Biomedical subjects
Publications and source records attributed to A Wiskemann.
We report on 14 patients suffering from extentise vitiligo, who underwent phototherapy with UVB. After 12 months of treatment, 8 (57.1%) of the patients showed repigmentation of more than 75%. Especially the patients with facial lesions of the skin types V and VI achieved a nearly complete and cosmetically very satisfying repigmentation.
To study whether fluorescent lighting at work might increase carcinogenesis, hairless mice were exposed to a bank of six 36 W standard fluorescent lamps (neutral-white) every workday for 8 h at an illuminance level of 1,000 lx. For comparison, other mice were exposed to UVB radiation or to simulated solar radiation. In experiment A the animals were irradiated for 6 weeks prior to the application of 7,12-dimethyl-benzanthracene once and--following an interval of 2 days--for 10 weeks after DMBA application. The number of blue nevi and papillomas was enhanced by exposure to all spectra 10 weeks after chemical tumor induction. In experiment B the animals were irradiated for 6 weeks prior to the transplantation of UV-induced fibrosarcoma cells from syngeneic mice into the dorsal and ventral skin. Within the following 4 months fibrosarcoma developed in the dorsal skin exposed to the fluorescent lighting and to the UVB radiation, as well as in the non-irradiated ventral skin of 10-20% of the mice. The results suggest that fluorescent lighting as used in certain work environments may increase carcinogenesis caused by other factors.
A report is given on the combination of local 5-fluorouracil and systemic etretinate to treat a patient suffering from intra-anal Bowen's disease.
A new combination of beta-carotene (25 mg) and canthaxanthin (35 mg) was clinically investigated in 74 patients with various photodermatoses and 111 patients with pigmentation disorders. The photoprotective action of this combination was ascertained in clinical experiments. Serum levels were determined in 20 patients; the absence of increased retinol levels could be confirmed. In 23 patients, ophthalmological controls did not reveal any abnormalities. In 65 of the 74 patients with photodermatoses, a satisfactory protective action was recorded. 85 of the 111 patients with depigmentations and hyperpigmentations experienced a marked decrease of the disturbing contrast between their lesions and the surrounding skin.
Differential radiotherapy is a way of making a diagnosis and treatment for keratoacanthoma at the same time. After having taken a punch biopsy in order to exclude basal cell carcinoma, we give an X-ray dose of 2500 r. This dose is sufficient to induce the healing of keratoacanthoma. If there is no tendency of healing, the tumor must be a squamous cell carcinoma. In this case, we apply the full tumor dose of totally 5000 r.
Topical sun-ray filter creams protect the skin from sunburn and from long-term damages caused by UV-radiation. The choice of the sun protecting factor depends on the radiation dose as well as on the individual sensitivity to UV-radiation. For the prevention of photodermatoses, the industry offers broad spectrum absorbents. For internal prophylaxis, oral ingestion of a new preparation containing 25 mg beta-carotene and 35 mg canthaxanthin per dragee, has proved to restore the tolerance of sunlight with polymorphic light eruption, light urticaria, protoporphyria, and other photodermatoses to a considerable degree. In case of failure, photo- or PUVA-prophylaxis using tolerated UV-doses is recommended. All the treatments have to be repeated every year.
Special fluorescent lamps as well as filtered high pressure lamps are used for photo- and photochemotherapy of psoriasis. The spectra of the lamps offered for phototherapy are compared with the antipsoriatic range of action (lambda ca.295-315 nm) and judged by their therapeutic effect. The spectra offered for photochemotherapy should be free of UVB-radiation. Visible and infrared rays are not effective with psoriasis. The production of heat may stress the patient and require heat removal. On the skin surface the distribution of irradiation should be as even as possible. PUVA treatments of longer duration are preferably performed in a lying position. Closed irradiation units may produce claustrophobia . Open irradiation units require remote control. The most decisive economic factors are the duration of a single exposure as well as space requirements.
Survival curves for human melanoma cells, irradiated with 137Cs gamma-rays, show somewhat less radiosensitivity than Hela cells, as well as a marked recovery after exposure to low individual doses. In clinical practice, high individual doses of 4-8 Gy up to total doses of 45-80 Gy have proved most effective. The retrogression of melanomas takes a longer time than that of other tumours. High-voltage irradiation is indicated after surgery of lymph node metastases as well as (with palliative doses) in case of metastases of bone, brain and skin. Primary melanomas should be irradiated in exceptional cases only, for instance in case of inoperability. In the case of high-risk melanomas, prophylactic irradiation of the regional lymph nodes might be considered.
Selective UV-Phototherapy with lambda 300-320 nm (SUP) as well as oral photochemotherapy with 8-methoxy-psoralene plus UVA-radiation (PUVA intern) are very effective in clearing the lesions of th generalized psoriasis and those of the chronic forms of parapsoriasis. Being treated with 4 suberythemal doses per week psoriasis patients are free or nearly free of symptoms after averaging 6.3 weeks of SUP-therapy or after 5.3 weeks of PUVA orally. The PUVA-therapy is mainly indicated in pustular, inverse and erythrodermic psoriasis as well as in parapsoriasis in plaques and variegata. In all other forms of psoriasis and in pityriasis lichenoides chronica, we prefer the SUP-therapy because of less acute or chronic side effects, and because of its better practicability. X-rays are indicated in psoriasis of nails, grenz-rays in superficial psoriatic lesions of the face, the armpits, the genitals and the anal region.
Etiology, pathogenesis and optimal therapy of Peyronie's disease are, 240 years after its first description, still unclear. Diagnosis includes palpation, measurement and exact drawing of the mostly dorsally and laterally located penile induration, photography of erectile deviation, cavernosography and ultrasound as follow-up controls. Pathogenesis of fibrotic stimulation is related to direct local causes such as vascular lesions, microtrauma and hemorrhage and to indirect induction of plasma exudation via autoimmune mechanisms by toxins, infections and vasoactive substances. Symptomatology in 116 of our own patients included the obligatory penile scar, erectile deviation in 75%, pain during erection in 33% and difficult or impossible intercourse in 40%. Radiotherapy in 113 patients led to healing or marked improvement in 44% of cases. In 41% the disease came to a standstill and in 15% of cases symptoms became worse. An analysis of the world literature shows surprisingly a 75% improvement by vitamin E therapy and almost a 60% amelioration by p-aminobenzoic acid and corticoid injections. Favorable results of radiotherapy vary in the literature between 50 and 70%. Reports on these successful treatments include unclear and optimistic criteria in small series and the possible spontaneous standstill or regression of the disease. Indications of operation are erectile pain, impossible invagination and a high degree of penile deviation. Surgical techniques are: (1) Excision of smaller fibrotic segments followed by longitudinal suture of the corpora cavernosa; (2) symmetric and cylindrical resection of both cavernous bodies followed by a watertight reanastomosis after mobilization of the corpus spongiosum; (3) after excision of larger plaques the defect may be covered by autologous material (danger: scar formation, aneurysmatic protrusion, impotence), and (4) hydraulic or semirigid penile prostheses are an ultima ratio. Since there was a 85% improvement or standstill of the disease and little side reactions in 113 of our patients following radiotherapy we recommend it particularly in the early inflammatory phase. An operation might be indicated for patients who do not benefit from this treatment and who show above-mentioned symptoms.
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Hydroa vacciniforme Bazin is a rare photodermatosis characterized by bullous skin lesions and distinctive scarring. Early diagnosis is important to provide disfiguring scarring at the light exposed areas of the skin. The onset of the disease occurs predominantly in early childhood and involutes spontaneously at puberty. The case of a 5 years old girl is reported and differentiation from other photodermatoses is discussed.
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In a 19 year old woman, suffering from an malignant histiocytoma of the upper lip, X-ray treatment was favored above a mutilating operation. Within 26 months no relapse occurred.
The antirheumatic drug dl-2-(4-chlorophenyl) -alpha-methyl-5-benzoxazole-acetic acid (benoxaprofen, Coxigon) can induce mild phototoxic immediate reactions of the skin after some hours of sun exposure and sometimes partial onycholysis. In Central Europe the incidence of this side-effect is about 3 and 1%, respectively. In clinical trials and after experimental high-dose UVA-irradiation (45-64 J/cm2) alpha short-lasting skin burning, already beginning during irradiation, and an erythema of up to 2 h duration could be observed after the ingestion of the recommended daily dose of 600 mg. Photosensitization of the skin can safely be inhibited by a UVA -irradiation absorbing sunscreen agent (Contralum ointment) and onycholysis by using an opaque nail varnish. After epicutaneous and intracutaneous application of benoxaprofen, photosensitization did not occur. The pathogenesis of this unusual phototoxic immediate reaction is unknown.
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Thin slices of s.c. implanted B-16 melanomas as well as of human melanomas have been incubated for 5 h with (H3) Uridine and (H3) Thymidine in the presence of different chemotherapeutical agents, whose concentration was equivalent to the tenfold therapeutical daily dose in men. In this short term test model, the sensitivity of a melanoma to a chemotherapeutical agent is indicated by the inhibition of the nucleoside uptake by more than 50%. The in vitro sensitivity rates, each based on 10--30 melanomas, are compared to the in vivo sensitivity rates. Sensitivity is indicated by the increase of life span (greater than 25%) in the melanoma bearing mice respectively by the regression of human melanoma metastases (greater than 50%). -- The in vivo sensitivity of the B-16 melanomas, evaluated by the uridine and/or thymidine uptake, was in line with the in vivo sensitivity to all chemotherapeutical agents with the exeption of Adriamycine and DTIC. The in vitro sensitivity of human melanomas to Dactinomicine, Vincristine, BCNU and DTIC corresponds to the in vivo sensitivity whereas no in vitro/in vivo correspondence could be observed in testing Bleomycine, Procarbacine and 5-Fluorouracile. Comparing the sensitivity of B-16 and human melanomas, similarity was observed in vitro but not in vivo.