Histological and immunohistochemical study of hepatitis B virus in human immunodeficiency virus infection

Because the risk factors for human immunodeficiency virus (HIV) infection and hepatitis B (HBV) are similar and therefore coinfection is not uncommon, a detailed histological and immunohistochemical study of chronic hepatitis B infection in a group of 20 HIV positive Caucasian males (who did not have AIDS) and 30 HIV negative controls were undertaken. Using both the conventional histological classification and the Knodell histological activity index it was shown that HIV negative patients were more likely to have active disease and also more scarring than HIV positive patients. Hepatitis B surface antigen (HBsAg) expression was not significantly different between the two groups but expression of hepatitis Be antigen (HBeAg) and HBV-DNA polymerase was greater in those who were HIV positive. HIV positive patients are therefore more likely to have immunohistochemical markers of active viral replication, although histologically, liver disease is less severe. These findings have important implications for assessing the biopsy specimens in this group of patients and for treatment strategies aimed at improving their immune function.     

Shunt surgery for treatment of portal hypertension in children

Shunt surgery in children suffering from portal hypertension (PH) is considered as an immediate and definite mode of prevention of recurrent gastrointestinal hemorrhage. Certain conditions must be met: (a) normal liver; (b) normal veins available within the portal system; (c) a sufficient portosystemic gradient of pressure; and (d) a surgical team with experience in portal venous surgery. In patients in whom PH is an epiphenomenon of severe liver disease, other means of hemostasis for bleeding esophageal varices should be sought. The difficult decision is in the child with specific liver alterations without major hepatocellular dysfunction but in whom the prognosis cannot be precisely foreseen. A few more years will be needed before one can tell if shunt surgery is the best choice for this category of patient.

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Resumen La cirugía derivativa (shunts portosistémicos) en los niños que sufren de hipertensión portal es considerada como una forma inmediata y definitiva de prevenir la hemorragia gastrointestinal recurrente. Ciertas condiciones deben existir para su realization: (a) hígado normal; (b) venas disponibles dentro del sistema porta; (c) suficiente gradiente en las presiones portosistémicas; y (d) disponibilidad de un equipo quirúrgico con experiencia en cirugía venosa portal. Otros medios de hemostasis de las várices esofágicas sangrantes deben ser utilizados en aquellos pacientes en quienes la hipertensión portal es un epifenómeno de enfermedad hepática severa. La decisión más difícil se presenta en el niño con alteraciones hepáticas específicas pero sin mayor disfunción hepatocelular en quien no se puede determinar con precisión el pronóstico. Todavía serán necesarios unos años más antes de poder afirmar que la cirugía derivativa representa la mejor escogencia para esta categoría de pacientes.

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Résumé La dérivation portale chez les enfants atteints d'hypertension portale constitue une méthode immédiate et définitive de prévention des hémorragies digestives récidivantes. Les conditions les plus favorables sont les suivantes: a) foie normal; b) veines disponibles dans le secteur porte pour l'anastomose; c) gradient de pression suffisant entre le système porte et le système cave et d) équipe entraînée à la chirurgie portale. Lorsque l'hypertension portale est un épiphénomène au cours d'une affection hépatique sévère, d'autres méthodes d'hémostase des varices oesophagiennes rompues doivent être envisagées. La décision du choix thérapeutique à adopter est difficile lorsqu'il existe une atteinte hépatique, sans altération hépatocellulaire majeure, mais de pronostic incertain à long terme. Quelques années encore seront nécessaires avant de pouvoir affirmer que la dérivation représente la meilleure opération pour traiter ce type d'hypertension portale.

     

Ipsilateral lobectomy versus bilateral lobar resection in papillary thyroid carcinoma: a retrospective analysis of surgical outcome using a novel prognostic scoring system

From a multivariate analysis of more than 14,200 patient-years' experience with papillary thyroid carcinoma (PTC), we devised a prognostic scoring system based on patient age, tumor grade, extent, and size (AGES). This scoring system can identify patients at increased risk of PTC mortality and was employed as an adjustment variable for analyzing the role of different types of surgical treatment in 860 PTC patients. Cancer mortality at 25 years in patients with an AGES score of 3.99 or less was 1% after ipsilateral lobectomy (n = 131) and 2% after bilateral resection (n = 603), whether subtotal or total (p = 0.15). Of patients with an AGES score of 4 or more, those who underwent lobectomy alone (n = 30) had a mortality rate from PTC at 25 years of 65%, while those undergoing bilateral resection (n = 86) had a lower rate of 35% (p = 0.06). For patients at minimal risk (score of 3.99 or less) of PTC death, no improvement in survival was demonstrable when patients underwent more than ipsilateral lobectomy. However, in a subgroup (score of 4 or more) identified to be at significant risk of PTC death, the survival after bilateral resection was much higher than after ipsilateral lobectomy alone. In neither the "minimal" nor the "higher" risk subgroup was PTC survival significantly improved by the performance of total thyroidectomy.     

The menopause: stressors and facilitators

Between about ages 40 and 55 years, women experience a transition known as the menopause, which marks the end of their childbearing years. Although the most striking feature of the menopause is the cessation of menstruation, other biologic and psychosocial events occur and can be classified as stressors and "facilitators". For a predisposed group of women the stressors are likely to cause psychiatric disorders. At the same time, the facilitators are opportunities for personal growth and development. Physicians who understand both types of events during this phase of life and who are sensitive to the overall effects of ageing on marital partners can provide comprehensive care to the menopausal patient rather than automatically pursuing drug therapy (substitution hormonal therapy) alone.     

Sun Exposure,Tanning Behaviors,and Sunburn: Examining Activities Associated With Harmful Ultraviolet Radiation Exposures in College Students

Journal of Prevention - Understanding the behaviors that lead to sunburn is an important objective toward developing intervention strategies to reduce risk for skin cancers. Our cross-sectional...     

Is orthorexia nervosa a healthy way of being or a mental health disorder? Commentary on He et al. (2020)

Orthorexia nervosa is a new syndrome that has seen a marked increase in research in the past decade. Very high prevalence estimates in non-clinical populations have fuelled the debate as to whether it is a disorder in its own right, or only a problem when occurring in the context of another mental health or eating disorder. More recent assessment instruments have gone some way to address this issue. However, He et al.'s (2020, International Journal of Eating Disorder) study in older East Asian persons was not supportive of orthorexia nervosa as a disorder. Rather, people with orthorexia nervosa had better physical and mental health and lower or similar levels of eating disorder features such as body dissatisfaction when compared with people who did not have orthorexia nervosa. Albeit that selection bias in participant recruitment may in part explain their findings, the status of orthorexia nervosa is unresolved. Further studies need to employ appropriate instruments that measure psychopathology and function more broadly and investigate people with orthorexia nervosa symptoms in representative populations with longitudinal designs. The last is critical, as the most compelling evidence supporting a disorder is to find an adverse health impact over time that can be avoided by appropriate intervention.     

Facial neglect

Following a stroke, a retired industrial chemist, K.L., complained that faces looked "different" and had become difficult to recognize. Investigation of this problem revealed that it particularly affected the left half of a face as seen by K.L. Defective recognition of this (left) half was found for normal faces, chimaeric faces, and for half-faces presented in isolation, whether upright or inverted. The problem was apparent for both internal and external facial features. Further studies with chimaeric faces demonstrated inattention to left-side features in K.L.'s judgements of facial expression and of resemblance between faces. Moreover, the left-half of a chimaeric face was affected even when it was itself forming part of the face positioned on the right in a display of two horizontally aligned chimaerics. K.L.'s spatial contrast sensitivity function was within normal limits for his age. He did not experience differential difficulty in recognizing the left side of everyday objects or of car-fronts (another stimulus class demanding within-category discrimination between visually similar items that display approximate left-right symmetry). He was also able to sort left or right half-stimuli correctly into the categories "human face", "dog face", or "tree". Although K.L. had a left visual field defect, the problem with faces occurred within otherwise intact parts of his field of vision. We suggest that his disorder can be considered a domain-specific form of unilateral neglect.     

Polymerase chain reaction for screening clinical isolates of corynebacteria for the production of diphtheria toxin.

AIMS--To assess the performance of the polymerase chain reaction (PCR) when used to screen rapidly large numbers of corynebacteria for toxin production; and to determine the incidence of false positive PCR results with non-toxigenic Corynebacterium diphtheriae isolates. METHODS--Eighty seven recent British isolates of corynebacteria were assayed by PCR. All isolates were assayed from both blood and tellurite agar within a five day period. Thirty three non-toxigenic isolates of C diphtheriae from six countries were also tested by PCR and by the Elek immunodiffusion assay. RESULTS--There was complete concordance between the results of PCR and traditional methods on the recent British isolates, with one exception: an Elek positive "C ulcerans" isolate, which was PCR positive from tellurite but not from blood agar. One of the thirty three (3%) non-toxigenic isolates of C diphtheriae was PCR positive. CONCLUSIONS--These results suggest that PCR compares favourably with traditional methods for the detection of toxigenic corynebacteria and that it represents a powerful new tool in the diagnosis of an old disease.