[The spectrum of lymphadenopathy in HIV-positive patients. Prospective analysis of 45 cases]

In the prospective analysis of 45 patients (intravenous drug addicts and homosexuals) with lymphadenopathy and positive HIV virus titers, including serology, immunological and histological lymph node studies, we examined the etiology and diagnostic results of the methods used. We found 19 cases with lymphoid follicular hyperplasia, 9 with lymph node tuberculosis, 7 with lymphoid depletion, 2 non-Hodgkin's lymphoma and one case with Hodgkin's disease. Routine serology did not provide more information concerning the lymphadenopathy and the immunological study showed a relationship, however not lineal, between the immunosuppression and the stage of HIV infection, while the histologic diagnosis did not, except in the cases with lymphoid depletion and non-Hodgkin's disease. In the asymptomatic patients (10 cases) biopsy results did not change the given treatment as well as the prognosis, thus, it could be eliminated in a routine study. Biopsy on occasions implied therapeutic management (lymph node tuberculosis) or a change in prognosis (lymphoma or lymphoid depletion) in symptomatic patients (35), therefore, it seems to de justified. Fine needle aspiration of the lymph nodes was harmless and safe and was shown to have good sensitivity (79%), thus, it can be recommended as a first elective diagnostic method for lymph node histology.

[The development of an enteral nutrition program (I): an analysis of the degree of compliance]

Preparation of a working plan for enteral nutrition consisting of: the application of the Heimburger criteria for including in the drug therapy guide enteral diets existing on the market, their indications in enteral nutrition, data on the extent of non-compliance and level of information of the patient in order to bring the enteral nutrition programme closer to the rational standards established in literature. The study concludes with the application of an algorithm for prescribing the diet based on the pathology and the preparation of an "informative leaflet" for the patient.

Cytologic, cytochemical, immunocytochemical and ultrastructural diagnosis of a sacrococcygeal chordoma in a fine needle aspiration biopsy specimen

The cytologic, cytochemical, immunocytochemical and ultrastructural findings on the aspirated material are presented for the case of a 57-year-old man with sacrococcygeal chordoma diagnosed by fine needle aspiration biopsy. Cytologically, two types of cellular elements were differentiated: medium-sized cells with few cytoplasmic vacuoles and classic physaliferous cells. Both types showed marked cytoplasmic positivity for keratin and S-100 protein; the absence of nuclear positivity in the physaliferous cells was notable. Ultrastructural study demonstrated the existence of true intracytoplasmic vacuoles and frequent rough endoplasmic reticulum-mitochondria complexes. The cytologic differential diagnosis with chondrosarcoma, myxoid liposarcoma, ependymoma and metastases of mucosecretory carcinomas is reviewed.

Oral challenge test with sodium metabisulfite in steroid-dependent asthmatic patients

Oral challenge tests were carried out with sodium metabisulfite solution doses of 0.5, 1, 10, 25, 50 mg and encapsulated doses of 100 and 200 mg, as well as with lactose-placebo, on 44 non-atopic patients with steroid-dependent bronchial asthma, without clinical evidence of intolerance to these agents. Only those patients with an acceptable and not very labile pulmonary function were tested. A single-blind challenge protocol was performed in 22 patients (sodium metabisulfite solutions at pH 2.2 to 2.6) and the positive responses were confirmed by double-blind challenge. The other 22 were tested directly in a double-blind manner (pH4). Initially, 6/44 presented a positive reaction. However, a careful analysis and the confirmation by double-blind challenge of the positive responses obtained with the single-blind test, allowed us to identify 4 false positive responses. Thus, the true prevalence of sulfite sensitivity in our population is 4.5%. A patient with intolerance to sulfite agents also suffered aspirin-induced asthma. The labile tendency of the pulmonary function of the asthmatic patients may have contributed to some false positive reactions and probably explain the very high prevalence found in some studies. It does not appear that the variations of pH decisively influence the result of the challenge test.

A practical method to analyze the phospholipids in the amniotic fluid using HPTLC

An operative method using HPTLC which makes possible the determination of nine phospholipids in the amniotic fluid individually is described: lysophosphatidylcholine, sphingomyelin, phosphatidylcholine, phosphatidylinositol, phosphatidylserine, phosphatidylethanolamine, phosphatidylglycerol, phosphatidic acid and cardiolipine. Since a simple and reliable method for clinical practice was sought, the working techniques, materials, chromatographic solvents and staining reagents were chosen accordingly. The standardization method was made by using standard phospholipids. This method was tested with 34 samples of amniotic fluid. A discussion of the practical application in the determination of some ratios of fetal pulmonary maturity is made.

Production of and response to erythropoietin in the splenectomized mouse

A reliable dose-response curve has been established by exposing normal mice to graded doses of exogenous erythropoietin (ESF). In CF1 femal mice, made polycythemic by exposure to reduced air pressure , 59 Fe incorporation in RBC following injections of ESF (ranging from 0.05 to 3.2 IRP-units) varied according to the log of the ESF dose from 2.5 to 29.0 percent. Experiments with plethorized splenectomized mice showed unequivocally that they were able to respond to ESF, although their responses were very much smaller than that of intact mice, ranging from 1.4 to 12.0 percent. ESF activity was not detected in plasma from intact mice, but was evident in the plasma of mice that had been splenectomized 4 or 10 days earlier. Under conditions of hypoxia the plasma ESF level rose rapidly during the first 48 hours and then fell . In the plasma of splenectomized, similarly treated mice, the ESF level at every interval studied was much higher and was maintained for a longer time. Re-exposure to low oxygen tension for brief periods (2-24 h) produced and erythropoietic response in both intact and splenectomized polycythemic mice, its magnitude increasing with increased exposure time. The response of splenectomized mice, however, was lower than that of intact mice in spite of the fact that the plasma ESF level in the former was higher than in the latter.

Corticoadrenal and adrenergic overactivity and hyperlipidemia in prolonged emotional stress

A group of 23 Air Force Lieutenant Colonels who attended a long General Staff Course were studied with assays of blood lipid fractions, 11-hydroxycorticoids and excretion of epinephrine, norepinephrine, free 11-hydroxycorticoids, 17-hydroxycorticoids (17-OHCS), dehydroepiandrosterone (DHA) and 17-ketosteroids (17-KS). More or less continuous emotional stress was expected as most of these subjects had familiar responsabilities and the course was extremely competitive, with a large percent of dropouts. This meant, for most of these officers, the end of their careers. Norepinephrine levels were significantly increased and correlated with aggressive behaviour. Significant (p < 0.001) elevations of plasma and urine-free 11-hydroxycorticoíds were registered showing levels in the range found in very stressed subjects. Blood total lipids and cholesterol raised significantly during the course, with levels comparable to those found in hyperlipidemic patients with coronary arteriopathy. The EKG changes were not significant. The possibility that this maintained stressful state might cause a hyperlipoproteinemia and consequent atheromatosis and coronariopathy is discussed.