Zunehmender Heroin- und Kokainkonsum in der Schweiz seit 1990

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Cosmetic results of histographically controlled excision of non‐melanoma skin cancer in the head and neck region

Background: Beside the primary goal of complete eradication, the cosmetic result is an important aspect of the treatment of non‐melanoma skin tumors especially in the head and neck region. Patients and Methods: From 1990 to 2000, we treated a total of 5,227 large basal cell carcinomas (BBC) and 1,189 squamous cell carcinomas (SCC) in the head and neck region by surgical excision in 4,239 inpatients at the Department of Dermatology, University of Tübingen. The procedure used in all patients was a conservative excision controlled by complete three dimensional histology of all margins (3D‐histology) and specifically targeted follow‐up surgery where required (histographic surgery). As part of the prospective tumor follow‐up, we asked the treating outdoor physician one and four years later to evaluate the results of our surgical procedures. Results: Of the 5,565 follow‐up questionnaires sent back, 4,868 contained answers regarding the cosmetic result. The data from both answers were pooled. In 1,972 (40,5 %) patients the cosmetic result was evaluated as “excellent”, in 1,992 (40,9 %) as “good”, in 662 (13,6 %) as “satisfactory”, in 191 (3,9 %) as “mediocre” and in 51 (< 1,0 %) as “poor”. In 697 of the responses, the physician did not comment the cosmetic results or the patient was lost for follow up. Conclusion: With respect to both long term safety and cosmetic outcome, tumor surgery with 3D‐histology of excisional margins has set very high quality standards in the treatment of non‐melanoma skin cancer of the head and neck area.     

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Therapeutic Effects of Angiotensin (AT1) Receptor Antagonists

Blockade of the renin-angiotensin system improves morbidity and mortality of patients with cardiovascular diseases, e.g. arterial hypertension, renal failure, following myocardial infarction and in congestive heart failure. The angiotensin II type 1 (AT(1)) receptor antagonists (angiotensin receptor blockers; ARBs), i.e. losartan, eprosartan, irbesartan and valsartan were developed by computer-based molecule design. Early observations already indicate that the ARBs elicit pleiotropic effects developing anti-aggregatory, anti-inflammatory and anti-mitogenic effects independent from their actions at the AT(1) receptor. Losartan metabolism indicates a number of known active intermediates and pointed to further interactions of these derivatives with other receptors and cellular signaling systems. Here we discuss a compilation of detailed pharmacokinetic and pharmacodynamic data of active metabolites of ARBs indicating their mode of action and suggest novel therapeutic implications. The clinical observations that ARBs elicit potencies in patients with cardiovascular diseases via the regulation of inflammatory, growth and homeostatic factors lead us to focus on specific, reactive metabolites, which hold potential for future indications and possible drug interactions in cardiovascular diseases.     

Epinephrine‐supplemented local anesthetics for ear and nose surgery: Clinical use without complications in more than 10,000 surgical procedures

Introduction: Local anesthetics supplemented with epinephrine are generally regarded as contraindicated for surgical procedures involving the fingers, toes, penis, outer ear and the tip of the nose [ 1 ], but epinephrine is essential if automated tumescence local anesthesia (Auto‐TLA) is used. Materials and methods: Infiltration anesthesia supplemented with 1 : 200,000 epinephrine was used from 1985 – 1997 in our department, while Auto‐TLA supplemented with 1 : 1.000,000 epinephrine was introduced in 1997 for all surgical procedures involving the ear or nose. During this period, 10,201 patients underwent surgery at these locations. In addition, dermal blood flow was analyzed by acral photoplethysmography (APPG) and laser Doppler flowmetry (LDF) in the right ear lobe of five normal volunteers and during epinephrine supplemented Auto‐TLA. Results: Epinephrine‐induced complications were not observed in a single patient. Cosmetic skin flap surgery was performed in 4,953 of these patients. Even in patients with extended surgical procedures that took up to one to two hours and that included extensive skin flaps or skin grafts, we observed no increase in complications when compared to procedures performed either under general anesthesia or local anesthesia without epinephrine supplementation. Measuring blood perfusion of the earlobe showed a 69 % reduction of LDF and a 42 % reduction of arterial inflow (APPG) immediately following anesthesia. Conclusion: Epinephrine supplementation of local anesthetics does not block blood perfusion in the ear and did not induce organ, tissue or flap necrosis. Local anesthesia with epinephrine supplementation is therefore safe for acral areas such as the ear or nose. Despite the relatively small influence on blood perfusion, epinephrine supplementation results in a relatively bloodless operating field and longer effectiveness of local anesthesia. The relative absence of blood in the operating field of the ear and nose significantly reduces the duration of surgery and increases the healing rate, as less electrocautery is needed.     

Toxicity parameters for cytotoxicity testing of dental materials in two different mammalian cell lines

The present study compares three specific toxicity parameters for cytotoxicity testing of chemically different dental materials. Two glass ionomer cements, a zinc phosphate cement, and a composite material were used to evaluate the sensitivity of three assays: two viability assays, the MTT assay and the quantifiable neutral red assay, and a proliferation assay based on the determination of the total protein content of a cell culture. The colorimetric assays were carried out using transformed mouse fibroblasts (L-929 cells) and fibroblasts derived from biopsies of normal human gingiva. In most cases. all colorimetric assays detected much weaker cytotoxic responses, if any in gingival fibroblasts than in L-929 cells. The viability assays indicated cytotoxicity of the extracts of two glass ionomer cements in L-929 cells when the materials were set at 0% relative humidity for 24 h. The severe cytotoxicity of the zinc-phosphate cement in both viability assays was less influenced by the setting conditions. The cytotoxicity of the composite material was most pronounced in the neutral red assay. In general, both the MTT assay and the neutral red assay were more sensitive than the colorimetric proliferation assay. These assays can be performed very effectively; only few cells are needed for rapid, reliable and inexpensive screening purposes of a large number of samples in a short time. Automated processing with a microplate reader after non-radioactive labeling of the cells and subsequent automated analyses of original data, with no need for sophisticated and expensive equipment, are additional advantages of the systems.     

Poor renal uptake of99mtechnetium-dimercaptosuccinic acid and near-normal99mtechnetium-mercaptoacetyltriglycine renogram in nephronophthisis

Four patients with the clinical diagnosis of nephronophthisis are presented, all having a very poor renal uptake of^99mtechnetium-dimercaptosuccinic acid (^99mTc-DMSA) but clearly visualized kidneys on early images with^99mtechnetium-mercaptoacetyltriglycine and a normal or almost normal renogram. There was no difference between a young patient in an early stage of the disease and the other three patients with more advanced renal disease. In contrast, a patient with tubulointerstitial nephritis with uveitis had considerably better renal uptake of^99mTc-DMSA despite impaired renal function. We suggest that the specific tubular function defect in nephronophthisis might be the cause of the poor uptake of^99mTc-DMSA. We also recommend the method to support the clinical suspicion of nephronophthisis, even in the early stages of the disease.     

The role of MT2 and anti-bcl-2 protein antibodies in the differentiation of benign from malignant cutaneous infiltrates of B-lymphocytes with germinal center formation

MT2/CD45RA and anti- bcl -2 protein (Bcl-2) monoclonal antibodies are useful markers in distinguishing follicular lymphomas from reactive follicular hyperplasia of the lymph nodes. We examined biopsy specimens from 11 patients with primary cutaneous B-cell follicle center lymphomas, 10 patients with cutaneous pseudolymphomas with germinal centers, and 6 patients with inflammatory infiltrates with germinal centers in non-lymphoid cutaneous tumors (3 basal cell carcinomas, 2 malignant melanomas, and 1 solar keratosis), in order to evaluate the utility of MT2 and anti-Bcl-2 antibodies in differentiating benign from malignant germinal center cell proliferations in the skin. Immunohistochemical evaluation of MT2 and Bcl-2 was focused exclusively on the reactivity of germinal center cells. Specific membranous MT2 positivity was found in 2/11 cutaneous follicle center lymphomas; a diffuse, non-specific staining pattern was identified in 3/11 follicle center lymphomas and in 1/6 inflammatory infiltrates in non-lymphoid tumors. A negative MT2 reaction was observed in 6/11 follicle center cell lymphomas, in all cases of pseudolymphomas and in 5/6 inflammatory infiltrates in non-lymphoid tumors. Bcl-2 positivity was detected only in 1/11 follicle center lymphomas. Germinal center cells in all other cases were Bcl-2 negative. Our results suggest that MT2 and anti-Bcl-2 antibodies are only of limited value in differentiating primary cutaneous follicle center lymphomas from cutaneous pseudolymphomas with germinal centers.