Women and AIDS

Summary: The number and proportion of women infected with the human immunodeficiency virus (HIV) and with the acquired immunodeficiency syndrome (AIDS) have increased rapidly throughout the last decade. Despite these increases, the scientific community has focused limited research attention on women living with HIV infection. Data from studies of predominantly gay/bisexual men may not reliably be extended to women; studies of the natural history of HIV infection in women are needed. Obstetrician-gynaecologists are increasingly called upon to diagnose HIV infection in women and provide care in both clinical and research settings. In this review we discuss the serodiagnosis of HIV infection in women; the impact of pregnancy on HIV disease progression; transmission of HIV infection from mother to offspring; gynaecological infections and malignancies which may manifest differently in HIV-infected women; and clinical care of women living with HIV.     

Contact sensitization to cyanoacrylate adhesive as a cause of severe onychodystrophy

Background The technology used for artificial nails, the chemistry of cyanoacrylates and the reported reactions to these products are briefly reviewed.
Materials and methods We studied three patients with prominent fingernail dystrophy, nail bed hyperkeratosis, fingertip eczema, and onycholysis, two of whom also had eczematous lesions at distant sites, ostensibly from hand transfer. Patch testing was performed with a standard screening tray, dried cyanoacrylate adhesives, and, in one case, with fingernail clippings.
Results All three patients were prominently patch-test positive to the polymerized 2-ethylcyanoacrylate, used as an adhesive on artificial (plastic) fingernails. One patient was also mildly formaldehyde sensitive, one was mildly reactive to two acrylate allergens, and one was extremely allergic to toluenesulfonamide formaldehyde resin. One patient had a positive patch test to her fingernail clippings 2 months after use of the adhesive was discontinued and an attempt was made to remove it.
Conclusions Reactions to cyanoacrylate adhesives used for artificial nails can cause both nail dystrophy and fingertip eczema, and may produce eczema elsewhere, probably from hand transfer. Persistence is likely due to retained polymer, which slowly degrades in the presence of water probably releasing antigens. Patch testing with the dried adhesive on an adhesive plaster seems to be reliable.     

Peripheral glucose metabolism in human hyperprolactinaemia

OBJECTIVE Prolactin has important biological actions in several species which include metabolic control and waterlelectrolyte balance. However, human PRL has generally been characterized as a mammotrophic hormone and it is unknown whether PRL has any important metabolic actions. This study was thus conducted to evaluate the effect of hyperprolactinaemia on peripheral muscle glucose metabolism. DESIGN The study was designed to determine forearm muscle glucose uptake and utilization (oxidative and non-oxidative metabolism) in normal and hyperprolactinaemic subjects in the post-absorptive state and lor 3 hours after the ingestion of 75 g of glucose. Peripheral glucose metabolism was analysed by the forearm technique to estimate muscle exchange of substrates combined with local indirect calorimetry. PATIENTS Eight hyperprolactinaemic patients (HP group, 6 females and 2 males) and ten normal sublects (N group, 7 females and 3 males) were studied. The hyperprolactinaemic patients showed no clinical or laboratory evidence of acromegaly or hypothyroidism and were not using any PRL releasing drugs. MEASUREMENTS Forearm blood flow was measured by capacitance plethysmography and arterial and venous blood samples were drawn simultaneously to determine plasma glucose, serum FFA, total blood CO₂ and O₂ and serum insulin in the post-absorptive state (0 time) and at 30, 60, 120 and 180 minutes after glucose Ingestion. RESULTS No significant difference in glucose uptake by the forearm muscle tissue was observed between the N and HP groups (823 plusmn; 103 vs 828 ± 110 μmol/100 ml forearm 3h, respectively), nor were any significant differences observed in the intracellular utilization of glucose (oxidative and non-oxidative metabolism). However, the serum insulin levels after glucose ingestion were significantly higher in hyperprolactinaemic patients than in normal subjects, especially at 30 (N 283 ± 46 vs HP 581 ± 133 pmol/l) and 60 minutes (N 291 ± 37 vs HP 544 ± 61 pmol/l). Furthermore, after glucose ingestion the suppression of serum FFA levels was smaller in the hyperprolactinaemic patients than in normal subjects. CONCLUSIONS This study demonstrated that insulin resistance is associated with the presence of spontaneous human hyperprolactinaemia. The hyperinsulinaemia detected in the hyperprolactinaemic patients after the oral glucose stimulus did not determine a proportional Increase in forearm glucose uptake and utilization, which were similar to the normal levels. The suppression of serum free fatty acid concentrations was also smaller in hyperprolactlnaemlc patients during the oral glucose challenge, suggesting an impaired antilipolytic effect of Insulin.     

Cognitive-behavioral techniques to reduce pain: a validation study

The purpose of this study was to identify and validate specific activities considered important in the implementation of three non-pharmacologic pain management interventions—relaxation, distraction and guided imagery. Using a two-round Delphi survey, nurses selected for their expertise in pain management were asked to validate definitions and activities considered important in the implementation of each of these strategies. Data were analyzed using a modification of Fehring's diagnostic content validity method. From this process, a list of activities for each intervention evolved that has implications for nursing research, practice and education.     

Intraoral ultrasound evaluation of peritonsillar abscess

Peritonsillar cellulitis and peritonsillar abscess are similar clinical entities with markedly different methods of treatment. Therefore, accurate diagnosis is paramount to appropriate treatment. This pilot study was designed to evaluate the sensitivity and specificity of intraoral ultrasound as a noninvasive method of differentiating abscess from cellulitis. Sixteen consecutive patients suspected of having peritonsillar abscess were prospectively evaluated with intraoral ultrasound. The results were confirmed with imaging or surgical drainage. Correct diagnoses were made in 9 (90%) of 10 abscesses and in 5 (83%) of 6 cases of cellulitis. Our results suggest that, while there is a learning curve for intraoral ultrasound, it is an accurate, noninvasive, and inexpensive tool to differentiate abscess from cellulitis. We believe that this will be a clinically useful technique in the future.     

Correlation between the M-echo and the calcified pineal gland

Summary The position of the pineal gland can be computed and surface marked on the hairy scalp. There is a correlation between the high M-echo spike in the echogram and the visible calcification of the pineal gland on the radiograph. As there is a great conformity in the outcome of the findings, the supposition that on this specific point these quantities are the same is reasonable in every respect. The unskilled operator will be able to find on this given point the position of the pineal gland in his echogram in regard to the midline.

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Korrelations zwischen dem Mittel-Echo und der verkalkten Pinealis

Zusammenfassung Die vorliegenden Untersuchungen wurden bei 650 Patienten durchgeführt. Es erfolgte dabei ein Vergleich zwischen dem Mittel-Echo und der verkalkten Pinealis.

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Correlation entre l'echo M et la pineale calcifiee

Résumé La hauteur de l'echo M correspond à la situation de la glande pinéale calcifiée. C'est ainsi qu'on peut utiliser l'information echographique pour compléter celle de la radiographie et vice-versa.

     

Evidence that Increased Circulating 1α,25-Dihydroxyvitamin D is the Probable Cause for Abnormal Calcium Metabolism in Sarcoidosis

Mean plasma 1(alpha),25-dihydroxyvitamin D[1(alpha),25(OH)(2)D] was significantly increased and serum parathyroid hormone was suppressed in three patients with sarcoidosis and hypercalcemia. Prednisone lowered the mean plasma 1(alpha),25(OH)(2)D to normal range and corrected the hypercalcemia. To elucidate the mechanism for the increased sensitivity to vitamin D in this disorder, the effects of orally-administered vitamin D(2) were determined in seven normal subjects, four patients with sarcoidosis and normal calcium metabolism and three patients with sarcoidosis and a history of hypercalcemia who were normocalcemic when studied. Serum and urinary calcium, serum 25-hydroxyvitamin D (25-OHD), plasma 1(alpha),25(OH)(2)D and, in some studies, calcium balance were measured. Vitamin D(2), 250 mug a day for 12 d, produced little, if any, change in mean plasma 1(alpha),25(OH)(2)D and in urinary calcium in the normals and in the patients with normal calcium metabolism. In contrast, vitamin D(2) produced increases in plasma 1(alpha),25(OH)(2)D from concentrations which were within the normal range (20-55 pg/ml) to abnormal values and increased urinary calcium in two patients with abnormal calcium metabolism. In an abbreviated study in the third patient, vitamin D(2), 250 mug a day for 4 d, also increased plasma 1(alpha),25(OH)(2)D abnormally from a normal value. There was a highly significant correlation between plasma 1(alpha),25(OH)(2)D and urinary calcium. Serum 25-OHD and serum calcium remained within the normal range in all subjects and patients. These findings provide evidence that the defect in calcium metabolism in sarcoidosis probably results from impaired regulation of the production and(or) degradation of 1(alpha),25(OH)(2)D. Prednisone may act to correct the abnormal calcium metabolism by reducing circulating 1(alpha),25(OH)(2)D.     

The community adaptation schedule and the California Psychological Inventory: A validational study with college students

To study the construct validity of the Community Adaptation Schedule (CAS), the CAS and the California Psychological Inventory (CPI) were administered to a group of 57 university students. The scores on the two instruments were correlated and a factor analysis was performed. The results of the study give further evidence for the construct validity of the CAS and indicate that the communityadapted person is personally well adjusted as measured by the CPI.     

Primary lymphomas of bone

Primary bone lymphoma is rare. The majority of cases are diffuse large B-cell non-Hodgkin's lymphomas. Classification, staging, and treatment are controversial. The relatively small number of cases has led to many case reports and series describing institutional experiences but precludes the use of randomized clinical trials to address the question of optimal management. This article will review clinical and radiologic presentations, diagnostic techniques, and histologic characteristics. Most important, it will present what limited information we do have regarding effective treatment options for this unusual type of lymphoma.