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Biomedical subjects

C Kunte

Publications and source records attributed to C Kunte.

At least 19 recordsLinked to original sources
PubMed2005

Deep subcutaneous application of poly-L-lactic acid as a filler for facial lipoatrophy in HIV-infected patients.

INTRODUCTION: Facial lipoatrophy is a crucial problem of HIV-infected patients undergoing highly active antiretroviral therapy (HAART). Poly-L-lactic acid (PLA), provided as New-Fill/Sculptra, is known as one possible treatment option. In 2004 PLA was approved by the FDA as Sculptra for the treatment of lipoatrophy of the face in HIV-infected patients. While the first trials demonstrated relevant efficacy, this was to some extent linked to unwanted effects. As the depth of injection was considered relevant in this context, the application modalities of the preparation were changed. The preparation was to be injected more deeply into subcutaneous tissue, after increased dilution. MATERIAL AND METHODS: To test this approach we performed a pilot study following the new recommendations in 14 patients. RESULTS: While the efficacy turned out to be about the same, tolerability was markedly improved. The increase in facial dermal thickness was particularly obvious in those patients who had suffered from lipoatrophy for a comparatively small period of time. CONCLUSION: With the new recommendations to dilute PLA powder and to inject it into the deeper subcutaneous tissue nodule formation is a minor problem. However, good treatment results can only be achieved if lipoatrophy is not too intense; treatment intervals should be about 2-3 weeks.

Adult↗
PubMed2004

Patients with lymphatic metastasis of cutaneous malignant melanoma benefit from sentinel lymphonodectomy and early excision of their nodal disease.

Early versus delayed excision of lymph node metastases is still being assessed in malignant melanoma. In the present retrospective, multicentre study, the outcome of 314 patients with positive sentinel lymphonodectomy (SLNE) was compared with the outcome of 623 patients with delayed lymph node dissection (DLND) of clinically enlarged lymph node metastases. In order to avoid the lead-time bias, survival was generally calculated from the excision of the primary tumour. Survival curves were constructed using the Kaplan-Meier product-limit estimate. Cox's proportional hazards model was used to perform a multivariate analysis of factors related to overall survival. Compared with SLNE and early performed complete lymph node dissection, DLND yielded a significantly higher number of lymph node metastases. Median and mean tumour thickness were nearly identical in the two therapy groups. The estimated 3-year overall survival rate was 80.1+/-2.8% (+/-standard error of the mean (SEM)) in patients with positive SLNs, and 67.6+/-1.9% in patients with DLND (5-year survival rates 62.5+/-5.5 and 50.2+/-5.4%, respectively). The difference between the two survival curves was statistically significant (P=0.002). Using multifactorial analysis, SLNE (P=0.000052), American Joint Committee on Cancer (AJCC) Breslow thickness category (P<0.000001), age (P=0.01) and gender (P=0.028) were independent predictors of overall survival. The location of the primary tumour (P=0.59) was non-significant. Considering only those centres with sufficient data for epidermal ulceration, this risk factor was also significant. In cutaneous malignant melanoma, early excision of lymphatic metastases, directed by the sentinel node procedure, provides a highly significant overall survival benefit.

Female↗
PubMed2004

[First experiences with a new radiopharmaceutical for sentinel lymph node detection in malignant melanoma: (99m)Tc colloidal rhenium sulphide].

UNLABELLED: AIM of this study was to localize the sentinel lymph node by lymphoscintigraphy using technetium-99m colloidal rhenium sulphide (Nanocis), a new commercially available radiopharmaceutical. Due to the manufacturers' instructions it is licensed for lymphoscintigraphy. PATIENTS AND METHODS: 35 consecutive patients with histologically proved malignant melanoma, but without clinical evidence of metastases, were preoperatively examined by injecting 20-40 MBq Nanocis with (mean particle size: 100 nm; range: 50-200 nm) intradermally around the lesion. Additionally blue dye was injected intraoperatively. A hand-held gamma probe guided sentinel node biopsy. RESULTS: During surgery, the preoperatively scintigraphically detected sentinel lymph nodes were identified in 34/35 (97%) patients. The number of sentinel nodes per patient ranged from one to four (mean: n = 1.8). Histologically, metastatic involvement of the sentinel lymph node was found in 12/35 (34%) patients; the sentinel lymph node positive-rate (14/63 SLN) was 22%. Thus, it is comparable to the findings of SLN-mapping using other technetium-99m-labeled nanocolloides. CONCLUSION: (99m)Tc-bound colloidal rhenium sulphide is also suitable for sentinel node mapping.

Adult↗
PubMed2002

[Kossard frontal fibrosing alopecia in a man].

In 1994 Steven Kossard described a new and peculiar type of hair loss that he named postmenopausal frontal fibrosing alopecia. In 6 elderly women he observed a symmetric regression of the frontal hair line. Often the eyebrows were also affected. Histology showed lichen planopilaris. There were no clinical signs of lichen planus on the rest of the body. Since the original description by Kossard, several cases of frontal fibrosing alopecia have been described--almost all of them in elderly women. We report a man with frontal fibrosing alopecia of the Kossard type.

Aged↗
PubMed2002

[Hypertrichosis and hirsutism].

Facial hypertrichosis and hirsutism may cause severe cosmetic and psychologic problems. There are several therapeutic options, both on the cosmetic and medical level. Hirsutism with androgen-excess should be diagnosed and treated by gynecologists. Although frequently used, systemic antiandrogens have not yet proven their efficacy against unwanted hypertrichosis in clinical studies using modern and objective endpoints. Conventional methods of hair removal include plucking, waxing and chemical depilation by thiogycolates, as well as electrolysis and thermolysis. A new medical treatment of hypertrichosis is eflornithine cream. It inhibits the enzyme ornithine-decarboxylase which is essential for the rapidly dividing cells of the hair follicle. Permanent depilation by photothermolysis with lasers and pulsed flash-light systems is currently the most promising treatment.

Clinical Trials as Topic↗
PubMed2001

[Current treatment of hypertrichosis].

Facial hypertrichosis and hirsutism may cause severe cosmetic and psychologic problems. In the following, new developments in the treatment of hypertrichosis will be presented. Permanent depilation by photothermolysis is currently the most promising treatment. A new topical treatment of hypertrichosis is eflornithine cream. It inhibits the enzyme ornithine decarboxylase which is essential for the rapidly dividing cells of the hair follicle. Furthermore, other methods of hair removal such as plucking, waxing, chemical depilation by thioglycolates, electrolysis, thermolysis and systemic therapies of hirsutism will be discussed.

Eflornithine↗
PubMed2000

[Lipoma of the forehead].

BACKGROUND AND OBJECTIVE: Lipomas should be included in the differential diagnosis of tumors located on the forehead. They require a different operative plan. PATIENTS/METHODS: Lipomas of the forehead were extirpated in ten patients. Dermatohistopathologic investigations confirmed the diagnosis lipoma in each case and exactly identified the anatomic layers surrounding the tumor. RESULTS: Histologic investigations revealed the localization of the lipoma in the submuscular layer in eight patients and in the subgaleal layer in two patients. CONCLUSIONS: Lipomas of the forehead should be differentiated into submuscular and subgaleal lipomas depending on the exact anatomic localization below the frontalis muscle or underneath the galea aponeurotica. This classification is simple and aids in operative planning.

Adult↗
PubMed1999

[Therapy of androgenetic alopecia with finasteride. What must be considered in consultation and drug prescribing].

Androgenetic alopecia in men is genetically determined, but occurs only when the testosterone metabolite dihydrotestosterone (DHT) is present in normal levels. The drug, finasteride, inhibits the enzyme 5-alpha-reductase II, which is responsible for converting testosterone to DHT. One 1 mg tablet (Propecia) of finasteride daily lowers serum DHT levels by about 70%, and increases serum testosterone by 10%. The efficacy of finasteride 1 mg has been demonstrated in a randomized, double-blind, placebo-controlled clinical trial involving more than 1,500 men in whom a significant increase in hair density over a specified area of the scalp, and a significant improvement in appearance was noted. Following one year to treatment 48%, and following 2 years 66%, of the finasteride patients (placebo group 7% after both treatment periods) presented with visibly thicker hair growth. Side effects such as decreased libido, ejaculation disorders and erectile dysfunction were seen in fewer than 2% of the men in both the finasteride and placebo groups.

Alopecia↗
PubMed1999

Paraneoplastic pemphigus with fatal pulmonary involvement in a woman with a mesenteric Castleman tumour.

A 42-year-old woman presented with oral and labial erosions, conjunctivitis, facial rash and lichenoid erythematous papules on the trunk. Paraneoplastic pemphigus (PNP) was suspected, and a search for a neoplasm revealed an intra-abdominal Castleman tumour sized 7 x 5 x 6 cm. After removal of the Castleman tumour, the skin and mucosal inflammation gradually subsided over the next 12 months. However, due to irreversible pulmonary involvement the patient died of intractable respiratory distress 2 years after the onset of the disease. Systemic corticosteroids, azathioprine, cyclophosphamide, high-dose intravenous immunoglobulins and thalidomide were ineffective. The diagnosis of PNP was confirmed by keratinocyte antigen immunoprecipitation with the patient's serum.

Adult↗
PubMed1999

Current management of androgenetic alopecia in men.

Androgenetic alopecia (AGA) is a common dermatological condition affecting both men and women. Until recently there has been little interest in AGA as a clinical condition, largely due to the lack of any genuinely effective treatment for it. A number of "remedies" exist, such as vitamin supplements, which are not generally harmful but which have no proven efficacy in promoting hair growth or preventing further hair loss. Hair systems and surgery provide camouflage for the symptoms but do not effect a cure. By far the most promising approaches to the treatment of AGA are drug therapies, such as minoxidil and finasteride. Finasteride, an inhibitor of the type II 5alpha-reductase that converts testosterone to dihydrotestosterone, has been shown to prevent further hair loss, and promotes new hair growth in the majority of the men taking part in clinical trials. Tailored drug approaches like this offer the greatest hope for the successful future treatment of AGA.

Alopecia↗
PubMed1998

Folliculitis spinulosa decalvans: successful therapy with dapsone.

A 27-year-old male patient presented with scaly erythema and crusts on the scalp. Since birth, he suffered from dry skin and inflammation of the eyelids. Scarring alopecia was noticed in some regions of his scalp. Folliculitis spinulosa decalvans was diagnosed. Therapy with isotretinoin and topical corticosteroids was without effect. In contrast, 100 mg of Dapsone per day led to resolution of the inflammatory signs. This enabled him to cover the disfiguring scarring alopecia with a permanent hairpiece. His condition has been stable after 18 months without the enlargement of the scarred alopecic areas.

Adrenal Cortex Hormones↗
PubMed1997

[Brazilian pemphigus foliaceus (fogo selvagem)].

Most of the clinical, histological and immunohistological features of fogo selvagem resemble those of idiopathic pemphigus foliaceus (PF). Both diseases are clinically characterized by small flaccid bullae evolving into to scaly and crusted lesions, sometimes with pustules, mainly in seborrheic areas of the skin. Mucosal surfaces are mostly spared. The main histologic feature of endemic pemphigus foliaceus is a subcorneal acantholytic blister. Standard immunofluorescence studies demonstrate intercellular IgG deposits throughout the entire epidermis. These IgG antibodies are mainly of the IgG4-subclass. Almost all patients have circulating IgG-autoantibodies in their serum directed against stratified epithelial desmosomes. The fogo selvagem autoantibodies and the PF antibodies are directed against the 160 kD desmosomal glycoprotein desmoglein 1 which together with plakoglobin (85 kD) forms a complex of adhesion proteins with desmosomes of stratified epithelia. Fogo selvagem occurs in endemic foci in some areas of Brazil and possibly in neighbouring South American countries, very often in children, adolescents and young adults. The etiology of fogo selvagem is still unknown. The frequent association with insect bites has lead to the concept of fogo selvagem being a transmissible disease with acquired immunity in adulthood. However, the infectious agent and possible vectors have not yet been identified.

Adolescent↗