Results and tissue healing after copper-vapour laser (at 578 nm) treatment of port wine stains and facial telangiectasias.

Twenty-four patients with port wine stains (PWS), and 33 patients with facial telangiectasias were treated with a copper-vapour laser (CVL) operating at 578 nm. Good to excellent results were obtained in 52% of PWS and 69% of facial telangiectasias. Enzyme histochemistry revealed vessel-selective damage with energy densities up to 12 J/cm2, but a non-specific coagulation necrosis with higher fluences (> or = 15 J/cm2). With vessel-selective fluences only moderate blanching was obtained in two PWS. All other evaluated patients were treated using non-selective energy densities. Tissue healing was comparable with that after argon laser treatment. The theoretically correct wavelength (578 nm) alone appeared to be no guarantee of vessel-selective damage. The laser employed lacked adequate power (only 1.3 W maximum) to transmit sufficient energy into the tissues in a short exposure time. However, the clinical results confirm the value of the CVL in the treatment of superficial cutaneous angiodysplasias.

Reactive lentiginous hyperpigmentation after cryosurgery for lentigo maligna.

BACKGROUND: Twenty patients treated for lentigo maligna of the face with cryosurgery developed benign lentiginous hyperpigmentation mimicking a recurrence. OBJECTIVE: When cryosurgery is used in the treatment of lentigo maligna, it is important to know whether repigmentation of the scar represents true recurrence or a benign process. METHODS: Twenty patients were treated with cryosurgery for lentigo maligna of the face. Within a follow-up period of 7 to 80 months, frequent clinical observations were made. RESULTS: Lentiginous hyperpigmentation developed within the treatment area in eight patients. Histologic investigation revealed recurrence of lentigo maligna in three and benign hyperpigmentation in five. CONCLUSION: Genetic factors and UV exposure after cryosurgery may favor the development of benign lentiginous hyperpigmentation. Because recurrence of lentigo maligna must be considered, histologic evaluation of repigmentation is mandatory.

Cryosurgery of lentigo maligna.

Lentigo maligna denotes flat, pigmented lesions predominantly in areas of actinic damage that have the propensity to become malignant. More than 10 years may pass before lentigo maligna evolves into an invasive neoplasma. As an invasive process, it is termed lentigo maligna melanoma (LMM), and it has the potential for both lymphatic and hematogenic metastases. Because of the size and location of the lesions, cosmetically unsatisfactory scars may result from conventional surgery. Therefore, alternative means of treatment, including cryosurgery, have been employed. We report on 12 patients suffering from lentigo maligna who had been treated successfully by cryosurgery between 1984 and 1990. The average follow-up period was 51.4 months, and the recurrence rate was 8.3 percent. Knowing that microinvasive components can be demonstrated in 15 percent of lentigo maligna lesions, we retrospectively reassessed our patients by immunohistochemical procedures with S-100 protein. Although intradermal microinvasion could be confirmed in one patient, no recurrence had been observed within 61 months of follow-up. Provided that patients are selected properly and extension of cryonecrosis is monitored, cryosurgery may prove an efficient alternative to conventional surgery in the treatment of lentigo maligna.

Ulcerative blepharitis in atopic patients--is Candida species the causative agent?

A total of 50 patients suffering both from atopic skin disease and different clinical forms of blepharitis have been included in this study. Microbiological investigations (for bacteria and fungi) of the lid margins were performed in all cases. In 21 (42%) of the patients an ulcerative blepharitis which heavily involved the follicles of the lashes was diagnosed. The remaining 29 cases presented with blepharitis of the squamous type. The cultures revealed that 19 of the 21 patients with ulcerative blepharitis were found to grow Candida species, whereas fungi could not be detected in any of the other cases of blepharitis. The frequencies of concomitant bacterial organisms found in the cultures were similar in both groups. As atopic patients are known to exhibit a defect in their cell-mediated immunity and possibly also a defective IgA antibody response it is a widely accepted assumption that these immunological changes are contributing factors to the development of a localised inflammation of the lids which is initiated by a variety of micro-organisms. We postulate that when Candida species happen to coincide with severe inflammation in atopic patients a blepharitis of the ulcerative type will develop or deteriorate thereby implying that these microorganisms may play an important role in the development or deterioration of this severe chronic inflammation. It is therefore advisable to perform repeated scrapings and cultures in every case of recalcitrant blepharitis.

Do telangiectases communicate with the deep venous system?

Telangiectases of the legs occur frequently, with most patients seeking treatment for cosmetic reasons. Sclerotherapy continues to gain popularity as a safe and valuable therapeutic approach; however, deep vein thrombosis as well as pulmonary embolism have been reported even after sclerotherapy of small intradermal venectases. Hoping to uncover anatomic risk factors predisposing a patient to iatrogenic thrombosis, we investigated 15 patients with telangiectases of the legs applying ascending venography concomitantly with direct injection of the telangiectases. A digital radiographic technique was used as an imaging system. In two patients an unrestrained flow of the contrast medium into the venae femorales was noticed. As far as we know this is the first in vivo demonstration of venae communicantes connecting intradermal venectases to the deep veins. That means that particular anatomic conditions favor the spillage of sclerosant into the deep veins, which might contribute to the development of iatrogenic deep vein thromboses in compression sclerotherapy.

Blepharitis--a diagnostic and therapeutic challenge. A report on 407 consecutive cases.

Over the last few years the number of patients with chronic bilateral blepharitis has increased dramatically. From January 1985 until the end of 1989, a total of 407 patients with this diagnosis underwent ophthalmological and dermatological investigations at our out-patient clinic. Keratoconjunctivitis sicca (KCS) in conjunction with blepharitis occurred in 14.5% of the patient population who also suffered from acne rosacea. A comparison of the spectrum of microorganisms that have previously been isolated from affected sites with data obtained in the present study revealed that the range of microorganisms associated with this chronic localized inflammation has apparently shifted in recent years. The prevalence of Staphylococcus aureus, which was considerable in the pre-antibiotic era, has markedly decreased, although a distinct entity of staphylococcal blepharitis seems to remain, either alone or in combination with seborrheic blepharitis (62.8% of our patients). The clinical picture, microbiological findings and therapy for this condition are presented.

Histochemical evaluation of the coagulation depth after argon laser impact on a port-wine stain.

A two-step excisional treatment of a port-wine stain (PWS) on the back of a 43-yr-old female patient was performed. Immediately before the first surgical treatment, two corresponding series of argon laser impacts were performed, each on one PWS half. Different laser parameters with irradiances ranging from 95 to 382 W/cm2 and energy fluences ranging from 19 to 114,6 J/cm2 were used. Laser spots on the first part ot be excised were biopsied 10 min after laser treatment and prepared for histochemical analysis by staining with nitro blue tetrazolium chloride (NBTC). Reduction of this redox dye by nicotinamide adenine dinucleotide diaphorase (NADH-diaphorase) leads on frozen tissue sections to an intense blue precipitate. The activity of NADH-diaphorase subsides immediately upon cell damage. All vital epidermal and dermal cells presented a dense blue granular pigment in their cytoplasm, sparing the nuclei. Laser induced arc-shaped epidermal and dermal necrosis did not stain, showing a clear demarcation from surrounding vital tissue. The depth of the thermal injury ranged from 0.28 to 0.45 mm; it did not correlate with the chosen fluences. With these penetration depths, the vast majority of PWS vessels was affected. Assessment of the remaining part of the PWS 8 months later yielded blanching of all laser-treated areas. With the NBTC method, an accurate definition of laser-induced tissue damage is feasible. It could be shown that the exposure time is the most relevant parameter influencing the penetration depth.

Cryosurgical management of myxoid cysts.

Eighteen patients with digital mucoid cysts and 31 with myxoid cysts of the oral mucosa were treated by cryosurgery using an intermittent spray technique. Double freeze-thaw cycle (FTC) is recommended for successful treatment of digital mucoid cysts, as the recurrence rate was fairly high when only a single FTC was used. This does not necessarily apply to oral mucous cysts, where the cure rate was nearly 100%, whether a single or double FTC was used. We conclude that liquid-nitrogen-spray cryosurgery is an effective alternative in treating mucous cysts.

[Tungiasis--an increasingly frequent vacation dermatosis]. / Tungiasis--eine immer häufigere Urlaubsdermatose.

Because of the increase in international air travel to the tropical areas, we often observe skin diseases now that were formerly restricted to the equatorial zones. As we have recently observed several cases of tungiasis in our department, we report here the epidemiology, clinical appearance and treatment of this "tourism-transmitted" rare form of tropical parasitosis.

[Isolation of Neisseria meningitidis from the urethra and cervix]. / Isolation von Neisseria meningitidis aus Urethra und Zervix.

Meningococcal infections of the urogenital tract were considered rare until recently, but over the past few years an increasing number of cases of this hitherto uncommon infection have been reported. The rising incidence of N. meningitidis isolated from these sites has important epidemiological implications. The need for careful diagnostic procedures is emphasized.

Contact sensitivity to aluminium.

Contact sensitivity to aluminium is extremely rare. Sensitization occurs during continuous application of aluminium containing antiperspirants or by aluminium adjuvants in vaccines and pollen extracts. Two types of reaction pattern are known: persistent granuloma at the injection site and recurrent eczema. We report a patient with a positive patch test reaction to Al (OH)3, who had been sensitized by aluminium adsorbed triple vaccine, Previous reports are reviewed.

[Granuloma disseminatum partim anulare partim papulosum. Clinical variant of granuloma anulare disseminatum--therapeutic trial with etretinate]. / Granuloma disseminatum partim anulare partim papulosum. Klinische Variante des Granuloma anulare disseminatum--Therapieversuch mit Etretinat.

We report on a clinically and morphologically interesting case of generalized granuloma anulare showing disseminated lichenoid papules as well as anulare formations. Histopathology confirmed the clinical diagnosis. Under oral application of etretinate, the lesions decreased significantly within 3 weeks; complete remission was noticed after 5 months.

Cardial decompensation caused by hypertension and polyglobulia associated with multiple renal oncocytomas.

A 43 year old man was referred to the Internal Department for the examination of cardial decompensation, hypertension, polyglobulia and atrophy blanche of the lower legs. Clinical and supersonic examination revealed two tumors in the left kidney (diameter 8 and 3.5 cm) and some small tumors in the right kidney. Laboratory studies disclosed erythropoietin levels up to 170 mU/ml (standard 14-61 mU/ml) and a red blood cell count of up to 8 X 10(6)/ml. After recompensation, a radical left nephrectomy and the removal of three small tumors of the right kidney four weeks later was initiated. Postoperative erythropoietin levels and red blood cell count sank to the normal range leading to the reduction of antihypertensive therapy. The clinical course indicates a strong etiological connection between hypertension as well as polyglobulia with the multiple bilateral oncocytomas. Polycythemia also led to the atrophy blanche which had resulted from disturbances of microcirculation.