Sclerodermiform basal cell carcinomas vs. other histotypes: analysis of specific demographic, clinical and dermatoscopic features.

BACKGROUND: Among the various types of basal cell carcinoma, the sclerodermiform variant has a high risk of recurrence and local invasiveness. A systematic description of the dermatoscopic features associated with specific body localization is lacking. OBJECTIVES: To describe the clinical and dermoscopic features of sclerodermiform basal cell carcinoma (BCC) according to localization in the body confronting with superficial and nodular types. METHODS: Clinical and dermoscopic images of sclerodermiform, nodular and superficial BCCs were retrospectively evaluated to study the location in the various body districts, maximum diameter, clinical appearance of the lesion, features of edges and presence or absence of specific dermatoscopic criteria of BCCs. RESULTS: We examined 291 histopathologically proven BCCs showing that in nodular BCCs, classical arborizing vessels were more frequently found in the body macro-area (trunk and limbs; n = 46, 97.9%) than in the head/neck area (n = 43, 82.7%); within sclerodermiform BCCs, short arborizing vessels were found more frequently in the head/neck district (n = 35, 49.3%) than in the body (n = 6, 23.1%; P-value 0.02); within nodular BCCs, multiple blue-grey dots and globules were more frequently found on the trunk (n = 23, 48.9%) than in the head/neck district (n = 12, 23.1%; P-value 0.01). In sclerodermiform BCCs, ulceration was found more frequently in the head/neck district (n = 38, 53.5%) than in the body (n = 4, 15.4%; P-value > 0.01), and in superficial BCCs, ulceration was found more frequently in the head/neck district (n = 5, 38.5%) than in the body (n = 8, 9.8%; P-value 0.02). CONCLUSION: Our study shows that superficial BCC are found frequently in the head/neck district dermoscopically characterized by ulceration and arborizing vessels; nodular BCCs are more frequently found in the body than in the head/neck district, and the dermoscopic pattern is characterized by the combination of three features: (i) classical arborizing vessels, (ii) multiple blue-grey dots and (iii) globules. Instead, sclerodermiform BCC is preferentially located in areas at high-moderate risk of recurrence; if pink-white areas and/or fine arborizing vessels are seen, clinicians should consider this diagnosis. Furthermore, location-specific dermatoscopic criteria have been described.

Dermatoscopy of combined blue nevi: a multicentre study of the International Dermoscopy Society.

BACKGROUND: Combined blue nevi (CBN) may mimic melanoma and are relatively often biopsied for diagnostic reasons. OBJECTIVE: To better characterize CBN and to compare it with melanoma. METHODS: We collected clinical and dermatoscopic images of 111 histologically confirmed CBN and contrasted their dermatoscopic characteristics with 132 partly blue coloured melanomas. Furthermore, we compared the accuracy of human experts using pattern analysis with a computer algorithm based on deep learning. RESULTS: Combined blue nevi are usually flat or slightly elevated and, in comparison with melanoma, more frequent on the head and neck. Dermatoscopically, they are typified by a blue structureless part in combination with either brown clods (n = 52, 46.8%), lines (n = 28, 25.2%) or skin-coloured or brown structureless areas (n = 31, 27.9%). In contrast with melanoma, the blue part of CBN is more often well defined (18.9% vs. 4.5%, P < 0.001) and more often located in the centre (22.5% vs. 5.3%, P < 0.001). Melanomas are more often chaotic (OR: 28.7, 95% CI: 14.8-55.7, P < 0.001), have at least one melanoma clue (OR: 10.8, 95% CI: 5.2-22.2 P < 0.001) in particular white lines (OR: 37.1, 95% CI: 13.4-102.9, P < 0.001). Using simplified pattern analysis (chaos and clues), two raters reached sensitivities of 93.9% (95% CI: 88.4-97.3%) and 92.4% (95% CI: 86.5-96.3%) at corresponding specificities of 59.5% (95% CI: 49.7-68.7%) and 65.8% (95% CI: 56.2-74.5%). The human accuracy with pattern analysis was on par with a state-of-the-art computer algorithm based on deep learning that achieved an area under the curve of (0.92, 95% CI: 0.87-0.96) and a specificity of 85.3% (95% CI: 76.5-91.7%) at a given sensitivity of 83.6% (95% CI: 72.5-91.5%). CONCLUSION: CBN usually lack melanoma clues, in particular white lines. The accuracy of pattern analysis for combined nevi is acceptable, and histopathologic confirmation may not be necessary in exemplary cases.

[Depression, anxiety, delirium and desire to die in palliative care : Recommendations of the S3 guideline on palliative care for patients with incurable cancer]. / Depression, Angst, Delir und Todeswunsch in der Palliativversorgung : Empfehlungen der S3-Leitlinie Palliativmedizin für Patienten mit einer nichtheilbaren Krebserkrankung.

BACKGROUND: The aim of palliative care is to optimize the quality of life of patients with incurable advanced diseases. Adequate psychotherapeutic and psychiatric care is essential in this context. OBJECTIVE: This article presents the recommendations of the S3 guideline on palliative care for patients with incurable cancer with regard to psychotherapeutic and psychiatric contents. MATERIAL AND METHODS: The guideline was developed under the leadership of the German Society for Palliative Medicine (DGP) within the methodological framework of the German Guideline Program in Oncology. Systematic literature reviews were carried out to identify relevant publications in the databases Medline, Cochrane Library, PsycInfo and Embase. Based on the publications included and clinical experience, representatives of 61 professional associations developed and agreed on evidence-based and consensus-based recommendations. RESULTS: Out of the total of 15 chapters in the guidelines, four have a special reference to psychiatry or psychotherapy; they cover the topics depression, anxiety, delirium in the dying phase and dealing with the desire to die. These chapters contain a total of 71 recommendations, almost one third of which are evidence-based. In view of the regularly undetected psychological symptoms in patients with incurable cancer, an early assessment is recommended. Optimal control of physical symptoms and support in social and existential matters are general measures that should be provided in addition to non-pharmacological and pharmacological procedures. CONCLUSION: The guideline on palliative care deals with important mental issues that should be considered by all disciplines and professions. The need for research in palliative care remains high.

[Guideline conform diagnostics for dysphagia : A representative survey of speech therapists at certified stroke units in Germany]. / Leitlinienkonforme Dysphagiediagnostik : Eine repräsentative Befragung von Logopäden an zertifizierten Stroke-Units.

BACKGROUND: Almost 260,000 people in Germany suffer from a stroke each year. As a consequence, for more than 60% this leads to dysphagia. In order to prevent secondary diseases, such as pneumonia, malnutrition and dehydration, a differentiated diagnosis by a multiprofessional team in a stroke unit is required. The guidelines in 2015 for diagnosing neurologic dysphagia by the German Society of Neurology recommend a detailed anamnesis, a standardized screening, a clinical swallowing examination and additional instrumental diagnostics. OBJECTIVE: This study examined whether dysphagia is diagnosed by speech therapists at certified stroke units according to the recommended guidelines. MATERIAL AND METHODS: An online questionnaire was compiled and sent to 1 speech therapist at each of the 195 certified stoke units and 112 participants responded to the questionnaire. The questionnaire consisted of questions about anamnesis, clinical swallowing diagnostics and the instrumental diagnostics. Of the speech therapists working on a stroke unit 57% participated in this study. RESULTS: The results show that 50% of the participants elaborated a detailed and differentiated anamnesis, 64% used a standardized screening (Daniels test) and 66% implemented a guideline conform swallowing test. As technical instruments, 35% of the respondents used video fluoroscopy and 71% of the respondents a fiber endoscopy. CONCLUSION: The implementation of a detailed and differentiated anamnesis, standardized screening, and a clinical swallowing examination with testing of different food consistencies suggests a high quality of the dysphagia diagnostics at stroke units in Germany. The increasing availability of technical instruments, especially fiber endoscopy, substantiates this view.

Dermatoscopy of flat pigmented facial lesions.

BACKGROUND: The diagnosis of flat pigmented lesions on the face is challenging because of the morphologic overlap of biologically different lesions and the unknown significance of dermatoscopic patterns. OBJECTIVE: To better characterize dermatoscopic patterns of various types of flat pigmented facial lesions and to analyse their significance by calculating their relative risks and diagnostic values. METHODS: We prospectively analysed dermatoscopic images of 240 flat pigmented facial skin lesions collected consecutively from 195 patients (41.5% females, mean age: 61 ± 14 years) between 2007 and March 2012 in a primary skin cancer practice situated in Queensland, Australia. RESULTS: Histopathologically 114 (47.5%) lesions were malignant (24 lentigo maligna, 21 basal cell carcinomas and 69 pigmented actinic keratoses). Compared with all other patterns the positive predictive value for lentigo maligna was highest for a pattern of circles (31.3%, 95% CI: 11.1-58.6%). A pattern of clods was associated with basal cell carcinoma. If grey structures were present the relative risk for malignancy was 2.2 (95%CI: 1.4-3.4). The best clues to differentiate pigmented actinic keratosis from other lesions were the presence of scale (positive predictive value: 72.2%, specificity: 94.2%), white circles (positive predictive value: 68.8%, specificity: 94.2%) and a sharply demarcated border (positive predictive value: 44.2%, specificity: 86.0%). CONCLUSIONS: In flat lesions a pattern of circles bears the highest risk for facial melanoma but other patterns do not exclude it. Scale, white circles and a sharply demarcated border are clues to pigmented actinic keratoses. The presence of grey colour is a clue to malignancy regardless of pattern.

Terahertz in vivo imaging of human skin: Toward detection of abnormal skin pathologies.

Terahertz (THz) imaging has long held promise for skin cancer detection but has been hampered by the lack of practical technological implementation. In this article, we introduce a technique for discriminating several skin pathologies using a coherent THz confocal system based on a THz quantum cascade laser. High resolution in vivo THz images (with diffraction limited to the order of 100 µm) of several different lesion types were acquired and compared against one another using the amplitude and phase values. Our system successfully separated pathologies using a combination of phase and amplitude information and their respective surface textures. The large scan field (50 × 40 mm) of the system allows macroscopic visualization of several skin lesions in a single frame. Utilizing THz imaging for dermatological assessment of skin lesions offers substantial additional diagnostic value for clinicians. THz images contain information complementary to the information contained in the conventional digital images.

Clinical and dermoscopic characteristics of Merkel cell carcinoma.

BACKGROUND: Merkel cell carcinoma (MCC) is an aggressive cutaneous malignancy with a high mortality rate. Diagnosis is often delayed. OBJECTIVES: To characterize the dermoscopic features of MCC. METHODS: Clinical and dermoscopic images of 12 biopsy-proven MCCs were analysed in a retrospective manner, with existing dermoscopic criteria being scored independently by three dermatologists. RESULTS: The four most frequent clinical features were cherry red colour, shiny surface, sharp circumscription and nodular morphology. Significant dermoscopic features included linear irregular and polymorphous vessels, poorly focused vessels, milky pink areas, white areas, structureless areas and architectural disorder. Pigmented structures were absent from all lesions. CONCLUSIONS: The dermoscopic features described herein help the clinician to distinguish MCC from other benign and malignant red nodules. Increasing recognition of the presenting features will facilitate earlier diagnosis of MCC and reduced mortality.

U mobilization and associated U isotope fractionation by sulfur-oxidizing bacteria.

Uranium (U) contamination of the environment causes high risk to health, demanding for effective and sustainable remediation. Bioremediation via microbial reduction of soluble U(VI) is generating high fractions (>50%) of insoluble non-crystalline U(IV) which, however, might be remobilized by sulfur-oxidizing bacteria. In this study, the efficacy of Acidithiobacillus (At.) ferrooxidans and Thiobacillus (T.) denitrificans to mobilize non-crystalline U(IV) and associated U isotope fractionation were investigated. At. ferrooxidans mobilized between 74 and 91% U after 1 week, and U mobilization was observed for both, living and inactive cells. Contrary to previous observations, no mobilization by T. denitrificans could be observed. Uranium mobilization by At. ferrooxidans did not cause U isotope fractionation suggesting that U isotope ratio determination is unsuitable as a direct proxy for bacterial U remobilization. The similar mobilization capability of active and inactive At. ferrooxidans cells suggests that the mobilization is based on the reaction with the cell biomass. This study raises doubts about the long-term sustainability of in-situ bioremediation measures at U-contaminated sites, especially with regard to non-crystalline U(IV) being the main component of U bioremediation.

Dermoscopy of scalp tumours: a multi-centre study conducted by the international dermoscopy society.

BACKGROUND: Little is known about the dermoscopic features of scalp tumours. Objective To determine the dermoscopic features of scalp tumours. METHODS: Retrospective analysis of dermoscopic images of histopathologically diagnosed scalp tumours from International Dermoscopy Society members. RESULTS: A total of 323 tumours of the scalp from 315 patients (mean age: 52 years; range 3-88 years) were analysed. Scalp nevi were significantly associated with young age (<30 years) and exhibited a globular or network pattern with central or perifollicular hypopigmentation. Melanoma and non-melanoma skin cancer were associated with male gender, androgenetic alopecia, age >65 years and sun damage. Atypical network and regression were predictive for thin (≤1 mm) melanomas, whereas advanced melanomas (tumour thickness > 1 mm) revealed blue white veil, unspecific patterns and irregular black blotches or dots. CONCLUSIONS: The data collected provide a new knowledge regarding the clinical and dermoscopy features of pigmented scalp tumours.

Blue-black rule: a simple dermoscopic clue to recognize pigmented nodular melanoma.

BACKGROUND: Dermoscopy improves melanoma recognition, but most criteria were described in the context of superficial spreading melanoma. OBJECTIVES: To test whether pigmented nodular melanoma could be recognized dermoscopically by the presence of a combination of blue and black colour within the lesion. METHODS: Dermoscopic images of histopathologically diagnosed pigmented nodular tumours with no (or only minimal) flat component were evaluated for the presence of standard melanoma criteria and for the presence of a new feature named blue-black (BB) colour. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for standard criteria and BB feature in relation to the diagnosis of melanoma and to diagnosis of malignancy. RESULTS: Of 283 lesions, 160 were malignant, including 78 (27·6%) melanomas, and 123 were benign. The BB feature and the standard criteria had 78·2% and 43·6% sensitivity for melanoma, respectively, whereas a combined method based on the presence of either the BB feature or one (or more) of the standard criteria reached 84·6% sensitivity, with 80·5% specificity and 93·2% negative predictive value. Sensitivity values for malignant lesions were only 24·4%, 56·9% and 60% for standard criteria, BB feature and the combined method, respectively. However, the combined method gave 91·9% specificity and 90·6% positive predictive value for malignancy. CONCLUSIONS: Using a method based on the BB feature or one of the standard melanoma criteria, only 9·4% of positive pigmented nodular lesions were found to be benign and only 6·8% of negative lesions were found to be melanoma histopathologically.

A probable case of rotavirus exanthem.

A generalized maculopapular exanthem and signs of hepatitis developed in a 28-year-old man one week after his two sons had suffered from rotavirus gastroenteritis. The patient's serum contained rotavirus antibody at titers of 1:256 and 1:512. Other known causes of exanthemata were excluded by clinical and laboratory investigations. The epidemiologic evidence and the results of serological tests suggested that the rotavirus caused the patient's exanthem.

How do patients with HIV perceive their general practitioners?

OBJECTIVE: To study the perceptions of patients with HIV of their general practitioners in terms of knowledge, abilities, confidence, and satisfaction. DESIGN: Questionnaire survey of inpatients, outpatients, and members of a self help group. SETTING: Two city hospitals, three outpatient clinics, and one AIDS self help group in Munich and Berlin, Germany. SUBJECTS: All 402 patients available between 1 September 1988 and 31 May 1989. MAIN OUTCOME MEASURES: General practitioners' attitudes towards the patients' HIV status; patients' experience of treatment rejection; reception in the general practitioner's office; the doctor's perceived knowledge about HIV and AIDS. RESULTS: 394 of 402 patients consented to interview; 87% were registered with a general practitioner and 91% of those indicated that the doctor was aware of their HIV diagnosis. The overwhelming majority of patients (94%) had a friendly or at least neutral reception in the general practitioner's surgery and only six patients' general practitioner changed his or her behaviour for the worse because of the HIV diagnosis. Two thirds of patients said they would consult first with their primary care doctor for a physical problem, but only 13% would do so for psychological problems. Over a third of the patients did not routinely inform other doctors or medical staff about their HIV status, but there was no significant correlation between this concealment and ever having been rejected by a doctor (7%) or a dentist (12%). CONCLUSION: Most patients expressed a high degree of satisfaction with their general practitioners in terms of confidential issues, attitudes, knowledge, and management.

[Familial Mycoplasma pneumonia. The varied picture of pulmonary and extrapulmonary manifestations]. / Familiäre Mykoplasmenpneumonie. Das bunte Bild pulmonaler und extrapulmonaler Manifestationen.

Mother, father (26 y.o.) and their only child (5 y.o.) developed nonproductive cough, fever (39.5 to 40.4 degrees C) and bilateral pulmonary infiltrates within three weeks. In addition the mother developed a small left pleural effusion and a pericardial effusion, a relative bradycardia, a pruritic vesicular exanthem of the extremities and the trunk, an erythema nodosum and arthritis of the tarsal joints. The father's coulter counter red blood count was distorted by microagglutination at room temperature (hemoglobin 13.2 gr/dl; erythrocytes 1,91 X 10(6) mm-3 and MCH 69.1 pg; MCV 120 fl and hematocrit 23.8%) but not at 37 degrees C (13.2; 4.15 and 31.8; 92 and 39.3, respectively). In the daughter myringitis, pharyngitis, cervical lymphadenopathy and splenomegaly were observed. Cold agglutinins and serologic evidence for mycoplasma pneumoniae infection were demonstrable in all three. Treatment with Tetracycline (parents) and Erythromycin (child) was effective.

[Cell membrane differences between malignant and nonmalignant cells]. / Zellmembranunterschiede zwischen malignen und nichtmalignen Zellen.

Malignant cells possesses an electric surface charge differing from their healthy counterparts. In many cases they exhibit increased electronegativity. We incubated blood or bone marrow with heparin--a polyanion--and subsequently stained the cells with a fluorochrome. In healthy subjects or patients with non-malignant disease heparin was found to attach closely to the cell surface, visualised through fluorescence. In a variable number of malignant cells heparin did not attach to the cell surface. Electrostatic repulsion of the negative heparin molecule through the increased negativity of the malignant cell is discussed as an explanation of this finding which can be corrected/inhibited by neuraminidase incubation.

Avoidance of perinatal transmission of hepatitis B virus: is passive immunisation always necessary?

Screening of 8918 pregnant women revealed that 107 (1.2%) were HBsAg-positive. 92 of them (50 of German and 42 of predominantly Asian origin) have already delivered and were followed up for 12 months together with their infants. 14 infants of HBeAg-positive (or anti-HBe-negative) carrier mothers received a single dose of hepatitis B immunoglobulin (HBIG) immediately after birth, while 60 infants of anti-HBe-positive mothers were not immunised. 57 of the 60 "unprotected" children remained seronegative for HBsAg and HBeAg. 3 children showed HBs-antigenaemia immediately after birth; 2 of these lost HBsAg and developed anti-HBs after 6 and 9 months. The third lost HBsAg after 4 months without an antibody response developing. This suggests that the HBsAg particle only was transmitted rather than the whole virus. 12 of the 14 infants born to HBeAg-positive, or anti-HBe-negative carrier mothers were protected with one single high dose of HBIG. 2 had HBs-antigenaemia, 1 had HBeAg as well. These data show that in a West European population the risk of perinatally acquired HBV infection in the infants of anti-HBe-positive carrier mothers is small, and that passive immunisation of this group is not necessarily indicated.

[Psychosocial problems in HIV infected families--possibilities for coping]. / Psychosoziale Probleme in HIV-infizierten Familien--Möglichkeiten der Bewältigung.

The psychosocial problems of 49 HIV-exposed children (data given as of September 1989) and 19 HIV-infected hemophiliacs cared for in the pediatric immuno-deficiency clinic of the Munich university hospital are described in detail. Drug addiction, financial needs, housing problems and delinquency play an important role in the first group. Hemophiliacs, however, live in more stable family conditions. Both groups are offered counseling, home and hospital visits, and legal, administrative and financial support. Furthermore we help with coordinating regular meetings, obtaining short-time housekeepers and arranging long-term addiction-treatments for mother and child. When dealing with hemophilic patients our team is frequently confronted with problems of friendship, sexuality and professional training.

Oxysporidinone: a novel, antifungal N-methyl-4-hydroxy-2-pyridone from Fusarium oxysporum.

Oxysporidinone (1), a novel 3,5-disubstituted N-methyl-4-hydroxy-2-pyridone, was isolated from fermentations of Fusarium oxysporum (CBS 330.95) by counter-current chromatography. The structure was determined by spectroscopic methods including NMR, MS, IR, and UV analysis. Oxysporidinone exhibited growth inhibitory activity against several common plant pathogenic fungi.

Cladobotryal: a fungal metabolite with a novel ring system.

In screening for antifungal metabolites a novel compound, cladobotryal, was isolated from the mycoparasitic fungus Cladobotryum varium. Its structure was established as (+)-(2R*,3R*)-2-[(Z)-2-buten-2-yl]-3, 7-dihydro-3-formyl-3-methyl-5-phenylfuro[2,3-b]pyridin-4(2H)-one on the basis of spectroscopic evidence and single crystal X-ray analysis of its methyl hemiacetal. The fused furo[2,3-b]pyridinone skeleton of cladobotryal seems unprecedented within the chemical literature.