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Biomedical subjects

R U Peter

Publications and source records attributed to R U Peter.

At least 19 recordsLinked to original sources
PubMed2005

[Indications and safety aspects of vacuum-assisted wound closure].

Problem wounds continue to challenge medical care. In recent times, good results have been achieved through the application of negative pressure wound therapy. This approach, known as vacuum-assisted wound closure (VAC) involves the use of a defined,controlled negative pressure over a polyurethane or polyvinyl sponge placed in the wound. The wound effluent is evacuated continuously. The result is an improvement of microcirculation, and wound healing is enhanced. Animal experiments have confirmed an increase in cell growth. The basis for surgical wound management continues to be appropriate debridement. In this connection, negative pressure therapy, as a supportive measure, has proved to have major advantages over traditional methods of wound management, advantages that need to be further investigated clinically and experimentally. Consideration of the safety aspects and risk factors associated with the procedure can contribute to the optimization of therapeutic safety.

Contraindications↗
PubMed2004

Risk and protective factors for sporadic basal cell carcinoma: results of a two-centre case-control study in southern Germany. Clinical actinic elastosis may be a protective factor.

BACKGROUND: There are very few data regarding sun exposure behaviour of patients with basal cell carcinoma (BCC) in central Europe. OBJECTIVES: A case-control study of patients with sporadic BCC was conducted to assess the risk of occupational and leisure-time sun exposure behaviour, precursor lesions for skin cancer and phenotypic factors on the development of sporadic BCC in Ulm and Dresden, Germany. METHODS: A comparison was made of 213 patients with BCC (128 from Ulm, 85 from Dresden; 103 men and 110 women; median age at diagnosis 69 years) and 411 controls (237 from Ulm, 174 from Dresden; 197 men and 214 women; median age 58 years). Crude odds ratios (ORs) and corresponding 95% confidence intervals for all of 64 possible risk factors revealed strong associations in 33 items. Selection of important risk factors was performed in a multiple logistic regression. RESULTS: For sporadic BCC, an increased risk was shown for persons with actinic cheilitis (OR 7.1), actinic keratosis (OR 2.7) and solar lentigo (OR 2.5). The only phenotypic factor indicating risk of sporadic BCC was hair colour, with a higher risk for red/fair than brown/black hair (OR 4.3). There was an increased risk for persons with BCC in first-degree relatives (OR 5.1) and those with sunburn 20 years before sporadic BCC was diagnosed (OR 3.6). Additionally, occupational ultraviolet (UV) exposure appeared to be a risk factor (OR 2.4). In contrast, clinical actinic elastosis showed a protective effect (OR 0.1). CONCLUSIONS: In contrast to earlier reports, clinical actinic elastosis turned out to be the only protective factor for sporadic BCC. A special relationship between wrinkling and BCC risk could not be shown. For basic research, future work should be aimed at elucidating further the different forms of collagen repair processes after intermittent and/or chronic UV exposure. The data strongly support the recommendation that a change in recreational UV exposure habits in individuals, and sunburn avoidance in particular, are necessary not only because of the increased long-term risk of melanoma, but also because of the risk of other skin cancers such as sporadic BCC.

Adult↗
PubMed2003

[Phototherapy and photochemotherapy of inflammatory dermatoses].

Stubborn and extensive dermatoses, such as psoriasis vulgaris or atopic dermatitis (eczema), are indications for phototherapeutic methods. These include UVB phototherapy, UVA photochemotherapy (PUVA), UVA irradiation following prior photosensitization, UVA, treatment and combination treatments. Phototherapy is contraindicated in the case of light-induced dermatoses. Caution must also be exercised in patients receiving photosensitizing medications. When establishing the indication, consideration must be given to the treatment-related increased risk of developing skin cancer. The patient must also be informed of such undesired potential side effects as burns and premature aging of the skin.

Administration, Topical↗
PubMed2003

[Death after bee-sting].

A ten-year-old girl collapsed on the street with the signs of acute anaphylaxis. Cardiopulmonary resuscitation was unsuccessful. At the autopsy a thorn-like object was found sticking in the tongue and was later identified as the stinger of a honey bee. Witnesses reported that the girl had drunk some ice tea from a box and then had complained about pains in the mouth. Postmortem blood tests revealed increased total IgE level as well as increased levels of specific IgE against bee and wasp poisons. Cause of death was a bronchospasm caused by an allergic reaction due to a sting of a honey bee.

Age Factors↗
PubMed2003

Chronic cutaneous sclerodermoid graft-versus-host disease: evaluation by 20-MHz sonography.

BACKGROUND: Chronic graft-versus-host disease (GVHD) is an immunological disorder frequently occurring as a late consequence of allogeneic bone marrow transplantation. Two variants, cutaneous lichenoid and sclerodermoid, have been described, based on clinical and histopathological examinations. It is, however, difficult to determine non-invasively the degree of cutaneous GVHD in vivo. Ultrasonographic methods have recently provided us with the means for objective and non-invasive monitoring of the dynamics of many chronic skin diseases. AIM, PATIENTS AND METHODS: In five patients with chronic cutaneous sclerodermoid GVHD skin thickness was measured with a 20-MHz B-mode ultrasound scanner (DUB 20S, taberna pro medicum, Lüneburg, Germany) in a clinically well-defined target skin lesion. Additionally cutaneous GVHD was assessed histologically before and after treatment. RESULTS: In all patients before treatment the corium of sclerotic skin was thicker than the corresponding areas of healthy skin. The skin thickness was increased from 45% to 83%. In the subcutaneous tissue proper echo-rich reflexes were prominent, representing the correlate of subcutaneous fibrotic trabeculae. In all patients ultrasonographic evidence of regression was shown (decrease of skin thickness by 18-83%). Moreover, it was demonstrated that quantitative assessment of skin thickness is feasible. CONCLUSIONS: In this paper we describe the detailed sonographic features of cutaneous sclerodermoid GVHD for the first time. As the method is simple and non-invasive, repeated examinations are possible. This provides the basis for monitoring treatment effects and efficient follow-up in these chronically progressive clinical conditions after bone marrow transplantation.

Adolescent↗
PubMed2003

Detection of cutaneous herpes simplex virus infections by immunofluorescence vs. PCR.

BACKGROUND: Detection of cutaneous infections with herpes simplex virus (HSV) has proven difficult, as serum antibody tests sometimes are not sensitive and specific enough for that purpose. OBJECTIVE: This study was conducted to compare the sensitivity for detection of HSV of an immunofluorescence method (Syva Microtrak) and an internally controlled PCR. METHODS: Cutaneous swabs from skin lesions were analysed by immunofluorescence separately for HSV types 1 and 2 and by competitive PCR. Detection of PCR products was done by ELISA, if positive additionally by agarose gel electrophoresis. RESULTS: Of 79 samples 34 were PCR-positive by ELISA (34 = 100%), of which 23 (68%) were also positive on the agarose gel. Eleven samples (32%) were positive by immunofluorescence. No sample was positive by immunofluorescence and negative by PCR. CONCLUSIONS: These results demonstrate that immunofluorescence using Syva Microtrak is not suitable for exclusion of herpes simplex virus infection as sensitivity was only 32%. However, as immunofluorescence is cheaper and faster than PCR, first screening can be done with immunofluorescence, and negative samples can be investigated by PCR to finally prove or exclude the presence of HSV DNA.

Base Sequence↗
PubMed2003

A teledermatological approach to enhance diagnostic accuracy in dermatohistopathology.

We determined whether digital photographs of skin lesions could enhance diagnostic accuracy in dermatohistological evaluations. Two dermatohistopathologists examined 375 unsorted consecutive cases. On a standardized questionnaire they recorded whether the final diagnostic interpretation would be improved by the availability of digital images of the skin lesions. In 101 cases (27%) they said that digital photographs would be helpful. Subsequently, 30 histological analyses were performed with and without digital photographs of the skin lesions. Presentation of digital photographs reduced the number of differential diagnoses significantly, from a median of 3 to 2. Ratings of ability to make a single definitive diagnosis increased significantly with the presentation of digital photographs. Enhancement of information given by the digital images was scored a median of 6 (on a scale of 0-10, with higher scores reflecting greater enhancement). Digital photographs of skin lesions are likely to refine diagnostic accuracy in histopathology.

Dermatology↗
PubMed2002

[Preliminary results in the therapy of psoriatic arthritis with mycophenolate mofetil].

BACKGROUND: Psoriatic arthritis concerns both the skin and the joints. Therapeutic interventions should therefore ideally improve both symptoms. Current disease modifying drugs are effective; however, they are usually limited to either psoriasis or arthritis. AIM OF THE STUDY: The aim of this study was to analyze the therapeutic effects of a new immunosuppressive drug (Mycophenolate mofetil) in the treatment of psoriatic arthritis. METHODS: Six patients with psoriatic arthritis were treated with Mycophenolate mofetil for a period of 12 weeks and examined every 14 days (range of motion, joint swelling, joint deformity, PASI score (Psoriasis Area and Severity Index). In addition, a life quality assessment (SF-36 Health Survey) was performed. White and red blood count as well as inflammation parameter were controlled regularly. RESULTS: 6 patients could be included in a complete follow-up (5 men, 1 woman, average age 50.3 years, average duration of psoriasis 8.3 years, average duration of arthritis 5.7 years). Four of 6 patients showed relevant improvement in pain, mobility and degree of psoriatic skin effluorescences. Only 3 of 6 showed relevant improvement in life quality. CONCLUSION: For the first time results of treatment of psoriatic arthritis with a new immunosuppressive drug (Mycophenolate mofetil) were presented. A positive influence on both, the arthritis and the psoriasis could be shown. These first observations warrant controlled, randomized clinical trials.

Adult↗
PubMed2002

Varicella zoster viraemia during herpes zoster is not associated with neoplasia.

BACKGROUND: Shingles are caused by an endogenous or exogenous reinfection with varicella zoster virus (VZV). Up to 50% of individuals with Hodgkin's disease develop herpes zoster; however, no association could be shown between the occurrence of herpes zoster and underlying subclinical malignancies. OBJECTIVE: This study was conducted to investigate whether VZV DNA could be detected by polymerase chain reaction (PCR) in the blood of herpes zoster patients and whether there was an association between VZV viraemia and previous or concurrent neoplasias. METHODS: At least five blood samples from 28 patients with herpes zoster were investigated by internally controlled PCR enzyme-linked immunosorbent assay prior to and during therapy with aciclovir. RESULTS: None of 13 patients, two with a history of neoplasia and two with a neoplasia at the time of the study, showed any signs of viraemia with VZV, and 14 patients had inconsistent viraemia, one with a history of neoplasia and two with neoplasia at the time of the study. In one patient VZV DNA was detected in the blood for 6 days. This patient died soon after from metastatic malignant melanoma. CONCLUSIONS: VZV viraemia may occur during herpes zoster episodes, even in patients without evidence of immunosuppression; however, this viraemia is, in most cases, inconsistent and does not provide any specific information concerning underlying unrecognized malignancies.

Acyclovir↗
PubMed2001

[Improving textile sun protection by regular washing of clothing].

The highest priority in the prevention of malignant tumors of the skin is given to the avoidance of sun-induced reddening of the skin and sunburn at any age. The usual recommendation is to keep out of the sun between 11 am and 3 pm, wear a sun-hat and appropriate clothing, and use a sun screen (UV-A and UV-B) that doesn't wash off on exposed skin and when in the water. With regard to the wearing of clothing protecting against UV radiation, compliance must be expected to be low, since just such protective clothing (in particularthick, densely-woven materials) is unsuitable for the summer. Using detergents containing a UV absorber in the home wash, even light summer wear can be made to offer good UV protection.

Adolescent↗
PubMed2001

Interferon-gamma in 5 patients with cutaneous radiation syndrome after radiation therapy.

BACKGROUND: Irradiation can cause acute inflammatory responses as well as chronic fibrotic alterations of the skin. Cutaneous radiation fibrosis evokes a complex of therapeutic problems. However, therapeutic options, apart from surgical approaches, are limited. PATIENTS AND METHODS: Five female patients suffering from severe cutaneous fibrosis were treated with interferon-gamma on a low-dose regimen, 3 x 100 microg/week subcutaneously for 6 months, then once per week for another 6 months. In 4 patients, skin thickness was measured with high-frequency (20 MHz) ultrasound in a clinically well-defined target skin lesion. In 1 patient, nuclear magnetic resonance imaging was performed to quantify the extent of cutaneous radiation fibrosis and to monitor the therapeutic outcome. RESULTS: All patients suffered from radiation-induced cutaneous fibrosis. Additionally, in 1 patient, a fistula, as assessed by lymph vessel scintigraphy, and in another patient a radiation ulcer was diagnosed. In all patients, reduction of radiation-induced fibrosis could be documented. Both fistula and radiation ulcer regressed completely under interferon-gamma therapy. CONCLUSION: Low-dose interferon-gamma therapy is a new and effective treatment modality for cutaneous radiation fibrosis caused by radiation therapy. The positive impact of interferon-gamma on our patients warrants randomized double-blind trials on therapy of radiation fibrosis.

Adolescent↗
PubMed2001

Interlaboratory evaluation of a new reverse transcriptase polymerase chain reaction-based enzyme-linked immunosorbent assay for the detection of circulating melanoma cells: a multicenter study of the Dermatologic Cooperative Oncology Group.

PURPOSE: Reverse transcription-polymerase chain reaction (RT-PCR)-based detection of tyrosinase mRNA is the most frequently used laboratory method for the detection of circulating tumor cells in melanoma patients. However, previously published results showed considerable variability in the PCR positivity rates. MATERIALS AND METHODS: We designed a collaborative study to assess the sensitivity, specificity, and clinical relevance of a new standardized RT-PCR-based enzyme-linked immunosorbent assay (ELISA) for the detection of circulating melanoma cells. Blood samples of healthy donors mixed with cells of a melanoma cell line were prepared in a blinded fashion, and aliquots were sent to seven participating laboratories experienced in RT-PCR. RESULTS: The results demonstrate a high sensitivity (1 melanoma cell/mL blood) and specificity (no false-negatives and 7.4% [2 of 28] false-positives) of the assay and a satisfactory rate of interlaboratory reproducibility. The analysis of aliquots of blinded samples derived from 60 melanoma patients identified tyrosinase mRNA in 17 of 60 (28.3%): three (20%) of 15 stage I patients, two (13.3%) of 15 stage II patients, five (35.7%) of 14 stage III patients, and seven (43.8%) of 16 stage IV patients. The interlaboratory reproducibility of positive samples, however, was extremely low and indicates the presence of low amounts of target mRNA. CONCLUSION: Reverse transcriptase-PCR ELISA has a high sensitivity and specificity for the detection of tyrosinase mRNA in peripheral blood cells. The low interlaboratory reproducibility for the detection of tumor cells in blood samples of melanoma patients, however, raises the question of relevance of this assay for clinical use.

Adult↗
PubMed2001

Extra c-myc oncogene copies in high risk cutaneous malignant melanoma and melanoma metastases.

Amplification and overexpression of the c-myc gene have been associated with neoplastic transformation in a plethora of malignant tumours. We applied interphase fluorescence in situ hybridization (FISH) with a locus-specific probe for the c-myc gene (8q24) in combination with a corresponding chromosome 8 alpha-satellite probe to evaluate genetic alterations in 8 primary melanomas and 33 advanced melanomas and compared it to 12 melanocytic nevi, 7 safety margins and 2 cases of normal skin. Additionally, in metaphase spreads of 7 melanoma cell lines a whole chromosome 8 paint probe was used. We investigated the functionality of the c-myc gene by detecting c-myc RNA expression with RT-PCR and c-myc protein by immunohistochemistry. 4/8 primary melanomas and 11/33 melanoma metastases showed additional c-myc signals relative to the centromere of chromosome 8 copy number. None of the nevi, safety margins or normal skin samples demonstrated this gain. In 2/7 melanoma cell lines (C32 and WM 266-4) isochromosome 8q formation with a relative gain of c-myc copies and a loss of 8p was observed. The highest c-myc gene expression compared to GAPDH was found in melanoma metastases (17.5%). Nevi (6.6%) and primary melanomas (5.0%) expressed the c-myc gene on a lower level. 72.7% of the patients with c-myc extra copies had visceral melanoma metastases (UICC IV), patients without c-myc gain in 35.0% only. The collective with additional c-myc copies also expressed the gene on a significantly higher level. These results indicate that a c-myc gain in relation to the centromere 8 copy number might be associated with advanced cutaneous melanoma.

Adolescent↗
PubMed2001

[Subcutaneous calcifications after radiotherapy].

A 75-year-old female patient presented with late stage cutaneous radiation syndrome, following postoperative combined radiotherapy for cervical carcinoma administered 32 years ago. She was hospitalized because of a deep abscess in the radiation-exposed area on the sacrum. Extension into the subcutaneous fibrosis was verified by 7,5-MHz-sonography and nuclear magnetic resonance imaging. With intravenous cefotiam (Spizef) 2.0 g three times daily, the inflammation decreased, as seen clinically and with nuclear magnetic resonance imaging. As a secondary finding, an unusual distinctive subcutaneous calcification was diagnosed in the radiation-exposed area by means of 7,5-MHz-sonography, as well as computer- and nuclear magnetic resonance imaging. These subcutaneous calcifications are most likely to have been radiation-induced.

Abscess↗
PubMed2001

[Evaluation of a telemedicine pilot project].

BACKGROUND AND OBJECTIVE: Rapid progress in computer and information technologies has led to an increased interest in the use of telemedicine during the past few years. Thus it should be clarified, whether teledermatology can achieve comparable results to conventional specialist examination and advice. PATIENTS/METHODS: We initiated a pilot study, comparing teledermatology with conventional examination in a dermatology outpatient setting. 60 patients were included. RESULTS: Out of 60 teledermatological examinations, remote clinicians were in agreement with face-to-face clinicians in 90%. Teledermatology was unable to make a useful diagnosis in 6 patients, however further diagnostic procedures were ordered, enabling teledermatologists to achieve correct diagnoses. Regarding need for further diagnostic tests, there was no difference between teledermatology and conventional examination. CONCLUSIONS: Teledermatology appears suitable to transfer a dermatologist's expertise over large distances.

Dermatology↗