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.     

Efficacy of transdermal clonidine for headache prophylaxis and reduction of narcotic use in migraine patients. A randomized crossover trial

Thirty patients completed a double-blind, randomized crossover study utilizing transdermal clonidine and an identical-appearing placebo. Crossover occurred at 6 weeks, with a total study time of 12 weeks. Subjects were asked to record daily in a special diary (1) the presence or absence of headache, (2) duration of headache, (3) severity of headache, and (4) use of pain medication for headache relief. The severity of the headaches was rated from 1 (very mild) to 5 (very severe). Although the subjects reported a decrease in frequency, duration, and intensity of headaches while using the medicated patch, these differences did not reach statistical significance. Nineteen patients subjectively preferred the medicated patch, while five preferred the placebo (P less than .01). During use of the medicated patch, a significant reduction (P = .039) occurred in use of class II narcotics. Three doses of these substances were used by the patients when treated with clonidine, while 34 doses were taken during placebo use. These findings suggest that clonidine might have a role in reduction of parenteral narcotic use in acute pain syndromes.     

Erinnerungen an traumatische Erlebnisse in der Zeit des Nationalsozialismus bei (ehemaligen) jüdischen Emigranten und Lagerhäftlingen

Zusammenfassung Halbstrukturierte Inteviews mit 248 (ehemaligen) jüdischen Emigranten und Lagerh?ftlingen in Deutschland und drei Ziell?ndern der jüdischen Emigration zeigen, da? Erinnerungen an traumatische Erlebnisse im Nationalsozialismus in zahlreichen allt?glichen Kontexten auftreten und von zentraler Bedeutung für die Wahrnehmung der pers?nlichen Lebenssituation im Alter sind. Auf der Grundlage der Ergebnisse einer Pilotstudie zur Frage nach der subjektiven Gliederung des Lebenslaufs bei (ehemaligen) jüdischen Emigranten und Lagerh?ftlingen werden unterschiedliche Abschnitte der pers?nlichen Entwicklung nach dem Holocaust unterschieden. Selbsteinsch?tzungen der Untersuchungsteilnehmer zur Intensit?t von Erinnerungen an traumatische Erlebnisse in diesen Entwicklungsabschnitten unterstützen die Annahme, da? belastende Erinnerungen im Alter deutlich zugenommen haben. Die Untersuchungsteilnehmer unterscheiden sich erheblich in den Formen der Auseinandersetzung mit solchen Erinnerungen. Einige Untersuchungsteilnehmer reagierten mit Depressionen, Angstzust?nden, Gefühlen von überlebensschuld und Rückzug aus sozialen Beziehungen. Andere engagierten sich hingegen in hohem Ma?e in sozialen Beziehungen, vor allem zu Angeh?rigen der jüngeren Generation, um dadurch zur Vermeidung von Diskriminierung, Rassismus und Fremdenfeindlichkeit beizutragen. Eingegangen: 14. August 1997, Akzeptiert: 26. Januar 1998     

Donor left ventricular hypertrophy increases risk for early graft failure

A review of factors contributing to early mortality after cardiac transplantation revealed that up to 25 % of deaths were due to primary graft dysfunction unrelated to rejection or infection. In light of this finding, evaluation of a donor heart with regard to its suitability for transplantation takes on added importance. In an effort to screen the suitability of donor hearts in the region covered by the Northwest Organ Procurement Agency (USA), all donors are evaluated by two-dimensional transthoracic echocardiography as part of the initial evaluation. A total of 110 donor echocardiograms were reviewed and an attempt was made to correlate the 30-day outcome with the parameters measured. An unexpected finding was that the presence of left ventricular hypertrophy in the donor heart was associated with an increase in the incidence of donor heart dysfunction compared with donors with normal echocardiographic profiles (33 % vs 3 %, P = 0.007). Received: 12 February 1996 Received after resision: 27 June 1997 Accepted: 14 July 1997     

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.