Multiple colon ulcerations, perforation and death during treatment of malignant melanoma with sorafenib.

BACKGROUND: Sorafenib (Nexavar) is an oral multi-kinase inhibitor with anti-angiogenic and antiproliferative effects. It has shown in-vitro and clinical activity against several kinds of tumors, such as malignant melanoma. HISTORY, DIAGNOSIS, TREATMENT AND COURSE: A 66-year-old man with malignant melanoma was treated with sorafenib, 2 yen 400 mg per day. Because of severe diarrhea and abdominal pain, sorafenib was eventually discontinued and the patient was hospitalized for further treatment. Diagnostic work-up by upper gastrointestinal endoscopy and colonoscopy revealed multiple deep ulcerations within the whole colon. One week after admission the patient developed symptoms of acute abdomen with signs of bowel perforation requiring an emergency operation. Colectomy of the right colon with ileostomy revealed multiple (20-30) acute and subacute colonic perforations. Despite intensive care treatment the patient died of septic complications 13 days after surgery. CONCLUSION: Treatment with anti-angiogenic multi-kinase inhibitors may be associated with gastrointestinal perforations. This has been reported for sorafenib in up to 2.3 % of cases.

[Varicella-zoster virus infections]. / Varizella-zoster-Virusinfektion.

The primary infection with varicella-zoster virus (VZV) is manifest clinically as varicella. It is a common very contagious disease, normally appearing in childhood. VZV is a ubiquitous virus with a high prevalence. Clinically it is characterized by pleomorphic skin lesions. Normally antiviral therapy is necessary only in severe cases, in adults or in immunosuppressed patients. Herpes zoster, also caused by (VZV), is a neurodermal disease representing the endogenous relapse of the primary varicella infection. Herpes zoster is characterized by lesions concentrated in the innervation region of a cranial or spinal nerve. One of the most feared manifestations of herpes zoster is pain. Several antiviral drugs are approved and many studies have shown that antiviral therapy, started early in the course of disease, can significantly reduce risk and duration of postherpetic neuralgia in elderly patients. Therefore, antiviral therapy in combination with an adequate pain management should be given to all elderly patients as soon as herpes zoster is diagnosed.

Early diagnosis of herpes zoster by polymerase chain reaction.

BACKGROUND: Herpes zoster is a common disease caused by the varicella-zoster virus. The use of virostatic agents as early as possible is necessary in shortening zoster-associated pain. OBJECTIVES: Rapid diagnosis is necessary for the optimal efficacy of antiviral therapy. The diagnosis in the early stage of infection is often difficult. METHODS: In the present study skin biopsies of patients with herpes zoster and unclear skin changes were analysed by detecting viral DNA using the polymerase chain reaction (PCR) in order to amplify open reading frames (ORF) 14, 29 and 63. RESULTS: Varicella-zoster virus DNA could be detected with PCR of all three ORF not only from blisters but also from erythematous skin. CONCLUSIONS: PCR is the method of choice for the viral diagnosis in herpes zoster before blister eruption.

[History of the Krefeld Dermatology Clinic]. / Die Geschichte der Dermatologischen Klinik Krefeld.

The dermatology clinic in Krefeld has treated a wide range of patients since its founding in 1845. Nowadays the spectrum consists of allergology, occupational dermatology, phototherapy, dermatosurgery, phlebology and proctology as well as special clinics for andrology, sexually transmitted diseases and patients with HIV-infection.

Assessment of pain in herpes zoster: lessons learned from antiviral trials.

Pain typically accompanies acute herpes zoster and, in a proportion of patients, it persists well beyond rash healing. Pain must therefore be analyzed in trials of antiviral agents in herpes zoster, but different methods have been used to analyze pain in recent published trials. These reports are reviewed and their methodological strengths and weaknesses examined. Based on this review, recommendations for the design and analysis of future trials of antiviral agents in herpes zoster are proposed. The principal recommendation is that antiviral efficacy should be evaluated both by distinguishing post-herpetic neuralgia from acute pain and by considering pain as a continuum. The primary endpoint should address both the prevalence and duration of post-herpetic neuralgia and should be examined in those patients who have post-herpetic neuralgia. Adopting the proposed recommendations in design and analysis of future trials should facilitate comparison across trials of the efficacy of antiviral agents in the treatment of herpes zoster.

Antipsoriatic effect of fumaric acid derivatives. Results of a multicenter double-blind study in 100 patients.

BACKGROUND: Psoriasis vulgaris may benefit from treatment with fumaric acid and/or its derivatives; however, because different preparations have been used, results have been contradictory and difficult to interpret. OBJECTIVE: The purpose of this clinical trial was to evaluate the therapeutic value of fumaric acid derivatives. METHODS: A randomized double-blind study was carried out in patients with psoriasis, comparing a well-characterized formulation of fumaric acid derivatives with placebo. RESULTS: The results indicated statistically significant superiority of the fumaric acid derivatives over placebo. Adverse events (flush, gastrointestinal disturbances) were initially relatively frequent, but decreased thereafter. CONCLUSION: Fumaric acid derivatives were found to be effective and safe in the treatment of psoriasis.

[Sexually transmitted diseases by herpes simplex, wart, hepatitis B, and human immunodeficiency virus]. / Sexuell übertragbare Erkrankungen durch Herpes-simplex-, Warzen-, Hepatitis-B-und das humane Immundefizienzvirus.

Sexually transmissible diseases (STD), caused by viruses are by far the most important ones, even though German legislation has ignored them up to now as STD. Anogenital herpes is easily diagnosed by means of monoclonal antibodies. This makes therapy available with acyclovir without delay in atypical cases or for example in persons with immunodeficiency. The therapy regimen usually is 5 x 200-400 mg/day. Recurrent herpes in high frequency and with severe pain may be successfully suppressed by 2-5 x 200 mg/day of acyclovir orally without serious side effects. This will not eliminate herpes viruses. Anogenital warts may look very different and occasionally cannot be detected before local application of 3% acetic acid. Histology is diagnostic. There are different strains causing diseases in men. Therapy of choice is destroying infected cells by CO2-laser coagulation. The incidence of hepatitis B in developed countries is decreasing slowly within the past years, this may partly be due to vaccines, that are available since the early eighties, producing immunity in about 95%. Treatment of chronic hepatitis with interferons seems to be beneficial. Infections with the human immunodeficiency virus (HIV) and their end stage disease AIDS are a growing problem all over the world. Interventions are possible with different nucleoside analogs, e. g. zidovudine (AZT), dideoxycytidine (DDC), dideoxyinosine (DDI). Up to now there is no agreement on when to start with one of the drugs and if or when to switch to combination therapy. Hopefully this may stabilize immunologic parameters and hold disease progression to some time.

[Treatment of recurrent herpes labialis using a herpes simplex Type-I subunit vaccine. A prospective randomized double-blind multicenter study]. / Behandlung des rezidivierenden Herpes labialis mit einer Herpes-simplex-Typ-I-Subunit-Vakzine. Eine prospektive randomisierte doppelblindkontrollierte Multicenter-Studie.

A herpes simplex type I subunit vaccine developed by Behring-Werke (Marburg/Lahn, FRG) was compared with placebo for therapeutic effectiveness in the treatment of recurrent orolabial herpes simplex in a multicentre study involving the major hospitals in Frankfurt/Main (n = 34), Hamburg (n = 18), Giessen (n = 17) und Kassel (n = 14). The effectiveness of the vaccine was judged on the reduction in the frequency of recurrences. Within the period of the 8-month study there was no statistically significant difference in the frequency of recurrences with vaccine or placebo. Both placebo and verum led to a significant decrease in the number of recurrences of orolabial herpes simplex, but the effect of placebo was slightly more pronounced.

[Ixodes ricinus bites]. / Ixodes-ricinus-Bisse.

Ticks (Ixodes ricinus) are found all over the world, with special preference of a few epidemic areas. They do not only invade their hosts one by one, but often in large groups.

[Current topics in mycology]. / Aktuelle Gesichtspunkte der Mykologie.

There is an urgent need of in vitro test methods with a good in vivo predictability both for the search of new antimycotics moderate in price and for the susceptibility testing of yeasts in antimycotic therapy. We discuss the problems of agar dilution test methods. Usually, the minimal inhibitory concentration (MIC) is measured. This parameter does not only depend on the susceptibility of the test fungus, but is greatly influenced by other factors such as inoculum size, incubation time, and culture medium. Thus the MIC of azoles can vary considerably. Moreover, the current test methods are not adjusted to the different ways of fungus growing in vitro and in vivo.