Methods for the evaluation of the protective efficacy of sunscreen products.

The objective of the present investigation was to examine the utilization of optical and spectroscopic methods for the noninvasive characterization of Anthelios XL Fluide Extreme (SPF 50+), an exemplary sunscreen, concerning its homogeneity of distribution on the skin, its spectroscopic properties and its overall protective efficacy. The homogeneity of the distribution of the sunscreen on the skin was investigated with a multiphoton tomography microscope. Additionally, the sum transmission spectrum was determined using tape stripping and spectroscopic measurements. The results revealed a very homogeneous distribution of the sunscreen on the skin surface and also in the deep furrows. The sum transmission spectrum reflects a high protective efficacy of the sunscreen in both the UVA and UVB ranges. The sunscreen Anthelios XL Fluide Extreme (SPF 50+) generates a comfortable feeling on the skin and can be easily distributed. The presented optical methods have been shown to be suitable to investigate the overall protective efficacy of sunscreen products objectively, noninvasively and quickly.

Comparison of the antiseptic efficacy of tissue-tolerable plasma and an octenidine hydrochloride-based wound antiseptic on human skin.

Colonization and infection of wounds represent a major reason for the impairment of tissue repair. Recently, it has been reported that tissue-tolerable plasma (TTP) is highly efficient in the reduction of the bacterial load of the skin. In the present study, the antiseptic efficacy of TTP was compared to that of octenidine hydrochloride with 2-phenoxyethanol. Both antiseptic methods proved to be highly efficient. Cutaneous treatment of the skin with octenidine hydrochloride and 2-phenoxyethanol leads to a 99% elimination of the bacteria, and 74% elimination is achieved by TTP treatment. Technical challenges with an early prototype TTP device could be held responsible for the slightly reduced antiseptic properties of TTP, compared to a standard antiseptic solution, since the manual treatment of the skin surface with a small beam of the TTP device might have led to an incomplete coverage of the treated area.

Non-invasive analysis of penetration and storage of Isoconazole nitrate in the stratum corneum and the hair follicles.

Bacteria and fungi are located in the stratum corneum and the hair follicles. Therefore, the development and assessment of efficient drugs requires standard in vivo investigation methods permitting a differentiation between intercellular and follicular penetration and storage of topically applied anti-microbial substances. In the present study, the penetration and storage of Isoconazole nitrate in the stratum corneum and hair follicles was investigated by differential stripping after a 14-day topical application period and during a follow-up period of a further 21 days. One week after the application had terminated, Isoconazole nitrate could still be detected in concentrations above the minimal inhibition concentration in the stratum corneum and the hair follicles. In some subjects, Isoconazole nitrate could even be detected 14 days after the last application. No relevant changes in TEWL values were measured, indicating that the investigated compound did not induce an impairment of the barrier function. The study showed that differential stripping is suited to investigate the penetration and storage of topically applied substances into the stratum corneum and the hair follicles. Also, the hair follicles are a long-term reservoir for topically applied substances. This is of clinical importance, where a long-lasting therapeutic effect beyond the application time is required.

In vivo investigations on the penetration of various oils and their influence on the skin barrier.

BACKGROUND: The skin represents a potent barrier to the environment, which can be enhanced by the topical application of skin care products, such as oil and oil-based formulations by moisturizing the skin. METHODS: The aim of this study was the investigation of the penetration behaviour of four vegetable oils and of paraffin oil into the stratum corneum by laser scanning microscopy. In addition, the occlusion capacity of these substances was assessed by transepidermal water loss (TEWL) measurements. Petrolatum served as a positive control for skin occlusion. The study was conducted in vivo and included six healthy volunteers. RESULTS: Paraffin oil, as well as the vegetable oils, penetrated only into the first upper layers of the stratum corneum. TEWL measurements indicated that the application of the vegetable oils (except jojoba oil) as well as paraffin oil, led to a similar occlusion of the skin surface. The most effective occlusion was found for petrolatum. CONCLUSION: For the investigated oils, a deeper penetration than into the first upper layers of the stratum corneum could be excluded. The decreased TEWL values indicate that the application of the oils leads to a semi-occlusion of the skin surface as it is intended by the use of oils to retain moisture in skin.

[Hepatocellular carcinoma in pregnancy]. / Hepatozelluläres Karzinom in der Schwangerschaft.

Primary hepatocellular carcinoma is a very rare disease, especially in association with a pregnancy. We report on a 22-year-old primigravida, who underwent Caesarean section in the 29th week of pregnancy in conjunction with tumour-reductive surgery for hepatocellular carcinoma. The further course of the disease was characterised by an early recurrence and lung metastases. Under palliative chemotherapy with 5-fluorouracil, the patient has been in a state of stable disease for several months. Typical risk factors for the hepatocellular carcinoma do not exist in the patient. Alternative explanations for the aetiology of the disease are discussed.

[Ovarian cancers and simultaneous primary cancers of the upper female genital tract]. / Ovarialkarzinome und simultane primäre Zweitkarzinome des oberen weiblichen Genitaltraktes.

258 patients with ovarian carcinomas who underwent surgery at the University Women's Hospital Charlottenburg/Berlin (during 1980-1987) and at the I. University Women's Hospital Munich (during 1987-1990) were re-examined for the occurrence of a simultaneous primary secondary carcinoma in the upper genital tract. The diagnoses were made according to strict histological criteria. In 13 cases (5%) simultaneous carcinomas of the upper genital tract were found. In this group we would like to especially mention 6 of the 33 patients (18.2%) with an endometroid ovarian carcinoma, 3 of the 47 patients (6.4%) with an ovarian tumor of low malignant potential and 1 of the 12 patients with a serous-papillary carcinoma of the peritoneum ("non-ovarian carcinoma of the ovary"). In our opinion these carcinomas are independent multifocal primaries originating from the primary and secondary Mullerian epithelium. Staging protocols of these simultaneous tumors, especially prognostic estimation and development of therapeutic strategies should consider this possible multifocal pathogenesis.

[Late disorders of bladder function after Wertheim operation--an analysis of urodynamic parameters with reference to surgical radicality]. / Späte Blasenfunktionsstörungen nach Wertheim-Operation--eine Analyse von urodynamischen Parametern unter Berücksichtigung der operativen Radikalität.

Permanent disturbances of bladder function are the most unpleasant and least tolerated side effects in patients, who underwent Wertheim hysterectomy because of cervical cancer. The cause of this problem with respect to the radical nature of the operation in relation to the possibly and responsible anatomical structures (sacrouterine ligament, parametrium, paracolpium) has not been completely elucidated. The aim of this prospective study was, to determine this interrelation in 39 (out of 120 radically hysterectomised) patients subjected to urodynamic examination preoperatively and 6-8 months postoperatively after Wertheim hysterectomy. With regard to preserved or lost postoperative bladder sensitivity, no correlation was found to either the length of the vaginal cuff or the parametric tissue. A statistically significant correlation was found between the length of the resected parametric tissue and the onset of postoperative stress urinary incontinence. Furthermore, there was a statistically significant correlation between the length of the resected vaginal cuff and the bladder capacity. The urodynamic parameters of maximum flow-rate, flow-time and residuals correlated rather with the radical nature of removal of the parametrial tissue than with the radicality of the vaginal resection, but that was not significant. The study leads to the conclusion, that within the variations of radical hysterectomy with medium radicality (Wagner-Wertheim procedure), the results presented here are not strikingly different regarding postoperative disturbances of bladder function. To determine such differences, investigations after more radical procedures (e.g. Latzko) would be more suitable.

[Neuroendocrine cancer of the uterine cervix: an especially aggressive form of cancer with clinical, diagnostic and therapeutic characteristics]. / Das neuroendokrine Karzinom der Cervix uteri: Eine besonders aggressive Krebsform mit klinischen, diagnostschen und therapeutischen Besonderheiten.

The compilation of neuroendocrine carcinomas of the cervix uteri comprises a rare group of carcinomas characterised by particularly aggressive behaviour. These carcinomas can be described and differentiated from similar carcinomas with different biological behaviour by light microscopy and immunohistochemical investigations. We present three patients with neuroendocrine carcinoma of the cervix, stage I b, all of them operated according to Wertheim's operation with pelvic lymphadenectomy and in one case paraaortal lymphadenectomy. In all three cases we found a clinical manifestation of hematogenic metastases. Since we are not aware of any reports on this form of carcinoma in German literature, we would emphasise the importance of diagnostic differentiation between neuroendocrine carcinomas of the cervix and other similar carcinomas of this localisation, in particular since this form of carcinoma requires specific therapeutic procedures.

[Hermaphroditism verus: clinical aspects, diagnosis and therapy in adulthood]. / Hermaphroditismus verus: Klinik, Diagnose und Therapie im Erwachsenenalter.

A 20-year old woman, who underwent an intersex operation during infancy, was presented for evaluation of the gonads because of suspected true hermaphroditism. The phenotype was female with regular menstruations. Examination revealed an ovarian tumour of 8 cm on the left side and a normal right ovary. During the operation, the tumour was revealed as an endometriosis cyst, which could be excised whilst preserving the ovarian tissue. The right gonad was an ovotestis. The testicular part was removed because of a 4% risk of malignancy. The different combinations of ovary/testis and ovotestis are described. Diagnosis and therapy of true hermaphroditism should be performed as early as possible to obtain an adequate gonadal function and an undisturbed psychosexual development.

[Success and quality control in prolapse and stress incontinence operations--comparative use of urodynamics and transrectal endosonography]. / Erfolgs- und Qualitätskontrolle von Deszensus- und Stressinkontinenzoperationen--Vergleichende Anwendung von Urodynamik und transrektaler Endosonographie.

We evaluated the significance of urodynamic parameters versus transrectal ultrasound with regard to postoperative outcome-control after operation for procedentia and urinary stress incontinence. We studied 30 continent women and 84 women with purely stress induced urinary incontinence. All had a pre- and postoperative urodynamic testing including urethral profilometry and cystometry, paralleled by a transrectal ultrasound examination. From the urodynamic parameters only the transmission ratio is suitable to judge the surgical outcome, although it is less correlative to the patient's complaints (p = 0.033) than the bladder neck mobility (p < 0.0001, Tab. 5). Within the rather short time of follow-up, each of the operation-techniques was able to improve the bladder neck mobility significantly. Nevertheless, anterior colporrhaphia is not suitable for incontinence-surgery (Fig. 2/Tab. 5). Concerning operative results, transrectal endosonography was found to be an adequate or even superior method as compared to urodynamic studies, because it can likewise demonstrate the function of the bladder neck, but furthermore can show the morphologic aspects of bladder, urethra and pelvic floor. As a result, for the first time, this minimal invasive method offers quality control for the individual surgeon as well as for long-term follow-up studies after operation for procedentia and stress induced urinary incontinence without using much time or causing great discomfort to the patient.

[The psychological status of the female with urinary incontinence]. / Die psychische Situation der harninkontinenten Frau.

In the former western part of Germany, in 1989 about three million people claimed social costs because of urinary incontinence. 80 percent of them were women. The psychic situation of these women is mainly determined by social consequences of their incontinence. Behavioural changes to avoid incontinence lead to social isolation. A coherence between incontinence or urgency and agony or depression is acknowledged. Especially in elderly people, who have to change their well-known environment due to nursing problems, incontinence is a major problem, which often deteriorates with the new situation. Incontinence also leads to avoidance of sexuality. Women are mostly more irritated than their partners. On the other hand incontinence is used to avoid sexuality and thus may be a sign of a sexual conflict.

[Serous papillary cancer of the peritoneum: a multicentric primary disease]. / Das serös-papilläre Karzinom des Peritoneums: eine multizentrische Primärerkrankung.

Protocols and histologic slides of 258 patients who underwent surgery for the diagnosis of an ovarian carcinoma from 1980 to 1987 at the University Hospital Charlottenburg/Berlin and from 1987 to 1990 at the I. University Women's Hospital Munich were reexamined. 12 out of 165 patients with a serous carcinoma were classified under the diagnosis of a peritoneal serous papillary carcinoma with minimal or absent ovarian involvement. These cases could be differentiated from patients with primary serous ovarian carcinomas by the sole existence of progressed FIGO stages. Especially the picture of small disseminated nodes could be seen. The excessive involvement of pelvic and paraaortic lymph nodes was impressive as well. The peritoneal carcinomatosis consisting of small nodes in our opinion could best be explained by in situ orthotopic multifocal growth. We were able to prove the in-situ genesis of these lesions in 6 of 12 cases by histologic examination. In this group of patients with peritoneal primary serous carcinoma we find the example for a multifocal disease originating from the coelomic epithelium.

Postoperative urological complications after radical surgery for cervical cancer.

Functional disorders of the lower urinary tract must be considered inevitable after Wertheim hysterectomy. These disorders include disturbances of the collecting phase as well as of the voiding phase of the bladder, and the development of urinary stress-incontinence. Urodynamic studies are necessary to find out more about the pathophysiology of these disorders. The results of our follow-up studies confirm that during the early postoperative phase patients do not feel the urge to void, and, after micturition, have no idea whether or not the bladder is empty. Micturition itself becomes difficult. At a later stage, sensitivity in respect of the bladder contents is regained. Some months later the incidence of urinary stress-incontinence rises markedly. The dysfunction is due partly to direct trauma of the bladder and urethra. As a reason for the long-lasting fall in urethral closure pressure, combined with urinary stress-incontinence, some damage to the pelvic nerves must be assumed. Disorders of micturition have been poorly investigated. It is only during the postoperative phase that functional infravesical obstruction must be assumed. At a later stage micturition mostly becomes normal. In contrast to the results of others (Schüssler, 1988) the results of our studies confirm that these disorders are due not only to nerve lesions. Disorders of the collecting phase as well as of the voiding phase of the bladder are mostly transient. As a consequence we suggest that the direct operative trauma, with oedema, haematoma and scar formation, is responsible for bladder dysfunctions during the early postoperative stage at least.(ABSTRACT TRUNCATED AT 250 WORDS)

[Significance of the urethral pressure profile in the diagnosis of urethral diverticulum]. / Die Bedeutung des Urethradruckprofils bei der Diagnostik des Harnröhrendivertikels.

Diverticulum of the urethra was diagnosed by us in ten women during the past two years. In nine of these, the urethral pressure profile showed a characteristic course: In the region of the diverticulum--confirmed subsequently by radiography--a drop in pressure was recorded as a sign of damage to the wall. The value and importance of the individual steps in the diagnosis of diverticula are discussed. Suspicion of a diverticulum in the urethra can be raised by careful anamnesis and by means of the urethral pressure profile. This suspicion can be safely confirmed or refuted via urethrography using the double-balloon catheter.

[Initial experiences with transvaginal sonography of the urethra and bladder within the scope of the diagnosis of incontinence]. / Erste Erfahrungen mit der transvaginalen Sonographie von Urethra und Blase im Rahmen der Inkontinenz-Diagnostik.

Female urinary incontinence can be visualized only insufficiently be means of static methods such as the lateral cystourethrogram. Detailed information on physiology and morphology or pathological abnormalities can be gained only by means of dynamic methods, where transvaginal or transrectal sonography could become the method of choice. The essential advantages of this method over the conventional imaging methods are discussed.

Changes in urethral closure pressure after radical hysterectomy for cervical cancer.

The behaviour of the urethral closure pressure at rest (UCP) both before and 14 days and 3 months after radical surgery for cervical cancer was examined. The results were compared with those of other authors. In contrast to the latter we were only able to establish a constant pressure drop in patients using a transurethral catheter at the time of the first postoperative measurement. Patients using a suprapubic catheter showed non-uniform postoperative UCP-changes. This pattern was comparable to that found after simple abdominal hysterectomy, performed for other reasons, in which a transurethral catheter had been in place for a maximum of 60 h. In contrast to our predecessors we were unable to confirm a causal relationship between surgical damage to the sympathetic system and postoperative falls in pressure, except after extremely radical surgery. The cause appears to be a complex process involving wound healing problems (edema, infection, scar formation and organ position changes) and direct traumatization of the urethra (transurethral catheter).

[CT diagnosis of glomus-jugulare tumours]. / CT-Diagnostik der Glomus-jugulare-Tumoren.

Glomus-jugulare tumours (chemodectomas, non-chromaffin paragangliomas) are semi-malignant tumours arising from the glomus structures of the jugular bulb. They are soft tissue tumours which usually expand the jugular foramen and destroy its bony margins. Conventional methods of examination are therefore very effective. However, they only demonstrate the bone destruction and are therefore an indirect method for showing the tumour. The actual size and extent of the tumour, which are important for the surgeon or radiotherapist, cannot be demonstrated by simple x-rays. Computer tomography is very effective in the diagnosis of soft tissue lesions in the skull. CT is therefore of great importance in the diagnosis of glomus-jugulare tumours.