Biomedical subjects
M Hundeiker
Publications and source records attributed to M Hundeiker.
[Not diagnosable malignant melanomas].
Of the 3574 malignant melanomas treated in Hornheide between December 1981 and August 1990 (not including preinvasive cases) 97 were not immediately recognized. These tumours did not look like melanomas. In 72% they were smaller than 10 mm in diameter, and in 20%, smaller than 5 mm. Clark's so often quoted "pencil rule" should no longer be used as an aid to exclusion of invasive melanoma. Localization of the unrecognized melanomas was on the head and neck in 22% of cases. In 37%, the patients were under the age of 40 years. No less than 25% of the patients had multiple melanomas. Many of these melanomas. Many of these melanomas were thin tumours (less than 0.75 mm in 55% and less than 1.5 mm in 77%). This explains why more than 50% of the lesions are described as "macules". The most common incorrect diagnoses were dysplastic naevi (44%) and common (23%) naevi. The most important anamnestic criteria are the patients' own statements about changes in size, colour and shape. These "dynamic" elements must be more carefully observed and documented during process of the clinical diagnosis.
[Congenital hereditary hypotrychosis. Generalized autosomal dominant hypotrichosis with pili torti (hypotrichosis congenita hereditaria Marie Unna)].
Report on a family with numerous relatives in 7 generations suffering from hypotrichosis congenita hereditaria Marie Unna type. Personal investigations were possible in 29 persons. 19 of them presented the characteristic features of the syndrome with pili torti, generalized inborn hypotrichosis and a type of baldness resembling androgenetic alopecia.
[Attempt at applying statistical methods to delimit melanoma types].
By means of the "multivariate variance analysis" ("MANOVA"; Friedrich and Olfert, 1977), we tried to differentiate the histologic types of malignant melanomas also by quantifiable criteria. The investigation depended upon data from 411 patients. Difficulties arose from incomplete data material. But in principle, the indication of this method is given in such problems. If the number of cases could be augmented, the method would be helpful as a support for diagnostic quality control.
[Accuracy of the clinical diagnosis in malignant melanomas].
Histologic findings and clinical data of 411 patients with malignant melanomas treated in 1952 up to june 1977 reveal an improvement of diagnostic accuracy. Within the last years, fewer patients were referred to the clinic with extensive tumor growth or with metastases. A change from the levels of invasion V and IV to III is evident. Further improvement to level II and I with a corresponding smaller tumor thickness is appearing in outlines.
[Vascular nevi and tumors of the skin].
Diagnosis and classification of dysontogenetic and neoplastic lesions of blood- and lymph-vessels depend upon the presence or absence of proliferating vascular elements and of non-involutive connective tissue and muscular wall structures. Angiectatic and angiokeratotic nevi, capillary and cavernous angiomas, glomangiomas and malignant vascular tumors are presented in a survey with special reference to frequent diagnoses.
[Diagnostic problems in skin tumors].
Several starting-points for improvement of diagnostic accuracy in skin tumors are illustrated by examples: Frequencies and direction of diagnostic errors, as well as the value of diagnostic criteria need further investigations. Frequent "customary" diseases need more attention in medical textbooks, compared with less frequent "interesting" syndromes. Erroneous denominations and historical false classifications which are handed down in the literature demand correction. The possibility continues, that apparently clearly defined entities may decay; they may be replaced by new entities in consequence of new perceptions.
[The clinical picture of "circumscribed granuloma diseases"].
Characteristic findings, differential diagnosis and clinical course of the so-called "circumscript granulomas" (Granuloma anulare, necrobiosis lipoidica, Miescher's granulomatosis, disciformis, necrobiosis maculosa, granuloma multiforme, actinic granuloma, granuloma faciale and lethal midline granuloma etc.) are represented in a condensed clinical survey.
[Differential diagnosis of pigmented tumors].
Some frequent diagnostic problems and the most important clinical and histologic criteria in differential diagnosis of malignant melanomas, benign pigment cell nevi, melanotic epithelial neoplastic lesions and frequent haemosiderotic tumors are delineated in a condensed survey. Considering the variety of diagnostic errors, one should never treat respectively destroy pigmented tumors of the skin without histologic investigation.
[Keratoacanthoma or carcinoma? Histological differential diagnosis].
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[Clinical variations of keratoacanthomas].
Clinical variants of Keratoacanthomas are, besides the very frequent crateriform types, and the plate-shaped ones, Keratoacanthoma marginatum centrifugum, aggregated Keratoacanthomas, successive multiple Keratoacanthomas, and rare special forms like multiple eruptive Keratoakanthomas and Keratoacanthomas combined with Hyperplasia of sebaceous glands and epitheliomas. A detailed description of the different types is derived from their growth and their origin from supraseboglandular epithelium of hair follicles.
[Cryotherapy of the cylindroma syndrome].
Two patients with dermal Cylindromas were successfully treated with a special cryoapplicator. This small cryosurgical unit consists of a copper core of 645 g with a 1,5 cm insulating styropore body. At the one end, the cylindrical core has a projection bearing the therapeutic surface, at the other a thread, which takes up a manipulator. This serves the purpose of transfering the core into liquid gas and, after throughout cooling, into the styropore body. After half an hour of therapeutic use, the warmed core requires new cooling in liquid nitrogen or liquid air.
[Classification of vascular neoplasms].
Neoplasms of blood and lymph vessels differ from angiectatic and angiokeratotic nevi by real proliferating growth. According to their features of growth and their wall structures, they are classified into three main groups: angiomas, glomangiomas and malignant vascular tumors. Within the angiomas on the one hand, capillary angiomas are classified into: planotuberous and tuberonodous angiomas of childhood and Kasabach-Merritt syndrome, multilocular hemangiomatosis, progressive multiple angiomas, tardive ("senile") angiomas, eruptive angiomas (granulomata pediculata), papular angioplasia, gemmangioma, and benign juvenile hemangioendothelioma. On the other hand, cavernous angiomas, i.e. arterial and venous cavernomas, as well as blue rubberbleb nevus, Mafucci's syndrome, angioleiomyoma, benign juvenile hemangiopericytoma and cavernous lymphangioma, form thick walled structures without involution. Glomangiomas occur as solitary, multiple systematized, and multiple disseminated and familiar forms. Within the group of malignant vascular tumors--Kaposi sarcoma, lymphangiosarcoma in lymphedema, hemangioendothelioma and angioplastic reticulosarcoma, hemangio- or lymphangiosarcoma, angioendotheliomastosis proliferans, rarity and increasing loss of characteristic differentiated structures give rise to difficulties in nosologic classification.
[Blepharoachalasis (Fuchs) and the Laffer-Ascher syndrome].
The case report of a 20 year old woman illustrates the course of blepharochalasis. This disease was defined as an entity by E. Fuchs in 1896. It is characterized by relapsong edematous tumefaction and increasing relaxation of the eye lids with atrophy of the skin, blepharophimosis and emergence of a pseudoepicanthus. Folding of the oral mucosa in the upper lip, the so-called double lip, euthyroid struma, and, in later stages, orbital fat hernia and prolapse of the lacrimal gland, are further facultative symptoms. Partially, late stages of the disease had been described as Ascher- or Laffer-Ascher-Syndrome. This syndrome is no separate entity.
[Epibulbar superficial spreading melanoma (author's transl)].
A report rarely a case of superficial spreading melanoma of the conjunctiva bulbi in a 40-year-old woman. As this kind of tumor is very found at this site, the unusual localisation rendered the differential diagnosis more difficult and delayed the radical operative therapy. After orbitectomy the patient has been free of local metastatic deposits for two years. She is fully rehabilitated by a good epithetis. The course of diagnosis in our case illustrates the necessity of uniform application of the nomenclature of cutaneous forms of melanomas and naevi in ophthalmology.
[Classification of angiectatic and angiokeratotic nevi].
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[Development and diagnosis of precancerous conditions].
The Evolution and substantial diagnostic criteria of solar and radiogenic keratoses, tar- and oil keratoses, praecancerous lesions induced by arsenic, Bowen's dermatosis, as well as their leucoplacic counterparts in oral and genital mucosa and melanotic praeblastomatous lesions are described, aiming at early diagnosis and consequent early therapy.
[Diagnostic errors in angiomas].
A comparison of clinical statements and histologic findings reveals a lower diagnostic success in angiomas, compared with other benign tumours. Cavernous forms of angiomas are very often not discerned. Capillary angiomas are misdiagnosed as cavernous ones, and teleangiectatic nevi as angiomas. Mistakes and their incidences are pointing not at real difficulties of differentialdiagnosis, but at wrong information of physicians as to the cause of errors. According to this supposition, a great part of textbooks in different medical disciplines offer no correct representation of this object. Our results reveal problems concerning the representation of some aspects of skin diseases outside of Dermatology. The diagnosis of angiomas, with special regard to the therapeutic consequences of the fundamental distinction of angiomas from angiectatic nevi by proliferation of endothelial cells, and of cavernous from capillary angiomas by vascular structure imitating arteries or veins, demands more attention in medical education.