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Enk AH, Hadaschik EN, Eming R, Fierlbeck G, French LE, Girolomoni G, Hertl M, Jolles S, Karpati S, Steinbrink K, Stingl G, Volc-Platzer B, Zillikens D. European Guidelines (S1) on the use of high-dose intravenous immunoglobulin in dermatology. J Eur Acad Dermatol Venereol 2016; 30:1657-1669. [PMID: 27406069 DOI: 10.1111/jdv.13725] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 02/09/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND The treatment of severe dermatological autoimmune diseases and toxic epidermal necrolysis (TEN) with high-dose intravenous immunoglobulin (IVIg) is a well-established procedure in dermatology. As treatment with IVIg is usually considered for rare clinical entities or severe clinical cases, the use of immunoglobulin is not generally based on data from randomized controlled trials that are usually required for the practice of evidence-based medicine. Owing to the rarity of the indications for the use of IVIg, it is also unlikely that such studies will be available in the foreseeable future. Because the high costs of IVIg treatment also limit its first-line use, the first clinical guidelines on its use in dermatological conditions were established in 2008 and renewed in 2011. MATERIALS AND METHODS The European guidelines presented here were prepared by a panel of experts nominated by the EDF and the EADV. The guidelines were developed to update the indications for treatment currently considered as effective and to summarize the evidence base for the use of IVIg in dermatological autoimmune diseases and TEN. RESULTS AND CONCLUSION The current guidelines represent consensual expert opinions and definitions on the use of IVIg reflecting current published evidence and are intended to serve as a decision-making tool for the use of IVIg in dermatological diseases.
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Affiliation(s)
- A H Enk
- Department of Dermatology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany.
| | - E N Hadaschik
- Department of Dermatology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - R Eming
- Department of Dermatology, Philipps-University Marburg, Marburg, Germany
| | - G Fierlbeck
- Department of Dermatology, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - L E French
- Department of Dermatology, University of Zurich, Zurich, Switzerland
| | - G Girolomoni
- Department of Dermatology, University of Verona, Verona, Italy
| | - M Hertl
- Department of Dermatology, Philipps-University Marburg, Marburg, Germany
| | - S Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - S Karpati
- Department of Dermatology, Semmelweis University Budapest, Budapest, Hungary
| | - K Steinbrink
- Department of Dermatology, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - G Stingl
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - B Volc-Platzer
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - D Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
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Hunzelmann N, Riemekasten G, Becker M, Moinzadeh P, Kreuter A, Melchers I, Mueller‐Ladner U, Meier F, Worm M, Lee H, Herrgott I, Pfeiffer C, Fierlbeck G, Henes J, Juche A, Zeidler G, Mensing H, Günther C, Sárdy M, Burkhardt H, Koehm M, Kuhr K, Krieg T, Sunderkötter C. The Predict Study: low risk for digital ulcer development in patients with systemic sclerosis with increasing disease duration and lack of topoisomerase‐1 antibodies. Br J Dermatol 2016; 174:1384-7. [DOI: 10.1111/bjd.14367] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- N. Hunzelmann
- Department of Dermatology and Venereology University Hospital of Cologne Kerpener Straße 62 Köln 50937 Germany
| | - G. Riemekasten
- Department of Rheumatology and Clinical Immunology University of Berlin, Charité Berlin Germany
| | - M.O. Becker
- Department of Rheumatology and Clinical Immunology University of Berlin, Charité Berlin Germany
| | - P. Moinzadeh
- Department of Dermatology and Venereology University Hospital of Cologne Kerpener Straße 62 Köln 50937 Germany
| | - A. Kreuter
- Helios St Elisabeth Clinic Dermatology and Venereology Oberhausen Germany
| | - I. Melchers
- University Medical Center Freiburg Clinical Research Unit for Rheumatology Freiburg Germany
| | - U. Mueller‐Ladner
- Justus Liebig University Giessen Kerckhoff Clinic Rheumatology and Clinical Immunology Bad Nauheim Germany
| | - F. Meier
- Justus Liebig University Giessen Kerckhoff Clinic Rheumatology and Clinical Immunology Bad Nauheim Germany
| | - M. Worm
- Department of Dermatology and Venereology University of Berlin, Charité Berlin Germany
| | - H. Lee
- Department of Dermatology and Venereology University of Berlin, Charité Berlin Germany
| | - I. Herrgott
- Department of Dermatology and Department of Translational Dermatoinfectiology University of Muenster Muenster Germany
| | - C. Pfeiffer
- University Hospital Ulm Dermatology Ulm Germany
| | - G. Fierlbeck
- Department of Dermatology University of Tübingen Tübingen Germany
| | - J. Henes
- Department of Rheumatology University of Tübingen Tübingen Germany
| | - A. Juche
- Johanniter Hospital Treuenbrietzen Rheumatology Treuenbrietzen Germany
| | - G. Zeidler
- Johanniter Hospital Treuenbrietzen Rheumatology Treuenbrietzen Germany
| | - H. Mensing
- Hamburg Alstertal Clinic for Dermatology Hamburg Germany
| | - C. Günther
- University Hospital Carl Gustav Carus Dermatology Dresden Germany
| | - M. Sárdy
- Ludwig Maximilian University Dermatology and Allergology Munich Germany
| | - H. Burkhardt
- Goethe‐University Frankfurt & Clinical Research Fraunhofer IME Translational Medicine and Pharmacology (TMP), RheumatologyFrankfurt/Main Germany
| | - M. Koehm
- Goethe‐University Frankfurt & Clinical Research Fraunhofer IME Translational Medicine and Pharmacology (TMP), RheumatologyFrankfurt/Main Germany
| | - K. Kuhr
- Institute of Medical Statistics, Informatics and Epidemiology University Hospital of Cologne Kerpener Straße 62 50937 Köln Germany
| | - T. Krieg
- Department of Dermatology and Venereology University Hospital of Cologne Kerpener Straße 62 Köln 50937 Germany
| | - C. Sunderkötter
- Department of Dermatology and Department of Translational Dermatoinfectiology University of Muenster Muenster Germany
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Moinzadeh P, Riemekasten G, Fierlbeck G, Henes J, Blank N, Melchers I, Mueller-Ladner U, Kreuter A, Susok L, Guenther C, Zeidler G, Pfeiffer C, Worm M, Aberer E, Genth E, Distler J, Hein R, Sárdy M, Mensing H, Koetter I, Sunderkoetter C, Hellmich M, Krieg T, Hunzelmann N. SAT0440 New Data on Renal Crisis and Predictive Markers from More Than 3000 Patients. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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4
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Guenova E, Schanz S, Hoetzenecker W, DeSimone J, Mehra T, Voykov B, Urosevic‐Maiwald M, Berneburg M, Dummer R, French L, Kerl K, Kamarashev J, Fierlbeck G, Cozzio A. Systemic corticosteroids for subcutaneous panniculitis‐like T‐cell lymphoma. Br J Dermatol 2014; 171:891-4. [DOI: 10.1111/bjd.13053] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2014] [Indexed: 11/30/2022]
Affiliation(s)
- E. Guenova
- Department of Dermatology University Hospital Zurich Gloriastraße 31 Zürich Switzerland
- Department of Dermatology University of Tübingen Liebermeisterstrasse 25 72076 Tübingen Germany
| | - S. Schanz
- Department of Dermatology University of Tübingen Liebermeisterstrasse 25 72076 Tübingen Germany
| | - W. Hoetzenecker
- Department of Dermatology University Hospital Zurich Gloriastraße 31 Zürich Switzerland
- Department of Dermatology University of Tübingen Liebermeisterstrasse 25 72076 Tübingen Germany
| | - J.A. DeSimone
- Washington Hospital Center Department of Dermatology Georgetown University Washington DC U.S.A
| | - T. Mehra
- Medical Directorate University Hospital of Zürich Rämistraße 100 8091 Zürich Switzerland
| | - B. Voykov
- Department of Dermatology University of Tübingen Liebermeisterstrasse 25 72076 Tübingen Germany
| | - M. Urosevic‐Maiwald
- Department of Dermatology University Hospital Zurich Gloriastraße 31 Zürich Switzerland
| | - M. Berneburg
- Department of Dermatology University of Tübingen Liebermeisterstrasse 25 72076 Tübingen Germany
- Department of Dermatology University Hospital Regensburg Franz‐Josef‐Strauss‐Allee 11 D‐93053 Regensburg Germany
| | - R. Dummer
- Department of Dermatology University Hospital Zurich Gloriastraße 31 Zürich Switzerland
| | - L.E. French
- Department of Dermatology University Hospital Zurich Gloriastraße 31 Zürich Switzerland
| | - K. Kerl
- Department of Dermatology University Hospital Zurich Gloriastraße 31 Zürich Switzerland
| | - J. Kamarashev
- Department of Dermatology University Hospital Zurich Gloriastraße 31 Zürich Switzerland
| | - G. Fierlbeck
- Department of Dermatology University of Tübingen Liebermeisterstrasse 25 72076 Tübingen Germany
| | - A. Cozzio
- Department of Dermatology University Hospital Zurich Gloriastraße 31 Zürich Switzerland
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Moinzadeh P, Elisabeth A, Blank N, Distler J, Fierlbeck G, Genth E, Guenther C, Hein R, Henes J, Hellmich M, Herrgott I, Koetter I, Kreuter A, Krieg T, Melchers I, Mensing H, Mueller-Ladner U, Pfeiffer C, Riemekasten G, Sárdy M, Susok L, Worm M, Wozel G, Zeidler G, Sunderkoetter C, Hunzelmann N. FRI0488 Analysis of REAL Life Vasoactive Therapy in over 3000 Patients with Systemic Sclerosis (SSC) Reveals Considerable Undertreatment and Significant Changes of Treatment Practice since 2004. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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6
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Schanz S, Häfner HM, Ulmer A, Fierlbeck G. Quality of life in men with involuntary childlessness: long-term follow-up. Andrologia 2013; 46:731-7. [DOI: 10.1111/and.12140] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2013] [Indexed: 11/29/2022] Open
Affiliation(s)
- S. Schanz
- Department of Dermatology; Eberhard Karl University; Tübingen Germany
| | - H.-M. Häfner
- Department of Dermatology; Eberhard Karl University; Tübingen Germany
| | - A. Ulmer
- Department of Dermatology; Eberhard Karl University; Tübingen Germany
| | - G. Fierlbeck
- Department of Dermatology; Eberhard Karl University; Tübingen Germany
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7
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Moinzadeh P, Hunzelmann N, Mueller-Ladner U, Meier F, Riemekasten G, Becker M, Kreuter A, Wozel G, Melchers I, Sardy M, Herrgott I, Graefenstein K, Fierlbeck G, Pfeiffer C, Worm M, Burkhardt H, Mensing H, Kuhr K, Sunderkoetter C, Krieg T. SAT0209 The Risk for Initial Digital Ulcer Involvement in SSC Patients Decreases with Disease Duration Since the Beginning of Raynaud Phenomenon. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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8
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Moinzadeh P, Hunzelmann N, Krieg T, Blank N, Fierlbeck G, Genth E, Kötter I, Kreuter A, Melchers I, Pfeiffer C, Müller-Ladner U, Riemekasten G, Sunderkötter C. FRI0244 Assessing organ involvement and current symptoms as indicators for disease progression in 3047 patient cohort. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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9
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Kötter I, Xenitidis T, Fierlbeck G, Schanz S, Melms A, Horger M, Ernemann U, Deuter C. [Behçet's disease]. Z Rheumatol 2012; 71:685-96; quiz 697. [PMID: 23052559 DOI: 10.1007/s00393-012-1012-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Behçet's disease is a systemic disorder with the histopathological correlate of leukocytoclastic vasculitis. Pathogenetically, besides a strong genetic component participation of the innate immune system and an autoinflammatory component are discussed. The disease is most common in countries along the former silk route but in Germany the disease is rare (prevalence approximately 0.6/100,000). Oral aphthous ulcers are the main symptom, followed by skin manifestations, genital ulcers and oligoarthritis of large joints. Severe manifestations, threatening quality of life and even life itself, are the gastrointestinal manifestations which often perforate, arterial, mainly pulmonary arterial aneurysms which cause life-threatening bleeding, CNS manifestations and ocular disease, which with occlusive retinal vasculitis often leads to blindness. For milder manifestations low-dose steroids and colchicine are used, for moderate manifestations such as arthritis or ocular disease not immediately threatening visual acuity, azathioprin or cyclosporin A are combined with steroids. For severe manifestations, interferon-alpha, TNF-antagonists or cytotoxic drugs are recommended. Interleukin 1 (IL-1) antagonists are currently being examined in clinical studies.
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Affiliation(s)
- I Kötter
- Zentrum für Interdisziplinäre Rheumatologie Stuttgart, Rheumatologische Schwerpunktpraxis Stuttgart Bad-Cannstatt, Seelbergstr. 11, 70372, Stuttgart, Deutschland.
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10
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Kötter I, Xenitidis T, Fierlbeck G, Schanz S, Melms A, Horger M, Ernemann U, Deuter C. Extraokuläre Manifestationen des Morbus Behçet. Ophthalmologe 2012; 109:548-57. [DOI: 10.1007/s00347-011-2502-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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11
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Quist S, Fierlbeck G, Seaton R, Loeffler J, Chaves R. Comparative randomised clinical trial against glycopeptides supports the use of daptomycin as first-line treatment of complicated skin and soft-tissue infections. Int J Antimicrob Agents 2012; 39:90-1. [PMID: 21982144 DOI: 10.1016/j.ijantimicag.2011.08.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 08/18/2011] [Accepted: 08/24/2011] [Indexed: 10/16/2022]
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12
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Schreiner T, Brzoska J, Fierlbeck G. Topical application of tretinoin, interferon beta and their combination in the treatment of flat warts. J DERMATOL TREAT 2009. [DOI: 10.3109/09546639509080584] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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13
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Huppert PE, Fierlbeck G, Pereira P, Schanz S, Duda SH, Wietholtz H, Rozeik C, Claussen CD. Transarterial chemoembolization of liver metastases in patients with uveal melanoma. Eur J Radiol 2009; 74:e38-44. [PMID: 19467811 DOI: 10.1016/j.ejrad.2009.03.064] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Revised: 02/03/2009] [Accepted: 03/13/2009] [Indexed: 11/27/2022]
Abstract
Metastases from uveal melanoma are often confined to the liver. Palliative hepatic chemoembolization has been considered to be a reasonable treatment approach. We enrolled 14 patients with hepatic metastases from uveal melanoma into a pilot trial of transarterial chemoembolization (TACE). All patients received additional systemic immuno-chemotherapy or best supportive care. In 31 procedures 100mg/m(2) of cisplatine was continuously infused by means of a power injector preceding embolization by manual injection of polyvinyl alcohol particles. In three procedures cisplatine was replaced by 200mg/m(2) carboplatine because of increased serum creatinine levels. Tumor response was evaluated using RECIST criteria. Fourteen patients received 34 TACE's (mean: 2.4 treatments). Eight patients (57%) achieved partial response (PR), four patients (29%) had stable disease and two patients (14%) tumor progression. Median time to progression was 8.5 months (5-35 months). Median survival after first TACE was 14.5 months in responders compared to 10 months in non-responders (p=0.18, not significant) and 11.5 months (3-69 months) in all patients. In seven patients with metastases occupying less than 25% of liver volume median survival was 17 months compared to 11 months in seven patients with tumor involvement of more than 25% (p=0.02) with partial response rate of 86% and 29%, respectively. TACE of liver metastases from uveal melanoma is well tolerated and may prolong survival in patients with limited tumor extension.
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Affiliation(s)
- P E Huppert
- Department of Diagnostic and Interventional Radiology, Klinikum Darmstadt, Darmstadt, Germany.
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Jaissle GB, Ulmer A, Henke-Fahle S, Aisenbrey S, Fierlbeck G, Bartz-Schmidt KU, Szurman P. [Intraocular bevacizumab as palliative therapy in melanoma-metastasis-associated rubeotic secondary glaucoma]. Klin Monbl Augenheilkd 2009; 226:70-2. [PMID: 19173168 DOI: 10.1055/s-2008-1027782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- G B Jaissle
- Universitäts-Augenklinik, Department für Augenheilkunde,Eberhard-Karls-Universität Tübingen, Tübingen.
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Hunzelmann N, Genth E, Krieg T, Lehmacher W, Melchers I, Meurer M, Moinzadeh P, Müller-Ladner U, Pfeiffer C, Riemekasten G, Schulze-Lohoff E, Sunderkoetter C, Weber M, Worm M, Klaus P, Rubbert A, Steinbrink K, Grundt B, Hein R, Scharffetter-Kochanek K, Hinrichs R, Walker K, Szeimies RM, Karrer S, Müller A, Seitz C, Schmidt E, Lehmann P, Foeldvári I, Reichenberger F, Gross WL, Kuhn A, Haust M, Reich K, Böhm M, Saar P, Fierlbeck G, Kötter I, Lorenz HM, Blank N, Gräfenstein K, Juche A, Aberer E, Bali G, Fiehn C, Stadler R, Bartels V. The registry of the German Network for Systemic Scleroderma: frequency of disease subsets and patterns of organ involvement. Rheumatology (Oxford) 2008; 47:1185-92. [PMID: 18515867 PMCID: PMC2468885 DOI: 10.1093/rheumatology/ken179] [Citation(s) in RCA: 188] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective. Systemic sclerosis (SSc) is a rare, heterogeneous disease, which affects different organs and therefore requires interdisciplinary diagnostic and therapeutic management. To improve the detection and follow-up of patients presenting with different disease manifestations, an interdisciplinary registry was founded with contributions from different subspecialties involved in the care of patients with SSc. Methods. A questionnaire was developed to collect a core set of clinical data to determine the current disease status. Patients were grouped into five descriptive disease subsets, i.e. lcSSc, dcSSc, SSc sine scleroderma, overlap-syndrome and UCTD with scleroderma features. Results. Of the 1483 patients, 45.5% of patients had lcSSc and 32.7% dcSSc. Overlap syndrome was diagnosed in 10.9% of patients, while 8.8% had an undifferentiated form. SSc sine scleroderma was present in 1.5% of patients. Organ involvement was markedly different between subsets; pulmonary fibrosis for instance was significantly more frequent in dcSSc (56.1%) than in overlap syndrome (30.6%) or lcSSc (20.8%). Pulmonary hypertension was more common in dcSSc (18.5%) compared with lcSSc (14.9%), overlap syndrome (8.2%) and undifferentiated disease (4.1%). Musculoskeletal involvement was typical for overlap syndromes (67.6%). A family history of rheumatic disease was reported in 17.2% of patients and was associated with early disease onset (P < 0.005). Conclusion. In this nationwide register, a descriptive classification of patients with disease manifestations characteristic of SSc in five groups allows to include a broader spectrum of patients with features of SSc.
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Affiliation(s)
- N Hunzelmann
- Department of Dermatology and Venerology, University of Cologne, Kerpener Str. 62, 50924 Cologne, Germany.
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Ulmer A, Wölbing F, Metzler G, Schanz S, Fierlbeck G, Röcken M. Severe exacerbation of chronic plaque psoriasis following initially effective therapy with efalizumab: clinical characterization and therapeutic management. Br J Dermatol 2008; 158:867-9. [DOI: 10.1111/j.1365-2133.2008.08455.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Kötter I, Fierlbeck G, Wacker A, Schanz S, Hetzel J, Schedel J. Diagnostik und Therapie der Systemsklerose. AKTUEL RHEUMATOL 2008. [DOI: 10.1055/s-2008-1027392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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18
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Hoetzenecker W, Schanz S, Schaller M, Fierlbeck G. Generalized tinea corporis due to Trichophyton rubrum in ichthyosis vulgaris. J Eur Acad Dermatol Venereol 2007; 21:1129-31. [PMID: 17714151 DOI: 10.1111/j.1468-3083.2006.02117.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Ulmer A, Metzler G, Schanz S, Fierlbeck G. Dapsone in the management of 'insect bite-like reaction' in a patient with chronic lymphocytic leukaemia. Br J Dermatol 2007; 156:172-4. [PMID: 17199590 DOI: 10.1111/j.1365-2133.2006.07576.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Schanz S, Baeckert-Sifeddine IT, Braeunlich C, Collins SE, Batra A, Gebert S, Hautzinger M, Fierlbeck G. A new quality-of-life measure for men experiencing involuntary childlessness. Hum Reprod 2005; 20:2858-65. [PMID: 15980002 DOI: 10.1093/humrep/dei127] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Infertility may considerably reduce quality-of-life. Many of the existing generic quality-of-life measures, which often focus on physical impairments, do not represent the specific complaints of infertile patients. In this article, we report on the development and validation of the TLMK (Tübinger Lebensqualitätsfragebogen für Männer mit Kinderwunsch), an instrument for measuring quality-of-life in male patients with involuntary childlessness. METHODS The first version of the questionnaire, which consisted of 91 items, was administered to 275 men who attended andrology and gynaecology clinics for fertility evaluations. After the questionnaires were scored, item analysis and reduction, principal component analysis and internal consistency analyses were conducted. RESULTS The final version of the TLMK consists of 35 items in four scales and provides an internally consistent quality-of-life profile for men experiencing involuntary childlessness. Convergent and discriminant validity was supported through the correlation of the TLMK scales with established questionnaires on life satisfaction (FLZ) and partnership (PFB). CONCLUSION The TLMK provides information about the quality-of-life in men experiencing involuntary childlessness and was found to be easy to administer and acceptable to patients. It may be used to assess patients' baseline and ongoing quality-of-life during fertility treatment and as an outcome variable in the evaluation of integrated psychological counselling.
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Affiliation(s)
- S Schanz
- Department of Dermatology, Eberhard-Karls-University, Tübingen, Germany.
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Forschner A, Autenrieth IB, Fierlbeck G. Soft-tissue abscess caused by Salmonella enterica serovar Enteritidis at the site of melanoma metastasis. Clin Microbiol Infect 2004; 10:86-7. [PMID: 14706095 DOI: 10.1111/j.1469-0691.2004.00808.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Anorectal malignant melanoma is an uncommon tumour. Unlike for cutaneous melanoma, there are few guidelines for its optimal management. In particular, very few palliative treatment strategies have been described for patients with advanced disease. We report on an 80 year old patient with locally advanced anorectal melanoma nearly completely blocking the anal orifice and disseminated metastases. Complete regression of the primary tumour and partial remission of the metastases was achieved with intratumoral injections of natural interferon-beta and systemic administration of dacarbazine. The quality of life in this patient was improved markedly by providing relief from severe rectal pain and bleeding. We propose that conservative treatment strategies such as intratumoral injections with interferon-beta should be considered as a palliative treatment option for stenosing anorectal melanoma before an abdominoperineal resection is recommended.
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Affiliation(s)
- A Ulmer
- Universitäts-Hautklinik, Eberhard-Karls-Universität, Liebermeisterstr. 25, D-72076 Tübingen, Germany
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Abstract
Mycophenolate mofetil (MMF) is an immunosuppressive agent that has been shown to be effective in transplant patients. Some case reports and pilot studies have suggested efficacy against systemic lupus erythematosus (LE), particularly in the case of lupus nephritis. Reports on MMF treatment of skin manifestations of LE are still anecdotal. We report two cases with extensive skin lesions owing to subacute cutaneous LE (SCLE). Both patients had been treated with azathioprine and antimalarials without effect. Finally both patients were given highly dosed glucocorticosteroids, which were also ineffective but led to vertebral fractures because of long-term steroid treatment in one patient and steroid-induced psychosis in the other. MMF 2 g daily caused the skin manifestations to disappear within a few weeks in both patients. One patient was followed up for more than 24 months, and showed good toleration of MMF treatment. The skin remained stable over this period when at least 1 g MMF per day was administered. In conclusion, MMF appears to be an attractive treatment option in skin manifestations of SCLE, and seems to be beneficial for patients with steroid-refractory lesions that are also resistant to treatment with immunosuppressants or antimalarials. The observations suggest that further evaluation of this route in randomized controlled trials is warranted.
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Affiliation(s)
- S Schanz
- Department of Dermatology, University of Tübingen, Liebermeisterstrasse 25, Germany
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Abstract
The detection of circulating melanoma cells has been the subject of numerous investigations in recent years. We developed a cellular approach to identifying circulating melanoma cells in peripheral blood using immunomagnetic cell sorting. The examination covered 205 blood samples from 155 melanoma patients and 30 samples from healthy persons and nonmelanoma patients. After density gradient centrifugation, the interphase was incubated with the 9.2.27 antibody. Positive cells were labeled with magnetic microbeads and enriched by immunomagnetic cell sorting. Cells were stained using an alkaline phosphatase-anti-alkaline phosphatase assay and examined by light microscopy. In spiking experiments, melanoma cells seeded at a concentration of one melanoma cell per milliliter of whole blood could be detected reliably. Circulating melanoma cells were not found in 30 controls, nor were 9.2.27-positive cells found in 41 patients with primary malignant melanoma. In patients with regional lymph node metastases and disseminated disease, circulating 9.2.27-positive cells could be detected in 3 of 29 patients (10%) and 13 of 85 patients (15%) examined, respectively. We conclude that immunomagnetic cell sorting is a promising method with high sensitivity and specificity. The method is not suitable for early detection of metastases but is a valuable tool for further investigating the biological characteristics of circulating melanoma cells.
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Affiliation(s)
- A Benez
- Department of Dermatology, Eberhard-Karls-University, Tübingen, Germany
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Benez A, Metzger S, Metzler G, Fierlbeck G. Aleukemic leukemia cutis presenting as benign-appearing exanthema. Acta Derm Venereol 2001; 81:45-7. [PMID: 11411915 DOI: 10.1080/00015550117638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Aleukemic leukemia cutis is a rare condition characterized by the infiltration of the skin by leukemic cells before their appearance in the peripheral blood or bone marrow. We report here a 62-year-old seemingly healthy patient who presented with disseminated erythematous maculae. A skin biopsy showed leukemia cutis of monocytic type. No involvement of bone marrow or peripheral blood was found. The patient developed acute monocytic leukemia 7 months later. We present this case to illustrate how leukemia cutis can masquerade as a clinically benign-appearing cutaneous eruption without leukemic changes in blood or bone marrow. To confirm the diagnosis of aleukemic leukemia cutis, immunohistochemistry of the skin lesions as well as a complete staging procedure is necessary.
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Affiliation(s)
- A Benez
- Department of Dermatology, University of Tubingen, Germany
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Abstract
Subcutaneous panniculitic T-cell lymphoma is categorized as a subtype of peripheral T-cell lymphoma. Patients typically present with nontender subcutaneous nodules. The characteristic histologic features include the presence of atypical lymphocytes and benign macrophages that infiltrate between the adipocytes of the subcutis mimicking panniculitis. We report a 75-year old patient with a three week history of asymptomatic subcutaneous nodules. The diagnosis of subcutaneous T-cell lymphoma was confirmed by immunohistological and molecular biological studies. Chemotherapy had to be interrupted due to a rapid worsening of the patient's general condition. She died few weeks after confirmation of diagnosis.
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Affiliation(s)
- A Benez
- Universitäts-Hautklinik Tübingen
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Middleton MR, Grob JJ, Aaronson N, Fierlbeck G, Tilgen W, Seiter S, Gore M, Aamdal S, Cebon J, Coates A, Dreno B, Henz M, Schadendorf D, Kapp A, Weiss J, Fraass U, Statkevich P, Muller M, Thatcher N. Randomized phase III study of temozolomide versus dacarbazine in the treatment of patients with advanced metastatic malignant melanoma. J Clin Oncol 2000; 18:158-66. [PMID: 10623706 DOI: 10.1200/jco.2000.18.1.158] [Citation(s) in RCA: 857] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To compare, in 305 patients with advanced metastatic melanoma, temozolomide and dacarbazine (DTIC) in terms of overall survival, progression-free survival (PFS), objective response, and safety, and to assess health-related quality of life (QOL) and pharmacokinetics of both drugs and their metabolite, 5-(3-methyltriazen-1-yl)imidazole-4-carboximide (MTIC). PATIENTS AND METHODS Patients were randomized to receive either oral temozolomide at a starting dosage of 200 mg/m(2)/d for 5 days every 28 days or intravenous (IV) DTIC at a starting dosage of 250 mg/m(2)/d for 5 days every 21 days. RESULTS In the intent-to-treat population, median survival time was 7.7 months for patients treated with temozolomide and 6.4 months for those treated with DTIC (hazards ratio, 1.18; 95% confidence interval [CI], 0.92 to 1.52). Median PFS time was significantly longer in the temozolomide-treated group (1.9 months) than in the DTIC-treated group (1.5 months) (P =.012; hazards ratio, 1.37; 95% CI, 1.07 to 1.75). No major difference in drug safety was observed. Temozolomide was well tolerated and produced a noncumulative, transient myelosuppression late in the 28-day cycle. The most common nonhematologic toxicities were mild to moderate nausea and vomiting, which were easily managed. Temozolomide therapy improved health-related QOL; more patients showed improvement or maintenance of physical functioning at week 12. Systemic exposure (area under the curve) to the parent drug and the active metabolite, MTIC, was higher after treatment with oral temozolomide than after IV administration of DTIC. CONCLUSION Temozolomide demonstrates efficacy equal to that of DTIC and is an oral alternative for patients with advanced metastatic melanoma.
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Abstract
We developed a cellular approach to the identification of circulating melanoma cells in peripheral blood using immunomagnetic cell sorting. One hundred seventy-eight blood samples from 129 melanoma patients and 30 samples from healthy persons and nonmelanoma patients were examined. After density gradient centrifugation the interphase was incubated with the mAb 9.2.27. Positive cells were labeled with magnetic microbeads and enriched by immunomagnetic cell sorting. Cells were stained using an alkaline phosphatase-antialkaline phosphatase assay and examined by light microscopy. In spiking experiments, melanoma cells seeded at a concentration of one melanoma cell per ml whole blood could be detected reliably with the assay. Circulating melanoma cells were not found in 30 controls examined, nor were 9.2.27-positive cells found in 41 patients with primary malignant melanoma. In patients with regional lymph node metastases and in patients with disseminated disease, circulating 9.2.27-positive cells could be detected in 3 out of 22 patients (13.6%) and 10 out of 66 patients (15.2%) examined. We present a sensitive and specific immunocytological approach to detect circulating melanoma cells in peripheral blood. The method is not suitable for early detection of metastases but is a valuable tool for further investigating biological characteristics of circulating melanoma cells.
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Affiliation(s)
- A Benez
- Department of Dermatology, University of Tübingen, Tübingen, Germany
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Benez A, Geiselhart A, Handgretinger R, Schiebel U, Fierlbeck G. Detection of circulating melanoma cells by immunomagnetic cell sorting. J Clin Lab Anal 1999. [PMID: 10494132 DOI: 10.1002/(sici)1098-2825(1999)13:5<229::aid-jcla7>3.0.co;2-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023] Open
Abstract
We developed a cellular approach to the identification of circulating melanoma cells in peripheral blood using immunomagnetic cell sorting. One hundred seventy-eight blood samples from 129 melanoma patients and 30 samples from healthy persons and nonmelanoma patients were examined. After density gradient centrifugation the interphase was incubated with the mAb 9.2.27. Positive cells were labeled with magnetic microbeads and enriched by immunomagnetic cell sorting. Cells were stained using an alkaline phosphatase-antialkaline phosphatase assay and examined by light microscopy. In spiking experiments, melanoma cells seeded at a concentration of one melanoma cell per ml whole blood could be detected reliably with the assay. Circulating melanoma cells were not found in 30 controls examined, nor were 9.2.27-positive cells found in 41 patients with primary malignant melanoma. In patients with regional lymph node metastases and in patients with disseminated disease, circulating 9.2.27-positive cells could be detected in 3 out of 22 patients (13.6%) and 10 out of 66 patients (15.2%) examined. We present a sensitive and specific immunocytological approach to detect circulating melanoma cells in peripheral blood. The method is not suitable for early detection of metastases but is a valuable tool for further investigating biological characteristics of circulating melanoma cells.
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Affiliation(s)
- A Benez
- Department of Dermatology, University of Tübingen, Tübingen, Germany
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Abstract
OBJECTIVE To increase the awareness of bovine serum albumin (BSA) sensitivity as a potentially lethal complication during ET. DESIGN Case report. SETTING Routine ET in university hospital. PATIENT(S) A 26-year-old woman who was undergoing her first ET. INTERVENTION(S) ET with BSA containing standard fluid medium. MAIN OUTCOME MEASURE(S) Specific immunoglobulin (Ig) E antibodies and skin tests. RESULT(S) The patient demonstrated increased levels of specific IgE antibodies to BSA and a clearly positive scratch test for BSA. CONCLUSION(S) Anaphylactic reactions to BSA can occur during ET. The risk can be reduced substantially if a detailed medical history is obtained.
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Affiliation(s)
- J Wehner-Caroli
- Department of Dermatology, Eberhard-Karls-Universität, Tübingen, Germany.
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Schneider GA, Klump B, Porschen R, Fierlbeck G. [Seeping gastrointestinal hemorrhage from telangiectasia in CREST syndrome]. Hautarzt 1998; 49:313-6. [PMID: 9606634 DOI: 10.1007/s001050050748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A 55-year-old man with CREST syndrome had marked telangiectasias of the palms, the face and the gastrointestinal tract. The latter caused slow bleeding and anemia. The telangiectasias were definitely associated with the CREST syndrome. Iron substitution was sufficient therapy. If a need for further therapy should arise, endoscopic sclerotherapy could be employed. Gastrointestinal bleeding in the CREST syndrome is rarely described, probably because it is unrecognized or interpreted as hemorrhagic gastritis. The possibility of gastrointestinal telangiectasias and concomitant bleeding should be kept in mind in cases of CREST syndrome.
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Affiliation(s)
- G A Schneider
- Abteilung für Dermatologie und Venerologie, Universität Tübingen
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Abstract
The extent and consequences of professional delay in diagnosis were analysed in 83 patients with palmoplantar and subungual melanomas treated from January 1986 to March 1997 in our department. Seventeen (52%) out of 33 subungual melanomas and 10 (20%) out of 50 palmoplantar melanomas were clinically misdiagnosed by physicians. Three palmoplantar melanomas (6%) were initially misinterpreted by pathologists. In 23 of the 27 cases (85%) the clinical misdiagnosis was made by non-dermatologists. Misdiagnosis caused a median delay of 12 months in the diagnosis of palmoplantar melanomas and 18 months in the diagnosis of subungual melanomas. Delay in diagnosis was associated with increased tumour thickness, more advanced stage at time of melanoma diagnosis and a lower estimated 5-year survival rate (15.4% versus 68.9% for palmoplantar; 68.5% versus 90.9% for subungual). Acral melanomas are frequently misdiagnosed due to their less common locations and because plantar and subungual melanomas often do not fit the 'changing mole' pattern. To Improve the patient's prognosis it is necessary to increase the physicians' skill in the diagnosis of acral melanomas. Histological examination should always be performed in acral lesions that do not heal.
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Affiliation(s)
- S Metzger
- Department of Dermatology, University of Tübingen, Germany
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Ulmer A, Körber V, Schmid H, Fierlbeck G. Increased activity of cathepsin B in fibroblasts isolated from primary melanoma in comparison to fibroblasts from normal skin. Exp Dermatol 1998; 7:14-7. [PMID: 9517917 DOI: 10.1111/j.1600-0625.1998.tb00297.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We determined activity of cathepsin B in early-passage fibroblasts isolated from primary melanoma and in fibroblasts from normal skin. Our results show an up to 5-fold increase in activity of cathepsin B in the tumor-derived fibroblasts in comparison to the fibroblasts from normal skin. We conclude that fibroblasts isolated from melanoma tissue are altered with regard to their specific activity of cathepsin B and preserve this elevated activity in early-passage cell culture. The data support the idea that stromal cells are not passive elements of the peritumoral environment but actively participate in the production of proteolytic enzymes.
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Affiliation(s)
- A Ulmer
- Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen, Germany
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40
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Ulmer A, Schaumburg-Lever G, Bauer J, Kötter I, Fierlbeck G. [Scleredema adultorum Buschke. Case report and review of the literature]. Hautarzt 1998; 49:48-54. [PMID: 9522193 DOI: 10.1007/s001050050700] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Scleredema adultorum of Buschke is a rare disorder of unknown aetiology. It is characterized by diffuse, non-pitting swelling and induration of the skin. Skin biopsies reveal marked thickening of the dermis due to collagenous replacement of the subcutis and deposition of hyaluronic acid between the collagen fibers. The disease classically only affects the skin. In 24 cases an associated monoclonal gammopathy has been detected. A 75-year-old patient had a 19-year history of scleredema adultorum. In addition to a monoclonal gammopathy the patient suffered from involvement of the tongue, pharynx and upper esophagus. Furthermore a polyneuropathy, ocular involvement with restricted eye movements and a sicca syndrome were present. The simultaneous occurrence of cutaneous scleredema with any one of the above mentioned symptoms has been reported before. The wide variety of extracutaneous manifestations of scleredema as found in our patient is amazing and has not been previously described.
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Affiliation(s)
- A Ulmer
- Universitäts-Hautklinik Tübingen
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Mayer P, Schmid H, Schaber B, Fierlbeck G. Tumor-associated cysteine proteinase activities in human melanoma cells and fibroblasts of different origin. Eur J Cell Biol 1997; 73:344-51. [PMID: 9270877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Specific catalytic activities of cysteine proteinases including cathepsins B (EC 3.4.22.1) and L (EC 3.4.22.15) in human melanoma cell lines SK-MEL-28, SK-MEL-30, MEL-HO and in fibroblasts of different origin are reported. Cell line-specific pH profiles of these cysteine proteinases were determined fluorometrically with benzyloxycarbonyl-phenylalanyl-arginine-amidomethylcoumarine (Z-Phe-Arg-AMC) under saturated conditions. Single activities of cathepsins B and L were inactivated by urea and by benzyloxycarbonyl-phenylalanyl-phenylalanine-diazomethylketone (Z-Phe-Phe-CHN2) in order to describe the activities of these enzymes separately. The melanoma cell line MEL-HO, which originated from a primary lesion, showed highest activity of an unknown cysteine proteinase. This enzyme is not inactivated by urea and Z-Phe-Phe-CHN2 and has a Michaelis constant (K(M) value) of approximately 1 mM. The specific characteristics suggest that it is a tumor-associated cathepsin B. In addition, high invasive subpopulations of SK-MEL-28 and SK-MEL-30 cell lines isolated by an invasion assay showed higher proteinase activities than the low invasive subpopulations. Furthermore, in fibroblasts originating from melanoma tissue cysteine proteinase activities were increased compared to normal skin fibroblasts. In conclusion, these results indicate that these cysteine proteinases shown here are tumor-associated proteinases, possibly facilitating invasion and dissemination of melanoma cells.
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Affiliation(s)
- P Mayer
- Department of Dermatology, University of Tübingen, Germany
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42
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Abstract
Superantigens like the Staphylococcus enterotoxin A (SEA) can direct cytotoxic T lymphocytes expressing certain T cell receptor V beta regions to lyse MHC class II-positive target cells. This superantigen-dependent cellular cytotoxicity (SDCC) has been extended to MHC class II-negative tumour cells by targeting T cells via conjugates of a tumour-specific monoclonal antibody (moAb) and a superantigen. In the present study the MHC class II-negative human melanoma cell lines G361 and MaRI were tested for susceptibility to SDCC in vitro. Antibodies recognizing the disialoganglioside GD3 and the CD10 antigen were linked to SEA either by a recombinant protein A-SEA fusion protein or an anti-kappa moAb-SEA chemical conjugate. Specific lysis of melanoma cells was dose- and effector to target (E:T) cell ratio-dependent. Introduction of a point mutation into the SEA gene (producing SEAm9) in order to reduce MHC II affinity of the superantigen, which has already been shown to severely diminish superantigen-dependent binding and lysis of MHC class II-positive cells, did not influence antibody-targeted SDCC. Cytotoxicity was equal with both antibodies (anti-GD3 and anti-CD10) and independent of whether protein A-SEA, protein A-SEAm9 or anti-kappa-SEA were used.
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Affiliation(s)
- F Krull
- Department of Oncology and Hematology, Children's University Hospital, Tübingen, Germany
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Klump B, Schneider GA, Fierlbeck G, Hoeft S, Gregor M, Porschen R. [Argon plasma coagulation in endoscopic therapy of CREST syndrome associated upper gastrointestinal hemorrhage]. Z Gastroenterol 1997; 35:469-76. [PMID: 9281240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We report on the case of a 55-year-old patient suffering from progressive systemic sclerosis (PSS). The patient was sent to our department when clinical symptoms of an acute upper gastrointestinal hemorrhage occurred. Upper endoscopy showed a watermelon stomach and fresh blood in the stomach. The presence of teleangiectasias in the antrum could be proved histologically. Since the teleangiectasias found in the antrum were the only possible source of the hemorrhage three sessions of endoscopic argon plasma coagulation were performed. Macroscopically, a nearly complete disappearance of teleangiectasias could be achieved. After a follow-up of six months, there have been no clinical signs of another hemorrhage episode. This case shows that the existence of gastrointestinal teleangiectasias should be considered when chronic anemia or acute gastrointestinal hemorrhage occur in patients with PSS. Further it is demonstrated that even extended gastrointestinal teleangiectasias can be successfully treated by endoscopically performed argon plasma coagulation.
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Affiliation(s)
- B Klump
- Abteilung Innere Medizin I, Universitätsklinikum Tübingen
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Hunzelmann N, Anders S, Fierlbeck G, Hein R, Herrmann K, Albrecht M, Bell S, Thur J, Muche R, Adelmann-Grill B, Wehner-Caroli J, Gaus W, Krieg T. Systemic scleroderma. Multicenter trial of 1 year of treatment with recombinant interferon gamma. Arch Dermatol 1997; 133:609-13. [PMID: 9158414 DOI: 10.1001/archderm.133.5.609] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To confirm significant improvement of the skin score in systemic sclerosis by treatment with interferon gamma in a larger group of patients and to investigate on a molecular level the influence of interferon gamma on collagen type I messenger RNA expression. DESIGN Open, noncontrolled multicenter study. SETTING Five outpatient clinics specializing in the care of systemic scleroderma. PATIENTS Thirty-two patients suffering from the diffuse or limited form of systemic sclerosis and progressive disease were recruited; 20 patients finished the study. INTERVENTION Each patient received interferon gamma, 50 micrograms subcutaneously 3 times a week for 1 year. MAIN OUTCOME MEASURE Skin score, collagen type I messenger RNA in skin biopsy specimens. RESULTS The patients who completed the study showed an unchanged median skin score after 1 year of therapy. In addition, similar collagen type I messenger RNA levels were detected in skin biopsy specimens taken from involved skin before and after therapy in these patients. CONCLUSIONS Treatment of systemic scleroderma with interferon gamma is associated with stabilization of the skin score and lack of worsening of visceral involvement.
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Affiliation(s)
- N Hunzelmann
- Department of Dermatology, University of Cologne, Germany
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45
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Welte B, Handgretinger R, Rassner G, Fierlbeck G. Expression of GD3 disialoganglioside antigen on peripheral T-lymphocytes in patients with disseminated malignant melanoma. Exp Dermatol 1997; 6:64-9. [PMID: 9209886 DOI: 10.1111/j.1600-0625.1997.tb00148.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Disialoganglioside antigens GD2 and GD3 are expressed on most melanoma cells. On melanoma surrounding T-cells in immunohistological sections, disialogangliosides can also be found, as well as in a small % of T-lymphocytes in peripheral blood from healthy persons. In order to find out if there is a difference in ganglioside expression on peripheral T-lymphocytes between melanoma patients and healthy persons, we examined the expression of CD3 as T-lymphocytic antigen and GD2 or GD3 antigens, respectively, by flow cytometry. We used peripheral mononuclear blood cells of 12 patients with advanced disseminated malignant melanoma and of 12 healthy control donors. For immunostaining, murine monoclonal antibodies Leu-4, 14G2a and MB3.6 were used, recognizing CD3, GD2 and GD3. GD2 expression was found on only a low proportion of T-lymphocytes in patients and healthy persons (pat.: mean = 1.2% +/- 0.7%, co.: mean = 0.4% +/- 0.4%). Disialoganglioside antigen GD3, however, could be demonstrated on an average of 8.4% +/- 4.6% of patients' and on 4.0% +/- 2.1% of healthy persons' T-cells. There is a statistically significant difference (P < 0.01) between the data of patients' and control group. We conclude that there is a correlation between advanced malignant melanoma and expression of GD3 antigen on patients' peripheral T-lymphocytes. The immunological relevance of our findings is discussed.
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Affiliation(s)
- B Welte
- Department of Dermatology, University of Tübingen, Germany
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Hunzelmann N, Anders S, Fierlbeck G, Hein R, Herrmann K, Albrecht M, Bell S, Muche R, Wehner-Caroli J, Gaus W, Krieg T. Double-blind, placebo-controlled study of intralesional interferon gamma for the treatment of localized scleroderma. J Am Acad Dermatol 1997; 36:433-5. [PMID: 9091475 DOI: 10.1016/s0190-9622(97)80221-6] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Localized scleroderma is characterized by circumscribed fibrotic plaques and may progress to widespread skin involvement and fibrosis. Interferon gamma (IFN-gamma) has been shown to be a potent inhibitor of collagen synthesis and of the migration and proliferation of dermal fibroblasts. OBJECTIVE Our purpose was to determine whether IFN-gamma is effective in the treatment of localized scleroderma. METHODS A double-blind, randomized, placebo-controlled, multicenter study was conducted. Twenty-four patients with progressive lesions received 100 micrograms of IFN-gamma or placebo subcutaneously on 5 consecutive days for 2 weeks followed by 100 micrograms of IFN-gamma or placebo once weekly for 4 weeks. Thereafter patients were observed for 18 weeks. To determine whether improvement could be related to an altered level of collagen messenger RNA (mRNA), biopsy specimens were taken from uninvolved and involved skin before and after therapy. RESULTS The patients treated with IFN-gamma or placebo showed no significant difference in size or fibrosis of lesions or collagen type I mRNA synthesis. However, a reduction in the number of new lesions was observed in the IFN-gamma-treated group. The biopsy specimens obtained from involved skin showed a moderate increase of type I collagen and a significant decrease in the small proteoglycan decorin mRNA levels. CONCLUSIONS The results indicate that IFN-gamma is ineffective in the treatment of localized scleroderma, but may inhibit the development of new lesions.
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Affiliation(s)
- N Hunzelmann
- Department of Dermatology, University of Cologne, Germany
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47
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Abstract
Malignant melanoma of the vulva is an uncommon disease. The amelanotic subtype is only rarely mentioned. We report a 60-year-old patient with a 6 month history of vulvar pruritus. Ivory lesions combined with erosions and fine "cigarette paper'-like wrinkling were suspicious for lichen sclerosus et atrophicus. Histologically the diagnosis of an amelanotic malignant melanoma was made. Amelanotic melanoma may present with a wide variety of clinical features. Even in the uncommon location of the vulva, amelanotic melanoma should be suspected in any nonhealing nonpigmented lesion.
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Affiliation(s)
- A Ulmer
- Universitäts-Hautklinik, Tübingen
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Fierlbeck G, Ulmer A, Schreiner T, Stroebel W, Schiebel U, Brzoska J. Pharmacodynamics of recombinant IFN-beta during long-term treatment of malignant melanoma. J Interferon Cytokine Res 1996; 16:777-81. [PMID: 8910762 DOI: 10.1089/jir.1996.16.777] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The pharmacodynamics and biologic activities of recombinant human interferon-beta (rHuIFN-beta) derived from chinese hamster ovary (CHO) cells were examined during long-term therapy in 7 melanoma patients. The CHO-derived rHuIFN-beta was given s.c. in a dose of 3 x 10(6) U three times per week for 24 weeks. Serum levels of IFN could not be detected before and 48 h after the s.c. injections. 2'-5'-Oligoadenylate synthetase (2-5 OAS), beta 2-microglobulin, and neopterin levels increased significantly 48 h after application, with a maximum after 96 h. Subsequently, the values decreased and remained only slightly elevated during the long-term therapy. Natural killer (NK) cell activity increased in the first 96 h significantly and fell below pretreatment values after 4 weeks. The decrease of biologic response could not be attributed to the occurrence of anti-IFN-beta antibodies because only 2 of the 7 patients developed neutralizing antibodies after 16 and 24 weeks of treatment, respectively. This trial confirms the biologic potency of CHO-derived rHuIFN-beta. However, the selected parameters demonstrate that immunostimulation is only possible over a short treatment period.
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Affiliation(s)
- G Fierlbeck
- University of Tuebingen, Department of Dermatology, Germany
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Ulmer A, Dietl J, Schaumburg-Lever G, Fierlbeck G. Amelanotic malignant melanoma of the vulva. Case report and review of the literature. Arch Gynecol Obstet 1996; 259:45-50. [PMID: 8933929 DOI: 10.1007/bf02505308] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We report on a 60 year old patient with a 6 month history of vulval pruritus and an erosive vulval lesion which was mistaken for lichen sclerosus et atrophicus. Histologically the diagnosis of an amelanotic malignant melanoma of the vulva was established. We review the literature about this rare malignant tumor.
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Affiliation(s)
- A Ulmer
- Universitäts-Hautklinik, Tübingen, Germany
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Kötter I, Dürk H, Eckstein A, Zierhut M, Fierlbeck G, Saal JG. Erosive arthritis and posterior uveitis in Behçet's disease: treatment with interferon alpha and interferon gamma. Clin Exp Rheumatol 1996; 14:313-5. [PMID: 8809448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Very few patients with Behçet's disease (BD) have been treated with interferon alpha (IFN alpha) or interferon gamma (IFN gamma) to date. We report the successful longterm treatment of a female German patient with erosive arthritis and posterior uveitis with IFN alpha and IFN gamma sequentially and in combination.
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Affiliation(s)
- I Kötter
- University Hospital, Department of Internal Medicine, Rheumatology/Clinical Immunology, Tübingen, Germany
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