Impact of suppression of viral replication by highly active antiretroviral therapy on immune function and phenotype in chronic HIV-1 infection

We compared immune phenotypes, lymphocyte proliferation (LP), and delayed type hypersensitivity (DTH) responses in 28 male antiretroviral treatment-naive and experienced HIV-1-infected patients, matched pair-wise according to age and CD4+ T-lymphocyte count. Median CD4+ T-lymphocyte counts were 441 cells/microL and 483 cells/microL and median CD4+ T-lymphocyte nadirs were 435 cells/microL and 150 cells/microL in both groups, respectively. Absolute numbers of circulating T-lymphocyte subpopulations and proportions of naive and memory T-lymphocytes were comparable in the two groups. Untreated patients had greater proportions of activated CD4+ (p <.05) and CD8+ (p <.01) T-cells expressing human leukocyte antigen (HLA)DR and CD38 and fewer CD8+ cells expressing CD28 (p <.05). DTH and LP responses were comparable in both groups except for HIVp24, LP responses, and mumps DTH responses, which were of greater magnitude in the group treated with highly active antiretroviral therapy (HAART) (p <.05). Thus, HIV-1-infected patients who experienced substantial increases in CD4+ T-lymphocyte counts after suppression of viral replication on HAART had fewer activated lymphocytes and similar immune function when compared with findings in untreated patients with similar CD4+ T-cell counts. HIV replication has minimal real-time effect on CD4+ T-cell function in response to non-HIV antigens but helper T-cell responses to HIV-gag antigen are impaired during ongoing viral replication and may be restored by antiretroviral therapy.     

A new coumarin from Murraya paniculata

A new natural product, 2'-O-ethylmurrangatin (1) was isolated along with two previously known compounds murranganone (2) and paniculatin (3) from the leaves of Murraya paniculata. The structure of compound 1 was elucidated with the help of spectroscopic studies and by chemical reactions. Compounds 2 and 3 have been found to be cholinesterase inhibitors.     

CT pulmonary angiography: a comparative analysis of the utilization patterns in emergency department and hospitalized patients between 1998 and 2003

OBJECTIVE: The purpose of our study was to objectively examine the temporal utilization patterns of CT pulmonary angiography in emergency department and hospitalized patients in an academic tertiary care center. SUBJECTS AND METHODS: Patients who underwent CT examination for suspected pulmonary embolism either through our emergency department or as inpatients during a recent 9-month interval were identified. The absolute number of studies and incidence of positive results and ancillary findings were compared with similar data published from our institution during the corresponding 9-month interval in 1997-1998. RESULTS: The overall number of patients imaged for pulmonary embolism was significantly greater in the 2002-2003 period than in the 1997-1998 period (homogeneity of rates = 88.45, p < 0.0001). The absolute number of scans obtained was significantly greater in both the emergency department (chi(2) = 167.03, p < 0.0001) and inpatient (chi(2) = 210.62, p < 0.0001) groups in the more recent population. Significantly fewer ancillary findings were reported in both the emergency department (chi(2) = 5.93, p = 0.019) and inpatient (chi(2) = 6.03, p = 0.015) groups in the more recent population. The incidence of CT-detected pulmonary embolism was significantly less in both the emergency department (chi(2) = 34.26, p < 0.0001) and inpatient (chi(2) = 8.52, p < 0.01) groups in the more recent population. This decrease in the incidence of scans with positive findings for pulmonary embolism over time was significantly greater in the emergency department group than the inpatient group (homogeneity of odds = 0.003, p < 0.007). CONCLUSION: The evolution of CT pulmonary angiography utilization has led to a significant increase in the number of patients being imaged for pulmonary embolism with a coincident significant decrease in the rates of CT-detected pulmonary embolism and ancillary findings both in emergency department and hospitalized patients.     

The corporo-glans ligament: description and functional significance of a ligament connecting the corpora cavernosa to the glans penis

The two corpora cavernosa (CC) end blindly under cover of the glans penis (GP). The method of attachment of the CC to the GP could not be traced in the literature. The current communication investigated the hypothesis of a ligamentous attachment existing between the two corporal ends and the GP. In all, 18 male cadaveric specimens were studied by direct dissection and histologically. Six were neonates and 12 adults (mean age 32.3+/-10.6 s.d. y). After examining and photographing the connection between the CC and GP, sagittal, parasagittal, and coronal sections of the connection were stained and studied microscopically. A triangular fibrous tissue band connected the distal blind ends of the two CC with the GP. The base of this band was attached to the tunica albuginea of the two CC, while the apex was continuous with the fibrous septa between the sinusoids of the cavernous tissue of the GP. Microscopically, the ligament consisted of collagen and elastic fibers; in some sections, the collagen fibers of the tunica albuginea were continuous with those of the band. A band of collagen and elastic fibers could be identified connecting the two CC to the GP; we term it the 'corporo-glans ligament'. This ligament presumably affords the connection with rigidity, flexibility, and tissue strength. We suggest that it firmly connects the GP to the CC during penile thrusting. Further studies are required to assess the possible role of this ligament in erectile dysfunction.     

Brown tumor of the femur associated with double parathyroid adenomas

Severe parathyroid bone disease is a rare clinical presentation of primary hyperparathyroidism. Double parathyroid adenomas are even more rare cause of primary hyperparathyroidism. The authors present a case of double parathyroid adenomas in a 48-year-old man, who presented with painful left lower limb swelling, which was slowly growing in size in the last 20 years. Magnetic resonance imaging revealed a cystic bony lesion and coincidentally, a urinary bladder calculus. Biopsy of the mass revealed giant cell lesion. Laboratory investigations showed hypercalcemia and hypophosphatemia with elevated parathyroid hormone level. A computerized tomography scan of the neck delineated an adenoma of the left superior parathyroid gland, which was surgically removed. The left inferior parathyroid was also enlarged and was removed. Histological diagnosis confirmed double parathyroid adenomas. The rarity and the interesting clinical presentation of such association are discussed.