Treatment satisfaction of patients with psoriasis.

Treatment satisfaction of patients with psoriasis largely depends on the treatment modality, but evidence on preferences for specific medications is scarce. Here we assessed treatment satisfaction of 200 participants with moderate-to-severe psoriasis from a German University hospital with a 5-point scale and the Treatment Satisfaction Questionnaire for Medication (TSQM) and determined sociodemographic and disease-related influence factors. Participants obtaining biologicals and traditional systemic medications were significantly more satisfied than those receiving phototherapy or topical agents (TSQM = 323.3, 288.0, 260.6 or 266.8; p < 0.001). The highest TSQM score was calculated for ustekinumab (350.1), followed by acitretin (338.1), adalimumab (323.0), fumaric acid esters (304.7), infliximab (300.2), etanercept (298.8), and methotrexate (272.3; p < 0.001). High disease-related quality of life impairment (ß = -0.437, p < 0.001) and psoriatic arthritis (ß = -0.185, p = 0.005) were associated with decreased satisfaction. Optimising satisfaction is essential to improve adherence and outcome. We show high preferences for biologicals, particularly ustekinumab, but also good satisfaction with certain traditional medications.

An inducible hepatocellular carcinoma model for preclinical evaluation of antiangiogenic therapy in adult mice.

The limited availability of experimental tumor models that faithfully mimic the progression of human tumors and their response to therapy remains a major bottleneck to the clinical translation and application of novel therapeutic principles. To address this challenge in hepatocellular carcinoma (HCC), one of the deadliest and most common cancers in the world, we developed and validated an inducible model of hepatocarcinogenesis in adult mice. Tumorigenesis was triggered by intravenous adenoviral delivery of Cre recombinase in transgenic mice expressing the hepatocyte-specific albumin promoter, a loxP-flanked stop cassette, and the SV40 large T-antigen (iAST). Cre recombinase-mediated excision of the stop cassette led to a transient viral hepatitis and resulted in multinodular tumorigenesis within 5 to 8 weeks. Tumor nodules with histologic characteristics of human HCC established a functional vasculature by cooption, remodeling, and angiogenic expansion of the preexisting sinusoidal liver vasculature with increasing signs of vascular immaturity during tumor progression. Treatment of mice with sorafenib rapidly resulted in the induction of vascular regression, inhibition of tumor growth, and enhanced overall survival. Vascular regression was characterized by loss of endothelial cells leaving behind avascular type IV collagen-positive empty sleeves with remaining pericytes. Sorafenib treatment led to transcriptional changes of Igf1, Id1, and cMet over time, which may reflect the emergence of potential escape mechanisms. Taken together, our results established the iAST model of inducible hepatocarcinogenesis as a robust and versatile preclinical model to study HCC progression and validate novel therapies.

Medicinal leeches for the treatment of venous congestion and hematoma after plastic reconstructive surgery.

BACKGROUND: Leeches were used for medical purposes as long as 2 000 years ago in ancient Egypt. In recent years the use of medicinal leeches became rather popular again, e. g. to improve blood circulation in ischemic tissue after reconstructive plastic surgery. PATIENTS AND METHODS: In a single center, retrospective study 23 consecutive cases were analyzed in which medicinal leeches had been used therapeutically after plastic reconstructive surgery. All cases were categorized regarding the indication for leech therapy, the onset, the duration, the number of leeches and the number of sessions. RESULTS: Among the group of patients there were 7 female and 16 male patients with a mean age of 73 ± 14 years (48-94 years) altogether. The main indications were venous congestion (12/23; 52 %) and hematoma (9/23; 39 %). Two cases were diagnosed with a necrosis of the tip of the flap and therefore received leech therapy (2/23; 9 %). The average number of leeches was 2.6 leeches/session, the number of sessions was 1.7 ± 0.8. 20/23 patients (87 %) showed a restitutio ad integrum after leech therapy, in 3/23 patients (13 %) a necrosis of the tip of the flap could not be prevented. A clinical improvement was noticed after an average of 1.1 ± 0.3 days. CONCLUSIONS: The early application of medicinal leeches can improve local hemodynamic conditions. Leech therapy is a simple and effective method; the cost efficiency of the treatment is high.

Combination therapy with extracorporeal photopheresis, interferon-alpha, PUVA and topical corticosteroids in the management of Sézary syndrome.

BACKGROUND: Extracorporeal photopheresis (ECP) is recommended for the treatment of Sézary syndrome (SS), the leukemic variant of cutaneous T-cell lymphoma (CTCL). Several combination therapies are used to increase response rates to ECP. PATIENTS AND METHODS: We report our experience with the combination therapy of ECP, interferon-alpha, PUVA and topical corticosteroids in SS. RESULTS: The treatment outcome in 12 SS patients was retrospectively analyzed and showed an overall response rate to this combination treatment of 42 % with 4/12 patients achieving a partial remission and 1/12 patients a stable disease. The median overall survival time was 42 months. We investigated several clinical and laboratory parameters as an indicator for a response to treatment in our patient cohort. A combined analysis of the erythroderma assessment scale, WBC, LDH, CD4/CD8 ratio and the number of Sézary cells revealed that a reduction of several parameters significantly correlated with response to treatment. The parameters which correlated best with response were number of Sézary cells, CD4/CD8 ratio and WBC. CONCLUSIONS: The investigated combination therapy was effective and well-tolerated in a subgroup of SS patients but needs to be evaluated in a larger patient population.

[Angioma serpiginosum following the lines of Blaschko--an effective treatment with the IPL technology]. / Angioma serpiginosum in den Blaschkolinien--eine effektive Behandlung mit der IPL Technik.

Angioma serpiginosum, first described by Hutchinson in 1889, is a rare benign vascular nevus with dilatation and proliferation of the capillaries in the upper dermis. A 15-year-old boy presented with an angioma serpiginosum on the right side of the body following the lines of Blaschko. Both the clinical pattern and the appearance in a male are unusual. Treatment with IPL technology (intense pulsed light), which emits polychromatic light from a high-intensity flashlamp, proved to be an effective approach.

Predominant telangiectatic erythema in linear atrophoderma of Moulin: novel variant or separate entity?

Linear atrophoderma of Moulin is a distinctive disease originally described in 1992 and characterized by acquired, mildly atrophic, non-sclerotic, slightly hyperpigmented lesions following the lines of Blaschko. Here, we describe a 15-year-old girl with a 13-year history and a 29-year-old male with a 6-year history of prominent linear telangiectatic erythema and mild atrophoderma following the lines of Blaschko that involved the right leg and hip, and both legs, the trunk and both arms, respectively. As pronounced telangiectatic erythema within lesions of atrophoderma of Moulin has not hitherto been described, we propose that the disease in our patients represents a novel variant of linear atrophoderma of Moulin. Due to considerable overlap, we do not favour the notion that our cases constitute an entity entirely separate from linear atrophoderma of Moulin.

[Occupational allergy to mugwort]. / Berufliche Beifuss-Allergie.

BACKGROUND: Mugwort (Artemisia vulgaris) has traditionally been used as a spice, vegetable and as a herbal medicine. The main representatives of the Artemisia family besides Artemisia vulgaris include Artemisia absinthum and Artemisia dracunculus (estragon). Mugwort pollen allergens are important in triggering late summer and fall pollinosis; in addition cross reactivity occurs between Artemisia vulgaris pollen allergens and celery, carrottes and certain spices belonging to the family of Umbelliferae. PATIENTS: A florist with a pre-existing sunflower allergy developed a life-threatening glottal edema after occupational contact with mugwort. She did not suffer from an oral allergy syndrome towards mugwort pollen cross allergens. RESULTS: Skin testing (prick and scratch testing) revealed a strong sensitisation against mugwort and estragon. Specific IgE antibodies against mugwort, sunflower, carrots, celery, fennel and anis were elevated in the peripheral blood. CONCLUSIONS: The observation of a severe mugwort allergy with life-threatening complications in a florist underscores the high allergenic potential of Artemisia vulgaris and documents for the first time the occupational significance of this allergy.