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Biomedical subjects

Bernhard Zelger

Publications and source records attributed to Bernhard Zelger.

At least 19 recordsLinked to original sources
PubMed2007

Focus floating microscopy: "gold standard" for cutaneous borreliosis?

Borrelia burgdorferi is difficult to detect in routine biopsy material from patients with skin lesions of borreliosis. In this study, a new immunohistochemical method, focus floating microscopy (FFM), was developed to detect B burgdorferi in tissue sections and was compared with polymerase chain reaction (PCR). By using standard histologic equipment, tissue sections stained with a polyclonal B burgdorferi antibody were simultaneously scanned through 2 planes: horizontally in serpentines and vertically by focusing through the thickness of the section. Borrelia were detected in 47 of 71 ticks, 34 of 66 tick bites, 30 of 32 erythema chronicum migrans cases, 41 of 43 borrelial lymphocytomas, and 50 of 51 acrodermatitis chronica atrophicans cases. FFM proved to be more sensitive than PCR (96.0% vs 45.2%) and nearly equally specific (99.4% vs 100%). All 169 control cases, except 1 false-positive case of secondary syphilis, were negative with FFM. FFM is an easy, quick, and inexpensive method to reliably detect Borrelia in cutaneous tissue sections.

Acrodermatitis↗
PubMed2005

Prospective, randomized, multicenter, double-blind placebo-controlled trial comparing adjuvant interferon alfa and isotretinoin with interferon alfa alone in stage IIA and IIB melanoma: European Cooperative Adjuvant Melanoma Treatment Study Group.

PURPOSE: The combination of interferon alfa (IFNalpha) and isotretinoin has shown a direct antiproliferative effect on human melanoma cell lines, but it remained unclear whether this combination is more effective than IFNalpha alone in patients with metastatic melanoma. We evaluated safety and efficacy of IFNalpha and isotretinoin compared with IFNalpha alone as adjuvant treatment in patients with primary malignant melanoma stage IIA and IIB. PATIENTS AND METHODS: In a prospective, randomized, double-blind, placebo-controlled trial, 407 melanoma patients in stage IIA (301 patients) and IIB (106 patients) were randomly assigned to either IFNalpha and isotretinoin (isotretinoin group; 206 patients) or IFNalpha and placebo (placebo group; 201 patients) after excision of the primary tumor. IFNalpha was administered three times a week at a dose of 3 million units subcutaneously for 24 months. Isotretinoin at a dose of 20 mg for patients < or = 73 kg, 30 mg for patients greater than 73 kg, or placebo daily for 24 months. RESULTS: A scheduled interim analysis revealed no significant differences in survival rates, with the isotretinoin group and the placebo group showing 5-year disease-free survival rates of 55% (95% CI, 46% to 65%) and 67% (95% CI, 59% to 75%), respectively, and overall 5-year survival rates of 76% (95% CI, 67% to 84%) and 81% (95% CI, 74% to 88%), respectively. The trial was stopped for futility. CONCLUSION: The addition of isotretinoin to an adjuvant treatment of low-dose IFNalpha in patients with stage IIA and IIB melanoma had no significant effect on disease-free or overall survival and is therefore not recommended.

Adolescent↗
PubMed2005

Analysis of original contributions in three dermatology journals.

In a cross-sectional analysis, the three top ranking dermatology journals ( Archives of Dermatology , British Journal of Dermatology , and the Journal of the American Academy of Dermatology ) were evaluated for their scientific content, the characteristics of their authors, and funding aspects in 2002. A flood of scientific papers are published each year covering a broad variety of dermatologic topics. Aside from the actual content, a scientific article provides information about the number of authors, their nationality and affiliations, and, with some limitation, about previous presentations and funding. The present study analyzes this situation in dermatology by evaluating the content in the three top dermatologic journals.

Advertising↗
PubMed2005

Mucinous carcinoma of the skin, primary, and secondary: a clinicopathologic study of 63 cases with emphasis on the morphologic spectrum of primary cutaneous forms: homologies with mucinous lesions in the breast.

We present the largest series of mucinous carcinoma involving the skin, describing the histopathologic, immunohistochemical, electron microscopic, and cytogenetic findings. Our aim was fully to characterize the clinicopathologic spectrum and compare it with that seen in the breast. In addition, we wished to reevaluate the differential diagnostic criteria for distinguishing primary mucinous carcinomas from histologically similar neoplasms involving the skin secondarily, and study some aspects of their pathogenesis. We demonstrate that primary cutaneous mucinous carcinomas span a morphologic spectrum compatible to their mammary counterparts. Both pure and mixed types can be delineated morphologically, and some lesions have mucocele-like configurations. Most lesions seem to originate from in situ lesions that may represent, using mammary pathology terminology, ductal hyperplasia, atypical ductal hyperplasia, or ductal carcinoma in situ or a combination of the three. Inverse cell polarity appears to facilitate the progression of the changes similar to lesions in the breast. The presence of an in situ component defines the neoplasm as primary cutaneous, but its absence does not exclude the diagnosis; although for such neoplasms, full clinical assessment is essential. Mammary mucinous carcinoma involving the skin: all patients presented with lesions on chest wall, breast, axilla, and these locations can serve as clue to the breast origin. Microscopically, cutaneous lesions were of both pure and mixed type, and this correlated with the primary in the breast. Dirty necrosis was a constant histologic finding in intestine mucinous carcinomas involving the skin, and this feature may serve as a clue to an intestinal origin.

Adenocarcinoma, Mucinous↗
PubMed2005

Indeterminate cell histiocytosis: fact or fiction?

Indeterminate cell histiocytosis is a rare disorder, in which the predominant cells have the characteristics of both Langerhans cells and macrophages. We, in this study, describe 18 patients and compare them with those previously published. Most patients were adults with either solitary or multiple red-brown papules or nodules. While most lesions were confined to the skin, both conjunctival and bony involvement was seen. Histologically, the lesions showed patterns resembling those described for xanthogranulomas, with predominantly oncocytic (nine patients), spindled (five patients), scalloped (two patients) or vacuolated (two patients) macrophages. The accompanying infiltrate was mainly lymphocytic, although eosinophils and occasionally plasma cells were seen. All lesions were positive for macrophage markers, such as KP1 (CD68) and Ki-M1p, as well as for S-100 protein and showed variable reactivity for CD1a. No Birbeck granules were seen ultrastructurally in one patient. Some patients shared features with sinus histiocytosis with massive lymphadenopathy. It is unclear whether this disorder is a separate entity or represents various macrophage disorders identified at various time points in the inflammatory response. Ratzinger G, Burgdorf WHC, Metze D, Zelger BG, Zelger B. Indeterminate cell histiocytosis: fact or fiction? A clinicopathological series of 18 patients.

Adult↗
PubMed2004

Vasculopathy in von Recklinghausen's neurofibromatosis--a diagnostic quandary.

Vasculopathy is a not well-described presentation of neurofibromatosis type 1 in the dermatologic literature. We report a fatal case of neurofibromatosis vasculopathy in a 28-year-old woman who presented with skin ulcers and livedo racemosa; extensive gastrointestinal ulcers; and infarction of the bowel, liver, and spleen. Being alert to this manifestation may avoid unnecessary delay in diagnosis and enable, whenever possible, appropriate therapy.

Adult↗
PubMed2004

Unusual spindle cell squamous carcinoma in a renal transplant patient.

The histopathological diagnosis of spindle cell tumours is often difficult. We present a patient who developed a painful tumour on his head 6 years after renal transplantation. Histologically, the tumour was first interpreted as scar tissue with an unusual fibrohistiocytic component. Cytokeratins, desmin, CD31, CD34 and S100 could not be detected using conventional immunohistochemistry. After two recurrences and intensive immunohistochemical examinations, cytokeratin-positive tumour areas in direct connection with the epidermis were detected. The final diagnosis was therefore spindle cell squamous carcinoma. The patient finally died from brain metastases after experiencing further painful recurrences that were removed surgically. Our case underscores the importance of refined immunohistochemical methods in establishing the diagnosis of spindle cell squamous carcinomas, methods that should be taken into account especially if painful spindle cell tumours arise on sun-exposed skin in immunosuppressed patients.

Carcinoma, Squamous Cell↗
PubMed2004

The value of immunohistochemistry in atypical cutaneous fibrous histiocytoma.

Atypical cutaneous fibrous histiocytoma is a rare variant of dermatofibroma/fibrous histiocytoma characterized by striking atypia, thus resembling atypical fibroxanthoma. We studied 9 examples of ACFH histopathologically and immunohistochemically to investigate the nature of these atypical cells. Histology revealed ill-defined skin nodules, which were polypoid in 6 cases. A minority of mononuclear and giant cells (< 5%) revealed striking pleomorphism and showed large nuclei with prominent nucleoli. Immunohistologically, the atypical cells expressed vimentin, but were negative for S-100 protein, the keratin marker MNF116, alpha smooth muscle actin, CD34, factor XIIIa, and monocyte/macrophage markers Ki-M1p, KP1 (CD68), and MAC387. Positivity for MiB1 was very modest (< 1%) and limited to small- and medium-sized, inconspicuous cells. Multinucleate giant cells proved to be heterogenous, on one hand cells with differentiation toward macrophages with positivity for Ki-M1p and KP1, on the other toward fibroblasts positive for vimentin only. These immuno-histochemical results for differentiation markers in atypical cutaneous fibrous histiocytoma are similar to our previous findings and data in atypical fibroxanthoma; MiB1 helps to separate these entities from each other as the latter shows a very high proportion of proliferative atypical cells corresponding to the numerous mitoses seen in routine sections.

Adult↗
PubMed2004

Angiomatoid metastatic melanoma.

Two patients with metastatic melanoma, both with the same bizarre morphology and an unusual, comparatively benign course, are described: a 50-year-old female who more than 20 years after a primary melanoma on the right upper arm, Clark level III, maximum tumor thickness of 1.1 mm, developed multiple metastases in the deep soft tissue and a 62-year-old male with an acrolentiginous melanoma, Clark level III, maximum tumor thickness of 0.55 mm, who 6 months after the excision of the primary tumor developed metastasis in regional lymph nodes. Histology of all metastases revealed extensive central necrosis and hemorrhage with a demarcating granulomatous reaction imitating angiomatoid malignant fibrous histiocytoma but no obvious melanoma tissue. Although extensive immunohistochemistry and ultrastructural examination failed to solve the quandary, careful macroscopy revealed tiny foci of remnants from melanoma in the granulation center. The female developed multiple soft tissue metastases managed by surgery, immunochemotherapy, and autologous vaccination. Both patients are well without internal manifestations 9 and 5 years, respectively, after the first metastatic episode.

Antineoplastic Agents↗
PubMed2004

Dermatofibroma-a critical evaluation.

Dermatofibromas are common cutaneous lesions. In most cases, they can be readily identified clinically and show a typical histology. In a small percentage of cases they show unusual clinical and more often histologic features that may cause differential diagnostic problems. In addition there are reactive fibrous lesions with neural or smooth muscle features that we speculate may represent dermatofibroma variants.

Biomarkers, Tumor↗
PubMed2003

Stevens-Johnson syndrome associated with Malarone antimalarial prophylaxis.

To the best of our knowledge, Stevens-Johnson syndrome (SJS) has not been reported previously as an adverse reaction to Malarone, which is a combination of atovaquone and proguanil hydrochloride used for antimalarial prophylaxis and therapy. We describe a 65-year-old patient who had SJS with typical clinical and histopathological findings associated with the use of Malarone prophylaxis for malaria. This report should alert physicians to this severe cutaneous reaction, and Malarone should be added to the list of drugs that can potentially cause SJS.

Aged↗
PubMed2003

Unilateral blepharochalasis.

Unilateral blepharochalasis is an extremely rare disorder with an unknown etiology and pathogenesis. The authors present a 22-year old patient in whom a right-sided skin overhang of the upper eyelid caused visual field impairment. The condition was corrected by a standard blepharoplasty. The histological examination suggested a localised anomaly of the lymphatic system and an almost complete absence of elastic fibres as the causative agent.

Adult↗