Localized Kaposi''s sarcoma in a patient with pemphigus vulgaris

We report the case of a patient with a 13-year history of pemphigus vulgaris (PV) treated with immunosuppressive agents, prednisone and mycophenolate mofetil who had developed lesions of Kaposi's sarcoma (KS) on a sole plaque of PV that had been previously treated with intralesional injections of steroids. The lesions were surgically removed and polymerase chain reaction (PCR) demonstrated human herpesvirus-8 (HHV-8) DNA. There were neither recurrences nor later dissemination of KS following gradual decrease of the immunosuppressive therapy. We suggest that the treatment with intralesional steroids may have influenced the local reactivation of a latent infection of the virus, determining the appearance of this localized KS.     

FEASIBILITY OF CONDUCTING CARDIOVASCULAR OUTCOME RESEARCH IN AUSTRALIAN GENERAL PRACTICE: RESULTS FROM THE ANBP2 PILOT STUDY

1. The present study aimed to determine the feasibility of conducting a 5 year cardiovascular outcome trial of the treatment of 6000 elderly hypertensive patients in Australian general practices. 2. General practitioners (GPs) were invited to participate by mail and personal follow-up. Patient records were reviewed to identify subjects for a blood pressure (BP) screening programme. Blood pressure was measured on three occasions and eligible subjects were included if the average BP was 160 mmHg systolic or 90 mmHg diastolic if systolic BP was 140 mmHg. 3. Seven hundred and forty-one GPs were approached and 89 were enrolled in the study (12% of mail invites and 75% of those receiving a personal contact). In 16 practices where screening was completed, 82 000 records were reviewed to identify 4% patients eligible for screening. Twenty-two per cent of eligible subjects attended screening. Of 1938 subjects screened, 180 (9%) had BP 5=160/90 mmHg. Forty-seven percent of subjects (n = 916) were receiving antihypertensive therapy and 184 (20%) were withdrawn from therapy. One hundred and sixteen (63%) of these subjects had BP return to study entry levels within 6 weeks. Fifty-seven newly diagnosed and 81 previously treated subjects were randomized (7% of the screened population). 4. Based on the high participation rate of GPs, the response rate of patients to attend a BP screening programme and the 7% randomization to screening ratio for entry into the study, the ANBP2 pilot study has demonstrated that it is feasible to recruit subjects from Australian general practices to a cardiovascular outcome trial.     

The cognit: a network model of cortical representation.

The prevalent concept in modular models is that there are discrete cortical domains dedicated more or less exclusively to such cognitive functions as visual discrimination, language, spatial attention, face recognition, motor programming, memory retrieval, and working memory. Most of these models have failed or languished for lack of conclusive evidence. In their stead, network models are emerging as more suitable and productive alternatives. Network models are predicated on the basic tenet that cognitive representations consist of widely distributed networks of cortical neurons. Cognitive functions, namely perception, attention, memory, language, and intelligence, consist of neural transactions within and between these networks. The present model postulates that memory and knowledge are represented by distributed, interactive, and overlapping networks of neurons in association cortex. Such networks, named cognits, constitute the basic units of memory or knowledge. The association cortex of posterior-post-rolandic-regions contains perceptual cognits: cognitive networks made of neurons associated by information acquired through the senses. Conversely, frontal association cortex contains executive cognits, made of neurons associated by information related to action. In both posterior and frontal cortex, cognits are hierarchically organized. At the bottom of that organization-that is, in parasensory and premotor cortex-cognits are small and relatively simple, representing simple percepts or motor acts. At the top of the organization-in temporo-parietal and prefrontal cortex-cognits are wider and represent complex and abstract information of perceptual or executive character. Posterior and frontal networks are associated by long reciprocal cortico-cortical connections. These connections support the dynamics of the perception-action cycle in sequential behavior, speech, and reasoning.     

Subcostal incision versus midline laparotomy in gallstone surgery: a prospective and randomized trial

We report the results of a prospective and randomized trial designed to study the incidence of abdominal and pulmonary complications in gallstone surgery comparing subcostal (SI) with midline incision. The need for postoperative analgesia was lower in the SI group. There was no difference in the degree of hypoxaemia in the first two postoperative days, but there was less impairment of pulmonary function in terms of vital capacity and forced expiratory volume in 1 s (P less than 0.0001) in the SI group. SI patients also had a lower incidence of pulmonary or abdominal complications but the difference was not significant. Finally, we found a reduced hospital stay for the SI patients (P less than 0.01), probably related to a reduced postoperative analgesic requirement and an improved pulmonary function. We conclude that subcostal incision is a better approach for biliary tract surgery and should be used whenever possible.     

Temporal correlates of information processing during visual short-term memory.

The question is raised whether the sequence of spikes of a cortical neuron, i.e. its spike train, is related to cognitive functions. Neuronal patterns of firing in the inferotemporal cortex of monkeys performing visual delayed-matching tasks showed that short-term memory was accompanied by decreased bursting and changes in the incidence of recurrent spike-interval patterns. The temporal structure of the spike train suggests an inverse relationship between the incidence of repeated patterns and the degree of selectivity of sustained firing frequency elicited by the memorandum (sample stimulus).