Regulatory effects of interleukin-11 during acute lung inflammatory injury

The role of interleukin-11 (IL-11) was evaluated in the IgG immune complex model of acute lung injury in rats. IL-11 mRNA and protein were both up-regulated during the course of this inflammatory response. Exogenously administered IL-11 substantially reduced, in a dose-dependent manner, the intrapulmonary accumulation of neutrophils and the lung vascular leak of albumin. These in vivo anti-inflammatory effects of IL-11 were associated with reduced NF-kappaB activation in lung, reduced levels of tumor necrosis factor alpha (TNF-alpha) in bronchoalveolar lavage (BAL) fluids, and diminished up-regulation of lung vascular ICAM-1. It is interesting that IL-11 did not affect BAL fluid content of the CXC chemokines, macrophage inflammatory protein-2 (MIP-2) and cytokine-inducible neutrophil chemoattractant (CINC); the presence of IL-11 did not affect these chemokines. However, BAL content of C5a was reduced by IL-11. These data indicate that IL-11 is a regulatory cytokine in the lung and that, like other members of this family, its anti-inflammatory properties appear to be linked to its suppression of NF-kappaB activation, diminished production of TNF-alpha, and reduced up-regulation of lung vascular ICAM-1.

Techniques for improving ear definition in microtia reconstruction

Surgeons involved in microtia repair recognize the difficulty in creating a natural appearing ear. One key to successful reconstruction is to provide sufficient relief between the helix, scaphoid fossa and antihelix to create the illusion of thin skin overlying thin cartilage. Problems such as thick skin, hair-bearing skin and poor-quality cartilage serve to frustrate the surgeons attempt to achieve the desired result. Surgical techniques to improve cartilaginous framework definition in microtia repair are discussed.

Regulation of acute lung inflammatory injury by endogenous IL-13

Using IgG immune complex deposition to trigger acute lung inflammation in rats, we have previously shown that exogenously administered IL-13 suppresses the acute inflammatory response. In the same model, expression of both mRNA and protein for IL-13 has now been detected. Treatment of rats with Ab to IL-13 accentuated the inflammatory response, with significant increases in lung vascular permeability and in the number of neutrophils in bronchoalveolar lavage fluids. In the presence of anti-IL-13, activation of the transcription factor, NF-kappaB, was significantly increased in lung. In addition, anti-IL-13 caused significant increases in bronchoalveolar lavage levels of TNF-alpha, macrophage inflammatory protein-2, and cytokine-inducible neutrophil chemoattractant but no changes in lung vascular ICAM-1. These data suggest that during lung inflammation endogenous IL-13 regulates NF-kappaB activation and related cytokine/chemokine generation, all of which determines the intensity of the lung inflammatory response.

Inhibition of NF-kappaB activation and augmentation of IkappaBbeta by secretory leukocyte protease inhibitor during lung inflammation

In earlier experiments, exogenous administration of secretory leukocyte protease inhibitor (SLPI) suppressed acute lung injury induced by deposition of IgG immune complexes. In the current studies we examined the mechanism of the protective effects of SLPI in this model. The presence of SLPI in the IgG immune complex-model of lung injury reduced the increase in extravascular leakage of 125I-albumin, the intensity of up-regulation of lung vascular intercellular adhesion molecule-1, and the numbers of neutrophils accumulating in the lung. The presence of SLPI caused greatly reduced activation (ie, nuclear translocation) of the transcription nuclear factor-kappaB (NF-kappaB) in lung cells but did not suppress activation of lung mitogen-activated protein kinase. SLPI did not alter NF-kappaB activation in alveolar macrophages harvested 30 minutes after initiation of lung inflammation. In the presence of SLPI, content of tumor necrosis factor-alpha, CXC chemokines, and C5a in bronchoalveolar fluids was unaffected. In the inflamed lungs, inhibition of NF-kappaB activation by SLPI was associated with elevated levels of lung IkappaBbeta (but not IkappaBalpha) protein in the absence of elevated mRNA for IkappaBbeta. When instilled into normal lung, SLPI also caused similar changes (increases) in lung IkappaBbeta. Finally, in the lung inflammatory model used, the presence of anti-SLPI caused accentuated activation of NF-kappaB. These data confirm the anti-inflammatory effect of SLPI in lung and point to a mechanism of anti-inflammatory effects of SLPI. SLPI appears to function as an endogenous regulator of lung inflammation.

Globoside expression within the human placenta

This report demonstrates the presence of the neutral glycosphingolipid, globoside, on the villous trophoblast layer of human placenta. Immunoreactivity for globoside which is the receptor used by human parvovirus B19 was strongest in villous trophoblast cells of first trimester placentae, with diminished reactivity in second trimester placentae, and a near lack of staining for the antigen in those of third trimester. This relative reduction in globoside-specific immunoreactivity in placentae of increasing gestational ages was confirmed using thin-layer chromatographic analyses of extracted neutral glycolipids from the syncytiotrophoblast layer and cytotrophoblast cells of first and third trimester placental villi. The presence of globoside on the protective trophoblast layer of the villi provides a potential pathway whereby B19 may be transmitted from an infected mother to the fetus. The virus once across the placental barrier, may gain access to its erythroid precursor target cells within fetal villus capillaries. The observed change found in globoside immunoreactivity correlates well with the observation that fetal outcome is worse when maternal infection occurs during first or second trimester as compared to an infection occurring near term. The reason for this observed difference in fetal outcome may be due not only to the presence of more target cells potentially to infect during the first and second trimesters, but also to the greater number of viral receptors present on the villous trophoblast layer.

Calcium pyrophosphate deposition disease of the temporal bone

Massive calcium pyrophosphate crystal deposition is a rare disorder that may affect the temporomandibular joint and temporal bone. The diagnosis is difficult, and misdiagnosis as malignancy, particularly chondrosarcoma, is frequent. This can lead to unnecessarily aggressive management. The clinical, radiographic, and pathologic features of this entity are reviewed, and treatment options are discussed.

Endoscopic cauterization for treatment of fourth branchial cleft sinuses

Fourth branchial cleft sinuses are rare, and the nature of their origin is controversial. Clinical presentation is varied because they may present as asymptomatic neck masses, recurrent neck abscesses, or suppurative thyroiditis. We describe herein 7 children who presented with abscesses on the left side of their necks, 3 of whom had abscesses that involved the thyroid gland. Direct laryngoscopy revealed that all 7 children had a sinus tract opening into the apex of the piriform sinus. Endoscopic obliteration of this tract was achieved using an insulated electrocautery probe either when the abscess was initially incised and drained or 4 to 6 weeks later. All 7 children recovered uneventfully. Four of the 7 children were followed up for more than 18 months without recurrence.

Geriatric rhinitis: what it is, and how to treat it

In the nose, normal physiologic changes of aging include loss of nasal tip support, atrophy of mucus-producing mucosal glands, and decreased olfaction. These changes contribute to geriatric rhinitis, the symptoms of which are often attributed by the older patient to "allergies" or "sinus trouble." An understanding of these anatomic changes, linked with a thorough history and physical examination, allows the physician to properly manage geriatric rhinitis. Medical management most often involves liquifying--not drying--nasal secretions with oral and topical preparations. Conservative surgical treatment is occasionally indicated.

Observer variability among colposcopists from the West Midlands region

OBJECTIVE

To assess variation in diagnoses and management decisions among colposcopists when presented with cervical images; to see the impact of the referral cytology report on diagnostic accuracy.

DESIGN

A two-part video questionnaire study.

PARTICIPANTS

Colposcopists from West Midlands Region.

METHODS

Twenty cervical images displaying a range of transformation zones from normal through varying abnormalities up to cervical intraepithelial neoplasia (CIN) grade 3 were shown on video tape together with basic patient information. Two sets of videos were made, the second being identical to the first other than including the referral cytology. Participants recorded their diagnoses and management decisions on prepared questionnaires. The two sets of videos were viewed several weeks apart.

RESULTS

Completed questionnaires to both videos were received from 30 colposcopists. Diagnostic accuracy improved with knowledge of the cervical cytology result in cases of CIN 2/3 (chi 2 = 19.45, P < 0.0001) but not where the histology was CIN 1 or less (chi 2 = 2.64, P = 0.10). Overall interobserver agreement improved slightly from kappa = 0.169 to kappa = 0.212 when the cytology was revealed. While only 2.6% of cases of CIN 2/3 would have been under-managed after the second questionnaire, 37.5% cases where the abnormality did not amount to CIN would have been overtreated.

CONCLUSION

There is considerable inter-observer variability and variation in diagnostic accuracy in scoring cervical images particularly at the lower end of the spectrum of abnormality which has the potential to lead to over-treatment. We rely considerably on the cervical cytology result in forming a diagnosis. We recommend that a see-and-treat approach be abandoned when the referral smear shows minor abnormalities. The study has implications for both training and audit in colposcopy.

Competition and performance on a computer-based complex perceptual-motor task

Employees of temporary agencies practiced Space Fortress, a complex video game task, for 10 sessions, each consisting of 8 practice and 2 test games of 3 min each. Trainees practiced individually, in dyads, or in tetrads, and they were classified as having high or low aptitude based on computer attitude scores and baseline performance. Competition for monetary prizes was introduced early in training, late in training, or not at all. Competition facilitated high-aptitude trainees but not low-aptitude trainees. Group size and the timing of competition instructions had no main effects or interactions. The results are discussed in terms of social facilitation theory, according to which competition facilitates dominant responses, which helps high-skill trainees but not low-skill trainees.

Transient erythroblastopenia of childhood associated with human herpesvirus type 6, variant B

Transient erythroblastopenia of childhood (TEC) is a disorder of young children ages 3 months to 4 years that is characterized by anemia associated with reticulOcytopenia and decreased red blood cell precursors in the bone marrow aspirate (BMA). A viral cause has been suspected for TEC. Bone marrow aspirate-derived DNA from 14 children with anemia or another hematologic disorder, including two children with TEC, were analyzed by polymerase chain reaction for human herpesvirus type 6 (HHV-6) DNA and human parvovirus B19 DNA. Testing revealed an HHV-6 variant B DNA in both children with TEC but not in the children who did not have TEC. The BMAs from these two children contained large pronormoblasts and an extensive lymphoid infiltrate. We proposed that HHV-6 may be a causative agent of TEC in immunocompetent children. This hypothesis is based on the demonstrated ability of HHV-6 to suppress the formation of burst-forming units-erythroid (BFU-E) and granulocyte macrophage-colony-forming units (GM-CFU) in vitro, and in vivo in HHV-6-infected patients who undergo bone marrow transplantation.

Pediatric respiratory papillomatosis: prognostic role of viral typing and cofactors

Children with recurrent respiratory papillomatosis vary greatly in their clinical disease course. Many have mild disease with eventual remission while others present with an early aggressive airway obstructive course. This study consisted of 24 pediatric patients whose specimens underwent polymerase chain reaction analysis for cytomegalovirus (CMV), herpes simplex virus (HSV), and human papillomavirus (HPV) type. Nineteen of 24 specimens contained enough DNA for this study. None of the specimens were found to contain DNA from HPV-16, -18, -31, -33; CMV; or HSV, which contrasts with our previous findings in adults. Ten patients were infected by HPV-11 and seven of these underwent tracheotomy because of an aggressive tumorigenic clinical course. Nine patients were infected by HPV-6 alone of whom only two required a tracheotomy (P = 0.05, Fisher's Exact Test). The early airway obstructive course associated with HPV-11, however, had no bearing on achieving eventual disease remission, with decannulation achieved in eight of nine children.

Randomised trial of immediate versus deferred treatment strategies for the management of minor cervical cytological abnormalities

OBJECTIVE

To compare immediate and deferred treatment in women with cervical smears showing borderline nuclear abnormalities or mild dyskaryosis.

DESIGN

Prospective randomised trial.

SETTING

Colposcopy clinics at Birmingham and Midland Hospital for Women and the City Hospital NHS Trust, Dudley Road, Birmingham.

PARTICIPANTS

Four hundred and thirty-five women with minor cytological abnormality younger than 35 years of age, of whom 353 were randomised to immediate treatment or deferred treatment.

MAIN OUTCOME MEASURES

Comparison of histologies in the subsequent two years in the immediate and deferred treatment groups.

RESULTS

Thirty-six women (21%) defaulted from follow up. The percentage of high grade abnormalities (CIN II and III) in the deferred treatment arm at two years is similar to that in the immediate treated arm at first colposcopy (25% vs 24%). Cytology failed to pick up two cases of CIN III and there was one case of early invasive carcinoma at the six month follow up. If treatment is deferred, the proportion with CIN I is almost halved (25% vs 13%); the proportion with koilocytic atypia is slightly reduced (51% vs 42%) and the proportion with no abnormality is substantially increased (0.6% vs 20%).

CONCLUSION

Immediate referral and a select-and-treat management strategy of all women with any degree of dyskaryosis is recommended based on the case of invasive cervical cancer, high default rate and the failure of cytology to pick up two cases of CIN III.

Congenital syringocystadenoma papilliferum of the ear and neck treated with the CO2 laser

Syringocystadenoma papilliferum (SCAP) is a rare benign skin tumor which clinically resembles papilloma. It is characterized by extensive papillary epithelial elements growing into the dermis. SCAP often presents at birth and most commonly in the head and neck. We present a case of a newborn with SCAP of the right ear and neck, treated with CO2 laser excision because the lesion was poorly amenable to excision and closure or grafting. Two CO2 laser procedures have produced a good result and reasonable cosmesis. CO2 laser excision of SCAP of the head and neck is a clinical treatment option in anatomic areas unfavorable to excision and grafting.

Vulvoperineal reconstruction after excision of anogenital multifocal intraepithelial neoplasia ("MIN")

Over the past 7 years, 12 women have been treated utilising a radical surgical approach for extensive vulval involvement as a component of multifocal intraepithelial neoplasia (MIN) of the female genital tract. The patients were analysed with respect to the anatomical site of involvement, age, presenting complaints and their duration, colposcopic examination, histopathology and surgical treatment. Gynaecologists, general surgeons and plastic surgeons were involved in the surgical treatment which was an initial colostomy followed by a definitive vulvoperineal resection and simultaneous vulval reconstruction using meshed split skin grafts or a combination of skin grafts and local flaps. 17 vulvoperineal reconstructions were done for 12 patients. Three had an incomplete histopathological clearance at the initial operation. Apart from these three patients, one had recurrence of symptoms alone, without any evidence of MIN, which was possibly due to human papilloma virus infection. One patient developed malignant squamous invasion 4 years later, which was cured with surgical excision and reconstruction. Colostomy closure was done after achieving local control of the disease. This staged approach does achieve the objectives of eliminating disease and alleviating symptoms. It preserves function and attempts to reconstruct normal anatomy without compromising the principles of surgical oncology and results in a high patient satisfaction.

Parvovirus B19 in anemic liver transplant recipients

Five hundred thirty-three liver transplant recipients were seen for follow-up care over a 6-month period. Of these, 23 (4.3%) had a hemoglobin level of < or = 9 g/dl, with 19 being eligible for inclusion in this study. The median hemoglobin level was 8.7 g/dl. Two patients had iron-deficiency anemia. All of the patients were on therapeutic drugs which can suppress erythropoiesis or shorten the lifespan of mature erythrocytes. Six patients (31.6%) were viremic for human parvovirus B19 but none was B19 immunoglobulin M seropositive. Two patients were immunoglobulin M seropositive for cytomegalovirus. The patients with circulating B19 DNA were not easily distinguished from those without the virus by their laboratory results. The absence of reticulocyte counts for these patients contributed to this inability to differentiate B19 from other causes of anemia, particularly drug myelotoxicity. The high likelihood of making a specific diagnosis with the increasing availability of PCR should spur the search for this virus in the liver transplant population.

Vulvar intraepithelial neoplasia: long term follow up of treated and untreated women

OBJECTIVE

To investigate the long term outcome of patients with vulvar intraepithelial neoplasia.

DESIGN

A retrospective study using information obtained from patient casenotes.

SAMPLE

One hundred and thirty-three women with a primary diagnosis of vulvar intraepithelial neoplasia (VIN), identified during a 15-year period.

RESULTS

The diagnosis of vulvar intraepithelial neoplasia increased throughout the study period. Human papilloma virus changes were noted in 104 patients (78%); these women were significantly younger than those without (P < or = 0.001). Nineteen (14%) were managed by observation or medical treatment and the remainder by surgical methods. Histological or symptomatic recurrence after surgical treatment occurred in 55 (48%). When disease recurred, it usually did so within four years of treatment. Recurrence was more common following laser vapourisation than after local excision (75% vs 40%; P < or = 0.01). Progression to invasive disease occurred in nine patients (7%), none of whom were in the group being observed. Four deaths occurred in this group, three from gynaecological malignancies of the lower genital tract.

CONCLUSION

Patients with vulvar intraepithelial neoplasia require long term follow up, and the risk of invasion may be higher than previously thought. Surgical treatment when required should be by excisional rather than ablative methods in most instances. In selected cases it is also possible to safely manage patients by more conservative methods.

Vulvar intraepithelial neoplasia with superficially invasive carcinoma of the vulva

OBJECTIVE

To investigate the long-term outcome of patients presenting with vulvar intraepithelial neoplasia (VIN) with superficially invasive carcinoma of the vulva (SICa).

DESIGN

A retrospective study using information obtained from patient case notes.

SAMPLE

Twenty-six women found at presentation to have VIN in association with superficially invasive carcinoma were identified during a 15-year period.

RESULTS

Pruritus vulvae was the most frequent presenting symptom in 18 patients (69%). Sixteen women (61.5%) had multiple symptoms. Features noted at vulvar examination were variable and none were pathognomonic of either VIN or of superficial invasion. All patients had VIN 3 in association with a superficially invasive carcinoma. Histological changes associated with human papillomavirus were found in 19 (73%) women. Half had a co-existent or previous abnormality of the lower genital tract. Local excision was the most frequent initial treatment (n = 9 [35%]). Mean follow up time was 65 months (range 12-174). Disease persisted after primary treatment in five women (19%). Both histological recurrence (of either VIN or SICa) or symptomatic recurrence occurred in 10 patients (38%). All patients who experienced recurrence did so within 36 months of treatment. Overall, 12 patients (46%) relapsed (histological or symptomatic recurrence); the mean time was 18 months. Fourteen patients (54%) were managed satisfactorily by their initial treatment. One patient died of recurrent cervical cancer. Three progressed to frankly invasive disease: two (aged 31 and 39 years) with carcinoma of the vulva and one aged 34 years with carcinoma of the perianal margin. All are alive and well after treatment. One patient had recurrence of superficially invasive carcinoma treated by local excision with no further problems. No episode of metastasis via lymphatic or vascular channels has been seen.

CONCLUSIONS

Patients with superficially invasive carcinoma of the vulva may be safely treated by local excisional methods without recourse to lymphadenectomy. Relapse after primary treatment is common, and there appears to be a significant risk of progression to frankly invasive carcinoma.

The effect of directed biopsy on the atypical cervical transformation zone: assessed by digital imaging colposcopy

OBJECTIVE

To determine the effect of directed punch biopsy trauma on the natural history of atypical cervical transformation zones.

DESIGN

A prospective randomised clinical trial.

SETTING

Academic Unit colposcopy clinics in Birmingham.

PARTICIPANTS

One hundred and eighty women attending the colposcopy clinics were recruited over an 18 month period, of which 161 were eligible for analysis.

METHODS

Three-way randomisation of patients into 1. no biopsy, 2. central biopsy and 3. peripheral biopsy groups. Quantitative assessment of the change in surface area and severity of cervical intra-epithelial neoplasia (CIN) lesions in each group measured six weeks apart using digital imaging colposcopy.

RESULTS

No significant difference in change in lesion size (P = 0.40) was noted in the three treatment groups. Results suggest that the severity of the lesion was underestimated by the peripheral biopsy.

CONCLUSIONS

The results of this study suggest that directed punch biopsy trauma does not have a significant effect on the immediate natural history of CIN. No statistically significant differences were found in lesion size whether biopsy was employed or not. In addition, the site of biopsy had no influence on the outcome. It appears, therefore, that tissue trauma from punch biopsy and the subsequent inflammatory and wound healing processes do not modify the course of CIN. The regressive changes observed after punch biopsy in previous natural history studies are probably not a result of the initial inflammatory response to biopsy trauma and subsequent re-epithelialisation with normal cells, but may result from processes that continue long after tissue repair is completed.

Parvovirus B19 infection in patients with hemophilia

BACKGROUND

The long-term consequences of parvovirus B19 infection in transfusion recipients are not known, and thus the value of B19 screening of blood donors remains unresolved. Hemophiliacs, at risk for B19 through their chronic exposure to clotting factor concentrates, have frequent, close medical follow-up and thereby constitute an ideal group in which to study the hematologic sequelae of B19 infection.

STUDY DESIGN AND METHODS

An enzyme-linked immunosorbent assay was used to detect B19 IgG and IgM and the polymerase chain reaction was used to detect B19 DNA in frozen, stored plasma samples, obtained between 1987 and 1994, from 136 subjects with hemophilia, including 71 who were human immunodeficiency virus (HIV)-positive and 65 who were HIV-negative. Then the results of the tests were compared with clinical hematological data and blood product usage data.

RESULTS

B19 seroprevalence in the hemophilic cohort was 81.6 percent (111/136), including 74.6 percent (53/71) of HIV-positive and 89.2 percent (58/65) of HIV-negative hemophiliacs. It was not affected by age, type or severity of hemophilia, HIV status, CD4 number, or yearly blood product usage. Only 1 (0.7%) of the 136 samples was positive for B19 IgM and none was positive in polymerase chain reaction for B19 DNA. After adjusting for HIV status, there were no differences between B19-positive and B19-negative hemophiliacs in hematologic values, CD4 counts, or blood product use.

CONCLUSION

Although B19 IgG seroprevalence in this hemophilic cohort is high and indicative of past B19 infection, there is no detectable B19 viral activity or any associated long-term clinical or hematologic sequelae.

Effectiveness of individual and dyadic training protocols: the influence of trainee interaction anxiety

The present study focuses on the consequences of the social dynamics that are created whenever two or more individuals are brought together for the purpose of training. An investigation of the role of individual differences in interaction anxiety on training outcomes demonstrated that the comparative effectiveness of dyadic versus individual protocols for computer-based training is moderate by trainees' level of interaction anxiety. Specifically, assignment to a dyadic protocol adversely affected the performance of high-interaction-anxiety participants but appeared to be advantageous for low-interaction-anxiety participants. Implications are discussed for changing the design and implementation of computer-based protocols for training groups and individuals in military and industrial training centers.

Comparison of a modified DNA hybridization assay with standard culture enrichment for detecting group B streptococci in obstetric patients

Infection with group B streptococcus (GBS) results in 12,000 to 15,000 cases of neonatal sepsis annually in the United States. GBS is transmitted vertically in up to 70% of infants born to colonized women. Early-onset GBS disease (septicemia, pneumonia, or meningitis occurring within 7 days of life) has a mortality rate of up to 50%, with permanent neurologic sequelae occurring in 15 to 50% of infants surviving meningeal infection. Because of the fulminant nature of neonatal infection, it would be useful to have a rapid assay for determining the GBS status of laboring women. This study illustrated how a commercially available DNA probe-based test was modified to achieve this goal. Modifications included the use of mixed cultures rather than pure isolates for detecting GBS, along with a shorter culture enrichment time and a sample concentration step. To this end, vaginal and rectal swabs from 402 pregnant women during their third trimester were cocultured and tested for GBS rRNA. The 8-h enrichment protocol resulted in an assay with a sensitivity of 95% and specificity of 98%, while the 3-h enrichment protocol revealed a sensitivity of 73% and specificity of 99%. In summary, GBS was detected in the majority of colonized women in less than 4 h. This study illustrated the usefulness of the approach in identifying the most heavily colonized women, who are at the highest risk of transmitting GBS to their neonates. The modified test would have a significant impact on both the medical management and antibiotic therapy for these women and their newborns.

Identification of human parvovirus B19 infection in idiopathic nonimmune hydrops fetalis

OBJECTIVE

This retrospective study was designed to determine the incidence of B19 associated with idiopathic nonimmune hydrops fetalis by use of a sensitive molecular tool, the polymerase chain reaction assay.

STUDY DESIGN

Placental and fetal tissues from 57 cases of nonimmune hydrops fetalis were analyzed for B19 deoxyribonucleic acid. Thirty-four of these cases were classified as idiopathic. The remaining 23 cases had known, noninfectious-based causes.

RESULTS

Eighteen percent of all cases (6/34) of idiopathic nonimmune hydrops fetalis contained B19 deoxyribonucleic acid. In contrast, none of the 23 cases of known, noninfectious-based nonimmune hydrops fetalis examined contained any B19 deoxyribonucleic acid. Presence of the virus was confirmed in each of the six cases by either B19-specific deoxyribonucleic acid in situ hybridization or immunocytochemistry. However, histologic examination was unsuccessful at detecting characteristic viral-like inclusions in one third of the cases.

CONCLUSION

Eighteen percent of cases of idiopathic nonimmune hydrops fetalis contained B19 deoxyribonucleic acid. This significant finding demonstrates the usefulness of polymerase chain reaction to aid in the differential diagnosis of this disease.

Adult respiratory papillomatosis: human papillomavirus type and viral coinfections as predictors of prognosis

Pathologic material and the records of 29 patients with laryngeal papillomatosis were reviewed. The relationship between the type of human papillomavirus (HPV) and the presence of viral coinfections was correlated with clinical outcome. Using polymerase chain reaction, paraffin-embedded specimens were analyzed for the presence of HPV, Epstein-Barr virus (EBV), cytomegalovirus (CMV), and herpes simplex virus (HSV). The HPV type could be identified in 24 patients' specimens. Twenty-one patients were infected with HPV type 6. The other 3 were infected with HPV type 11 or 16. Three patients developed squamous cell carcinoma, of whom 2 had HPV type 11 or 16. We found HSV, EBV, and CMV in 50%, 12.5%, and 0% of specimens, respectively. An aggressive clinical course was observed in 17 patients. Evidence of coinfection with other viruses was identified in 11 (65%) of these patients. In contrast, a benign clinical course was observed in 7 patients, of whom 2 (29%) had viral coinfections. We conclude that the HPV type and the presence of viral coinfections may be predictive of an aggressive clinical course.

PCR identification of four medically important Candida species by using a single primer pair

A single pair of primers was used in a PCR assay to amplify and identify the DNAs from four medically important Candida species: C. albicans, C. parapsilosis, C. tropicalis, and C. (Torulopsis) glabrata. The report describes the first successful amplification of a chitin synthase-specific fragment from the four Candida species responsible for more than 90% of all cases of neonatal candidemia. The primer pair sequence was based on that from the C. albicans chitin synthase gene, CHS1 (J. Au-Young and P.W. Robbins, Mol. Microbiol. 4:197-207, 1990). Each of the four amplified products is a single band of a different size. The DNA sequence of each PCR product was determined, and four species-specific probes were synthesized. The DNAs from as few as 10 organisms in 100 microliters of plasma could be detected after amplification and Southern blot analysis. In a retrospective study of 27 paired blood samples from 16 patients with culture-proven candidemia, PCR analysis was successful at detecting and correctly identifying to the species level 26 of the 27 Candida isolates. The speed and accuracy of this PCR-based technology make it a very powerful tool for detecting and diagnosing candidemia. Implementation of this assay for analyzing blood samples should result in the more timely treatment of neonatal candidemia, thereby reducing morbidity and mortality.