The use of calcipotriol in HIV-related psoriasis

We report the case of a 28-year-old homosexual man with advanced HIV disease (CDC classification group IV A) who developed erythrodermic psoriasis which responded to calcipotriol, a topical vitamin D analogue. We believe this to be the first reported case of HIV-related psoriasis responsive to this form of treatment. Systemic therapy for HIV-related psoriasis is limited because of immunosuppressive effects. We suggest that calcipotriol may prove to be a useful therapeutic option in these patients.

A case of cavitating pneumonia in AIDS

Tuberculosis is a common cause of cavitating pneumonia in Singapore. In patients with the human immunodeficiency virus (HIV), cavitary pneumonias mimicking tuberculosis can mislead the clinician, delaying diagnosis, resulting in increased morbidity. We describe a HIV seropositive patient with cavitating pneumonia in whom the diagnosis of Pneumocystis carinii pneumonia (PCP) was ultimately established only on bronchoscopy.

The phytoestrogens present in de-ethanolized bourbon are biologically active: a preliminary study in a postmenopausal woman

Bourbon and some other alcoholic beverages have been shown to contain phytoestrogens which, as a result of an excessive intake and alcohol associated liver disease, have been suggested as contributing to the feminization of chronic alcoholic men. To evaluate this hypothesis directly, de-ethanolized bourbon was prepared and orally administered to a single postmenopausal woman. Serum or plasma levels of luteinizing hormone, follicle stimulating hormone, sex steroid binding globulin, high density lipoprotein cholesterol, and estradiol were monitored before, during, and after administration of the de-ethanolized bourbon at a dose equivalent to 4 ounces of bourbon for 20 days. The changes observed for each parameter during the injection of the bourbon extract are consistent with the presence of a biologically active estrogenic substance being present in the bourbon extract. These observations provide the first direct evidence in man for the presence of a biologically active estrogenic substance(s) in bourbon.

Detection of human papillomavirus DNA by PCR in semen from patients with and without penile warts

OBJECTIVES

To determine the prevalence of urethral HPV infection, as indicated by the presence of HPV DNA in semen, in males with and without penile warts.

DESIGN

Prevalence study of HPV types 6/11 and 16 DNA using PCR and Southern blot hybridisation analysis of semen.

SETTING

Department of Genitourinary Medicine, Blundell Street Clinic, Leeds General Infirmary and the Assisted Conception Unit (ACU) Kings' College, London.

SUBJECTS

Patients attending the Genitourinary Clinic for treatment of sexually transmitted diseases including penile warts and males attending Kings' ACU for investigations of infertility.

MAIN OUTCOME MEASURES

HPV DNA detected by polymerase chain reaction (PCR) and/or Southern blot hybridisation in semen.

RESULTS

HPV DNA was detected by PCR in 23 of 27 (85%) specimens from patients attending the GUM clinic for treatment of genital warts and in one of two specimens from patients attending the clinic for other conditions. By Southern blot, nine (33%) of the 29 specimens from GUM clinic patients were HPV DNA-positive. HPV DNA was detected by PCR in 43 of 104 (41%) of specimens from males attending the ACU, whilst 70 of these tested by Southern blot hybridisation were all negative for HPV DNA.

CONCLUSIONS

The data suggest that urethral HPV infections, as indicated by the presence of HPV DNA in semen, are prevalent in males with and without genital warts.

HIV infection and Pneumocystis carinii pneumonia--bronchoscopic diagnosis in two patients

Pneumocystis carinii pneumonia is extremely common in patients with the acquired immunodeficiency syndrome (AIDS). Diagnostic techniques vary between different institutions depending on availability of expertise. We have limited experience in the workup and evaluation of patients with human immunodeficiency virus infection because we have at present only 56 reported cases of HIV positive individuals. We report here two cases where Pneumocystis carinii pneumonia was the index illness and the diagnosis was confirmed by bronchoscopy.

Insulin protects cognitive function in experimental stroke

There is evidence from in vitro systems that the extent of neuronal loss in acute central nervous system ischaemia can be reduced by manoeuvres which restrict availability of glucose to the ischaemic area. Experiments were designed to test whether hypoglycaemia induced with insulin is associated with improved behavioural outcome in a recovery model of stroke. Rats learned a maze task as a test of working memory, believed to be subserved by the hippocampus, and then had a period of cerebral ischaemia, followed by reperfusion. After an interval of 14 days they were tested on the same maze, where lesioned animals had very significant (p less than 0.0001) impairment of working memory, whereas lesioned and treated (2.0 u/kg-1 insulin, minimum single plasma glucose value: 3.1 mmol/l-1) animals were indistinguishable from control animals. It is concluded that a striking degree of protection can be obtained with levels of mild hypoglycaemia which may be acceptable and practicable for use in humans.

[Activity of beta-N-acetylglucosaminidase in chronic alcoholic liver disease]

Serum N-acetyl-B-glucosaminidase (NAG) activity was determined in a control group of 76 normal people and in 23 patients with hepatic cirrhosis: 15 non-compensated patients and 8 with compensated chronic liver fibrosis. NAG is significantly increased in the non-compensated group--mean value of 931.67 units vs 637.71 units for the controls (p less than 0.001). There is no significant elevation regarding the compensated group. No significant correlations were observed between NAG activity and hepatic functional tests. In the follow-up of the non-compensated group, NAG activity returned to normal with the clinical improvement; in 7 cases where this goal was not achieved there was elevation of NAG activity, with higher values in photo-systemic encephalopathy.

Detection of human papillomavirus DNA in semen from patients with intrameatal penile warts

Fifteen semen specimens from 10 men with intrameatal penile warts attending a genitourinary clinic were tested by Southern blot hybridisation for the presence of human papillomavirus (HPV) DNA. Five specimens were positive for HPV types 6/11. This observation may have implications for screening of semen used for artificial insemination by donor.

Histocompatibility antigens: markers of susceptibility to and protection from alcoholic liver disease in a Portuguese population

The distribution of six HLA antigens in a population of 88 Portuguese chronic alcohol abusers with biopsy-proven liver disease was compared to that in 66 Portuguese normal controls. Among the group of 88 alcohol abusers, the presence of HLA antigens A1, A9, A28 and Bw35 marked a significant 2.5- to 3-fold increased estimated risk for the development of alcohol-induced cirrhosis, while the presence of HLA B5 was found to be associated with a significantly decreased risk of alcohol-induced cirrhosis. Further, compared to controls, the estimated risk of any stage of alcohol-induced liver disease was significantly increased in alcoholic individuals with HLA A28 and Bw35, and the protective effect of HLA B5 was again observed. The findings of this study suggest that at least in a relatively homogeneous population group such as the Portuguese, the presence of HLA B5 may confer protection against alcohol-induced liver disease, including cirrhosis. The presence of HLA Bw35 and A28 appear to mark susceptibility to all histologic manifestations of alcohol-induced liver disease, while in addition to Bw35 and A28, A1 and A9 may mark increased risk for cirrhosis in particular.

Anti-reticulin antibodies: a diagnostic and monitoring test for childhood coeliac disease

The importance of anti-reticulin antibodies (ARA)--R1 pattern--has been evaluated as a diagnostic and monitoring test for childhood coeliac disease. A prospective study was performed in 140 patients: 68 children with coeliac disease, 32 with miscellaneous diarrhoea, and 40 controls. An indirect immunofluorescent test was used for ARA screening. The indirect correlation found in our study between the presence of ARA and coeliac disease in children on a normal diet and after gluten challenge and between the absence of ARA and coeliac disease in children on a gluten-free diet seems to be of value in the diagnosis of coeliac disease and in monitoring the response to treatment in coeliac disease children.

Antithyroid antibodies as an early marker for thyroid disease induced by amiodarone

Changes in thyroid function may occur during treatment with amiodarone. A double blind prospective trial of amiodarone and placebo was performed in 37 patients in the subacute phase of myocardial infarction. Though none of the patients assigned to receive placebo developed any antibody, six of 13 patients treated with amiodarone developed antithyroid microsomal antibodies. There was no difference in triiodothyronine and thyroxine concentrations between the two groups, but a significant difference in concentrations of thyroid stimulating hormone was noted on day 30 (p less than 0.05). Six months after the withdrawal of amiodarone autoantibodies could not be detected and concentrations of thyroid stimulating hormone were normal. These antibodies have not previously been reported to develop during short term treatment with amiodarone. They could have an important role in the detection of early thyroid changes in patients given amiodarone.

Isolation of mucoid Vibrio parahaemolyticus strains

Mucoid strains of Vibrio parahaemolyticus were isolated from the stools of two asymptomatic carriers and a patient with gastroenteritis. The strains demonstrated biochemical reactions and antibiotic susceptibility typical of nonmucoid strains of V. parahaemolyticus isolated locally. The slime substance was typed by coagglutination and was antigenically similar to the capsular antigen of the same strain. Three different serotypes (O10:K24, O5:K17, and O5:K15) were involved.

[Subacute sclerosing panencephalitis: comparative study between human and experimental lesions determined by encephalitogenic agents of human origin]

Neste trabalho estudamos as alterações histopatológicas encontradas no sistema nervoso central de dois pacientes com "panencefalite subaguda esclerosante" comparando-as com as modificações estruturais determinadas no sistema nervoso central de sete macacos rhesus nos quais este material foi inoculado. Os animais apresentaram sinais de comprometimento neurológico, traduzido por caquexia e paralisia do trem posterior, após um longo período de incubação, em torno de 18 meses. Dois animais morreram antes de qualquer manifestação neurológica, de infecção pulmonar intercorrente acidental. Nas passagens sucessivas houve um encurtamento do periódo de incubação para cerca de 40 dias. As alterações histopatológicas encontradas, consistiram, nos casos humanos, em leptomeningite focal, focos de neuronofagia, granulomas corticais e nos núcleos basais, grande perda da população neuronal com ocasional estado esponjoso do córtice cerebral, infiltrados perivasculares, e gliose da substância branca, sem perda de mielina. No material experimental foram observadas estas mesmas modificações, se bem que de caráter muito menos intenso. Tanto no material humano como no experimental a mielina estava praticamente normal. Sugere-se que o quadro anátomo-clínico chamado "panencefalite subaguda esclerosante (SSPE) possa ser determinado, não apenas pelo vírus do sarampo, mas também por outros vírus, especialmente os do grupo papova, já encontrado por outros autores, em casos de "panencefalite subaguda esclerosante".

[Subacute sclerosing panencephalitis: transmission of a human encephalitogenic agent to Macacus rhesus]

Material proveniente do cérebro de um paciente com "panencefalite subaguda esclerosante" foi inoculado, por via intracerebral, em dois Macacus rhesus. Os animais permaneceram assintomáticos, aparentemente bem, por mais de um ano. Entretanto, 21 e 22 meses após as inoculações começaram a apresentar sinais de comprometimento neurológico, traduzido por paralisia dos membros posteriores, com apatia e caquexia progressivas. Os animais foram sacrificados. O exame histopatológico do sistema nervoso central mostrou gliose marginal e gliose da substância branca, com os neurônios exibindo sinais de "lesão celular crônica". Foram vistos discretos manguitos inflamatórios perivasculares. Em um animal foi encontrada inclusão acidófila intra- nuclear. Havia também proliferação da glia satélite perineuronal, com satelitose, notadamente no tronco cerebral. No exame das vísceras foi encontrado discreto processo de miocardite crônica. Foram retirados fragmentos dos encéfalos destes animais e inoculados em 4 outros, também por via intracerebral. Estes animais de 2.ª passagem após 2 meses de inoculação, em média, apresentaram sinais de comprometimento do sistema nervoso central semelhante ao dos animais doadores, de 1ª passagem. Houve, portanto, um encurtamento do período de inoculação da moléstia. Estes animais também foram sacrificados, sendo encontradas gliose marginal, gliose da substância branca, "lesão celular crônica" neuronal e proliferação da glia satélite, notadamente no tronco cerebral; vasos sangüíneos congestos; espongiose cortical. Os animais testemunhas, do mesmo lote, permaneceram normais. Acreditamos que as lesões observadas nos animais de 1.ª passagem, e que se repetiram com maior intensidade e com menor tempo de incubação nos de 2.ª passagem somente podem ser explicadas admitindo-se a existência de um agente virai que, pela natureza do quadro histopatológico (gliose, "lesão celular crônica" neuronal e espongiose cortical) bem como pelo período longo de incubação, deva pertencer ao grupo dos chamados vírus lentos.

[Behavior of poliomyelitis virus after ionising radiation]

Prosseguindo nas suas experiências referentes à ação dos Raios X e do Radium sôbre vírus, iniciadas em 1953, quando verificaram que o vírus da gripe submetido a doses não elevadas de Raios X mostra-se com poder patogênica aumentando para camundongos, os autores, nas pesquisas referidas no presente trabalho, submeteram o vírus da poliomielite, amostra MEF1 do tipo 2, à ação de Raios X em doses que que foram de 307r até 3.408.500 r. Empregaram-se 2.140 animais, nas experiências aqui relatadas, o que permitiu conclusões seguras. Os autores observaram irregularidade no comportamento do vírus da poliomielite submetido à ação dos Raios X, no sentido de aumentar-lhe o poder patogênico, em relação com o vírus testemunha, não irradiado. Assinalaram a observação que fizeram sôbre a resistência do vírus seguramente a 3.101.000 r o que julgaram de interêsse registrar. A resistência quase desaparece a 3.386.000 r. Após aplicação de 3.408.500 r o vírus tornou-se inativo.

[Radiation effects on benign lymphocytic choriomeningitis virus]

O presente trabalho faz parte de uma seqüência iniciada em 1953 com a verificação do efeito dos raios X sôbre o vírus da gripe em que observamos que os mesmos, em doses fracas, tem aumentado o seu poder patogênico para camundongos. Posteriormente, verificamos a ação do radium sôbre o vírus da gripe e da poliomielite. Neste último caso, o vírus irradiado mostrou-se ativo durante maior número de dias. Nas pesquisas aqui referidas, submetemos o vírus da coriomeningite linfocitária benigna a ação do radium, usando quatro agulhas de 1 mg desse elemento em dispositivo que idealizamos para êste fim. Depois de irradiada, foi a suspensão de vírus diluida a 10*-1, 10*-2 e 10*-3 para as inoculações em camundongos, juntamente com as diluições testemunhas. Observamos que o vírus resistiu pelo menos 264 dias, à temperatura de 4ºC. Quanto às alterações do poder patogênico provocadas pelo radium verificamos que o mesmo não se altera após 24 horas de irradiação. Diminue após 8 dias para aumentar, de modo seguro, após 20 e 33 dias. Iguala-se ao testemunha depois de 78 dias.