Irradiation with water-filtered infrared A plus visible light improves cutaneous scleroderma lesions in a series of cases.

BACKGROUND: Cutaneous scleroderma is a chronic inflammatory disease of the dermal and subcutaneous connective tissue leading to sclerosis. Sclerosis of the skin can lead to dysmorphism, contractures and restrictions of movement. OBJECTIVE: The purpose of the study was to evaluate sclerosis in cutaneous scleroderma patients and to determine the efficacy of water-filtered infrared A plus visible light treatment, wIRA(+VIS), in 10 patients. METHODS: Hardness of the normal and diseased skin was measured by durometry in 10 controls and 8 patients. Moreover, circumscribed scleroderma (CS) was treated with wIRA(+VIS) irradiations in 10 patients who had not responded to conventional therapies. RESULTS: wIRA(+VIS) therapy led to a marked improvement, persistent even during long-term follow-up, in 7 out of 10 patients with CS. Of the other patients, 1 showed decreased sclerosis and disease activity and developed a worsening after cessation of therapy. In 2 further patients, where previous UVA1 treatment had failed to reduce disease activity, wIRA(+VIS) produced a slight decrease in sclerosis, but disease activity was still present. CONCLUSION: wIRA(+VIS) appears to be effective in the treatment of CS. Durometry proved to be helpful in assessing the degree of sclerosis and in documenting the response to therapy in these patients.

[Virus-induced anorectal diseases. Condylomata acuminata and herpes simplex]. / Virusinduzierte, anorektale Erkrankungen. Condylomata acuminata und Herpes simplex.

Genital warts (condylomata acuminata) are very common sexually transmitted infections which may be present in perianal, anal and rarely rectal sites. Their incidence in the population is about 0.1%. As a rule, the diagnosis is simple and can be made by inspection; some variants pose a diagnostic challenge. The therapy is not uniform; it must be adjusted to the clinical manifestations and can be conservative or operative. Herpes simplex infections are also common; they too may be transferred by sexual intercourse and then commonly appear in the perianal skin and the rectal mucosa. While the clinical diagnosis is often difficult, the treatment is simple and effective.

[Compression treatment after burns]. / Kompressionsbehandlung nach Verbrennungen.

After healing up of the injury wounds, hypertrophic scars and keloids often develop, which are histologically characterised by irregulary arranged collagen fibre bundles and a strong vascularisation. Approximately 20 years ago, the so-called compression clothing, as for example suits, masks, gloves, stockings, were first employed for the prevention and therapy of these complications. These means of compressions are crosswise and lengthwise elastical and consist predominantly of elasthan and viscose. The pressure acting on the skin lies between 25 and 32 mmHg: thereby the values are above the average capillary pressure of 20 mmHg. The efficiency of the compression clothing after a burn injury is well proved by several studies, and one knows today that, for example in the case of children as from the 5th year of life, the results are better than in the case of adults from the 35th year of life. The compression effected at least during a period of 15 months slows down the blood circulation, reduces the number of capillaries and makes the scar become more pale. Furthermore, the orthologically parallel arranged collagen fibres maintain their arrangement due to the compression pressure and do not get irregularily arranged.

Bedside testing (SimpliRED) in the diagnosis of deep vein thrombosis. Evaluation of 250 patients.

RATIONALE AND OBJECTIVES: The authors evaluate the sensitivity and specificity of a bedside test (SimpliRED) in the diagnosis of deep vein thrombosis compared with contrast phlebography. METHODS: Two hundred fifty patients, referred for phlebography, underwent bedside testing for detection of deep vein thrombosis. Contrast phlebography was performed immediately afterward. SimpliRED provides a clearly visible agglutination of the patient's red blood cells in the presence of elevated levels of cross-linked fibrin derivative (D-dimer), which is specific for fibrin breakdown. RESULTS: In 82 (32.8%) patients, deep vein thrombosis was confirmed venographically. An abnormal D-Dimer test was found in 79 of the 82 patients with thrombosis (sensitivity: 96.3%). The three patients who were diagnosed falsely as normal on agglutinin testing, had venograms which showed only an isolated calf thrombosis in small muscle veins (< 2 cm in diameter) not requiring treatment. One hundred of 168 patients without venographic thrombosis were diagnosed correctly by SimpliRED (specificity: 59.5%). The positive predictive value was 53.7%; the negative predictive value was 96.8%. CONCLUSIONS: All thrombotic disorders in the leg that required further treatment were identified correctly. SimpliRED is a very sensitive test with moderate specificity in the diagnosis of deep vein thrombosis. Therefore, further invasive testing is needed only in those patients in whom the D-dimer test is abnormal. A false-positive result of the bedside test may be nonspecific or due to elevated levels of fibrin split products, which can occur whenever the coagulation system has been activated by any of several conditions.

[The diagnosis of deep venous thromboses of the leg using a new rapid test (SimpliRED)]. / Diagnostik tiefer Beinvenenthrombosen mittels eines neuen Schnelltests (SimpliRED).

PURPOSE: Evaluation of sensitivity and specificity of a bed-side test in the diagnosis of deep-vein thrombosis compared to contrast phlebography. METHODS: 122 patients, referred for phlebography, underwent bedside testing (SimpliRED) for detection of deep vein thrombosis. Contrast phlebography was confirmed immediately afterwards. SimpliRED provides a clearly visible agglutination of the patient's red blood cells in the presence of elevated levels of crosslinked fibrin derivatives (D-dimer) in the sample, being specific for fibrin breakdown. RESULTS: In 37 (30.3%) patients deep vein thrombosis could be confirmed. An abnormal D-dimer test was found in 35 of the 37 patients with thrombosis (sensitivity: 94.6%). Two patients who had not been identified by agglutinin testing, showed an isolated calf thrombosis in small muscle veins (< 2 cm in diameter) not requiring treatment. 55 of 85 patients without thrombosis in phlebography were stated correctly by SimpliRED (specificity: 64.7%). CONCLUSION: All thrombotic disorders in the leg with the need for further treatment were identified correctly. SimpliRED is a very sensitive test with moderate specificity in the diagnosis of deep vein thrombosis. Therefore, further invasive testing is needed only in such patients where the D-dimer test is abnormal. A false positive result of the bed-side test may be non-specific or due to elevated levels of fibrin split products, if the coagulation system is activated in several other conditions.

Influence of medical compression stockings on venolymphatic drainage in phlebologically healthy test persons and patients with chronic venous insufficiency.

The goal of this study was to investigate the influence of medical compression stockings on venolymphatic drainage in phlebologically healthy test persons and patients with chronic venous insufficiency. Using this new method, the outflow of an intradermally injected sodium fluorescein solution can be densitrometrically determined over a period of 60 min. In an evaluation of the method carried out over 5 weeks with 4 test persons, the variation coefficient was 19.3%, indicating a sufficient reproducibility. Concerning the effect of below-knee stockings (ankle pressure 30 mm Hg) on venolymphatic drainage, improvements of around 200 (p < 0.0001) and 250% were recorded for 10 healthy test persons (mean age 29.0 +/- 3.1 years) and 20 patients suffering from chronic venous insufficiency (classes 4 and 5; p < 0.001), respectively. The results lead us to conclude that (i) the method presented here enables a quantification of the venolymphatic drainage and (ii) that therapy with compression stockings, for both healthy test persons and patients suffering from chronic venous insufficiency, leads to a significant improvement of venolymphatic drainage.

Long-term, indwelling setons for low transsphincteric and intersphincteric anal fistulas. Experience with 108 cases.

PURPOSE: The purpose of this study was to determine the technique and results of long-term, indwelling setons for low transsphincteric and intersphincteric anal fistulas. METHOD: Long-term, indwelling setons were performed in 108 consecutive patients with low transsphincteric and intersphincteric anal fistulas. Progress and results of 73.1 percent of cases were assessed in a retrospective study. RESULTS: Therapy lasted for an average of 54.8 weeks; mean follow-up was 62 weeks. Relapse occurred in 3.7 percent of cases and incontinence in 0.9 percent. Average period spent in a hospital was 0.3 days/case. CONCLUSIONS: A long-term, indwelling seton is a good alternative to primary surgical treatment of low transsphincteric and intersphincteric anal fistulas. Relapse quota is comparable with that of primary surgically treated cases; incontinence is rarer with long-term, indwelling seton. Complete treatment can generally be performed in the outpatient department. One disadvantage is that therapy takes much longer than cases treated by primary surgery.

[Angiokeratoma corporis diffusum universale (Fabry disease)]. / Angiokeratoma corporis diffusum universale (Morbus Fabry).

Fabry's disease (Angiokeratoma corporis diffusum) is a rare X-chromosome linked recessive disorder belonging to the group of sphingolipoidoses. The basic defect involves the gene encoding alpha-galactosidase. Because this enzyme is responsible for decomposition of glycosphingolipids, its deficiency results in their accumulation in endothelial and smooth muscle cells. With time, generalized angiokeratomas, paresthesias, renal and cardiac insufficiency and cerebrovascular complications develop. We report a patient who in addition to the well-described findings also showed unique nail fold capillary changes not described so far. Analysis of serum concentration of alpha-galactosidase identified three female heterozygous carriers in the patient's family.

Dermofluorography as a possibility for therapeutic control following sympathectomy.

The assessment of completeness of a sympathectomy can be objectively recorded and documented by dermofluorography. This method enables measurement of increased skin perfusion which leads to an earlier appearance time and steeper initial rise in fluorescence of intravenously administered sodium fluorescein. The most significant parameters are the quotients of the average appearance time and the initial rise in fluorescence of the untreated versus treated leg. Following a successful lumbar sympathectomy, these parameters were outside 3 standard deviations of the values obtained from healthy test persons.

[Chronic venous insufficiency]. / Die chronisch-venöse Insuffizienz.

In severe chronic venous insufficiency (CVI) the fascia cruris is increasingly involved in the pathological process. The resulting loss of compliance as a consequence of altered fascia texture leads to increased pressure in the compartments of the lower extremity, followed by reduced circulation. Arteries and nerves, which penetrate the fascia along with insufficient perforating veins, are damaged through the increased pressure and are therefore functionally impaired. Accordingly many pathological changes in the crural ulcer have their anatomical substrate here. The microcirculation is distributed by either primary varicosis with secondary insufficiency of the deep veins or by primary insufficiency of the deep venous system as seen in a post-thrombotic syndrome. Subsequent therapy should be based on this knowledge and therefore consists of medication and basic physical therapy along with dissection of the perforating veins-fasciotomy and fasciectomy combined with plastic surgery. All of the therapeutic measures have to take the stage of the CVI into consideration. In order to eliminate the insufficient perforating veins and to perform fasciotomy the endoscopic approach is considered the state of the art. In extreme cases, only fasciectomy combined with plastic surgery can lead to durable healing.

[Measuring capillary resistance values in atopic dermatitis]. / Kapillarresistometrische Befunde bei atopischer Dermatitis.

For over 100 years many different methods have been used to determine capillary resistance as a measure of small vessel fragility. There is still no firm agreement as to the most suitable method; the procedure is not standardized and an objective system for measurement is lacking. We have developed a computerized system that makes it possible to count petechiae and determine their area without the results varying with different examiners. Although we tried to keep the conditions for our examinations constant, we found a wide individual spread. In spite of this, the capillary resistance of atopic subjects was significantly lower than that of healthy persons.

[Modification of the flexibility of the upper and lower ankle joint by medical compression stockings]. / Beeinflussung der Beweglichkeit im oberen und unteren Sprunggelenk durch medizinische Kompressionsstrümpfe.

Using a special measurement equipment the motility range of the ankle joint and the talo-calcaneo-navicular joint in healthy young volunteers was compared with and without compression hosiery. There was no limitation in joint motility using the stockings of moderate compression (german compression class 1 and 2) but a reduced motility using strong compression hosiery (german compression class 3 and 4) was found especially in the ankle joint. This difference was significant in the products of two manufacturers.

A new method for assessing the gloss of human skin.

A new method for an objective assessment of the gloss of human skin is presented. The reflectometric measuring set-up complies with DIN 67530. The principle of this new method is based on a contactless determination of the skin's reflection of light from a tungsten filament lamp, recorded at an angle of 60 degrees by a silicon photocell. In a comparative study with 30 test persons it was discovered that the forehead, with 2.70 standardised reflectometer units (RU; SD +/- 0.59 RU), displayed a significantly higher gloss than the lower arm (1.99 RU, SD 0.28 RU, p < 0.0001). In an investigation into the influence of four different cream bases on the skin gloss it could be determined that the value depends on the percentage of grease, the water concentration and the consistency of the respective base. The method presented permits a fast, contactless, randomly repeatable objective assessment of skin gloss. Since the acceptance of cosmetics and pharmaceutical products depends not least on their skin gloss effect, this method can provide valuable information when estimating the success of old and new products.

["Spatial shift alignment (SSA)"--a new method for determining blood flow velocity in video capillary microscopy]. / Das "Spatial Shift Alignment (SSA)"--eine neue Methode zur Bestimmung der Blutflussgeschwindigkeit in der Video-Kapillarmikroskopie.

A new technique (spatial shift alignment [SSA]) for measuring capillary blood velocity in human capillaries in the skin is described. A capillaroscopic image is digitized by means of a frame grabber. Within the lumen of a suitable capillary limb a region of interest known as a slot is placed. At a frame frequency of 25 per second, this slot is copied in a free part of the frame grabber store along a horizontal axis. A static space-time image with light diagonal bands representing the plasma gaps in their passage through the capillary limb is obtained. By determining the gradient of the diagonal bands, a measure of the capillary blood velocity is obtained. The SSA system was validated by means of a simulated model using known fixed velocities between 0 and 1.0 mm/sec (r = 0.979, n = 24). The procedure can be employed with any image processing systems, and enables continuous monitoring of the velocity measurements. Since it is time-saving and just as accurate as the frame-to-frame method, SSA could be widely applied to the measurement of blood cell velocity in capillaroscopy.