Excess mortality has repeatedly been found in patients with recurrent affective disorders. In previous studies our group has shown that during long-term lithium treatment the mortality of such patients is not significantly higher than that of the general population. In the present study, we extended our investigation to 273 patients from the earlier IGSLI cohort who subsequently dropped out from regular lithium prophylaxis. The standardized mortality ratio (SMR) for the whole group was 2.5, significantly higher (P < 0.01) than 1.0, which is the SMR of the general population. Furthermore, the SMR of the patients from each of the participating countries, namely Denmark, Germany and Austria, was significantly higher than 1.0. These findings strengthen the evidence accumulated in previous investigations that regular long-term lithium treatment does in fact markedly reduce the excess mortality of patients with recurrent affective disorders.

The high return rate of this survey allows a relatively precise description of the current diagnostic methods used in German dermatology departments. Standard diagnostic tests are available nationwide and in bullous pemphigoid and pemphigus, the antigen-specific detection of autoantibodies is routinely performed in half of the departments. Rare disorders may be diagnosed by cooperation with some specialized centers.

While treating a 63-year-old woman with leg ulcerations, we observed an unusual phenomenon. A wound débridement was planned to remove adherent necrotic material. After topical anesthesia with a lidocaine-prilocaine mixture (EMLA cream) a hemorrhagic,livid margin area developed around the ulcer 90 minutes after application. The area turned necrotic over days and the center was débrided. A more detailed history revealed that similar necrosis had occurred previously when EMLA cream had been employed. We interpreted the current event,as well as the past episodes,as a pathological reaction of the small cutaneous blood vessels to EMLA cream. The history also revealed an overlap connective tissue disease with microvascular impairment. After exposure to the topical anesthetics, the pre-damaged cutaneous blood vessels presumably produced a critical ischemia with subsequent necrosis. Based on this case, we recommend careful use of EMLA cream with frequent monitoring for necrosis when treating patients with a known disorder of microcirculation.

The importance of Aggregatibacter actinomycetemcomitans in chronic wounds needs to be explored.

Zusammenfassung Wir berichten ?ber eine 75-j?hrige Patientin mit insulingef?hrtem Diabetes mellitus Typ IIb, bei der das Auftreten einer auffallend schmerzhaft verlaufenden erworbenen reaktiven perforierenden Dermatose (ERPD) zeitlich sowie lokalisationsbezogen mit einer interventionsbed?rftig sich zuspitzenden pAVK der Beine korrelierte.