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ABSTRACT: Wir berichten über einen 47-jährigen Patienten mit seit Jahren bestehender arterieller Hypertonie und dialysepflichtiger,
terminaler Niereninsuffizienz. Im Laufe von drei Monaten hatten sich progrediente, großflächige, teilweise hämorrhagische
Erosionen der Mundschleimhaut und weniger ausgeprägt auch der Nasen- und Genitalschleimhaut entwickelt. Kurz darauf traten
spontane subkutane Hämatome auf. Die erhobenen Befunde ergaben eine Faktor-VIII-Hemmkörperhämophilie, in den Immunfluoreszenztests
zeigte sich außerdem ein dezentes Pemphigoid-typisches IgG-Muster. Im Immunoblot war eine “atypische” IgG-Reaktivität mit
einem Anteil des BP180-Antigens (extrazelluläre Domäne) nachweisbar. Die Diagnose eines Pemphigoids war unerwartet, da das
klinische Bild eher an einen (paraneoplastischen) Pemphigus denken ließ. Im weiteren Verlauf kam es zu lebensbedrohlichen
Komplikationen, durch eine Antikörperreduktion mittels Plasmaseparation und anschließende immunsuppressive Therapie konnte
schließlich aber eine anhaltende Verbesserung sowohl der blasenbildenden Erkrankung als auch der Blutungsneigung erzielt werden.
A 47-year old patient who had been suffering from hypertension and chronic renal failure for many years developed progressive
extensive haemorrhagic erosions of the mouth within 3 months and less severe erosions of the genital and nasal mucosa. Additionally,
subcutaneous haematomas developed spontaneously. Laboratory investigations demonstrated circulating antibodies against factor
VIII while direct and indirect immunofluorescent microscopy showed discrete tissue-bound and circulating IgG reactive with
the epidermal basement membrane in a pemphigoid-like fashion. Immunoblot analysis of the patient's serum revealed an “atypical”
IgG reactivity against a central portion of the extracellular domain of the BP180 antigen. These findings were unexpected,
since the clinical aspect showed striking resemblance to (paraneoplastic) pemphigus. The patient developed life-threatening
complications. Eventually, reduction of circulating autoantibodies by a combination of plasmapheresis and subsequent immunosuppressive
therapy led to a stable remission of both autoimmune bullous skin disorder and acquired haemophilia.
Der Hautarzt 04/2012; 53(6):412-415. · 0.58 Impact Factor
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ABSTRACT: das diagnostische Vorgehen bei bullösen Autoimmundermatosen,
die wichtigsten morphologischen und immunserologischen Untersuchungen,
immunserologische und klinische Verlaufsparameter sowie
etablierte und neue Therapien bullöser Autoimmundermatosen.
Entscheidend für die Diagnosestellung von bullösen Autoimmundermatosen sind Klinik, Histologie, direkte Immunfluoreszenz-
sowie indirekte Immunfluoreszenzuntersuchung (Abb. 1). Neuerdings besteht die Möglichkeit, durch den Einsatz weiterer, z.
T. kommerziell verfügbarer Testsysteme Spezifität und Titer zirkulierender Autoantikörper zu bestimmen und damit die Diagnose
einer spezifischen bullösen Dermatose zu sichern. Wegweisend ist und bleibt allerdings die klinische Klassifikation, die im
ersten Teil erörtert wurde. Im Folgenden wird das diagnostische Vorgehen mit Hilfe histologischer, Immunfluoreszenz- und immunserologischer
Spezialuntersuchungen erläutert (Tabelle 1).
Der Hautarzt 04/2012; 53(5):352-368. · 0.58 Impact Factor
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[show abstract]
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ABSTRACT: Economic factors dominate more and more the healthcare systems; modern technologies advance every day and offer opportunities for savings.
In a pilot study, digital speech recognition based on Dragon NaturallySpeaking, Version 7 was compared with common dictation in dermatology.
The conventional method took 24.1 minutes per page and reports could be sent out after 16.8 days; in sharp contrast, the reports dictated by digital speech recognition took 15.8 minutes per page and were sent out after 3.2 days.
Digital Speech recognition in dermatology has advantages compared to ordinary dictation, if the dictating person is trained with the software and it is implemented in a digital patient documentation system.
Der Hautarzt 03/2008; 59(2):131-4. · 0.58 Impact Factor
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Der Hautarzt 03/2008; 59(2):144-7. · 0.58 Impact Factor
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Journal of the European Academy of Dermatology and Venereology 02/2008; 22(1):109-10. · 2.98 Impact Factor
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ABSTRACT: HintergrundBei zunehmendem Kostendruck in der Medizin im Rahmen von sog. Gesundheitsreformen bestehen mögliche Einsparungspotenziale
durch Einsatz fortschreitender Technologien.
Materialien und MethodenIn einer Pilotstudie wurde ein digitales Spracherkennungssystem, basierend auf Dragon NaturallySpeaking®, Version7, in der
Dermatologie mit dem konventionellen Diktat verglichen.
ErgebnisseWährend mit der konventionellen Methode pro Seite durchschnittlich 24,1min Zeit aufgewendet und die Briefe nach durchschnittlich
16,8Tagen versendet wurden, war der Zeitaufwand mit der digitalen Spracherkennung durchschnittlich 15,8min, und die Briefe
wurden nach durchschnittlich 3,2Tagen verschickt.
SchlussfolgerungDigitale Spracherkennung hat in der Dermatologie dann Vorteile gegenüber der konventionellen Methode des Diktats, wenn der
Diktierende gut eingearbeitet ist und eine Einbindung in ein Dokumentenmanagementsystem besteht.
BackgroundEconomic factors dominate more and more the healthcare systems; modern technologies advance every day and offer opportunities
for savings.
Material and methodsIn a pilot study, digital speech recognition based on Dragon NaturallySpeaking®, Version 7 was compared with common dictation
in dermatology.
ResultsThe conventional method took 24.1 minutes per page and reports could be sent out after 16.8 days; in sharp contrast, the reports
dictated by digital speech recognition took 15.8 minutes per page and were sent out after 3.2 days.
ConclusionDigital Speech recognition in dermatology has advantages compared to ordinary dictation, if the dictating person is trained
with the software and it is implemented in a digital patient documentation system.
Der Hautarzt 01/2008; 59(2):131-134. · 0.58 Impact Factor
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Der Hautarzt 01/2008; 59(2):144-147. · 0.58 Impact Factor
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British Journal of Dermatology 02/2007; 156(1):178-80. · 3.67 Impact Factor
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ABSTRACT: Vaccinia virus (VV) has been tested as oncolytic virus against malignant melanoma in clinical trials for more than 40 years. Until now, mainly strains comparable to viral strains used for smallpox vaccination have been probed for anti-tumoral therapy. We have shown recently that the wild-type strain Western Reserve (WR) can interfere with crucial functions of monocyte-derived dendritic cells (DCs). Our aim was to examine whether viral immune evasion mechanisms might be responsible for the ineffectiveness of WR-based vaccination strategies and whether the highly attenuated strain modified virus Ankara (MVA) differs from WR with respect to its possible immunostimulatory capacity after intratumoral injection. Using in vitro experiments, we compared the effect of both strains on melanoma cells and on local bystander DCs. We found that both VV-strains infected melanoma cells efficiently and caused disintegration of the actin cytoskeleton, as shown by fluorescence microscopy. In addition, both VV-strains caused apoptotic cell death in melanoma cells after infection. In contrast to MVA, WR underwent a complete viral replication cycle in melanoma cells. Bystander DCs were consecutively infected by newly generated WR virions and lost their capacity to induce allogeneic T cell proliferation. DCs in contact with MVA-infected melanoma cells retained their capacity to induce T cell proliferation. Immature DCs were capable of phagocytosing MVA-infected melanoma cells. Priming of autologous CD8(+) T cells by DCs that had phagocytosed MVA-infected, MelanA positive melanoma cells resulted in the induction of T cell clones specifically reactive against the model antigen MelanA as shown by enzyme-linked immunospot (ELISPOT) analysis. We conclude that the clinical trials with oncolytic wild-type VV failed probably because of suppression of bystander DCs and consecutive suppression of T cell-mediated anti-melanoma immunity. The attenuated VV-strain MVA facilitates the generation of tumour associated antigen (TAA)-specific T cell response as it is oncolytic for melanoma cells, but non-toxic for DC, and should be a promising candidate for intralesional metastatic melanoma therapy.
Clinical & Experimental Immunology 12/2006; 146(2):344-53. · 3.36 Impact Factor
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ABSTRACT: The treatment of inflammatory skin diseases is at present often empirical as causal therapeutic approaches, based on an incomplete knowledge of the immune pathogenesis, are mostly unavailable. The currently applied treatments can in fact lead to remission of the disease; however, under certain circumstances undesirable side-effects must be expected. On the basis of experience gained in cytokine modulation therapy of chronic inflammatory diseases such as rheumatoid arthritis and psoriasis, the application of TNF-alpha inhibitors represents a novel, more specific, and effective therapeutic option for distinct chronic inflammatory diseases.
The current status of the therapeutic effect of TNF-alpha blockers is discussed based on our own observations and a review of the current literature. Also discussed are potential undesirable side-effects and possible contraindications of this therapy.
Based on recent findings, the use of TNF-alpha blockers seems to be promising in the treatment of therapy-resistant inflammatory dermatoses. At present, guidelines for indications and contraindications of anti-TNF-alpha treatment of inflammatory skin disorders are rare. Such guidelines are necessary to improve the efficacy of anticytokine treatment and the reduction of side-effects.
Journal of the European Academy of Dermatology and Venereology 12/2006; 20(10):1171-87. · 2.98 Impact Factor
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ABSTRACT: Rosacea fulminans (also known as pyoderma faciale) has been reported to occur in association with Crohn's disease. It is still unclear whether the papulopustules and confluent nodules of rosacea fulminans represent a manifestation of mucocutaneous Crohn's disease or whether this association is a mere coincidence. A 46-year-old woman presented with the spontaneous outbreak of rosacea fulminans and pyostomatitis/pyovulvitis. Complete remission of the mucocutaneous symptoms was achieved with 2 months combination therapy with methylprednisolone, isotretinoin and dapsone. The patient's Crohn's disease, already diagnosed for 3 years, did not flare during this period.
Der Hautarzt 11/2006; 57(10):898-902. · 0.58 Impact Factor
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Der Hautarzt 10/2006; 57(9):814-7. · 0.58 Impact Factor
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ABSTRACT: ber das Auftreten einer Rosacea fulminans (auch als Pyoderma faciale bezeichnet) bei M.Crohn wurde berichtet. Ob es sich hierbei um eine zufllige Assoziation handelt oder ob die pustulsen, knotigen Hautvernderungen der Rosacea fulminans eine weitere Manifestationsform des mukokutanen M.Crohn darstellen, ist unklar. In dem hier beschriebenen Krankheitsverlauf einer 46-jhrigen Patientin mit spontaner Entwicklung einer Rosacea fulminans sowie einer Pyostomatitis und Pyovulvitis konnte eine Abheilung des massiven Haut- und Schleimhautbefundes durch eine Kombinationstherapie mit Methylprednisolon, Isotretinoin und Dapson innerhalb von 2Monaten erzielt werden. Der zugrunde liegende, seit 3Jahren bekannte enterale M.Crohn war zu diesem Zeitpunkt ohne wesentliche Aktivittszeichen.Rosacea fulminans (also known as pyoderma faciale) has been reported to occur in association with Crohns disease. It is still unclear whether the papulopustules and confluent nodules of rosacea fulminans represent a manifestation of mucocutaneous Crohns disease or whether this association is a mere coincidence. A 46-year-old woman presented with the spontaneous outbreak of rosacea fulminans and pyostomatitis/pyovulvitis. Complete remission of the mucocutaneous symptoms was achieved with 2 months combination therapy with methylprednisolone, isotretinoin and dapsone. The patients Crohns disease, already diagnosed for 3 years, did not flare during this period.
Der Hautarzt 09/2006; 57(10):898-902. · 0.58 Impact Factor
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D Schadendorf,
S Ugurel,
B Schuler-Thurner,
F O Nestle,
A Enk,
E-B Bröcker,
S Grabbe,
W Rittgen,
L Edler,
A Sucker,
C Zimpfer-Rechner,
T Berger,
J Kamarashev,
G Burg,
H Jonuleit,
A Tüttenberg,
J C Becker,
P Keikavoussi,
E Kämpgen, G Schuler
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ABSTRACT: This randomized phase III trial was designed to demonstrate the superiority of autologous peptide-loaded dendritic cell (DC) vaccination over standard dacarbazine (DTIC) chemotherapy in stage IV melanoma patients.
DTIC 850 mg/m2 intravenously was applied in 4-week intervals. DC vaccines loaded with MHC class I and II-restricted peptides were applied subcutaneously at 2-week intervals for the first five vaccinations and every 4 weeks thereafter. The primary study end point was objective response (OR); secondary end points were toxicity, overall (OS) and progression-free survival (PFS).
At the time of the first interim analysis 55 patients had been enrolled into the DTIC and 53 into the DC-arm (ITT). OR was low (DTIC: 5.5%, DC: 3.8%), but not significantly different in the two arms. The Data Safety & Monitoring Board recommended closure of the study. Unscheduled subset analyses revealed that patients with normal serum LDH and/or stage M1a/b survived longer in both arms than those with elevated serum LDH and/or stage M1c. Only in the DC-arm did those patients with (i) an initial unimpaired general health status (Karnofsky = 100) or (ii) an HLA-A2+/HLA-B44- haplotype survive significantly longer than patients with a Karnofsky index <100 (P = 0.007 versus P = 0.057 in the DTIC-arm) or other HLA haplotypes (P = 0.04 versus P = 0.57 in DTIC-treated patients).
DC vaccination could not be demonstrated to be more effective than DTIC chemotherapy in stage IV melanoma patients. The observed association of overall performance status and HLA haplotype with overall survival for patients treated by DC vaccination should be tested in future trials employing DC vaccines.
Annals of Oncology 05/2006; 17(4):563-70. · 6.43 Impact Factor
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ABSTRACT: Vitiligo and psoriasis are both common skin disorders. However, psoriasis strictly confined to pre-existing vitiligo areas is rare and suggests a causal relationship. We report here on two patients with a strict anatomical colocalization of vitiligo and psoriasis. The histopathological examinations showed typical changes for both diseases together with a dense infiltrate of CD4+ and CD8+ T cells. By immunohistochemistry, intracytoplasmatic granzyme B and tumour necrosis factor alpha (TNF-alpha) were detected within the T-cell population, suggesting the functional activity of these cells and the creation of a local T helper 1 (Th1)-cytokine milieu. Additionally, in one patient we could identify anti-melanocytic T cells by tetramer staining and enzyme-linked immunospot (ELISPOT) analysis. These skin-infiltrating lymphocytes might trigger, by the local production of Th-1 cytokines such as TNF-alpha and interferon-gamma (IFN-gamma), the eruption of psoriatic plaques in patients with a genetic predisposition for psoriasis.
Journal of the European Academy of Dermatology and Venereology 03/2006; 20(2):178-83. · 2.98 Impact Factor
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ABSTRACT: The clinical picture in vasculitis varies from few self-limiting symptoms to life-threatening illnesses affecting multiple organs. We describe the course of a woman patient who had had a severe cutaneous necrotizing vasculitis for more than 10 years. Various immunsuppressants, including cyclophosphamide, had failed to improve the clinical course, although adequate doses were given for a sufficient period. Treatment with DADPS (diaminodiphenylsulfone, dapsone), however, finally led to complete remission of the severe and chronic vasculitic ulcerations. Indications for DADPS treatment of inflammatory cutaneous diseases are discussed, and an overview of cutaneous vasculitis is provided.
Der Hautarzt 02/2006; 57(1):47-50. · 0.58 Impact Factor
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W Römer,
A Nömayr,
H Greess,
E Fiedler,
G Platsch,
B Schuler-Thurner,
A Pfahlberg,
T Hothorn, G Schuler,
J Hornegger,
W Bautz,
T Kuwert
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ABSTRACT: This study investigates whether interactive rigid fusion of routine PET and CT data improves localization, detection and characterization of lesions compared to separate reading. For this purpose, routine PET and CT scans of patients with metastases from malignant melanoma were used.
In 34 patients with histologically confirmed malignant melanoma, FDG-PET and spiral CT were performed using clinical standard protocols. For all of these patients, gold standard was available. Clinical and radiological follow-up identified 82 lesions as definitely pathological. Two board-certified nuclear medicine physicians and two board-certified radiologists analyzed PET and CT images independently from each other. For each patient up to 32 anatomical regions (24 lymph node regions, 8 extranodular regions) were systematically classified. Discordant areas were interactively analyzed in manually and rigidly registered images using a commercially available fusion tool. No side-by-side reading was performed.
Image fusion disclosed that the evaluation of the PET images alone led to a mislocalization in 26 of 91 focally FDG enhancing lesions. The overall sensitivities of PET, CT, and image fusion were 85, 88, and 94%, respectively; the overall specificities of PET, CT and image fusion were 98, 95 and 100%, respectively. Image fusion exhibited statistically significant higher specificity values as compared with CT. Ten definitely malignant sites were false-negative in CT, but could be detected by PET. On the other hand, twelve metastases were false-negative in PET, but could be detected by CT. These included two lesions, which had a clear correlate on the PET image when the fused images were evaluated. On the whole, registration of the PET and CT images yielded additional diagnostic information in 44% of the definitely malignant lesions.
Retrospective image fusion of independently obtained PET and CT data is particularly valuable in exactly localizing foci of abnormal FDG uptake and improves the detection of metastases of malignant melanoma.
Nuklearmedizin 02/2006; 45(2):88-95. · 1.28 Impact Factor
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Der Hautarzt 01/2006; 57(9):814-818. · 0.58 Impact Factor
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S Fikenzer,
R Falz,
K Drechsler,
A Busse, G Schuler,
Zusammenfassung Fikenzer,
S Falz,
K Schulze,
Busse A,
M Prävalenz,
M Prevalence
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ABSTRACT: Orthopädische Klinik und Poliklinik der Universität Leipzig 2 (Direktor: Prof. Dr. med. G. von Salis-Soglio) Sportmedizinisches Zentrum der Med. Hochschule Hannover 3 (Leiter: PD Dr. med. U. Tegtbur) Klinik für Kardiologie, Herzzentrum, Universität Leipzig 4 (Direktor: Prof. Dr. med. der arteriellen Hypertonie bei Studenten der Universität Leipzig. KCS 2006; 7 (2): 19-22. Einleitung: Einer der wichtigsten Risikofaktoren für die Ursache von Erkrankungen des Herz-Kreislaufssystems ist die arterielle Hypertonie [8]. Die Hypertonieprävalenz und die Einflüsse von anthropometrischen sowie sozialen Parametern auf den Blutdruck in dem speziellen Probandenkollektiv der Studenten wurden in dieser Studie untersucht. Material und Methode: 1129 Studenten der Universität Leipzig nahmen an der Studie teil. Bei den Probanden wurde mit elektronischen und manuellen Messgeräten der Blutdruck nach fünfminütiger Ruhephase erfasst und Informationen über den Körperbau und die Lebensweise mit Hilfe eines Fragebogens aufgenommen. Ergebnisse: 1. Die Hypertonieprävalenz bei Studenten liegt bei 22,7%, dabei ist die Prävalenz bei männlichen Studenten mehr als doppelt so hoch als bei weiblichen Studenten. 2. Die Probanden mit normalen Blutdruckwerten sind mit einer Häufigkeit von 21,7%, die prähypertonen Probanden mit 55,6%, die Probanden im Hypertoniestadium I mit 19,1 und Studienteilnehmer im Hypertoniestadium II mit 3,6% vertreten. 3. Hypertone Probanden haben im Vergleich mit normotonen Probanden einen signifikant höheren BMI, eine höhere Ruheherzfrequenz, ein signifikant höheres Alter und haben häufiger eine positive Familienanamnese. Des Weiteren sind hypertone Studenten häufiger männlichen Geschlechts und trinken signifikant mehr Alkohol als normotone Studenten. Fazit: In vorliegender Untersuchung beträgt die Prävalenz der arteriellen Hypertonie bei Leipziger Studenten 21,7%. Im Vergleich zu früheren Studien ist diese überdurchschnittlich hoch und erhöhte Blutdruckwerte sind häufiger mit höherem BMI, erhöhter Ruherherzfrequenz, höherem Alter, männlichen Geschlecht, höherem Alkoholkonsum und positiver Familienanamnese assoziiert. Eine frühzeitige Blutdruckmessung zur Erfassung einer potentiellen Hypertonie scheint bei bisher gesunden jungen Erwachsenen sinnvoll. Abstract of arterial Hypertension by Students of the University of Leipzig. KCS 2006; 7 (2): 19-22. Objective: One of the most important risk factors for illnesses of the heart-circulation-system is arterial hypertension [8]. In this study, the prevalence of hypertension and the influences of anthropometrical as well as social parameters on the blood pressure in the special collective of the students was investigated. Material and methods: 1129 students of the University of Leipzig participated in the study. After a break of five minutes the blood pressure was recorded with electronic and manual measuring instruments. Information about the physique and the lifestyle have been recorded by means of a questionnaire. Results: 1. The prevalence of hypertension among students is 22,7%, among male students the prevalence is more as twice as high than among female students. 2. The incidence of test persons with normal blood pressure is 21,7%, for prehypertension it is 55,6%, for test persons in the hypertension stage I it is 19,1% and the incidence of study participant in the hypertension stage II is 3,6%. 3. Hypertensive test persons have a significantly higher BMI, a significantly higher heart rate at rest, a significantly higher age in the comparison to normotensive test persons and have significantly more frequently a positive family anamnesis. Hypertensive students are significantly more frequently male sex and drink significantly more alcohol than normotensive students. Conclusion: In the study, the prevalence of arterial hypertension among students in Leipzig is 21,7%. In comparison to former studies it is higher than average. High RR values are more common in students with high KCS 2006; 7(2): 19-22 Hypertonieprävalenz bei Studenten (http://klinische-sportmedizin.de) 20 BMI, high heart rate at rest, high consume of alcohol and positive family history. The establishment of an early blood pressure measurement in healthy humans should be recommended.
KCSDirektor: Prof. Dr. med. M. W. Busse). 01/2006; 7(1):19-22.
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Der Hautarzt 09/2005; 56(8):778-81. · 0.58 Impact Factor
