Biomedical subjects
H A Neumann
Publications and source records attributed to H A Neumann.
Long cotton wool rolls as compression enhancers in macrosclerotherapy for varicose veins.
BACKGROUND: Macrosclerotherapy in combination with compression has proven to be safe and effective in the treatment of varicose veins. Local compression is increased by pads, according to Laplace law. Firm rolls of cotton wool are fixed over the course of the entire vein to increase local compression and to reduce complications. Additional compression is given by a combination of a class I (daytime and nighttime) and class II (daytime only) medical compression hosiery. PURPOSE: To evaluate the effectiveness and side effects of sclerocompression therapy with cotton wool rolls in combination with medical compression hosiery. METHOD: Prospective study with 100 patients (120 legs) with primary varicose veins, which are treated with polidocanol as sclerosant with the empty vein technique. Immediately after the injection, a long cotton wool roll is placed over the entire vein and fixed. Additional compression is obtained with class I and class II medical compression hosiery. The interface pressure on the skin, just under the cotton wool roll, is measured on 12 legs with the aid of an interface pressure measuring instrument (Oxford Pressure Monitor). RESULTS: Good sclerosing results are obtained in all patients. Side effects are classified as early and late. In 16 patients, minor side effects which needed no treatment are observed. In only 3 cases (2.5%), intravascular blood clots (2) and phlebitis (1) needed incision and expression. The mean interface pressure of all measuring sensors under the cotton wool roll is 84 mm/Hg (68 to 122 mm/Hg). CONCLUSION: This study proves the high effectiveness of a cotton wool roll compression right at the place of treatment. By using these long cotton wool compression rolls, the compression part of sclerocompression therapy becomes more effective and much easier to perform.
Bockenheimer's syndrome.
A case of a very extensive form of the rare Bockenheimer's syndrome (genuine diffuse phlebectasia) in a 45-year-old female patient is presented. The subject presented phlebectasias of the upper right leg, the vulva and the right side of the abdomen. The diagnostic and therapeutic possibilities for cases of patients with Bockenheimer's syndrome are described.
[The treatment of basal cell carcinoma patients by dermatologists in Netherland].
OBJECTIVE: To determine the policy of dermatologists practising in the Netherlands in the treatment of basal cell carcinoma. DESIGN: Written enquiry. SETTING: Catharina Hospital, Eindhoven, the Netherlands. METHOD: All 293 dermatologists practising in the Netherlands were sent a questionnaire in May 1996 containing 15 questions about diagnosis and treatment of basal cell carcinoma. RESULTS: Eighteen forms dropped off because of termination of the practice or joint completion in group practices. The response was 76% (208/275). The diagnosis was made usually on the basis of histological examination (71% of the respondents; 84% in a tumour recurrence). Excision was the preferred treatment for all subtypes of basal cell carcinoma; second choices were cryosurgery or curettage/electrocoagulation. Roentgen contact therapy has been practically abandoned. New methods such as photodynamic therapy and immunotherapy are being used only sporadically on an experimental basis. Most dermatologists regarded tumour recurrences as a bigger problem than primary tumours. They attempt to reduce the percentage of recurrences by giving advice about risk factors (sunlight). CONCLUSION: Too little use is being made of diagnostic biopsy to enable an optimal choice of therapy of basal cell carcinomas, especially in cases of recurrence tumours.
Muller's ambulatory phlebectomy for varicose veins of the foot.
BACKGROUND: Ambulatory phlebectomy is an accepted therapy for varicose veins. It has also been used for ankle and foot varicosities with success although the anatomy of the venous system of the foot is poorly described in the literature. OBJECTIVE: To review the relevant literature on the anatomy of the veins of the foot. Also to form an opinion on safe possibilities for the treatment of foot varicosis. METHODS: The English, French, German, and Dutch language literature was reviewed for anatomy and treatment of varicose veins of the foot. Fourteen patients (19 feet) were treated for varicose veins of the foot with ambulatory phlebectomy. RESULTS: Literature concerning the venous anatomy of the foot is very limited. Venous surgery, sclerotherapy, and ambulatory phlebectomy have all been used for the treatment of varicose veins of the foot. The former two have resulted in serious complications. All treated patients showed excellent results with ambulatory phlebectomy. No serious side effects were seen. CONCLUSIONS: The venous anatomy of the foot does not indicate major restrictions in the treatment of its varicosities. Ambulatory phlebectomy is the safest and most elegant treatment option for varicose veins of the foot. Venous surgery and sclerotherapy may be used successfully in special cases only.
Muller's ambulatory phlebectomy and compression.
BACKGROUND: Compression therapy will relieve patients of symptoms of venous disease, if not prevent the occurrence of complications, and is used either alone or in combination with other treatment options. OBJECTIVE: To describe the use of compression in the two main therapy modalities: sclerocompression and ambulatory phlebectomy. METHODS: Aim and mechanism of compression therapy are analyzed and clinical implications are discussed. RESULTS: A modification of compression therapy after ambulatory phlebectomy is suggested based on empirical evidence. CONCLUSIONS: The use of broad compression pads after ambulatory phlebectomy reduces hemorrhage and enhances resorption.
Mohs micrographic surgery for an erosive adenomatosis of the nipple.
BACKGROUND: Erosive adenomatosis of the nipple is a rare but distinct benign tumor of the nipple. It is usually considered to be derived from the apocrine sweat ducts of the nipple epithelium but probably of lactiferous duct origin. Total excision is the treatment of choice. OBJECTIVE: We report the clinical and histological features of this rare tumor, and the surgical technique employed. METHODS: Treatment consisted of Mohs micrographic surgery (MMS), fresh tissue technique, followed by primary closure. RESULTS: The described procedure resulted in a cure of the erosive adenomatosis of the nipple. CONCLUSION: Total excision of erosive adenomatosis of the nipple can be obtained by MMS. This technique prevents recurrence of the disease and minimizes resulting deformation of this important anatomic area.
Compression therapy with medical elastic stockings for venous diseases.
BACKGROUND: Compression therapy is the cornerstone in the treatment of venous disease. In many cases, but especially for the maintenance of compression, medical elastic compression stockings (MECS) are being used. Preprescription investigation includes determining the severity of venous insufficiency and the arterial system. An ankle/arm index < 0.6 will be the contraindication for compression therapy. MECS can be divided in flat-knitted and round-knitted MECS. Flat-knitted MECS can be made tailor sized, with a tolerance up to 0.5 cm. Several classes of MECS are characterized by the elasticity coefficient (EC) of the used elastic threads. The stiffer the stocking (high EC), the better a MECS will prevent edema formation during the day, but the more difficult it is to put them on. MECS with a high EC are always flat-knitted. Most round-knitted MECS will last 4-6 months, and flat-knitted MECS, 6-9 months. RESULTS: The physician can prescribe MECS for a wide variety of venous and some other diseases. He can determine the amount of compression as well as the stiffness of the MECS. CONCLUSION: Only a well-motivated patient and an experienced physician together are able to ensure ongoing successful compression therapy with MECS.
An intense light source. The photoderm VL-flashlamp as a new treatment possibility for vascular skin lesions.
BACKGROUND: Up to now, vascular diseases were treated with various lasers, such as argon, pulsed dye, and copper vapor lasers, which can lead to side effects like hypopigmentations, hyperpigmentations, and scarring. We treated patients with vascular lesions with an incoherent intense light source, the PhotoDerm VL-flashlamp. OBJECTIVE: The aim of the study was to test the effectiveness and safety of the PhotoDerm VL for vascular skin lesions. METHODS: One hundred and twenty patients with facial or leg telangiectasias, spider nevi, erythrosis interfollicularis, and senile angiomas were treated with the PhotoDerm VL. RESULTS: In 73.6% of patients there was an immediate clearing, and in 84.3% a clearing after 1 month was found of leg telangiectasias up to 1 mm in diameter. Facial telangiectasias and erythrosis interfollicularis colli showed clearance up to 90%. Spider nevi and senile angiomas often only needed to be treated once. CONCLUSION: From our experience we conclude that the PhotoDerm VL is an excellent device to treat vascular lesions as there were hardly any side effects seen, however, the user needs a sufficient experience to get good results.
Aromatic DNA adducts in human white blood cells and skin after dermal application of coal tar.
A group of eczema patients topically treated with coal tar (CT) ointments was used as a model population to examine the applicability of DNA adducts in WBC subpopulations as a measure of dermal exposure to polycyclic aromatic hydrocarbons (PAHs). Aromatic DNA adducts were examined by 32P-postlabeling in exposed skin and WBC subsets, and urinary excretion of PAH metabolites was determined to assess the whole-body burden. The median urinary excretion of 1-hydroxypyrene and 3-hydroxybenzo(a)pyrene was 0.39 (range, 0.12-1.57 micromol/mol creatinine) and 0.01 micromol/mol creatinine (range, <0.01-0.04 micromol/mol creatinine), respectively, before the dermal application of CT ointments. After treatment for 1 week, these levels increased to 139.7 (range, 26.0-510.5 micromol/mol creatinine) and 1.18 micromol/mol creatinine (range, <0.01-2.14 micromol/mol creatinine), respectively, indicating that considerable amounts of PAHs were absorbed. Median aromatic DNA adduct levels were significantly increased in skin from 2.9 adducts/10(8) nucleotides (nt; range, 0.7-10.0 adducts/10(8) nt) before treatment to 63.3 adducts/10(8) nt (range, 10.9-276.2 adducts/10(8) nt) after treatment with CT, in monocytes from 0.28 (range, 0.25-0.81 adducts/10(8) nt) to 0.86 adducts/10(8) nt (range, 0.56-1.90 adducts/10(8) nt), in lymphocytes from 0.33 (range, 0.25-0.89 adducts/10(8) nt) to 0.89 adducts/10(8) nt (range, 0.25-3.01 adducts/10(8) nt), and in granulocytes from 0.28 (range, 0.25-0.67 adducts/10(8) nt) to 0.54 adducts/10(8) nt (range, 0.25-1.58 adducts/10(8) nt). A week after stopping the CT treatment, the DNA adduct levels in monocytes and granulocytes were reduced to 0.38 (range, 0.25-0.71 adducts/10(8) nt) and 0.38 adducts/10(8) nt (range, 0.25-1.01 adducts/10(8) nt), respectively, whereas the adduct levels in lymphocytes remained enhanced [1.59 adducts/10(8) nt (range, 0.25-2.40 adducts/10(8) nt)]. Although the adduct profiles in skin and WBC subsets were not identical, and the adduct levels in WBCs were significantly lower as compared with those in skin, the total DNA adduct levels in skin correlated significantly with the adduct levels in monocytes and lymphocytes, but not with those in granulocytes. Excretion of urinary metabolites during the first week of treatment was correlated with the percentage of the skin surface treated with CT ointment and decreased to background levels within a week after the cessation of treatment. 3-Hydroxybenzo(a)pyrene excretion, but not that of 1-hydroxypyrene, correlated significantly with the levels of DNA adducts in skin that comigrated with benzo(a)pyrene-diol-epoxide-DNA. This study indicates that the DNA adduct levels in mononuclear WBCs can possibly be used as a surrogate for skin DNA after dermal exposure to PAHs.
[Plastic surgery as a last resort in lichen sclerosus].
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[Mohs' method of micrographic surgery as treatment for recurrent basal cell carcinoma].
OBJECTIVE: Evaluation of Mohs' micrographic surgery as treatment for recurrent basal cell carcinoma of the skin. DESIGN: Retrospective. SETTING: University Hospital Maastricht, the Netherlands. METHOD: In the period April 1992 to December 1995, 91 recurrent basal cell carcinomas (88 patients) were treated by Mohs' micrographic surgery. Medical records were analysed retrospectively with respect to different aspects. RESULTS: The mean age of the patients was 69 years. The recurrent basal cell carcinomas, with an mean diameter of 19.7 mm, were mainly localized on the nose and forehead. There were equal numbers of solid and morphea-like types of basal cell carcinomas. Most of these tumours had been treated by means of surgical excision in the past. The last treatment had taken place 3 years previously on average. Reconstruction was performed by means of primary closure, a graft or a flap. The mean follow-up period after Mohs' micrographic surgery was 12 months, in which one tumour recurred. CONCLUSION: Mohs' micrographic surgery is a surgical technique which provides the best prospect of total tumour removal together with maximal functional and cosmetic preservation. Mohs' micrographic surgery is of particular value for the treatment of recurrent basal cell carcinomas.
Immunohistochemical localization of granzyme B in peritumoral infiltrates of basal cell carcinoma.
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Red and blue telangiectasias. Differences in oxygenation?
BACKGROUND: Leg telangiectasias are visible, ectatic dermal arteriols, capillaries, or veins with a diameter of 0.1-1 or 2 mm. Their origin is still not known and different opinions have been published. OBJECTIVE: In our study we were interested in the different colors of telangiectasias and we wanted to demonstrate whether a difference in blood gases is causing the difference in color between red and blue telangiectasias. METHODS: We measured a capillary astrup in 20 patients, who had red as well as blue telangiectasias on the lower limb. Therefore, we took two samples, one of a red and one of a blue telangiectasia. By this we measured the oxygen saturation and the carbon dioxide concentration of the samples. Furthermore, we introduced the appearance of telangiectasias in two rather newly developed techniques, such as high-frequency 20- and 50-MHz ultrasound and laser Doppler perfusion imaging (LDPI). RESULTS: Red telangiectasias of all 20 patients had an average oxygen concentration of 5.9 kPa, (range, 3.94-7.46 kPa); their average CO2 concentration was 5.45 kPa (range, 4.54-7.06 kPa). Blue telangiectasias had an average oxygen concentration of 5.11 kPa (range, 3.12-7.0 kPa); their average CO2 concentration was 6.07 kPa (range, 5.38-7.36 kPa). Statistically work-up with a paired student's t-test showed a higher oxygen saturation of the red telangiectasias and a higher carbon dioxide concentration of the blue vessels. CONCLUSION: As telangiectasias are assumed to be located in the capillary bed, the reason for differences in oxygenation could possibly be found in underlying physiological and anatomical principles of the capillary loops with the red telangiectasia representing the arterial loop of the capillary and the blue telangiectasia representing the venous loop of the capillary. With high frequency ultrasound and LDPI it is possible to get useful information for finding the underlying feeder veins, which "feed" the superficial telangiectasias. Injecting into the nutritional vessel telangiectases can potentially decrease the number of side effects and, may reduce the number of necessary injections.
Transforming growth factor-beta and bcl-2 distribution patterns distinguish trichoepithelioma from basal cell carcinoma.
BACKGROUND: Trichoepithelioma (TE) and basal cell carcinoma (BCC) have many features in common both clinically and histologically. Despite these many similarities TE and BCC represent different biological entities. OBJECTIVE: Recently, bcl-2 and CD34 have been reported as reliable markers in distinguishing the two types of tumor. Transforming growth factor-beta (TGF-beta), a multifunctional regulator of both cell growth and differentiation, was evaluated in this study. METHODS: The immunohistochemical expression of TGF-beta was compared with the distribution patterns of bcl-2 and CD34 in five BCCs, five TEs, and seven borderline cases. RESULTS: All five TEs showed a diffuse cytoplasmic staining of tumor cells for TGF-beta, whereas four of five BCCs were TGF-beta negative. Of the seven equivocal cases of TE/BCC, five tumors demonstrated TGF-beta positivity in combination with negative bcl-2 staining corresponding to TE. The remaining two cases demonstrated the opposite staining pattern, characteristic for BCC. CONCLUSION: The TGF-beta staining pattern appears to be a helpful additional marker together with bcl-2 in differentiating between TE and BCC. The demonstrated staining differences may relate to the distinct origin and biological behavior of the two tumors and may therefore be of value in subsequent patient management.
Pressure differences of elastic compression stockings at the ankle region.
BACKGROUND: Elastic compression stockings are widely used medical devices for the prevention of edema and treatment of venous diseases. Many beneficial effects have been described in the past. The exact amount of pressure underneath elastic compression stockings at different areas of the leg remains controversial. OBJECTIVE: To examine the pressure at the skin underneath class II elastic compression stockings at different places around the ankle at the B level. METHODS: Patients with known venous insufficiency and regularly using class II elastic therapeutic compression stockings (25-35 mm Hg) for venous diseases were included. All subjects were wearing completely new stockings at the time of the study. Measurements were performed with an electropneumatic interface pressure measuring device (Oxford Pressure Monitor MK II) with inflatable small sensoring cells. Six sensors were placed around the smallest circumference at the ankle (B-area). The highest and lowest recordings as well as the means were evaluated. RESULTS: The mean pressure of class II elastic stockings measured around the ankle was 24.7 mm Hg (SD, 8.4). The lowest pressures were found at the medial site (18.3 mm Hg; 74% of the mean), and the highest at the pretibial zone (33.9 mm Hg, 137%). CONCLUSIONS: The pressure exerted by pressure class II elastic compression stockings a the medial site just above the ankle (B area) is too low to have influence and improve the venous insufficiency. For phlebology this is the target area. It might be a reason for the high recurrence rate of venous ulcers even if patients wear stockings. Also, the mean pressure of class II stockings was found to be below the normal levels of its pressure class (25-35 mm Hg according to the European CEN classification). The results advocate the use of pressure class III elastic compression stocking more often and the use of pelottes or foam pads.
Melanosis naeviformis of Becker and scoliosis: a coincidence?
Melanosis naeviformis of Becker (MNB) can be associated with hypoplasia of soft tissue or extremities, spina bifida and scoliosis of the vertebral column. We have investigated 50 patients (42 men, 8 women) with MNB radiologically. Scoliosis was diagnosed in 13 patients (26%). The curves of scoliosis varied from 11 degrees to 17 degrees. Physical examination revealed no gross asymmetries of the trunk, extremities or breasts. No correlation was seen between the age of patients and the scoliotic curve. In one family the father and oldest son had MNB with scoliosis and the other son and daughter had MNB without scoliosis. Since only mild scoliosis is found in patients with MNB, X-ray examination of the vertebral column has no therapeutic consequences.