Nitrogen mustard gel-induced inflammation triggers lymphomatoid papulosis in patients with mycosis fungoides

Lymphomatoid papulosis (LyP) is a paraneoplastic primary cutaneous CD30⁺ lymphoproliferative disorder (LPD) that has been associated with malignant lymphomas, most commonly mycosis fungoides (MF). We observed 10 patients with MF who developed severe inflammation after using nitrogen-mustard (NM) gel from 1 to 8 months and who developed LyP. We hypothesized that NM gel produced local inflammation, which induced CD30 expression in malignant T cells in situ leading to the appearance of LyP papules. The high frequency of induction of LyP lesions in patients with severe inflammation while on treatment with NM gel suggests an association between inflammatory stimuli and development of LyP. Our observation provides insight into the pathogenesis of CD30⁺ LPD.     

This Month in Medicine

Analysis is made of 2000 cases of primary cancer of the lung. In more than 10 per cent, the first symptoms were due to metastases, most commonly to bone and brain. The lack of symptoms of early cancer of the lung is emphasized, and the importance of searching for peripheral nodes either in the presence of known lung cancer or to establish the diagnosis is pointed out. The necessity for surveys to detect early lung cancer, when a high cure rate is possible, is stressed, and the need for exploratory thoracotomy in a suspicious lesion when other diagnostic measures fail is noted.     

Asymmetric septal hypertrophy in patients on long-term hemodialysis.

Echocardiographic studies were performed in 23 hypertensive patients who were receiving therapy with long-term hemodialysis. Five patients (22 percent) had normal thickness of the left ventricular wall. Eleven (48 percent) had symmetric left ventricular hypertrophy, and seven (30 percent) showed asymmetric septal hypertrophy, with a ratio of septal to posterior wall thickness of 1.3 or greater. The latter group differed from patients with hypertrophic cardiomyopathy in that patients on long-term hemodialysis had a dilated left ventricular dimension, a relatively normal diastolic slope of the mitral valve, absence of systolic motion of the mitral valve, and a septal to posterior wall ratio of less than 1.5. A high incidence of asymmetric septal hypertrophy in this and other studies indicates that this condition is not specific for hypertrophic cardiomyopathy. We suggest that in addition to asymmetric septal hypertrophy, the diagnosis of hypertrophic cardiomyopathy should be made in the light of the clinical picture, as well as other echocardiographic features.     

Is Internet-based support for dyspnea self-management in patients with chronic obstructive pulmonary disease possible? Results of a pilot study

BACKGROUND: As of 2003, approximately 67% of US adults have Internet access. The purpose of this study was to determine the feasibility and preliminary efficacy of an Internet-based dyspnea self-management program (iDSMP) for people with chronic obstructive pulmonary disease. A related aim was to compare the differential effects of the iDSMP on 2 different groups: (1) to test a "booster" effect and (2) to evaluate the program as a primary intervention. METHODS: Two groups (n = 16) were evaluated at baseline and at 3 months after completing the iDSMP, which included education, exercise, self-monitoring, and support. Dyspnea, self-efficacy, perception of available support, and exercise behavior were measured. Paired, independent t tests and Mann-Whitney U tests were used. RESULTS: Most subjects (87%) reported that the program increased their access to information and resources for managing dyspnea. Dyspnea with activities of daily living and self-efficacy for managing the symptom showed significant improvements (both P < .01), whereas more modest changes were noted in perceived support and exercise behavior in the overall sample. There were no differences between the 2 groups on these outcomes. CONCLUSIONS: The findings suggest that additional investigations of Internet-based interventions to promote self-management in patients with chronic obstructive pulmonary disease are warranted.