Changing comorbidity classification patterns at radical prostatectomy during a 10-year period

OBJECTIVE: To investigate the consistency of several comorbidity classifications and concomitant diseases at radical prostatectomy (RP) during a 10-year period. METHODS AND MATERIALS: In 1,297 patients who underwent RP between 1993 and 2002, age and several comorbidity classifications were derived from patient records and assigned to the year of surgery. Trends were evaluated using the Cochran-Armitage trend test. RESULTS: Parallel to an increasing frequency of RPs and a shift toward more organ-confined tumors (P = 0.0094), the proportion of patients aged > or =70 years increased (P = 0.0077). The proportion of the American Society of Anesthesiologists (ASA) Physical Status class 3 increased (P < 0.0001), whereas that of ASA class 1 decreased (P < 0.0001). A Charlson score > or =1 has been assigned with an increasing frequency (P = 0.0008), whereas the trend with a Charlson score of > or =2 did not reach statistical significance (P = 0.07). In contrast to the latter 2 classifications, no significant trends were observed with classifications related to diabetes mellitus and heart disease. CONCLUSIONS: This study shows that the application of the ASA classification may change significantly over time, whereas cardiac and diabetes-related conditions, as well as the Charlson score were apparently less sensitive to changing classification standards in the RP setting.     

Tuberös-pustulöse Demodikose

Zusammenfassung Berichtet wird über eine 38j?hrige Patientin, bei der es zum pl?tzlichen Auftreten eines plattenartig infiltrierten, derben Tumors mit Pusteln im Kinnbereich gekommen ist. Das klinische Bild, histologische Ver?nderungen sowie mikrobiologische Untersuchungen best?tigen die Diagnose einer Demodikose. Histologisch zeigten sich Follikelzysten mit Perforation sowie chronisch granulomat?ser Perifollikulitis mit Nachweis von Demodex folliculorum. In Abstrichpr?paraten aus Pusteln fanden sich massenhaft Milben der Gattung Demodex folliculorum. Im Rahmen der Durchuntersuchung fanden sich keine Hinweise auf Malignome, Systemerkrankungen oder einen zellul?ren bzw. humoralen Immundefekt. Unter interner Gabe von Metronidazol und Prednisolon kam es zu einer guten Rückbildung der Hauterscheinungen. Eingegangen am 9. Februar 1998 Angenommen am 11. M?rz 1998     

Case of Pediatric Bullous Systemic Lupus Erythematosus Treated with Intravenous Immunoglobulin

This is a case report of a 16‐year‐old girl recently diagnosed with systemic lupus erythematosus (SLE) who presented with multiple blisters on the face, hands, arms, legs, trunk, and vaginal and oral mucosa. Skin biopsy was consistent with bullous SLE (BSLE). Dapsone is often the first‐line treatment option for BSLE, but the patient's history of anemia and leukopenia and long‐term immunosuppression requirement for her systemic symptoms raised concerns about dapsone and bone marrow toxicity, especially hemolytic anemia and agranulocytosis. She was started on intravenous immunoglobulin (IVIG), 2 g/kg divided over 3 days, with significant improvement in her cutaneous symptoms. IVIG is a treatment option for BSLE patients in whom agents such as dapsone are contraindicated.