quality and signal intensity of the reconstructed ligaments. During the first postoperative year there was a significant increase of signal intensity and in homogeneity of the neoligament on in the MRI. Seventeen patients had an average value for signal/noise of 1.1 at two weeks after surgery, which had increased to 7.1 at 1 year. In 14 patients the reconstructed ligament could not be evaluated in MRI scans after 1 year but clinical instability was not suspected in any of these patients. Two years after operation the MRI signal, intensity of the neoligament was again decreasing.
Adolescent↗
5 alpha-reductase activity in the human hair follicle concentrates in the dermal papilla.
Hair growth depends on a close interaction of different cell populations of the hair follicle. In certain regions of the body, androgens interfere with this highly regulated cooperation in a yet poorly understood manner. The response of hair follicles to androgens can be categorized as androgen-dependent, e.g. in the beard, androgen-sensitive, e.g. in the frontal scalp of affected individuals, or androgen-independent, e.g. in the occipital scalp. At the target cell level, the balance between 5 alpha-reductase, 17 beta-hydroxysteroid-dehydrogenase (17 beta-HSD) and 3 alpha-hydroxysteroid dehydrogenase (3 alpha-HSD) yields metabolites with different androgenic potential. We examined this target cell-specific androgen metabolism in microdissected intact sub-units of dermal papillae, connective tissue sheaths (CTS) and root sheaths. In dermal papillae, 5 alpha-reductase predominated with an accumulation of the strong androgen 5 alpha-dihydrotestosterone. The specific activity of 5 alpha-reductase in the papillae exceeded those in the other hair follicle compartments by a factor of at least 14 in the scalp (5.4, 0.4 and 0.1 pmol/h per mm3 in the papilla, CTS and root respectively and at least 80 in the beard (16.0, 0.2 and 0.4 pmol/h per mm3 in the papilla, CTS and root respectively). The root sheath keratinocytes expressed low 5 alpha-reductase levels, but high 17 beta-HSD levels, with androstenedione as the major metabolite. The CTS expressed both 5 alpha-reductase and 17 beta-HSD, resulting in androstenedione, 5 alpha-androsterone and 5 alpha-androstanedione. In the CTS and the root sheath, only minor amounts of 5 alpha-DHT were found. In beard papillae, the 5 alpha-reductase activity was three times that in the occipital scalp papillae. These results indicate that the androgen response of hair follicles depends on a differentiated intrafollicular androgen metabolism and that the dermal papilla might be a primary target in this process.
Androgens↗
Natural infection with microsporidian organisms (KW19) in Vannella spp. (Gymnamoebia) isolated from a domestic tap-water supply.
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Amoebida↗
Intravascular ultrasound predictors of angiographic restenosis in lesions treated with Palmaz-Schatz stents.
OBJECTIVES: This study sought to evaluate the clinical, procedural, preinterventional and postinterventional quantitative coronary angiographic (QCA) and intravascular ultrasound (IVUS) predictors of restenosis after Palmaz-Schatz stent placement. BACKGROUND: Although Palmaz-Schatz stent placement reduces restenosis compared with balloon angioplasty, in-stent restenosis remains a major clinical problem. METHODS: QCA and IVUS studies were performed before and after intervention (after stent placement and high pressure adjunct balloon angioplasty) in 382 lesions in 291 patients treated with 476 Palmaz-Schatz stents for whom follow-up QCA data were available 5.5 +/- 4.8 months (mean +/- SD) later. Univariate and multivariate predictors of QCA restenosis (> or = 50% diameter stenosis at follow-up, follow-up percent diameter stenosis [DS] and follow-up minimal lumen diameter [MLD]) were determined. RESULTS: Three variables were the most consistent predictors of the follow-up angiographic findings: ostial lesion location, IVUS preinterventional lesion site plaque burden (plaque/total arterial area) and IVUS assessment of final lumen dimensions (whether final lumen area or final MLD). All three variables predicted both the primary (binary restenosis) and secondary (follow-up MLD and follow-up DS) end points. In addition, a number of variables predicted one or more but not all the end points: 1) restenosis (IVUS preinterventional lumen and arterial area); 2) follow-up DS (QCA lesion length); and 3) follow-up MLD (QCA lesion length and preinterventional MLD and DS and IVUS preinterventional lumen and arterial area). CONCLUSIONS: Ostial lesion location and IVUS preinterventional plaque burden and postinterventional lumen dimensions were the most consistent predictors of angiographic in-stent restenosis.
Adult↗
Three-dimensional echocardiographic determination of left ventricular volumes and function by multiplane transesophageal transducer: dynamic in vitro validation and in vivo comparison with angiography and thermodilution.
The goal of this study was to validate 3-dimensional echocardiography by multiplane transesophageal transducer for the determination of left ventricular volumes and ejection fraction in an in vitro experiment and to compare the method in vivo with biplane angiography and the continuous thermodilution method. In the dynamic in vitro experiment, we scanned rubber balloons in a water tank by using a pulsatile flow model. Twenty-nine measurements of volumes and ejection fractions were performed at increasing heart rates. Three-dimensional echocardiography showed a very high accuracy for volume measurements and ejection fraction calculation (correlation coefficient, standard error of estimate, and mean difference for end-diastolic volume 0.998, 2.3 mL, and 0.1 mL; for end-systolic volume 0.996, 2.7 mL, and 0.5 mL; and for ejection fraction 0.995, 1.0%, and -0.4%, respectively). However, with increasing heart rate there was progressive underestimation of ejection fraction calculation (percent error for heart rate below and above 100 bpm 0.59% and -8.6%, P < .001). In the in vivo study, left ventricular volumes and ejection fraction of 24 patients with symmetric and distorted left ventricular shape were compared with angiography results. There was good agreement for the subgroup of patients with normal left ventricular shape (mean difference +/-95% confidence interval for end-diastolic volume 5.2+/-6.7 mL, P < .05; for end-systolic volume -0.5+/-8.4 mL, P = not significant; for ejection fraction 2.4%+/-7.2%, P = not significant) and significantly more variability in the patients with left ventricular aneurysms (end-diastolic volume 23.1+/-56.4 mL, P < .01; end-systolic volume 5.6+/-41.0 mL, P = not significant; ejection fraction 4.9%+/-16.0%, P < .05). Additionally, in 20 critically ill, ventilated patients, stroke volume and cardiac output measurements were compared with measurement from continuous thermodilution. Stroke volume as well as cardiac output correlated well to thermodilution (r = 0.89 and 0.84, respectively, P < .001), although both parameters were significantly underestimated by 3-dimensional echocardiography (mean difference +/-95% confidence interval = -6.4+/-16.0 mL and -0.6+/-1.6 L/min, respectively, P < .005).
Adult↗
Elevated pretreatment serum levels of soluble vascular cell adhesion molecule 1 and lactate dehydrogenase as predictors of survival in cutaneous metastatic malignant melanoma.
Very rapid progression of disease with a median survival of 6-9 months is a common feature of metastatic cutaneous malignant melanoma. Nevertheless, substantial variability of survival suggests that metastatic cutaneous malignant melanoma can be divided into several biological subgroups. Pretreatment serum levels of soluble adhesion molecules and various clinical parameters in cutaneous metastatic malignant melanoma were evaluated to determine their prognostic value. In this study pretreatment serum levels of soluble vascular cell adhesion molecule 1 (sVCAM-1), soluble intercellular cell adhesion molecule 1 (sICAM-1), soluble endothelial leukocyte adhesion molecule 1 (sE-selectin) and multiple clinical factors were assessed in relation to overall survival of 97 consecutive patients with metastatic cutaneous malignant melanoma seen at our institution between May 1990 and April 1996. For statistical analysis, both univariate and multivariate Cox proportional-hazards models were used. Elevated pretreatment serum levels of sVCAM-1 (P < 0.005) and of lactate dehydrogenase (P < 0.002) were rendered statistically independent and were significantly associated with unfavourable outcome. Patients were assigned to one of three risk categories (low, intermediate and high) according to a cumulative risk score defined as the function of the sum of these two variables. There were significant differences in overall survival (P < 0.0001) between low- (n = 53, 5-year survival probability of 23.3%), intermediate- (n = 29, 5-year survival probability of 9.9%) and high-risk (n = 15) patients. Elevated pretreatment serum levels of sVCAM-1 and of lactate dehydrogenase correlate with poor outcome in metastatic cutaneous malignant melanoma. These data support risk stratification for future therapeutic trials and identify factors that need to be validated in prospective studies and may potentially influence decision-making in palliative management of patients with disseminated cutaneous malignant melanoma.
Adult↗
Risk and outcome in metastatic malignant melanoma patients receiving DTIC, cisplatin, BCNU and tamoxifen followed by immunotherapy with interleukin 2 and interferon alpha2a.
Combined chemo-/immunotherapy has shown high objective response rates and a significant though small proportion of long-term complete responders in metastatic malignant melanoma. The purpose of this study was to determine response rates, freedom from treatment failure (FFTF) and overall survival in patients with advanced metastatic malignant melanoma treated with combined chemo-/immunotherapy, and to determine the value of a prognostic model for prediction of treatment outcome, FFTF and survival. Sixty-nine patients with metastatic malignant melanoma received combined chemo-/immunotherapy consisting of up to four cycles of DTIC (220 mg m(-2) i.v. days 1-3), cisplatin (35 mg m(-2) i.v. days 1-3), BCNU (150 mg m(-2) i.v. day 1, cycles 1 and 3 only) and tamoxifen (20 mg orally, daily). Two cycles of chemotherapy were followed by 6 weeks of outpatient immunotherapy with combined interleukin 2 (20 x 10(6) IU m(-2) days 3-5, weeks 1 and 4; 5 x 10(6) IU m(-2) days 1, 3, 5, weeks 2, 3, 5, 6) and interferon-alpha (6 x 10(6) IU m(-2) s.c. day 1, weeks 1 and 4; days 1, 3, 5, weeks 2, 3, 5, 6). All patients were evaluated on an intention-to-treat basis. Of 69 patients entered in the study, seven achieved complete remissions and 20 reached partial remissions with an objective response rate of 39% (95% confidence interval 28-52%). Median survival was 11 months, median FFTF was 5 months. Seven patients achieved ongoing long-term remissions, with maximum survival of 58 + months, and maximum FFTF of 58 + months. By Kaplan-Meier survival analysis and two-proportional Cox regression analysis, pretreatment performance status and serum lactic dehydrogenase were statistically significant and independent predictors of survival; risk groups could be defined as (a) the absence of both or (b) the presence of either one or both of these risk factors. Whereas survival and response were significantly influenced by patient risk, no influence could be demonstrated for FFTF. This combined outpatient chemo-/immunotherapy is feasible and results in objective response rates and survival similar to earlier trials. Pretreatment risk, as defined by serum lactate dehydrogenase (LDH) and performance status, has a significant impact on treatment outcome and patient survival.
Adult↗
Pharmacokinetics of recombinant human interleukin-2 in advanced renal cell carcinoma patients following subcutaneous application.
AIMS: The aim of the study was to investigate the pharmacokinetics of recombinant human interleukin-2 (rhIL-2) in patients with metastatic renal cell carcinoma following different subcutaneous (s.c.) administration regimens. METHODS: RhIL-2 was administered subcutaneously to 10 patients according to two different dosing regimens: group A received 20 x 10(6) IU m(-2) once daily and group B 10 x 10(6) IU m(-2) twice daily (every 12 h). Additionally, in all patients the influence of soluble interleukin-2 receptor (sIL-2R) on the pharmacokinetics of rhIL-2 was investigated. RESULTS: The mean area under the serum concentration-time curve to 24 h (AUC(0,24 h)) was 627 IU ml(-1) h in treatment group A and 1130 IU ml(-1) h (P=0.029) in treatment group B. In both study groups Cmax and AUC(0,12 h) were not significantly different. Seventy-two hours after the beginning of s.c. rhIL-2 therapy the sIL-2R increased significantly (P=0.016), and sIL-2R levels over 1200 pmol l(-1) seemed to reduce the AUC. CONCLUSIONS: In patients with metastatic renal cell cancer administration of 20 x 10(6) IU m(-2) of rhIL-2 s.c. in two daily doses (10 x 10(6) IU m(-2) every 12 h) provides better bioavailability and is preferable to the single dose administration.
Aged↗
Treatment of calcified coronary lesions with Palmaz-Schatz stents. An intravascular ultrasound study.
AIMS: To evaluate the result of coronary stenting in calcified lesions and to find morphological and procedural factors influencing the final result. METHODS AND RESULTS: Three hundred and twenty three native coronary artery lesions in 303 patients (197 men, mean age 63.9 +/- 11.5 years) treated with Palmaz-Schatz stents were differentiated into four groups depending on their degree of circumferential calcification as defined by intravascular ultrasound [0-90 degrees (n=120), 91-180 degrees (n=58, 181-270$ (n=71) and 271-360 degrees n=74)]. In 117 lesions rotational atherectomy was used prior to stent placement. Intravascular ultrasound and quantitative angiography were performed prior to treatment and after stent placement to measure minimal and maximal lumen diameter and lumen cross-sectional area at the lesion site and the reference segments. Acute lumen gain and eccentricity index were calculated. Although higher balloon pressures were used than in the minimally calcified lesions. the final angiographic minimal lumen diameter decreased with increasing arc of calcification (3.01 +/- 0.47, 3.04 +/- 0.43, 2.85 +/- 0.53, 2.83 +/- 0.40 mm, respectively, P=0.0320) resulting in a decrease in acute diameter gain with increasing arc of calcification (2.06 +/- 0.51, 1.91 +/- 0.46, 1.81 +/- 0.56, 1.78 +/- 0.51 mm, respectively, P=0.0067). Adjunctive rotational atherectomy prior to stent placement resulted in a greater acute diameter and a greater lumen cross-sectional area gain, coupled with less final residual stenosis than pre-treatment with balloon angioplasty. CONCLUSION: Implantation of stents in calcified lesions results in less optimal stent expansion, especially in lesions with thick, eccentric calcific plaque layers. Use of adjunctive rotational atherectomy before stent placement may improve the procedural result.
Aged↗
Nonunion of the humerus following intramedullary nailing treated by Ilizarov hybrid fixation.
A case of a posttraumatic humeral shaft nonunion, after intramedullary stabilization with a Seidel nail, is presented. Severe osteoporosis, an oligotrophic nonunion, subclinical infection, and adhesive capsulitis of the glenohumeral joint were present. Due to the subclinical infection and severe osteoporosis, other major invasive therapeutic options such as intramedullary nailing or compression plating and bone grafting were not applicable. Nonoperative treatment was also not indicated secondary to the pain and disability present. External fixation with the Ilizarov hybrid fixator seemed to offer a minimally invasive treatment modality without the need of additional bone grafting. After fourteen weeks of "callus massage," consisting of closed alternating compression and distraction with an Ilizarov hybrid fixator, osseous consolidation was achieved. Eight months after Ilizarov treatment the patient had returned to work as a mechanic. At the one-year follow-up examination, the patient presented pain free and with near normal shoulder and elbow motion, with stable osseous consolidation of the humerus. In some cases of nonunion of the humerus shaft, when standard treatment options are not recommended, external fixation with an Ilizarov hybrid fixator may offer a salvage procedure with a successful clinical outcome.
External Fixators↗
Continuous ambulatory haemodynamic monitoring: necessary and available?
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Ambulatory Care↗
[Keeping reptiles].
Keeping of reptiles in captivity is permanently increasing. As there exists such a great number of species of reptiles, the conditions of the natural habitat of the kept species have to be imitated as exactly as possible. Disorders in reptiles are often caused by inadequate maintainance.
Animal Diseases↗