High-frequency ultrasonography-New non-invasive method in assessment of skin lymphomas.

BACKGROUND: Mycosis fingoides (MF) is the most common subtype of primary cutaneous T-cell lymphomas. Current evaluation of disease extent and severity is based on mSWAT scoring system, which seems to be relatively subjective. The aim of this subject was to present the usefulness of 20 MHz in objective 5-year long monitoring of response to therapy in MF patients. MATERIALS AND METHODS: The 5-years long follow-up based on 19 skin USG images of patients diagnosed as early stages of MF was studied. The assessed USG parameter was the mean diameter of subepidermal low echogenic band (SLEB). RESULTS: In every MF patient during exacerbation within lesional skin we could observe SLEB, which thinning or complete disappearance was detected after finishing the therapy. Lack of complete absence of SLEB was related to the lack of complete remission assessed by mSWAT. CONCLUSION: We present for the first time the possibility of monitoring patients' clinical state on the base of non-invasive USG imaging. We recommend additional use of 20 MHz USG to reduce intra-observer variability and to assess residual disease. USG imaging can complement evaluation of skin lesions in MF and can support clinical judgement.

Photoprotection: facts and controversies.

Excessive exposure of the skin to sunlight can lead to many negative effects, such as sunburn, photoaging and skin cancer development. Pollution and stratospheric ozone layer depletion are factors that increase exposure to ultraviolet radiation. This work is an accurate summary of the current state of knowledge on broad-spectrum photoprotection. Avoiding the sun, skin protection through the use of protective clothing and protective filters are currently the most effective methods of sunscreen provided that they are suitably used. In addition, discussed are controversial issues such as the toxicity of zinc used in sunscreen preparations and the potential for deficiency of vitamin D3 in relation with the application of strict photoprotection. The study has also addressed issues concerning the most recent lines of research in the exploration of modern methods of photoprotection both local and systemic, such as with the use of photolyase or examination of various enzymes repairing damage after sun exposure, as well as the promising future in photoprotection technology.

Monitoring of therapy in atopic dermatitis--observations with the use of high-frequency ultrasonography.

BACKGROUND: In reactive and proactive therapy of atopic dermatitis a well established agent is tacrolimus, a member of calcineurin inhibitors' family. The clinical safety and efficacy of this drug were evaluated previously in randomized multicenter trials. However, so far in clinical studies the assessment of its action on the skin has been made only on the basis of different scores and scales. We present the 6-month observations of tacrolimus therapy in atopic dermatitis patients monitored with the use of noninvasive techniques like high-frequency ultrasonography and evaporimetry. METHODS: The study consisted of 39 patients with AD and their mean age was 26.3 ± 12.8 years. The study lasted 6 months and every 4 weeks patient visited the outpatient clinic (totally 7 visits). The evaluation of disease severity within right antecubital fossa was obtained on the basis of Investigator's Global Assessment (IGA) score. During every control visit noninvasive measurements were carried in the form of HF-USG (with determination of subepidermal low echogenic band, SLEB) and evaporimetry. RESULTS: 39 patients started the study and 22 of them (54.6%) finished it. Out of 39 patients, 31 (79.5%) received at least 4 week long proactive treatment. We observed statistically significant change of IGA, mean SLEB value and TEWL during underwent therapy. There were also statistically significant differences in mean SLEB and TEWL values between lesional and nonlesional measures. CONCLUSIONS: This report shows the usefulness of HF-USG in monitoring tacrolimus therapy in atopic dermatitis. It is worth emphasizing, that this tool is easily reproducible and allows clinicians to visualize pathologic changes of all skin in vivo. As a noninvasive and independent of subjective judgment method, HF-USG should be included in overall evaluation of atopic dermatitis disease severity together with common scores or scales, especially in the era of evidence based medicine.

Topical tacrolimus vs medium-dose ultraviolet A1 phototherapy in the treatment of atopic dermatitis - a preliminary study in relation to parameters of the epidermal barrier function and high-frequency ultrasonography.

INTRODUCTION: Atopic dermatitis (AD) is a chronic, relapsing skin disorder, which is characterized by intense pruritus, skin dryness and concomitant epidermal barrier dysfunction. The basic therapy involves the application of anti-inflammatory topical drugs like; glucocorticosteroids and calcineurin inhibitors. Phototherapy in AD is regarded as an additional form of treatment. The latest invention, ultraviolet A1-UVA1 phototherapy (340-400 nm), was introduced to the treatment of AD by Krutmann et al in 1992. It appears that the main mode of action of UVA1 phototherapy in AD is through activation of apoptosis of T lymphocytes. Additionally, new studies show that UVA1 can also inhibit the activity of calcineurin phosphatase, similarly to calcineurin inhibitors such as cyclosporin A or tacrolimus. The aim of this study is to, for the first time, compare the efficacy of medium dose UVA1 phototherapy and tacrolimus ointment in patients with moderate-severe AD. PATIENTS AND METHODS: This study involved 20 AD patients. Half of the patients were treated with UVA1 phototherapy, while another 10 participants were treated with the application of tacrolimus ointment. The severity of the disease progress was assessed on the basis of EASI score (Eczema Area Severity Index). Moreover, the clinical condition of patients was assessed using non-invasive techniques such as measurement of transepidermal water loss - TEWL and skin capacitance, as well as high-frequency ultrasonography (20 MHz). RESULTS: This study described above confirmed the beneficial influence of both therapies on the course of moderate-severe AD. Tacrolimus induced a greater reduction in TEWL, while phototherapy caused the reduction of subepidermal low echogenic band-SLEB within sites affected with pathological lesions. CONCLUSIONS: Both tacrolimus and phototherapy treatment seemed to significantly reduce EASI.

Ultraviolet A1 phototherapy for mycosis fungoides.

BACKGROUND: Mycosis fungoides (MF) is the most common form of primary cutaneous lymphoma, and is characterized by a malignant proliferation of CD4+ cells. Psoralen ultraviolet A (PUVA) irradiation is the most common treatment for cutaneous lesions. However, PUVA carries the risk of adverse reactions to psoralens and long-term risk of skin cancer. UVA1 may be a safer alternative. AIM: To assess the efficacy of UVA1 phototherapy in patients with early-stage MF (T1-T2). METHODS: Four patients with early-stage MF were treated with 1630-2710 J/cm(2) UVA1 given in 29-40 fractions, and the effect was assessed by clinical examination and by high-resolution ultrasonography. RESULTS: Complete clinical remission of MF was achieved in all cases. CONCLUSIONS: This preliminary report indicates that UVA1 phototherapy might be an efficient treatment for early-stage MF.

[Detection of pituitary autoantibody in patients with pituitary tumors and hypopituitarism]. / Wykrywanie autoprzeciwcial przysadkowych u chorych z gruczolakami przysadki i w niedoczynnosci przysadki.

UNLABELLED: In 80 patients, 73 cases of pituitary tumours and 7 cases of hypopituitarism, we performed pituitary autoantibodies assays in serum samples because in our previous studies we had found a high prevalence of pituitary autoantibodies in several autoimmune endocrine disorders. To detect the presence of pituitary autoantibodies we applied 2 methods, radioimmunoassay (RIA) and immunoblotting. The RIA was performed by solid phase technique in human pituitary microsome-coated polyethylene tubes. Following incubation with diluted sera of the patients labelled 125I-protein A was added to the tubes to detect the retained antibodies. In the sera of 33 patients we detected the presence of antibodies; in the other 47 patients no antibodies were found. The majority of the patients with positive antibody results were previously treated by pituitary irradiation. To evaluate the molecular weights of pituitary autoantigens the microsomal proteins were separated on SDS PAGE, then electrophoretically transferred to nitrocellulose membranes and reacted with diluted sera of 30 antibody-positive patients. The nitrocellulose strips were incubated with labelled 125I-protein A and autoradiographed. Using immunoblotting, 13 out of these 30 patients we found autoantibodies reacting with pituitary microsomal antigens of different molecular weights, most frequently reacting with a 68 kDa autoantigen. CONCLUSIONS: The prevalence of pituitary autoantibodies in patients with pituitary diseases is 41% lower than in autoimmune endocrine diseases. Pituitary autoantibodies usually appear in patients after pituitary irradiation or after neurosurgery followed by irradiation, but occur rarely in untreated patients with pituitary adenomas.

[Histiocytosis X--report of 3 cases with different types of lung changes]. / Histiocytoza X--opis 3 przypadków o róznym przebiegu zmian plucnych.

Three cases of histiocytosis X were described. Diagnosis was confirmed with histological examination of the lung taken during pleuroscopy in 2 cases and--with typical HRCT lung scan in 1 case.

Evaluation of chemical tests for fetal bleeding from vasa previa.

OBJECTIVES: To evaluate different alkaline denaturation tests and compare with hemoglobin electrophoresis and the Kleihauer test, and to identify the simplest and most sensitive test that may help to rapidly show the presence of fetal hemoglobin and establish the diagnosis of fetal bleeding from vasa previa. METHODS: Maternal and fetal cord blood were obtained from 20 women with uncomplicated deliveries and the samples were mixed in known concentrations ranging from 0-100% fetal blood. Further samples were prepared in which maternal and fetal blood mixtures were diluted with amniotic fluid so that the final concentration of fetal hemoglobin similarly ranged from 0-100%. Alkaline denaturation tests (Apt, Ogita, Loendersloot), hemoglobin electrophoresis and Kleihauer tests were performed on all 40 samples. RESULTS: The Apt and Loendersloot tests were clearly positive at 60% concentrations of fetal blood. It took approximately 7 and 4 min, respectively, to complete the tests. The Ogita test was positive from fetal blood concentrations of 20% and took approximately 5 min. Hemoglobin electrophoresis took approximately 1 h to complete and the Hb-F band was present even at 0% concentration of fetal blood and the band became more marked with increasing fetal blood concentration. The Kleihauer test was negative at 0% but positive from 0.01% fetal blood concentration. The test took approximately 45 min to perform. CONCLUSIONS: The Ogita test is the best all round alkaline denaturation test that may help to rapidly identify the presence of fetal hemoglobin and so establish the need to expedite delivery when there is fetal bleeding from vasa previa. It is simple to perform, does not require sophisticated equipment, unlikely to give false positive results, and takes only 5 min. The simplicity of the test makes it attractive for routine use on the labor ward.