Differences in demographic data regarding physicians and patients in the US or abroad using a medically oriented Internet information service.

Since early 1994 we have offered access to the National Cancer Institute's guidelines for current cancer therapy to physicians via WWW. These guidelines, which are provided by the NCI in accordance with the rules for evidence-based medicine, are accompanied by general information for non-professionals. Since we launched this comprehensive cancer-related WWW information service in 1994, more than about 1 million customers retrieved documents from our CancerNet service via WWW (http://www.meb.uni-bonn.de/cancernet/). From user surveys in 1996, 1997, 1998, and 1999, we obtained demographic data about our users, their interests, and their opinions regarding this information service. The following analysis shows how this service was used over the years and includes some unexpected differences between users in the US, Europe, and developing countries.

QEEG in hemophiliacs with HIV infection.

Conventional visual analysis of the EEG was performed on 320 hemophiliacs infected with HIV, who spanned the range of the Walter Reed (WR) system for classifying clinical stage of HIV infection, and on 50 HIV seronegative hemophiliac controls. Intermittent or paroxysmal slowing was the conventional EEG abnormality most commonly seen in early stages of HIV infection (stages WR1 and 2), with increased focal epileptiform activity and generalized slowing appearing in patients with the full clinical syndrome of AIDS (WR6). Slowing of the manually measured alpha rhythm was noted in stages WR2 and above. Quantitative EEG (qEEG) was obtained in a subset of 103 male HIV seropositive male hemophiliacs and 35 male HIV seronegative hemophiliac controls. The principal findings were a progressive relative increase in theta power with a tendency towards an anterior topographic distribution, and a progressive decline of spectral power in fast alpha relative to slow alpha with increasing severity of HIV disease. Significant qEEG differences from controls were apparent in WR2 subjects (seropositive with lymphadenopathy and without other constitutional symptoms), and were relatively greater in WR3-6 subjects. These results suggest sensitivity of qEEG to early CNS involvement with HIV infection.

Early signs of cognitive deficits among human immunodeficiency virus-positive hemophiliacs.

A total of 181 human immunodeficiency virus (HIV)-seropositive hemophiliacs and 28 hemophilic controls were evaluated by psychometric tests and by electroencephalogram (EEG). Patients were classified from stages 1-6 according to the immunological criteria of the Walter Reed staging system. Statistical analysis of psychometric data showed an effect of the stage of the disease on test performances, indicating a decline in attention, accumulation of perceptual interferences, decline in visuoperceptual speed and visuomotor response speed and reduced verbal memory performance, especially in stage 6 patients. Comparison of performance levels with normative test data already revealed cognitive deficits in about 20-30% of the patients in stages 2-5. As regards verbal memory, especially learning and recognition of new verbal information were impaired. In contrast, there was no significant deficit for nonverbal memory processing. Compared with the controls, patients exhibited an increasing number of abnormal EEG findings in stages 2-6. As a conclusion, in the stages before acquired immunodeficiency syndrome (AIDS) develops, EEG findings as well as psychometric findings indicate central nervous system involvement of AIDS in about 20-30% of cases, whereas in full-blown AIDS there is a marked increase to 80%. Besides a more general deficit of attention and psychomotor speed as is seen in subcortical dementia, there is evidence for a particular verbal learning disorder, suggesting additional selective impairment of the brain.

Ocular pseudo-myasthenic reaction induced by interferon in an AIDS patient.

A 32-year-old, HIV-positive homosexual with Kaposi's sarcoma was given subcutaneous interferon-A (IFN) for two- and a-half months. The patient complained of ocular symptoms (ptosis of the left eyelid and intermittent diplopia) after the application of IFN-A. These symptoms persisted for the period of treatment and subsided after therapy was stopped. However after IFN-A was resumed, ptosis and diplopia recurred. Intensive serological and neurological diagnostic investigations failed to present any reason for these ocular symptoms. From data and the clinical appearance we suppose that in this case the patient suffered a pseudo-myasthenic reaction to IFN-A.

Remarkable improvement of neuropsychiatric symptoms in HIV-infected patients after AZT therapy.

Treatment of neuropsychiatric symptoms with AZT (Azidothymidine) seems to be effective in many AIDS patients. In earlier studies, 204 of 525 patients treated with AZT showed neuropsychiatric improvement. In this presentation, two patients with affective disorder and dementia are described. Both patients showed remarkable improvement of their severe psychiatric symptoms after AZT. The authors recommend treatment of AIDS-associated dementia and psychoorganic symptoms with AZT.

[Azidothymidine and the nervous system]. / Azidothymidin und das Nervensystem.

By December 1988 reports on 525 ARC- (AIDS-Related Complex) and AIDS-patients with neurological or neuropsychological signs treated with Zidovudine (AZT = 3'-Azido-2,3'Dideoxythymidine) had been published in literature. In 204 (38.8%) cases of HIV infection a temporary improvement in the neurological deficits was reported. Peripheral and central neurological side-effects were observed in 124 (23.6%) patients.

[HIV and nervous system manifestations: a review]. / HIV und Nervensystemmanifestationen: Eine Ubersicht.

Since 1986 the notation Human Immunodeficiency Virus (HIV) is used for the retroviral agent of the Acquired Immunodeficiency Syndrome (AIDS). At the beginning of the therapeutical interest in the immunodeficiency syndrome have been primarily focussed in the internal complications. 1982 one reported for the first time about nervous system manifestations (NS-M) in HIV-patients; according to the latest reports NS-M are diagnosed in 39-63% of these patients. In this review all important aspects of the pathogenesis, clinic and therapy for the HIV-associated peripheric- and central-neurological (like e.g. acute and chronic meningitis/meningoencephalitis, dementia, opportunistic infections, polyneuropathies and myopathies) and psychiatric diseases are described.

[Status epilepticus in MVEC chemotherapy of urothelial cancer]. / Status epilepticus unter MVEC-Chemotherapie eines Urothelkarzinoms.

We present a patient with an urethral urethelial carcinoma (T3N2M0) treated by chemotherapy with methotrexate, vinblastine, epirubicin and cisplatin, which induced a non-convulsive status epilepticus. In this report the possible mechanism for this phenomenon and its management are discussed.

Gastrointestinal type 1 hypersensitivity to azathioprine.

We report the case of a 49-year-old patient with progressive sensomotor polyneuropathy who developed nausea, vomiting, and diarrhea after 2 1/2 months of azathioprine therapy. Administration of the drug was interrupted. These symptoms recurred immediately after rechallenge with azathioprine. A duodenal biopsy demonstrated a massive local eosinophilia without peripheral blood eosinophilia. Cutane testing with azathioprine showed a positive type 1 reaction. We diagnosed a hypersensitive reaction type 1 in the duodenal mucosa on the basis of the histological features, the history, and the cutane reaction.

[EEG topography in HIV-positive hemophiliacs]. / EEG-Topogramm bei HIV-infizierten Hämophilen.

HIV-central nervous system manifestations, here the AIDS-Dementia complex, are at the moment of special interest owing to its unexpected development. With EEG-topography one can expect to gain more information about possible changes in frequency according to topographical location. We recorded 69 HIV-positive hemophiliacs (23 WR 2, 26 WR 3-5 and 6 patients) plus 50 HIV-seronegative controls with a 12 channel EEG-topography evaluation. During the critical examination we looked for the results of two parameters: a) alpha 1-3/alpha 4 and b) alpha 4-4/9. In comparison to the control group we found a statistical significance (p less than 0.05) for WR 2-6 in alpha 1-3/alpha 4 index. Concerning the alpha 1-4/9 index one can only recognize a statistical significance (p less than 0.05) for WR 3-6 patients in comparison to the controls.

EEG discharges in WR 1-5 HIV-seropositive hemophiliacs.

Human immunodeficiency virus (HIV)-seropositive patients show involvement of the central and/or peripheral nervous system. We present here the results of electroencephalographic (EEG) findings in stage WR 1-5 HIV-seropositive hemophiliacs from a total of 184 who attended our clinic prior to October 1987.