Absence of HIV-1 DNA in cartilage from HIV positive patients

Human immunodeficiency virus (HIV) infections are mainly transferred by blood, semen or organ transplantations. Since allogenic transplants have an established place in reconstructive surgery, the possibility of transferring HIV with such transplants has been a subject of much concern. Postmortem cartilage samples were obtained from eight HIV-infected patients and examined using the polymerase chain reaction in order to detect proviral HIV-1 DNA (gag, pol, env). Blood, brain and spleen samples were also obtained and used as positive controls. Results showed that no cartilage sample contained any HIV-DNA, whereas proviral sequences were clearly demonstrated in perichondrium from six patients. These findings indicate that HIV is not present in cartilage of HIV-infected patients, making HIV transmission through cartilage grafting improbable when transplants from HIV-negative donors are used.     

Influence of Chemical Allograft Preservation Procedures on the Human Immunodeficiency Virus

Since chemically preserved allogenic transplants have an established place in reconstructive procedures, the possibility of transferring the human immunodeficiency virus (HIV) with these transplants has been intensively discussed. In this study the authors obtained brain and spleen samples from six HIV-infected cadavers and preserved them with Merthiolate, Cialit, and formaldehyde. After preservation, the tissues were examined for proviral HIV-1 DNA (gag, pol, env) using the polymerase chain reaction. Proviral sequences were clearly demonstrated after the preservation procedure. The results of this study indicate that HIV remains in tissues that have been treated with Merthiolate, formaldehyde, or Cialit. Further investigations are necessary to determine if the virus is in an inactivated or activated form. It can be concluded that, because of the possible transmission of HIV by chemically preserved homografts, serologic screening of donors should be mandatory. Laryngoscope, 106:645-647, 1996     

Use of allogenic dermis for radial forearm free flap donor site coverage

OBJECTIVE: The radial forearm free flap has become the method of choice for reconstruction of head and neck defects following oncologic ablation. Harvesting of a radial forearm free flap leaves a donor site defect. This is most commonly closed with a split-thickness skin graft. Morbidity, most commonly owing to a lack of graft take over the tendons, can be quite high. Recently, an acellular matrix (Alloderm) has been advocated to decrease complications at the radial forearm donor site, as well as obviate taking a split-thickness skin graft from the thigh. MATERIAL AND METHODS: Tertiary referral academic centre. Retrospective chart review of 15 patients. Five patients received allogenic dermis, 10 patients received split-thickness skin grafting to the radial forearm donor site. RESULTS: Patients with allogenic dermis took between 12 and 16 weeks to heal completely. Patients undergoing split-thickness skin graft were completely healed within 4 to 6 weeks. Cosmesis was judged to be marginally better in the allogenic dermis group. Allogenic dermis placement had a greater impact on hand function owing to prolonged healing, whereas patients with split-thickness skin graft required wound care at the thigh for a 2- to 3-week period owing to the harvesting of the skin graft. CONCLUSIONS: Allogenic dermis may be a viable alternative to split-thickness skin grafting and radial forearm free flap donor sites. Prolonged healing with subsequent increased health care services use needs to be addressed.     

内衬上皮的管状组织工程软骨构建的实验研究

目的研究以聚丙交酯-乙交酯共聚物[poly（DL-lactide-co-glycolide）,PLGA]包埋甲壳胺无纺布为细胞支架,在有免疫力的动物体内构建内衬上皮的管状组织工程软骨的可行性,为喉、气管缺损的修复探索新方法。方法取1月龄兔耳廓软骨,收集体外培养第3～4代的软骨细胞,接种于经多聚赖氨酸处理的以PLGA包埋甲壳胺无纺布的片状细胞支架材料上,体外培养7～10d后包裹于兔腹部缝制的皮管上并深埋于体内,分别于6、12、18周取材行大体和组织学观察以及HE染色、甲苯胺蓝染色和Masson＇s三色染色。结果同种异体软骨细胞/PLGA包埋甲壳胺无纺布的细胞支架复合物体外培养1周时有基质产生;植入体内6周后,复合物中有基质分泌,软骨细胞不成熟;12周时,软骨细胞接近成熟并形成凹陷,内衬上皮的管状组织工程软骨形成;18周时,新生软骨基本接近正常软骨。结论以PLGA包埋甲壳胺无纺布为细胞支架,同种异体软骨细胞与细胞支架所形成的复合物在有免疫力的动物体内可构建出内衬上皮的管状组织工程软骨。     

IV. Die transplantation menschlicher trommelfelle im allogenen und xenogenen system

Zusammenfassung Bei ausgedehnten Kettenzerstörungen stehen wir bei der Wiederherstellung einer guten Schallübertragung mitunter vor Problemen, die sich durch die Verwendung von allogenen Transplantaten and hier wiederum speziell mit dem zusammengesetzten Trommelfell-Hammertransplantat zum. Teil besser lösen lassen würden als mit den bisherigen Methoden. Dieser in das allogene Trommelfell eingelassene Hammer verfällt aber nach den bisherigen Erfahrungen der allmählichen Resorption, da ihm als wesentlicher Faktor für die knöcherne Integration eines allogenen Knochentransplantates der direkte Kontakt zum knöchernen Ersatzlager fehlt. Das allogene Trommelfelltransplantat wird in etwa 70% tauglich in das Empfängergewebe integriert, wobei jedoch mit stärkeren immunologisch bedingten Entzündungen und Reaktionen gerechnet werden muß als nach einer allogenen Gehörknöchelchen-Transplantation. Der Grunt hierfür ist in einem höheren Gehalt an Proteinen and einer vermehrten Mitübertragung von spendereigenen Plasmaproteinen zu sehen. Durch die Konservierung der Transplantate in Cialitlösung wird die Lösliehkeit der Proteine erniedrigt and die Freisetzung der Antigene verzögert, so daß these Transplantate mit einem besseren Resultat einheilen als die unkonservierten Transplantate.

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Allogenic and xenogenic transplantations of human tympanic membranes

Summary Reconstructions of the middle-ear system after extensive destructions might best be handled by means of allogenic transplants, i. e., by a combined tympanic membrane/malleus transplant. Clinical experience indicates that the malleus is being resorbed; it lacks sufficient contact with the surrounding bones, a condition that is necessary for the integration of an osseous allogenic transplant. The tympanic membrane is being functionally integrated into the host tissues in about 700% of all cases. Nevertheless, the incidence of immunological reactions is considerably higher than that following a mere ossicular transplant. The reason for this lies in the higher protein content and the higher transference rate of donor serum protein. Cialit-stored transplants possess a low solubility of proteins, and, thus, the liberation of antigens is retarded. For these reasons, Cialit-treated transplants are better tolerated than untreated ones.

     

Are cialit-preserved ossicles as middle ear implants still bacteriologically defensible? Their replacement by pre-formed implants fashioned from teeth

Recent studies have demonstrated a limited bactericidal activity of Cialit in the preservation of otologic transplants. The authors therefore performed several tests following routine treatment of the grafts. First, the contamination of allogenic ossicles was studied; afterwards, the bactericidal activity of Cialit was tested against standardized germs and clinical isolates. At the highly toxic concentration of 1:2000, Cialit is bactericidal. For clinical purposes, however, the less toxic solution of 1:5000 is generally used, which is not sufficiently safe against certain resistant clinical isolates. The fact that the activity of Cialit depends on its concentration explains the controversial findings in the literature. Furthermore, it is doubtful whether a weaker solution would prevent transmission of an HIV or hepatitis infection. Therefore, the authors recommend the autoclaving of otologic allografts. This also has forensic reasons; for example if the serologic status of the donor is unknown. As ossicles become brittle under this procedure, the authors now use sculptured parts of teeth, in which the hydroxyl-apatite is much more compact. The preformed prostheses can be autoclaved without problem. More than 150 reconstructions have proved the acceptance of this cheap implant material. Furthermore, forensic problems with ossicles from corpses do not arise.     

Otologic manifestations of AIDS: the otosyphilis connection

Five cases of otosyphilis presenting in patients with HIV infection are discussed. The group is representative of the known stages of the disease, from asymptomatic carrier to the fully expressed immunodeficiency syndrome, and it is of relevance because otosyphilis appears to have developed at an accelerated rate from the primary infection. Four patients had been treated with penicillin 2 to 5 years previously and had a positive fluorescent treponemal antibody absorption (FTA-ABS) test. The fifth had concurrent neurosyphilis and was VDRL-test (Venereal Disease Research Laboratory) negative 2 years prior to the onset of symptoms. In all five patients, syphilis was in the latent stage. It is proposed that it is during this phase of the disease that HIV may alter its course and hasten the development of otosyphilis. It is also suggested that otosyphilis can present at any stage of HIV infection and should be considered in seropositive patients presenting with otologic complaints.     

Thirty years of the human immunodeficiency virus epidemic and beyond

After more than 30 years of battling a global epidemic, the prospect of eliminating human immunodeficiency virus （HIV） as the most challenging infectious disease of the modern era is within our reach. Major scientific discoveries about the virus responsible for this immunodeficiency disease state, including its pathogenesis, transmission patterns and clinical course, have led to the development of potent antiretroviral drugs that offer great hopes in HIV treatment and prevention. Although these agents and many others still in development and testing are capable of effectively suppressing viral replication and survival, the medical management of HIV infection at the individual and the population levels remains challenging. Timely initiation of antiretroviral drugs, adherence to the appropriate therapeutic regimens, effective use of these agents in the pre and post-exposure prophylaxis contexts, treatment of comorbid conditions and addressin~ social and nsvcholo2ical factors involved in the care of individuals continue to be important considerations.     

Isolated bilateral facial paralysis revealing AIDS: a unique presentation

HIV is a recognized etiologic agent in the development of peripheral facial paralysis (PFP). In most cases, the paralysis appears in the acute phase of the HIV infection, and its prognosis is similar to Bell's palsy. Other etiologic agents are generally involved in the development of the paralysis in the later stages of the disease. Bilateral facial palsy is a rare clinical entity in HIV infection. Only 19 cases have been reported. A case of facial diplegia revealing AIDS is described in this review. To the best of our knowledge, this is the first report of such an advanced state of the disease in a previously asymptomatic patient.     

Adenoidal tissue mass as a clinical guide of disease evolution in vertically HIV-1 infected children

INTRODUCTION: it is known that in early-stage HIV-induced disease there is a discrepancy between the levels of viral burden and virus replication in peripheral blood versus lymphoid organs. HIV disease is active in the lymphoid tissue throughout the period of clinical latency. However, it is not known how long term progression of HIV infection is influenced by short-term changes in the adenoidal size. OBJECTIVE: To assess the reliability of adenoidal-nasopharyngeal (AN) ratio in predicting clinical evolution of pediatric HIV infection. METHODS: lateral radiographs of the nasopharynx in 94 Caucasian children born to HIV-1-infected mothers ranged from 6 months to 15 years (60 children infected with HIV-1 and 34 without HIV infection), and in a control group of 692 normal children were evaluated to obtain the AN ratio in order to identify the relationship of AN profiles with different stages of the disease. Patients were rated regarding their clinical and immunological status according to the Center for Disease Control Classification. RESULTS: statistically significant differences between the groups of HIV-1-infected children, seroreverters and controls in the AN ratio were found (P < 0.001). Moreover, significant differences were also found in individual children that correlated with clinical progression. CONCLUSION: examination of radiographic changes in adenoidal size by AN ratio in relation to clinical status during one year period in the whole group showed strong prognostic value. These findings may have important implications in the design of therapeutic strategies.     

ENT presentations in children with HIV infection

Illnesses of the ear, nose and throat (ENT) are common in children with human immunodeficiency virus (HIV) infection. We reviewed the case files of 107 HIV seropositive children in the paediatric HIV unit at St Mary's Hospital. The prevalence, age of onset and type of ENT disease were reviewed. We also determined sex distribution, maternal country of origin and mode of transmission of HIV. Fifty per cent of the HIV children had ENT illnesses. Fifty-five per cent of the children presented with their first ENT symptom before age 3 years with 98% of the children having ENT manifestations by age 9 years. The commonest ENT diseases were cervical lymphadenopathy (70%), otitis media (46%), oral candidiasis (35%) and adenotonsillar disease (31%). HIV transmission was vertical in 90%. Maternal country of origin was Africa in 70% and the UK in 13%. Compared with previous studies, the proportion of HIV children with ENT problems appears to have decreased. Although our figures report a similar ENT symptom profile, the age at onset of these symptoms has increased.     

Nasopharyngeal lymphatic tissue in patients infected with human immunodeficiency virus. A prospective clinicopathologic study

A prospective clinicopathologic study of the nasopharyngeal lymphatic tissue, using a standardized approach, was carried out in 66 patients infected with human immunodeficiency virus (HIV) in Aviano, Italy. Two hundred eighteen patients without HIV infection served as a control group. A significantly higher percentage of nasopharyngeal lymphatic tissue hypertrophy was observed in HIV-infected patients compared with the control group, both clinically and pathologically. The finding of a higher incidence of nasopharyngeal lymphatic tissue hypertrophy during some stages of the disease, when cervical lymph nodes are enlarged, suggests that the extranodal nasopharyngeal district behaves in the same way as the lymph nodes. Nasopharyngeal lymphatic tissue hypertrophy should be placed at the forefront of the hitherto known head and neck manifestations of HIV infection. An ear, nose, and throat examination is mandatory for all patients with known or suspected HIV infection.     

Immunocytochemical identification of HIV (p24) antigen in parotid lymphoid lesions

Antibodies to specific human immunodeficiency virus (HIV) polypeptides are important laboratory markers of HIV infection. We have used an antibody to the major structural gag protein p24 of HIV-1 virus to immunochemically localize this capsid antigen in lymphoid cells from seven of eight patients at risk for HIV infection and who presented with parotid lymphadenopathy and lymphoepithelial cysts of the parotid gland. A clinicopathological assessment of these two manifestations as they relate to HIV infection is also presented.     

Adenoidal hypertrophy as the presenting feature of HIV infection

A case of symptomatic recurrent adenoidal hypertrophy, as the presenting feature of HIV infection in a haemophiliac child, is reported. The incidence of non-malignant nasopharyngeal lymphoid hyperplasia in HIV infection is examined and the relevance of the histological appearance is discussed in relation to progression of disease.     

Head and neck manifestations of non-Hodgkin's lymphoma in human immunodeficiency virus-infected patients

PURPOSE: Non-Hodgkin's lymphoma is the 2nd most common malignancy in human immunodeficiency virus (HIV)-infected patients. However, limited information regarding head and neck manifestations of non-Hodgkin's lymphoma is present in the literature. The aim of this article is to describe the head and neck manifestations of non-Hodgkin's lymphoma in HIV-infected patients and compare it with that seen in noninfected patients. PATIENTS AND METHODS: A case-control study was performed including 124 patients with non-Hodgkin's lymphoma presenting over a 5.5-year period to tertiary care center in a metropolitan location. RESULTS: Overall, the anatomic distribution of non-Hodgkin's lymphoma is not altered in the presence of HIV infection with the head and neck region (63%) most often involved overall. However, within the head and neck region, extralymphatic disease is significantly more common in HIV-infected patients (59%) than noninfected patients (33%; P = .001). Central nervous system (CNS) involvement accounts for 41% of head and neck non-Hodgkin's lymphoma in HIV-infected patients, in contrast to only 12% of noninfected patients. High-grade lymphoma (68%) are more common than intermediate (30%) or low-grade disease (2%) in the HIV-infected population, whereas low (24%) and intermediate (60%) grades are more common than high-grade lymphoma (16%) in noninfected patients (P < .001). The large cell immunoblastic type (48%) is the most common subtype in HIV-infected patients, whereas diffuse large-cell type (32%) was most common in HIV-negative patients (P < .05). Survival is significantly poor for HIV-infected patients (P < .05). The impact of HIV infection on survival remain significant even after controlling for the effects of confounding factors. CONCLUSIONS: Head and neck involvement with non-Hodgkin's lymphoma occurs in a significant number of HIV-infected patients. Our data show that the distribution and course of non-Hodgkin's lymphoma is unique in HIV-infected patients. A high level of suspicion for non-Hodgkin's lymphoma is required in all cases of head and neck lesions in patients with HIV infection to facilitate management.     

Treatment of oral ranula in HIV-positive patient

HIV-associated salivary gland disease refers to the pathology in head and neck lesions such as ranula, salivary gland swelling, xerostomia, and benign lymphoepithelial cysts in the parotid gland. Here, we present a unique case of the ranula patient with HIV infection treated with OK-423 sclerotherapy. Case report: The patient was a 42-year-old Japanese male with a few months history of oral floor swelling. Computed tomography (CT) showed a low-density area limited within the right floor of the mouth. Magnetic resonance imaging (MRI) revealed a distinct T2-high intensity area localized on the same location. The puncture fluid was bloody mucus, and the cytology was no malignancy. We diagnosed a simple ranula. He was, however, found to be HIV-antibody positive at the examination before treatment by chance. He was referred to the department of infectious diseases and definitively diagnosed HIV infection by western blot. We chose OK-432 sclerotherapy because of its minimally invasive and the risk of HIV infecting medical staff. Two times OK-432 injection made the lesion disappear. Conclusion: The case indicated that OK-432 sclerotherapy could be effective for ranula related to HIV.     

Auditory function in patients infected with the human immunodeficiency virus.

A prospective study of auditory function in 18 HIV positive male patients at different CDC (Centres for Disease Control) stages was undertaken. One-third had abnormalities on either auditory evoked response testing or pure tone audiometry. No correlation was found between interwave latencies I-V, I-III, III-V and stage of disease determined either clinically or by T-cell subset. There was a weak correlation between pure tone averages at 1,2,4 kHz and 2,4,8 kHz and T-cell subset ratio in CDC Group IV disease (Rs = 0.56 and 0.57 respectively; P less than 0.05). Abnormalities of BSER were similar to those previously reported in HIV infection, and suggest isolated changes within the brain-stem.     

Pediatric infection with the human immunodeficiency virus: issues for the otorhinolaryngologist

Pediatric HIV infection is increasing at a rapid rate. It has many features that distinguish it from the adult forms of the disease. An understanding of the epidemiology and pathophysiology of HIV infection in children is necessary for the clinician to accurately diagnose and effectively treat infected children. Particular emphasis is placed on the infectious and neoplastic conditions of the head and neck region in infected children.     

Pediatric human immunodeficiency virus infection: an otolaryngologist's perspective

Children with human immunodeficiency virus (HIV) frequently have recurrent otitis media, chronic rhinorrhea, parotitis, cough and other common pediatric otolaryngologic problems. As these complaints often occur before more unusual opportunistic infections or pulmonary conditions prompt a diagnosis of acquired immunodeficiency syndrome (AIDS), members of our specialty are liable to see HIV-positive children before infection with the virus has been recognized. Children with HIV infection are also likely to be referred to us after diagnosis, as is any immunosuppressed child with otolaryngologic infections. These children may require procedures such as bronchoscopy, sinus irrigations or tympanocentesis. The subject of this review is the natural history of pediatric HIV infection with special emphasis on otolaryngologic manifestations and recommendations for safe techniques of examination and treatment.     

HIV-associated cerebral lymphocyte infiltration mimicking vestibular schwannoma

The association of unilateral, rapidly progressive hearing loss, tinnitus and vestibular dysfunction in combination with a contrast-enhancing mass within the internal auditory canal on MRI is suggestive of a vestibular schwannoma (VS). We report the rare finding of a HIV-associated cerebral lymphocyte infiltration, most probably malignant lymphoma, which was presumed initially to be a VS. A 36-year-old male presented with progressive unilateral hearing loss accompanied by acute, ipsilateral tinnitus. Interpreted first as sudden sensorineural hearing loss, his symptoms were treated with rheologic therapy. Ipsilateral facial palsy appeared. MRI with gadolininium disclosed a contrast-enhancing mass within the internal auditory meatus of the left side. Within five weeks an extended leptomeningeal lymphocyte infiltration evolved and the diagnosis of an underlying HIV infection was made. Unilateral, rapidly progressive hearing loss and a fast growing cerebello-pontine mass is atypical for VS and highly suspicious of malignant disease. To our knowledge we report the first case of an HIV-associated cerebral lymphocyte infiltration, mimicking a VS. In such cases the diagnostic work-up should include a HIV test.