[Characteristics of Focal Degenerative Cartilage Lesions in the Knee Joint. A Radiologic, Spectroscopic, Histological and Biochemical Study]. / Eigenschaften fokaler degenerativer Knorpelschäden am Kniegelenk. Eine radiologische, spektroskopische histologische und biochemische Untersuchung.

OBJECTIVE: The aim of this study was to perform a macroscopic, spectroscopic and biochemical/histological examination of the defect margins of grade IIIb cartilage lesions in the patella, the medial femoral condyle, the corresponding articular surface and the remaining cartilage surfaces of the knee joint. Our null hypothesis was that there would be no difference in characteristics between the cartilage surrounding the defect, the corresponding articular surface and the remaining articular surfaces of the knee joint on the one hand and the cartilage within the defect on the other. METHOD: The study included ten patients treated for focal cartilage lesions (ICRS classification grade IIIb) by autologous cartilage transplantation (ACT). All patients underwent a preoperative magnetic resonance imaging scan (1, 5 T). The articular cartilage lesions were classified pursuant to the recommendations of the International Cartilage Repair Society (ICRS). During the arthroscopic procedure, spectroscopic examinations were performed to measure the degree of cartilage degeneration in a total of 14 defined areas including the defect itself and the region of the defect margins. Biopsies for a histological and biochemical examination (collagen II, glycosaminoglycan, DNA) were taken from the centre of the defect and the defect margins that seemed to be intact on macroscopic examination. RESULTS: All knee joints had focal grade IIIb cartilage lesions with an intact margin and an intact corresponding articular surface. The readings obtained on spectroscopic examination both in the defect, the apparently intact margins, the corresponding articular surface and all other examined areas of the knee suggested that severe degenerative changes had already occurred in the cartilage. The histological and biochemical examinations of the residual cartilage in the centre of the defect and the apparently intact margins revealed no significant differences. CONCLUSIONS: Focal cartilage lesions frequently occur in the main weight-bearing zones of the patella and the medial femoral condyle. If they are the result of degenerative changes in the knee joint, the residual cartilage in the defect does not differ from the cartilage of the defect margins, the corresponding articular surface and the other cartilage surfaces. This leads to the conclusion that focal cartilage defects seen in degenerative joint damage are only one aspect of general joint degeneration.

[Histological, biochemical and spectroscopic changes of articular cartilage in osteoarthritis: is there a chance for spectroscopic evaluation?]. / Arthrosebedingte histologische, biochemische und spektroskopische Veränderungen am hyalinen Gelenkknorpel: Welchen Stellenwert hat die spektroskopische Evaluation?

BACKGROUND: Non-destructive techniques for the detection and classification of pathological changes of cartilage in the early stages of osteoarthritis are required for arthroscopic and open surgery of joints. Biochemical and histological changes in cartilage with different degrees of destruction were analysed and correlated to changes in the spectroscopic characteristics of cartilage. PATIENTS, MATERIAL AND METHODS: 24 patients (n = 25 knees) with severely destructed knee joints received total knee replacement. The cartilage of the resected joints was classified according to the ICRS system. Defined cartilage specimens were investigated spectroscopically employing NIRS (near-infrared spectroscopy). In the following the cartilage specimens were harvested to determine the content of proteoglycan (GAG) and hydroxyproline (HP) as an essential part of collagen. Histological evaluation of the Mankin score and Otte score was performed using haematoxylin/eosin and safranin-O staining. Spearman's rank correlation coefficient was used to characterise links between the parameters investigated. RESULTS: We found significant correlations between spectroscopic, histological and biochemical characteristics. NIRS corresponded to the content of GAG (ρ = 0.58) and HP (ρ = 0.59), as well as to the Mankin (ρ = 0.55) and Otte (ρ = 0.5) scores. Furthermore, the ICRS classification correlated with histological evaluation (Mankin score ρ = 0.725 and Otte score ρ = 0.736), as to be expected. CONCLUSION: Characteristic cartilage changes in different degrees of osteoarthritis can be detected and evaluated by the spectroscopic method NIRS as a non-destructive technique. However, the quality of this technical evaluation cannot compete with biochemical and histological analysis.

[Evaluation of cartilage degeneration by near infrared spectroscopy (NIRS): methodical description and systematic literature review]. / Bestimmung des Degenerationsgrads am hyalinen Gelenkknorpel durch Nah-Infrarot-Spektroskopie (NIRS): Methodenbeschreibung und Literaturübersicht.

Damage to hyaline cartilage is the most important pathophysiological tool in the development of osteoarthritis. Cartilage lesions are the most frequent pathological findings during arthroscopic operations. Arthroscopies as well as magnetic resonance tomography are gold standards for detection of cartilage lesions. But the arthroscopic evaluation of cartilage lesions is descriptive and subjective only. The surgeon is able to differentiate between intact cartilage surface, softening, superficial or deep fissure or flake and finally a complete defect. In routine arthroscopy the grading mostly is made by use of different scores [e.g. ICRS (International Cartilage Repair Society), Outerbridge, Insall, Jäger-Wirth or others]. Because the arthroscopic evaluation is subjective the reliability of this method is poor. Spectroscopic methods are established for evaluation of different tissue diseases in different indications. NIRS (near infrared spectroscopy) has become an important method for medical diagnostics in the last years. NIR is very energy-rich and suitable for glass fibre transport without relevant reduction. Insofar this technology may be ideal for endoscopic procedures. Our systematic literature review reveals that NIRS is a sufficient method for an objective diagnosis of cartilage lesions. In the current work we demonstrate an NIRS-based device for intraoperative, real-time cartilage evaluation. Furthermore, we discuss the possible clinical consequences from such measurements.

[Rare types of vasculitis as markers of plasmocytoma]. / Seltene Vaskulitiden als Hinweis auf Plasmozytom.

We report on two female patients who presented with painful recurrent palpable purpura, ulcers and necroses on the extremities. The results of all examinations and laboratory tests considered together suggested a diagnosis of necrotizing leukocytoclastic vasculitis. Leukocytoclastic vasculitis is an inflammatory necrotizing condition of the superficial dermal vessels, presenting with variable clinical symptoms. In most cases it becomes manifest as palpable purpura, but hemorrhagic-necrotizing, bullous, nodular and urticarial presentations also occur. Common etiological factors include bacterial, viral or drug antigens, chronic infections (hepatitis B and C), non-Hodgkin lymphomas (monoclonal gammopathy, multiple myeloma), leukemia (hairy cell leukemia), and tumors (bronchial, breast, and gastric cancer) and also connective tissue disorders. In the course of the work-up, a plasmocytoma was discovered as the cause of the leukocytoclastic vasculitis, presenting in a similar way to livedo reticularis in one case and to pyoderma gangraenosum in the other.

[Purely cutaneous Rosai-Dorfman disease]. / Rosai-Dorfman-Erkrankung mit ausschliesslich kutaner Beteiligung.

Sinus histiocytosis with massive lymphadenopathy or Rosai-Dorfman disease is a non-Langerhans cell histiocytosis of unknown etiolosy. The most characteristic feature is lymphadenopathy, especially that of cervical lymph nodes. In approximately 40% of patients there are extranodal manifestations of the disease. Skin is the most commonly affected organ (27%). We report a 79-year-old female patient with purely cutaneous manifestations. This form of the disease is a very rare differential diagnosis in dermatology.

[Large B-cell lymphoma of the lower leg]. / Grosszelliges B-Zell-Lymphom des Unterschenkels.

Primary cutaneous B cell lymphomas are rare malignant lymphoproliferative disorders of the skin. The prognosis is dependent on the clinical and histologic subtype; generally, these disorders show an indolent clinical course. We describe a 80-year-old woman with a large cutaneous B cell lymphoma of the lower leg. In contrast to other variants of cutaneous B cell lymphomas, this entity is characterized by an aggressive clinical course with an unfavorable prognosis. The mean survival rate is approximately 50%. This should be taken into account in the choice of treatment.

[Lymphomatoid papulosis type C or transition to CD30+-T-cell lymphoma? A difficult differential diagnosis]. / Lymphomatoide PapuloseTyp C oder Ubergang in CD30+-T-Zell-Lymphom? Eine schwierige Differenzialdiagnose.

Lymphomatoid papulosis (LyP) is a recurrent papulonodular eruption, characterized by self-healing skin lesions. While this disorder usually has a benign course, about 10% of the patients develop lymphoproliferative disorders such as CD30+ T cell lymphoma. We report 2 patients with LyP type C. In one case progress to a cutaneous CD30+ large T cell lymphoma could not be excluded. Histologic differentiation between LyP and malignant lymphoma causes considerable problems. In this regard, the evaluation of the clinical course is essential. A long-term follow-up including diagnostic imaging studies is required.

Applications of autofluorescence for characterisation of biological systems (biomonitoring).

We describe a system capable of measuring the laser induced fluorescence emission of two coenzymes (NADH and FAD) via an optical fibre for in vivo monitoring of anatomical, physiological or pathological changes in biological systems. This optical technique permits the measurement of changes in the metabolism of cells in real-time and is nearly non-destructive. We present results of examinations on the localisation of transitions between different tissue and the monitoring of the oxygenation level (ischemia) in muscle or changes in the cellular activity of bacteria in a bioreactor.

Photoaging of human skin.

Chronic sun exposure causes photoaging of human skin, a process that is characterized by clinical, histological and biochemical changes which differ from alterations in chronologically aged but sun-protected skin. Within recent years, substantial progress has been made in unraveling the underlying mechanisms of photoaging. Induction of matrix metalloproteinases as a consequence of activator protein (AP)-1 and nuclear factor (NF)-KB activation as well as mutations of mitochondrial DNA have been identified recently. This has increased our understanding of photoaging significantly and has led to new prophylactic and therapeutic strategies aimed at the prevention and repair of the detrimental effects of chronic sun-exposure on the skin.

Ultraviolet A1 (340-400 nm) phototherapy for cutaneous T-cell lymphoma.

BACKGROUND: The results of a recent study suggested that ultraviolet A1 radiation (UVA1R; 340-400 nm) phototherapy for atopic dermatitis works through induction of apoptosis in skin-infiltrating helper T cells, indicating the possibility that other helper T cell-mediated skin diseases may respond to UVA1R as well. OBJECTIVE: The purpose of this open pilot study was to assess the therapeutic effectiveness of UVA1 phototherapy for cutaneous T-cell lymphoma (CTCL). METHODS: UVA1 phototherapy was used as monotherapy in patients (n = 3) with histologically proven CTCL (stages IA and IB). For daily whole body UVA1 irradiations, either a high-dose (n = 2; 130 J/cm2 UVA1 per exposure) or medium-dose (n = 1; 60 J/cm2 UVA1) regimen was used. Therapeutic effectiveness was assessed clinically and histologically. RESULTS: In each of the 3 patients, skin lesions began to resolve after only a few UVA1 radiation exposures. Complete clearance was observed between 16 and 20 exposures, regardless of whether the high- or medium-dose regimen had been employed. CONCLUSION: These studies suggest that patients with CTCL stages IA and IB can be treated effectively with UVA1 phototherapy.

[Comparative test of the bioavailability and pharmacokinetics of 2 oxazepam preparations using high-pressure liquid chromatography]. / Vergleichende Prüfung der Bioverfügbarkeit und Pharmakokinetik zweier Oxazepam-Präparate mit Hilfe der Hochdruckflüssigkeitschromatographie.

The relative bioavailability and pharmacokinetic profile of two oxazepam preparations were evaluated in 12 normal volunteers by a newly developed HPLC-method. After oral application of one tablet of the test (Noctazepam) and reference preparation, respectively, no statistically significant differences of the AUC, Cmax Tmax and t1/2 were found. As compared to the reference preparation the relative bioavailability of the test preparation as 110%; both preparations are therefore bioequivalent.