Famciclovir for ophthalmic zoster: a randomised aciclovir controlled study.

AIMS: To compare the efficacy and safety of famciclovir with aciclovir for the treatment of ophthalmic zoster. METHODS: Randomised, double masked, aciclovir controlled, parallel group in 87 centres worldwide including 454 patients with ophthalmic zoster of trigeminal nerve (V(1)) comprised the intent to treat population. Oral famciclovir 500 mg three times daily or oral aciclovir 800 mg five times daily for 7 days. Assessments included day 0 (screening), days 3 and 7 (during treatment), days 10, 14, 21, 28 and monthly thereafter, up to 6 months (follow up). Proportion of patients who experienced ocular manifestations, severe manifestations and non-severe manifestations; loss of visual acuity was the main outcome measure. RESULTS: The percentage of patients who experienced one or more ocular manifestations was similar for famciclovir (142/245, 58.0%) and aciclovir (114/196, 58.2%) recipients, with no significant difference between groups (OR 0.99; 95% CI 0.68, 1.45). The percentage of patients who experienced severe and non-severe manifestations was similar between groups, with no significant difference. The prevalence of individual ocular manifestations was comparable between groups. There was no significant difference between groups for visual acuity loss. CONCLUSION: Famciclovir 500 mg three times daily was well tolerated and demonstrated efficacy similar to aciclovir 800 mg five times daily.

Economic evaluation of the treatment of chronic wounds: hydroactive wound dressings in combination with enzymatic ointment versus gauze dressings in patients with pressure ulcer and venous leg ulcer in Germany.

OBJECTIVE: The treatment costs for pressure ulcers and venous leg ulcers were estimated based on the hospital administrator's perspective in Germany. DESIGN: A spreadsheet model using input data from various hospitals in Germany was developed. INTERVENTIONS: Five currently used treatment strategies were analysed: gauze, impregnated gauze, calcium alginate and hydroactive wound dressing with enzymatic ointment. PARTICIPANTS: All cases used for and in the analysis were treated in the inpatient setting (4 hospitals and 120 patients were included). MAIN OUTCOME MEASURES AND RESULTS: The outcome distributions were calculated using the Monte Carlo method. For the whole treatment process, the attributable costs for the hospital were calculated for different cases (severity) and all treatment strategies (1997 values). The costs for treatment with gauze were the highest, whereas the costs for treatment with hydroactive wound dressings and enzymatic ointment were the lowest. The relation between personnel and material costs for gauze is approximately 95 to 5% and for hydroactive wound dressings 67 to 33%, respectively. The cost savings per case were between 1196 deutschmark (DM) and DM9826 using hydroactive wound dressings instead of gauze dressings (depending on the severity of the pressure ulcer), and between DM135 and DM677 for venous leg ulcers. The results were robust and did not change in any performed sensitivity analysis (parameter: 'personnel costs per minute', 'time required for changing a wound dressing', 'total number of wound dressing changes'). CONCLUSIONS: Despite the higher material costs of the hydroactive wound dressings in combination with enzymatic wound cleaning compared with other wound dressings, they should be recommended for the treatment of pressure ulcers and venous leg ulcers. This therapy alternative brings about significant reductions in total costs for hospitals because of significant reductions in personnel costs and the duration of treatment.

Expression of cathepsins in dermal fibrous tumors: an immunohistochemical study.

Cathepsins are lysosomal proteases that are distributed in many normal tissues and are primarily responsible for intracellular catabolism and turnover. The increased level of cathepsins in tumors together with their ability to degrade extracellular matrix proteins has led to the hypothesis that they are involved in the process of invasion and metastasis. We studied immunohistochemically the expression of cathepsins B, pro-D and pro-L in 8 cases of dermatofibrosarcoma protuberans (DFS), five cases of atypical fibroxanthoma (AFX) and twenty cases of dermatofibroma (DF). Expression of cathepsins B and pro-D could be detected in 5 of the 8 cases (62.5%) of DFS, whereas cathepsin pro-L was found in 4 (50%) cases. All AFX expressed cathepsin pro-L, whereas cathepsins B and pro-D were observed in 4 out of 5 cases. None of the malignant tumors showed a recurrence or metastasis after a period of four years. We found no expression of cathepsins in DF. In the epidermis and appendages, an expression of cathepsins pro-D, pro-L and B was seen. We conclude that cathepsins may be markers of increased metabolism rather than specific markers of malignancy.

Disseminated Kaposi's sarcoma that is not associated with acquired immunodeficiency syndrome in a bisexual man.

We report a case of a moderately disseminated, slowly progressing Kaposi's sarcoma, with a primary cutaneous nodule on the glans penis. The multifocal skin tumor appeared in a 44-year-old bisexual man and was not associated with acquired immunodeficiency syndrome.

Internet advice in dermatology and allergy: 1 year analysis of telerequests and answers.

The purpose of this study was to analyze the content and objectives of questions asked by internet users who accessed the homepage of the Department of Dermatology and Allergy Biederstein at the Technical University of Munich. Users were offered the opportunity to ask free questions on the Web site. The results of lay and medical individuals seeking advice were collected over a 12 month period and the answers given were reviewed. We received inquiries from 279 laypersons and 31 physicians. The majority of questions (53.8%) asked by non-medical users dealt with dermatology-related problems. Inquiries related to hair (13.3%) and acne or rosacea (11.3%) were most common. 46.2% of e-mail requests were allergy-related. Most of the interest focused on food allergy and adverse food reactions (22.5%) or hay fever and perennial rhinoconjunctivitis (19.4%). Previous consultation of a physician was reported in 40.9%. 13.6% had consulted an allergist or dermatologist. The majority of questions asked by physicians concerned allergy-related topics (64.6%). Most questions were answered by a short letter giving advice and encouraging the non-medical user to visit a dermatologist and/or allergist (72.4%). In 27.6% we felt that the inquiries were answered completely.

[Comparative studies of food product contamination with carcinogenic aromatic polycyclic hydrocarbons (APH) in the USSR and the GDR (defining the problem)]. / Sravnitel'nye issledovaniia zagriazneniia pishchevykh produktov kantserogennymi politsiklicheskimi aromaticheskimi uglevodorodami (PAU) v SSSR i GDR (k postanovke problemy).

The article is the first in a series of joint publications relating to work carried out in the USSR and GDR in studying possible carcinogenicity of alimentary products and pertinent preventive measures to exclude it. It contains brief information on the effect produced by carcinogenic additives in nutritional products upon the cancer involving the gastro-intestinal tract (in workers of meat packing plants and smokehouses). Under discussion is the relation between the disease-incidence and nutritional specificity. Major sources of possible carcinogenicity of alimentary products, such as additions of some dyestuffs, admixtures of some natural substances (cycsdine, thiourea, etc), contaminations of biological origin, with mycotoxins, carcinogens finding their way from the environment and, what is most important caused by specific technology of manufacturing the nutritional product (smoking, direct drying, frying, etc) are considered. The significance of carcinogenic PAH and benzpyrene, nitrose-amines and mycotoxins is discussed. The possibility and the need for determining carcinogenic compounds, of PAH above all, and their technical limitations in alimentary products with a view of preventing cancer of the gastro-intestinal tract are considered.

[Hyperlipoproteinemia type III with apolipoprotein E phenotype 2/2]. / Hyperlipoproteinämie Typ III mit Apolipoprotein E-Phänotyp 2/2.

A 47-year-old male patient with tuberous xanthomas, xanthochromia striata palmaris, hypercholesterolemia, hypertriglyceridemia, chylomicronemia and a "broad-beta" band on agarose gel electrophoresis is the subject of this report. The classification of the metabolic disturbances as hyperlipoproteinemia, type III, with apo E-3 deficiency was derived from the results obtained by isoelectric focusing and density gradient ultracentrifugation. Since June 1983, the patient has been successfully treated with probucol (Lurselle) with no complementary diet. The serum cholesterol concentration was reduced by a maximum of 45%, together with clear regression of the xanthochromia striata palmaris and beginning xanthoma regression. The HDL cholesterol level did not climb again, and there were no side effects as a result of the probucol therapy.

[Interactions of toxic trace elements with special regard to selenium]. / Zur Wechselwirkung toxischer Spurenelemente unter besonderer Berücksichtigung des Selens.

The significance of the trace elements in nutrition is often decisively affected by the interaction of trace elements with other trace elements and of trace elements with other substances. These processes, which include synergistic and antagonistic effects, are of great importance not only to the essentiality, but also to the toxicity of trace elements. There is considerable experience with interactions of essential elements. There is considerable experience with interactions of essential elements or of elements in essential concentrations. On contrast, there is a scarcity of information pertaining to toxic effects that are influenced by synergisms and antagonisms. This situation is illustrated by some examples and especially by the role of selenium. It is shown that these problems deserve closer attention.

[Therapy of herpes zoster]. / Therapie des Zoster.

Regarding the treatment of herpes zoster, aciclovir (ACV) is as the most effective and safe drug available. ACV reduces the viral shedding time and promotes the cutaneous healing and pain resolution. Oral ACV in high doses (5 x 800 mg daily), as well, has proved effective in the treatment of acute herpes zoster. If there is no convincing effect on the pain, additional application of corticoids in high doses may be of benefit.

[Therapy of herpes simplex]. / Therapie des Herpes simplex.

The efficiency of nucleoside analogs for the management of herpes-simplex-infections has been established. It has been pointed out by many studies, that aciclovir is well tolerated and shortens both symptoms and lesions of herpes-simplex-infections. A continuous oral aciclovir management up to six month suppresses recurrences of genital herpes under therapy significantly.

[Formation and occurrence of cancer-producing hydrocarbons in cereals and possibilities for their reduction]. / Untersuchungen zur Bildung und zum Vorkommen krebserzeugender Kohlenwasserstoffe in Getreide und Möglichkeiten zu ihrer Reduzierung.

According to the authors' investigations every inhabitant of the GDR takes between 0.2 and 1.0 mg BaP. per year by food consumption including amounts of 0.03 to 0.17 mg on account of cereals and mill products. For the contamination of cereals the following sources are in consideration: environmental contamination on account of industry dust (distant from industry 0.1 to 0.6, near to industry 0.3 to 4.2 micrograms BaP/kg), passing over from soil to plant (with model experiments with soils more than 10 000 micrograms BaP/kg up to 22.3 micrograms BaP/kg dry matter) as well as technologically caused contamination for instance by direct fume-and-gas drying (with the use of raw lignite up to 10 micrograms BaP/kg). As it can be concluded from model experiments BaP passes to flour at milling in dependence of the extraction rate. By separating the husks prior to milling more than 50% of BaP can be removed from the stock.

[Climate therapy of psoriasis: critical evaluation]. / Klimatherapie der Psoriasis: Kritische Wertung.

As with many chronic, recurrent skin diseases, psoriasis in all its forms is within the domain of dermatological climatotherapy. However, this is only successful in genuinely stimulating climates, such as in the North Sea islands or in particularly high alpine regions (over 1500 m) under correct topographical conditions. If dermatological climatotherapy is to retain its justifiably good name, care must be taken not to misuse this important therapeutic means (unsuitable climates), or it may be discredited due to insufficient conditions and thus poor results.

[Mycosis fungoides. Results of helioclimate therapy in high mountains (Davos, 1,560)]. / Mycosis fungoides. Ergebnisse einer Helioklimatherapie im Hochgebirge (Davos, 1560 m).

The efficacy of topical steroids, chemotherapy, photochemotherapy, grenz-ray therapy and electron beam therapy has already been established in the treatment of mycosis fungoides. In addition, the results of dermatological climatotherapy in the high Alpine region (Davos, 1,560 m) demonstrate that natural sun irradiation in this particular climate is very effective in treating mycosis fungoides. A total of 63% out of 128 treatment cycles of 84 patients suffering from mycosis fungoides went into remission, which lasted a maximum of at least 13 months. The best results are obtained in the early stages of mycosis fungoides and if climatotherapy lasts long enough and is repeated.