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  • 1
    Publication Date: 2017-09-26
    Keywords: ddc: 610
    Language: German
    Type: conferenceObject
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  • 2
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  51. Kongress für Allgemeinmedizin und Familienmedizin; 20170921-20170923; Düsseldorf; DOC17degam221 /20170905/
    Publication Date: 2017-09-05
    Keywords: ddc: 610
    Language: German
    Type: conferenceObject
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  • 3
    ISSN: 1432-1173
    Keywords: Schlüsselwörter Photochemotherapie ; Extrakorporale Photopherese ; Kutane T-Zell Lymphome ; Progressive systematische Sklerodermie ; Graft versus host Krankheit ; Key words Photochemotherapy ; Extracorporeal photopheresis ; Cutaneous T-cell lymphoma ; Progressive systemic scleroderma ; Graft-versus-host disease
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Extracorporeal photophoresis (ECP), a therapeutic modality that has been under investigation for some years, is based on separation of a leucocyte/lymphocyte-enriched cell fraction from the peripheral blood, extracorporeal treatment of the cells with 8-MOP/UVA and subsequent reinfusion of the cells in the patient. Its main effects seem to consist in changes to the immunologic behaviour of the photoinactivated/modulated cells. The immune response of the host is obviously stimulated by this treatment. ECP is normally performed for 4 h per day on 2 consecutive days every 4 weeks. The treatment is well tolerated and causes few side effects. In our department, 1210 ECP treatments were administered to 41 patients between 1990 and 1994 and a preliminary evaluation was performed. These patients included 21 with cutaneous T-cell lymphoma (CTCL), 10 with progressive systemic scleroderma, 4 with chronic graft-versus-host disease and 1 each with pemphigus vulgaris, epidermolysis bullosa acquisita, lupus erythematosus and cutaneous mucinosis. Patients with erythroderma and preserved immunocompetence achieved the best responses of all patients with CTCL. A treatment combining ECP with rlFN-α, PUVA and/or radiation was also successful in patients with tumour-stage CTCL and lymph node involvement. Progressive systemic scleroderma responded in more than 50% of our cases. Treatment results were impressive in 4 patients with chronic graft-versus-host disease presenting with sclerodermatous and lichenoid changes of the skin and mucous membranes. A clear improvement was also observed in the patient with pemphigus vulgaris refractory to standard therapies and in another patient with scleromyxoedema (Arndt-Gottron syndrome). The effectiveness of ECP seems to be quite well established in CTCL, but remains to be examined in autoimmune dermatoses. ECP is an attractive addition to the dermatological therapies available but our experience is still preliminary.
    Notes: Zusammenfassung Die Extrakorporale Photopherese (ECP) stellt ein seit fast 10 Jahren geübtes und inzwischen erprobtes Behandlungsverfahren dar, bei dem eine leukozytenangereicherte Zellfraktion aus dem peripheren Blut separiert, extrakorporal mit 8-MOP/UVA behandelt und anschließend dem Patienten reinfundiert wird. Hierbei werden Änderungen des immunologischen Verhaltens der photoinaktivierten und -modulierten Zellen bewirkt, die nach Reinfusion eine Immunantwort des Körpers induzieren sollen. Die ECP wird in der Regel in 4-wöchigen Abständen an 2 aufeinanderfolgenden Tagen über jeweils 4 Stunden durchgeführt. Sie ist gut verträglich und nebenwirkungsarm. Wir haben 1990 bis 1994 1210 ECP-Behandlungen bei 41 Hautkranken durchgeführt und vorläufig ausgewertet, darunter 21 Patienten mit kutanem T-Zell-Lymphom, 10 mit progressiver systemischer Sklerodermie und 4 mit chronischer Graft-versus-Host-Krankheit. CTCL-Patienten mit Erythrodermie und erhaltener Immunkompetenz sprachen am besten auf die ECP an. Im Rahmen einer Kombinationsbehandlung mit rIFN-α, PUVA und/oder lokaler Röntgenbestrahlung ließen sich auch fortgeschrittene CTCL im Tumorstadium mit LK-Befall erfolgreich mittels ECP angehen. Die Hälfte der Patienten mit PSS im aktiven Stadium spricht sehr gut an. Eindrucksvoll ist die Besserung der GvH-Krankheit mit sklerodermiformen Veränderungen. Kasuistische Erfahrungen mit günstigem Erfolg liegen uns bei Pemphigus vulgaris, Epidermolysis bullosa acquisita, Lupus erythematodes, kutaner Muzinose und Sklermyxödem Arndt-Gottron vor. Insgesamt dürfte die Wirkung der ECP bei cTCL und GvHD als weitgehend gesichert gelten, hingegen ist die Wirksamkeit bei Autoimmundermatosen noch weiter zu untermauern. Das Spektrum der Dermatotherapie erweitert sich durch das Verfahren der ECP erheblich.
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Der Hautarzt 51 (2000), S. 518-518 
    ISSN: 1432-1173
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1432-1173
    Keywords: Schlüsselwörter Shave-Exzision ; Nävi ; Rezidive ; Kosmetische Ergebnisse ; Frühmelanome ; Keywords Shave excision ; Nevi ; Recurrences ; Cosmetic results ; Early melanoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Background and objective. Shave excision of nevi is a technique still under debate. Speed, simplicity, and the fact that it provides excised material for histologic examination are contrasted with the lack of excision margins and a higher rate of nevus recurrences. In this study, the pros and cons of shave excision were evaluated. Patients and methods. Conventional excisions (268 nevi with intracutaneous butterfly sutures) and shave excisions (403 nevi) were compared with the patients' subjective assessments and objective parameters as recurrence, color, depth, surface smoothness of the scars, and the healing process. The nevi, found on the entire integument, ranged in diameter from 2 to 15 mm, with an average of 5 mm. A second excision was performed only in cases in which an early malignant melanoma could not be excluded. Results. Shave excisions were evaluated subjectively as being better. Shave excisions resulted in fewer complications (7.9% versus 15%), but recurrences were more frequent (18.1% versus 6.0%). There was no close realtionship between histopathologic finding of complete excision and recurrences. Conclusions. Small nevi without clinical suspicion of malignant melanoma can be removed with the shave excision technique with good results. Patients should be informed about the higher rate of recurrences. The appliance of the shave technique requires exact knowledge and experience, enabling good histopathologic examinations.
    Notes: Zusammenfassung Hintergrund und Fragestellung. Die Shave-Exzision von melanozytären Nävi ist umstritten. Der Schnelligkeit und Einfachheit des Eingriffs mit der Möglichkeit der histologischen Untersuchung des Exzisats stehen die oft knappe Entfernung und häufigere Nävusrezidive gegenüber. Hier werden Vor- und Nachteile gegeneinander abgewogen. Material und Methode. Konventionelle Exzisionen mit Wundverschluss durch intrakutane Schmetterlingsnähte (n=268) und Shave-Exzisionen (n=403) wurden verglichen durch die subjektive Beurteilung der Patienten und objektive Parameter wie Rezidiv, Farbe und Oberfächenbeschaffenheit der Narben. Die Nävi hatten einen Durchmesser von 2–15 mm, im Median 5 mm, und befanden sich am gesamten Integument. Eine Nachexzision erfolgte nur, wenn ein Frühmelanom nicht sicher auszuschließen war. Ergebnisse. Die Patienten bewerteten die Shave-Exzisionen etwas besser. Sie zeigten seltener Komplikationen (7,9% vs. 15%), aber häufiger Rezidive (18,1% vs. 6,0%). Es bestand keine enge Beziehung zwischen den histologischen Befunden inkompletter Exzision und Rezidiven. Schlussfolgerung. Kleinere Nävi sind recht gut durch Shave-Exzisionen zu entfernen, wenn kein Melanomverdacht besteht. Die höhere Rezidivrate muss dem Patienten mitgeteilt werden. Die Technik verlangt eingehende Kenntnis des Vorgehens und Erfahrung, damit gute histologische Untersuchungen gewährleistet sind.
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Der Hautarzt 51 (2000), S. 693-694 
    ISSN: 1432-1173
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1432-1173
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1432-1246
    Keywords: Key words Occupational UV radiation ; Lifeguard ; Mountain guide ; Ski instructor ; Occupational disease
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: Ultraviolet (UV) radiation is noted to be one of the most important risk factors for non-melanoma and melanoma skin cancers. The recent development of a spore film test chamber containing spores of Bacillus subtilis resulted in a new method of UV measurement with a spectral sensitivity profile similar to erythema-weighted data calculated from spectroradiometric measurements. Methods: The practical application of dosimeters was tested on 11 persons for 43 days, under different conditions of UV exposure in five different geographical regions. Four professional lifeguards at a public swimming pool carried dosimeters attached to their shoulders or to their caps, for 11 days. Three mountain guides attached dosimeters laterally to their heads on 27 different occasions of mountaineering activity in different mountain regions. Four ski instructors carried lateral head dosimeters during eight days of skiing in the Alps. Results: The life guards received daily UV exposures ranging from 3.6 to 9.5 minimal erythema doses (MED) (mean 5.9, SD ± 1.9). The mountain guides had personal daily UV exposures of from 4.4 to 17.1 MED (11.9 ± 3.9) and ski instructors from 2.8 to 8.8 MED (6.1 ± 1.8). Conclusions: Bacillus subtilis spore film dosimeters can be applied effectively for personal solar UV measurements of occupationally exposed persons, such as lifeguards, mountain guides and ski instructors. UV levels in these occupations exceed international limits of exposure.
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    Der Hautarzt 47 (1996), S. 473-474 
    ISSN: 1432-1173
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1432-1173
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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