Common Health Problems in HIV-infected Travelers to the (Sub) tropics

BACKGROUND: A study was conducted to estimate the incidence of health problems in HIV-infected travelers with various degrees of immunodeficiency to the (sub)tropics. METHODS: A retrospective questionnaire-based study among HIV-infected patients attending the outpatient department of a university hospital during three months in 1996 with a history of travel to (sub)tropical destinations in the proceeding 12 months. The outcome measures were incidences of and medical consultation rates for common travel-associated illnesses. RESULTS: Of 293 HIV-infected patients, 59 (20%) had traveled during the preceding 12 months; of these 36 (61%) responded. Ten (28%) had traveled more than once during this period. There were no significant differences between travelers and nontravelers regarding CD4 count and age. Fifteen respondents (42%) used cotrimoxazole (CTX) for PCP prophylaxis; 22 (61%) had sought pretravel health advice. Median duration of travel was 3 weeks. Respiratory infections were recorded by two respondents (6%, 95% confidence intervals 1-19%) and skin problems by 10 (28%, 14-45%). Of 31 respondents without diarrhea on departure, 10 recorded diarrhea (32%, 19-57%). The overall rate of medical consultation for travel-related complaints ws 5% abroad and 28% after return, respectively. There was no association between the risk of diarrhea and CD4 count or CTX prophylaxis, even after adjustment for differences in age, duration of travel and travel experience. CONCLUSIONS: Although numbers in this study are small, HIV-infected travelers tend to have a high rate of medical consultation for (possibly) travel-related illness. Diarrhea is the most frequent complaint, but shows no strong association with degree of immunodeficiency.     

Risk-group discrimination in node-negative breast cancer using invasion and proliferation markers: 6-year median follow-up.

Factors reflecting two major aspects of tumour biology, invasion (urokinase-type plasminogen activator (uPA), plasminogen activator inhibiter (PAI-1), cathepsin D) and proliferation (S-phase fraction (SPF), Ki-67, p53, HER-2/neu), were assessed in 125 node-negative breast cancer patients without adjuvant systemic therapy. Median follow-up time was 76 months. Antigen levels of uPA, PAI-1 and cathepsin D were immunoenzymatically determined in tumour tissue extracts. SPF and ploidy were determined flow-cytometrically, Ki"'-67, p53, and HER-2/neu immunohistochemically in adjacent paraffin sections. Their prognostic impact on disease-free (DFS) and overall survival (OS) was compared to that of traditional factors (tumour size, grading, hormone receptor status). Univariate analysis determined PAI-1 (P < 0.001), uPA (P = 0.008), cathepsin D (P = 0.004) and SPF (P = 0.023) as significant for DFS. All other factors failed to be of significant prognostic value. In a Cox model, only PAI-1 was significant for DFS (P < 0.001, relative risk (RR) 6.2). In CART analysis for DFS, the combination of PAI-1 and uPA gave the best risk group discrimination. For OS, PAI-1, cathepsin D, tumour size and ploidy were statistically significant in univariate, but PAI-1 was the only independently significant factor in Cox analysis (P < 0.001, RR 8.9). In particular, this analysis shows that PAI-1 is still a strong and independent prognostic factor in node-negative breast cancer after extended 6-year median follow-up.     

Case report. Tinea corporis purpurea

We report a case of tinea corporis purpurea localized to a calf in a 36-year-old woman. The patient, who was also affected by mild superficial venous insufficiency of lower limbs, complained of intense pruritus. Microsporum canis was the aetiological agent. Clinically atypical varieties of tinea corporis were sometimes reported in the literature, particularly in HIV-positive patients, although they are uncommon in immunocompetent patients; in particular, tinea corporis purpurea is very rare.     

The post-winter prevalence rate of middle ear effusion in four-year-old children,judged by tympanometry

Tympanometry and otologic examinations were performed in 373 four-year-old children randomly selected from the Central National Register at the end of February, 1979. A close interaural correlation of the middle ear pressures of a child was found and therefore the tympanometric results represent related as well as independent data. Consequently, the post-winter prevalence rates of type B tympanograms were calculated according to different sampling units: per all ears 13.7%; per right ears 12.9%; per left ears 14.5%; per ears selected at random 13.9%. Additionally, the prevalence rate was estimated per child at 20.4% type B in at least one ear and at 7% type B in both ears. Based upon the literature the validity of the tympanometric method in detecting middle ear effusion is described. The predictive values of positive and negative tests mostly depend on the degree of the cutoff point (pass—fail point) which has been chosen. In this study the cutoff point was the presence of a type B tympanogram. The advantage and disadvantage of applying ‘one ear’ or ‘one child’ as the sampling unit is discussed from a statistical as well as a clinical point of view. When calculating either per ear or per child no sex differences in the prevalence rates could be proved.     

Cerebellar abscess as an intracranial complication of otogenic origin (author's transl)

Three cases of otogenic cerebellar abscesses, treated between 1976 and 1978, are reviewed. Early diagnosis is the most important factor in the successful management of these lesions. In localising subtentorial intracranial abscesses, computed axial tomography appears superior to other neuroradiological methods. Lumbar puncture is both inaccurate in diagnosis and dangerous to the patient, when increased intracranial pressure exists.     

HER-2/neu gene amplification by fluorescence in situ hybridization allows risk-group assessment in node-negative breast cancer

In a collective of 112 node-negative breast cancer patients, we compared the prognostic impact of HER-2/neu gene amplification (AMP) determined by fluorescence in situ hybridization (FISH) and HER-2/neu protein overexpression (EXP) measured by immunohistochemistry (IHC) with traditional prognostic factors (tumor size, grade, steroid hormone receptor status, menopausal status) and tumor invasion markers uPA (urokinase-type plasminogen activator) and its inhibitor PAI-1 determined by enzyme immunoassay (ELISA). Median follow-up in patients still alive at time of analysis was 7 years. Automated FISH and IHC were performed on parallel-cut formalin-fixed paraffin-embedded tissue sections. HER-2/neu AMP was detected by FISH in 31% and HER-2/neu EXP was measured by IHC in 41% of the cases. In 13% of the tumors, both AMP and EXP were found. FISH and IHC results were concordant in 56% of all analyzed cases. In univariate analysis, HER-2/neu AMP significantly predicted both disease-free (DFS) and overall survival (OS). HER-2/neu EXP was significant for OS, only. In multivariate analysis of all analyzed prognostic factors, HER-2/neu AMP was the only independent predictive factor for both DFS and OS. CART analysis revealed that HER-2/neu AMP together with the combination uPA/PAI-1 allowed optimal risk-group assessment after a 7-year median follow-up: patients with low levels of both uPA and PAI-1 and no HER-2/neu AMP had a significantly lower relapse rate (4.6%) than the remaining patients (32%). In conclusion, HER-2/neu gene AMP determined by FISH allowed a more accurate risk-group assessment than HER-2/neu protein EXP measured by IHC. Combining the HER-2/neu gene status measured by FISH with levels of tumor invasion markers uPA and PAI-1 improves clinically relevant risk-group assessment. In addition to its prognostic strength, the significant impact of HER-2/neu AMP on OS may reflect its ability to predict resistance to systemic therapy.     

Bone marrow-derived dendritic cells incorporate and process hydrophobized polysaccharide/oncoprotein complex as antigen presenting cells

We have previously shown that a novel hydrophobized polysaccharide/oncoprotein complex vaccine can induce immune responses against the HER2/neu/c-erbB2 (HER2) expressing tumors. Bone marrow-derived dendritic cells (DCs), as antigen presenting cells (APCs), are the first candidates for presentation of tumor antigens. The aim of this study was to see whether DCs are able to elicit antigen specific host immune responses by stimulating the proliferation of T cells after exposure to cholesteryl group bearing pullulan (CHP) and HER2 protein complex. Vaccination by CHP-HER2 complex was as effective as cholesteryl group bearing mannan (CHM) and HER2 complex on which we reported previously. Immunization of mice with HER2 expressing CMS17HE tumor cells generated both CD4+ T cells and CD8+ T cells reactive with CHP-HER2 complex pretreated DCs. In addition, immunization with either CHP-HER2 complex or HER2 protein alone could also generate both CD4+ T cells and CD8+ T cells specifically reactive with CHP-HER2 complex pretreated DCs. The complete rejection of tumors occurred when immunization with CHP-HER2 complex pretreated DCs was started 10 days after tumor inoculation. Therefore, bone marrow-derived DCs pretreated with hydrophobized polysaccharide/oncoprotein complex are a powerful tool for enhancing the effectiveness of oncoprotein for anti-tumor vaccination, opening new options for immune cell therapy.     

Diazepam has no beneficial effects on stress-induced behavioural and endocrine changes in male tree shrews

The present study evaluated the effect of subchronic oral treatment of psychosocially stressed male tree shrews with diazepam on locomotor activity, marking behavior, avoidance behavior, and urinary cortisol and noradrenaline. To mimic a realistic situation of anxiolytic intervention, the treatment started 14 days after the beginning of psychosocial stress; at that time, the stress-induced behavioral and endocrine alterations had been established. The drug (5 mg/kg/day) was administered orally in the morning, while the psychosocial stress continued during the whole treatment period; the therapeutic action of diazepam treatment was followed across 7 days. Twenty-four hours after the last application serum concentrations of diazepam and its major metabolites were determined via HPLC. The results revealed concentrations of 7 ng/ml for diazepam, 106 ng/ml for nordiazepam, 22 ng/ml for temazepam, and 30 ng/ml for oxazepam. Treatment of subordinate animals with diazepam did not reveal a beneficial effect to any of the parameters studied. This contrasts to earlier findings showing that the behavioral and neuroendocrine alterations produced by this stress paradigm are sensitive to chronic treatment with the tricyclic antidepressant clomipramine. The present results support the view that in male tree shrews the state induced by psychosocial stress might be more depression related than anxiety related.