[Immunochemical demonstration of human herpes virus 8 in conjunctival Kaposi's sarcoma]. / Vaskulärer Bindehauttumor. Immunhistochemischer Nachweis von humanem Herpesvirus 8 bei einem konjunktivalen Kaposi-Sarkom.

BACKGROUND: Angiomatous lesions of the conjunctiva and chronic conjunctivitis are frequently difficult to differentiate. CASE: A 28 year old white male sought help because of a conjunctival swelling. A biopsy made elsewhere had revealed a capillary haemangioma of the conjunctiva. Recently striking alterations of the skin led to the suspicion of a Kaposi's sarcoma. Immunohistochemical and dermatological examinations confirmed the diagnosis of a Kaposi's sarcoma and viral testing of serum revealed an HIV-infection. Besides intensive antiviral therapy, our patient underwent local irradiation of the right eye, the nose and of the left shoulder with an external beam. CONCLUSIONS: Kaposi's sarcoma is the most frequent Aids-associated malignant tumor. In about 30% of all patients with Aids, a Kaposi's sarcoma is diagnosed. The angiomatous character may lead to the histopathological diagnosis of a haemangioma. Human herpes virus 8 is known to be the transforming element.

[The Titmus Fly Test--evaluation of subjective depth perception with a simple finger pointing trial. Clinical study of 73 patients and probands]. / Die Titmus-Fliege--Beurteilung der subjektiven Sehtiefe mit einem einfachen Fingerzeigeversuch. Klinische Studie an 73 Patienten und Probanden.

BACKGROUND: Subjects with different binocular defects were tested for their stereoscopic achievement. The determination of the subjects limiting disparity (in seconds of arc) was not used to characterize their stereoscopic acuity, but the subjective depth perception as a simple clinical method. METHODS: 52 subjects with different binocular defects and 21 normosensoric volunteers were examined for their stereoscopic achievement. In our stereoscopic measurement we ask the subjects to indicate the subjective plane of the fly's wings manually by their own finger, or by a hand-held plastic card, or with the aid of a mechanic instrument. The results of the different methods were compared with each other. RESULTS: There were no differences between the results within the group of normosensoric subjects. The patients with reduced abilities exhibit significantly different results in depth perception when measured manually or by machinery. The subjective depth localization correlates well with the binocular defect and is independent of the used stereoscopic method. CONCLUSIONS: The basic finger test of the subjective level of the Fly's wings gives a quite reasonable approximation of local stereoscopic depth perception. In terms of practical investigation the finger test shows in convincing manner whether the individual stereoscopic ability is based on normal, subnormal or anomalous binocular interaction.

Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a 7-month multicenter randomized controlled trial (ALADIN III Study). ALADIN III Study Group. Alpha-Lipoic Acid in Diabetic Neuropathy.

OBJECTIVE: To evaluate the efficacy and safety of alpha-lipoic acid given intravenously, followed by oral treatment in type 2 diabetic patients with symptomatic polyneuropathy. RESEARCH DESIGN AND METHODS: In a multicenter randomized double-blind placebo-controlled trial (Alpha-Lipoic Acid in Diabetic Neuropathy [ALADIN] III Study), 509 outpatients were randomly assigned to sequential treatment with 600 mg alpha-lipoic acid once daily intravenously for 3 weeks, followed by 600 mg alpha-lipoic acid three times a day orally for 6 months (A-A; n = 167); 600 mg alpha-lipoic acid once daily intravenously for 3 weeks, followed by placebo three times a day orally for 6 months (A-P; n = 174); and placebo once daily intravenously for 3 weeks, followed by placebo three times a day orally for 6 months (P-P; n = 168). Outcome measures included the Total Symptom Score (TSS) for neuropathic symptoms (pain, burning, paresthesias, and numbness) in the feet, and the Neuropathy Impairment Score (NIS). Data analysis was based on the intention to treat. RESULTS: No significant differences between the groups were noted for the demographic variables and the nerve function parameters at baseline. The TSS in the feet decreased from baseline to day 19 (median [range]) by -3.7 (-12.6 to 5.0) points in the group given alpha-lipoic acid intravenously and by -3.0 (-12.3 to 8.0) points in the placebo group (P = 0.447), but the area under curve on a daily basis was significantly smaller in the active as compared with the placebo group (85.6 [0-219] vs. 95.9 [5.5-220]); P = 0.033). After 7 months, the changes in the TSS from baseline were not significantly different between the three groups studied, which could be due to increasing intercenter variability in the TSS during the trial. The NIS decreased after 19 days by -4.34+/-0.35 points (mean +/- SEM) in A-A and A-P and -3.49+/-0.58 points in P-P (P = 0.02 for alpha-lipoic acid versus placebo) and after 7 months by -5.82+/-0.73 points in A-A, -5.76+/-0.69 points in A-P, and -4.37+/-0.83 points in P-P (P = 0.09 for A-A vs. P-P). The rates of adverse events were not different between the groups throughout the study. CONCLUSIONS: These findings indicate that a 3-week intravenous treatment with alpha-lipoic acid, followed by a 6-month oral treatment, had no effect on neuropathic symptoms distinguishable from placebo to a clinically meaningful degree, possibly due to increasing intercenter variability in symptom scoring during the study. However, this treatment was associated with a favorable effect on neuropathic deficits without causing significant adverse reactions. Long-term trials that focus on neuropathic deficits rather than symptoms as the primary criterion of efficacy are needed to see whether oral treatment with alpha-lipoic acid over several years may slow or reverse the progression of diabetic neuropathy.

Effects of acarbose treatment in Type 2 diabetic patients under dietary training: a multicentre, double-blind, placebo-controlled, 2-year study.

This 24-months, placebo-controlled, double-blind, randomised, group comparison study investigated the effect of acarbose vs placebo for improving metabolic control in patients with Type 2 diabetes under dietary training insufficiently controlled by diet alone. Patients randomised to acarbose had their dose increased in a stepwise manner to week 5. From week 5 onwards, they received 100 mg three times daily. This incremental dosing scheme was matched in the placebo group. All patients received specialist, intensive, continuous dietary training and counselling throughout the 2 yr of the study. Of the 74 patients randomised, 60 were included in the per-protocol analysis (28 receiving acarbose; 32 receiving placebo). HbA1c was the primary target variable. Per-protocol analysis found that, after 24 months, the mean difference in HbA1c relative to baseline value was -1.71+/-1.6% in the acarbose group and -0.82+/-1.1% in the placebo group. End-point values were 6.85+/-1.7% in the acarbose group and 7.41+/-1.1% in the placebo group. This difference between acarbose and placebo was statistically significant (p=0.02). Patients were defined as responders if they did not require additional treatment with an antidiabetic agent during the study. The responder rate under acarbose therapy was 89%, compared with 47% for placebo (p=0.0005). Acarbose-treated responders improved their HbA1c level to 6.45+/-0.82% after 24 months. The efficacy of acarbose was consistent throughout the study; decreasing efficacy was not evident. The results demonstrate the efficacy of acarbose for improving metabolic control in patients with Type 2 diabetes, even when such patients receive good dietary treatment and counselling.

[Diabetes in professional life]. / Diabetes im Berufsleben.

The diagnosis of diabetes mellitus signifies for many an incisure in their life. Besides the individual problems of acceptance there are often difficulties in professional life. Not only when choosing a profession but also when doing one's job problems often result from the risk of hypoglycaemia. Callings that endanger other people are impossible such as pilot, engine-driver, bus-driver etc.). Occupations with a high risk situation for the diabetic himself (like roofer, diver etc.) may have legal difficulties with the insurance companies. All other jobs are principally possible although there are individual restrictions.

Intradermal desensitization with human insulin (recombinant DNA) in a patient with severe allergic skin reaction due to insulin.

This is a case report of a 70-yr-old female patient with a severe allergic skin reaction (necroses) due to insulin injections. Because of insulin dependency, desensitization to insulin was mandatory. For desensitization, a schedule with intradermal injections of increasing insulin concentrations (from 0.02 to 2 U per injection) at time intervals of 3 h was used. With highly purified pork insulin, the concentration limit of 0.04 U was reached in spite of 75 injections. After changing to human insulin (recombinant DNA), a rapid desensitization could be performed at the same concentration. Desensitization resulted not only to human insulin but also to highly purified pork insulin, as shown by intradermal testing 6 mo later.

[Self-inflicted hypoglycaemia (three cases)]. / Hypoglycaemia factitia Drei Fallbeschreibungen.

A woman with normal metabolism but addictive tendency injected insulin, as was proven by the presence of insulin antibodies in serum. Another woman with a normal metabolism caused hypoglycaemia by taking sulphonylurea preparations, apparently from self-destructive motives. After all laboratory and other tests had at first pointed to organic hyperinsulinism, the diagnosis of self-inflicted hypoglycaemia was finally made by demonstrating the drug in plasma. A young diabetic who required insulin caused hypoglycaemia by injecting additional insulin. The complete absence of C-peptide and especially the strict supervision confirmed the diagnosis.

[Patterns of allergic skin reactions during insulin treatment (author's transl)]. / Verteilung allergischer Hautreaktionen bei Insulintherapie.

Intracutaneous testing was done in 85 patients with allergic reactions during insulin treatment. Six patients showed immediate reactions (type I), 76 showed allergic late reactions (type IV) and three showed combined allergy (type I/IV) to intracutaneous undiluted insulin. Whereas immediate and combined allergies were exclusively pure insulin allergies, several allergens were shown to be responsible in late reactions: nine patients had pure surfen allergy, 34 patients pure insulin allergy (against all insulins) and 11 pure bovine insulin allergy. A further 22 patients reacted to various allergens, 16 of them to surfen and all insulins, and 6 to surfen and bovine insulins. Estimation of the diameter of the erythema showed a significantly better skin tolerance of neutral than of acid insulins. Intracutaneous pig insulin led to less erythema than bovine insulin. Neutral pig insulins thus have the least antigenicity.

[Intracutaneous desensitization in a case of insulin allergy with anaphylactic shock (author's transl)]. / Intrakutane Desensibilisierung bei einem Fall von Insulinallergic mit anaphylaktischem Schock.

In a 72-year-old woman with keto-acidaemia due to out-of-control diabetes, anaphylactic reaction occurred immediately after intravenous administration of 8 units of insulin. Extensive intracutaneous testing with highly purified insulins, including sheep and human insulin, revealed an allergy of the immediate type against the insulin molecule itself. Desensitization with subcutaneous insulin administration failed. Intracutaneous insulin injection three hours apart, starting at a dilution of 1:100, produced good subcutaneous tolerance of insulin within seven days.