Biomedical subjects
Publications and source records attributed to P Altmeyer.
We report on a 39-year-old female patient who has had a pincer-nail syndrome affecting most of the toenails and all her fingernails since early childhood. A conservative treatment with uric acid ointment under occlusion was used to dissolve the central part of the curved nail. With this therapy, the growing nail slowly curved back into its normal shape and all clinical symptoms of the pincer-nail syndrome disappeared.
In order to assess the value of 20-MHz sonography in the pre-operative diagnosis of malignant melanomas, 54 melanomas were examined. The pre-operative ultrasound scans were compared with corresponding histological sections from the excised tumours. A computer-aided measurement of the tumour thickness (sonometry) and the internal echo density (densitometry) was performed in the ultrasound scans. The melanomas appeared as largely echolucent zones. There was a significant correlation between the tumour thickness measured in the ultrasound scan and those measured in the histological sections (r = 0.938, p less than 0.001). As a rule the tumour thickness determined by sonometry were greater than the histometrically determined values. Subtumoral inflammatory infiltrate and other hypo-echoic structures in the region of the tumour are possible causes of the discrepancies. Some of those hypo-echoic structures can be identified and disregarded in B scan measurement. Even if a definite differential diagnosis is not possible on the basis of the ultrasound scan alone, 20-MHz sonography provides additional information which can be of use in surgical planning.
Psoriasis on the palms and soles is characterized by pustules, vesicles and hyperkeratotic plaques. Several studies have postulated that the pustules and vesicles are round or egg-shaped. This three-dimensional study reveals that neither pustules nor vesicles have a regular spherical morphology. The vesicles are located in the upper and middle layers of the epidermis and may exhibit dumb-bell- or banana-shaped lumina. The pustules consist of different compartments combining characteristics of a dyshidrotic vesicle with those of a microabscess of Munro.
Two different forms of scleroderma in one family are described: the mother suffers from systemic sclerosis and her daughter from linear morphoea. The observed HLA antigens indicate that systemic sclerosis and morphoea have various features in common. The immunogenetic data can be used to calculate the aetiological and preventive fractions, which together with environmental hazards and other risk factors describe the HLA-associated potential for provocation of scleroderma.
We report on a 63-year-old woman who had been suffering from generalized parakeratosis variegata since she was 7 years old. Increased tightness of the skin was the only clinical symptom. On the whole integument except for the face, we found a fine network of hyper- and depigmentation and telangiectasias. The skin surface was dry and atrophic with fine lamellar scaling. Histological, immunohistological and ultrastructural findings indicated early infiltration by a cutaneous T-cell lymphoma. However, PCR analysis of the T-cell receptor gamma-chain genes revealed multiple amplification products favouring a polyclonal T-cell proliferation. In light of the clinical history over a period of 56 years, we consider parakeratosis variegata to be a benign, chronic inflammatory condition, as is confirmed by the results of PCR analysis in this patient.
A 56-year-old female patient had suffered from isolated, unclassified palmoplantar keratosis since childhood. During the climacteric horny papules appeared for the first time on the extremities and trunk. Histologically, the efflorescences on the body and the palmoplantar keratosis were classifiable as keratosis follicularis. Predilection sites of Darier's disease were spared. Altogether, the usual pattern of involvement was reversed.
A 6 year-old boy with de Sanctis-Cacchione syndrome is reported. This syndrome is characterized by the triad xeroderma pigmentosum (XP), mental deficiency and neurological disturbances. The patient's cells were assigned to genetic complementation group A by use of the cell fusion technique. DNA repair capacity as measured by unscheduled DNA synthesis (UDS) was drastically reduced to 7.5%, compared with 100% of the controls. The rate of sister chromatid exchange (SCE), an indicator of the hypermutability in XP, was clearly elevated after ultraviolet radiation of skin fibroblasts of the patient.
Two patients, a 79-year-old man suffering from familial lichen amyloidosus and a 44-year-old women with biphasic cutaneous amyloidosis, developed small, centrally ulcerated papules. Histological and ultrastructural examination confirmed transepidermal elimination of amyloid. In contrast to other transepidermal elimination diseases, the material eliminated in perforating cutaneous amyloidosis is of epidermal origin.
A herpes simplex type I subunit vaccine developed by Behring-Werke (Marburg/Lahn, FRG) was compared with placebo for therapeutic effectiveness in the treatment of recurrent orolabial herpes simplex in a multicentre study involving the major hospitals in Frankfurt/Main (n = 34), Hamburg (n = 18), Giessen (n = 17) und Kassel (n = 14). The effectiveness of the vaccine was judged on the reduction in the frequency of recurrences. Within the period of the 8-month study there was no statistically significant difference in the frequency of recurrences with vaccine or placebo. Both placebo and verum led to a significant decrease in the number of recurrences of orolabial herpes simplex, but the effect of placebo was slightly more pronounced.
A 37-year-old woman developed ichthyosiform desquamation of the skin and a severe diffuse alopoecia 3 weeks after taking the antidepressant maprotilin. No signs of inflammation were present. Histology revealed acanthosis with preserved stratum granulosum, follicular hyperkeratosis and dystrophic changes of the hair follicle. Electron microscopy revealed rarefication of tonofilaments and necrobiotic changes of epidermal keratinocytes with vacuolar degeneration of the cytoplasm and disorganization of the organelles. Pathogenetically this disease represents a drug-induced transitory disorder to keratinization, which had resulted in desquamation of the stratum corneum and alopecia. The authors propose the designation corneolysis for this pathogenetic principle.
Ultrasonographic methods have recently provided us with the means for objective and non-invasive monitoring of the dynamics of chronic skin diseases. We examined 34 patients with localized scleroderma (morphea) using a 20-MHz B-mode ultrasound scanner (DUB 20, Taberna pro Medicum, Lüneburg). In patients with plaque-type and linear band-type localized scleroderma intraindividual comparison of sclerotic skin with corresponding areas of healthy skin showed thickening of the corium. The increase in corium thickness was between 2% and 251%. The extent of the difference in corium thickness between sclerotic and healthy skin depended on the location-originally thin skin showed a greater degree of sclerosis. We also frequently found enhanced reflexes in the lower corium and hyperechoic, widened bands of connective tissue traversing the subcutaneous fatty tissue from the corium-subcutis border in the direction of the muscle fascia. 20 patients were examined several times in the course of one year. In nine patients we found ultrasonographic evidence of regression (decrease in thickness 26%) and in nine the ultrasound examination showed progression (increase in thickness 28%). 20-MHz B-mode ultrasound imaging is a suitable non-invasive method for monitoring the course and treatment of localized scleroderma. Its routine use is strongly recommended.
Peripheral blood lymphocytes of atopic patients were analyzed with regard to spontaneous as well as mitogen-induced CD23 expression, sCD23 release as well as Ig (M, G, A, E) synthesis in vitro. The data were correlated with the results for phenotypically defined peripheral cells (T cells, B cells, monocytes), sCD23 release and amounts of Ig (M, G, A, E). A positive correlation was obtained for serum sCD23 and serum IgE of patients with high and intermediate IgE levels, of sCD23 with the percentage of B cells and sCD23 with serum IgA levels. No correlation was obtained for the mitogen (SAC, PWM) induced amounts of Ig (E, A, M, G) synthesis and, furthermore, sCD23 levels determined in cell culture did not correlate with serum IgE levels. Our data support the role of sCD23 in atopic diseases and in isotype regulation.
The incidence rate of all skin cancer forms has been increasing during the last few decades. The incidence of malignant melanoma is important due to its very high malignancy and its growing spread especially among young patients. Malignant melanoma is mainly observed on the external skin and is therefore well suited for screening methods. During a campaign in the city of Bochum, 1226 patients were examined. A total of 9 malignant melanomas and 10 basal cell carcinomas were discovered. The statistical data show that most of the patients could be motivated to participate by regional media and not by supraregional media. The wide acceptance of our prevention week shows that prevention campaigns are feasible, important and necessary.
This case report deals with the giant form of porokeratosis of Mibelli, porokeratosis Mibelli gigantea. Over the last 40 years, the 55-year-old man concerned had observed a centrifugal expansion of a single hyperkeratotic lesion until it covered the whole of the right hand and forearm. Besides the characteristic histological alterations, we saw capillaries with unusually thickened walls owing to basal lamina multiplication. In the centre of the lesion atrophy of the epidermis and of the corium was visible. These observations indicate an alteration in two germ layers in porokeratosis.
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Digital 20 MHz b-scan sonography is a new non-invasive tool in dermatological routine diagnostics. The 20-MHz linear scanner employed in this study has a signal penetration of 7 mm, a lateral resolution of 200 microns and an axial resolution of 80 microns. Seventy-five basal cell carcinomas were examined by ultrasound. An exact correlation of histological slides and sonographic images allowed us to explain the sonographic phenomena of basal cell carcinoma (BC). BCs exhibit a well-defined area with poor echoes; they sometimes even show a total loss of reflection. In the tumor parenchyma inhomogenously distributed internal echos were found. Below the tumor post-tumoral enhancement of the signal reflection is common (depending on the type of BC -up to 70%). Our results prove that digital 20 MHz ultrasonic imaging systems are well suited for studying the extension, thickness and tissue texture of basal cell carcinoma.
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B-scan 20 MHz ultrasonography is a new non-invasive technique to study the skin architecture. In a study on 236 patients, we showed that ultrasonic investigations can provide an efficient means to determine the thickness and extension of tumors. In addition, ultrasound may help make the differential diagnosis. This method is particularly accurate in the measurement of tumor thickness of malignant melanomas and the determination of depth and width of basal cell carcinomas. Furthermore, b-scan ultrasound offers additional criteria for the differential diagnosis of pigmented skin lesions. We believe, therefore, that high frequency ultrasound in vivo can definitely improve surgical planning.