Effects of RYGB on energy expenditure, appetite and glycaemic control: a randomized controlled clinical trial

OBJECTIVES

Increased energy expenditure (EE) has been proposed as an important mechanism for weight loss following Roux-en-Y gastric bypass (RYGB). However, this has never been investigated in a controlled setting independent of changes in energy balance. Similarly, only few studies have investigated the effect of RYGB on glycaemic control per se. Here, we investigated the effect of RYGB on EE, appetite, glycaemic control and specific signalling molecules compared with a control group in comparable negative energy balance.

SUBJECTS/METHODS

Obese normal glucose-tolerant participants were randomized to receive RYGB after 8 (n=14) or 12 weeks (n=14). The protocol included a visit at week 0 and three visits (weeks 7, 11 and 78) where 24-h EE, appetite and blood parameters were assessed. Participants followed a low-calorie diet from weeks 0-11, with those operated at week 12 serving as a control group for those operated at week 8.

RESULTS

Compared with controls, RYGB-operated participants had lower body composition-adjusted 24-h EE and basal EE 3 weeks postoperatively (both P<0.05) but EE parameters at week 78 were not different from preoperative values (week 7). Surgery changed the postprandial response of glucagon-like peptide-1 (GLP-1), peptide YY3-36 (PYY), ghrelin, cholecystokinin, fibroblast growth factor-19 and bile acids (all P<0.05). Particularly, increases in GLP-1, PYY and decreases in ghrelin were associated with decreased appetite. None of HOMA-IR (homeostasis model assessment-estimated insulin resistance), Matsuda index, the insulinogenic index, the disposition index and fasting hepatic insulin clearance were different between the groups, but RYGB operated had lower fasting glucose (P<0.05) and the postprandial glucose profile was shifted to the left (P<0.01).

CONCLUSIONS

Our data do not support that EE is increased after RYGB. More likely, RYGB promotes weight loss by reducing appetite, partly mediated by changes in gastrointestinal hormone secretion. Furthermore, we found that the early changes in glycaemic control after RYGB is to a large extent mediated by caloric restriction.

Short-term spatial memory responses in aged Japanese quail selected for divergent adrenocortical stress responsiveness

Stress-induced glucocorticoids can dampen learning and spatial memory via neuronal damage to the hippocampus. Cognition losses can be transient (associated with acute stress episodes) or permanent as in aged individuals who show chronic glucocorticoid-induced accelerated brain aging and neurodegeneration (dementia). Thus, chronic versus acute stress effects on spatial memory responses of quail selected for reduced (low stress, LS) or exaggerated (high stress, HS) plasma corticosterone (B) response to brief restraint were assessed. Aged food-motivated male LS and HS quail were tested for 10 min in a feed-baited 8-arm radial arm maze (RAM) 1) at 255 d of age (quail who had experienced lifelong management stressors but who were otherwise never intentionally stressed; that is, chronically stressed birds), 2) on the next day post-acute stressor treatment (5 min of restraint), and 3) on the next day without treatment (acute stress recovery). The RAM tests used the win-shift procedure in which visited arms were not rebaited. Radial arm maze performance was measured by determination of the total number of arm choices made, the number of correct entries made into baited arms out of the first 8 choices, the time required to make a choice, and the number of pellets eaten. Line effects (P < 0.001 in all cases) were detected for total number of arm choices made (HS < LS), number of correct entries made into baited arms out of the first 8 choices (HS < LS), time required to make a choice (HS > LS), and number of pellets eaten (HS < LS). However, neither the effects of day of RAM testing nor its interaction with line further influenced these variables. Thus, although selection for divergent plasma B responsiveness to an acute stressor was found to be associated with severe impairment of spatial memory in aged male HS compared with LS quail, the observed spatial memory impairments (HS > LS) could not be further altered by acute stressor treatment. Line differences in cognition may reflect lifelong management-induced stress episodes that periodically produce higher plasma B responses in HS than LS quail, which underlie HS quail memory deficits, or other etiologies, or both.

Influence of maternal corticosterone treatment on incubation length of eggs laid by Japanese quail hens selected for divergent adrenocortical stress responsiveness

1. Previous studies have shown that more yolk corticosterone is found in the eggs of random bred Japanese quail hens implanted with corticosterone during egg formation; both unstressed and stressed quail hens selected for exaggerated (high stress) rather than reduced (low stress) plasma corticosterone response to brief restraint deposit more corticosterone into their egg yolks. The length of egg incubation is also known to be shorter in eggs laid by high than low stress hens. 2. Here we investigated the interactive effects of quail stress line (low vs. high stress) with maternal corticosterone treatment (empty implant controls vs. corticosterone-implants) during egg formation on length of egg incubation. 3. Mean (+/-SEM) length of egg incubation for high stress control eggs (3973 +/- 04 h) was similarly shorter (by about 4.5 h) than that found for low stress control eggs (3928 +/- 02 h). In addition, on average, the incubation length of eggs laid by corticosterone-implanted hens (3929 +/- 05 h) was nearly 3 h shorter than that found for eggs laid by control hens (3958 +/- 02 h) regardless of stress line. 4. Line x hen-implant treatment effects on mean (+/-SEM) length of egg incubation partitioned in rank order as follows: low stress control (3978 +/- 05 h) > low stress corticosterone-implant (3959 +/- 07 h) > high stress control (3938 +/- 03 h) > high stress corticosterone-implant (3912 +/- 04 h). 5. Our original contention that selection for exaggerated adrenocortical responsiveness is associated with a reduction in the length of egg incubation was supported. Because maternal stress-induced elevations of yolk B are known to occur, the present findings of further shortenings of the hatching times of eggs of corticosterone-treated hens of both stress lines are also important to the poultry industry because they warn producers that unless stress in hens during egg formation is minimised, abbreviated egg incubation periods may result beyond the effects that a hen's genetic predisposition to adrenocortical stress responsiveness has on the length of egg incubation.

Maternal corticosterone reduces egg fertility and hatchability and increases the numbers of early dead embryos in eggs laid by quail hens selected for exaggerated adrenocortical stress responsiveness

Quail hens selected for exaggerated (HS, high stress) rather than reduced (LS, low stress) plasma corticosterone (B) response to brief restraint deposit more B into their egg yolks than do LS hens. Female progeny of HS hens implanted with B also show reduced egg production when compared with female offspring of LS- and HS-control and LS-B-implanted hens. Herein, LS and HS hens were implanted (s.c.) with empty (controls, CON) or B-filled silastic tubes to assess the interactive influences of maternal B-treatment with quail stress line on egg fertility (FERT), total egg hatchability (TOTHATCH) and fertile egg hatchability, and the percentages of embryonic mortality (early dead, ED; late dead) and pipped eggs. Mean FERT was dramatically reduced in eggs of HS compared with LS hens and B-implanted compared with CON-treated hens (P < 0.0001, both cases). Line x implant treatment FERT outcomes partitioned (P < 0.05) as follows: LS-B = LS-CON > HS-CON > HS-B. In addition, TOTHATCH was also affected by line (LS > HS; P < 0.0001) and implant treatment (CON > B-implant; P < 0.0002) and line x implant treatment TOTHATCH means differed (P < 0.05) as follows: LS-CON = LS-B = HS-CON > HS-B. Fertile egg hatchability was reduced (P < 0.05) in HS-B-treated hen eggs when compared with LS-B and HS-CON hen eggs and more (P < 0.05) ED embryos were found in eggs laid by HS-B-implanted hens than in any other treatment group. Late dead and pipped egg percentages were unaffected by any treatment. The findings are important to avian geneticists because they further emphasize the benefits that selection for reduced adrenocortical responsiveness has on hen reproductive performance. The maternal B findings also warn poultry and hatchery managers that unless hen stress during egg formation is avoided, negative consequences in FERT, TOTHATCH, and ED can result, particularly in hens genetically predisposed toward exaggerated adrenal stress responsiveness.

Influences of maternal corticosterone and selection for contrasting adrenocortical responsiveness in Japanese quail on developmental instability of female progeny

Differences in developmental instability were assessed in female offspring of Japanese quail hens selected for reduced (low stress, LS) or exaggerated (high stress, HS) plasma corticosterone (B) response to stress and treated with a placebo or B during egg formation. Hens of each line were implanted (s.c.) with either a silastic tube containing no B (controls) or one filled with B. Female chicks hatched from each of the 4 line x implant treatment combinations were retained for examination of 3 bilateral traits at 130 d of age: length of the tibiotarsus, middle toe length, and distance between the auditory canal and the nares (face length, FL). Greater bilateral trait size variances were associated with measurement of tibiotarsus length (P < 0.04) and middle toe length (P < 0.06) in the HS line, supporting our previous findings in the opposite sex that developmental instability (i.e., fluctuating asymmetry, FA) of certain morphological traits is more pronounced in HS than LS adult quail. The HS quail are also known to exhibit greater adrenocortical responsiveness to a wide range of stressors, and they are more easily frightened than LS birds. Therefore, the line differences in FA (HS > LS) found previously in males and herein in females may simply reflect the differential responsiveness of the birds to chronic social and physical environmental stressors. In addition, the present study detected more (albeit marginally so, P < 0.06) bilateral variability (i.e., heightened FA) in FL of quail hatched from mothers treated with B, a finding entirely due to the very high FL variance observed in the female offspring of B-treated HS hens. Because others have found in ovo B treatment to be associated with heightened FA in chick tarsus bone length and because we have also demonstrated that greater yolk B deposition occurs in eggs from both unstressed and stressed HS quail hens than their LS counterparts, the present maternal B treatment may be acting independently, or in combination with HS genomic effects, to adversely affect developmental stability.

Fear responses of offspring from divergent quail stress response line hens treated with corticosterone during egg formation

Increased fearfulness has been associated with adrenocortical activation. Maternal corticosterone (B) treatment increases egg B, and elevated B in ovo enhances chick avoidance of humans. Quail selected for exaggerated (high stress, HS) rather than reduced (low stress, LS) plasma B response to stress are more fearful, and more B is found in HS hen eggs. Thus, we used tonic immobility (TI) and hole-in-the-wall box (HWB) emergence tests to assess fear in chicks hatched from eggs of LS and HS hens implanted with B or no B (CON). The number of inductions required to attain TI, latency to first alert head movement, and duration of TI were determined in one study and the latency until first vocalization (LATVOC), numbers of vocalizations (VOCS), proportions of chicks vocalizing, and the latencies to head (HE) and full-body (FE) emergence from a HWB were assessed in another. The LS chicks required less inductions (P < 0.0005) and had shorter latency to first alert head movement (P < 0.02) than HS chicks, although the duration of TI was unaffected by any of the treatments. During the acclimation period of the HWB tests, more (proportions of chicks vocalizing; P < 0.0001) HS chicks alarm-called sooner (LATVOC; P < 0.0001) and more often (VOCS; P < 0.0001) than did LS chicks, and, although maternal implant treatment did not affect LATVOC, progeny of B-implanted hens showed a tendency toward less (P < 0.07) VOCS than the CON. Chicks hatched from eggs of B-implant mothers also took longer to achieve HE (P < 0.06) and FE (P < 0.05) from the HWB than did their CON counterparts. Stress line, implantation treatment, and their interaction did not alter HE or FE responses. The data suggest that quail stress line genome may or may not be affecting certain fear and alarm responses in chicks via the same mechanism(s) that underlies how elevating maternal B increases egg levels of B that in turn alters the fear behavior of progeny.

A prospective, randomized, double-blind, placebo-controlled study on the influence of a hormone replacement therapy on skin aging in postmenopausal women

BACKGROUND

There is mounting evidence that menopause affects some functions of the skin. Hormone replacement therapy (HRT) appears to limit some of the climacteric aspects of cutaneous aging.

OBJECTIVE

In the light of a growing interest in the endocrinological influence of skin, we performed a study evaluating the effects of HRT on skin aging in postmenopausal women.

METHODS

Forty non-hysterectomized, postmenopausal women were included in this prospective, randomized, double-blind, placebo-controlled study on the influence of oral sequential treatment with a combination of 2 mg 17beta-estradiol/10 mg dydrogesterone (Femoston) for seven 28-day cycles. Skin elasticity, skin surface lipids, skin hydration and skin thickness were measured by non-invasive methods, and both adverse-event profile and clinical-dermatological status were evaluated.

RESULTS

After 7 months of HRT, skin elasticity increased significantly at the right ramus of the mandible, while skin hydration tended to improve significantly at the right upper arm (inner side); skin thickness improved significantly but skin surface lipids did not. Absolute effects did not differ significantly between HRT and placebo patients. A dermatological evaluation was largely consistent with measurement results. Safety and tolerability of HRT were positive.

CONCLUSION

The results showed improvements in the parameters involved in skin aging in the HRT group as compared to baseline. While skin aging is no indication for systemic hormone supplementation, a positive effect on aging skin can be observed.

Effects and side-effects of 2% progesterone cream on the skin of peri- and postmenopausal women: results from a double-blind, vehicle-controlled, randomized study

BACKGROUND

For many years topical progesterone has been prescribed by gynaecologists as an antiageing and skin-firming treatment, without any clinical scientific evidence of its effects, tolerability and safety when applied to skin.

OBJECTIVES

To evaluate the influence of 2% progesterone cream on function and texture of the skin in peri- and postmenopausal women.

METHODS

A double-blind, randomized, vehicle-controlled study was conducted in 40 subjects. Objective methods for measuring skin elasticity, epidermal hydration and skin surface lipids, clinical monitoring and self-assessment, and determination of blood hormone levels (luteinizing hormone, follicle-stimulating hormone, oestrogen and progesterone) were used to determine effects and side-effects of this treatment at four visits over a 16-week period.

RESULTS

The study demonstrated a significant (P < or = 0.05) increase of the elastic skin properties in the treatment group, as demonstrated by objective measurements of three skin elasticity parameters, whereas in the control group no such effect was observed. This effect in the treatment group was further paralleled by the results of the clinical monitoring, where the 2% progesterone cream yielded consistent superiority over vehicle in counteracting different signs of ageing in the skin of peri- and postmenopausal women. Clinical monitoring showed a greater reduction in wrinkle counts (29.10% vs. 16.50%) and wrinkle depth (9.72% vs. 7.35%) around the right eye, a greater decrease in nasolabial wrinkle depth (9.72% vs. 6.62%) and a significantly higher (P < 0.05) increase in skin firmness (23.61% vs. 13.24%) in the treatment group. Epidermal hydration and skin surface lipids did not change significantly in either group during the study. Progesterone was well absorbed in the systemic circulation: mean blood levels rose minimally, but statistically significantly (P = 0.001), by 0.53 ng mL(-1). No serious side-effects of the treatment were observed.

CONCLUSIONS

The results of this study demonstrate that topical 2% progesterone acts primarily in increasing elasticity and firmness in the skin of peri- and postmenopausal women. These effects in combination with good tolerability make progesterone a possible treatment agent for slowing down the ageing process of female skin after onset of the menopause.

Clinical evidence of the endocrinological influence of a triphasic oral contraceptive containing norgestimate and ethinyl estradiol in treating women with acne vulgaris. A pilot study

BACKGROUND AND OBJECTIVE

The aim of this study was to evaluate the efficacy of a triphasic combination oral contraceptive (OC) containing norgestimate and ethinyl estradiol in the treatment of women with acne vulgaris.

METHODS

12 female patients were included and 10 completed the trial. Over a period of 6 months, efficacy was assessed by means of facial acne lesion counts, by an investigator's global assessment, by patients' self-assessments and by measuring epidermal moisture and skin surface lipids. In addition, a photo documentation was compiled and hormone levels were measured.

RESULTS

After 6 months of therapy, the number of acne counts improved. The success of treatment was rated positively both by the investigator and by all patients but one who did not report any changes. Skin surface lipids were significantly reduced while skin hydration showed no significant change. Testosterone and progesterone decreased, and sex-hormone-binding globulin increased, significantly.

CONCLUSION

Our data show that an OC containing norgestimate and ethinyl estradiol is a good therapeutic option for women of fertile age suffering from mild to moderate acne vulgaris.

Objective assessment of photoageing effects using high-frequency ultrasound in PUVA-treated psoriasis patients

BACKGROUND

Skin ageing can be differentiated into intrinsic (chronological) ageing, and photoageing due to chronic sun exposure. Photoageing is the superimposition of photodamage on the ageing process.

OBJECTIVES

The aim of the study was to investigate possible differences between the skin of photochemotherapy (PUVA)-treated psoriasis patients and of untreated normal subjects using a high-frequency ultrasound system.

METHODS

A total of 124 volunteers (aged 21-88 years, median 52 years, 62 female, 62 male), 62 psoriasis patients who had received PUVA therapy and 62 healthy controls, were investigated. Skin thickness and a subepidermal low-echogenic band (SLEB), a parameter for photodamage, were measured in 12 different areas.

RESULTS

Female skin is thinner than male skin. The skin thickness values of PUVA patients were more markedly decreased than those of the controls for the older patients. There was a clear dependence of the occurrence of SLEB on PUVA therapy in psoriasis patients.

CONCLUSIONS

Long-term PUVA treatment in psoriasis patients accelerates thinning of the skin in comparison to age-matched controls. The results show that ultrasonography is a sensitive method to investigate the effects of PUVA-induced skin ageing.

Design and synthesis of 4-substituted benzamides as potent, selective, and orally bioavailable I(Ks) blockers

Multiple delayed rectifier potassium currents, including I(Ks), are responsible for the repolarization and termination of the cardiac action potential, and blockers of these currents may be useful as antiarrhythmic agents. Modification of compound 5 produced 19(S) that is the most potent I(Ks) blocker reported to date with >5000-fold selectivity over other cardiac ion channels. Further modification produced 24A with 23% oral bioavailability.

[Measurement of skin thickness by high-frequency ultrasound to objectify the effects of hormone replacement therapy in the perimenopause]

AIM

The aim of this study was to show the influence of three different hormone replacement therapy regimes (HRT) by comparing the changes in skin thickness.

METHOD

Skin thickness was measured using a high-frequency ultrasound system on the inner side of the left upper arm of perimenopausal women with a low oestradiol level (< 45 pg/ml). The patients were allocated to different groups: Group1 (n = 6) received oestradiol merely transdermally; Group 2 (n = 7) was given transdermal oestradiol as well as progesterone vaginally; Group 3 (n = 8) took oral oestradiol and vaginal progesterone; Group 4 (n = 3) served as the control group without therapy.

RESULTS

The median value of skin thickness in all HRT-groups increased highly significantly (0.15 mm) after six months (0.91 mm before therapy versus 1.06 mm after six months of HRT), but there was no significant change in the control group.

CONCLUSIONS

The study shows that HRT leads to an increase of skin thickness which can be demonstrated by a high-frequency ultrasound.

The influence of hormone replacement therapy on skin ageing: a pilot study

OBJECTIVES

We studied the effect of hormonal treatment on skin ageing in menopausal women.

METHODS

Twenty-four patients (45-68 years; mean age, 54.9 years) without hormone treatment for at least 6 months were included. Patients were assigned to three therapy groups: 1, oestrogen only (Estraderm TTS 50) (n=6); 2, transdermal oestrogen and progesterone (Estraderm TTS 50 and 0.4 mg progesterone vaginal suppository) (n=7); and 3, oral oestrogen and progesterone (2 mg Progynova and 0.4 mg progesterone vaginal suppository) (n=8). One group without therapy was included as a control group (n=3). Treatment was continued for 6 months. Three patients, one from group 2 and two from group 3, discontinued therapy before the study endpoint. The following skin parameters were measured at monthly intervals during treatment: skin surface lipids, epidermal skin hydration, skin elasticity and skin thickness. Concomitant clinical evaluation included a subjective clinical evaluation form, a patient questionnaire and laboratory tests for oestradiol, progesterone and follicle stimulating hormone.

RESULTS

Mean levels of epidermal skin moisture, elasticity and skin thickness were improved at the end of treatment based on both subjective and objective evaluation in patients with hormone replacement therapy (HRT). Skin surface lipids were increased during combined HRT, which may reflect stimulatory effects of the progestagen component on sebaceous gland activity, while oestrogen alone has a sebum-suppressive action. In the HRT groups, the questionnaire for climacteric complaints demonstrated significant improvements, while laboratory tests showed increases in oestradiol and progesterone and decreases in FSH.

CONCLUSIONS

HRT with the mentioned regimes significantly improved parameters of skin ageing.

Punctate keratoderma-like lesions on the palms and soles in a patient with chloracne: a new clinical manifestation of dioxin intoxication?

We report what we believe to be a novel skin manifestation of dioxin intoxication. A 30-year-old woman with 2,3,7, 8-tetrachlorodibenzo-p-dioxin levels of 144,000 pg g-1 blood fat presented with severe chloracne that affected the entire integument. She also exhibited acral granuloma annulare-like lesions and distal onycholysis and, at a later time point, showed signs of hypertrichosis, as well as brownish-grey hyperpigmentation of the face. In addition, she developed punctate keratoderma-like lesions on the palms and soles. These lesions were negative for human papillomavirus and histologically characterized by cone-shaped hyperkeratoses invaginating, but not penetrating, into the dermis. Squamous syringometaplasia of the eccrine glands was observed in the immediate vicinity of these lesions. Both clinically and histologically these alterations are essentially indistinguishable from what is described as keratosis punctata palmaris et plantaris (KPPP). Although a fortuitous coincidence of chloracne and KPPP cannot be formally excluded, the possibility exists that in our patient toxic levels of dioxin were causally involved in this disorder of keratinization.

Other antiandrogens

Various substances of steroidal or nonsteroidal structure may serve as an alternative for the antiandrogenic treatment of acne. Compounds with antiandrogenic properties like cimetidine or ketoconazole are rarely administered for acne due to their weak effects. In contrast, spironolactone is an effective antiandrogen that shows good treatment effects in hirsutism and acne. Side effects occur frequently and are dose dependent. Isotretinoin--the most effective agent in acne therapy--has been under discussion for additional antiandrogenic properties for years. At present there is additional evidence for the antiandrogenic effects of isotretinoin. Regarding substances acting on both levels, androgen receptor binding and 5 alpha-reductase inhibition, the question is raised whether the term 'antiandrogen' should be amplified by including the 5 alpha-reductase inhibitors. This would pay tribute to the biological aspect of antiandrogenicity that takes into account not only the mode of action but also the effects of the substance. Under this aspect type 1 5 alpha-reductase inhibitors may gain attention in the future.

Generalized pustular psoriasis of pregnancy (impetigo herpetiformis)

A 17-year-old woman had a sudden eruption of pustules in her intertriginous areas as well as of erythematosquamous plaques on the scalp, elbows, palms and soles in the third trimester of her first pregnancy. Histopathological evaluation of a biopsy revealed typical changes of pustular psoriasis with parakeratosis and abscesses of neutrophils (Kogoj's spongiform pustules). The diagnosis of pustular psoriasis was established by the typical clinical and histopathological findings. Laboratory parameters showed a highly elevated blood sedimentation rate, hypoferric anemia and decreased albumin levels. Serum concentrations of parathormone and its metabolites were normal. After systemic treatment with glucocorticosteroids and antibiotics, the lesions improved but did not clear. After delivery of a healthy boy, therapy was switched to retinoid photochemotherapy with isotretinoin and PUVA that resulted in rapid and complete clearing of the eruption. The coincidence of plaque-type psoriasis and a pustular eruption as described previously in impetigo herpetiformis supports the view that this dermatosis of pregnancy is a variant of generalized pustular psoriasis.

Adherence to colposcopy among women with HIV infection

In the general population, nonadherence to the recommendation to have colposcopy in women with abnormal cytologic smears is estimated at 30% to 80%, but studies have failed to identify consistent risk factors for nonadherence. The purpose of this analysis is to assess adherence to colposcopy in a subset of participants in the Women's Interagency HIV Study (WIHS), an ongoing multisite longitudinal study of HIV infection in women in the United States and determine factors associated with nonadherence. Identification of such predictors would be useful in designing strategies to improve adherence in this group.

METHODS

Adherence to colposcopy was examined in a cohort of 462 women with, or at risk for, HIV infection with abnormal cervical cytology on entry into WIHS. Adherence was defined as having colposcopy done within 6 months of an abnormal cytology result.

RESULTS

Overall adherence to colposcopy was 65% (302 of 462). A multivariate logistic regression model revealed that the odds of adherence were significantly lower for the women who were HIV-infected (p = .011), current crack/cocaine users (p = .040), ever too ill to get medical care (p = .033), not recruited by WIHS study staff (p = .004), and less concerned about the care of their children (p = .037). Among HIV-seropositive women, low CD4 counts, high viral loads, and presence of AIDS-defining illness were not predictive of nonadherence.

DISCUSSION

Adherence to colposcopy among WIHS participants was at the upper limit of the reported range in the United States. Chemical dependency and domestic violence may negatively impact on colposcopy adherence whereas supportive study personnel, having health insurance, and concerns about raising one's children appear to be motivators for adherence to colposcopy in this study. HIV infection was a risk factor for nonadherence, but markers of advanced disease were not predictive of nonadherence.

Tretinoin-iontophoresis in atrophic acne scars

BACKGROUND

Atrophic acne scars are a frequent problem after acne. Hitherto, mainly invasive treatment measures were possible. In a recent paper, we demonstrated the positive effects of iontophoresis with 0.025% tretinoin gel vs. estriol 0.03%.

OBJECTIVE

In this further study, the recording of the clinical effects of iontophoresis with 0.025% tretinoin gel in atrophic acne scars was supplemented by immunohistochemistry investigations of collagen I and III, proliferation markers, and the estimation of epidermal thickness.

METHODS

The treatment was performed twice weekly in 32 volunteer patients for a period of 3 months by application of the substance under a constant direct current of 3 mA for 20 min. Skin biopsies prior to and at the end of treatment were performed in 32 voluntary patients in order to investigate collagen I/III and proliferation markers by immunohistochemistry methods.

RESULTS

Clinically, at the end of treatment, in 94% of patients a significant decrease in the scar depth was observed. Neither epidermal thickness nor proliferation markers revealed a significant increase at the end of treatment. Furthermore, collagen I and collagen III showed no common trend, as expressed statistically by a lack of significance. In some cases, increases in collagen III became evident at the end of treatment.

CONCLUSIONS

Tretinoin-iontophoresis is an effective, noninvasive treatment of atrophic acne scars without causing disturbing side-effects.

A comparison of capitated and fee-for-service Medicaid reimbursement methods on pregnancy outcomes

OBJECTIVE

To determine if the payment method influenced the likelihood of selected obstetrical process measures and pregnancy outcome indicators among Medicaid women.

DATA SOURCE/STUDY SETTING

Data from the live birth certificates computer file for 1993 from the State of California. The computer files contain information about the demographic characteristics of the mother, her medical conditions prior to delivery, medical problems during labor and delivery, delivery method, newborn and maternal outcomes, and expected principal source of payment for prenatal care and for hospital delivery.

STUDY DESIGN

The study sample consisted of singleton live births to women in the California Medi-Cal program residing in one of two counties in which a mixed-model managed care plan was the method of reimbursement or in one of three counties in which fee-for-service was the payment method. The study and control counties were matched in terms of geographic proximity and sociodemographics.

PRINCIPAL FINDINGS

Among Medi-Cal women, the likelihood of low birth weight (LBW) was lower in the capitated payment group than in the fee-for-service payment group even when controlling for maternal and newborn characteristics and adequacy of prenatal care. There was no difference in either the adequacy of prenatal care, the cesarean birth rate, or the likelihood of adverse pregnancy outcomes other than LBW between the two payer groups.

CONCLUSIONS

Results of this "natural experiment" suggest that enrollment of pregnant Medi-Cal beneficiaries in capitated healthcare services through a primary care case management system in a county-organized health system/health insuring organization can have a beneficial effect on low birth weight and provide care comparable to a fee-for-service system.

Treatment of skin aging with topical estrogens

BACKGROUND

The coincidence of climacteric symptoms and the beginning of skin aging suggests that estrogen deficiency may be a common and important factor in the perimenopausal woman. Often hormones have been considered important in endogenous aging of the skin, but their role has not been clearly defined. Therefore, we investigated, whether topical treatment of the skin with estrogen could reverse some of the changes in the aging skin.

MATERIAL AND METHODS

The effects of 0.01% estradiol and 0.3% estriol compounds were compared in 59 preclimacteric women with skim aging symptoms. Monthly determinations of estrodiol (E2), follicle-stimulating hormone (FSH), and prolactin (PRL) were done and the monthly clinical monitoring was supplemented by measurements of skin hydration by corneometry and profilometry. In 10 patients, skin biopsies were taken for immunohistochemical determination of collagen types I and III.

RESULTS

After treatment for 6 months, elasticity and firmness of the skin had markedly improved and the wrinkle depth and pore sizes had decreased by 61 to 100% in both groups. Furthermore, skin moisture had increased and the measurement of wrinkles using skin profilometry, revealed significant, or even highly significant, decreases of wrinkle depth in the estradiol and the estriol groups, respectively. On immunohistochemistry, significant increases of Type III collagen labeling were combined with increased numbers of collagen fibers at the end of the treatment period. As to hormone levels, only those of PRL had increased significantly and no systemic hormonal side effects were noted.

New treatment of atrophic acne scars by iontophoresis with estriol and tretinoin

BACKGROUND

Common treatment of atrophic acne scars consists of invasive methods such as dermabrasion, chemopeeling, or implantation of bovine collagen. In our study a new noninvasive treatment method consisting of local iontophoresis is demonstrated. Local iontophoresis was performed with either estriol--a mainly topically active estrogen--or with tretinoin.

PATIENTS AND METHODS

Eighteen women were treated with estriol iontophoresis twice weekly for a period of 3 months. In addition to photographic and clinical documentation of the skin, venous blood for determination of serum levels of prolactin and estradiol according to standard radioimmunoassay methods was obtained monthly. Tretinoin iontophoresis was performed according to the same time schedule in 28 patients (19 women and 9 men) with atrophic acne scars.

RESULTS

Improvement of acne scars was observed in 93% of patients treated with tretinoin iontophoresis and in 100% of the group treated with estriol iontophoresis. No hormonal changes were noted in the estrogen group. Side effects involving the skin appeared in the tretinoin group in 4 cases and consisted of increased dryness and of retinoid dermatitis.

CONCLUSION

Both treatments were shown to be clinically effective in decreasing acne scars and persistence of effects. This promising new therapeutic approach may thus replace invasive treatment methods in many patients.

Treatment of skin ageing symptoms in perimenopausal females with estrogen compounds. A pilot study

A wide range of somatic symptoms of the perimenopausal female is due to the decrease of estrogen at that age. Minor attention has been paid hitherto to the involvement of estrogens in female skin ageing symptoms. In our study, the ageing skin of the face of perimenopausal females was treated with a 0.3% estriol cream (8 patients) or with a 0.01% estradiol cream (10 patients) for 6 months. Dermatologic follow-up was performed monthly. At each follow-up venous blood for radioimmuno assay determination of prolactin (PRL), follicle stimulating hormone (FSH) and estradiol (E2) was sampled. In addition, prior to and after 3 and 6 months of treatment, gynecological examinations for climacteric symptoms, mammary and colposcopic investigations and vaginal smears for cytology were performed. Both treatment groups showed improvement of the various skin ageing symptoms at the end of treatment. The effects of the group treated with topical estriol were slightly superior with regard to their extent and onset. No hormonal side effects were noted either clinically or by hormone monitoring. According to these preliminary results, local estrogen treatment appears to be a promising new approach for the treatment of skin ageing in perimenopausal females. However, for minimizing the risk of systemic hormonal side effects, concentrations and size of application field should be limited.

[Profilometry. A method for documenting skin structure]

Profilometry is a novel procedure allowing precise analysis of skin surface structure. With the help of a synthetic material a negative image of a defined area of the skin is taken. During the subsequent analytical procedure the roughness is determined by means of a profilometer. A commercially available statistics software program is used for statistical analysis of the results. This procedure was applied to check for to evaluate positive effects of oestrogen creams on the structure of the skin surface on the face.

Monte Carlo approach in assessing damage in higher order structures of DNA

We have developed a computer monitor of nuclear DNA in the form of chromatin fibre. The fibres are modeled as a ideal solenoid consisting of twenty helical turns with six nucleosomes per turn. The chromatin model, in combination with are Monte Carlo theory of radiation damage induces by charged particles, based on general features of tack structure and stopping power theory, has been used to evaluate the influence of DNA structure on initial damage. An interesting has emerged from our calculations. Our calculated results predict the existence of strong spatial correlations in damage sites associated with the symmetries in the solenoidal model. We have calculated spectra of short fragments of double stranded DNA produced by multiple double strand breaks induced by both high and low LET radiation. The spectra exhibit peaks at multiples of approximately 85 base pairs (the nucleosome periodicity), and approximately 1000 base pairs (solenoid periodicity). Preliminary experiments to investigate the fragment distributions from irradiated DNA, made by B. Rydberg at Lawrence Berkeley Laboratory, confirm the existence of short DNA fragments and are in substantial agreement with the predictions of our theory.

Hormonal basis of male and female androgenic alopecia: clinical relevance

A broad range of hormones was determined in males and females with androgenic hair loss (AH). The androgens testosterone, androstenedione, dehydroepiandrosterone sulfate, 17-hydroxyprogesterone and sex hormone binding globulin were evaluated in 65 male and 46 female patients. Besides estradiol (E2), cortisol (F), and the hypophyseal hormones LH, FSH, and prolactin (PRL) were investigated. Hormone levels were compared with those of 58 age-matched male and 45 female controls. In 38 of the 46 female AH patients, hypophyseal function was moreover evaluated by the 'TRH test', which detects slight, secondary hypothyroidism and/or hyperprolactinemia. Our findings showed a significant elevation of F in both male and female AH patients compared to controls, pointing to the suprarenes as a contributing factor in AH. This is confirmed by the observation of exacerbated AH in periods of increased stress. Concerning specifically male androgens, a significant elevation of androstenedione was noted. The mainly peripheral activity of this hormone and elevated E2 levels in males stress the importance of androgen metabolism especially at the peripheral level. Additional TRH tests in females demonstrated significant hypophyseal hypothyroidism. Multilayered interaction between thyroid hormones and androgens may contribute to the development of AH in hyperthyroid patients. Another significant finding was elevated PRL after TRH stimulation. Thus, the androgen-stimulating effect of PRL may also play a role in female AH. Our findings show multilayered hormonal influences in AH. Broad-range hormone determination demonstrated a differentiated hormonal situation in this disorder.

When applied to facial skin, does estrogen ointment have systemic effects?

We examined cytological vaginal smears of 17 women before and after three months of dermal estrogen (1 g of 0.01% estradiol ointment or 0.3% estriol ointment once daily), applied to the face for dermatological indications. The mean age was 57.1 +/- 7.6 years (range from 46 to 66). Seven women had estrogenic smears (more than 10% superficial cells) before therapy. Nine women were treated with 0.01% estradiol ointment and 8 were treated with 0.3% estriol ointment. Both groups had gynecological examinations including cervical and vaginal smears before and after treatment and also monthly measurements of serum follicle-stimulating hormone, prolactin and estradiol levels. Serum hormone levels and the appearance of vaginal smears showed no significant change during treatment.

[Hyperprolactinemia and hypophyseal hypothyroidism as cofactors in hirsutism and androgen-induced alopecia in women]

A more comprehensive hormonal diagnosis than has previously been performed shows that androgen-dependent diseases of hair growth are due to more varied hormonal disturbances than elevated androgen serum levels alone. In 46 female patients with androgenic hair loss and 27 patients with hirsutism, the levels of the androgens testosterone, free testosterone, androstenedione, dehydroepiandrosterone sulphate and 17-hydroxyprogesterone and of sex hormone-binding globulin, cortisol, oestradiol and the hypophyseal hormones follicle-stimulating hormone and luteinizing hormone were determined and compared with the hormone levels of 27 female patients without endocrine disorders. Of the androgens, only androstenedione showed a slightly significant elevation in hirsutism. Cortisol was elevated significantly in androgenic hair loss, and with a low degree of significance in hirsutism. In view of the complex hormonal interactions of thyroxin, prolactin and androgens and thyroid hormones the thyrotropin-releasing hormone (TRH)-stimulation test was performed in 38 female patients with androgenic hair loss and 27 with hirsutism, and the results were compared with those recorded in 45 female control persons. The test is based on feedback mechanisms between hypothalamic TRH and hypophyseal TSH and prolactin and peripheral thyroid hormones. Baseline concentrations of TSH prior to stimulation were significantly elevated in hirsutism, while in androgenic hair loss both baseline and stimulated TSH levels were significantly elevated; thus, hypothyroidism is a significant finding in both clinical pictures. In the case of prolactin, both baseline and stimulated levels were highly significantly elevated in hirsutism, while in androgenic hair loss the stimulated levels were significantly elevated.(ABSTRACT TRUNCATED AT 250 WORDS)

Hormonal parameters in androgenetic hair loss in the male

Alopecia in the male is considered as a genetically determined disorder. Increased local androgen metabolism and androgen receptor binding in the balding areas confirm the importance of the target organ hair follicle as regulative of androgen influences. In our study the hormonal parameters of 65 male patients with male pattern hair loss with a mean age of 24.31 years were compared with those of 58 age-matched controls. Determinations of the androgens, sex-hormone-binding globulin, the hypophyseal hormones luteinizing hormone, follicle-stimulating hormone and prolactin, 17 beta-estradiol and cortisol were performed by standard radioimmunoassay. Significant differences in serum levels of androstenedione, cortisol, 17 beta-estradiol and luteinizing hormone were noted between hair loss patients and control subjects. Suprarenal stimulation as well as hypophyseal feedback mechanisms therefore seem to be involved in male pattern alopecia.

Hormone studies in females with androgenic hairloss

Reports on hormone analysis in androgenic hairloss in the female show partly contradicting results. Elevated as well as normal-range androgen levels have been found. The present study aimed at the investigation of a possibly more differentiated hormonal constellation by hormone analysis and additional determination of the hypophyseal level by the thyrotropin-releasing hormone (TRH) test. In 46 female patients with androgenic hairloss blood sampling for hormone analysis was performed. Determination of the androgens testosterone (T), androstenedione (A), dehydroepiandrosterone sulfate (DHEAS), 17-hydroxy-progesterone acetate (17-OHP) and free testosterone (FT), of sex-hormone-binding globulin (SHBG), estradiol (E2), cortisol (F) and the hypophyseal luteinizing hormone (LH) and follicle-stimulating hormone (FSH) was performed by standard radioimmunoassay methods. The TRH-test is based on feedback mechanisms between the hypothalamic TRH which stimulates hypophyseal TSH and PRL release. Thus, even mild forms of hypothyroidism or hyperprolactinaemia can be detected. The control group for the TRH test consisted of 45 volunteer females without hairloss or any other hormonal or menstrual disturbances. Statistical analysis was performed according to the Wilcoxon two-sample test. The results of the study show no significant elevation of androgens in females with androgenic hairloss, but a more complex condition with involvement of the glandula suprarenalis and the hypophyseal level. Significantly elevated TSH levels prior to and after TRH stimulation in the hairloss group indicate that hypothyroidism may be an important hormonal disturbance in androgenic hairloss. Interactions between hypothyroidism and androgen metabolism are possible at various links.(ABSTRACT TRUNCATED AT 250 WORDS)

Endocrine parameters in acne vulgaris

Hormonal parameters (see below) were determined in 78 male acne patients of both sexes (mean age 21.2 +/- 3.8 years; (mean +/- S.D.) and compared with 63 controls (25.0 +/- 4.2 years). In a female group consisting of 60 patients acne (23.2 +/- 5.0 years) and 28 controls (26.1 +/- 5.7 years) of age, blood sampling was performed in the luteal phase of the menstrual cycle. Testosterone (T), dehydroepiandrosterone-sulfate (DHEAS), androstenedione (A), free testosterone (FT) and 17-hydroxy-progesterone (17-OHP) were determined by standard radioimmunoassay methods. In addition, sex hormone binding globulin (SHBG), follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), 17 beta-estradiol (E2) and cortisol (F) were evaluated. Moreover, the counts of acne lesions in the face were performed in 34 males and females patients in order to investigate possible correlations between hormones and acne lesions. The results in the male group revealed a significant elevation only for F but not for the other hormones. However, the female acne group significantly elevated levels of T, DHEA and F and a decrease of E became apparent. In addition, the correlation between both free and total T and acne lesions were found in the total of males and females. In the female group, free T and total A were found to correlate with acne lesions. The evaluation of these results indicates that androgens play a more important role in female than in male acne at the hormonal and at the peripheral level in skin. Another interesting finding was the significant increase of F in both male and female acne subjects, thus stressing the role of suprarenal involvement.

Characterization of fragmented heavy-ion beams using a three-stage telescope detector: detector configuration and instrumentation

Accelerated heavy-ion beams used in biological and medical research are often utilized in conjunction with absorbers which lead to the fragmentation of the beam. The BERKLET, initially a two-stage solid-state telescope detector, was designed to make rapid, on-line energy and linear energy transfer (LET) measurements of individual particles in a heavy-ion beam, thus allowing characterization of fragmented beams. From data collected with the BERKLET, one is able to determine a number of important parameters. These include: residual energy and LET histograms for the full beam and for the individual Z components, relative number of particles with a given Z, and dose and track average LET's for the full beam and for the individual Z's. Improvements to the BERKLET design and changes in data analysis are discussed and contrasted with the results of an earlier BERKLET configuration. The most notable improvements are the addition of a thin scintillation detector for improved LET measurement, a tenfold improvement in the dynamic range of the event discriminator, reported here as 1:2000, and dual high-and low-gain amplification of the LET signals, permitting the identification of particles with Z's ranging from 12 down to 1.

Characterization of fragmented heavy-ion beams using a three-stage telescope detector: measurements of 670-MeV/amu 20Ne beams

Measurements of a 670-MeV/amu 20Ne beam at the Lawrence Berkeley Laboratory Bevalac heavy-ion accelerator with various thicknesses of water absorber were obtained with the BERKLET. The BERKLET, a simple three-stage solid-state telescope detector, has been described previously. This instrument measures the linear energy transfer (LET) and residual energy of particles, allows the identification of the particle's charge, and provides a means of obtaining LET and energy statistics for the beam, separated by particle charge. The track and dose averaged LET dependence on the amount of water absorber was determined for each species of fragment in the beam. Large numbers of low-LET particles in the fragmented beam were detected. The results of the analysis are presented followed by a discussion of the effects of multiple scattering and secondary fragmentation on the measurements. A brief discussion of the implications of the BERKLET measurements for radiobiology is also presented.

Hormone receptors in pubic skin of premenopausal and postmenopausal females

Various functions of the skin are hormone-dependent. Recently hormonal involvement in aging processes of the skin has attracted increasing interest. The rapid onset of aging of the skin from the climacterium on seems to be correlated with the decrease of estrogens. In order to evaluate hormonal stimulability of the skin a study of hormone receptors was performed in pre- and postclimacteric women. Pubic skin of a total of 106 females was obtained during gynecologic operations for determination of estrogen receptors (ER), androgen receptors (AR) and gestagen receptors (PgR) by saturation analysis. In the preclimacteric group consisting of 62 females with a mean age of 39.6 +/- (SD) 6.5 years the operations were performed in the luteal phase of the menstrual cycle. The results were compared with those of 44 postmenopausal females with a mean age of 63.2 +/- 9.4 years. AR concentrations were significantly lower in the skin of postmenopausal women. 47.4% positive findings with a mean receptor level of 15.3 +/- 33.3 fmol/mg protein were to be found against 85.2% positive AR with a mean level of 31.4 +/- 20.3 fmol/mg protein in the ovulatory cycling females. These findings were of high significance. In addition, diminished PgR in the postmenopausal group were noted for incidence and mean receptor levels. PgR were positive in 18.4% with a mean level of 34.2 +/- 72.8 fmol/mg protein versus 36.3% with a mean receptor level of 34.2 +/- 72.8 in the ovulatory group. In contrast, no significant differences between ER of premenopausal and postmenopausal skin became evident. Results of hormone receptor determinations in the premenopausal and postmenopausal group with regard to the aging process are interpreted.

[Hypothyroidism and hyperprolactinemia as a possible cause of androgenetic alopecia in the female]

31 female patients suffering from androgentic alopecia were examined by means of the TRH test with regard to hypothyroidism and hyperprolactinemia. Before, as well as 20 and 40 minutes after, application of thyroxine releasing hormone (TRH), the serum concentrations of the hypohyseal thyroxine stimulating hormone (TSH) and prolactin (PRL) were measured by radioimmunoassay (RIA). In 7 of the patients (23%), we found increased TSH levels after stimulation with TRH--indicative of hypothyroidism. In 9 of the patients (29%), we observed increased PRL levels after TRH stimulation, indicating prolactinemia. TSH and PRL can interact with androgen metabolism at various levels. Thyroxine may influence the unbound, metabolically active testosterone via the sex hormone binding globulin (SHBG). Prolactine, which is stimulated by TRH, promotes the suprarenal cortisol and androgen production. In 48% of the patients, we found either hypothyroidism or hyperprolactinemia. This suggests that both conditions may contribute to the clinical picture of female androgenetic alopecia, as they interfere with the androgen metabolism.

[1 percent clindamycin phosphate solution versus 5 percent benzoyl peroxide gel in papulopustular acne]

In a multicenter study, 60 patients suffering from mainly moderate papulopustular acne were treated to pically either with 1% clindamycin phosphate in alcoholic solution or with 5% benzoyl peroxide gel, 30 patients each. During the treatment period of 9 weeks, clinical controls with lesion counts were performed every 3 weeks and after a 3 weeks follow-up. The therapeutic efficacy according to the reduction of papules and pustules was 72% in the benzoyl peroxide group and 73% in the clindamycin group, the latter showing significantly less side effects. On account of its good therapeutic results, we consider topical treatment with clindamycin phosphate an important alternative to systemic antibiotic or topical benzoyl peroxide therapy in acne.

[Effect of topical glucocorticoids on endogenous cortisol production]

In a randomized double blind study, we investigated the systemic effects of 3 different ointments containing corticoids. Every 7 patients out of a total of 21 patients suffering from various skin diseases were daily treated with 40 g of one of the 3 corticoid preparations over 8 days (group A: 0.05% clobetasol-17-propionate; group B: 0.25% fluocortolone trimethyl acetate; group C: 0.25% fluocortolone trimethyl acetate + 0.25% fluocortolone capronate). The plasma cortisol levels were determined by radioimmune assay. In group B and C, we did not observe any effect on the pituitary-adrenal axis, whereas in group A the plasma cortisol levels were extremely low already after 1 day of corticoid application. This adrenal suppression did not return to normal within 4 days after discontinuation of the corticoid. Our results suggest that highly potent topical corticoids are capable of adrenal suppression even without occlusive dressing and even in healthy persons.

Nuclear and cytosol androgen receptor in androgen dependent dermatoses in female patients

Determination of cytosol and nuclear androgen receptor (AR) was performed in females with androgen dependent dermatoses. 34 patients with acne, hirsutism and androgenetic alopecia were punch biopsied on day 21 of the menstrual cycle under local anesthesia within correspondent predilection sites. The tissue was snap frozen in liquid nitrogen and stored until receptor assays were performed. Overall evaluation of both, cytosol and/or nuclear AR was positive in 76% of all cases. In 86% of (10 out of 14) females with androgenetic alopecia, in 80% (8 out of 10) of patients with acne and 60% (6 out of 10) of hirsute females cytosol and/or nuclear AR were positive. No significant differences of cytosol androgen receptor levels became evident between the dermatoses. In contrast, nuclear androgen receptor levels showed a trend towards distinct differences with highest levels in hirsutism, followed by androgenetic alopecia and acne. Androgen stimulability thus seems to be superior in the first and minor in the latter. Comparison with previous studies on cytosol androgen receptor in androgen dependent dermatoses shows significantly higher number of positive results by additive nuclear receptor determination. Additional nuclear androgen receptor assay, thus gives a more complete picture of local hormone action.

[An effective topical antiandrogen--17 alpha-propylmesterolone--in acne]

17 alpha-Propylmesterolon, a new topically active antiandrogen, was administered to 25 patients with papulopustular or comedo acne and severe seborrhoea. The patients were supplied with a 3% solution of 17 alpha-propylmesterolone in 70% alcohol and were advised to apply it to the face twice daily for a mean duration of 14 weeks. Clinical follow-ups and thin-layer-chromatography determination of the sebum secretion rate (SER) and the lipid fractions were performed monthly. At the end of the treatment period 72% of the patients had improved. Comedo acne was reduced by 2 grades, papulopustular acne by 1.8 grade. The mean reduction of seborrhoea was 2 grades. SER was reduced in 62.5% of the patients to 76.4 +/- 8.8% of pretreatment values. In addition to sebaceous gland lipids, epidermal lipids were also inhibited effectively. This finding is in accordance with the marked reduction of comedones. Thus, in addition to sebaceous gland inhibition, epidermal structures may also be the target of the antiandrogen.

[Dandruff--an atopic sign?]

Dandruff is a sign of low specificity but high sensitivity for atopic constitution. Of 32 (40%) patients consulting the clinic for other reasons than dandruff, atopic dermatitis, or seborrheic dermatitis, 13 had raised IgE PRIST values of greater than 120 IU/ml. In only 6 (19%) of these patients was screening for atopy completely negative (family and personal history, total and specific IgG, prick test).

Efficacy of topically applied 17 alpha-propylmesterolone in acne patients

A new substance--17 alpha-propylmesterolone--was tested in the treatment of acne. 8 male and 5 females patients applied a 3% alcoholic solution of the substance twice daily on the face for a mean period of 13 weeks. Besides clinical controls with acne grading also the determinations of the sebum excretion rate (SER) and separation of the lipid fractions was done before onset of treatment, after 14 days and then monthly. Concomitantly, the levels of several hormones (serum testosterone, prolactine, follicle stimulating hormone, luteinizing hormone and estradiol) were determined. Clinical results were moderate to excellent in most of the patients. In two patients no therapy effects became apparent after 8 weeks. SER was decreased in all patients to values between 70 and 4% of pretreatment values. Sebaceous gland lipids and epidermal lipids were both inhibited effectively. Hormonal parameters showed no significant difference of pretreatment and posttreatment values. For the first time positive effects of a topical new antiandrogen--17 alpha-propylmesterolone--could be demonstrated. The interesting finding of decrease of dermal and epidermal lipids suggests that not only sebaceous glands but also overstimulated epidermal structures may be inhibited by this antiandrogen.

[Endocrine constellation in androgenetic alopecia in the female]

The mechanisms which induce androgenetic alopecia in females are only poorly understood at the molecular biological level. In predisposed, mainly centroparietal areas, androgenic stimulation of genetically predisposed hair follicles is considered to cause transformation from terminal to vellus hair follicles. However, reports on serum androgen levels in androgenetic alopecia in the female show broad variations. In the present study serum androgens, gonadotropins, oestradiol and sex hormone binding globulin were determined in the luteal phase of the menstrual cycle in 25 patients with female pattern androgenetic alopecia by radioimmunosorbent assay. In 16 of these patients skin slices from the alopecic areas were punch biopsied under local anaesthesia for determination of cytosol- and nuclear androgen receptor (AR). Mean values of all serum hormone levels were within the normal range. Cytoplasmatic AR was positive in 75% of cases, with a mean level of 22 fmol/mg protein. In 50% of cases nuclear AR was demonstrated, with a mean level of 119 fmol/mg DNA. No correlation was found between serum androgen levels and AR. Highly positive AR levels indicate a high androgen stimulability in female androgenetic alopecia. These findings support the concept of AR as regulators of genetically determined hair follicles in androgenetic alopecia.

Parenteral and oral cyproterone acetate treatment in severe hirsutism

In the present study a parenteral treatment regimen with cyproterone acetate was compared with the high dose peroral administration in patients with severe hirsutism. Two groups consisting of 10 patients each performed treatment with either 100 mg cyproterone acetate perorally for the first 10 days of the menstrual cycle or received a monthly implant of 300 mg cyproterone acetate intramuscularly applied on the first day of each cycle. In addition, contraception was performed with Diane in both patient groups. 9 treatment cycles were followed by a posttreatment period of 3 months. Hair parameters and serum androgens were monitored regularly. No significant differences of testosterone, androstenedione, dehydroepiandrosterone-sulfate and prolactin serum levels became evident between both cyproterone acetate regimens. Measurements of facial hair diameters revealed a better reduction for the parenteral application. Also the improvement of dermatological parameters was more prominent in the parenteral treatment group. The good effects of a medium dose parenteral application against higher dose peroral treatment thus was documented. The lack of significant differences of androgenic suppression in both regimens turns up the question if different metabolism at the cellular level may be responsible for that phenomenon.

Does cyclosporin A influence sex hormone level?

Cyclosporin A is an effective immunosuppressive substance which is extensively applied in various conditions. A well known side effect of high dose Cyclosporin A treatment is the occurrence of hypertrichosis, often referred to as hirsutism. The purpose of the study was therefore to investigate ovarian, adrenal and pituitary hormones as possible mediators of increased hair growth. In 5 female and 11 male patients who had developed hair overgrowth during Cyclosporin A treatment serum androgens (testosterone, dehydroepiandrosterone-sulfate, androstendione), sex hormone binding globuline (SHBG), prolactin (HPRL), 17-hydroxyprogesterone (17-OHP), 17 beta-estradiol (17 beta-E) and cortisol (F) were determined by standard radioimmunoassay methods. The same number of age matched patients with Azathioprine treatment served as control. Both patient groups received additive cortisone treatment of the same dosage. No significant differences of serum androgens were noted between Cyclosporin A treated patients and controls. In addition, normal prolactin levels were defected. 17-OHP was in the low normal range and cortisol below normal due to the additive cortisone treatment. SHBG was within normal range. The findings thus indicate that increased hair growth caused by Cyclosporin A seems not to be caused by an action of the substance on the hormonal level.

[Immunoglobulin A in the sebaceous glands. Light and electron microscopy immunomorphologic detection]

This paper presents evidence for the presence of immunoglobulin A in human sebaceous glands. Light- and electron-microscopic immune cytochemistry techniques revealed secretory IgA in normal sebocytes and within pilosebaceous ducts. The secretory process corresponds to the well-established production of IgA at the site of other internal body surfaces. Basal and suprabasal sebocytes contain IgA in linear extracellular, as well as aggregated intracellular patterns. However, maximal diffuse concentrations are present at the opening of the pilosebaceous duct. This distribution pattern indicates an antimicrobial protective character of IgA, corresponding to similar functions on mucous membrane surfaces. Thus, another important humoral factor contributing to the complex system of skin-associated lymphoid tissue is postulated.

[Parameters of cellular and humoral immunity in patients with severe acne]

Severe forms of acne, characterized by predominance of inflammatory reactions and persistence of the disease for years, still present therapeutic problems. The purpose of our study was to investigate the role of the immune system in severe persisting forms of acne by means of determination of cellular and humoral immunobiological parameters. The study was performed on 52 patients (47 males and 5 females) having suffered from severe acne for six years on an average, including papulopustular acne grade IV resistant to therapy, nodulocystic acne, conglobate acne, and acne tetrade. The results were compared with those of 52 healthy controls of the same age showing no inflammatory diseases, who were tested on the same day. In 56% of the acne patients, one or more parameters showed pathological values, while in nodulocystic and conglobate acne there were similar results with regard to cellular defects and acute phase reactants. The lymphocytic proliferation induced by mitogens was significantly decreased in 35% of the acne patients. We assume that the immunodeficiency observed in these patients may be mainly secondary; however, it may contribute to the perpetuance of the disease and its resistance to therapy.

[Marghescu-Braun-Falco syndrome]

A 32-year-old male patient with congenital poikilodermia syndrome is presented. The case history details of blister formation in the past and the association of the characteristic symptoms prompted us to make the diagnosis of Marghescu-Braun-Falco Syndrome in a male patient.

[Topical cimetidine treatment of acne]

We present first results of topically applied cimetidine in acne. Ten patients suffering from papulopustular and comedone acne administered 2% cimetidine in indifferent lotion on their face twice a day. Clinical controls were performed every two weeks; sebum was monthly determined. After treatment of 13 weeks on the average, the clinical success was generally good. Comedones responded best, followed by papules. Pustules were hardly reduced. There was no significant reduction of SER and the lipid fractions at the end of treatment. Low concentration or insufficient penetration might be possible explanations. The efficient reduction of comedones might be an antiandrogenic effect due to modulation of the keratinization in the follicle excretory duct. Immune-modulatory effects of cimetidine and effects on the skin vessels are other possible explanations for the clinical efficacy of topical application of cimetidine in acne.

[Inhibition of ovulation with 35 micrograms of ethinyl estradiol and 2 mg of cyproterone acetate (Diane 35)]

In the study reported here the ovulation inhibition dose for cyproterone acetate was determined. Experiments showed that the ovulation inhibition dose is 1 mg of cyproterone acetate, administered daily. Results proved that the cyproterone acetate dose cannot be reduced when cyproterone acetate is combined with ethinyl estradiol. However, the objective of this study was to determine whether it is possible to reduce the estrogen dose to 35 micrograms when the common combination of 2 mg cyproterone acetate and ethinyl estradiol is being used. After a control menstruation cycle, 2 mg cyproterone acetate and 35 micrograms ethinyl estradiol were administered daily to six women with normal menstruation. Drug administration began on Day 5 and ended on Day 25. During the control cycle, the first treatment cycle, and the third treatment cycle, LH, FSH, 17 beta estradiol, progesterone, testosterone, prolactin, and SHGB were examined daily. Cervix score and karyopyknosis index were determined at the same time. In addition, antithrombin III was examined during the control cycle and during the third treatment cycle. Present results show that ovulation inhibition is possible with dose reduction of ethinyl estradiol to 35 micrograms, combined with 2 mg of cyproterone acetate. Increase in SHBG and reduction in testosterone serum level point to an additional antiandrogenic effect of cyproterone acetate, aside from its cellular effect. The combined preparation discussed here does not bring about any changes in antithrombin III values. Results permit the conclusion that ovulation inhibition is insured with a reduction of the daily estrogen dose from 50 micrograms to 35 micrograms.