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Biomedical subjects

Peter Altmeyer

Publications and source records attributed to Peter Altmeyer.

At least 19 recordsLinked to original sources
PubMed2007

In vivo optical coherence tomography of basal cell carcinoma.

BACKGROUND: Optical coherence tomography (OCT) is a promising non-invasive imaging technique that has not systematically been studied in skin cancer such as basal cell carcinoma (BCC). OBJECTIVE: We aimed, first, to describe the in vivo histologic features of BCC by using OCT, and second, to find out whether it is possible to differentiate BCC subtypes by means of OCT. METHODS: Prior to the excision, the BCCs (n=43) as well as adjacent non-lesional skin sites were assessed by OCT in vivo. The lesional area of interest was marked prior to OCT and tattooed after excision, respectively, in order to enable topographical concordance between the cross-sectional OCT images and the histologic sections. RESULTS: Compared to non-lesional skin, a loss of normal skin architecture and disarrangement of the epidermis and upper dermis was observed in the OCT images of BCCs. Features that were frequently identified by OCT and correlated with histology included large plug-like signal-intense structures, honeycomb-like signal-free structures, and prominent signal free cavities in the upper dermis. With regard to the aforementioned OCT features, no statistically significant (P<0.05) difference was found between nodular, multifocal superficial, and infiltrative BCCs, respectively. CONCLUSIONS: OCT is capable to visualize altered skin architecture and histopathological correlates of BCC. However, there is not at this time sufficient data supporting the clinical use of OCT for the differentiation of BCC subtypes.

Aged↗
PubMed2006

Differential expression of decorin in localized scleroderma following ultraviolet-A1 irradiation.

Patients with localized scleroderma underwent an 8-week course of ultraviolet A1 phototherapy. At baseline, decorin levels of lesional skin were significantly lower than those of nonlesional skin and healthy control subjects. After ultraviolet A1 phototherapy, decorin levels of lesional skin were significantly higher than baseline. Decorin may be of significance in the pathogenesis of localized scleroderma.

Adult↗
PubMed2006

An adherence typology: coping, quality of life, and physical symptoms of people living with HIV/AIDS and their adherence to antiretroviral treatment.

BACKGROUND: Research has found that patient adherence to antiretroviral therapy is crucial to treatment success, but this research did not investigate the patient's viewpoint. This study examined relationships between types of adherence and coping, psychosocial factors, quality of life (QoL), and physical symptoms from the perspective of people living with HIV/AIDS. MATERIAL/METHODS: The quantitative study involved 100 HIV-positive participants. Questionnaires comprised the Trier Scales on Coping with Physical Illness, Medical-Outcomes-Study HIV Health-Survey QoL, Social Factors of Antiretroviral Therapy, and the HIV/AIDS Physical Symptom-Checklist. A sub-sample of 41 participants underwent semi-standardized interviews eliciting the type of adherence. Grounded Theory was the method of qualitative analyses. RESULTS: Maladaptive coping (rumination) related to poor mental health (p<0.001), concealing the HIV-infection (p<0.01), and being treatment-naive (p<0.01). Spiritual coping was more likely in women (p<0.001). Overall, QoL was worse in participants with more physical symptoms (p<0.001) and in those seeking mental health care (p<0.001). Working and maintaining a regular daily routine were associated with better adherence (p<0.05). Four adherence types were identified: 'Traditional Adherence' (with indifferent, faithful, and anxious subtypes), 'Traditional Non-Adherence', 'Critical Adherence', and 'Critical Non-Adherence'. The traditional types underscored a paternalistic medical model, while critical types emphasized 'autonomous patients'. Critical types were less frequent (39%), although superior to traditional types (p<0.001) in internal locus of control, optimal social support, and adaptive coping. CONCLUSIONS: Critical adherence is superior to traditional adherence with respect to physical and psychosocial factors. Strategies to improve adherence should therefore target empowerment and autonomy rather than patient obedience.

Acquired Immunodeficiency Syndrome↗
PubMed2006

In vivo data of epidermal thickness evaluated by optical coherence tomography: effects of age, gender, skin type, and anatomic site.

BACKGROUND: The knowledge of epidermal thickness (ET) is of great significance in many areas of medical and biological research. OBJECTIVES: We aimed to assess optical coherence tomography (OCT) in terms of precision, and to investigate the influence of several constitutional factors, such as age, gender, skin type, and anatomic site, on the mean ET using OCT in vivo. METHODS: Eighty-three subjects were studied using OCT in vivo. Intra- and inter-day repeatability measurements were performed. The mean ET was assessed in six different body sites of young (20-40 years old) and old (60-80 years old) Caucasians, respectively. An ethnic group was included into the study. RESULTS: OCT proved to be a precise technique in terms of repeatability and reproducibility as expressed in low coefficients of variation. Comparison of young and old Caucasians demonstrated a significant decrease of ET with age in all anatomic sites investigated. ET assessed in males and females did not significantly differ, except for forehead skin which is significantly thinner in old females than in males. ET observed in Caucasians did not significantly differ from ET measured in ethnic individuals. Anatomic sites insignificantly influenced ET on an inter-individual level. However, differences of ET between body sites on an intra-individual level are significant. CONCLUSIONS: This was the first systematic in vivo study on ET investigating several influencing parameters of the epidermal dimension in a reasonable study sample by means of OCT. The results presented here may serve as ET reference data in a variety of clinical and experimental matters.

Adult↗
PubMed2006

Ultraviolet A1 phototherapy decreases inhibitory SMAD7 gene expression in localized scleroderma.

Localized scleroderma (LS) is a connective skin disease with marked sclerosis of the skin as the most prominent feature. Transforming growth factor beta (TGF-beta) plays a central role in the pathogenesis of sclerotic skin diseases. Recently, special attention was contributed to a family of transcription factor proteins involved in TGF-beta signal transduction from cell surface to the nucleus, the so-called SMADs. Ultraviolet (UV) irradiation has been reported to alter TGF-beta/SMAD pathway in human skin. We sought to investigate the effects of UVA1 on the gene and protein expressions of the TGF-beta/SMAD pathway in LS. UVA1 phototherapy was performed in eight LS patients five times weekly for 8 weeks resulting in a total of 40 treatment sessions (single dose 50 J/cm(2), cumulative dose 2,000 J/cm(2)). TGF-beta1, SMAD3, SMAD4, and SMAD7 mRNA expressions were determined by semiquantitative real-time reverse transcription polymerase chain reaction in lesional and unaffected skin of patients with LS. Additionally, immunohistochemical staining was performed in lesional skin before and after irradiation. Skin status markedly improved in all patients, resulting in a significant reduction of the clinical score from baseline to the end of treatment. Inhibitory SMAD7 mRNA was significantly higher in lesional skin as compared to unaffected skin, and significantly decreased after UVA1 phototherapy. In contrast, SMAD7 mRNA levels remained unchanged in irradiated, healthy skin after UVA1. Both TGF-beta and SMAD3 mRNA levels decreased after UVA1, whereas SMAD4 mRNA increased. However, changes in TGF-beta, SMAD3, and SMAD4 mRNA after UVA1 did not reach statistical significance. Immunohistochemical investigation did not reveal significant changes in the protein expression of SMADs after UVA1. Similar to scleroderma, SMAD7-mediated negative regulation seems to be impaired in LS. UVA1 phototherapy demonstrated the alteration of SMAD7 gene expression in LS, as SMAD7 mRNA levels normalized after UVA1. The pathogenetic relevance of SMAD7 levels with respect to clinical improvement needs further investigation.

Adult↗
PubMed2006

Topical tacrolimus neither prevents nor abolishes ultraviolet-induced erythema.

A dose- and vehicle-controlled study on the pretreatment and posttreatment effect of 0.1% tacrolimus ointment on erythema induced by solar-simulated ultraviolet (UV) radiation was performed. Surprisingly, comparisons of clinical erythema scores and colorimetric data obtained 24 and 72 hours after UV exposure did not reveal significant differences between the control, tacrolimus, and vehicle preirradiation and postirradiation treated sites (P > .05). Our data strongly indicate that topical tacrolimus neither prevents nor abolishes UV-induced erythema in a clinical meaningful degree.

Administration, Topical↗
PubMed2006

A randomized controlled study of low-dose UVA1, medium-dose UVA1, and narrowband UVB phototherapy in the treatment of localized scleroderma.

BACKGROUND: In previous trials, UV therapy has been demonstrated to be effective in the treatment of localized scleroderma (LS). To date, a randomized comparison study to evaluate the efficacy and safety of different, commonly used phototherapeutic modalities in LS is still outstanding. OBJECTIVE: The aim of this study was to compare the safety and efficacy of low-dose (LD) UVA1, medium-dose (MD) UVA1, and narrowband (NB) UVB phototherapy in the treatment of LS. METHODS: Sixty four patients with LS were consecutively included in a prospective, open, randomized controlled 3-arm study. Severity of LS was determined by means of a clinical score, and clinical improvement was also monitored by histopathologic analysis and 20-MHz ultrasound. RESULTS: A total of 27 patients were treated with LD UVA1 (20 J/cm2), 18 patients received MD UVA1 (50 J/cm2), and 19 patients were treated with NB UVB dependent on their skin type. Phototherapy was performed 5 times weekly for 8 weeks. Two of the 64 patients included in this trial discontinued therapy. Skin status significantly improved in all patients who finished the treatment protocol, resulting in a reduction of the clinical score in all groups (LD UVA1, 7.6-5.0 [P < .001, 95% confidence interval 1.6-3.4]; MD UVA1, 11.1-6.6 [P < .001, 95% confidence interval 2.5-6.2]; NB UVB, 7.3-4.9 [P < .001, 95% confidence interval 1.6-3.2]). The reduction of the score was accompanied by an improvement of the visual analog scale for itching and tightness, histologic score, and 20-MHz ultrasound. MD UVA1 was significantly more effective than NB UVB (P < .05). There were no significant differences between LD UVA1 and NB UVB and the former and MD UVA1 (P > .05). LIMITATIONS: We had a relatively small study sample and nonblinded assessment of primary outcome. CONCLUSION: Phototherapy, as previously reported in several noncontrolled trials, is an effective therapeutic option in LS, with a favorable risk/benefit ratio. UVA1 phototherapy should be considered among the first approaches in the management of LS.

Adolescent↗
PubMed2006

Imiquimod treatment of anal intraepithelial neoplasia in HIV-positive men.

OBJECTIVE: To evaluate the treatment of anal intraepithelial neoplasia (AIN) with the local immune response modifier imiquimod in human immunodeficiency virus (HIV)-positive men who have sex with men (MSM). DESIGN: Prospective, nonrandomized, open-label pilot study, with a mean follow-up time of 9(1/2) months. SETTING: Dermatology department of a university hospital. Patients Twenty-eight consecutive HIV-positive MSM with histologically confirmed perianal (n = 23) or intra-anal (n = 5) AIN. Intervention Overnight treatment with self-applied imiquimod cream (perianal AIN) or suppositories (intra-anal AIN) 3 times a week for 16 weeks. MAIN OUTCOME MEASURES: Response to treatment was documented using clinical, cytologic, and histologic criteria. Human papillomavirus (HPV) typing and HPV DNA load determination for the high-risk HPV types 16, 18, 31, and 33 were performed. RESULTS: Seventeen (61%) of all 28 patients included in the study and 17 (77%) of the 22 patients with AIN, who applied imiquimod as instructed, showed clinical and histologic clearance at the end of therapy. Four patients had residual AIN and 1 patient did not improve. Clinical response was accompanied by a sharp decline in HPV DNA loads and by a reduction in the number of HPV types, but long-term HPV clearance was rarely achieved. In the follow-up period, AIN cleared in 3 patients with residual AIN. Fourteen (78%) of 18 imiquimod responders with at least 5 five months of follow-up had a normal cytologic and clinical picture at the end of the follow-up period. Three primary responders developed a recurrence. In 6 noncompliant patients, there was no clinical or morphological improvement and the HPV DNA loads remained high. CONCLUSIONS: Imiquimod appears to be a safe and effective treatment option for AIN in HIV-positive MSM. Clinical response is accompanied by a significant decrease in high-risk HPV DNA load. These results should encourage controlled randomized studies of imiquimod treatment of AIN.

Administration, Cutaneous↗
PubMed2006

1% pimecrolimus, 0.005% calcipotriol, and 0.1% betamethasone in the treatment of intertriginous psoriasis: a double-blind, randomized controlled study.

OBJECTIVE: During the last decades, management of intertriginous psoriasis (IP) has been unsatisfactory because of the adverse effects associated with long-term corticosteroid application and the lack of alternatives. Recently, both pimecrolimus and tacrolimus have been investigated for this indication and shown to be safe and effective. So far, to our knowledge, a comparison of one of these drugs with standard regimens for IP has not been performed. DESIGN: A single-center, 4-week, double-blind, randomized, vehicle-controlled comparison study to assess the safety and efficacy of 1% pimecrolimus, 0.005% calcipotriol, and 0.1% betamethasone valerate in the treatment of IP. SETTING: Dermatologic hospital at Ruhr University of Bochum. PATIENTS: Eighty adults with IP. INTERVENTIONS: Treatment of IP with 1% pimecrolimus, 0.005% calcipotriol, 0.1% betamethasone, or the vehicle once daily for 28 days. MAIN OUTCOME MEASURES: Mean reduction of the Modified Psoriasis Area and Severity Index (M-PASI) score after 28 days of treatment was considered the primary outcome measure, which was analyzed on an intention-to-treat basis. The secondary outcome was a visual analog scale score for itching. RESULTS: After 4 weeks of treatment, the 3 active compounds and the vehicle resulted in a significant decrease in mean M-PASI score (86.4% for 0.1% betamethasone, 62.4% for 0.005% calcipotriol, 39.7% for 1% pimecrolimus, and 21.1% for vehicle). The 0.1% betamethasone was significantly more effective than 1% pimecrolimus during the study period (P<.05). No significant difference was found between 0.005% calcipotriol and 0.1% betamethasone and between 0.005% calcipotriol and 1% pimecrolimus. The visual analog scale score for pruritus decreased by 78% for 0.1% betamethasone, 57% for 0.005% calcipotriol, 35% for 1% pimecrolimus, and 43% for the vehicle, again demonstrating a clear advantage for the corticosteroid (P<.05). CONCLUSIONS: The 1% pimecrolimus was shown to be less potent than 0.1% betamethasone in the treatment of IP. Considering the adverse-effect profile of long-term application of corticosteroids, occasional or intermittent rescue therapy with short-term topical corticosteroids and maintenance with a less potent agent, such as 1% pimecrolimus or 0.005% calcipotriol, might be appropriate for patients with IP in general practice.

Administration, Cutaneous↗
PubMed2006

Endoscopic thoracic sympathectomy for severe hyperhidrosis: impact of restrictive denervation on compensatory sweating.

BACKGROUND: Compensatory sweating is noted frequently after sympathectomy and may be difficult to control in some patients. This prospective trial was projected to measure the impact of limited denervation on compensatory sweating while performing endoscopic thoracic sympathectomy. METHODS: One hundred seventy-eight patients (127 female and 51 male) with severe primary hyperhidrosis unsuccessfully treated by conservative means entered the study. Group A was treated with sympathectomy from T2 to T4. In group B sympathectomy was performed from T3 to T5. Physical condition was measured after 1, 6, and 24 months by means of the SF-36 Health Survey Test. RESULTS: Evaluation rate was 94.9%. Horner's syndrome was not detected, recurrence rate was 0.6%, and rate of persistent pneumothorax was 2.3%. Compensatory sweating was reported with 17.1% in group A and diminished to 4.9% in group B. Gustatory sweating was comparable in both groups (4.3% versus 4.9%). Satisfaction rate was 97% in patients with palmar hyperhidrosis, 95% for axillary hyperhidrosis, and 87% for facial hyperhidrosis. Discomfort originating from compensatory sweating was less than symptoms from primary hyperhidrosis 24 months after endoscopic thoracic sympathectomy in more than 90%. Only 7.1% of the entire group was not satisfied. CONCLUSIONS: Our study demonstrates that limiting denervation beyond T2 ganglion offers good clinical results in axillary as well as palmar hyperhidrosis and may reduce the risk for compensatory sweating. In women, reduction was as high as 75% and in men, near 50%. Our impression is that severe compensatory sweating and the majority of stellate ganglion lesions occur as a result of starting sympathectomy at level T2.

Adult↗
PubMed2006

Clinical and serological characteristics of progressive facial hemiatrophy: a case series of 12 patients.

BACKGROUND: Progressive facial hemiatrophy (PFH) is characterized by a slowly progressive atrophy of soft tissues and in some cases bony structures. Coexisting features of localized scleroderma (LS) are commonly observed, indicating the close nature of both disorders. OBJECTIVE: We sought to investigate clinical, serological, and radiographic findings in PFH from 278 patients with LS and to discuss the relationship to linear scleroderma en coup de sabre (LSCS). METHOD: A total of 12 patients with PFH were retrospectively evaluated on the basis of clinical, serological, and radiographic findings. RESULTS: Five patients (42%) presented with complete PFH, and 7 patients (58%) with partial PFH involving either cheek or forehead. Five of the patients (42%) had a coexisting LSCS lesion, and 3 of them (25%) had concomitant LS of the trunk. Intraoral involvement was present in 6 cases. Neurological involvement was common, in particular, epileptic seizures. Serologic investigations showed neither evidence for infection with Borrelia burgdorferi nor any other indication of underlying systemic immunological disorders. LIMITATIONS: There were a relatively small number of patients in a retrospective study. CONCLUSION: The reported cases suggest a close relationship between PFH and LSCS. PFH might appear as two different subtypes, one involving cutaneous structures and presenting with clinical features similar to LSCS, one being strictly restricted to subcutaneous structures, primarily affecting the cheek area. The manifold clinical features of central nervous system involvement indicate the pathogenetic importance of neurological involvement in the development of PFH. Magnetic resonance imaging should be included in the tools of standard diagnostic procedures in patients with PFH. The etiologic relevance of autoimmunity as well as preceding trauma should be investigated in larger collective studies.

Adolescent↗