An investigation of possible immunologic reactions to human serum albumin used as a stabilizer in allergy extracts

Two hundred fifteen patients who had received allergy immunotherapy for at least 1 year with an extract preparation containing 0.03% human serum albumin (HSA) were tested for evidence of an immunologic reaction to HSA by immediate skin testing. Sera from 39 of these subjects and from control subjects were studied in a microtiter enzyme-linked immunosorbent assay for anti-HSA antibodies. The 39 subjects' sera were examined by immunoelectrophoretic analysis for evidence of "tailing albumin" indicative of HSA bound to immunoglobulins. All studies were negative. We conclude that in these patients HSA-containing allergy extracts used in immunotherapy failed to induce the production of specific antibodies against HSA. This suggests that HSA was a safe extract stabilizing agent for allergy extracts in these representative allergic patients.     

CONCURRENT HPV-16 INFECTION OF THE NIPPLE AND PERI ANAL AREA IN AN HIV-1+ PATIENT

Background. In patients with HIV-1 disease there has been an increasing association with human papilloma virus (HPV) infections in multiple locations as well as an increase in associated tumors. In addition, there has been increased recovery of HPV in individuals with decreasing T4 cell counts. Case Report. Recently we have seen an HIV-I+ patient with a cutaneous lesion on the nipple, as well as multiple perianal lesions in which HPV-16 was demonstrated by in-situ hybridization. Although these lesions contained the same subtype of HPV virus, they had very different clinical and histopathologic morphologies, and this represents the first reported association of HPV-16 in a nipple lesion. Discussion. Our patient illustrates that in HIV-I disease, HPV infections may present in more diffuse and atypical locations. In addition, the diffuse staining with the in-situ probe for HIV-16 within the lesions, tends to support the findings of others, that viral recovery increases with the immune suppression induced by HIV-I.     

Cimetidine reduces running-associated gastrointestinal bleeding

A prospective observational study was undertaken to compare the effect of cimetidine usage immediately before and during a 100-mile running race on the frequency of detectable gastrointestinal bleeding and to relate these data to the frequency and intensity of gastrointestinal symptoms and to training data collected from pre- and postrace questionnaires. Nine of 25 runners in the 1989 Old Dominion 100-mile Endurance Race took 800 mg of cimetidine 1 hr before the start and at 50 miles. Sixteen other runners acted as controls and were not different in age, gender, or training data. All runners also submitted three stool specimens from the week before the race and from the first three bowel movements after the race on standard Hemoccult cards. All runners were Hemoccult negative before the race. One of the 9 (11%) cimetidine runners and 14 of the 16 (87.5%) control runners were Hemoccult positive afterwards (P less than or equal to 0.05). Nausea and vomiting were less in those runners taking cimetidine (P less than or equal to 0.05). There was no difference in the race performance as related to the ability to finish or in the number of miles run during the race. This study may help to define the etiology of this common gastrointestinal bleeding in these ultradistance runners and may be useful in preventing some of the symptoms associated with long-distance running.     

The admission urinalysis

Although urinalysis is one of the most frequently ordered tests in primary care, its usefulness in screening has not been demonstrated. A retrospective review of 1,607 admission urinalyses for inpatients in a referral/community hospital identified 861 as clinically indicated and 746 as routine. Routine urinalyses were abnormal less frequently than clinically indicated urinalyses (18.1% vs 39.6%) and when abnormal, were responded to less often (33.3% vs 75.4%). Forty-five (6.0%) of the routine urinalyses yielded an abnormality that led to diagnostic action. Of these, 18 were normal on repeat testing and 17 were considered unlikely to represent significant disease. Therefore, only ten (1.3%) of the routine urinalyses affected patient therapy. In eight of these cases, the abnormality was pyuria, of which six proved to be asymptomatic bacteriuria. The admission urinalysis as a routine test had little impact on patient care in the authors' institution.     

A controlled trial of a seminar to improve medical student attitudes toward,knowledge about,and use of the medical literature

Objective: To determine whether an interactive seminar could affect medical student knowledge of research design, basic critical appraisal skills, and attitudes toward and clinical use of the medical literature. Design: Controlled, nonrandomized clinical trial Participants: Third-year clinical clerks (n=146) during their core medicine clerkship. Interventions: Two 90 minute interactive seminars. Measurements and main results: Pre- and postquestionnaires were used to assess knowledge and attitudes regarding the use of the medical literature among 65 study and 81 control students. Blinded review of write-ups assessed actual use of the medical literature. Overall, 80% of the students subscribed to one or more journals and reported reading three or more journal articles per month. After the intervention, the study students were more likely than the control students to consider: 1) study design important in article selection and 2) use of medical literature critical to patient care decisions. Knowledge scores were significantly improved in the study group (p=0.0001). The intervention yielded no increase in the actual use of medical literature in patient write-ups over that encouraged by usual clerkship goals. 51% of the study and 48% of the control students cited literature at baseline, and 53% of all the students did so after the intervention. Of these citations, 50% were for journal articles and the remainder were for textbooks. The students infrequently mentioned the quality of the cited literature. Conclusions: An interactive seminar designed to introduce medical students to critical appraisal improved student knowledge and attitudes but did not increase the actual use of literature in patient writeups. Presented at the annual meeting of the Society of General Internal Medicine, May 1, 1992, Washington, DC. Supported by an Education Grant from the Uniformed Services University of Health Sciences, Bethesda, Maryland. The opinions or assertions contained herein are the private views of the authors and are not to be construed as reflecting the views of the Department of the Army or the Department of Defense.     

Adult acquired antral web

Summary Gastric antral webs in adults have been considered to be either congenital or acquired lesions. We present the first radiographically documented progression from a normal antrum to the development of an antral ulcer followed by healing with web formation.In a single study we feel that irregularity of the web and deformity or eccentricity of the antrum favor an acquired rather than a congenital web. Obtaining prior radiographs as well as follow-up examinations may be the only way to prove associa tion with peptic disease.The figures shown are published with permission from the Armed Forces Institute of Pathology.