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Biomedical subjects

G Sebastian

Publications and source records attributed to G Sebastian.

At least 19 recordsLinked to original sources
PubMed2006

[Cutaneous malignant melanoma. Excision margins and lymph node dissections].

Excision is the treatment of choice in stage I malignant melanoma. As supported by several controlled clinical studies, reduced safety surgical margins from 0.5 to 2 cm are sufficient. Most surgical defects can be closed by simple skin flap techniques. In critical anatomic sites (e. g. face, hand, foot) micrographic surgery is the therapy of choice. Sentinel lymph node biopsy (SLNB) was proposed as a minimally-invasive procedure for the histopathologic staging of the regional lymph nodes. Today SLNB is standard in the diagnostic approach to melanomas thicker than 1 mm. The therapeutic relevance of SLNB is unclear. The most common sign of tumor progression is involvement of regional lymph nodes. The treatment of choice in patients with neck metastases is the radical, modified or selective neck dissection. In the case of axillary metastases, levels I-III of the axillary lymph nodes are excised. With groin metastases, superficial inguinal dissection is usually preferred. There are no randomized controlled trials comparing the outcome of combined inguinal and pelvic lymph node dissection and superficial inguinal lymph node dissection.

Humans↗
PubMed2005

[Secondary healing of the face].

Immediate reconstruction of full-thickness skin defects after micrographic surgical removal of facial skin cancers is a commonly accepted principle. Healing by secondary intention on the face is controversial. Considering both the literature and our own experience, we offer indications and contraindications for this approach, tailored to the various facial anatomic units. Secondary wound healing is a safe, effective and cost-saving alternative to surgical reconstruction in selected areas.

Clinical Trials as Topic↗
PubMed2004

[Treatment of recalcitrant wounds with autologous epidermal equivalents. After excision of multiple cylindromas of the scalp].

A 63 year old man developed non-healing ulcerations after en-bloc resection of multiple cylindromas of the scalp. After excision and granulation-stimulating local therapy, the wound was covered with mesh grafts from the thighs. He developed widespread tension blisters with superficial ulcerations in the occipital region which did not heal despite adequate topical therapy. We then treated him successfully with EpiDex, a tissue engineered fully differentiated epidermal equivalent derived from keratinocytes of the outer root sheath of plucked anagen hair follicles. We introduce this treatment modality as a non-invasive effective option in treating non-healing ulcers.

Carcinoma, Adenoid Cystic↗
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

[Acne inversa].

Explore the source record for details and available documents.

Abscess↗
PubMed2003

[The treatment of keloids].

Keloids are benign fibrous growths with characteristic clinical features, whose underlying pathogenic mechanisms are not fully understood. While numerous treatment approaches are available, there is little evidence for efficacy based on controlled clinical studies. Therapeutic results are often not satisfactory. The best approach employs multiple modalities appropriate for the stage of the lesion. Combining invasive methods such as cryotherapy, surgery, intralesional steroid injections, laser or radiotherapy with external or physical approaches has helped to optimize treatment efficacy. Newer clinical studies with intralesional substances such as interferons which may directly influence collagen metabolism show promising results; these substances may be valuable therapeutic additions.

Adolescent↗
PubMed2002

[Giant cavernous hemangioma of the scalp].

Cavernous hemangiomas of the scalp associated with vascular tumors of the skull occur rarely in older patients. Giant hemangiomas can cause complications secondary to extensive bleeding. Here we report on a 78-year-old female presenting with a giant ulcerated cavernous hemangioma of the scalp. Before admission to the hospital, she had suffered from severe bleeding of the vascular tumor, with resulting anemia. Because of her cardiovascular disease, the tumor mass, and possible vascular connections to osseous hemangiomas, complete surgical removal of the hemangioma was not indicated. Therefore the superficial ulceration was covered with a split skin transplant. After complete wound healing, no further bleeding occurred.

Aged↗
PubMed2001

Dacarbazine and interferon alpha with or without interleukin 2 in metastatic melanoma: a randomized phase III multicentre trial of the Dermatologic Cooperative Oncology Group (DeCOG).

In several phase II-trials encouraging tumour responses rates in advanced metastatic melanoma (stage IV; AJCC-classification) have been reported for the application of biochemotherapy containing interleukin 2. This study was designed to compare the efficacy of therapy with dacarbazine (DTIC) and interferon alpha (IFN-alpha) only to that of therapy with DTIC and IFN-alpha with the addition of interleukin 2 (IL-2) in terms of the overall survival time and rate of objective remissions and to provide an elaborated toxicity profile for both types of therapy. 290 patients were randomized to receive either DTIC (850 mg/m(2)every 28 days) plus IFN-alpha2a/b (3 MIU/m(2), twice on day 1, once daily from days 2 to 5; 5 MIU/m(2)3 times a week from week 2 to 4) with or without IL-2 (4.5 MIU/m(2)for 3 hours i.v. on day 3; 9.0 MIU/m(2) i.v. day 3/4; 4.5 MIU/m(2) s.c. days 4 to 7). The treatment plan required at least 2 treatment cycles (8 weeks of therapy) for every patient. Of 290 randomized patients 281 were eligible for an intention-to-treat analysis. There was no difference in terms of survival time from treatment onset between the two arms (median 11.0 months each). In 273 patients treated according to protocol tumour response was assessable. The response rates did not differ between both arms (P = 0.87) with 18.0% objective responses (9.7% PR; 8.3% CR) for DTIC plus IFN-alpha as compared to 16.1% (8.8% PR; 7.3% CR) for DTIC, IFN-alpha and IL-2. Treatment cessation due to adverse reactions was significantly more common in patients receiving IL-2 (13.9%) than in patients receiving DTIC/IFN-alpha only (5.6%). In conclusion, there was neither a difference in survival time nor in tumour response rates when IL-2, applied according to the combined intravenous and subcutaneous schedule used for this study, was added to DTIC and IFN-alpha. However, toxicity was increased in melanoma patients treated with IL-2. Further phase III trials with continuous infusion and higher dosages must be performed before any final conclusions can be drawn on the potential usefulness of IL-2 in biochemotherapy of advanced melanoma.

Adolescent↗
PubMed2001

Accuracy of the intra-operative radioguided localization of the sentinel lymph node (SLN) 24 hours after lymphoscintigraphy in patients with malignant melanoma.

AIM: For optimized logistics for the sentinel lymphadenectomy (SL) it might be helpful for the clinics involved if a longer time period between the lymphoscintigraphy (LS) and surgery is possible. Therefore, we investigated if a precise localization of the sentinel lymph node is possible 24 hours after LS. METHODS: 78 patients with primary malignant melanoma (MM; n = 44) or with MM pre-operated by excisional biopsy (n = 34) were investigated. In 40 cases the tumor was localized on the trunk and in 38 cases on the extremities. Mean MM thickness was 2.68 mm (range: 0.29 to 12 mm). In all patients a lymphoscintigraphy (LS) with an average of 85 MBq of Tc-99m nanocolloid was performed one day prior to surgery. Immediately after tracer application dynamic data acquisition was started at a LFOV gamma camera followed by a whole body scan. With a hand-held gamma detector (C-Trak) 2, 4, 6, 8, and 24 hours after tracer administration the SLN was identified and the counts registered. RESULTS: 94 SLNs were identified in 87 lymphatic basins from which 86 could be resected. Nine MM showed two draining channels. After 24 hours 15.5% (as an average) of the initial counts could be measured in the SLN. The uptake in the SLN in pre-operated versus patients with primary tumor was statistically not significant (p = 0.4). In 16 cases (20.5%) the SLN was tumor positive. Four of those patients developed distant metastases and two died within the first year. None of the patients with negative SLN developed distant metastases or died. CONCLUSION: The remaining activity in the SLN up to 24 hours after administration is sufficient for their intra operative localization. The method of lymphoscintigraphy and localization of the SLN by a hand-held gamma detector optimizes the intra operative identification of the SLN in patients with malignant melanoma.

Adult↗
PubMed2000

[Laparoscopic cholecystectomy in isolated gallbladder metastasis of malignant melanoma].

Metastasized malignant melanomas can affect all organs of the human body. However, isolated metastatic spreading into the gallbladder is rare. We treated two asymptomatic patients who had undergone primary curative resection of a melanoma. Gallbladder structures suggesting the presence of tumors were noticed in the follow-up investigations. The two patients underwent laparoscopic cholecystectomy to clarify their pathological relevance. Histologically, the tumor was a metastasis of the malignant melanoma in each case. Surgery is indicated in stage IV in isolated metastatic spreading to the gallbladder in order to avoid symptoms or tumor complications. Since the vast majority of melanoma metastases of the gallbladder are located intraluminally and lymphadenectomy in the region of the hepatoduodenal ligament does not appear to be appropriate, the operation should be carried out laparoscopically. The value of postadjuvant chemoimmunotherapy after metastasis resection is being investigated in numerous studies at present.

Aged↗