Repigmentation of pretibial vitiligo with calcineurin inhibitors under occlusion

Treatment of vitiligo is a challenge, especially in children. Recently, topical calcineurin inhibitors have been introduced in the management of vitiligo, but significant repigmentation is not achieved except on the face. Large pretibial lesions of a 15‐year‐old female with progressive vitiligo were treated twice daily over six months with 0.1% tacrolimus ointment on the right and 1% pimecrolimus cream on the left side without effect. Additional overnight occlusion with polyurethane and hydrocolloid foils during the following 18 months led to substantial repigmentation on both sides (tacrolimus‐treated side, 88% repigmented area; pimecrolimus‐treated side, 73%). Tacrolimus serum levels measured at four different time points did not exceed 1.8 ng/ml. This case report on a direct comparison of topical tacrolimus and pimecrolimus in vitiligo shows that on the shins considerable improvement could be induced with both agents only by additional long‐term occlusion and that tacrolimus was somewhat more effective than pimecrolimus.     

Unilateral lentiginosis--a segmental neurofibromatosis without neurofibromas]

Segmental neurofibromatosis (NF) is a usually non-inherited form of NF that is characterized by unilateral neurofibromas and/or café-au-lait spots. In partial unilateral lentiginosis (PUL), apart from unilateral lentigines, café-au-lait spots of different dimensions have been described in some patients without fulfilling the diagnostic criteria for NF. We report on three patients representing the 4th to 6th cases of segmental NF without neurofibromas. The diagnosis resulted from unilateral café-au-lait spots of different sizes in all patients and axillary "freckling" and associated skeletal alterations in two patients each. As these findings are clinically and histologically comparable to reported cases of PUL and moreover fulfil the diagnostic criteria for segmental NF, our cases support the hypothesis that PUL is a segmental NF lacking neurofibromas.     

Botulinum toxin type a is a safe and effective treatment for axillary hyperhidrosis over 16 months: a prospective study

OBJECTIVE: To evaluate the safety and efficacy of botulinum toxin type A (BTX-A) (BOTOX) over 16 months in the treatment of bilateral primary axillary hyperhidrosis. DESIGN: A 16-month study with initial double-blind randomization to 50 U of BTX-A or placebo per axilla. After 4 months, participants could receive up to 3 further treatments with open-label BTX-A over 12 months. SETTING: Fourteen dermatology or neurology clinics in Germany, Belgium, and the United Kingdom. PARTICIPANTS: Of 207 individuals aged between 17 and 74 years who had persistent bilateral primary axillary hyperhidrosis that interfered with daily activities, 174 (84%) completed the study. The baseline gravimetric assessment was a spontaneous sweat production of 50 mg or greater in each axilla prior to initial treatment. MAIN OUTCOME MEASURES: At week 4 after each treatment, the response rate of subjects who had at least a 50% reduction from baseline in axillary sweating, as measured by gravimetric assessment, was evaluated. Adverse events were spontaneously reported throughout the study, together with quality-of-life parameters and assessment of neutralizing antibodies to BTX-A. RESULTS: Over the 16-month period, 356 BTX-A treatments were given to 207 subjects. After placebo treatment, the response rate at week 4 was 34.7%. After the first, second, and third treatment with BTX-A, response rates at week 4 were 96.1%, 91.1%, and 83.3%, respectively. For subjects receiving more than 1 treatment, the mean duration between BTX-A treatments was approximately 7 months; however, 28% of subjects completed the study after only 1 BTX-A treatment. Subjects' satisfaction after treatments was consistently high, their quality of life improved, and there was a reduction in the impact of the disease on their lives. The safety profile of BTX-A after repeated treatments was excellent and no confirmed positive results for neutralizing antibodies to BTX-A occurred. CONCLUSION: Repeated intradermal injections of BTX-A over 16 months for treatment of primary axillary hyperhidrosis is safe and efficacious.     

Ein ambulantes Schulungsprogramm f��r Betroffene und Partner nach Erstimplantation eines implantierten Kardioverter/Defibrillators (ICD)

Background

The implantation of an implantable cardioverter defibrillator (ICD) is commonly followed by a physical and psychological process of adaptation to the new situation. Psychological support is often not provided and patients are left alone with questions and their needs. Because of the emerging sense of support group programs have proven to be apt for clearing up questions and addressing personal concerns. In the present study a psychoeducational program is presented and evaluated in detail.

Material and methods

A total of 308 patients with ICDs as well as their partners participated in a 2 day psychoeducational program. Of the patients 100 as well as their partners were asked to complete questionnaires concerning anxiety and depression (HADS) as well as their satisfaction with the program. The program consists of five modules: a warm up and getting to know each other; medical and technical information concerning the ICD, psychoeducation concerning the topics anxiety and avoidance, relaxation and an experience report of a patient who has had an ICD for many years.

Results

The evaluation results of 72 participants are present. All patients would definitively recommend participation in the program to other patients with an ICD without restrictions. The satisfaction with the five different modules of the intervention was very high. The depression as well as the anxious symptomatology in the HADS decreased significantly in the 1 year follow-up but did not exceed the cut-off point of 8. The anxiety and depression symptoms of the partners decreased significantly and exceeded the cut-off point of 8 in the follow-up.     

Akutes Koronarsyndrom

Update Intensivmedizin

Akutes Koronarsyndrom     

Clinical outcome of patients treated with an early invasive strategy after out-of-hospital cardiac arrest

Little is known about the impact of early invasive treatment in patients following out-of-hospital cardiac arrest (OHCA). The present study investigated the clinical characteristics and long-term prognosis of 1254 patients with suspected acute coronary syndrome, including 65 with OHCA who underwent successful cardiopulmonary resuscitation (CPR) and 1189 patients who did not require CRP. All patients underwent immediate coronary angiography even if clear signs of myocardial infarction (MI) were absent. The incidence of ST-elevation and non-ST-elevation MI did not differ between the two groups. Cardiac biomarkers were significantly higher in CPR patients despite a shorter period from symptom onset to admission. The 6-month mortality rate was 29% in the CPR group and 4% in the non-CPR group, with > 90% of fatalities occurring ≤ 3 weeks after admission. In summary, early invasive treatment leads to a considerably reduced mortality and improved prognosis in patients after OHCA.     

Metacognition and social function in schizophrenia: associations of mastery with functional skills competence

Research has suggested that many with schizophrenia experience deficits in the ability to form complex ideas about their own mental states and those of others and to use that in the service of responding to the challenges of both everyday life and the illness itself. Preliminary evidence suggests that deficits in such metacognitive and social cognitive functions are a predictor of function independent of other aspects of schizophrenia. In this study, we explored whether the domain of metacognition that reflects the ability to form knowledge about one's own mental states and those of others and to use that knowledge to respond to psychological challenges, known as Mastery, was related to performance on a test of functional skills competence. Participants were 40 adults with schizophrenia spectrum disorders in a non-acute phase of illness. Metacognitive Mastery was assessed using the Metacognitive Assessment Scale (MAS) and skills competence was assessed using the UCSD Performance-Based Skills Assessment Battery (UPSA). Symptoms were also assessed using the Positive and Negative Syndrome Scale and executive function was assessed with the Wisconsin Card Sorting Test. Correlations revealed a significant relationship between Mastery and the UPSA comprehension/planning subscale. This relationship persisted even after controlling for symptoms and executive function in a regression analysis. Results are consistent with the possibility that the ability to use metacognitive knowledge to respond to daily life is uniquely linked with certain forms of functional competence among persons with schizophrenia, independent of the effects of illness severity.