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Structured approach to dilated superficial veins
Course
Cl -11 n
C2. AIDS and S7’D
Structured approach to dilated superficial veins
H. A.M. Neumann. Accc~le,tiicHospital
Maastricht,
Maastricht,
The Netl~eriand~
Clinical spectrum of varicose veins is very broad. A careful step by step approach is necessary to obtain optimal results. Taking the history of the patient it is not only important to ask about complaints like heavy legs, restless legs, night cramps, and pain, but nlso if they have got in the past deep venous thrombosis, superficial thrombophlebitis, erysipelas or a leg ulcer. Next step will be a careful clinical investigation which includes palpation of the longest and shortest saphenous veins and a careful mapping of all present varicose veins. Retlux detection can be done for the superlicial system by Doppler or duplex. Duplex scanning is perfect for the deep venous system. Reflux will not always lead to functional changes, so a functional test is also necessary. One of the easiest routine functional tests is photoplethysmogmphy. In all cases in which a normal venous refilling time is present or can be obtained after occlusion of the superficial venous system, this test is conclusive. In case venous refill time will stay short, other tests like air plethysmography or strain gauge plethysmogmphy or direct venous pressure measurement will be necessary to rule out problems of the deep venous system. Cl-12
s43
C2.
AIDS and STD
IC2-1
Epidemiology of HIV and STDs In Europe
Derek Freedman. St. Janres’
Hospital.
Dablin,
Ireland
The epidemiology of HIV in Europe is well established with a preponderance of homosexually acquired cases in Northern Europe and intravenous drug user associated cases in the western Meditemmean countries. This knowledge is available through reporting to the Eumpean Centre for the Epidemiologcial Monitoring of AIDS and Infectious Diseases, in France. In Europe, a fall off of the new cases of AIDS is seen, hugely through improved thempy reducing the rate of disease progression. This should not induce complacency, as the real measure of the disease is HIV infection rates. Heterosexual infections are continuing to increase, showing the true nature of the infection. Reportage of other STDs is uneven, with reasonable reporting of the classical infections, syphilis and gonotrhoea, but only poor or patchy reporting of the commoner infections, such as chlamydia and its consequence PID; Warts/HPV infection and Herpes. Incomplete reporting has been seen to be associated with higher endemicity and poor contact tracing services. Perhaps in the em of E.U. one should propose a European reporting and co-on&nation centre for STDs, which could provide a partner notification/contact tracing service for the infections which so often transcend national borders.
The sentinel lymph node biopsy in staging patient with melanoma
G. Landi. Ospedale
M. Bafalini,
Cesetw
Italia
A more accumte staging for cutaneous melanoma at higher risk for regional metastasis has been recently provided by a new technique of lymphatic mapping and biopsy of the sentinel lymph node (SLN). the first node that dmins the primary tumor. That node was demonstrated to be predictive of tumor stage of the entire regional lymphatic basin. In I80 patients with localized melanoma, a pteopemtive lymphoscintigmphy by intradermic injection of Tc 99”’ albumin. combined with the intraopemtive use of a handheld gamma probe and patent blue V mapping technique permitted us to identify one or mote SLN in all cases. In 45 melanomas less than I mm thick, SLN were negative for metastases whereas in I35 patients with thicker tumors. SLN micrometastases were demonstrated in 29 cases (21%). Patients with SLN metastases subsequently underwent regional lymph node dissection and in the majority of them the SLN resulted the only site of disease. Our data confirm that the SLN detection and biopsy are extremely selective and useful to find early micmmetastases. Patients with primary melanoma should be informed on the availability of such procedure.
1C2-2 1 STDs in HIV-infected patients M. Janier. STD Clinic,
Hopital
Saint-Laais,
h-is,
Fmnce
STDs and HIV-infection are inextricably linked and sexual tmnsmission of HIV is more frequent than any other mode of transmission. Behavioral changes and safer sex have resulted in a dmmatic decrease of STDs in developed countries but a high incidence of STDs is still observed in minorities and in developing countries. STSs are independent predictors of HIV-semconversion. Both genital ulcers (syphilis, chancmid and herpes) and non ulcemtive STDs facilitate HIV transmission. HIV viral load in genital secretions is lower after treatment of STDs. HIV-infection facilitates HSV2 carriage and recurrences of genital herpes, a protracted course of condylomata acuminata. higher incidence of anal and cervical dysplasia, HVB viremia and carriage, severe neurological and ocular syphilis. Semlogical tests for syphilis may be altered with semnegative secondary syphilis and TPHA semreversion after treatment. STD management is critical for controlling the spread of HIV-infection.
IC2-3
The course of syphilis in HIV-infected >.I patients
E. Tschachler. Departtnent Henna,
Vienna,
Austria
of Detmatologx
University ,,
of
Epidemiological studies demonstrate that a history of sexuaIIy transmitted diseases (STDs), including syphilis, Cs associated with an increased risk for HIV infection and ~gettital ulcers are important cofactors for acquiring HIV infection. Therefore STD
Cl -11 n
C2. AIDS and S7’D
Structured approach to dilated superficial veins
H. A.M. Neumann. Accc~le,tiicHospital
Maastricht,
Maastricht,
The Netl~eriand~
Clinical spectrum of varicose veins is very broad. A careful step by step approach is necessary to obtain optimal results. Taking the history of the patient it is not only important to ask about complaints like heavy legs, restless legs, night cramps, and pain, but nlso if they have got in the past deep venous thrombosis, superficial thrombophlebitis, erysipelas or a leg ulcer. Next step will be a careful clinical investigation which includes palpation of the longest and shortest saphenous veins and a careful mapping of all present varicose veins. Retlux detection can be done for the superlicial system by Doppler or duplex. Duplex scanning is perfect for the deep venous system. Reflux will not always lead to functional changes, so a functional test is also necessary. One of the easiest routine functional tests is photoplethysmogmphy. In all cases in which a normal venous refilling time is present or can be obtained after occlusion of the superficial venous system, this test is conclusive. In case venous refill time will stay short, other tests like air plethysmography or strain gauge plethysmogmphy or direct venous pressure measurement will be necessary to rule out problems of the deep venous system. Cl-12
s43
C2.
AIDS and STD
IC2-1
Epidemiology of HIV and STDs In Europe
Derek Freedman. St. Janres’
Hospital.
Dablin,
Ireland
The epidemiology of HIV in Europe is well established with a preponderance of homosexually acquired cases in Northern Europe and intravenous drug user associated cases in the western Meditemmean countries. This knowledge is available through reporting to the Eumpean Centre for the Epidemiologcial Monitoring of AIDS and Infectious Diseases, in France. In Europe, a fall off of the new cases of AIDS is seen, hugely through improved thempy reducing the rate of disease progression. This should not induce complacency, as the real measure of the disease is HIV infection rates. Heterosexual infections are continuing to increase, showing the true nature of the infection. Reportage of other STDs is uneven, with reasonable reporting of the classical infections, syphilis and gonotrhoea, but only poor or patchy reporting of the commoner infections, such as chlamydia and its consequence PID; Warts/HPV infection and Herpes. Incomplete reporting has been seen to be associated with higher endemicity and poor contact tracing services. Perhaps in the em of E.U. one should propose a European reporting and co-on&nation centre for STDs, which could provide a partner notification/contact tracing service for the infections which so often transcend national borders.
The sentinel lymph node biopsy in staging patient with melanoma
G. Landi. Ospedale
M. Bafalini,
Cesetw
Italia
A more accumte staging for cutaneous melanoma at higher risk for regional metastasis has been recently provided by a new technique of lymphatic mapping and biopsy of the sentinel lymph node (SLN). the first node that dmins the primary tumor. That node was demonstrated to be predictive of tumor stage of the entire regional lymphatic basin. In I80 patients with localized melanoma, a pteopemtive lymphoscintigmphy by intradermic injection of Tc 99”’ albumin. combined with the intraopemtive use of a handheld gamma probe and patent blue V mapping technique permitted us to identify one or mote SLN in all cases. In 45 melanomas less than I mm thick, SLN were negative for metastases whereas in I35 patients with thicker tumors. SLN micrometastases were demonstrated in 29 cases (21%). Patients with SLN metastases subsequently underwent regional lymph node dissection and in the majority of them the SLN resulted the only site of disease. Our data confirm that the SLN detection and biopsy are extremely selective and useful to find early micmmetastases. Patients with primary melanoma should be informed on the availability of such procedure.
1C2-2 1 STDs in HIV-infected patients M. Janier. STD Clinic,
Hopital
Saint-Laais,
h-is,
Fmnce
STDs and HIV-infection are inextricably linked and sexual tmnsmission of HIV is more frequent than any other mode of transmission. Behavioral changes and safer sex have resulted in a dmmatic decrease of STDs in developed countries but a high incidence of STDs is still observed in minorities and in developing countries. STSs are independent predictors of HIV-semconversion. Both genital ulcers (syphilis, chancmid and herpes) and non ulcemtive STDs facilitate HIV transmission. HIV viral load in genital secretions is lower after treatment of STDs. HIV-infection facilitates HSV2 carriage and recurrences of genital herpes, a protracted course of condylomata acuminata. higher incidence of anal and cervical dysplasia, HVB viremia and carriage, severe neurological and ocular syphilis. Semlogical tests for syphilis may be altered with semnegative secondary syphilis and TPHA semreversion after treatment. STD management is critical for controlling the spread of HIV-infection.
IC2-3
The course of syphilis in HIV-infected >.I patients
E. Tschachler. Departtnent Henna,
Vienna,
Austria
of Detmatologx
University ,,
of
Epidemiological studies demonstrate that a history of sexuaIIy transmitted diseases (STDs), including syphilis, Cs associated with an increased risk for HIV infection and ~gettital ulcers are important cofactors for acquiring HIV infection. Therefore STD