Dietary and herbal supplements use among patients hospitalized in internal medicine departments.

OBJECTIVES: To assess consumption of dietary and herbal supplements (DHS) among patients in internal medicine departments and determine whether such use is documented in their medical files. METHODS: 267 patients from three internal medicine departments of an academic medical center in Haifa, Israel were assessed prospectively with questionnaires about their DHS use in the month preceding hospitalization. DHS were categorized into vitamins & minerals, herbal supplements and others. Further data was then collected from patients' medical records on socio-demographic and medical characteristics, as well as documentation of DHS use. RESULTS: 123 patients (50.6 %) used DHS on a daily basis. Most of them (53.7 %) were using more than one DHS. DHS use was more prevalent in older (OR = 1.02 [1.001-1.036], p = 0.034) and educated (OR = 0.482 [0.252-0.923], p = 0.028) patients. Vitamins & minerals were used mainly to enhance vitality and address laboratory abnormalities, whereas herbal supplements were used mainly for gastrointestinal problems (p < 0.001). DHS use was reported to the physicians by 42 % of the patients, mostly at the patients' initiative [92 (82.1 %), p < 0.001)]. Vitamins and minerals were the most reported category of DHS (94 (57.3 %), p < 0.001). The use of DHS was reported to physicians for 112 DHS (41.8 %) but only 32 DHS (11.9 %) were documented in their medical files. The documentation of vitamins and minerals was significantly higher compared to herbal supplements documentation (29 (17.7 %) & 3 (2.9 %) respectively, P < 0.001). CONCLUSIONS: DHS are commonly used by patients hospitalized in the internal medicine departments. Many patients do not report such use to the physicians, and more strikingly, physicians do not document DHS use in patient medical files. This communication gap may have serious medico-legal ramifications due to DHS side effects and DHS interactions with other DHS and with conventional drugs.

Attitudes and emotions towards pain and sensitivity to painful stimuli among people routinely engaging in masochistic behaviour.

BACKGROUND: People engaged in masochistic behaviour (MB) seek to experience pain and the pleasure it evokes in sadomasochistic (S&M) sessions. The sensitivity and attitude to pain in these individuals has hardly been tested. We evaluated pain perception among these individuals and tested whether their experiences and attitudes towards pain are context-related. METHODS: Thirty-four healthy subjects participated; 17 routinely engaged in MB and 17 controls. Pressure pain threshold (PPT) was measured in two body regions. A structured questionnaire on S&M activities and context-related pain experiences and emotions was completed, as well as the pain catastrophizing (CAT) and fear of pain (FOP) questionnaires. RESULTS: PPT was significantly higher among MB individuals and positively correlated with the frequency of S&M sessions. MB individuals also had lower levels of CAT, and FOP correlated negatively with the frequency of MB and the number of body regions involved. Pleasure evoked during S&M sessions correlated positively with pain intensity and number of body regions involved. Pain in everyday life correlated negatively with MB activities. However, the emotional attitude to everyday pain was ambivalent: MB individuals perceived pain intensity and unpleasantness similar to the controls, but simultaneously gained pleasure from the pain. CONCLUSIONS: MB individuals exhibited pain hyposensitivity, presumably resulting from frequent engagement in MB. Alternatively, these subjects may have a predisposition which enables this engagement. Attitudes towards pain in MB individuals are complex. They appear to be context-related with pain experienced as pleasurable and rewarding during S&M sessions, and negative but still pleasurable in everyday life.

CD40.FasL inhibits human T cells: evidence for an auto-inhibitory loop-back mechanism.

A chimeric CD40.FasL (CD40-CD95L) protein was designed with the combined capacities to bind to two surface receptors on activated T cells, CD40 ligand (CD40L; CD154) and Fas receptor (CD95). CD40.FasL, once tethered to the cell surface via one of its ends, can transmit a signal via its other end. In principle, simultaneous triggering from both ends is possible, and thus there is the intriguing potential for 'auto-inhibition' if such dual triggering occurs on the same cell itself. Several lines of evidence support this mechanism: (i) CD40.FasL is cytotoxic to Fas receptor-positive cell lines of different cell lineages, (ii) CD40.FasL's function is potentiated when there is enforced expression of CD40L on target cells, (iii) CD40.FasL inhibition does not require intercellular contact, as demonstrated by soft agar clone formation and cell dilution analysis and (iv) introduction of exogenous CD40 into the system interferes with CD40.FasL inhibition. Taken together, these data are consistent with a 'loop-back' inhibitory mechanism within individual activated (CD40L and Fas receptor expressing) T cells causing suicide of these T cells. Significantly, this type of fusion protein provides a unique way to confine immunoinhibition to activated T cells.

Hypodermoclysis: an alternative infusion technique.

Hypodermoclysis, the subcutaneous infusion of fluids, is a useful and easy hydration technique suitable for mildly to moderately dehydrated adult patients, especially the elderly. The method is considered safe and does not pose any serious complications. The most frequent adverse effect is mild subcutaneous edema that can be treated by local massage or systemic diuretics. Approximately 3 L can be given in a 24-hour period at two separate sites. Common infusion sites are the chest, abdomen, thighs and upper arms. The preferred solution is normal saline, but other solutions, such as half-normal saline, glucose with saline or 5 percent glucose, can also be used. Potassium chloride can be added to the solution bag if needed. Hyaluronidase can also be added to enhance fluid absorption. Hypodermoclysis can be administered at home by family members or a nurse; the technique should be familiar to every family physician.

[Management of malignant bowel obstruction in terminal care--is home care possible?].

Malignant bowel obstruction occurs in about 10% of those with advanced abdominal cancer and in about 25% of those with advanced pelvic cancer. Such patients usually develop nausea, vomiting, constipation, abdominal dilatation and colicky pain. Traditional therapy consists of intravenous fluids and decompression by duodenal tube, gastrostomy or operation but postoperative mortality is high. Treatment requires hospitalization and therefore such patients have not been considered candidates for home care. Palliative medical techniques can cope with this syndrome and allow home care. Hypodermoclysis, non-prokinetic antiemetics like haloperidol and scopolamine, octeotride, corticosteroids, and narcotics for severe abdominal pain can alleviate symptoms. Medications can be combined and infused subcutaneously in a syringe driver and patients can remain with their families in their natural environment. Such techniques can give these patients who have short life expectancies reasonable quality of life.

Crohn's disease and acute leukocytoclastic vasculitis of skin.

A 39-yr-old white male with a prolonged history of Crohn's disease presented with worsening diarrhea associated with an increasingly painful rash of both lower extremities as well as left ankle swelling. A skin biopsy revealed an acute leukocytoclastic vasculitis. Intravenous hydrocortisone followed by oral prednisone achieved a rapid remission of the both cutaneous and gastrointestinal manifestations. Long-term remission has been maintained with 6-mercaptopurine and mesalamine. The rare association between cutaneous vasculitis and Crohn's disease is discussed and earlier reported cases reviewed.

Malignant primary skin tumors in children.

Primary malignancies of the skin are uncommon in childhood. A low index of suspicion may lead to a delay in diagnosis. This paper reviews the most common pediatric primary skin tumors: melanoma, squamous cell carcinoma, and basal cell carcinoma. Because almost all skin cancers in children occur in the setting of a predisposing condition, identifying children at greatest risk is crucial to their management. Important precursor lesions and syndromes are stressed.

Porokeratosis and cutaneous malignancy. A review.

BACKGROUND: Porokeratosis is a disorder of epidermal keratinization manifested clinically by a raised border and histologically by a cornoid lamella. While cutaneous malignancy has been reported to arise in porokeratosis, the risk remains unknown. In the past it has been associated with a history of radiation therapy. OBJECTIVE: The purpose of this study is to estimate the frequency of cutaneous malignancy arising in porokeratosis and define those patients who are at highest risk. METHODS: All cases in the English language literature in the last 30 years were reviewed. RESULTS: Twenty-one (7.5%) of 281 cases reported revealed a malignancy arising within porokeratosis. Large lesions, those of long-standing duration, and the linear type were at greatest risk. Radiation therapy was an infrequently identified risk factor. CONCLUSION: Porokeratosis is a premalignant condition, with certain groups of patients at greatest risk for malignant transformation.

Photography without film: low-cost digital cameras come of age in dermatology.

BACKGROUND: Photography is integral to the practice of dermatology. Digital imaging techniques have only recently been used to assess cutaneous disorders. Previously reported imaging systems have been both expensive and cumbersome. Consequently, they have failed to gain wide-spread acceptance. METHODS: We describe our experience using an inexpensive digital camera. Photographs taken with this portable digital camera (FotoMan) compare favorably to those obtained with conventional 35 mm cameras. RESULTS: This inexpensive digital camera provides photographs of acceptable quality for a variety of dermatologic applications. Images created with this system are available within minutes and are less expensive than traditional photographs. CONCLUSIONS: Digital imaging is a new and exciting development. The digital camera described is simple to operate and provides a useful alternative or adjunct to conventional photography.