The Presentation and Outcome of HIV-related Disease in Nairobi

The range of clinical presentations of HIV-related disease inAfrica has not been adequately described, despite the fact thatmany hospitals have to rely heavily on clinical diagnosis. Sixhundred adult medical patients seen in the Casualty Departmentof the main Government hospital in Nairobi were enrolled ina study of the presentation and outcome of HIV-related disease:506 of these patients were admitted, of whom 19 per cent (95)were HIV seropositive. The remaining 94 were dealt with as outpatients:11 percent (10) of these were seropositive. A history of priortreatment for sexually transmitted disease and, if male, beinguncircumcised, were associated with being seropositive. Threepresentations were strongly associated with HIV infection: acutefever with no focus except the gastrointestinal tract (entericfever-like illness), acute cough with fever (community-acquiredpneumonia) and chronic diarrhoea with wasting. The WHO clinicalcase definition (CCD) for AIDS missed a substantial amount ofHIV-related morbidity (sensitivity 39 per cent) and misidentifiedmany seronegative patients (positive predictive value 59 percent). In comparison with the Centers for Disease Control surveillancedefinition for AIDS, the CCD was specific (91 per cent) andsensitive (79 per cent) but only had a positive predictive valuesof 30 per cent: the CCD may therefore be a poor surveillancetool for AIDS. Seropositive patients were much more likely todie than were seronegative patients (39 per cent vs. 15 percent mortality). Enteric fever-like illness was the presentationwhich most commonly proved fatal. A wider spectrum of diseaseis associated with underlying HIV immunosuppression than haspreviously been described in Africa.     

A syndrome of alacrima, achalasia, and neurologic anomalies without adrenocortical insufficiency

We describe a single case of a 2-year, 8-month-old male child with alacrima, achalasia, and neurologic anomalies and proven clinical and laboratory evidence of normal adrenocortical function. As the child was the product of a first cousin marriage, the possibility of autosomal recessive mode of inheritance was considered. Differentiation between this syndrome and other previously described associated syndromes is illustrated. This article emphasizes the presence of multisystem anomalies as described in the presence of normal suprarenal function.     

肾上腺素对促肾上腺皮质激素分泌的影响及其作用机制的初步探讨

对颈外静脉预先置入硅橡胶导管的大鼠注射肾上腺素,应用放射免疫测定法,直接测定血浆促肾上腺皮质激素(ACTH)浓度的改变,以了解肾上腺素影响肾上腺皮质活动的机理。实验在脑内正中隆起损伤和假损伤两组动物中进行,结果外周给肾上腺素兴奋垂体前叶释放ACTH,从而兴奋肾上腺皮质的活动;作用点在下丘脑,兴奋促肾上腺皮质激素释放激素(CRF)的分泌,而非直接作用于腺垂体.     

Adrenal masses: characterization with T1-weighted MR imaging

The ability of a T1-weighted spin-echo magnetic resonance (MR) sequence to allow differentiation of benign from malignant adrenal masses at 0.5 T was investigated in 28 patients with 35 adrenal masses. All nine lesions with an adrenal mass-liver signal intensity ratio of 0.71 or less were metastases, and all 15 with a ratio of 0.78 or more were adenomas. Eleven masses (31%)--including six adenomas, three metastases, a pheochromocytoma, and a neuroblastoma--had ratios between these values. Nine of ten masses with adrenal mass-fat intensity ratios of 0.35 or less were metastases, and all 12 with ratios of 0.42 or more were benign. Eleven masses (31%), four malignant and one benign, had ratios between these values. The ratios for two masses could not be calculated due to lack of fat. The specificity of T1-weighted MR imaging in differentiating benign from malignant adrenal masses appears similar to that reported for T2-weighted imaging. However, significant overlap occurred, as has also been reported for T2-weighted imaging. While both imaging sequences may help distinguish benign from malignant adrenal masses in some cases, biopsy is still necessary when an accurate histologic diagnosis is essential.