[The clinical picture and treatment of HIV-associated Kaposi's sarcoma].
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Biomedical subjects
Publications and source records attributed to W Meigel.
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The pathogenesis of the HIV associated Kaposi's sarcoma is still unclear, but it appears to be a multifactorial process. Different investigations have shown, that cytokines and growth factors influence the development of KS. Several cases with tumor manifestation after irritation of the skin are demonstrated. Therefore a mechanism of development comparable with the Koebner Phenomenon can be postulated.
We report on a 73-year-old woman who, 12 years after liquid silicone injection for cosmetic purposes, developed siliconoma of her forehead within 9 months. We discuss the clinical and histopathological aspects of this foreign body granuloma.
Operations on the cutaneous surfaces are mainly performed under local anesthesia. Local infiltrative anesthesia is the most frequently used form in cutaneous surgery. Nerve or field block anesthesia can be used in areas like the external ear, nose, digits or penis. Local anesthesia is easy to administer, rapidly effective and relatively free of side effects. In contrast to general anesthesia it can be used in risk patients e.g. with ischemic heart disease or respiratory illnesses. Adverse reactions must be taken into account, especially toxic effects, allergy, drug interactions or traumatic lesions of nerves or blood vessels.
In a multicenter study, 788 patients suffering from severe acne resistant to therapy were treated with isotretinoin by 758 dermatologists in private practices. The study was conducted using standardized test forms and questionnaires. The goal of the study was to establish the risk/benefit ratio of the drug, if it was applied to patients of a dermatological practice. The initial daily dose amounted to 0.5 mg/kg body weight, the time of treatment was 12 to 16 weeks. The clinical efficacy was judged very good or good by 90% of the doctors and patients. The kind, frequency, and intensity of the side effects observed corresponded with those found in previous studies conducted at hospitals. Our critical analysis of the results left no doubt about the therapeutic value and the safety of isotretinoin, if it is used by dermatologists in private practices.
Operations on the cutaneous surfaces are mainly performed under local anesthesia. Local infiltrative anesthesia is the most frequently used form in cutaneous surgery. Nerve or field block anesthesia can be used in areas like the external ear, nose, digits or penis. Local anesthesia is easy to administer, rapidly effective and relatively free of side effects. In contrast to general anesthesia it can be used in risk patients e.g. with ischemic heart disease or respiratory illnesses. Adverse reactions must be taken into account, especially toxic effects, allergy, drug interactions or traumatic lesions of nerves or blood vessels.
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Twenty-three patients with biopsy-proven Kaposi's sarcoma and HIV infection were treated with recombinant interferon-alpha-2a (Roferon-A). Two dosage regimens were used: 21 patients received 18 X 10(6) units intramuscularly per day for 3 months, followed by injections of 18 X 10(6) units three times a week. The remaining 2 patients were treated with 2 X 18 X 10(6) units i.m. per day for 3 months. Three patients either refused further treatment or were lost to follow-up within the first few weeks. Thus, a median observation period of 7.5 months (range 1.5-17) was available for 20 patients. Within the first 3 months, 6 patients (30%) responded to treatment, 6 patients (30%) showed no progression, whereas in 8 cases (40%) progressive disease was noted. A similar rate of responders versus nonresponders was found after 6 months of observation. In progressive disease, interferon could be effectively combined with cytostatic drugs. Dose-dependent neurological and hematological side effects were observed in a few patients only. Opportunistic infections were diagnosed in 12 patients with a median onset of 6 months (range 1-10) after start of interferon treatment. The total number of lymphocytes expressing the CD4 antigen or the ratio of CD4 to CD8 positive cells were of prognostic value. These data suggest that interferon alpha is an active agent in the treatment of Kaposi's sarcoma, that it shows tolerable side effects and can be combined effectively with cytostatic drugs in case of progression.
The effects of unsaturated fatty acids were examined in a double-blind study on 34 patients suffering from atopic dermatitis. In comparison to the placebo group a clinical improvement (24%) was seen after a three month period during which patients had received linoleic acid and gamma-linolenic acid.
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The disseminated form of Kaposi's sarcoma (KS) is an important cutaneous manifestation of acquired immune deficiency syndrome (AIDS). Since 1983, we observed 5 patients suffering from this rare multifocal cancer associated with AIDS. We report on clinical picture, histopathologic changes, and immunologic parameters.
The author presents his personal therapeutic principles with regard to atopic dermatitis using glucocorticoids antibiotics, and antihistamines. The role of diet as well as treatment with evening primrose seed oil are discussed.
This short review deals with the cutaneous manifestations of the acquired immune deficiency syndrome (AIDS), which comprise Kaposi's sarcoma, as an important marker disease for AIDS, as well as various skin infections caused by bacteria, fungi and viruses. In patients at risk of acquiring AIDS, an extensive immunological investigation should be performed if skin infections are established. In addition, a large number of cutaneous complications encountered in AIDS patients have an immunological background, e.g. an extreme hypersensitivity to trimethoprim-sulfamethoxazole. Therefore, the dermatological investigation of patients at risk of acquiring AIDS is urgently recommended as a regular part of the general check-up.
Patients from five German Departments of Dermatology (Düsseldorf, Erlangen, Frankfurt am Main, Hamburg and Munich) affected with progressive systemic scleroderma (PSS) were classified and examined. The results of the clinical investigations are presented. In order to guarantee a uniform classification of all patients, the patients were divided into three groups according to the distribution of the affected skin: type I consisted of those with acrosclerosis distal to the wrist, type II had scleroderma extending along the wrist in a proximal direction, and type III had diffuse scleroderma beginning on the trunk. Altogether, 194 patients with PSS were investigated, and the following distribution was found: type I, 32%; type II, 60%; type III, 7%; 1% of the patients could not be classified. The distribution according to the patients' sex and age was in good agreement with published reference data. The incidence, significance, and localization of the major symptoms were investigated. The Raynaud symptom could be identified as being the main clinical symptom in 90% of the patients. Joint involvements (10%-73% depending in the applied parameters), dysphagia (51%), and rest dyspnea (30%) contributed to the main internal symptoms. The extensive clinical, chemical, and immunological results are summarized. In 80% of the cases, high ANA titers could be detected, but these were not correlated to the type of disease.
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Coronavirus-like particles were identified by electronmicroscopy in the feces of homosexual men. The particles banded at a density of 1.21 g/ml after cesium chloride density gradient centrifugation. To determine whether the presence of this virus might be related to clinical symptoms, several patient groups were studied prospectively. In 8 of 16 (50%) homosexual males with acquired immunodeficiency syndrome (AIDS) or unexplained lymphadenopathy syndrome (LAS), coronavirus particles were found. In contrast, such particles were found in none of 18 heterosexual controls and in only 3 of 20 homosexual males without AIDS or LAS. Thus, coronavirus excretion correlated significantly (2 alpha less than 0.01) with the clinical diagnosis of AIDS or with syndromes belonging to the AIDS-related complex. In addition, such particles identified in the serum of one patient with LAS and diarrhea suggest invasion and systemic spread of the agent and underline that this virus behaves differently from "common cold" human coronaviruses.
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