[Phlebology in German departments of dermatology. An analysis on behalf of the German Society of Phlebology]. / Phlebologie an deutschen Hautkliniken. Eine Bestandsaufnahme im Auftrag der Deutschen Gesellschaft für Phlebologie.

BACKGROUND: Phlebologic diseases have become extremely common and have major socio-economic impact. However, the percentage of dermatologists working in phlebology appears to be decreasing according to the data of the German Society of Phlebology (DGP). METHODS: To investigate the reasons for this development, we--on behalf of the DGP--sent a questionnaire to 120 German Departments of Dermatology in autumn 2012. RESULTS: In 76 returned questionnaires, the number of physicians with additional fellowship training in phlebology averaged 1.5; the average number of those who fulfill the criteria for training fellows in phlebology was 0.9. In 71.1 % of the departments there was a phlebologist. A special phlebologic outpatient clinic existed in 73.7 % of the departments. Sonography with Doppler (89.5 %) and duplex (86.8 %) was used as the most frequent diagnostic tool. For therapy, compression (94.7 %), sclerotherapy (liquid 78.9 %, foam 63.2 %, catheter 18.4 %), endoluminal thermic procedures (radio wave 28.9 %, laser 17.1 %) and surgery (especially crossectomy and stripping 67.1 %, phlebectomy of tributaries 75 %) were used. The average number of treatments was very heterogenous in the different departments. CONCLUSIONS: Phlebology definitely plays an important role in dermatology. Most departments fulfill the formal criteria for the license to conduct advanced training in phlebology. A wide spectrum of phlebological diagnostic and therapeutic procedures is available.

Sonography of the skin at 100 MHz enables in vivo visualization of stratum corneum and viable epidermis in palmar skin and psoriatic plaques.

A main drawback of 20-25 MHz ultrasound units for skin imaging is their limited resolution. We used a transducer with a center frequency of 95 MHz and a resolution of 8.5 microm axially and 27 microm laterally - an almost 10-fold increase compared with 20 MHz. By means of a new scanning technology we reached a depth of field of 3.2 mm. We examined normal palmar skin, normal glabrous skin on the abdomen, the upper back, the calf and the dorsal forearm, and 35 lesions of psoriasis vulgaris. From 11 psoriatic plaques biopsies were taken for correlation with the sonograms. In normal palmar skin, the horny layer is represented as an echopoor band below the skin entry echo, traversed by echorich coils, which correspond to eccrine sweat gland ducts. The thickness of this band significantly increases after occlusive application of petrolatum. Its lower border is defined by an echorich line, representing the stratum corneum/stratum Malpighii-interface. Underneath, a second echopoor band is visible, which corresponds to the viable epidermis plus the papillary dermis, bordered by the scattered echo reflexes of the reticular dermis. This band is also visible in glabrous skin; however, the stratum corneum cannot be detected. In psoriatic lesions, the thickened horny layer appears echorich; after application of petrolatum, its echodensity decreases. Below, the acanthotic epidermis plus the dermis with the inflammatory infiltrate are represented as an echopoor band. There is an excellent correlation between the sonometric thickness of this band and the histometric thickness of the acanthosis plus the infiltrated dermis. Our results show that 100 MHz sonography is a valuable tool for in vivo examination of the upper skin layers.

[100 MHz sonography in the visualization of the palmar stratum corneum after application of various creams and ointments]. / 100-MHz-Sonographie zur Darstellung des Stratum corneum an der Palmarhaut nach Anwendung verschiedener Externa.

To visualise the effects of different topically applied substances on the stratum corneum in vivo by means of sonography, it is necessary to have an ultrasound unit with a much higher resolution than provided for by the 20 MHz scanners currently used in dermatology. We developed a workstation with a highly focussed transducer with a large bandwidth, providing a resolution of 9 microns axially and 27 microns laterally. Using this ultrasound unit, we investigated the effects of different creams and ointments in 10 persons on the palmar side of the distal finger segments (vaseline, a water-in-oil-emulsion, an oil-in-water-emulsion, 10% urea in an oil-in-water-emulsion and water). Sonograms were taken after an occlusion period of 0, 30, 60, 120, 180 and 240 min. In 100 MHz sonograms of palmar skin, the stratum corneum is represented as an echo-poor band below the echo-rich entry echo--the correlate of the interface between the coupling water and the horny layer. The echo-poor band is traversed by echo-rich coils, representing eccrine sweat gland ducts. It is separated by an echo-rich line from the viable epidermis, which is echo-poor as well. The topically applied substances differ in the time course of the swelling of the stratum corneum. After longer application all externals cause a significant thickening of the stratum corneum (p < 0.005) and a reduction of the echogenicity of the skin entry echo due to altered impedance. 100 MHz sonography is well suited to visualise and quantify the effects of externals on the stratum corneum in vivo.

Sweat gland proliferations in scleromyxedema.

Eccrine sweat duct proliferations may be found in various inflammatory and neoplastic skin lesions. We report a patient with scleromyxedema with extensive proliferations of intradermal sweat ducts. Three-dimensional reconstruction demonstrated extensive coiling and branching of the sweat ducts leading into cystic lacunae. In contrast to the basal cell carcinoma that had grown within the scleromyxedematous skin, the ducts close to the lumen stained positive for carcinoembryonic antigen and could therefore be differentiated from basal cell carcinoma. In micrographically controlled surgery of cutaneous epithelial tumors that are located in chronically inflamed skin, such sweat gland proliferations have to be considered as differential diagnosis.

[Cyclical intravenous antibiosis as an effective therapy concept in chronic recurrent erysipelas]. / Zyklische intravenöse Antibiose als effizientes Therapiekonzept des chronisch-rezidivierenden Erysipels.

The treatment of choice for prevention of recurrent erysipelas is the long-term therapy with intramuscular penicillin. The results are often unsatisfactory. Usually erysipelas recurs when the treatment is stopped. The aim of the present study was to evaluate a new treatment regimen, consisting of intravenous penicillin combined with lymphatic drainage. Fifteen patients who had suffered from three or more episodes of erysipelas within the last two years received 10 Mega I.U. of penicillin per day over ten days every third month over a one year period (patients who were allergic to penicillin received erythromycin). Use of intravenous penicillin was combined with lymphatic drainage performed by a sequential pneumatic compressing device. The treatment results were assessed by clinical examination and laboratory tests as well as by laser Doppler imaging every third month. During the one year treatment period and a further year of follow-up, 14 of 15 patients had no recurrent erysipelas. Only a 65 year old patient suffering from Parkinson heart failure, chronic lymphedema and an extensive stasis ulcers had recurrent erysipelas. The present treatment regimen appears to be an effective therapy for prevention of recurrent erysipelas.

[100 MHz ultrasound of psoriasis vulgaris plaque]. / 100-MHz-Sonographie von Psoriasis-vulgaris-Plaques.

PURPOSE: 20 MHz sonography of inflammatory diseases has concentrated on the evaluation of the echo-poor area in the upper dermis. With regard to higher resolution, this study focuses on the alterations of the epidermis and upper dermis skin using 100 MHz sonography. METHOD: 70 fully developed psoriasis vulgaris plaques of 20 patients were examined using our 100 MHz ultrasound equipment after application of salicylic acid in petrolatum for 24 h. After informing the patient about the aims of the study, a small knife biopsy was taken from 11 plaques. RESULTS: All psoriasis plaques exhibited, in comparison with normal skin, a significant widening of the skin entry echo (p < 0.001). Focally, this echo-rich line broke up into two thinner lines. Correlating histology exhibited in these areas an orthohyperkeratosis and focal parakeratosis. The upper dermis showed an echo-poor, band-shaped area which corresponded histologically to an acanthosis, elongation of rete ridges, and widening of the stratum papillare. The mean grey level of the echo-poor area and of the dermis beneath was significantly lower (p < 0.001) than the normal adjacent dermis. The thickness of the echo-poor area correlated with the thickness of the sum of the acanthosis and the inflammatory infiltrate in the histological sections (r = 0.94). CONCLUSION: Using 100 MHz sonography changes of the skin entry echo and the upper dermis can be visualized and quantified.

The role of Galen in the development and progress of medical sciences.

Early Roman medicine was a mixture of religion and witchcraft, but as time went by, it became more influenced by the Greek medical sciences, which were more developed. The most famous Greek physician during the Roman period was Galen (129-200 AD). In the 4th century A. D. The Byzantine physicians of the Emperor Julian, made the Galenic writings available to ordinary practitioners, and so Greek medicine spread throughout Syria and was carried by the Nestorians into Persia, where it became available to the Islamic World.

Hormones throughout history.

Since remote ages man believed that, the different parts of his body and that of the animals, contained therapeutical elements, with effective powers like magic, and that he can fortify his own personality by consuming some parts of the bodies of human beings or animals. He also believed that his organic diseases were due to deficiency in these organs concerning ailments, so he treated them with similar organs of different animals.

In psoriasis the epidermis, including the subepidermal vascular plexus, grows downwards into the dermis.

In psoriatic lesions, capillaries in the papillary bodies seem elongated and increased in number. Most researchers postulate that there is angiogenesis of intrapapillary capillaries in psoriatic plaques. In this study we will show, by means of computer-aided three-dimensional reconstructions in four patients suffering from chronic plaque-type psoriasis, and in a healthy volunteer, that the elongation and increase of intrapapillary capillaries are not the result of angiogenesis. Our three-dimensional reconstructions show that the papillary body of psoriasis contains lymph capillaries besides the blood capillaries. Additionally, an inclusion of two tips of papillary bodies into one papilla at the base of the rete ridges becomes obvious. The vessels of the two tips are connected by a horizontal vessel. At the level of the horizontal connecting vessel there is the blind beginning of a lymphatic vessel. The connecting blood vessel, as well as the lymph capillary, belong to the horizontal subpapillary venous plexus but lie within the papillary body. The three-dimensional reconstructions show that by growing towards the dermis, the rete ridges include the vessels of the horizontal plexus. Surrounded by rete ridges, these vessels appear as intrapapillary capillaries.

The relation between Greek and Islamic materia medica.

Many studies have been made on the exact data of the introduction of Greek sciences to the Arabic culture. During the 8th and 9th centuries A.D. a big progress was done in the Arab-Islamic sciences, when the Caliphs of the Omayad and Abbasid dynasties invited many scientists, researchers and translators for translation of all sciences into Arabic. The Arabs paid special attention to the Greek natural sciences such as botany and pharmacy. Greek materia medica was a major common basis for Arab-Islamic medicine and pharmacy which in turn paved the way to the modern pharmaceutical therapy.

A model to assess the efficacy of moisturizers--the quantification of soap-induced xerosis by image analysis of adhesive-coated discs (D-Squames).

Clinical grading of dry skin syndromes (xerosis) is beset by many variables which limit its reliability. Removing scales onto adhesive coated discs (D-Squames) has provided a means for objective measurement of xerotic states. Using image analysis we have modified the basic procedure to assure greater accuracy and reproducibility. The distribution of grey values on the discs was determined, from which a single value of the degree of scaling was calculated. We term this the scaling index. To induce xerosis, the lower legs of 22 women, aged 26-64, were washed daily for 10 days with soap. After washing, one side received a moisturizing lotion, the other served as an untreated control. At specified intervals, scaling was graded clinically, electrical conductance was measured and D-Squames were obtained. On the moisturizer-treated legs there was a significant decrease in dryness grades and scaling indices at all time points. Conductance was significantly increased on days 8 and 11. The untreated washed legs showed no changes in clinical grades, although conductance significantly decreased and the scaling indices increased in the last stage of the study. D-Squame analysis unequivocally revealed the beneficial effect of a moisturizer on soap-induced xerosis and the expected increase in scaliness without treatment.

Improved resolution of magnetic resonance microscopy in examination of skin tumors.

Magnetic resonance imaging has become increasingly important for visualization and tissue differentiation of internal organs. Because of limited resolution, investigation of skin has been of little diagnostic value so far. We combined a homogeneous magnetic field of 9.4 T, as used in magnetic resonance spectroscopy, with gradient fields of 11.7 G/cm and an imaging unit to obtain a voxel resolution of 40 x 40 x 300 microm(3). With this magnetic resonance microscopy unit, we studied normal skin, 12 nevocellular nevi, 20 basal cell carcinomas, 8 melanomas, and 8 seborrheic keratoses after excision in vitro. The specimens were visualized in spin-echo images. The proton relaxation times T1 and T2 were determined for the different skin layers and tumor tissues. Interpretation of the spin-echo images was based on comparison with the correlating histology. Epidermis, dermis, subcutaneous tissue, and hair follicle complexes could be distinguished. Stratum corneum and hairs emitted no signal. All tumors presented as distinct, signal-rich, homogeneous structures within the dark, signal-poor dermis. Their shape corresponded to their outline in the histologic sections. Buds of superficial basal cell carcinomas could be resolved. The proton relaxation times T1 and T2 were significantly different among all skin layers and tumors. Our results demonstrate that with sufficient resolution, differentiation of skin tumors is possible using magnetic resonance imaging.

The effect of fumaric acid esters and dithranol on acanthosis and hyperproliferation in psoriasis vulgaris.

In this study we investigated the histological changes, regression of acanthosis and rate of proliferation, that accompany the healing of psoriatic lesions after fumaric acid esters and dithranol treatment. Biopsies were taken before and during therapy as well as from neighbouring untreated, clinically uninvolved skin and healthy, non-psoriatic volunteers. Specimens were assessed using computer-supported image analysis and immunohistology. The parameters primarily examined were the height of the rete pegs and of the epithelium above the papillary body, the rate of proliferation, the actual number of cells in the two epidermal compartments and the cellular density in the epidermis. Both fumaric acid esters and dithranol reduce the degree of acanthosis; however, the mechanism and the rate of the reduction differ. While under fumaric acid esters the reduction is more rapid at first but subsequently slows down, dithranol leads to a slow but steady decrease of epidermal thickness, so that at the end of our study the degree of acanthosis was less under dithranol. As an underlying mechanism of action, we found that fumaric acid esters reduce the rate of proliferation and thereby decrease the number of cells per rete peg as well as the size of the individual keratinocytes. Dithranol in contrast does not reduce cell renewal. The decrease of the number of cells in the rete pegs might be caused by an increased differentiation time.

Preparation of ethereal oils (Al-Duhoun) by Ibn Al-Quff (13th century A.D.).

Ibn Al-Quff was born in Damascus. He learned medicine from Ibn Abi Usaibia. Ibn Al-Quff was excelled in medicine as well as in Surgery. He wrote several books, of which was "Al-Qumdah" (The Authority on Surgery). Another book was "Al-Shafi" (The Healer) on medicine. In the book "The Authority on Surgery", Ibn Al-Quff has devoted a special chapter, on the preparation of ethereal oils, which was commonly known as Al-Duhoun. He has described about 34 different oils together with their medical action.

[Objectivity, reproducibility and validity of 3D ultrasound in dermatology]. / Objektivität, Reproduzierbarkeit und Validität der 3D-Sonographie in der Dermatologie.

Recently it has become possible to visualize the three-dimensional (3D) architecture of sonographic structures using high-resolution ultrasound above 20 MHz (Dermascan C, Denmark; DUB 20, Germany). We studied the objectivity, reproducibility, and validity of these two 3D analysis systems on 22 skin tumors. To validate both systems, we compared the sonometric and histometric volume in 4 tumors. The objectivity was calculated by repeated evaluation of the volume on the same serial B-scan sections at 3-month intervals. The two-dimensional B-scans and 3D images exhibited similar characteristics. Volumetric evaluations were reproducible with both systems (variation coefficient < or = 9.9%), when the applicator was oriented longitudinal to the body axis. By changing the orientation, the coefficient increased up to 58.1% (DUB 20). Sonometric and histometric volumes of a phantom model and of the tumors exhibited small deviations in the Dermascan C (< or = 8.1%) and in some tumors large deviations in the DUB 20 (< or = 93.1%). We can conclude that the 3D sonography is a reproducible method, which can be used to evaluate the volume of skin tumors and metastases under chemotherapy or radiotherapy. We suggest in particular to use the in-vivo tumor volume as a prognostic parameter for the malignant melanoma.

20 MHz sonography, colorimetry and image analysis in the evaluation of psoriasis vulgaris.

For objective evaluation of the treatment of psoriasis vulgaris standard techniques are desirable. They should be reproducible, sensitive and non-invasive. In this study non-invasive bioengineering techniques, especially high frequency/high resolution ultrasound for measurement of the healing of psoriasis vulgaris were evaluated. Fifty patients with chronic stationary plaque type psoriasis participated in a prospective study; in each patient two psoriatic plaques were examined by means of sonography, colorimetry and image analysis during treatment until complete resolution had occurred. Skin thickness and density could be quantified by means of high frequency ultrasound. In active psoriatic lesions, an echopoor area underneath the entry echo in the ultrasound image caused by acanthosis and inflammatory infiltrate is typical. Under therapy the thickness of this echopoor area diminishes while its density increases. Intensity of the erythema especially the decrease of erythema through healing could not exactly be quantified with the colorimeter because the 'Lab'-CIE-colour representation system cannot distinguish well enough between the colours red and brown. Image analysis allowed to measure the sizes of the psoriatic plaques and to quantify their resolution under therapy. The measuring of plaque size by the aid of computer based image analysis is possible and useful.

Rhazes contribution to the development and progress of medical sciences.

Rhazes was fond of music since his childhood, then studied philosophy and wrote several books about it. Later on he indulged himself in the study of chemistry and medicine. After finishing his studies, Rhazes went back to his home town and practised medicine and soon became very famous. He wrote more than 224 books on various subjects. His most important work is the medical encyclopaedia "continens" (Al-Hawi) which greatly effected the human civilization specially in Europe.

Non-invasive assessment of the antipsoriatic activity of fumaric acid derivatives.

BACKGROUND/AIMS: Noninvasive methods are introduced for the monitoring of healing of psoriasis. Fumaris acid derivatives (FAD) were used in the treatment of psoriasis vulgaris for more than 30 years, but the effectiveness of these drugs has remained controversial. The object was to study the efficacy of FAD in a prospective study including noninvasive techniques, which may allow more accurate assessment in a smaller patient group. METHODS: High-frequency ultrasound including image analysis, and colorimetry was employed. 14 patients were treated for 20 weeks. RESULTS: In the ultrasound image, acanthosis and inflammatory infiltrate of active psoriasis cause an echopoor area under the entry echo. Under theray, this echo area diminishes while its density increases. During healing, the decrease in redness could be quantified. CONCLUSIONS: Monitoring of the healing of psoriasis is possible with ultrasonography and colorimetry. Fumaric acid was found efficient and safe in the treatment of psoriasis.

Determination of density of follicles on various regions of the face by cyanoacrylate biopsy: correlation with sebum output.

The density of follicles on various regions of the human face has received scant attention. We used cyanoacrylate follicular biopsies to determine the number of follicles on the forehead, cheek, chin and nose of 12 healthy adult white women. Sebum output was assessed on the same regions by means of Sebutape. The density of follicles and sebum output followed a centrolateral decreasing gradient. There was no correlation between these two parameters. These regional patterns are important for studies of the pathogenesis of common disorders of the face and their response to treatment.