Updated Swiss guidelines for the treatment and follow-up of cutaneous melanoma.

Melanoma is the most common lethal cutaneous neoplasm. In order to harmonize treatment and follow-up of melanoma patients, guidelines for the management of melanoma in Switzerland have been inaugurated in 2001. These have been approved by all Swiss medical societies involved in the care of melanoma patients. New data necessitated changes concerning the safety margins (reduction to maximally 2 cm) and modifications of the recommendations of follow-up.

Prevention campaign against skin cancer.

BACKGROUND: The melanoma incidence has increased over recent decades. Educational campaigns aim to encourage protection from the sun and early detection of melanoma. METHODS: During a campaign in Switzerland, information on risk factors, sun protection and melanoma prevention was distributed. 10987 people completed a questionnaire regarding risk factors, and 2746 people were examined by a dermatologist. RESULTS: Men had a higher risk as assessed by skin type, ultraviolet exposure, family history, number of moles and sunburns during childhood. Changes in moles were reported significantly more often by people with: (1). a positive family history (p < 0.0001); (2). multiple moles (p < 0.0001), and (3). sunburns during childhood (p < 0.0001). A precancerous or cancerous condition was suspected in 16% of individuals examined. CONCLUSION: Early detection of melanoma can be achieved by this type of campaign. Primary prevention is a long-term approach and educational efforts targeting risk groups must be continued.

Swiss guidelines for the treatment and follow-up of cutaneous melanoma.

Melanoma is the most common lethal cutaneous neoplasm. There is major controversy over the best management of this malignancy. In order to harmonize treatment and follow-up of melanoma patients, guidelines for the management of melanoma in Switzerland have been inaugurated. They have been approved by all Swiss medical societies involved in the care of melanoma patients.

Steal syndrome complicating hemodialysis access procedures: can it be predicted?

The development of steal syndrome distal to an arteriovenous fistula (AVF) created for hemodialysis access remains a significant clinical problem. This study was undertaken to determine the role of intraoperative noninvasive testing in the prediction and management of steal syndrome following arteriovenous fistula creation. First, in order to determine a threshold digital/brachial index (DBI) for patients at risk for steal syndrome, we performed a retrospective review of patients who had had the DBI measured and who developed symptoms (steal syndrome) following AVF creation. This was followed by a prospective evaluation of the ability of the DBI to predict which patients undergoing AVF surgery would develop steal syndrome. A DBI of <0.6 identifies a patient at risk for steal syndrome. Intraoperative DBI cannot be used to predict which patient will develop steal syndrome; however, if revision is indicated, the DBI should be increased to >0.6. Failure to accomplish this puts the patient at risk for continued steal syndrome.

Iron and atherosclerosis: inhibition by the iron chelator deferiprone (L1).

BACKGROUND: Accumulating evidence suggests that oxidative modification of lipoproteins may play a significant role in atherogenesis. In this study, we hypothesized that the iron chelator deferiprone (L1) would function as an antioxidant and decrease atherosclerosis progression. MATERIALS AND METHODS: For the in vitro studies, human low-density lipoprotein (LDL) was collected and then subjected to oxidation by either hemin/H2O2 or copper sulfate in the presence of various concentrations of L1. Lag time to oxidation was measured to assess antioxidant activity of L1. In addition, human umbilical vein endothelial cells (HUVEC) were subjected to oxidized LDL in the presence of varying concentrations of L1 to assess the antioxidant cytoprotective ability of L1. For the in vivo studies, rabbits (n = 21) were maintained on a 0.25% by weight cholesterol diet for 10 weeks; 9 rabbits also received twice daily L1 by gavage (total dose = 100 mg/kg/day). Lipid profiles were measured during the study. At 10 weeks, rabbits were sacrificed, and thoracic aorta cholesterol content (TACC) and planimetry were determined to assess atherosclerosis severity. RESULTS: In vitro, L1 prevented oxidation of LDL and protected HUVEC from the cytotoxic effects of oxidized LDL in a concentration-dependent manner. In vivo, L1 reduced TACC (P = 0.001), while also significantly decreasing total plasma cholesterol (P = 0.003), very-low-density lipoprotein cholesterol (P = 0.01), and LDL cholesterol (P = 0.002) compared to control animals. However, no significant differences between L1-treated animals and controls were evident for the surface area of plaque involvement by planimetry (P = 0.3) or in the serum iron levels (P = 0.3). CONCLUSIONS: These results confirm that L1 possesses antioxidant activity in vitro and may reduce atherogenesis in vivo.

The wellness movement: imperatives for health care marketers.

This paper examines the impact of the growing national health consciousness on the delivery of health care services. The health-involved consumer is first profiled and implications for health care marketing strategy are then identified. Suggestions are also made regarding the tailoring of health services to the health-involved segment.

Histopathology of pityriasis rosea Gibert. Qualitative and quantitative light-microscopic study of 62 biopsies of 40 patients.

62 biopsies of 40 patients with pityriasis rosea Gibert (PRG) were analyzed qualitatively and quantitatively. The main histopathological feature is eczematoid. In addition, the following characteristics, especially in combination, are helpful for the differential diagnosis: absence or decrease of the granular cell layer, erythrocytes in the papillary dermis and partly in the epidermis, and homogenization of the collagen of the papillary dermis. Recent and older lesions show little difference although the number of eosinophils in the inflammatory infiltrates has generally increased.

[Partial synchronization and cytostatic combination therapy of disseminated malignant lymphomas of the skin]. / Partielle Synchronisation und zytostatische Kombinationstherapie dissseminierter maligner Lymphome der Haut.

Six patients with advanced disseminated malignant lymphomas of the skin were treated with cytostatics using the method of partial synchronisation of the tumor cell growth phases. Though five patients had already shown a resistance against the usual chemo- and/or radiotherapy, all patients responded to this therapeutical principle. Full remission was achieved in four patients. We proved that vincristine effectively synchronizes the growth of proliferating human tumor cells in vivo. Treatment was applied in two steps. First a partial synchronisation of tumor cell growth was induced by vincristine as a pharmacologic means. Then the cytostatics were applied in killing doses at the calculated time. For this purpose we determined the average length of each generation of cells and developed individual therapy schemes. To get the best results with this method usually several therapy cycles were used. In case of a relapse the therapy scheme was adjusted to the altered cellular kinetics. This principal of partial synchronisation is suitable for treating malignant lymphomas with high efficiency, especially those with rapid proliferation even in advanced states.

[Double flap method in the frontal and temporal area to cover larger defects left by surgery]. / Die doppelte Verschiebeplastik im Stirn- und Schläfenbereich zur Deckung grösserer Operationsdefekte.

Regional flaps are often necessary to cover defects left after operations in the forehead and temple area, since the skin of the scalp does not stretch well and because of the likelihood of dislocation of the eyebrow. We find the double advancement-flap technique using curving incisions of great use in this area. These curved flaps margins follow the wrinkles of the forehead and the relaxed skin tension lines. This contributes to easy healing and inconspicous scars. At the same time undersired facial asymmetry or disturbance of expression can be avoided.

[Pilar tumor of the scalp. Case report and study of 59 cases]. / Pilartumor der Kopfhaut. Fallbericht und Studie über 59 Fälle.

The pilar tumor occurs mainly in elderly women. It is a solitary lesion, localized on the scalp in most cases. In spite of the usually long course of the disease, pilar tumors very rarely metastasize. Small tumors look like "sebaceous cysts", large and very large tumors are diagnosed as squamous cell carcinomas. In these cases one could directly come to the right diagnosis if sex, age and localization do correspond. Microscopic examination reveals interlacing lobules of squamous eqithelium that undergo in their center abrupt keratinization of pilar or trichilemmal cysts. The pilar tumor, therefore, keratinizes like the middle portion of the outer root sheath. Our own case shows the typical above-mentioned clinical and histological signs of the pilar tumor.

Oral retinoid and UVB radiation: a new, alternative treatment for psoriasis on an out-patient basis.

The combined application of an oral retinoid (Ro 10-9359) and phototherapy with predominantly UVB radiation (Selective Ultraviolet Phototherapy=SUP) is a new, highly effective method of treating psoriasis. It has few side effects and can be performed on an out-patient basis. With the aid of this combined treatment we achieved good or very good improvement in 19 out of 23 patients with generalized psoriasis (=82.6%). The average number of radiation sessions required to achieve this was 22.9, and the mean total therapeutic dose (TTD) was 73 J/cm2. In a control group of 40 psoriasis patients, who received only radiation therapy, we achieved good or very good results in only 60% with an average of 26 radiation sessions and 94 J/cm2 TTD. The effect of the oral retinoid and UVB radiation therapy is apparently additive, since the retinoid does not increase the sensitivity of the skin to light.

Transformation of seborrheic keratosis into Bowen's disease.

This case proves the possibility of a malignant transformation of seborrheic keratosis. This evidence is furnished by a biopsy specimen that shows not only a topical relationship between seborrheic keratosis and Bowen's disease, but also the progressive transition. An evident biopsy has to be made prior to clinical suspicion of malignant degeneration, that means prior to the destruction of the transitional zone by the tumor.

[Treatment of pustular psoriasis with a new aromatic retinoid (RO 10-9359). Report on 9 generalized and 8 localized cases (author's transl)]. / Traitement du psoriasis pustuleux par un nouveau rétinoïde aromatique (RO 10-9359). A propos de 9 cas généralisés et 8 cas localisés.

17 patients with pustular psoriasis, i. e. 9 generalized and 8 localized types, were treated orally with the new aromatic retinoid RO 10-9359. The given dose was 0.5-1.0 mg/kg body weight per day. After 4-8 weeks the result was very good or good in 13 cases. Side effects were moderate; only in one female patient the oral treatment was interrupted because of drug-induced alopecia. Histologic examinations revealed spongiform pustules before treatment and typical features of psoriasis vulgaris after 2 weeks; after 4 weeks most tissue changes had returned to normal. An unusual fine granular mucoid material was seen under the electron microscope in the intercellular spaces of the epidermis, being most likely produced in the keratinocytes.

[Lipoatrophia semicircularis in the male. Coincidence of arterial variations and micro-traumas as a possible disease cause]. / Lipotrophia semicircularis beim Mann. Zusammentreffen von Arterienvarietät und Mikrotraumata als mögliche Krankheitsursache.

Semicircular lipoatrophy is a new entity with horizontal depressions involving half the circumference of thigh, on the antero-lateral aspect. After seven female patients we observed this condition for the first time in the male. Therefore semicircular lipoatrophy is not specific to the female. The cause could not be determined clinically, nor by biochemical, immunological or histological methods. In our opinion semicircular lipoatrophy represents an ischemic atrophy of the fatty tissue, manifested by repeated microtraumata (corners of wash-basins, dressing tables or desks). The perfusion on the antero-lateral aspect of the thighs is tenous, especially when the course of the lateral femoral circumflex artery varies from the normal. In this case semicircular anastomotic areas become ischemic and horizontal bands of lipoatrophy result.

Technetium-99m stannous phytate as an imaging agent for lymph nodes.

This report describes preliminary results using technetium-99m stannous phytate as a lymph-node imaging agent in animals. After the subcutaneous administration there is good visualization of the draining nodes, best obtained 2-4 hr from the time of injection. There is also visualization of the liver, spleen, kidneys, and bladder. This agent appears suitable for lymph-node imaging in areas where the extranodal concentration does not interfere.