A randomized, intraindividual, non-inferiority, Phase III study comparing daylight photodynamic therapy with BF-200 ALA gel and MAL cream for the treatment of actinic keratosis.

BACKGROUND: The most effective treatment modality for actinic keratosis (AK) is photodynamic therapy (PDT). Major obstacles of PDT are the need of a special illumination device and pain accompanying the illumination. These issues may be overcome by replacing an artificial high-power light source with natural daylight for more extended illumination at lower light doses. OBJECTIVE: To determine whether BF-200 ALA (a nanoemulsion gel containing 7.8% 5-aminolaevulinic acid) is non-inferior to MAL (a cream containing 16% methyl-aminolaevulinate) in the treatment of mild-to-moderate AK with daylight PDT (dPDT). Non-inferiority of the primary efficacy variable (total lesion clearance rate per patient's side 12 weeks after PDT) is established if the mean response for BF-200 ALA is no worse than for MAL, within a statistical margin of Δ = -12.5%. METHODS: The study was performed as an intraindividual comparison with 52 patients in seven centres in Germany and Spain. Each patient received one dPDT. Results include clinical endpoints as well as 1-year follow-up results. RESULTS: Twelve weeks after a single dPDT, 79.8% of the AK lesions treated with BF-200 ALA gel and 76.5% of the lesions treated with MAL cream were completely cleared. The median of differences was 0.0 with a one-sided 97.5% CI of 0.0, establishing non-inferiority (P < 0.0001). Results for secondary efficacy parameters were in line with the primary outcome. Recurrence rates 1 year after the treatment were 19.9% for lesions treated with BF-200 ALA and 31.6% for lesions treated with MAL. Adverse reactions including pain were mostly mild and transient and identical to those previously described for dPDT. CONCLUSION: Daylight PDT of AK with BF-200 ALA is well-tolerated and non-inferior to MAL/dPDT. The study demonstrates a trend towards higher efficacies after 3 months and significantly lower recurrence rates after 1 year follow-up.

SAHA induces caspase-independent, autophagic cell death of endometrial stromal sarcoma cells by influencing the mTOR pathway.

Endometrial stromal sarcomas are rare and molecular mechanisms involved in their pathogenesis are poorly understood. Covalent modifications of histone proteins, in particular de/acetylation of lysine residues, play an important role in the regulation of gene transcription in normal and neoplastic cells, but there are only limited data about these processes in solid mesenchymal tumours. We treated endometrial stromal sarcoma cells (ESS-1) and non-malignant human endometrial stromal cells (HESCs) with suberoylanilide hydroxamic acid (SAHA), a histone deacetylase inhibitor. SAHA was able to mediate the cell cycle and expression of genes related to the malignant phenotype of endometrial stromal tumours, eg p21(WAF1) and HDAC7. SAHA led to dose-dependent differentiation and death of ESS-1 cells but not of HESCs. Exposure of HESCs to SAHA resulted only in slightly decreased cell proliferation. SAHA also increased the p21(WAF1) expression and caused significant changes in the cell cycle by inhibiting the G1/S transition in ESS-1 cells. Recovery experiments indicated that these changes became irreversible when the tumour cells were treated with SAHA for longer than 24 h. In our experimental system, not apoptotic but autophagic processes were responsible for the cell death. Monodansyl cadaverine accumulation in treated ESS-1 cells and decreased expression of the mTOR and phospho-S6 ribosomal protein (S6rp) additionally supported this observation. Taken together, our study indicates that HDACs might be considered as potential drug targets in the therapy of stromal sarcomas and that SAHA might be a promising therapeutic agent for endometrial stromal sarcoma.

Are allergic reactions to skin clips associated with delayed wound healing?

BACKGROUND: Metal skin clips are used in surgery. They may contain metals that might cause allergic reactions and delayed wound healing. METHODS: The metal composition of 18 different surgical clamps was examined. The allergy status of 184 patients was determined by patch tests and was correlated with the clinical outcome of wound healing after application of skin clips. RESULTS: Skin clips contained chromium, nickel, molybdenum, cobalt, and titanium in concentrations high enough to cause allergic reactions. Eighteen percent of the men and 23% of the women were sensitive to nickel and 16% of the men to chromium. We found a positive correlation between the grade of nickel allergy and the reaction to the skin clips. CONCLUSIONS: Our study suggests that allergic reactions and delayed wound healing can be caused by the use of surgical skin clips. Therefore skin clips are not recommended for patients with a history of contact dermatitis to metals and/or atopy.

The triage-function of a psychosomatic liaison-service for gynecological patients.

The psychosomatic psychotherapeutic consultation liaison (CL)-service for gynecological patients at the Vienna University has been evaluated. Research interest focused on success and failure of the initial interview, conceptualized for a specific clientele. The interview has a triage function for treatment planning. By the type of treatment that was applied, patients were divided into three groups: Group A, patients with one single contact with the unit; Group B, patients who were referred to external psychotherapy; Group C, patients who were treated with short-term psychoanalytic psychotherapy as offered by the service unit. The drop-outs figured as Group D. The questionnaires completed by the patients at the first consultation and 6 moths after their final contact with the clinic covered socio-demographic data, ego functions; the motivation for psychotherapy, a complaints list and finally, at the second contact only, an individual retrospective judgement concerning personal consequences of the consultation. Patients needs in CL-services call for quick decisions, which therapeutic measure would be most adequate. An experienced clinician's decision is based on several circumstances: individual feeling of suffering, therapy-motivation and ego-strength, as well as social and demographic facts. Comparing groups with different therapeutic recommendations showed that the psychometric tests discriminated well between these four groups and thus the validity of the clinical recommendation has been confirmed.

Self-report versus interview data of women's subjective theories of illness: concordance and predictive validity in a psychosomatic-gynecological liaison service.

Between-method comparisons of patient data from standardized self-report instruments and corresponding patient interview data frequently have poor agreement. We investigated the concordance and predictive validity of self-report measures and expert-rated interview data of women's subjective theories of illness in a psychosomatic-gynecological consultation liaison service. 31 patients completed two questionnaires (KKG, PATEF) on subjective theories of illness and were interviewed with a semistructured instrument on the same topic at the time of the initial appointment and after 1.5 years. External criteria for assessing the predictive validity of questionnaire versus interview data were: follow-up participation and psychotherapy utilization during the follow-up interval. Questionnaire and interview rating data were only modestly associated. Rater concordance on the interview data was low. Neither the initial-assessment interview nor the questionnaire data had predictive validity for patients' participation in the follow-up. None of the interview rating data but a portion of the questionnaire data, had predictive validity for patients' utilization of psychotherapy during the follow-up interval. The cognitive conceptualization of subjective theories of illness may fail in patients with psychosomatic disorders, due to their very mode of experience. A wider approach that includes assessment of nonverbal communication and countertransference might be useful.

[Sarcoid granuloma in green tattooing]. / Sarkoide Granulome in grüner Tätowierung.

The case report is presented of a 34-year old man with the sudden appearance of multiple granulomas at the site of green tattoo markings which had been undertaken 8 years previously. Unusual was his case history of an anaphylactic reaction after the ingestion of green pistachio nuts. A non-immunological food intolerance without cross-reaction to the dye of the green tattoo namely phthalocyanine, was detected. Aerosil, colloidal silica, was found to be the trigger substance; it was present exclusively in the green dye, and was responsible for the patient's sarcoid reaction. Excision of the green tattoos employing pedicle flaps was successful. At the latest follow-up examination no features of sarcoidosis were detected.

[Celery allergy (celery contact urticaria syndrome) and relation to allergies to other plant antigens]. / Sellerieallergie (Selleriekontakturtikariasyndrom) und Zusammenhänge mit Allergien gegen andere Pflanzenantigene.

Comparative study of 13 patients (group A) with severe attacks of angio-oedema and urticaria after eating celery and 143 atopics with hypersensitivity to mugwort-pollen (group B). Due to the severity of the reactions (group A) no oral provocation tests were performed. Scratch chamber tests with raw and cooked celery (and related plants) confirmed the case histories. RAST answers to celery were compared for both groups. RAST inhibition indicated that celery and mugwort-pollen and also celery and birch-pollen allergens cross-react. Whether or not the reactions (in group A) are type I allergic or non-specific reactions is discussed. The term celery-"contact urticaria syndrome" should be used (Maibach and Johnson, 1975).

[Rudolf Ekstein's contributions to psychotherapy and child psychiatry]. / Rudolf Eksteins Beiträge zur Psychotherapie und Kinderpsychiatrie.

Rudolf Eksteins scientific career is closely linked to his personal history, with his Jewish heritage, his political involvement and his social work with young people, which guided him towards psychoanalytic educational theory. Following his forced emigration to the USA in 1938 he became a world-famous child therapist, psychoanalyst, scientist and professor of medical psychology at the Department of Psychiatry, UCLA. The most significant areas of Eksteins extensive scientific output are described in an attempt to do justice to his contributions to psychotherapy and child psychiatry. Eksteins introduction of a special technique for treating psychotic children with psychoanalytic psychotherapy was of major importance. His underlying concept of schizophrenic psychosis and borderline personality disorders in children is outlined. Further, we have tried to show in what way his contributions to psychoanalytic theory and techniques were influenced by his profound knowledge of philosophy and linguistics. Finally Eksteins dedications to the teaching and learning of psychotherapy is stressed, from which a whole generation of Austrian psychiatrists, psychologists and pedagogues have profited enormously, as a result of his long-standing teaching commitments as guest professor at Vienna University.

[The problem of delays of effective medical treatment in female patients with breast cancer]. / Zur Frage der Verzögerung effektiver medizinischer Behandlung bei Patientinnen mit Mammakarzinom.

In a study on psycho-social aspects of breast-cancer, information is presented on delays in the initiation of medical treatment. Two types of delay are distinguished: 1. Patient delay: i.e. the time elapsing between initial discovery of a lump in the breast by the patient herself and her seeking medical opinion; and 2. iatric delay: i.e. the time span between first presentation of the symptom by the patient to the doctor and onset of effective treatment. In order to obtain this information, semi-structured psychoanalytically oriented interviews, including rating scales for ego functions were carried out in a group of 32 patients with metastatic breast carcinoma. Patient delay is connected with the significance given to the symptom by the patient. This significance seems to depend on the degree to which the patient is informed, and on her body image, influenced by previous pregnancies and childbirth. Iatric delay is probably largely independent of these factors. Such delay cannot even be influenced by patients who take their symptoms seriously and request medical attention immediately. When trying to define a population at risk for breast cancer, the importance of denial is stressed as an additional factor.

Medical students' attitudes towards psychotherapy: an intervention-based pre-post comparison.

BACKGROUND: Despite a wealth of studies on medical students' attitudes towards psychiatry in general, little is known about their specific attitudes towards psychotherapy. There is no evidence on the flexibility of these attitudes in the context of a curriculum-implemented psychotherapy information session. OBJECTIVES: To assess medical students' attitudes towards psychotherapy and short-term flexibility therein, with an introductory course on psychotherapy as the relevant intervention for this pre-post comparison. METHODS: A random sample of 159 advanced medical students completed a short questionnaire before and after a short course on psychotherapy. The questionnaire consisted of indirect attitude measures towards psychotherapy (associations and connotations), a likelihood rating for future training in psychotherapy, a statement about one's most preferred medical specialty for one's future career, and basic demographics. RESULTS: Participants' pre-interventional connotations of psychotherapy were predominantly positive. In the pre-post comparison, more than one third of the connotation measures shifted substantially and favorably. Post-interventionally, participants' distinctive static word association style regarding psychotherapy was attenuated in favor of a more differentiated style and an enlarged field of associations. The data are suggestive of significant pre-interventional sex differences, with females holding more positive views towards psychotherapy and reporting a greater likelihood of future psychotherapeutic training. The data also suggest that the intervention acted differently upon the sexes. Likelihood ratings for future training in psychotherapy did not decline after the course, despite the fact that the cost and duration of training were mentioned in the course. CONCLUSIONS: Even minimal educational interventions can enhance medical students' predominantly positive attitudes towards psychotherapy. This finding calls for further implementation of psychotherapy-related material in medical curricula.

[Quality control in the allergy laboratory--4 years "Allergy Ring Trial" in Austria]. / Qualitätskontrolle im Allergielabor--4 Jahre "Ringversuch Allergie" in Osterreich.

In 1988 the Austrian Society for Allergology and Immunology initiated an external quality control program for the in vitro allergy diagnosis. In 12 mailings, 62 sera from allergic patients were sent to selected laboratories in order to determine total and antigen specific IgE according to the laboratory-specific methods. The values for total IgE varied considerably (73.9% were within +/- 1 SD, 94.3% within +/- 2 SD and 99.1% within +/- 2 SD, but only 0.9% beyond that). Sources of error were mainly attributable to inappropriate equipment and low quality reagents, but also bad test performance, with respect to personnel and the routines. In contrast, antigen specific IgE against pollen, mites, moulds, insect venoms, animal danders, drugs, parasites, environmental and food antigens revealed quite homogeneous results. Out of 1492 data, only 46 (3.1%) had to be declared as "wrong", and the variability of the RAST-classes was low. Whereas the quality of the reagents from all the different suppliers was not absolutely reliable at the beginning of the study, it improved considerably with time, as consequence of our complaints. The comparability of the methods for detecting total-IgE were non-satisfactory, whereas those for antigen specific IgE were generally good. The variety of methods employed (radio- and enzyme immunologic, fluoro- and nephelometric methods, etc.) should entail appropriate consequences, especially critical comparisons within one and the same laboratory; in addition, international standardization of the "normal" values should replace company-standards, and quality control programs for each test system before it is marketed should be mandatory. Our results confirm, that external control should be obligatory for any laboratory.(ABSTRACT TRUNCATED AT 250 WORDS)

[Psychic effects of an adjuvant hormone replacement therapy in premenopausal patients: influence on the quality of life]. / Psychische Auswirkungen einer adjuvanten Hormonersatztherapie bei prämenopausalen Patientinnen: Einfluss auf die Lebensqualität.

The influence of acute and chronic affects on hormonal activities via the neuropeptides is beyond speculation: for some women, times of hormonal changes are more likely to be linked with affective disorders - the biological or sociocultural reasons may be heterogenous. Our aim must be to identify this group at risk and offer hormonal, psychopharmacological, or psychotherapeutical support. We cannot rely on evidence-based recommendations for improving the quality of life in patients with gynecological malignoma by hormone replacement therapy. But we have evidence that adequate psychotherapeutic support has a positive effect on the individual woman s well-being.

[Food allergies--oropharyngeal reactions]. / Nahrungsmittelallergien--oropharyngeale Reaktionen.

Clinical symptoms induced by eating foods of plant origin in pollen allergic individuals are the cause of special interest. The investigation of 286 patients with a sensitation to pollen revealed, that oral and pharyngeal reactions to vegetal foods were seen in a high percentage (about 70% in birch-pollen allergic patients).

[Frequency of the so-called "apple allergy" ("apple contact urticaria syndrome") in patients with birch pollinosis]. / Zur Häufigkeit sogenannter "Apfelallergie" ("Apfelkontakt-Urticariasyndrom")bei Patienten mit Birkenpollenallergie.

Rhinitis, itching and tingling and other mild reactions on the oropharyngeal mucosa are the most common complaints after eating raw apples (in about 30% of patients with hypersensitivity to birch pollen). Angioedema, urticaria and shock are rare, but must be noticed. On the basis of three case reports we are illustrating the difficulties of reliable test procedures. 49 patients have been examined by means of "scratch-chamber" test method, RAST and peroral provocation tests. The nature of the actual allergens (lectins?) is still unknown. The term "contact urticaria syndrome" should be used.