High prevalence of vitiligo in lepromatous leprosy

BACKGROUND: Leprosy and vitiligo are common affections in the West Indies. Vitiligo frequently occurs in lepromatous patients, an observation rarely reported in the literature. METHODS: We studied the prevalence of vitiligo in patients affected by leprosy by performing a retrospective study between 1978 and 1999 in the French West Indies (Martinique). RESULTS: Eleven patients presented with vitiligo among 101 with lepromatous (multibacillary) leprosy. None presented with vitiligo among the 364 with the tuberculoid (paucibacillary) form. The mean age of the vitiligo patients was 55. 4 years at vitiligo onset. The sex ratio was 0.8. Vitiligo occurred 19 years after the diagnosis of leprosy, with a range from 3 to 42 years. The prevalence of vitiligo in lepromatous patients was 10.9%, compared to 0% in tuberculoid patients. Such an increase in prevalence compared with that in the general population (0.34%) was shown to be highly significant (P< 0.0001). CONCLUSIONS: Our data confirmed that the association of vitiligo and leprosy was not fortuitous. The physiopathology leading to this high rate of vitiligo in lepromatous leprosy is unclear, despite the fact that autoimmunity plays a major role in both diseases.     

Three-dimensional Transesophageal images of a pulmonary autograft in the mitral position (Ross II Procedure) in an adult

Few images are available in the literature of the Ross II procedure wherein the pulmonary valve is autotransplanted into the mitral position. These images are from a 33-year-old woman who underwent the procedure 18 years ago.     

Quantitative analysis of anastomotic intimal hyperplasia in paired Dacron and PTFE grafts

The purpose of this investigation was to compare and contrast the occurrence and progression of anastomotic intimal hyperplasia in two commonly used prosthetic arterial grafts. Twenty paired carotid artery interposition grafts of Dacron and PTFE (polytetrafluoroethylene) were implanted in a canine model. The grafts were electively removed at intervals from one week to seven months or at the time of thrombosis. Areas of hyperplastic growth were determined at each anastomosis using a quantitative histologic technique. The number of grafts quantitatively evaluated was 16 Dacron and 12 PTFE, excluding all thrombosed grafts. In both materials, hyperplasia occurred to a significantly greater degree at the distal or downstream anastomosis as compared with the proximal or upstream anastomosis (Dacron P less than 0.001, PTFE P less than 0.05). Quantitative and qualitative evaluation of these two commonly used but different arterial grafts did not demonstrate a significant difference in the occurrence of anastomotic hyperplasia.     

Klebsiella pneumoniae bacteremia in the community hospital

The purpose of this study was to elicit the circumstances of occurrence and organism sensitivities of Klebsiella pneumoniae bacteremia in the community hospital, since data on this illness from the community hospital are rare. All records of documented Klebsiella pneumoniae bacteremia (46 cases) at Alachua General Hospital, Gainesville, Florida, over the period July 14, 1982, through July 27, 1985, were reviewed in detail. Fifty-nine percent (27 organisms) were nosocomial, whereas 41% (19 organisms) were community acquired. The most common predisposing disorders in these patients were, in decreasing order, malignancy; following gastrointestinal or biliary surgery; biliary tract obstruction; diabetes; and unknown. Twenty-two percent (10) of the patients died from bacteremia. The majority of organisms tested were sensitive to mezlocillin, cephalothin, cefoxitin, tetracycline, tobramycin, gentamicin, co-trimoxazole and ceftizoxime. Therapy was considered to be appropriate in 89% (41) of the patients and inappropriate in 10.9% (5) of the patients. Contrary to previous thought, Klebsiella pneumoniae bacteremia is a relatively common problem in the community hospital and may be community acquired as well as nosocomial. There are many characteristics of this disease in the community that are different from those reported in studies on Klebsiella pneumoniae bacteremia from large referral centers.     

A consistent model of insulin-dependent diabetes mellitus hypertension.

Hypertension is frequently seen in insulin-dependent diabetes mellitus (IDDM), but the mechanism of the hypertension is unknown. An animal model of IDDM hypertension could be helpful in determining the mechanism, but experimental IDDM has been infrequently and irregularly associated with hypertension. In an attempt to develop a consistent model of IDDM hypertension, we superimposed streptozotocin (STZ)-induced IDDM on surgical reduction of renal mass (RRM) in Wistar rats. Seven groups of rats were studied: 1) 60% RRM receiving 65 mg/kg body weight (BW) STZ; 2) 60% RRM receiving 40 mg/kg BW STZ; 3) 25% RRM receiving 65 mg/kg BW STZ; 4) two kidney normal rats receiving 65 mg/kg BW STZ; 5) 60% RRM receiving vehicle (control for group 1); 6) 60% RRM receiving vehicle (control for group 2); and 7) 25% RRM receiving vehicle. STZ produced diabetes and hypertension within 1 to 2 weeks in all three groups of RRM rats but blood pressure was unaffected by 60% or 25% RRM alone. STZ alone had no effect on blood pressure until the 5th week when the blood pressure increased slightly. Progressive weight loss resulted from 65 mg/kg BW STZ combined with 60% RRM; the animals had to be terminated after 5 weeks. In only 60% of animals with 40 mg/kg BW STZ plus 60% RRM was IDDM produced. On the other hand, 65 mg/kg BW STZ in rats with 25% RRM regularly produced IDDM and hypertension without excessive loss of body weight. In these rats, albuminuria developed in 2 weeks. Extracellular fluid volume was elevated and plasma renin activity was depressed. The animals were healthy and hypertensive when killed at the 13th week. We suggest that the 25% RRM rat receiving 65 mg/kg BW STZ is a consistent model of IDDM hypertension, which may be useful in probing the mechanism of this type of hypertension.     

Descending Aortic Dissection Originating from a Juxtaductal Traumatic Aneurysm: Technical Considerations

A 65-year-old male presented with a descending aortic dissection. His past history was remarkable for severe blunt chest trauma 26 years prior to presentation. Operative and pathologic findings included a posttraumatic pseudoaneurysm of the thoracic aorta and an aortic dissection that originated from the orifice of the pseudoaneurysm. The ductal fovea, the mouth of the pseudoaneurysm, is an area that may be more susceptible to accelerated atherosclerosis and the complications of atherosclerosis including aortic dissection. (J Card SUrg 1994;9:65–69)     

Exercise for managing cancer- and treatment-related side effects in older adults

The incidence of cancer in adults aged 60?years and older is expected to rise, and because cancer is associated with aging, the overall prevalence of cancer will rise as well. With advances in cancer treatment, more older adults will receive treatment but they will also suffer the biopsychosocial consequences of cancer and cancer treatment. In this review, we describe the importance of assessing biopsychosocial needs in this vulnerable population and highlight studies supporting the use of exercise in addressing these needs. We discuss challenges and research gaps in several areas including 1) Identifying the exercise doses and modes for specific outcomes, 2) Understanding risks and safety of exercise, and 3) Implementing exercise programs into clinical practice at the individual, health care team, and organizational levels, including strategies to increase adherence.