PubMed Health⌕ Search

Biomedical subjects

N H Brockmeyer

Publications and source records attributed to N H Brockmeyer.

At least 19 recordsLinked to original sources
PubMed2006

Unilateral generalized morphea is a rare variant of localized scleroderma.

Localized scleroderma (LS) is a rare connective tissue disorder generally involving the entire dermis and usually limited to the subcutaneous tissue. However, it may progress to large indurated plaques, growth retardation, muscle atrophy, and even to flexion deformities or poorly healing ulcerations. LS has been classified as plaque, generalized, bullous, linear, and deep forms exhibiting different clinical subtypes. Recently, an unusual case of unilateral generalized morphea (UGM) in childhood extending from the middle dermis to the subcutaneous fat tissue has been reported. We here describe four young patients exhibiting a similar subtype of LS. All patients demonstrated a prominent unilateral skin involvement starting in childhood or adolescence. Histology revealed prominent accentuation of intradermal involvement. Except for positive anti-nuclear antibodies, no specific antibody pattern could be observed. In presenting these clinically homogenous cases we hereby introduce UGM as an extreme variant of the linear form of LS in childhood. As the onset of UGM usually occurs in pediatric patients, pediatricians should be cognizant of the presentation of this uncommon condition. Treatment with combined low-dose methotrexate and pulsed high-dose corticosteroid therapy might represent a promising treatment option for UGM.

Adolescent↗
PubMed2006

Treatment of condylomata acuminata with pegylated interferon alfa-2b in HIV-infected patients.

BACKGROUND: Interferon in a variety of topical, interlesional, and parenteral preparations has been used for condylomata acuminata (CA) in HIV negative patients. - STUDY GOALS: This open trial was initiated to determine the safety and efficacy of a new formulation of interferon, pegylated interferon-alpha2b (PEG-IFN, PegIntron in the treatment of recalcitrant CA in patients with HIV infection. - STUDY DESIGN: 22 HIV-1 infected patients in virologic steady state with clinically demonstrable anogenital CA were enrolled in this study (treatment group, n=12; control group, n=10). Patients in the treatment group received 80 microg PEG-IFN s.c. once a week for 24 weeks. Follow-up period was 6 month. The effects were assessed by a clinical scoring system (complete response; major response; minor response; stable disease; progression of disease). - RESULTS: 2 patients did not finish the study because of side effects. PEG-IFN was well accepted and completed by ten patients. Four patients revealed complete response, four patients had major response and two had minor response after PEG-IFN. In the control group, all patients showed progression of CA during the 24 weeks of this study (p < 0.001). 7/10 patients of the treatment group and 8/10 patients of the control received HAART. - While the differences of CD4 cell counts between treatment group and control group were not significant (increase of the mean CD4 cell count in the treatment group was 31.5 (75.33 without patient 1 with leucopenia under ribavirine), in the control group 69.75 CD4 cells), the HIV RNA decline in the PEG-IFN group was impressive (0.74 log subset10). Biological side effects of PEG-IFN treatment included flu-like symptoms, fatigue, local reaction, leucopenia, and increase of AST. This result makes an educated guess that PEG-IFN enhances the benefit of HAART. - CONCLUSION: PEG-IFN is an effective and safe therapy option in HIV infected individuals with CA with concomitant positive effects on the suppression of HIV-1 replication and CD4 cell count. It might be considered as an alternative in patients that have failed to standard therapies of CA and - at the same time -could improve the benefit of HAART to a great extent. This last hypothesis needs further research.

Adult↗
PubMed2006

[HIV-associated tumors].

In the beginning of the HIV epidemic, Kaposi sarcoma was a common stigma in AIDS patients and one of the leading causes of death. While Kaposi sarcoma is seen less frequently since the introduction of antiretroviral therapy, lymphoma and other malignancies are an increasing therapeutic challenge. The incidence of HPV-related anal carcinoma and its precursor lesions is rising so dramatically that screening programs as they are already established for cervical carcinoma should be implemented. The role of HPV in UV-associated tumors is not yet determined. Additional risk factors like smoking and HCV co-infection seem to play important roles in the high incidence of lung and hepatocellular carcinomas. While fewer patients die from opportunistic infections, we face a growing problem with malignancies in HIV-positive patients.

AIDS-Related Opportunistic Infections↗
PubMed2006

[Human papilloma virus-induced disease in HIV-positive patients].

Since the introduction of highly active antiretroviral therapy (HAART), opportunistic infections by bacteria and fungi have been reduced in human immunodeficiency virus (HIV)-positive patients. However, diseases caused by human papilloma virus (HPV) have become more frequent despite HAART. There is an increased incidence of anal and cervical carcinomas, their precancerous lesions such as anal/cervical intraepithelial neoplasia, and condylomas and oral warts. In order to prevent anal carcinomas, HIV-positive patients should receive proctoscopic examinations regularly. The examination should include anoscopy and smears for cytology and HPV polymerase chain reaction.

AIDS-Related Opportunistic Infections↗
PubMed2006

[HIV-related symptoms].

The course of HIV-infection has changed dramatically since the beginning of the epidemic. Opportunistic infections and AIDS-defining tumors are diagnosed less frequently since the introduction of antiretroviral therapy and the time of survival has increased. According to German-Austrian therapy guidelines highly active antiretroviral therapy (HAART) should be started on the onset of HIV-related symptoms and/or when the CD4 cell count is lower than 350/microl. Patients should be treated in specialized centres because of the complexity of HIV-infection and its therapy. For monitoring CD4 cell counts and viral load are determined. Reasons for therapeutic failure can be drug interactions, resistance or compliance problems. Although HIV-infection is often compared to insulin dependent diabetes mellitus psychological and social impact on HIV patients is still high. Increasing viral multi-drug resistance, long-term toxicity like lipodystrophy, osteoporosis and cardiovascular disease are only some problems HIV-infected patients are facing in the next years. In Germany 600 to 700 patients still die because of AIDS every year.

Anti-HIV Agents↗
PubMed2005

GNB3 C825T polymorphism and response to anti-retroviral combination therapy in HIV-1-infected patients--a pilot study.

METHODS: Analyses were based on a cohort of 55 HIV infected patients whose treatment was changed due to therapy failure. Viral load, CD4+ and CD8+ cell counts were determined before therapy and after 8 weeks and 16-32 weeks, respectively. GNB3 genotyping was performed using Pyrosequencing. Chemotaxis of purified CD4+ cells was quantified in a Boyden chamber using stromal cell-derived factor 1alpha (SDF-1alpha) as a stimulus. RESULTS: Age gender, route of infection, treatment, and baseline values for viral load and CD4+ and CD8+ cell counts were not associated with GNB3 genotypes (10 TT, 24 TC, 21CC). After 8 weeks of treatment viral load was lowest in TT genotypes (log copies/ml: TT: 1.88 +/- 0.32; TC: 2.49 +/- 0.24; CC: 3.06 +/- 0.22; p = 0.039) and this trend tended to persist until final visit. Unexpectedly, TT genotypes had lowest CD4+ cell counts at final visit (TT: 165.3 +/- 34.0; TC: 414.4 +/- 72.1; CC: 441.5 +/-70.9; p = 0.047). SDF-1alpha-stimulated chemotaxis was reduced in CD4+ cells from HIV-1-infected patients compared to healthy controls. Still cells from TT genotypes displayed strongest chemotaxis. CONCLUSIONS: This pilot study suggests that the GNB3 C825T polymorphism is associated with short-term success of HAART treatment in HIV-1-infected patients.

Adult↗
PubMed2005

Skin disorders in association with monoclonal gammopathies.

Monoclonal gammopathy represents a condition characterized by clonal proliferation and accumulation of immunoglobulin producing B-cells. A variety of skin disorders are associated with an increased level of monoclonal immunoglobulin proteins. These skin disorders can be divided into two groups. The first group represents a direct consequence of plasma cell proliferation. The colonization of the plasma cell clone in the dermis expressed as a deposition of proteins related to the M component belongs to this group for which the pathogenesis is well identified, as is the case for example with AL amyloidosis and cryoglobulins. The second group represents skin disorders such as scleromyxedema and Schnitzler syndrome that are highly associated with an M component, or diseases such as pyoderma gangrenosum and leukocytoclastic vasculitis that are more weakly associated with increased levels of monoclonal immunoglobulins. In some other dermatoses such as pemphigus, bullous pemphigoid, epidermolysis bullosa aquisita, Sezary syndrome, lymphomatoid papulosis, urticaria pigmentosa, and acquired ichthyosis, only presumptions exist regarding associations with monoclonal gammopathies. In this the pathogenesis, therapy and prognosis of the most relevant dermatoses shall be described in order of their degree of association with monoclonal gammopathies, which shall also be discussed.

Humans↗
PubMed2005

Expression of beta-defensin 1 and 2 in nasal epithelial cells and alveolar macrophages from HIV-infected patients.

BACKGROUND: The incidence of respiratory infection is high in HIV-infected patients. beta-defensins are anti-microbial peptides derived from epithelia on the mucosal surfaces of the respiratory, gastrointestinal and urinary tract. Nothing is known about the rate of expression of beta-defensin 1 and 2 mRNAs in nasal epithelial cells and alveolar macrophages in HIV-infected patients. METHODS: Semiquantitative rt-PCR measurement of beta-defensins 1 and 2 and beta-actin were carried out on nasal epithelial cells of 109 patients (76 HIV-infected) and alveolar macrophages from 56 patients (18 HIV-infected). RESULTS: The levels of beta-defensin 1 and 2 mRNAs in nasal epithelial cells did not differ significantly between HIV-infected and non-infected patients. In the nasal epithelial cells of HIV-negative patients who suffered from respiratory infections beta-defensin levels were decreased. beta-defensin 1 mRNA expression was significantly reduced in alveolar macrophages from HIV infected patients. beta-defensin 2 mRNA expression in alveolar macrophages was very low. beta-defensins 1 and 2 mRNA expression did not correlate with CD 4 cell numbers in the blood of HIV-infected patients. CONCLUSION: HIV infection and CD 4 cell numbers in the blood do not influence beta-defensin 1 and 2 expressions in nasal epithelial cells. In alveolar macrophages, beta-defensin 1 expression is decreased in HIV-infected patients.

Adult↗
PubMed2005

[Syphilis and HIV infection. Characteristic features of diagnosis, clinical assessment, and treatment].

The incidence of syphilis has increased dramatically in Germany since 2001. Homosexual men have been particularly afflicted. Several characteristic features should be taken into account in the diagnosis and treatment of HIV patients with concomitant syphilis. Since laboratory analyses are frequently unreliable, the experienced physician must pay special attention to the clinical picture. The stages in the clinical course of syphilis do not differ essentially between HIV-positive and HIV-negative patients. However, atypical and serious courses with rapid progression and CNS involvement are observed more frequently. Moreover, incorrect diagnoses are often reached. Treatment requires particular diligence. Penicillin is the agent of choice for all stages of syphilis in patients infected with HIV. Because the stages are often difficult to differentiate, the choice of which penicillin derivative should be administered is the subject of controversy. There is no safe alternative for patients allergic to penicillin.

AIDS Serodiagnosis↗
PubMed2005

Treatment of HIV-1-associated Kaposi's sarcoma with pegylated liposomal doxorubicin and HAART simultaneously induces effective tumor remission and CD4+ T cell recovery.

BACKGROUND: The combination of highly active antiretroviral therapy (HAART) and liposomal doxorubicin is a promising approach for the treatment of progressive HIV-related Kaposi's sarcoma (KS). Here, we determined the safety, tolerability, and efficacy of liposomal doxorubicin and HAART as a combined treatment approach for advanced KS, and assessed the impact of liposomal doxorubicin on HAART-mediated immune reconstitution and viral suppression. PATIENTS AND METHODS: In an uncontrolled observational trial, KS treatment responses were assessed in 54 HIV-1-infected patients with advanced KS according to ACTG criteria. Immunological and virological treatment responses were compared to 54 non-KS-affected HIV-1 patients who were individually matched to the study participants according to sex, age (+/- 5 years), CD4+ T cell count (+/- 25%), HIV RNA load (+/- 25%) and previous antiretroviral therapy exposure. RESULTS: In 81.5% of the study patients, complete or partial responses were observed within a median of 8 weeks. Treatment-related side effects were predominantly confined to leukopenia (44.4% of patients) and mild-to-moderate liver enzyme elevation (22.3% of patients). Relative CD4+ T cell counts increased to a similar degree both in study patients and matched pairs (7% vs 6%, respectively), yet, absolute CD4+ T cell counts augmented considerably stronger in chemotherapy-naive matched pairs than in the study patients. CONCLUSION: The simultaneous administration of HAART and liposomal doxorubicin is a safe and effective treatment approach for advanced KS and HAART-mediated recovery of relative CD4+ T cell counts does not seem to be impaired by concomitant treatment with liposomal doxorubicin.

Antibiotics, Antineoplastic↗
PubMed2004

German-Austrian recommendations for the antiretroviral therapy of HIV-infection (status May 2004).

The availability and application of effective antiretroviral combination therapies have now almost become routine. More than 20 antiretroviral substances in four classes have been approved. Although an almost incalculable number of combinations can be conceived, it must be stressed, that only a small number of the theoretically possible combinations are actually applicable. As a result of the broad therapeutic armamentarium, HIV infection can be better treated. However, the decisions to start, monitor and change therapy have become even more difficult because the indication for treatment, the selection of the most suitable therapy for an individual, the information and counselling of the patient, and the monitoring of the success of treatment all demand a high level of knowledge and experience. This guideline evaluates the indication and selection of the initial antiretroviral therapy for HIV infection.

Anti-Retroviral Agents↗
PubMed2004

[Pseudomonas aeruginosa infection presenting as gonorrhea].

A 68 year old man presented with urethritis and a purulent discharge, carrying the tentative diagnosis of gonorrhea. He had already been treated with multiple antibiotics. Microbiological investigation revealed Pseudomonas aeruginosa, a relatively frequent Gram-negative bacteria in hospitals, which can cause several nosocomial diseases such as pneumonia, wound infections and urogenital infections. Therapy can be difficult because of frequent antibiotic resistance. Guided by sensitivity studies, the patient was successfully treated with gyrase inhibitors. Pseudomonas aeruginosa-induced urogenital infections in ambulatory patients are extremely rare and usually not associated with a gonorrhea-like discharge.

Aged↗
PubMed2004

[Off-label use in dermatological practice. The conflict between professional duty and legal requirements].

When making therapeutic decisions, doctors often find themselves faced with a dilemma regarding ethical, professional, legal liability, social and service aspects of their duties. These conflicts may be enhanced when medications have to be prescribed for non-approved usages, known as off-label prescribing, because existing therapy options have been exhausted. This option become considerably more difficult since the German Federal Social Court decision of March 2002 which limited off-label use to a number of very strictly defined circumstances. In order to clarify the basis for taking decisions in a given situation, an oncology expert commission has been formed under the coordination of the Department of Health and Social Security. However, this is no solution for the great variety of uncommon dermatological diseases which often require off-label medication usage.

Clinical Trials as Topic↗
PubMed2004

[HIV/AIDS competence network research group presents first results].

Germany's clinical HIV research efforts are underrepresented on an international level. This deficit is primarily due to a lack of clinical studies involving patients from across the country and the fact that no national patient cohort system exists in Germany which could provide a basis for such clinical studies. The competence network HIV/AIDS is filling this shortcoming by serving as a comprehensive, nationwide research alliance. The establishment of a patient cohort is linked to 20 projects. The success of this new structure is becoming visible.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Generalized fungal infection in a patient with AIDS appearing as skin papules.

Human immunodeficiency virus infection (HIV) is unique among cutaneous fungal infections caused by defects of the cell-mediated immune system. Infections with Candida albicans occur with increased frequency and severity among HIV-infected individuals. Oral candidiasis is the most common manifestation, superficial cutaneous infections of the dermis are rarely seen. We report a HIV-positive man from Cameroon presenting with generalized cutaneous papules and nodes, oral candidiasis, and soor esophagitis, who was successfully treated with fluconazole monotherapy.

AIDS-Related Opportunistic Infections↗
PubMed2003

[Screening and therapy of anal intraepithelial neoplasia (AIN) and anal carcinoma in patients with HIV-infection].

Anal intraepithelial neoplasia (AIN) is a potential precursor of invasive anal carcinoma. Introduction of highly active antiretroviral therapy (HAART) in the treatment of HIV infection substantially reduced the incidence of some diseases associated with opportunistic viral infections. However, the incidence of AIN is reported to increase and HAART seems to have only little impact on the regression or progression of AIN. Paradoxically, improvement of survival in the HAART era results in an increased risk of anal cancer. The incidence of anal carcinoma amongst homosexual men is substantially higher compared to the normal population (35/100.000). This incidence is similar to the incidence of cervical cancer before screening for CIN with cervical cytology. Recent data suggest that the incidence of AIN and anal cancer is even higher among HIV-infected individuals. Both cancer entities share biologic similarities, including the association with human papillomavirus infection (HPV). Screening for CIN with cervical cytology and early treatment has resulted in a significant decline in the incidence of cervical carcinoma. Like cervical cancer, anal carcinoma may be preventable through identification and treatment of its precursors. Future efforts should focus on a screening protocol, training of clinicians in the diagnosis and treatment of AIN and anal carcinoma, and novel approaches to treatment of these lesions. This screening protocol could help to reduce anal cancer in HIV-infection as well as save limited resources in health care system.

Antiretroviral Therapy, Highly Active↗