[The localized form of reflex sympathetic dystrophy-a case report.]. / Die lokalisierte Form einer sympathischen Reflexdystrophie : Ein Fallbericht.

INTRODUCTION: The reflex sympathetic dystrophy (RSD) syndrome usually shows a distally generalized distribution pattern of symptoms. Here we report a case with a distally localized form of RSD. PATIENT AND METHODS: In a 53-year-old woman, following a local lesion in the nail bed of the left thumb, a neuroma developed at the side of the lesion during the next half year. She was finally operated upon. Following that intervention, a complex and painful clinical syndrome occurred that for the most part affected only the thumb. A clinical neurological examination was carried out, including distal suprasystolic compression of the affected extremity after bandaging it (the so-called ischemia test). For diagnostic and therapeutic reasons, afterwards a conventional blockade of the ipsilateral stellate ganglion was applied. RESULTS: The clinical investigation showed a triad of autonomic (swelling, side difference of skin temperature, hyperhydrosis), motor (reduced movement ability, tremor) and sensory disturbances (spontaneous pain, allodynia), which nearly exclusively affected the entire left thumb. The spontaneous pain showed an orthostatic component (the pain being diminished or exaggerated when the extremity was elevated or lowered, respectively) and was suppressed by the ischemia test. Following the sympathetic block, all symptoms disappeared within one day (follow-up period: 5 months). CONCLUSION: In contrast to the common clinical picture of RSD, with a distally generalized distribution of symptoms, the present case showed a so-called localized form of RSD, its triad affecting only the thumb with the lesion. Typically, the pain showed an orthostatic component and was suppressed by the ischemia test. The sympathetic block was immediately successful, proving the occurrence of this form of RSD for the first time. In similar clinical cases, this form of RSD should be considered as a differential diagnosis.

[Grzybowski type eruptive keratoacanthomas and ectropion. A therapeutic problem]. / Eruptive Keratoakanthome Typ Grzybowski und Ektropium. Ein therapeutisches Problem.

Eruptive Grzybowski-type keratoacanthoma is a rare variant of multiple keratoacanthoma and is not accompanied by internal malignancies. Up to now only 16 cases of eruptive Grzybowski-type keratoacanthoma have been described in the literature. Eruptive and solitary keratoacanthomas cannot be distinguished histologically. The multiplicity of skin lesions may be due to a genetic background. Our patient presented with multiple eruptive keratoacanthomas, ectropion and a mask-like face. Conservative treatment, e.g. with etretinate, did not lead to any improvement of symptoms in this case. Therefore surgical therapy was recommended for the patient's ectropion.

Time course of wound healing.

Wound healing is a special kind of inflammation. Undisturbed wound healing is subject to a fixed time schedule of biochemical and cellular events. It is virtually impossible to deal with the time course of wound healing without describing the cellular and non-cellular events involved. The activity and mode of cell action after injury are coordinated by spatial and chronological factors, as well as by different mediators and cell-cell interacting signals. During wound healing the sequence of different signals and message substances, such as mediators of inflammation, fulfill a key function in wound repair. The report describes the time course of healing and the control of cellular events by different mediators and cell interactions. Emphasis is placed on temporal aspects, including the various signals leading to typical cellular events in wound healing.

[Peri-capillary fibrin cuffs--an O2 diffusion block?]. / Perikapilläre Fibrinmanschetten--ein O2-Diffusionsblock?

In 42 patients with a chronic venous insufficiency Stage I-III transcutaneous oxygen tension was measured above the medial ankle and the leg ulcer edges respectively at 44 degrees C. The measurement point was biopsied and evaluated immunfluorescencehistologically for pericapillary fibrin cuffs (PCF). Fibrin cuffs are associated with decreased tcpO2-tensions. All PCF-positive biopsies were from areas with a tcpO2 less than 35 mmHg. The difference of PCF-positive and PCF-negative biopsies concerning the mean tcpO2 was significant (Wilcoxon-U-Test; p less than 0.001). The evidence of pericapillary fibrin cuffs associated with tcpO2 tensions up to 33 mmHg proves that this phenomenon alone cannot be a diffusion barrier.

Factor XIII-deficiency in the blood of venous leg ulcer patients.

Pericapillary fibrin cuffs are probably involved in the pathogenesis of venous leg ulcers. Factor XIII (Fibrin stabilizing factor) is of importance in wound healing. Its activity, which may affect ulceration, was found to be significantly reduced in the blood of venous leg ulcer patients and in post-phlebitic patients, compared with healthy controls.

[Cutaneous myofibroma--late manifestations]. / Kutanes Myofibrom--Spätmanifestation.

Infantile myofibromatosis is a rare, but nevertheless well-known, entity that was first described in 1954 in Stout's classic article on juvenile fibromatosis. Usually the tumour mass is noted at birth or during the first weeks of life. Solitary lesions are at least twice as common as multiple lesions. A case of a 17-year-old woman with a tumour macroscopically resembling a basal cell epithelioma is presented. This tumour did not develop until the patient was 17 years old and cannot be distinguished histologically from an infantile myofibroma. Because of the very late appearance of this tumour the term "cutaneous myofibroma" is proposed for it. In young patients with a basal cell epithelioma-like lesion the diagnosis of cutaneous myofibroma has to be considered.

Pericapillary fibrin cuff: a histological sign of venous leg ulceration.

The incidence of pericapillary fibrin cuffs was investigated in 49 biopsies of venous leg ulcers and 67 biopsies of leg ulcers of non-venous etiology. Pericapillary fibrin cuffs were seen in 28 biopsies (57.1%) of venous leg ulcers, but only in 11 biopsies (16.4%) of non-venous leg ulcers. In the venous leg ulcers pericapillary fibrin cuffs occurred predominantly near the ulcer surface and around dilated capillaries. Dilation of the capillaries and inflammation probably contribute more to the pathogenesis of pericapillary fibrin cuffs than venous hypertension.

Leg ulcers in a patient with spherocytosis: a clinicopathological report.

In a case of spherocytosis combined with ulcus cruris, Doppler sonography and phlebography revealed a chronic venous insufficiency, together with fibrinous precipitates in capillary and venous vessel walls. Some haemolysis and fragmentation of red cells in the biopsy was also observed. It is suggested that the haemodynamic alteration due to chronic venous insufficiency may have played the main role in the development of the ulcers, although the rheological disturbance caused by the spherocytosis may have had an aggravating effect. Circulatory disorders should be excluded, if skin ulcers are to be classified as haematological disorders.

[Malleolar and plantar light reflection rheography]. / Malleoläre und plantare Lichtreflexionsrheographie.

It is reported about the plantar LRR. This modification of the malleolar LRR distinguishes venous healthy from venous patients like the malleolar procedure. By the plantar procedure LRR becomes possible in cases where malleolar LRR is not performable like in larger leg ulcers and lymphedemas. The evaluation of plantar LRR has to regard changed normal values i.e. a prolonged refilling time and an increased delta R.

[Bee and wasp venom allergy]. / Bienen- und Wespengiftallergie.

Since allergic reactions to insect venom can become life-threatening, accurate diagnosis and proper treatment are important. The diagnosis of insect venom allergy is made on the basis of the history, a skin test taking the form of an intradermal titration series, and serodiagnosis (IgE). In proven allergy, the patient must be informed about measures to be taken to avoid being stung. Furthermore, the patient will have always to carry a "shock kit" comprising an antihistaminic, a steroid and adrenalin in the form of an aerosol. As specific therapy, desensitization is available.

[Open, controlled multicenter trial of 2 benzoyl peroxide preparations in the treatment of acne vulgaris]. / Offene, kontrollierte multizentrischen Prüfung zweier Benzoylperoxid-Zubereitungen bei der Behandlung der Akne vulgaris.

In an open multicenter study, 109 patients with acne vulgaris were treated with Cordes Benzoyl Peroxide (BPO) 3%, 5%, and 10%, or a reference preparation. With few exceptions, both preparations resulted in a good therapeutic outcome. Cordes BPO 5% and 10% were significantly better tolerated than the reference preparation. The efficacy of topical treatment with benzoyl peroxide depends largely on the patient's acceptance of this preparation; good tolerance leads to good compliance.

Morphology and localization of sunburst varicosities: an electron microscopic and morphometric study.

The results of light and electron microscopy of 18 punch biopsies of sunburst varicosities are presented. Sunburst varicosities are widened cutaneous veins located within the superficial vessel net as well as within descending branches, often with an asymmetrically thickened wall. The thickened vessel walls contain collagenous and muscle fibers. Only a few elastic fibers have been detected, as opposed to numerous oxytalan fibers. Electron microscopy reveals an interfibrillar collagenous dysplasia, lattice collagen, and some matrix vesicles. The center of sunburst vessels is found at depths ranging from 175 to 382 microns below the stratum granulosum.

Acitretin versus etretinate in psoriasis. Clinical and pharmacokinetic results of a German multicenter study.

175 patients with severe psoriasis of different types were treated with 10, 25, or 50 mg acitretin and compared with patients receiving 50 mg etretinate over a period of 8 weeks in a randomized, double-blind multicenter study in the Federal Republic of Germany. Plasma concentrations of etretinate and its metabolite acitretin were measured during therapy and also 3 weeks after cessation of treatment. After 4 weeks of treatment, a trend toward clinical improvement was shown in all groups with increasing dosage. Those groups receiving the lower acitretin doses (i.e., 10 and 25 mg/day) had more dropouts than the groups taking 50 mg acitretin or 50 mg etretinate. Complete remissions before the end of therapy occurred only among those receiving higher doses. Enlargement of psoriatic lesions, however, could be observed during treatment with both retinoids, despite improvement of other parameters, as measured by psoriasis area and severity index (PASI) and psoriasis severity index (PSI). After 8 weeks, a significant improvement was calculated by the PASI score and by a newly defined, corrected PASI score for all four dose regimens compared with baseline levels. A greater than 50% PSI score improvement was seen in 50% of patients treated with 10 mg acitretin, 40.5% with 25 mg acitretin, 53.8% with 50 mg acitretin, and 61.1% with 50 mg etretinate. No statistical differences were found among these groups at any time during the 8-week period. No new or unexpected side effects occurred during acitretin treatment. Moreover, cholesterol levels did not significantly change. Three weeks after cessation of drug administration, the plasma concentrations of acitretin were below the sensitivity level of the assay, whereas etretinate was still quantifiable. It is interesting that acitretin plasma concentrations during therapy with 50 mg acitretin were markedly lower (means = 18 ng/ml) than were acitretin levels during treatment with 50 mg etretinate (means = 36 ng/ml).

[Gemmangioma. Case report and review of the literature]. / Das Gemmangiom. Kasuistik und Literaturübersicht.

A benign gemmangioma with a diameter of 1 cm was found on the mons pubis of a 56-year-old woman. Gemmangiomas are rare tumours that occur in different locations. They have their origin in pluripotentional angioblastic cells and develop typical immature capillaries in a mesenchymal tumour stroma with few cells. The great variability and uncertain nature of the tumours are caused by the pluripotential capacity of the tumour cells. A review is presented of the cases reported in the literature since the first description by Orsós in 1932.

[B-scan ultrasound in dermatology]. / B-Scan-Ultraschall in der Dermatologie.

Using a new polyacrylamide material, ultrasonic B-scanning can now be successfully used to show the upper layers of the skin and its tumors. Examples demonstrate the possibilities of this procedure in daily dermatological diagnostics.

[The nitrazine yellow test. A simple clinical method for diagnosing epidermal wound healing]. / Nitrazingelb-Test. Eine einfache klinische Methode zur Objektivierung der epidermalen Wundheilung.

Nitrazine yellow test has proved successful in determining toxic degenerative hand eczema. Additionally, it may be regarded as helpful in the quantitative registration of kinetic data on epidermal wound healing.

[Does the anesthesia method modify the results of dermatologic surgery of the nose?]. / Beeinflusst das Anästhesieverfahren die Ergebnisse dermatochirurgischer Eingriffe an der Nase?

Since dermatosurgery has become a generally acknowledged subsection of dermatology, it seems strange that we have got so little account regarding the influences of anesthesia on the results of plastic surgery in the antrofacial region. A long-term follow-up of 139 patients, who had received regional flaps or free grafts because of tumors of the nose, revealed that the functional and esthetic results of operations carried out in local anesthesia were perfectly comparable with those in general anesthesia. We recommend local anesthesia because of its easy handling and little complications even in elderly polymorbid patients.

[Effect of zinc on wound healing]. / Der Einfluss von Zink auf die Wundheilung.

Topical application of zinc sulfate 0.5% leads to improvement of the healing process: In comparison to controls, the granulation tissue is constructed more systematically, the formation of collagen is more advanced, and its amount is increased.