S. El Gammal

Malignant Melanoma in 20-MHz B Scan Sonography

In order to assess the value of 20-MHz sonography in the pre-operative diagnosis of malignant melanomas, 54 melanomas were examined. The pre-operative ultrasound scans were compared with corresponding histological sections from the excised tumours. A computer-aided measurement of the tumour thickness (sonometry) and the internal echo density (densitometry) was performed in the ultrasound scans. The melanomas appeared as largely echolucent zones. There was a significant correlation between the tumour thickness measured in the ultrasound scan and those measured in the histological sections (r = 0.938, p less than 0.001). As a rule the tumour thickness determined by sonometry were greater than the histometrically determined values. Subtumoral inflammatory infiltrate and other hypo-echoic structures in the region of the tumour are possible causes of the discrepancies. Some of those hypo-echoic structures can be identified and disregarded in B scan measurement. Even if a definite differential diagnosis is not possible on the basis of the ultrasound scan alone, 20-MHz sonography provides additional information which can be of use in surgical planning.

Determination of density of follicles on various regions of the face by cyanoacrylate biopsy: correlation with sebum output

The density of follicles on various regions of the human face has received scant attention. We used cyanoacrylate follicular biopsies to determine the number of follicles on the forehead, cheek, chin and nose of 12 healthy adult white women. Sebum output was assessed on the same regions by means of Sebutape®. The density of follicles and sebum output followed a centrolateral decreasing gradient. There was no correlation between these two parameters. These regional patterns are important for studies of the pathogenesis of common disorders of the face and their response to treatment.

Gastrobiliary motility after liquid fatty meal in progressive systemic sclerosis : a sonographic study

Gastric emptying, antral motility, and gallbladder emptying after a liquid fatty meal were studied by ultrasound in 25 patients with progressive systemic sclerosis and in 25 sex- and age-matched controls. In patients with systemic sclerosis, the possible role of autonomic dysfunction was evaluated by four noninvasive cardiovascular reflex tests. Despite a significant delay of gastric emptying and a significant postprandial antral hypomotility in the patients with systemic sclerosis, the fat-induced gallbladder emptying was only slightly reduced, reaching no significant level when compared to the controls. The prolongation of gastric emptying correlated significantly with the duration of the disease. Although 36% of the patients in the systemic sclerosis group exhibited signs of autonomic cardiac dysfunction, there was no evidence of an association between these signs and gastric motor dysfunction. In conclusion motility disorders of the gallbladder seem to play a minor role in the upper gut involvement of systemic sclerosis, whereas motility disorders of the stomach are frequent and can be easily recognized noninvasively by real-time ultrasound.

In psoriasis the epidermis, including the subepidermal vascular plexus, grows downwards into the dermis.

In psoriatic lesions. capillaries in the papillary bodies seem elongated and increased in number. Most researchers postulate that there is angiogenesis of intrapapillary capillaries in psoriatic plaques. In this study we will show, by means of computer‐aided three‐dimensional reconstructions in four patients suffering from chronic plaque‐type psoriasis, and in a healthy volunteer. that the elongation and increase of intrapapillary capillaries are not the result of angiogenesis. Our threedimensional reconstructions show that the papillary body of psoriasis contains lymph capillaries besides the blood capillaries. Additionally. an inclusion of two tips of papillary bodies into one papilla at the base of the rete ridges becomes obvious. The vessel of the two tips are connected by a hrizontal vessel. At the level of the horizontal connecting vessel there is the blind begining of a lymphatic vessel. The connecting blood vessel. as well as the lymph capillary. belong to the horizontal subpapillary venous plexus but lie within the papillary body. The three‐dimensional reconstructions show that by growing towards the dermis, the rete ridges include the vessels of the horizontal plexus. Surrounded by rete ridges, these vessels appear as intrapapillary capillaries.

Phlebologie an deutschen Hautkliniken

BACKGROUND Phlebologic diseases have become extremely common and have major socio-economic impact. However, the percentage of dermatologists working in phlebology appears to be decreasing according to the data of the German Society of Phlebology (DGP). METHODS To investigate the reasons for this development, we--on behalf of the DGP--sent a questionnaire to 120 German Departments of Dermatology in autumn 2012. RESULTS In 76 returned questionnaires, the number of physicians with additional fellowship training in phlebology averaged 1.5; the average number of those who fulfill the criteria for training fellows in phlebology was 0.9. In 71.1 % of the departments there was a phlebologist. A special phlebologic outpatient clinic existed in 73.7 % of the departments. Sonography with Doppler (89.5 %) and duplex (86.8 %) was used as the most frequent diagnostic tool. For therapy, compression (94.7 %), sclerotherapy (liquid 78.9 %, foam 63.2 %, catheter 18.4 %), endoluminal thermic procedures (radio wave 28.9 %, laser 17.1 %) and surgery (especially crossectomy and stripping 67.1 %, phlebectomy of tributaries 75 %) were used. The average number of treatments was very heterogenous in the different departments. CONCLUSIONS Phlebology definitely plays an important role in dermatology. Most departments fulfill the formal criteria for the license to conduct advanced training in phlebology. A wide spectrum of phlebological diagnostic and therapeutic procedures is available.

Noninvasive Measurement of Wound Healing of the Skin

Clinical research has tried to speed up wound healing for more than a century. In order to develop appropriate medication for this purpose, we need to have an exact understanding of the physiology of wound healing. The development of wound healing models and the capacity to evaluate wound healing in an objective way are additional, important prerequisites. So far, there has been a lack of highly standardized or generally recognized wound healing models developed in human beings which meet strict scientific and ethical requirements. Investigations referring to wound healing models therefore have largely been restricted to animal experiments or to observations of the healing process on the surfaces of wounds.

High Resolution Estimation of Axial and Transversal Bloodflow with a 50 MHZ Pulsed Wave Doppler System for Dermatology

In this paper an approach for the combined estimation of axial and transversal velocity with special emphasis on high resolution is presented. Our proposed approach was tested using simulated data and measurements obtained from a flow phantom. With the estimated flow profile for the axial velocity it was shown that the flow profile inside the vessel with a diameter of 500 μm and with a flow rate of 0.18 μ1/s was parabolic. The proposed method gives adequate results at the center of the vessel, while the low velocities at the border are over estimated. With the combined estimation strategy complex vessel structures with unknown flow directions are taken into consideration. Subject of our future work is the imaging of the microcirculatory system of the skin.

Kombinierte Erfassung von axialem und transversalem Blutfluß mit einem 50MHz-Ultraschall-B-Bild System für die Dermatologie

Zusammenfassung Hochfrequenter, breitbandiger Ultraschall im Bereich von 50 bis 150 MHz ermoglicht die hochauflosende und nichtinvasive Abbildung sowie die sonographische Funktionsdiagnostik der Haut bei dermatologischen Fragestellungen. Neben der morphologischen Abbildung ist die funktionelle Diagnostik von grosem Interesse, insbesondere in Hinblick auf die qualitative und quantitative Detektion von Blutflus im mikrozirkulatorischen System der Haut [2]. Die hier vorliegenden Bedingungen, insbesondere gegeben durch kleine Gefasdurchmesser und kleine Flusgeschwindigkeiten, stellen sehr hohe Anforderungen an den Entwurf eines solchen Abbildungssystems und an geeignete Methoden der Echosignalverarbeitung. In dieser Arbeit wird ein Verfahren vorgestellt, welches unter spezieller Berucksichtigung eines grosen Orts- und Geschwindigkeitsauflosungsvermogens die kombinierte Schatzung der in Bezug auf die Schallausbreitungsrichtung axialen und transversalen Flusgeschwindigkeit und damit die Schatzung der tatsachlichen Geschwindigkeitsverteilung ermoglicht. Die Eigenschaften des Verfahrens werden an Simulationsdaten und Mesdaten eines Flusphantoms demonstriert.

A Color Image Analysis System (CD-CWA) for the Quantification of Wound Healing in Multicenter Trials

Clinical trials in wound healing are confronted with difficulties in the selection, definition, and assessment of parameters. Presently, there are no clear-cut, internationally accepted clinical research guidelines to quantify wound healing [1].

Phlebologie an deutschen Hautkliniken@@@Phlebology in German departments of dermatology: Eine Bestandsaufnahme im Auftrag der Deutschen Gesellschaft für Phlebologie@@@An analysis on behalf of the German Society of Phlebology

BACKGROUND Phlebologic diseases have become extremely common and have major socio-economic impact. However, the percentage of dermatologists working in phlebology appears to be decreasing according to the data of the German Society of Phlebology (DGP). METHODS To investigate the reasons for this development, we--on behalf of the DGP--sent a questionnaire to 120 German Departments of Dermatology in autumn 2012. RESULTS In 76 returned questionnaires, the number of physicians with additional fellowship training in phlebology averaged 1.5; the average number of those who fulfill the criteria for training fellows in phlebology was 0.9. In 71.1 % of the departments there was a phlebologist. A special phlebologic outpatient clinic existed in 73.7 % of the departments. Sonography with Doppler (89.5 %) and duplex (86.8 %) was used as the most frequent diagnostic tool. For therapy, compression (94.7 %), sclerotherapy (liquid 78.9 %, foam 63.2 %, catheter 18.4 %), endoluminal thermic procedures (radio wave 28.9 %, laser 17.1 %) and surgery (especially crossectomy and stripping 67.1 %, phlebectomy of tributaries 75 %) were used. The average number of treatments was very heterogenous in the different departments. CONCLUSIONS Phlebology definitely plays an important role in dermatology. Most departments fulfill the formal criteria for the license to conduct advanced training in phlebology. A wide spectrum of phlebological diagnostic and therapeutic procedures is available.