Allergic rhinitis: managing the adult spectrum.

With the general population increasing in age, clinicians will be seeing more elderly patients. Many present with bothersome rhinitis. A number of physiological and anatomic changes associated with age predispose the elderly population to develop rhinitis. A number of categories of rhinitis occur in elderly people and it is important to make the correct diagnosis. Appropriate therapy is available but the clinician must be wary of side effects, particularly to antihistamines and decongestants that may be more severe in elderly patients.     

Understandings of risk among HIV seroconverters in Sydney

This paper examines the risk discourses of Sydney gay men who had recently become HIV positive. 92 in depth interviews were conducted eliciting narratives about the incident in which they believed they became infected. The veracity of this narrative was negotiated between the interviewer and participant. Qualitative analysis was performed in order to distinguish different styles of thinking and acting in relation to risk. Two overarching discourses were distinguished that broadly related to the fields of public health, HIV prevention education, social theory and health policy. These we characterise as ‘quantifiable/objectivist’ and ‘social/subjectivist’. The first approach sees risk as objectively knowable through the application of scientific method or reasoned thinking. The second regards actors as culturally embedded in relation to risk, itself a cultural category. The fact that all men in this study became infected demonstrates the potential fallibility of both approaches. HIV prevention strategies need to take account of both the cultural aspects of risk, understanding the embedded quality of everyday cultural practices such as hygiene, and understand these assumptions are often inadequate for preventing HIV infection. Objectivist approaches also entail problems as many men using them felt HIV infection to be inevitable or unavoidable in some circumstances.     

Pituitary apoplexy associated with cardiac surgery

Two cases of pituitary apoplexy were detected in the immediate postoperative period after cardiac surgery with extracorporeal bypass. Both patients had pituitary adenomas that were asymptomatic and previously undiagnosed. One patient, a 57-year-old man, had unilateral total ophthalmoplegia and blepharoptosis with sparing of the visual system. The second patient, a 55-year-old man, had headache, marked bilateral visual loss, and ophthalmoplegia with subsequent development of a hemiparesis. Pituitary apoplexy was confirmed pathologically in both cases. Hemodynamic instability during and immediately after surgery and anticoagulation are probable precipitating factors.     

The treatment of intractable rheumatoid arthritis with lymphoid irradiation

Subdisphragmatic lymphoid radiation was used as an alternative to cytotoxic drug therapy to treat six patients with progressive erosive rheumatoid arthritis. All were previously unresponsive to conventional therapy. Radiation (4,000 rad) was given to subdispbragmatic lymphoid tissues in fractionated doses of 150–250 rod each. Three of the six patients demonstrated long-lasting clinical improvement with a decrease in synovitis and morning stiffness and an increase in joint function. All six patients showed a profound depression in the peripheral blood lymphocyte count which persisted for at least six months. The irradiation was well tolerated; there have been no serious complications due to radiotherapy with follow-up ranging from 13 to 36 months. The substantial efficacy in some patients and the lack of severe toxicity in all suggests that radiotherapy deserves further study as an alternative to cytotoxic drugs in the treatment of rheumatoid arthritis.     

Nodular lymphoid hyperplasia of the bowel in primary hypogammaglobulinaemia: study of in vivo and in vitro lymphocyte function.

In vitro and in vivo lymphocyte function was studied in six patients with primary hypogammaglobulinaemia and nodular lymphoid hyperplasia (NLH) of the bowel. Lymphocyte transformation, numbers of circulating T and B lymphocytes, and delayed hypersensitivity skin tests did not significantly differ when compared with hypogammaglobulinaemic patients without NLH. However, patients with NLH had higher jejunal juice IgM concentrations and a tendency to higher serum IgM concentrations than those without NLH. The morphological features of NLH are similar to the germinal centres of lymph nodes but more closely resemble the follicle zone of Peyer's patches. These findings suggest that NLH represents a local immune response to antigens originating in the gut lumen.     

Serum transcobalamin levels as an early indicator of bone marrow engraftment following transplantation

Three B12 binding proteins, the transcobalamins TCI, TCII and TCIII, were determined serially in the serum of five patients who underwent bone marrow transplantation. The increase in TCII, followed by the increase in TCI, proved to be an early indicator of bone marrow regeneration, reaching a peak of up to twice its normal levels at least 5 d prior to the rise of the peripheral white blood cell count.     

Cytogenetic analysis of the spontaneous murine B-cell leukemia (BCL1

Cytogenetic studies were carried out on the spontaneous transplantable murine B cell leukemia (BCL₁) of BALB/c mice, a recently discovered model of chronic lympholytic leukemia. BCL₁ tumor cells appear as medium to large size mature lymphocytes located predominantly in the blood (up to 500,000/mm³) and in the x50 enlarged spleen. BCL₁ cells obtained from the spleen show a certain degree of spontaneous proliferation unlike peripheral blood lymphocytes (PBL), but both show a good in vitro response to the B-cell mitogen lipopolysaccharide (LPS). Out of 213 spontaneously dividing spleen cells and LPS stimulated PBL studied, the majority (75.5%) showed a rather stable and complex female karyotype consisting of 36 chromosomes. No normal representative of chromosome Nos. 6, 8, 12 and 15 was present and only one normal representative was found for chromosome Nos. 4, 5, 9, 14 and X. Two deleted chromosomes and seven characteristic marker chromosomes, originating from complex chromosomal rearrangements could be identified in each cell. Of special interest was the t(12:15) translocation, which had been found in several murine plasmacytomas. No direct correlation between the chromosomal changes and the phenotypic characteristics of BCL₁ tumor cells could be made. However, the highly specific karyotype may serve as a useful marker in identifying single BCL₁ tumor cells.     

Prognostic value of tumour thickness in cutaneous malignant melanoma

The relation between survival and histological features in 91 patients with malignant melanoma was studied and the results were analysed by Clayton's method for interpretation of censored survival data. There was a significant correlation between tumour thickness and survival. The risk of dying from malignant melanoma after 10 years of follow up was less than 15% if the primary tumour was less than 1·5 mm thick but more than 80% if the lesion was thicker than 8 mm.