Antiseptic efficacy of local disinfecting povidone-iodine (Betadine) therapy in chronic wounds of lymphedematous patients.

In chronic wounds (ulcus cruris) of lymphedematous patients (n = 25) opportunistic infections caused by gram-negative rods and methicillin-resistant Staphylococcus aureus can be detected in 35% of cases. The healing of the wound takes a long time, which is the reason why the patients are taught how to manage the wound care. Local antibiotics must be avoided. The elimination of the wound infections is the first step of the complex decongestive physiotherapy. The infection aggravates the lymphostasis and makes the complaints of the patients (inflammation, pain, odor) more unacceptable, the systemic infections (erysipelas, lymphadenopathy, fever) more probable and the costs of the treatment higher. Betadine solution and ointment were used locally. The clinical and bacteriological efficacy of povidone-iodine has been validated. Excellent local tolerability has also been observed. The opinion of the patients was registered on a visual analog scale and statistically analyzed. No development of resistance has been noted. For local treatment, Betadine proved to be an effective preparation tolerable for a long time in the treatment of chronic wounds.

The current surgical treatment of primary malignant melanoma of the skin.

In our Department, between 1991 and 1996, 132 patients, there of 87 male-45 female, average age of 48.2 years underwent surgery because of stage 1 (T2) to stage 3 melanoma that was located on the skin. None of patients suffered from early or in situ melanoma. Our retrospective study was based on those 94 patients who had been followed up by Department or dermatology-oncology in our medical centre. Surgery is still the primary treatment for cutaneous malignant melanoma. Thin melanomas (up to 2 mm in thickness) can be excised with 2 cm margins. Whether this is also true for thicker melanomas is not known and the only way to obtain more knowledge is to participate in prospective randomised studies. Elective lymph node dissection is associated with significant morbidity which includes lymphedema, wound complications and paresthesias of the extremity. For this reason we use an alternative operative approach uses selective lymphadenectomy with identification of the sentinel node.

[Connection between Helicobacter pylori infection and chronic gastrointestinal urticaria]. / A Helicobacter pylori fertözés és a gastrointestinalis krónikus urticaria összefüggésének vizsgálata.

Chronic urticaria is a disease of unknown etiology. One type of the disease is accompanied by gastrointestinal complaints. The aim of the present study was to determine the prevalence of Helicobacter pylori (H. pylori) infection in patients with chronic urticaria, and measure the effectiveness of eradication of HP on the skin disease. Patients with chronic urticaria of other origin were excluded from the study. Forty patients out of 95 studied fulfilled the criteria of gastrointestinal urticaria. H. pylori was measured both by measuring H. pylori-specific IgG in the serum and by direct staining of biopsy specimen taken upon endoscopy prior to and after the treatment. Seventeen patients out of 40 with gastrointestinal urticaria were H. pylori positive which incidence (43%) is not higher than that of the age matched healthy population in Hungary. H. pylori positive patients were treated with amoxycillin (4 x 500 mg/die), bismuth subsalicilate (3 x 512 mg/die) and metronidazole (2 x 500 mg/die) for two weeks, respectively, and those remaining positive were treated by omeprazole (2 x 20 mg/die) and amoxycillin for additional two weeks. Eradication of HP infection was successful in all patients. Follow-up was conducted from 6-18 months for urticaria (frequency, duration) and antihistamine drug requirement. Chronic urticaria did not disappeared after the eradication of H. pylori, but there was a significant reduction both in frequency, duration of urticaria and the need for antihistamine therapy after eradication of H. pylori. It was concluded that H. pylorilinfection has no effect on the course of chronic urticaria. Reduction in frequency of urticaria symptoms and reduction of antihistamine requirement is partly due to the natural course of the disease and likely due to the altered bacterial flora of the gut following the combined antibiotic treatment.

[Position taken by the profession of dermatology on the use of the solarium]. / A börgyógyász állásfoglalása a szolárium használatáról.

This article is to summarize the potential adverse effects of exposure to ultraviolet radiation from sunbeds and to provide recommendations from the British Photodermatology Group that, if followed, will minimize the risks of such effects. The recommendations in this document apply only to the use of sunbeds for cosmetic purposes.

[Use of polyurethane foil for wound covering]. / Poliuretán fólia használata sebfedésre.

The authors account of the application of the Omiderm folie in connection with 29 cases. The transparent polyurethan skin substitute was used in dermatological diseases when presenting extensive shortage of tissue or for covering the half-thick skin's donor areas and for the treatment of deep second degree burns. The advantages of the application of the wound covering folie is being valued and the authors are calling attention to the most common complications being noticed during the application. The Omiderm is being judged as a suitable alternative bandage and skin substitute.

[Necrobiosis lipoidica]. / Necrobiosis lipoidica.

Authors report results of light and electron microscopic studies of dermal symptoms of 8 patients with non-diabetic lipoid necrobiosis. In all cases microangiopathy in skin, characterized by thickening of basal lamina and its becoming multilayered, and by narrowing of lumen of veins. Histological picture of dermal symptoms showed tuberculoid structure, which is characteristic of symptoms of non-diabetic necrobiosis. Orgastoplasmatic corpuscles found in plasma cells are conditioned upon atypical immune globulin synthesis.

[Subacute cutaneous lupus erythematosus based on a study of 15 cases]. / A szubakut cutan lupus erythematodesröl 15 beteg vizsgálata alapján.

15 cases of subacute cutaneous lupus erythematosus are reported. The diagnosis was based on the presence of the typical clinical features, on the histologic and immunpathologic examination of lesional skin and on the characteristic laboratory findings. 8 patients had annular type, 4 patients had papulosquamosus type of the characteristic skin signs of subacute cutaneous lupus erythematosus. In 3 patients both types of lesions existed simultaneously. 5 patients fulfilled the American Rheumatism Association criteria for systemic lupus erythematosus, however the systemic symptoms (arthritis, arthralgia, fever, myalgia, photosensitivity) were mild. 4 patients had positive ANA test, anti-Ro/SSA antibodies were determined in 5 patients, anti-RNP antibodies were detected in 8 patients. Anti-dsDNA antibodies were not detected. Subacute cutaneous lupus erythematosus is an intermediate subset in severity between discoid lupus erythematosus and severe systemic lupus erythematosus, therefore a milder form of therapy should be chosen.

[Necrobiosis lipoidica without diabetes mellitus (diagnostic and therapeutic possibilities)]. / Necrobiosis lipoidica diabetes mellitus nélkül (diagnosztikus és terápiás lehetöségek).

The goal of the present study was to follow the clinical behaviour of 6 non diabetic patients (5 females and 1 male, aged 23-68) suffering from necrobiosis lipoidica. Thickening of the basalmembrane of capillaries could be confirmed by electron microscopy, although the histological structure of skin alterations are not different from those observed in diabetes mellitus. Three patients (2 females and one male) showed impaired glucose tolerance, 2 other patients had increased levels of total cholesterol, whereas one patient suffered from both metabolic disturbances. After treatment with ASA (acetylsalicylic acid, 1.0 g/day) and dipyridamole (200 mg/day) for six weeks, the decrease of platelet in vitro aggregation in platelet rich plasma could be observed by stimulation with arachidonic acid, epinephrine, ADP and collagen, respectively. Healing of the exulceration of skin lesion could be detected by the use of the combined treatment of ASA and dipyridamole in 4 cases.

The effect of timolol, betaxolol and levobunolol on the surface of rabbit cornea.

Pigmented rabbits were treated with timolol maleate, betaxolol hydrochloride or levobunolol hydrochloride eye drops twice a day for six months. Animals of the same age group and breed were used as controls. There were no differences observed in corneal epithelium with light and transmission electron microscopy. With scanning electron microscopy, in the timolol and betaxolol treated animals the picture of the corneal surface was similar to that of normal rabbit corneas after exposure to air. In scanning electron micrographs of the levobunolol treated animals, the corneal surface resembled the corneas of normal rabbits treated with artificial tears.

[Multiple clear cell acanthomas]. / Multiple Klarzellakanthome.

Multiple clear cell acanthomas were observed on the legs of a 77-year-old male patient. Some of the tumors showed a tendency to aggregate in a circumscribed area on his right lower leg. The multiple occurrence of these benign epidermal tumors is extremely rare; moreover, there has not been observed any tendency to aggregation so far.

[Subungual exostosis]. / Subunguale Exostose.

A 56-year-old male patient suffering from subungual exostosis of the big toe is reported. The painful tumour was treated ineffectively for a number of years after being mistaken for verruca vulgaris. The histological diagnosis was benign osteochondroma, having a roentgenographic appearance of exostosis. Local curettage of the subungual exostosis is the treatment of choice.

Intraocular invasion of recurrent epibulbar malignant melanoma.

A case of a recurrent epibulbar naevus is presented; it underwent malignant transformation and subsequently invaded the eyeball. The tumour histologically was a predominantly epitheloid cell melanoma containing numerous histiocytes and degenerated tumour cells. Electron microscopy revealed rare special structures, e.g. annulated lamellae, tubuloreticular structures, pseudocrystals in huge mitochondria. Besides, invasion of tumour cells into a capillary could be shown.