[Characteristics of aging skin]. / Besonderheiten der Altershaut.

The change in the population's age structure in most industrial countries, as in Germany, requires geriatric medicine to play an increasingly important role. Dermatology also has to meet the new challenges by expert discussion and ethical considerations. The physiological aging process is influenced by intrinsic and extrinsic factors and causes a variety of morphological and functional alterations in the skin. Those alterations are the cause for an increasing prevalence of many dermatoses. Infections, wound healing disorders, inflammatory diseases, tumors and associated paraneoplastic syndromes are of particular importance. The structural and functional characteristics of aging skin in combination with the reduced mobility and declining cognitive abilities in elder patients require specific recommendations for skin protection as well as qualified advice about topical and systemic use of medications.

High efficacy of gemcitabine and cisplatin in patients with predominantly anthracycline- and taxane-pretreated metastatic breast cancer.

BACKGROUND: Effective and tolerable regimens are sought specifically in patients who have been pretreated with anthracyclines and taxanes. Gemcitabine and cisplatin demonstrated synergistic activity in vitro and provides a new mechanism of drug interaction. PATIENTS AND METHODS: Previously treated patients with metastatic breast cancer (MBC) were enrolled in a multicentre phase II study. Treatment consisted of gemcitabine (750 mg/m(2)) and cisplatin (30 mg/m(2)) given on day 1 and 8 every 3 weeks. RESULTS: Thirty-eight patients were recruited, all of whom had previously received chemotherapy (35 pretreated with taxanes, 33 pretreated with anthracyclines). A median of 5 cycles of the study treatment was delivered. There were 2 complete and 13 partial responses, for an overall response rate of 40% (95% confidence interval: 23-56%). Thirteen patients (35%) had stable disease. Tumour response appeared independent of previously applied chemotherapy. Median time-to-progression was 6 months and median overall survival was 13.5 months. Main toxicities were leucopenia and thrombocytopenia (grade 3/4 in 26 and 16% of cycles, respectively). Non-haematological toxicity was rarely severe. CONCLUSIONS: Combination chemotherapy with gemcitabine and cisplatin given on 2 out of 3 weeks is well tolerated and active in heavily pretreated patients with MBC, even after prior exposure to anthracyclines and taxanes.

Idarubicin monotherapy in multiply pretreated leukemia patients: response in relation to P-glycoprotein expression.

The aim of the study was to test whether fractionated (weekly) idarubicin administration to multiply pretreated leukemia patients is effective and tolerable for outpatient treatment, and whether idarubicin alone can overcome P-glycoprotein (P-gp)-related resistance. P-gp was assessed with an immunocytological technique using the monoclonal antibody 4E3.16. P-gp. expression was characterized as a percentage of P-gp-positive blasts. Additionally, the function of P-gp was determined with the rhodamine-123 (R-123) accumulation test in combination with or without verapamil and expressed as the R123 accumulation ratio. Fractionated idarubicin (12 mg/m2/week) was given to 36 acute myelogenous leukemia (AML) patients, 12 acute lymphoblastic leukemia (ALL) patients, and eight chronic myelogenous leukemia (CML) patients in blast crisis. Furthermore, 11 AML and four ALL patients were treated with fractionated daunorubicin at a dose of 50 mg/m2/week. All patients had been pretreated with drugs inducing P-gp-related resistance including daunorubicin and/or doxorubicin or vindesine (CML patients). Of 71 pretreated patients, 51 (72%) had a P-gp value between 25 and 98%. Six of these patients with increased P-gp expression had a nonpumping P-gp; four of them were CD34 positive. Of 51 patients with increased P-gp expression, 30 (59%) were CD34 positive. With regard to idarubicin monotherapy, overall response was 33/56 (59%) patients, and 23/33 (70%) responding patients showed a P-gp expression between 25 and 95%. All idarubicin-responding patients with high P-gp expression before treatment showed a clear reduction of P-gp-positive blasts. No patients with P-gp expression between 34 and 85% treated with fractionated daunorubicin showed response or reduction of P-gp-positive blasts in bone marrow. This study demonstrates that P-gp-related resistance can be overcome in multiply pretreated leukemia patients with idarubicin alone, and that the protocol used here is tolerable for outpatient treatment.

Treatment of metastatic sweat gland carcinoma by a four drug combination chemotherapy: response in two cases.

Two patients with metastatic sweat gland carcinoma were treated with a combination chemotherapy consisting of adriamycin, cyclophosphamide, vincristine and bleomycin. In one patient, a complete remission of two years' duration, and in the other a partial remission (4 + months) were achieved. A review of the literature about chemotherapy in metastatic sweat gland carcinoma is given.

[Combination chemotherapy with cis-dichloro-diammineplatinum (II) and ifosfamide in malignant melanomas (author's transl)]. / Kombinationschemotherapie maligner Melanome mit cis-Diamino-dichloro-platin (II) und Ifosfamid.

We report our results on 9 patients with disseminated malignant melanoma, treated with combination of DDP and IF, 3 in addition with VD. In none of them a complete remission was obtained, the median survival was 4.2 months. These disappointing results, in addition to the rather toxic side effects from the chemotherapy, do not present any benefit over less toxic regimens.

[Burkitt-like lymphoma: diagnosis, clinical features, and response to chemotherapy (author's transl)]. / Das Burkitt-like Lymphom: Differentialdiagnose, Klinik und Therapie.

The Burkitt-like lymphoma is extremely rare. It shows a predominance of presentation in abdominal and pelvic sites and an older median age as compared to the endemic Burkitt's lymphoma. Both are independent prognostic determinants and reflect a poor prognosis. This might be the reason for the low response rate to cytotoxic treatment. Cyclophosphamide is a substantial part of any chemotherapeutic regimen used. Serum lactic dehydrogenase (LDH) levels are closely correlated with the extent of tumor mass and the response to therapy. Chemotherapy might be associated with serious metabolic complications including hyperkalemia, lactic acidosis, anuria, and sudden death from lethal embolization of the lung. In contrast to Burkitt's lymphoma, the Burkitt-like tumor has no association with the Epstein-Barr-virus. In both lymphomas a translocation from the 8q onto 14q chromosome occurs being a characteristic marker for these malignancies.