[Hormone replacement therapy with a transdermal estradiol gel and oral micronized progesterone. Effect on menopausal symptoms and lipid metabolism]. / Die Hormonersatztherapie mit einem perkutan wirksamen Oestradiol-Gel und oral verabreichtem mikronisierten Progesteron. Auswirkung auf klimakterische Symptome und den Lipidstoffwechsel.

In a multicenter observational study, the efficacy and acceptance of two different regimens of postmenopausal hormone replacement therapy in the form of a combination of 17 beta-estradiol in percutaneous gel application and micronized oral progesterone were evaluated. Forty-eight patients (aged 40-66 years) received 2.5 g estradiol gel plus either continuously micronized progesterone 100 per day (group A) or, sequentially, 200 mg per day between day 16 and 25 of a monthly cycle (group B) for two months. A significant reduction in typical menopausal symptoms, especially vasomotor complaints like hot flushes or sweating, was observed in both groups (score average at the beginning for hot flushes: 2.0 in group A and 1.8 in group B; after two months of treatment, 0.7 in group A and 0.4 in group B). Cholesterol levels were slightly reduced but statistically significant (235.9 +/- 49.55 mg/dl vs. 226.3 +/- 52.24 mg/dl; p < 0.05) only in group A; a trend towards lower cholesterol was observed in group B (236.5 +/- 47.82 mg/dl vs. 227.4 +/- 44.72 mg/dl). Lipoprotein (a) was also significantly reduced in group A (32.57 +/- 36.52 mg/dl vs. 28.28 +/- 31.03 mg/dl in group A; 31.7 +/- 28.42 mg/dl vs. 28.34 +/- 23.71 in group B; p < 0.05). The overall acceptance of this therapy was excellent or good in 91.3% of group A and 92.8% of group B patients.

Treatment of psoriatic arthritis by extracorporeal photochemotherapy.

Five patients with long-standing seronegative arthritis resistant to conventional therapy and who also had psoriasis of the skin were treated with photopheresis. This mode of treatment combines a lymphocyte-enrichment procedure with 8-methoxypsoralen-photochemotherapy. There was a marked in vitro effect on treated lymphocytes, with a reduction of viability, proliferation and mitogen response. There was a slight to moderate clinical improvement in four of the five patients with regard to the strength of grip, swelling, pain, morning stiffness, the dosage of non-steroidal anti-rheumatic drugs and the radiographical changes. The skin lesions did not respond to photopheresis. Short-term side-effects were minimal and consisted of a temporary sensitivity of the eyes to light and signs of circulatory dysregulation immediately after treatment. This experimental therapy has some measurable but not dramatic effect in improving psoriatic arthropathy.

[Toxoplasma infection in dermatomyositis]. / Toxoplasmoseinfektion bei Dermatomyositis.

A 31-year-old woman with long-standing amyopathic dermatomyositis developed a maculopapular rash resembling erythema multiforme in some areas, accompanied by lymphadenopathy and malaise. An acute infection with Toxoplasma gondii was found to be the cause of clinical symptoms that mimicked an exacerbation of the underlying condition.