PubMed Health⌕ Search

Biomedical subjects

S el Gammal

Publications and source records attributed to S el Gammal.

17 recordsLinked to original sources
PubMed1999

[Cyclical intravenous antibiosis as an effective therapy concept in chronic recurrent erysipelas].

The treatment of choice for prevention of recurrent erysipelas is the long-term therapy with intramuscular penicillin. The results are often unsatisfactory. Usually erysipelas recurs when the treatment is stopped. The aim of the present study was to evaluate a new treatment regimen, consisting of intravenous penicillin combined with lymphatic drainage. Fifteen patients who had suffered from three or more episodes of erysipelas within the last two years received 10 Mega I.U. of penicillin per day over ten days every third month over a one year period (patients who were allergic to penicillin received erythromycin). Use of intravenous penicillin was combined with lymphatic drainage performed by a sequential pneumatic compressing device. The treatment results were assessed by clinical examination and laboratory tests as well as by laser Doppler imaging every third month. During the one year treatment period and a further year of follow-up, 14 of 15 patients had no recurrent erysipelas. Only a 65 year old patient suffering from Parkinson heart failure, chronic lymphedema and an extensive stasis ulcers had recurrent erysipelas. The present treatment regimen appears to be an effective therapy for prevention of recurrent erysipelas.

Adult↗
PubMed1999

[100 MHz sonography in the visualization of the palmar stratum corneum after application of various creams and ointments].

To visualise the effects of different topically applied substances on the stratum corneum in vivo by means of sonography, it is necessary to have an ultrasound unit with a much higher resolution than provided for by the 20 MHz scanners currently used in dermatology. We developed a workstation with a highly focussed transducer with a large bandwidth, providing a resolution of 9 microns axially and 27 microns laterally. Using this ultrasound unit, we investigated the effects of different creams and ointments in 10 persons on the palmar side of the distal finger segments (vaseline, a water-in-oil-emulsion, an oil-in-water-emulsion, 10% urea in an oil-in-water-emulsion and water). Sonograms were taken after an occlusion period of 0, 30, 60, 120, 180 and 240 min. In 100 MHz sonograms of palmar skin, the stratum corneum is represented as an echo-poor band below the echo-rich entry echo--the correlate of the interface between the coupling water and the horny layer. The echo-poor band is traversed by echo-rich coils, representing eccrine sweat gland ducts. It is separated by an echo-rich line from the viable epidermis, which is echo-poor as well. The topically applied substances differ in the time course of the swelling of the stratum corneum. After longer application all externals cause a significant thickening of the stratum corneum (p < 0.005) and a reduction of the echogenicity of the skin entry echo due to altered impedance. 100 MHz sonography is well suited to visualise and quantify the effects of externals on the stratum corneum in vivo.

Administration, Topical↗
PubMed1999

Sweat gland proliferations in scleromyxedema.

Eccrine sweat duct proliferations may be found in various inflammatory and neoplastic skin lesions. We report a patient with scleromyxedema with extensive proliferations of intradermal sweat ducts. Three-dimensional reconstruction demonstrated extensive coiling and branching of the sweat ducts leading into cystic lacunae. In contrast to the basal cell carcinoma that had grown within the scleromyxedematous skin, the ducts close to the lumen stained positive for carcinoembryonic antigen and could therefore be differentiated from basal cell carcinoma. In micrographically controlled surgery of cutaneous epithelial tumors that are located in chronically inflamed skin, such sweat gland proliferations have to be considered as differential diagnosis.

Carcinoembryonic Antigen↗
PubMed1998

[100 MHz ultrasound of psoriasis vulgaris plaque].

PURPOSE: 20 MHz sonography of inflammatory diseases has concentrated on the evaluation of the echo-poor area in the upper dermis. With regard to higher resolution, this study focuses on the alterations of the epidermis and upper dermis skin using 100 MHz sonography. METHOD: 70 fully developed psoriasis vulgaris plaques of 20 patients were examined using our 100 MHz ultrasound equipment after application of salicylic acid in petrolatum for 24 h. After informing the patient about the aims of the study, a small knife biopsy was taken from 11 plaques. RESULTS: All psoriasis plaques exhibited, in comparison with normal skin, a significant widening of the skin entry echo (p < 0.001). Focally, this echo-rich line broke up into two thinner lines. Correlating histology exhibited in these areas an orthohyperkeratosis and focal parakeratosis. The upper dermis showed an echo-poor, band-shaped area which corresponded histologically to an acanthosis, elongation of rete ridges, and widening of the stratum papillare. The mean grey level of the echo-poor area and of the dermis beneath was significantly lower (p < 0.001) than the normal adjacent dermis. The thickness of the echo-poor area correlated with the thickness of the sum of the acanthosis and the inflammatory infiltrate in the histological sections (r = 0.94). CONCLUSION: Using 100 MHz sonography changes of the skin entry echo and the upper dermis can be visualized and quantified.

Adult↗
PubMed1997

In psoriasis the epidermis, including the subepidermal vascular plexus, grows downwards into the dermis.

In psoriatic lesions, capillaries in the papillary bodies seem elongated and increased in number. Most researchers postulate that there is angiogenesis of intrapapillary capillaries in psoriatic plaques. In this study we will show, by means of computer-aided three-dimensional reconstructions in four patients suffering from chronic plaque-type psoriasis, and in a healthy volunteer, that the elongation and increase of intrapapillary capillaries are not the result of angiogenesis. Our three-dimensional reconstructions show that the papillary body of psoriasis contains lymph capillaries besides the blood capillaries. Additionally, an inclusion of two tips of papillary bodies into one papilla at the base of the rete ridges becomes obvious. The vessels of the two tips are connected by a horizontal vessel. At the level of the horizontal connecting vessel there is the blind beginning of a lymphatic vessel. The connecting blood vessel, as well as the lymph capillary, belong to the horizontal subpapillary venous plexus but lie within the papillary body. The three-dimensional reconstructions show that by growing towards the dermis, the rete ridges include the vessels of the horizontal plexus. Surrounded by rete ridges, these vessels appear as intrapapillary capillaries.

Aged↗
PubMed1996

Improved resolution of magnetic resonance microscopy in examination of skin tumors.

Magnetic resonance imaging has become increasingly important for visualization and tissue differentiation of internal organs. Because of limited resolution, investigation of skin has been of little diagnostic value so far. We combined a homogeneous magnetic field of 9.4 T, as used in magnetic resonance spectroscopy, with gradient fields of 11.7 G/cm and an imaging unit to obtain a voxel resolution of 40 x 40 x 300 microm(3). With this magnetic resonance microscopy unit, we studied normal skin, 12 nevocellular nevi, 20 basal cell carcinomas, 8 melanomas, and 8 seborrheic keratoses after excision in vitro. The specimens were visualized in spin-echo images. The proton relaxation times T1 and T2 were determined for the different skin layers and tumor tissues. Interpretation of the spin-echo images was based on comparison with the correlating histology. Epidermis, dermis, subcutaneous tissue, and hair follicle complexes could be distinguished. Stratum corneum and hairs emitted no signal. All tumors presented as distinct, signal-rich, homogeneous structures within the dark, signal-poor dermis. Their shape corresponded to their outline in the histologic sections. Buds of superficial basal cell carcinomas could be resolved. The proton relaxation times T1 and T2 were significantly different among all skin layers and tumors. Our results demonstrate that with sufficient resolution, differentiation of skin tumors is possible using magnetic resonance imaging.

Adult↗
PubMed1996

The effect of fumaric acid esters and dithranol on acanthosis and hyperproliferation in psoriasis vulgaris.

In this study we investigated the histological changes, regression of acanthosis and rate of proliferation, that accompany the healing of psoriatic lesions after fumaric acid esters and dithranol treatment. Biopsies were taken before and during therapy as well as from neighbouring untreated, clinically uninvolved skin and healthy, non-psoriatic volunteers. Specimens were assessed using computer-supported image analysis and immunohistology. The parameters primarily examined were the height of the rete pegs and of the epithelium above the papillary body, the rate of proliferation, the actual number of cells in the two epidermal compartments and the cellular density in the epidermis. Both fumaric acid esters and dithranol reduce the degree of acanthosis; however, the mechanism and the rate of the reduction differ. While under fumaric acid esters the reduction is more rapid at first but subsequently slows down, dithranol leads to a slow but steady decrease of epidermal thickness, so that at the end of our study the degree of acanthosis was less under dithranol. As an underlying mechanism of action, we found that fumaric acid esters reduce the rate of proliferation and thereby decrease the number of cells per rete peg as well as the size of the individual keratinocytes. Dithranol in contrast does not reduce cell renewal. The decrease of the number of cells in the rete pegs might be caused by an increased differentiation time.

Administration, Topical↗
PubMed1996

A model to assess the efficacy of moisturizers--the quantification of soap-induced xerosis by image analysis of adhesive-coated discs (D-Squames).

Clinical grading of dry skin syndromes (xerosis) is beset by many variables which limit its reliability. Removing scales onto adhesive coated discs (D-Squames) has provided a means for objective measurement of xerotic states. Using image analysis we have modified the basic procedure to assure greater accuracy and reproducibility. The distribution of grey values on the discs was determined, from which a single value of the degree of scaling was calculated. We term this the scaling index. To induce xerosis, the lower legs of 22 women, aged 26-64, were washed daily for 10 days with soap. After washing, one side received a moisturizing lotion, the other served as an untreated control. At specified intervals, scaling was graded clinically, electrical conductance was measured and D-Squames were obtained. On the moisturizer-treated legs there was a significant decrease in dryness grades and scaling indices at all time points. Conductance was significantly increased on days 8 and 11. The untreated washed legs showed no changes in clinical grades, although conductance significantly decreased and the scaling indices increased in the last stage of the study. D-Squame analysis unequivocally revealed the beneficial effect of a moisturizer on soap-induced xerosis and the expected increase in scaliness without treatment.

Adult↗
PubMed1994

Gastrobiliary motility after liquid fatty meal in progressive systemic sclerosis. A sonographic study.

Gastric emptying, antral motility, and gallbladder emptying after a liquid fatty meal were studied by ultrasound in 25 patients with progressive systemic sclerosis and in 25 sex- and age-matched controls. In patients with systemic sclerosis, the possible role of autonomic dysfunction was evaluated by four noninvasive cardiovascular reflex tests. Despite a significant delay of gastric emptying and a significant postprandial antral hypomotility in the patients with systemic sclerosis, the fat-induced gallbladder emptying was only slightly reduced, reaching no significant level when compared to the controls. The prolongation of gastric emptying correlated significantly with the duration of the disease. Although 36% of the patients in the systemic sclerosis group exhibited signs of autonomic cardiac dysfunction, there was no evidence of an association between these signs and gastric motor dysfunction. In conclusion motility disorders of the gallbladder seem to play a minor role in the upper gut involvement of systemic sclerosis, whereas motility disorders of the stomach are frequent and can be easily recognized noninvasively by real-time ultrasound.

Adult↗
PubMed1994

Determination of density of follicles on various regions of the face by cyanoacrylate biopsy: correlation with sebum output.

The density of follicles on various regions of the human face has received scant attention. We used cyanoacrylate follicular biopsies to determine the number of follicles on the forehead, cheek, chin and nose of 12 healthy adult white women. Sebum output was assessed on the same regions by means of Sebutape. The density of follicles and sebum output followed a centrolateral decreasing gradient. There was no correlation between these two parameters. These regional patterns are important for studies of the pathogenesis of common disorders of the face and their response to treatment.

Adult↗
PubMed1994

Sonographic quantification of the type IV reaction after intradermal application of recall antigens.

20-MHz B-scan high-resolution sonography permits non-invasive, two-dimensional visualisation of micromorphological structures in vivo, and allows precise measurement of the depth and extent of inflammatory skin lesions. In 50 patients, the reactions following intradermal application of 8 recall antigens to the volar forearm were evaluated clinically and sonographically at various times (0, 24, 48, 72 h). In 30 patients, one of the inflammatory papules was excised after 48 h for complete histological work-up (serial sections) and subsequent comparison with the sonographic image. Infiltrates were characterised in the ultrasound scans by the almost regular occurrence of convexity of the skin surface, by a loosened structure (loss of echogenicity) of the corium and by protrusion of the corium into the subcutaneous fatty tissue. It was also possible to follow the dynamics of the type IV reaction with the measurement of echogenicity (densitometry). High-frequency ultrasound is an objective, exact and very sensitive tool for the measurement of type IV reactions after intradermal application of recall antigens and therefore superior to clinical evaluation. The B-scan was superior to the A-scan. However, for routine evaluation of tuberculin-like reactions, sonography is too time-consuming. Our results suggest that densitometry provides no additional or necessary information compared to sonometry.

Adult↗
PubMed1994

The pseudo-elongation of capillaries in psoriatic plaques.

The intrapapillary vessels in the psoriatic plaque are described as elongated, twisted and multiplied. However there is neither proliferation nor necrosis of vessels in growing and dissolving psoriatic plaques. In 120 patients suffering from psoriasis vulgaris, computer-supported image analysis and in 8 patients additionally 3D reconstructions were made to investigate the regression process of the intrapapillary capillaries in the active and resolving psoriatic plaque. In acanthotic epidermis with a thickness of > 400 microns the first subpapillary horizontally oriented plexus is included in the papilla due to the down-growing of the epidermal rete pegs. In the evaluation of the computer-supported image analysis there is only little variation in the levels of the different vascular plexuses within the dermis, while the epidermis is decreasing from > 600 microns to > 100 microns. In the 3D reconstruction of the transition of a psoriatic lesion into adjacent non-involved skin it could be proved that, apart from the epidermal alterations, there is virtually no difference in the arrangement of the vessels between the psoriatic lesion and the adjacent non-involved skin. In psoriasis the vessels do not proliferate, they rest as resident structures and are embraced by the down-growing rete pegs.

Capillaries↗
PubMed1994

Psoriasis vulgaris in 50 MHz B-scan ultrasound--characteristic features of stratum corneum, epidermis and dermis.

One hundred and forty fully developed, non-treated plaques of psoriasis vulgaris from the arms and legs of 22 patients were examined using 50 MHz B-scan ultrasound and compared with the images from adjacent, clinically normal skin. To visualize the dermis, high pre-amplification (digitization range 200 mV) was used, determined according to A-scan images. For evaluation of epidermal phenomena, low pre-amplification (digitization range 380 mV) was chosen in order to avoid overmodulation of the skin entry echo. In 10 patients, sonographic images were compared with histological sections from the exact same planes at the same magnification. At low pre-amplification, the skin entry echo is displayed as a markedly widened, frequently interrupted band composed of spots varying in thickness, height and echo density. Within these spots, several lamellae can be observed, represented as fine, echo-rich lines stacked one upon another. These phenomena correspond histologically to focal hyperparakeratosis, scaling and cracking of the stratum corneum. Due to the low amplification of the echo-signal the dermis is not visible. High pre-amplification allows evaluation of dermal changes. Below the entry echo there is an echopoor band (EPB) corresponding to the sum of acanthosis and infiltrate in the upper dermis. Underneath the EPB the dermis is represented as a zone with scattered internal echoes which are less intense than in normal skin. Dorsal shadows are typically present. They are artifacts emanating from epidermal regions with marked hyperkeratosis and disappear when the sonographic characteristics of the epidermis are changed, for instance by application of ointments prior to sonographic examination.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[The pustular bacterid (Andrews). Are there clinical criteria for differentiating from psoriasis pustulosa palmaris et plantaris?].

A case report on the rare entity of "true" Andrews bacterid and a review of the literature are used to illustrate clinical and morphological criteria that allow discrimination between Andrews bacterid and psoriasis pustulosa palmaris et plantaris. The patient noted the eruption of sterile pustules on palms and soles for the first time in his life at the age of 73 during an attack of acute tonsillitis. He had no history of psoriasis and it was also unknown in the family history. In contrast to psoriasis pustulosa palmaris et plantaris, Andrews bacterid becomes manifest as isolated pustules with an erythematous rim, which do not destroy the ridged skin. On the rest of the integument disseminated pustules are seen but no psoriatic stigmata. Thus, apart from the criterion of coincidence with an infection and the short course, we can also differentiate between Andrews bacterid and psoriasis pustulosa palmaris et plantaris on the basis of clinical criteria.

Aged↗
PubMed1992

Malignant melanoma in 20-MHz B scan sonography.

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.

Adolescent↗
PubMed1989

[Digital 20 mhz sonography of the skin in preoperative diagnosis].

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.

Basal Cell Carcinoma↗