[Conception, implementation and evaluation of the new general medicine continuing education curriculum in Südbaden]. / Konzeption, Durchführung und Evaluation der neuen Kursweiterbildung Allgemeinmedizin in Südbaden.

Since 1994, seminars for the new curriculum in general practice are conducted by the Academy of Continuing Medical Education (consists of the regional medical board and the association of public health insurance in Südbaden). Specialists of different medical disciplines supported by general practitioners in the role of moderators are preparing and teaching a wide range of topics. The general practitioners are supervising the different courses, thus, facilitating the learning process of the participants. Furthermore, the facilitators have to work out the specific needs and requirements of general practice and family medicine. The topics are presented in a form of lessons and clinical cases discussed in small groups (problem-oriented approach). The evaluation of two seminars was carried out in 1994 and 1995 including two thirds of the complete curriculum in general practice. From the positive results of the evaluation, modification and improvement of the didactic concept for future seminars in 1996 are derived.

[Acne therapy with isotretinoin in dermatologic practice. A multicenter phase IV study of 788 patients]. / Aknetherapie mit Isotretinoin in der dermatologischen Praxis. Eine multizentrische Phase-IV-Studie an 788 Patienten.

In a multicenter study, 788 patients suffering from severe acne resistant to therapy were treated with isotretinoin by 758 dermatologists in private practices. The study was conducted using standardized test forms and questionnaires. The goal of the study was to establish the risk/benefit ratio of the drug, if it was applied to patients of a dermatological practice. The initial daily dose amounted to 0.5 mg/kg body weight, the time of treatment was 12 to 16 weeks. The clinical efficacy was judged very good or good by 90% of the doctors and patients. The kind, frequency, and intensity of the side effects observed corresponded with those found in previous studies conducted at hospitals. Our critical analysis of the results left no doubt about the therapeutic value and the safety of isotretinoin, if it is used by dermatologists in private practices.

[Treatment of rosacea with isotretinoin. Results of a multicenter trial follow-up]. / Behandlung der Rosacea mit Isotretinoin. Ergebnisse einer posttherapeutischen multizentrischen Verlaufsbeobachtung.

A follow up investigation was done on forty-seven patients of the German multicenter study with severe and long standing rosacea who had been treated with isotretinoin (0.5 mg/kg bw/day) over twelve or twenty weeks. During the post-treatment follow up which lasted an average of fifty-seven weeks, seven relapses were registered whereas forty patients remained in remission. After drug withdrawal, both the percentage of patients without inflammatory lesions (pustules, papules or nodules) as well as the mean values of inflammatory lesions remained almost constant over the whole observation period.

[Remission behavior following low-dose 13-cis-retinoic acid in papulopustular acne]. / Remissionsverhalten nach niedrigdosierter 13-cis-Retinsäuretherapie bei Acne papulo-pustulosa.

64 patients suffering from severe papulopustular acne previously resistant to therapy were treated with 13-cis retinoic acid (isotretinoin) at a dosage of 0.05, 0.1, or 0.2 mg/kg body weight for 20 weeks. After treatment, we performed follow-up examinations for 12 months concerning remission and side effects. After six months, more than half of the patients were free of relapses, even those treated with low doses, although there was a trend in favor of the 0.2 mg/kg body weight dose. According to lesion counts, the therapeutic effect of isotretinoin was even better after discontinuation of the drug. Mucocutaneous side effects disappeared within four to six weeks. In severe papulopustular acne, previously showing inadequate response to therapy, at least 0.2 mg/kg body weight isotretinoin should be given to ensure a good therapeutic result. These findings correspond with those observed in the initial reduction of lesions.

[13-cis-retinoic acid. Low dosage oral use in acne papulopustulosa. Results of a multicenter study]. / 13-cis-Retinsäure. Niedrig dosierte orale Anwendung bei Acne papulopustulosa. Ergebnisse einer multizentrischen Studie.

Successful treatment of acne conglobata with 13-cis-retinoic acid (isotretinoin, Ro 4-3780) has already been reported in this journal [25, 36]. The aim of the present study was to treat severe forms of papulopustular acne, unresponsive to conventional therapy, with low doses of 13-cis-retinoic acid to obtain good results with few side effects. A total of 191 patients from 14 departments of dermatology in the Federal Republic of Germany received 13-cis-retinoic acid under open randomized conditions in parallel dose groups of 0.05, 0.1, and 0.2 mg/kg body weight for 20 weeks in order to establish efficacy and tolerance. All inflammatory and non-inflammatory skin lesions were counted. The intensity of seborrhea was graded by using a scale. Adverse effects as well as laboratory values were registered. After 20 weeks of treatment a 79% (0.05 mg), 80% (0.1 mg), and 84% (0.2 mg) decrease in the number of inflammatory skin lesions was seen. Fourteen patients in the lowest dose group were considered to be dropouts. The decrease in non-inflammatory skin lesions was less marked and amounted to between 49% and 69%. A significant reduction of seborrhea could be observed in all patients. The main side effect was dryness of the skin and mucous membranes, which was, however, of low intensity. The elevation of triglyceride and cholesterol levels reported with higher doses of 13-cis-acid, especially in patients with high-risk factors, were not encountered in this study.