Biomedical subjects
Publications and source records attributed to U Hohenleutner.
A 35-year-old male patient affected with extensive, itching skin lesions of reticulate porokeratosis is reported. He was successfully treated by CO2-laser vaporization.
In this review, the epidemiology and prognosis of malignant melanoma in childhood and adolescence (CMM) are discussed with reference to 627 patients reported in the literature. CMM accounts for only 1-2% of all melanomas, but there is the same increasing incidence as in adult melanoma. A distinction is made between congenital CMM (n = 27), CMM on giant congenital pigmented naevi (n = 69) and CMM in small pigmented lesions or de novo. The latter are identical in biological behaviour to melanomas in adults, while the CMM on giant naevi nearly always have an unfavourable outcome. Chemotherapy seems to be more effective in CMM than in adult melanomas, but prophylaxis is also the best therapy in children: early removal of congenital giant pigmented naevi and frequent monitoring, if not excision, of all congenital melanocytic lesions must be considered.
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A 16-year-old boy presenting with multiple slightly painful, bluish red papules and plaques on the left thorax is reported. The skin lesions were arranged in a linear and arched pattern following the lines of Blaschko. Clinical examination led to the suspicion of multiple leiomyomas, syringomas or glomus tumours. Histological examination revealed that the lesions were typical benign eccrine spiradenomas.
Sexually transmitted diseases caused by human papilloma viruses, such as condylomata acuminata, are increasing in incidence and are often difficult to treat because of their tendency to recur. Many reports in the literature document the usefulness of interferons topically or systemically in these diseases. A randomized study was conducted to evaluate interferon Alfa-2b (Intron A) as adjuvant therapy following CO2 laser surgery of condylomata acuminata. A low-dose regimen was administered (two courses with 1 million I.U. s.c. daily for 6 days with a 2-week interval between the courses) and had hardly any side-effects. The recurrence rate in the therapy group was significantly reduced (42% vs 81%), so routine prophylaxis of recurrence with interferons in condylomata acuminata should be discussed.
We present 2 cases of subcutaneous fat necrosis associated with pancreatic disease. In 1 of these cases the correct diagnosis led to the detection of a clinically asymptomatic chronic pancreatitis. The pathogenesis of this disease, not yet fully explained, and the differential diagnosis of other forms of panniculitis are reviewed.
CO2 laser resection of giant condylomata acuminata of the penis, histologically confirmed, was successfully achieved with excellent cosmetic results in a 58-year-old man, penis amputation having previously been advised. Postoperative recurrence has been prevented, for six months so far, with low-dose, systemic administration of alpha-2b interferon.
Due to the high absorption of infrared light in water the CO2 laser (lambda = 10,600 nm) is suitable for cutting and vaporizing tissue. The ablation of pathological tissue by means of the CO2 laser can be exactly controlled. The treated area is usually dry and clear since blood and lymph vessels up to a diameter of 1 mm are sealed. Postoperative swelling and pain are reduced compared with electrosurgery. Important and frequent indications for CO2 laser application are HPV papillomas (condylomata acuminata, common warts, bowenoid papules) and the removal of tattoos. The CO2 laser is also suitable for the removal of benign and disseminated lesions such as angiofibromas, syringomas, trichoepitheliomas, epidermal nevi etc. Lesions of the oral mucosa (leukoplakias, mucosal warts) can be removed by means of the CO2 laser. Additionally, the treatment of vascular lesions (nevi flammei, lymphangiomas, telangiectasias) has been described, although the CO2 laser does not operate in a vessel-specific manner. As this review article demonstrates, the CO2 laser has a broad range of applications and represents an enrichment of dermatotherapy.
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We report on 901 patients with port wine stains treated by means of an argon laser. The treatment results have been definitively evaluated in 371 patients. They were significantly influenced by the patients' age and by the colour of the lesions. The worst response to the therapy was seen in pink port wine stains in children and juvenile patients (20% good results), in contrast to red and purple lesions in adult patients (80% excellent and good results). The size of the port wine stains did not significantly influence the treatment results, but in extensive lesions homogeneous lightening could not usually be attained and treatment often extended over some years. Port wine stains in the head and neck area responded best to therapy, and lesions on the legs, worst. Altogether, in 60%-70% of adult patients excellent or good results were obtained, the lesions being completely removed or significantly lightened and reduced in size. The side-effects of laser therapy were scar formation (7.3%) and changes in pigmentation (8.6%).
Treatment of vascular malformations is one of the main indications for laser application in dermatology. The argon laser is suitable for coagulation of superficial lesions, the Nd:YAG laser for thicker ones. Vaporization or excision of vascular lesions can be performed by means of the CO2 laser. International standard of argon laser therapy of port wine stains are 60 to 70% good results in adult patients afflicted with red and purple lesions. In contrast argon laser therapy of pink lesions and of children is less successful. But more recently the flashlamp pumped dye laser has improved treatment results in children, since this laser acts much more vessel specific than the argon laser. Other congenital vascular lesions that respond to laser therapy are capillary hemangiomas, cavernous hemangiomas, and lymphangiomas. Future development may expand application of laser in the treatment of vascular malformations.