Biomedical subjects

W C Marsch

Publications and source records attributed to W C Marsch.

At least 19 recordsLinked to original sources

PubMed2007

[Gold. Effective therapy for mucosal lesions of pemphigus vulgaris].

High-dose steroids in combination with other immunosuppressant substances, usually azathioprine, are the therapy of choice in pemphigus vulgaris. Complete remission can be difficult to achieve, with mucosal lesions often recalcitrant. We describe two patients in whom gold in the form of sodium aurothiomalate was effective in resolving mucosal lesions. Initially both patients were treated with high-dose corticosteroids, one in combination with mycophenolate mofetil. Their oral lesions proved to be stubborn but responded well to intramuscular gold, which also showed a steroid-sparing effect, so that the dosage of corticosteroids could be reduced to a minimum. Sodium aurothiomalate was continued until both patients were in remission without any side effects.

Adult↗

PubMed2007

[Chronic lupoid leishmaniasis. A rare differential diagnosis in Germany for erythematous infiltrative facial plaques].

Lupoid leishmaniasis is a unique form of cutaneous leishmaniasis characterized by unusual clinical features and a chronic relapsing course. Clinically and histologically it is similar to lupus vulgaris, which is thus the most important differential diagnostic consideration. All patients with granulomatous facial lesions coming from endemic areas or with a positive travel history should be suspected of having leishmaniasis. We describe a 59-year-old woman with facial lupoid leishmaniasis.

Chronic Disease↗

PubMed2007

[Steroid-aggravated rosacea: successful therapy with pimecrolimus].

Steroid-induced erythema in rosacea is a therapeutic challenge because of its tendency to rebound and the local characteristics of the facial skin. We describe 3 cases of steroid-induced rosacea with the typical history of steroid abuse with tachyphylaxis. Steroids with increasing potency had to be used with increasing frequency in the course of treatment in order to achieve a response. Acute exacerbations followed any attempt at withdrawal. The steroid treatment was discontinued and therapy with pimecrolimus cream 1% twice daily initiated. This brought rapid and marked improvement within a few days. The cases show that the calcineurin antagonist pimecrolimus offers an effective and well-tolerated therapy option in the acute therapy of steroid-aggravated facial dermatoses.

Aged↗

PubMed2006

Concomitant traumas influence prognosis in melanomas of the nail apparatus.

BACKGROUND: In nail apparatus melanomas (NAM), the role of standard melanoma prognostic factors is under discussion. The prognostic influence of traumas to the clinically apparent tumour has not been sufficiently examined. OBJECTIVES: To estimate the influence of traumas against the background of standard prognostic factors on the course of NAM. METHODS: In 33 patients (20 women, 13 men, median age 65.0 years) with NAM (median tumour thickness 3.5 mm), we retrospectively examined a detailed history of trauma to the affected extremity at first presentation. Histological or other standard prognostic factors and follow-up were studied prospectively using a standardized protocol. RESULTS: Of 33 patients, 21 had suffered injury to the clinically apparent melanoma primary between 4 and 72 months prior to definitive surgical treatment (diagnostic biopsy up to 3 months ahead of excision of the melanoma was not considered). Eight of these patients had undergone inadequate therapy procedures. In Kaplan-Meier analysis, trauma to the clinically apparent tumour and tumour thickness were found to be significant prognostic factors for recurrence-free survival, and trauma to the clinically apparent tumour, Clark level and tumour thickness were significant prognosis predictors for overall survival. In Cox's proportional hazards model, trauma to the clinically apparent tumour was found to be a significant and independent risk factor with regard to overall survival (hazard ratio 5.39; P = 0.029). An influence of trauma on the primary pathogenesis of NAM could not be confirmed. Only three patients reported trauma prior to the onset of tumour. CONCLUSIONS: From our data, trauma to the clinically apparent tumour might be a considerable risk factor in NAM. The diagnosis of NAM should be considered in lesions of the nail apparatus and further deterioration of the prognosis due to inadequate therapeutic attempts or injury to the NAM should be avoided.

Aged↗

PubMed2005

[A rare low-grade malignant scalp tumor. Atypical fibroxanthoma].

A 79-year-old patient presented with an asymptomatic scalp tumor which had grown over the past 9 months. Based on clinical, histological and immunohistochemical staining, we made the diagnosis of an atypical fibroxanthoma (AFX). AFX is a rare tumor, but important in the differential diagnosis of other scalp tumors. The routine histological staining allows one to identify a malignant fibrous histiocytoma, while a spindle-cell malignant melanoma can be excluded with immunohistochemical staining. An anaplastic squamous cell carcinoma cannot always be separated with completed certainty from atypical fibroxanthoma. AFX is a low-grade malignant tumor and most cases behave in a benign fashion. After complete excision, we recommend follow-up for a number of years because of the possibility of local recurrence.

Aged↗

PubMed2005

[Long-term locally-recurrent melanoma].

Malignant melanoma is a highly malignant skin tumor with a widely variable individual course. Currently, approximately 75% of German patients can be cured of malignant melanoma by early diagnosis and excision, while more than 20% die of distant metastases of the melanoma. In contrast, there are single cases of long-term locally recurrent melanomas with neither complete cure nor development of distant metastases. We report on a female patient with a nevus-associated melanoma who was treated in 1968 with X-ray radiation (Dermopan, 100 Gy) with curative intent. In the following 31 years, the patient developed four phases of in-transit and satellite metastases in a zosteriform pattern as well as ilioinguinal lymph node metastasis. Since 1999, the patient has been free of recurrence. Besides the unusual biological features of this case, this report reflects the changes of paradigms in the therapy of melanoma over the last forty years.

Female↗

PubMed2005

[The lymphatic system and the skin. Classification, clinical aspects und histology].

Dermatology offers many clinical examples of abnormalities in the production, absorption and transport of lymph. Lymphatic thromboses also occur. Many diseases are not named in accordance with their underlying pathogenesis. Malignant lymphedema must be recognized immediately. The differential diagnosis of regional lymphedema is also part of dermatology. Stemmer sign is a clue to chronic lymphedema. Lymphoedema is first divided into primary and secondary forms, depending on the cause, and then subdivided into stages depending on severity. Complications of chronic lymphedema include recurrent erysipelas, superficial lymphangiectases, verrucous lymphedema (papillomatosis lymphostatica) and angiosarcoma, which is often multifocal. Established diagnostic approaches are available to correctly diagnose lymphatic disease. The treatment of chronic lymphedema centers around reducing the edema which then influences all of the other problems. The physical therapeutic approach to reducing blockage is the best way to achieve these goals.

Humans↗

PubMed2004

[Sporotrichoid atypical mycobacterial infections. Antibiotic monotherapy].

Sporotrichoid forms of atypical mycobacterial infections usually do not show a tendency to spontaneous healing. The therapy of choice in such cases is systemic antibiotics. We report three cases of sporotrichoid atypical mycobacterial infections of the skin which healed completely under long-term monotherapy with modern antibiotics (levofloxacin, clarithromycin, minocycline). We recommend confirming the diagnosis by means of culture, followed by monotherapy with low side-effect antibiotics, based on sensitivity studies. If pathogen proof is obtained by PCR, antibiotic therapy should be based on the known sensitivity of the pathogen in question.

Adult↗

PubMed2004

[Graves disease. An important differential diagnostic consideration for systemic lupus erythematosus].

Graves disease is a frequent cause (30-40%) of hyperthyroidism. In addition to the classic clinical triad (goiter, exophthalmos and tachycardia), symptoms relating to other organ systems may be found at presentation. Cutaneous manifestations play an important role and may initially be the only clue to the endocrine disorder. A 40-year-old woman with Graves disease presented with features of systemic lupus erythematosus. She had a malar rash, as well as marked hematological changes (thrombocytopenia and leukocytopenia) and antinuclear antibodies (1:640). She also had hyperthyroidism and Graves disease-specific thyroid autoantibodies (TSIg). Her symptoms improved after initiation of antithyroid therapy. Because of overlapping clinical and laboratory criteria, Graves disease can mimic systemic lupus erythematosus. The differentiation requires careful laboratory evaluation. Moreover, both autoimmune diseases may occur in the same patient.

Adult↗

PubMed2004

[The dermatologic consultation].

BACKGROUND: Dermatology and venereology, as a cross-sectional discipline, plays an important role in the interdisciplinary care of inpatients. Nonetheless, only a few studies on dermatological consultations have been performed. We reviewed the dermatological consulting service at the University Hospital of the Martin-Luther-University, Halle, Germany. PATIENTS AND METHODS: All consultations performed in 2001 and 2002 were retrospectively assessed. In addition, the time spent in consulting activities was prospectively recorded over a period of six months (January-June 2003). RESULTS: A total of 2390 consultations were evaluated. Most of the consultations (42.8%) were made on internal medicine wards, followed by pediatrics (11.7%), neurology (9.9%) and cardiothoracic surgery (5.7%). Infectious skin diseases accounted for the most frequent diagnosis at 24.4%. The time lapse between request and performance of the consultation averaged 1.1 days. Patients older than 40 years needed dermatological consultation more frequently than younger patients. The duration of consultation averaged 23 minutes (time to site, patient examination, documentation). Thus, the man-hours required for the consulting service is 33.6 per month. CONCLUSION: The study emphasizes that dermatological consultation services make an important contribution to the care of inpatients. In light of increasing specialization in medicine, the consulting service guarantees interdisciplinary treatment of the patients and is thus an important quality parameter for inpatient care.

Comorbidity↗

PubMed2004

[Trauma due to blank cartridges and fireworks. Early and correct treatment prevents tattooing and scarring].

Traumata secondary to blank cartridges and fireworks are not harmless at all. They can cause cosmetic disfigurement due to permanent tattooing and scars. Often the face and hands are injured. Fourteen patients with blast injuries were treated between 1992 and 2002 in our clinic. The average age was 20.4 years (range: 13-41 years, median: 17.5 years). Eight patients were aged under 18 years. Most of the victims were males (11 of 14). According to the extent of the powder tattooing we removed the particles under local or general anesthesia within 24 h. We used sterile tooth and hand brushes. After the operation we treated the wounds with local antibiotics. We describe two cases to illustrate our procedure. Early correct treatment of tattooing caused by fireworks or gun powder explosions within 24 h up to a maximum of 72 h prevents the development of permanent cosmetic disfigurement. The technique is simple, effective, and saves the cost of later removal of traumatic tattoos by laser or dermabrasion.

Adolescent↗

PubMed2004

Patients with lymphatic metastasis of cutaneous malignant melanoma benefit from sentinel lymphonodectomy and early excision of their nodal disease.

Early versus delayed excision of lymph node metastases is still being assessed in malignant melanoma. In the present retrospective, multicentre study, the outcome of 314 patients with positive sentinel lymphonodectomy (SLNE) was compared with the outcome of 623 patients with delayed lymph node dissection (DLND) of clinically enlarged lymph node metastases. In order to avoid the lead-time bias, survival was generally calculated from the excision of the primary tumour. Survival curves were constructed using the Kaplan-Meier product-limit estimate. Cox's proportional hazards model was used to perform a multivariate analysis of factors related to overall survival. Compared with SLNE and early performed complete lymph node dissection, DLND yielded a significantly higher number of lymph node metastases. Median and mean tumour thickness were nearly identical in the two therapy groups. The estimated 3-year overall survival rate was 80.1+/-2.8% (+/-standard error of the mean (SEM)) in patients with positive SLNs, and 67.6+/-1.9% in patients with DLND (5-year survival rates 62.5+/-5.5 and 50.2+/-5.4%, respectively). The difference between the two survival curves was statistically significant (P=0.002). Using multifactorial analysis, SLNE (P=0.000052), American Joint Committee on Cancer (AJCC) Breslow thickness category (P<0.000001), age (P=0.01) and gender (P=0.028) were independent predictors of overall survival. The location of the primary tumour (P=0.59) was non-significant. Considering only those centres with sufficient data for epidermal ulceration, this risk factor was also significant. In cutaneous malignant melanoma, early excision of lymphatic metastases, directed by the sentinel node procedure, provides a highly significant overall survival benefit.

Female↗

PubMed2004

Unilateral nevoid telangiectasia syndrome.

We report on a 29-year-old patient with a unilateral nevoid telangiectasia syndrome (UNTS). Based on microcirculation examinations, both functional impairments at the blood vessel level (laser-Doppler flowmetry) and morphologically altered capillaries (capillary microscopy) could be observed. We could demonstrate that microcirculatory examinations are suitable to demonstrate pathophysiological defects at the vascular level, especially since subclinical functional defects can also be recorded. To our knowledge, no such observations have yet been published with regards to UNTS.

Adult↗

PubMed2003

[Necrotizing otitis externa caused by Stenotrophomonas maltophilia].

The gram-negative bacterium Stenotrophomonas maltophilia is feared, especially in intensive care wards, as a nosocomial opportunistic pathogen causing fulminant septicemia and organ failure in immunosuppressed patients. A patient with chronic lymphocytic leukemia developed a cutaneous infection with the clinical pattern of necrotizing otitis externa.

Anti-Infective Agents↗

PubMed2003

[Congenital and postpartum ungues incarnati].

A 2 month old infant presented with ingrown toenails of both great toes with an accompanying inflammatory reaction. The appearance of the toenails became normal after 6 months of topical antiseptic and anti-inflammatory treatment.

Administration, Topical↗

PubMed2002

[Ulcerating Herpes simplex infections in intensive care patients].

Herpes simplex infections are potentially a life-threatening situation for immunocompromised as well as critically ill patients. The correct diagnosis is made more difficult in comatose patients by the fact that the characteristic symptom of extreme pain cannot be registered. The clinical dermatological findings (polycyclic configuration, easily bleeding ulcers) are thus especially important in patients under intensive care conditions. As examples, the cases of 3 critically ill patients (subarachnoid bleeding or head injury) developing therapy-resistant, flat sacral or perioral skin ulcers with peripheral blisters are presented. Herpes simplex virus was confirmed immunohistologically and in the smear test. All patients subsequently died. These cases emphasize that patients in the intensive care unit are in danger of developing a chronic persistent Herpes simplex infection due to latent immunosuppression. Chronic persistent Herpes infections may be underrated in intensive therapy, and must always be ruled out in case of therapy-resistant erosions or ulcerations.

Acyclovir↗

PubMed2002

[Arteriovenous fistula: an uncommon cause of leg ulcers].

A 69-year-old woman presented with a therapy-resistant ulcer on the medial aspect of her left ankle present for 2 years. Previously there had been a blood vessel tumor at the same site, but it had regressed almost completely in adolescence following a bacterial infection. A whirring flow sound was e heard over the ulcer. Numerous arteriovenous connections in the area of the ulcer were shown in the form of vascular convolutions with duplex sonography and angiography. The diagnosis of arteriovenous fistula was made. In addition, there was calcinosis around the ulcer. Successful therapy consisted of excision of the ulcer and the underlying calcinosis, and of ligature of the multiple arteriovenous connections. Our patient demonstrates that smaller arteriovenous fistulas may exist for decades without symptoms. The classification, clinical patterns, diagnostic approach, possible complications (bleeding, ulceration) and therapy of the rare arteriovenous fistulas are discussed.

Aged↗

PubMed2002

[Long-term results of adjuvant chemotherapy after therapeutic lymph node dissection in patients with cutaneous malignant melanoma].

BACKGROUND AND OBJECTIVE: 224 patients with malignant melanoma and palpable axillary or inguinal lymphadenopathy underwent therapeutic lymph node dissection at the Martin-Luther-University in Halle, Germany. between 1983 and 1994. 120 received adjuvant chemotherapy; we evaluated the effects of various regimens in this group. PATIENTS/METHODS: Surgical treatment alone was performed in 104 patients. This group's results were compared to those of 94 patients who additionally received an adjuvant polychemotherapy [dacarbazine (DTIC), vincristine, 5-fluorouracil and hydroxyurea] and 26 patients who received either DTIC monotherapy or DTIC plus interferon-alfa. RESULTS: The median follow-up was 88 months. The 5-year survival rates were 31.0+/-5% after surgery alone, 26.4+/-4% after adjuvant polychemotherapy and 27.0+/-9% after DTIC based chemotherapy. The three survival curves did not differ significantly. In a multifactorial analysis, the number of metastatic lymph nodes was the single significant predictor of survival after therapeutic lymph node dissection, whereas Breslow thickness, ulceration, site of the primary melanoma, age, sex and adjuvant therapy were not significant. CONCLUSION: No beneficial effect of adjuvant chemotherapies could be demonstrated.

Adult↗