Vidarabine: a preliminary review of its pharmacological properties and therapeutic use

Vidarabine is the first drug to become generally available in the USA for parenteral treatment of life-threatening or debilitating herpes simplex virus infections of man. For the past decade laboratory and clinical studies have been in progress to assess the pharmacology of the compound, its mechanism of action and its potential usefulness in clinical investigations. Currently, clinical usefulness has been established for herpes simplex infections of the eye and brain. Further studies in progress are evaluating the drug's ability to prevent progressive disease from herpes zoster in the immunocompromised patient, reduce mortality and morbidity from neonatal herpes simplex virus infection and improve outcome of chronic hepatitis B infection.

Enhanced delayed hypersensitivity skin test reactivity with serial testing in healthy volunteers

Delayed hypersensitivity skin testing with multiple antigens is frequently used to evaluate immunopotentiation therapy in man. Since serial skin testing with a single antigen has been shown to augment the skin test response, the present study was undertaken to assess the effect of serial delayed hypersensitivity skin testing on skin test reactivity with multiple antigens. Each of twelve healthy volunteers received 0.1 ml of five antigens on two occassion, 6 weeks apart. The antigens used were streptokinase-streptodornase, Candida, Trichophyton, mumps and Mycobacterium tuberculosis (PPD). The results demonstrated enhancement of skin test reactivity in the majority of tests. Indeed, 38.9% of the tests which were negative with the first skin test ( less than 10 mm induration) converted to positive. Enhancement in reactivity was observed in the majority of test subjects with all antigens except PPD. Similar enhanced skin test reactivity was observed in fifteen additional subjects tested serially with Candida only. The observations in this study suggest that uncontrolled studies of immunopotentiation must be interpreted with caution since serial delayed hypersensitivity skin testing with single or multiple antigens results in enhanced skin test reactivity.

Angiolymphoid hyperplasia with eosinophilia involving skeletal muscle

A vascular tumour involving the trapezius muscle is described. In addition to proliferating blood vessels with perithelial cuffing, there was a distinctive stroma of lymphoid aggregates, plasmacytoid cells, some mast cells and large numbers of eosinophils, many with a perivascular distribution. This solely intramuscular lesion was considered to be an example of angiolymphoid hyperplasia with eosinophilia. The aetiology and pathogenesis are discussed.

Abortion associated with intrauterine infection by candida albicans. Case report

A 27-year-old patient who became pregnant whilst fitted with an intrauterine contraceptive device developed an intrauterine Candida albicans infection and aborted. The diagnostic (and other inconspicuous) features of C. Albicans infection in the fetus are described. The presence of the intrauterine contraceptive device may have predisposed to the establishment of the infection.

Mixed mesenchymal sarcoma of the broad ligament: case report

A 55-year-old patient who presented with a pelvic mass was found to have a mixed mesenchymal sarcoma of the broad ligament. The histogenesis and diagnostic criteria of this rare tumour are discussed.

The immune response and the connective tissue diseases

Immunological aberrations are recognizable in a number of the connective diseases such as SLE and RA. Some of these abnormalities are reviewed, in particular the variety of circulating auto-antibodies and their possible relationship to disease, as well as some evidence for involvement of circulating immune complexes. A number of these abnormalities have become the basis for essential tests in the diagnosis and management of these disorders and helping monitor their response to therapy.

Urine cytology by a filter imprint method

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Rectal carcinoma presenting as massive metastatic involvement of foot bones

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Intestinal ischaemia associated with ileal carcinoid tumours

A case of intestinal infarction due to multiple ileal carcinoid tumours is presented in which abdominal pain due to intestinal ischaemia was the first manifestation of the underlying tumour. It is postulated that intestinal ischaemia may be of more importance in the production of abdominal pain by carcinoid tumours than has been generally accepted, and that it is the result of functional and structural changes in the around the mesenteric blood vessels, caused by substances secreted by the carcinoid tumour.

Plasma cell granuloma of the stomach

A case of plasma cell granuloma of the stomach is described, only one similar case having been previously recorded. Differentiation from a neoplastic plasmacytoma was achieved by demonstrating the polyclonal nature of the plasma cells using an immunoperoxidase technique.

Adenosquamous carcinoma in a gastroenteorstomy stoma

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Haemangiosarcoma following irradiation of a haemangioma of the face. (Case report)

The malignant complications of irradiating benign conditions are well known and fortunately less frequent than in a previous era of widespread use of superficial roentgen therapy. However, because of the long latent period from exposure to irradiation until the development of the tumour, the clinician must continue to be alert. The behaviour and treatment of a haemangiosarcoma occurring 18 years after irradiation of a haemangioma is described.

Vidarabine therapy of simple and IDU-complicated herpetic keratitis

Large scale, multiclinic evaluations of vidarabine (Ara-A, Vira A, adenine arabinoside) for treating herpetic keratitis have been conducted as double-blind studies (169 patients) in comparison with IDU and open studies (146 patients). In the open studies, the disease in the majority of patients had been refractory to IDU. The effects of vidarabine and IDU were approximately the same in improvement of symptoms (lacrimination, photophobia, sensitivity) and percent of and time for corneal reepithelialization. With vidarabine, significantly more patients had improved distant visual acuity than did with IDU. In the open studies, vidarabine also was effective. Of 116 patients whose ulcers had not responded to IDU, 91 (78%) had reepithelialization within four weeks of treatment with vidarabine. On the basis of results from these studies, vidarabine appears to be a safe and effective drug for treating herpes simplex keratitis.