Faculty Bibliography

BACKGROUND: There is no consensus concerning management of Spitz nevi. OBJECTIVE: This study was carried out to ascertain how dermatologists manage Spitz nevi. METHODS: A questionnaire was sent to 997 fellows of the American Academy of Dermatology, 284 pediatric dermatologists, and 27 directors of pigmented-lesion clinics. The results are based on the 381 questionnaires returned. RESULTS: The vast majority of responding dermatologists (93%) recommend biopsies of suspected Spitz nevi. Of this group, 43% recommend total biopsies and 55% recommend partial biopsies; 2% would recommend either total or partial biopsies, depending on the clinical situation. Sixty-nine percent of physicians would completely excise a lesion that was histologically diagnosed as an incompletely removed Spitz nevus. Seventy percent of general dermatologists and 80% of pediatric dermatologists would recommend excision with a 1- to 2-mm margin of normal-appearing skin around a Spitz nevus. Nine percent of general dermatologists would recommend margins of 4 mm or more; however, all pediatric dermatologists surveyed would recommend margins less than 4 mm. Physicians were less likely to monitor patients whose Spitz nevi were completely removed. Three fourths (74%) of respondents believe Spitz nevi are entirely benign, 4% believe they are precursors to melanoma, and 22% are not sure. Seven percent of general dermatologists and 4% of pediatric dermatologists have seen metastatic melanomas arise at sites of lesions initially diagnosed histologically as Spitz nevi; 40% of pigmented-lesion clinic directors have seen such lesions. CONCLUSIONS: We believe that the lack of consensus, both in our survey and in the medical literature, reflects to some extent the lack of certainty in the histologic differentiation of Spitz nevi from melanomas and that concern about melanoma influences management. At the pigmented-lesion clinic of the New York University Skin and Cancer Unit, because of this concern about melanoma, it is usually recommended that Spitz nevi be completely excised

A study of 74 patients in a clinic serving indigent primarily African American people found that most were in early stages of readiness to start exercising, and that HbA1c levels were lower in the later stages

AIDS has killed more than 20 million people since 1981, when the first cases were discovered in the United States. Today, 40 million people live with H.I.V., the AIDS virus, and most are doomed to die for lack of the powerful combinations of drugs that can control the infection. And because these people lack access to the blood test that can tell if they are H.I.V. infected, they may unwittingly transmit the virus to another 45 million people by 2010. To make therapy more effective in the third world, C.D.C. researchers have developed less costly versions of two tests commonly used to determine when to start anti-H.I.V. drugs and to monitor their effectiveness. One is a new method to monitor, at one-fourth the cost of the standard tests, the number of the CD-4 immune cells in the blood that the AIDS virus destroys. The second is a new way to monitor the amount of H.I.V. in the blood at one-fifth the cost of standard tests. Studies have shown that anti-H.I.V. therapy needs to be taken for a lifetime because the drugs cannot rid the body of the virus. And because H.I.V. has increasingly developed resistance to the drugs, the International AIDS Society, a conference sponsor, and the World Health Organization announced that they were developing a program to monitor H.I.V. drug resistance throughout the world

The danger of ignorance was a main topic of the 14th International AIDS Conference, in Barcelona. Up to a half million Americans are either unaware that they are infected with the AIDS virus, not receiving treatment for it, or both

Giving nevirapine to a woman during labor and then to her newborn is considered the most feasible way to prevent transmission of H.I.V. from an infected mother to her newborn in developing countries, Dr. [Glenda Gray] said. She said her team undertook the study because she and other pediatricians did not know how effective preventive therapy would be if they gave nevirapine only to a newborn and not to the mother. So Dr. Gray, Dr. James McIntyre and their team devised a study to compare nevirapine with AZT among newborns whose mothers chose not to take anti-H.I.V. therapy during pregnancy or labor. The risk of infection increased if the mother breast-fed and the infant received AZT. Dr. Gray speculated that one reason for the difference was that AZT irritated an infant's stomach, allowing easier entry of H.I.V

The drug, T-20 or enfuvirtide, is a member of a new class of drugs called fusion inhibitors that attack HIV, the virus that causes AIDS. When added to combinations of standard drugs, injections of T-20 significantly reduced high levels of HIV in the blood among patients who it had been documented were infected with resistant virus compared with those who took the standard drugs. Once started, lifetime treatment of HIV is needed, AIDS experts say. But because the T-20 trials lasted 24 weeks, the long-term benefits and dangers of the drug are not known. So HIV resistance to T-20 could eventually become a problem, [Anthony S. Fauci] and other AIDS experts said. T-20 blocks HIV's cell machinery at a site different from any of the standard anti-HIV drugs. Existing anti-HIV drugs disrupt enzymes in the virus; T-20 blocks the entry of HIV into body cells. That entry, a process called fusion, releases the virus' genetic material and allows it to replicate

The risk of infection increased if the mother breast-fed and the infant received AZT. [Glenda Gray] speculated that one reason for the difference was that AZT irritated an infant's stomach, allowing easier entry of HIV

Giving nevirapine to a woman during labor and then to her newborn is considered the most feasible way to prevent transmission of HIV from an infected mother to her newborn in developing countries, [Glenda Gray] said. She said her team undertook the study because she and other pediatricians did not know how effective preventive therapy would be if they gave nevirapine only to a newborn and not to the mother. So Gray, Dr. James McIntyre and their team devised a study to compare nevirapine with AZT among newborns whose mothers chose not to take anti-HIV therapy during pregnancy or labor