Search PubMed⌕ Search

Biomedical subjects

R Stadler

Publications and source records attributed to R Stadler.

At least 37 records · Page 2Linked to original sources

[Photodynamic therapy of cutaneous T-cell lymphoma at special sites].

Therapy of the heterogenous group of primary cutaneous B- and T-cell lymphomas is based upon type of lymphoma and its staging. Treatment, especially for rare forms, has not yet been standardised. Two patients with uncommon primary cutaneous T-cell lymphomas received both traditional therapy and topical photodynamic therapy (PDT) in areas that are difficult to reach with classic methods (ear, eyebrow, side of foot). The first patient had a rare type of medium/large cell pleomorphic, CD8-positive, CD30-negative, primary cutaneous T-cell lymphoma with primary involvement of the ear. As the tumor progressed during PUVA, interferon alpha and retinoid therapy, topical PDT was employed. A histologically confirmed partial remission was obtained. As the disease further evolved the patient received radiotherapy and has now been in complete remission for 10 months. The other patient preserted with the classical picture of mycosis fungoides in initial tumour stage. This patient received in addition to PUVA therapy and interferon alpha, topical PDT to the eyebrow and side of the foot. A complete remission was achieved and histologically confirmed. In the palliative treatment of cutaneous T-cell lymphoma, PDT is a new experimental method, especially for problem locations. It is tissue sparing, has few side effects, can be repeated as often as necessary and achieves good cosmetic results.

Aged↗

[Long-pulsed frequency-doubled neodymium:YAG laser in treatment of superficial varicose veins. Initial clinical experiences].

Many different therapeutic approaches are employed to treat small vessels on the leg. In recent years a variety of lasers (argon, Neodymium: YAG and dye lasers) have been used as well as sclerotherapy, cryosurgery and electrosurgery. None of these lasers are entirely satisfactory, and there are a number of side effects. Because of its special physical characteristics, the newly developed long-pulsed frequency-doubled neodymium: YAG laser has clear advantages in the treatment of vascular lesions compared to other laser systems. These include: no vessel rupture compared to dye laser, no epidermal lesions compared to argon laser. In clinical tests it shows a high rate of effectiveness with minimal side effects.

Adult↗

[Post-traumatic pyoderma gangrenosum: combination therapy with intravenous immunoglobulins and systemic corticosteroids].

Pyoderma gangraenosum is a rare, chronic type of skin ulceration of unknown aetiology. It occasionally appears following trauma. There are no set standards for the treatment of pyoderma gangraenosum. It is essential to consider acuteness of progression as well as underlying systemic diseases and possible drug side effects before initiating a therapy. Immunosuppressive as well as immunomodulating agents are most often used with varying degrees of success. We report a 45-year-old patient who suffered from an extensive posttraumatic pyoderma gangraenosum after cardiac bypass operation. With short-term combination therapy consisting of high dose intravenous immunoglobulins and systemic corticosteroids, the progression of the disease could be stopped within a few days.

Anti-Inflammatory Agents↗

[Differentiated local therapy of chronic wounds with modern wound dressings].

Differentiated local therapy of chronic wounds with modern wound dressings. The therapy of chronic wounds comprises besides treating the underlying disease, for instance compression therapy and phlebosurgery with venous ulcus cruris modern differentiated local therapy. Conventional wound therapy comprises primarily of colour solutions, various ointments, local antimicrobial agents, and sterile pressure bandages. Although it has been proven that conventional methods impede wound healing compared with modern wound dressings they are still widely used. In comparison the principle of moist wound healing is the basis of modern differentiated wound therapy. Therefore a vast number of modern wound dressings has been established in the last years. As not every wound dressing is suitable for every type of wound the knowledge of available modern wound dressings is essential in order to choose the wound dressing which is most suitable for the individual case. In the exudation/cleaning phase polyurethane foams, alginates and dressings containing activated charcoal are indicated. They can also be used in the granulation phase. The granulation phase is main indication for hydrokolloids and hydrogels. They are also used beside non-adhesive dressings and alginates in the epithelialisation phase. Besides the above synthetic wound dressings cytokines and biological skin equivalents are increasingly used in modern wound therapy. Biological skin equivalents comprise of epidermis equivalents, dermis substitutes and combined epidermis-dermis equivalents which are being developed at present. These will possibly be more effective on wound closure. Phase adapted use of modern wound dressings enables acute and chronic wounds to heal quickly and without complications. Present clinical studies are evaluating the importance of cytokines and new vital skin substitutes, which might offer interesting possibilities for further improvement in wound treatment.

Bandages↗

A male gametophyte-specific monosaccharide transporter in Arabidopsis.

The AtSTP2 gene (sugar transport protein 2) of Arabidopsis thaliana encodes a high affinity, low specificity monosaccharide carrier that can transport a number of hexoses and pentoses at similar rates. AtSTP2 has 12 putative transmembrane helices and a molecular mass of 55.0 kDa. AtSTP2 expression was localized in AtSTP2 promoter-beta-glucuronidase (GUS) Arabidopsis plants showing AtSTP2-driven GUS activity during pollen maturation and also in germinating pollen. Immunohistochemical studies with anti-AtSTP2 antiserum as well as RNA in situ hybridization analyses modified these results and showed that AtSTP2 expression is confined to the early stages of gametophyte development. Both AtSTP2 mRNA and AtSTP2 protein are first seen at the time of beginning callose degradation and microspore release from the tetrades. AtSTP2 mRNA and AtSTP2 protein are no longer detected after the mitotic divisions and the formation of the trinucleate gametophyte. No AtSTP2 mRNA or AtSTP2 protein is seen in fully developed or germinating pollen. The putative role of AtSTP2 in the uptake of glucose units resulting from callose degradation during pollen maturation is discussed.

Amino Acid Sequence↗

The AtSUC1 sucrose carrier may represent the osmotic driving force for anther dehiscence and pollen tube growth in Arabidopsis.

The Arabidopsis AtSUC1 protein has previously been characterized as a plasma membrane H+-sucrose symporter. This paper describes the sites of AtSUC1 gene expression and AtSUC1 protein localization and assigns specific functions to this sucrose transporter in anther development and pollen tube growth. RNase protection assays revealed AtSUC1 expression exclusively in floral tissue, which was confirmed by analyses of AtSUC1 promoter-beta-glucuronidase (GUS) plants. In situ hybridizations identified AtSUC1 expression in anther connective tissue, in funiculi and in fully developed pollen grains. Indirect immuno-fluorescence analyses with anti-AtSUC1 antiserum confirmed AtSUC1 protein localization in the connective tissue and funiculi. In mature pollen grains, however, despite high AtSUC1 mRNA levels no AtSUC1 protein was found. Only after pollination of stylar papillae was AtSUC1 protein detected inside the pollen and later inside the growing pollen tubes, suggesting a translation of pre-existing AtSUC1 mRNA after pollination. Pollen germination analyses underlined the important role of sucrose for pollen tube growth. The data presented suggest a role of AtSUC1 in the controlled dehiscence of Arabidopsis anthers. It is postulated that an important function of AtSUC1 is the cell-specific modulation of water potentials.

Amino Acid Sequence↗

Prospective randomized multicenter clinical trial on the use of interferon -2a plus acitretin versus interferon -2a plus PUVA in patients with cutaneous T-cell lymphoma stages I and II.

Cutaneous T-cell lymphoma (CTCL) constitutes a malignant proliferative disease involving mostly CD4(+) T cells arising in the skin. Because of the lack of curative treatment options, interferons (IFN) have been introduced into the therapy of CTCL. Although effective even in advanced disease, response rates were about 50% and the duration of response was short. To improve the results of interferon monotherapy, combinations of IFN with oral photochemotherapy (PUVA) or retinoids were investigated in nonrandomized trials showing higher response rates. We have therefore conducted this prospective randomized multicenter trial to compare these two combination therapies, ie, IFN plus PUVA and IFN plus acitretin. IFN -2a was administered at 9 MU three times weekly subcutaneously in both groups, with lower increasing doses during the first week. Photochemotherapy was applied after oral intake of 8-methoxypsoralen (0.6 mg/kg body weight) 5x weekly during the first 4 weeks, 3x weekly from weeks 5 through 23, and 2x weekly from weeks 24 through 48, with escalating doses beginning with 0.25 J/cm2. Twenty-five milligrams of acitretin was administered daily during the first week, and 50 mg was administered from weeks 2 through 48. Of 98 patients randomized in this study, 82 stage I and II patients were evaluable: 40 in the IFN+PUVA group and 42 in the IFN+acitretin group. With 70% complete remissions in the IFN+PUVA group, this treatment was significantly superior to the IFN+acitretin group with only 38.1% complete remissions. Time to response was significantly shorter in the IFN+PUVA group, with 18.6 weeks compared with 21.8 weeks in the IFN+acitretin group. Side effects were mostly mild to moderate and did not differ significantly in both treatment groups. However, there were more adverse events leading to study discontinuation in the IFN+acitretin group. Based on these findings, we conclude that IFN plus oral photochemotherapy is superior to IFN plus acitretin, inducing more complete remissions in patients with CTCL stages I and II.

Acitretin↗

Interferons in dermatology. Present-day standard.

Since the first clinical trials in the early 1980s with recombinant interferon, it was possible to show for a variety of indications that cytokines, especially interferons, at certain doses and at respective intervals, when applied in combination with other pharmaceutical compounds open new powerful therapeutic possibilities. Worldwide, recombinant interferon is licensed, especially in dermato-oncology, for the indication of HIV-associated Kaposi's sarcoma, cutaneous T-cell lymphoma, and recently for adjuvant therapy of high-risk malignant melanoma. Recombinant interferon is at present not licensed for dermatologic indication (septic granulomatosis). At the end of our century the indication spectrum for interferons as monotherapy and as combination therapy will undoubtedly be extended. Larger and controlled studies will prove the importance of interferons in dermato-oncology as well as in inflammatory and infectious dermatoses. The combination of interferons with standard therapies will surely be of the utmost importance in dermatotherapy.

Clinical Trials as Topic↗

[Sarcoidosis in interferon-alpha therapy].

Sarcoidosis is characterised by the formation of sarcoidal granulomas in all affected organs. Despite intensive research, the cause of the disease in unknown. There are only a few reports suggesting an induction of sarcoidosis by interferons. Three patients are presented in whom sarcoidosis developed during or after interferon alpha therapy. The probability of interferon therapy as cause of sarcoidosis is discussed.

Aged↗

[Standards in histopathologic diagnosis of malignant melanomas. Recommendations of the Working Group of the Central Malignant Melanoma Registry of the German Dermatologic Society].

The evaluation of melanocytic tumors represents one of the most intriguing and challenging aspects of the daily practice in dermatohistopathology. For the diagnosis of malignant melanoma and melanocytic nevi, standardized and reproducible criteria are required. In case of the diagnosis of melanoma, the histopathological report must include all important data relevant for the prognosis which may also influence the therapeutic procedure. The following paper summarizes the recommendations of the study group on malignant melanoma formed by the Deutsche Dermatologische Gesellschaft.

Biomarkers, Tumor↗

[Systemic treatment of acne with isotretinoin: current status].

Introduced in 1979, isotretinoin remains a major advance in acne therapy. Both hospital- and community-based dermatologists have experience with this valuable drug, which, owing to its causal principle of action, offers a large proportion of patients the prospect of a cure. Isotretinoin is now in use in more than 80 countries and has been prescribed for some six million patients. Based on accumulated clinical findings with the drug, more comprehensive recommendations can now be made with respect to indications, dosing and duration of treatment than was possible when the drug was launched. Experience with the drug also provides a basis for reevaluating its safety profile. Finally, at a time when healthcare resources are limited, it is important to examine the cost-benefit ratio of this acne treatment versus other options. This paper is accordingly intended to provide a critical status report as well as a detailed and balanced set of recommendations for clinical practice.

Acne Vulgaris↗

Epidemiological features of Adamantiades-Behçet's disease in Germany and in Europe.

The German Registry of Adamantiades-Behçet's disease was founded in 1990 in Berlin and it provides current data on the epidemiology, the clinical manifestations and the course of the disease in Germany on a continuous basis. A total of 218 patients, including 89 German and 100 Turkish patients, had been reported to the German Registry until October 1997. One hundred and ninety-six patients fulfilled the criteria of the Behçet's disease classification tree. The prevalence of the disease evaluated in Berlin-West was 1.68/100,000 in 1989 and had risen to 2.26/100,000 by 1994. The median age of onset was 25 years (range 5 to 66 years; German-Turks, ns). Juvenile disease was recorded in 6.9% of patients. The complete clinical picture according to the criteria of the International Study Group of Behçet's Disease developed in 15.5 months. The interval between onset of the disease and diagnosis was 35 months, which was significantly longer than the duration of the development of the complete clinical picture (p < 0.0001). The disease was diagnosed later in German (48.5 months) than in Turkish patients (25.5 months, p = 0.003). While German patients presented an equal male-to-female ratio, a male predominance was shown in Turkish patients (M:F 2.1:1, p = 0.022). Familial occurrence was detected in 2.0% of German and 15.9% of Turkish patients (p = 0.013). The frequencies of major clinical manifestations were: oral ulcers 99%, skin lesions 76%, genital ulcers 75%, ocular manifestations 59%, arthritis 59%, and positive pathergy test 52%. Clinical differences between German and Turkish patients were only found in the frequency of ocular lesions (48% vs. 66%, p = 0.025). Oral ulcers were with 72% the most common onset symptom of the disease followed by erythema nodosum (9%), uveitis (7%), arthritis (7%), genital ulcers (3%), superficial thrombophlebitis (2%) and papules/sterile pustules (2%). Uveitis and erythema nodosum as onset symptoms shortened the median interval to diagnosis to 1.5 and 15 months, respectively, while arthritis delayed diagnosis (43.5 months; p = 0.029). A severe course developed in 25% of the patients; irreversible retinal vasculitis to blindness in 15%, sterile meningoencephalitis in 8%, severe arthritis in 5%, hemoptysis in 2%, lethal outcome in 2% and bowel perforation in 1%. The relative risk of HLA-B5 positive German natives developing the disease. HLA-B5 was confirmed as a marker of severe prognosis. Cardiolipin autoantibodies were associated with cutaneous vasculitis and superficial thrombophlebitis was correlated with systemic vessel involvement.

Adolescent↗

[Therapy of Sézary syndrome by extracorporeal photochemotherapy].

Sézary syndrome is the leukemic and erythrodemic form of cutaneous T-cell lymphoma (CTCL). Since 1987 extracorporeal photochemotherapy (ECP) has been available for treatment of erythrodermic CTCL in the USA. Through a group of case reports, we want to emphasize ECP as the treatment of choice for erythrodermic CTCL.

Biopsy↗

[Association of chronic urticaria with Helicobacter pylori-induced antrum gastritis].

In spite of its high incidence, not much is known about the etiology of chronic urticaria. We performed gastroscopic evaluation of 10 patients in whom no cause for chronic urticaria had been found. In 8 of these 10 patients, Helicobacter pylori was identified in the gastric mucosa. The chronic urticarial lesions disappeared within a few days after starting therapy with amoxicillin and omeprazol.

Adult↗

[Reactive angioendotheliomatosis in chronic lymphatic leukemia].

An 82-year-old patient with untreated chronic lymphatic leukaemia known for 6 years developed large livid red plaques with central blisters and subsequent ulceration of the lower legs. Reactive angioendotheliomatosis was diagnosed based on histological immunohistological and electronmicroscopic examination, since proliferating endothelial cells with intravascular fibrin thrombi were identified. When the leukaemia was treated the skin eruption healed completely.

Aged↗

Kaposi's sarcoma limited to penis treated with cobalt-60 radiotherapy.

We report a 78-year-old German man of neither Mediterranean nor Jewish lineage who developed Kaposi's sarcoma localized to his penis. An evaluation for retrovirus infection or other causes of immunosuppression was negative. The nodules responded to radiotherapy with cobalt-60, rapidly involuting. The patient has no evidence of Kaposi's sarcoma for over two years.

Aged↗