Human immunodeficiency virus-related connective tissue diseases: a Zimbabwean perspective

Our clinical experience with patients in Zimbabwe suggests that an arthropathy may be a feature of HIV disease. This takes two forms: the first is a reactive arthropathy usually affecting the large, lower limb joints with no other clinical features of a connective tissue disease. The second form is seen in association with features of complete or incomplete Reiter's syndrome with involvement of large and small peripheral joints (having an asymmetric distribution). Although this arthropathy may been seen in association with HIV positive asymptomatic disease and often is the reason for first presentation at hospital, the majority of our patients have clinical features of persistent generalized lymphadenopathy, plus or minus features of constitutional illness (such as fever, weight loss, and diarrhea). A small percentage of our patients have arthropathy in association with secondary systemic infection. Other locomotor conditions have been observed, although their numbers are too small to determine whether or not they truly are related to HIV disease. In Zimbabwe there is no association between the development of HIV-associated arthropathy and the presence of HLA-B27.     

The psychometric properties of the Behaviour Assessment Record (the BAR schedule)

ABSTRACT. Two hundred and forty-seven completed Behaviour Assessment Records (BAR) for people with learning difficulties living in hospital, community residential facilities or the family home were subjected to item analysis and factor analysis. The instrument as a whole proved to be highly internally consistent, although the corrected item-total correlation coefficients suggest the redundancy of some items on individual sub-scales. Factor analysis produced a two-factor solution accounting for 32–9 and 10–8% of the variance. These factors were named Personal self-care and Use of public amenities. Summative scales based upon these factors were highly internally consistent. Comparisons are made between the internal consistency and factor structure of the BAR and those of similar measures of adaptive behaviour, such as the Social Training Achievement Record (Sturmey et al. , 1988), the Pathways to Independence Checklist (Walsh & McConkey, 1989), and the Adaptive Behavior Scale (Nihira, 1969a, b, 1976).     

Analysis of an experimental cortical network: II). Connections of visual areas 17 and 18 after neonatal injections of ibotenic acid.

Lesions of cortical areas 17 and 18 were produced in newborn kittens by local injections of the excitotoxin ibotenic acid. In the adult this results in a microcortex which consists of superficial layers I, II and III, in the absence of granular and infragranular layers. Horseradish peroxidase, alone or wheat germ agglutinin conjugated, was injected in the microcortex or in the contralateral, intact areas 17 and 18. The microcortex maintains several connections characteristic of normal areas 17 and 18 of the cat. It receives afferents from the dLGN, and several visual areas of the ipsilateral and contralateral hemisphere. However, it has lost its projections to dLGN, superior colliculus, and, at least in part, those to contralateral visual areas. Thus some parts of the microcortex receive from, but do not project into, the corpus callosum. In addition, the microcortex maintains afferents from ipsilateral and contralateral auditory areas AI and AII which are normally eliminated in development.     

Poisoning with oxybutynin.

A case of poisoning with 100 mg of oxybutynin in a 34-year-old female is reported. The main features were anticholinergic effects, including stupor, followed by disorientation and agitation on awakening, dilated pupils, dry skin and retention of urine. She had a sinus tachycardia which resolved 3 h after admission, and in addition ventricular ectopics and bigeminy which continued for a further 30 h. She recovered fully on symptomatic treatment alone.     

The Angelchik anti-reflux prosthesis and postoperative dysphagia

Dysphagia was studied in 29 patients after implantation of an Angelchik prosthesis for persistent reflux oesophagitis. The incidence of postoperative dysphagia occurred after three months (61%), six months (45%), and one year or more (41%). Severe dysphagia necessitated removal of the prosthesis in five patients (17%). The reoperative findings with regard to a possible explanation of dysphagia are discussed, and comparison is made with reports in literature. Implantation of the Angelchik prosthesis seems only indicated for the treatment of intractable reflux oesophagitis in patients where other operative modalities failed and who are at high risk for operation. The Nissen fundoplication remains the operation of choice.     

Comparison of loop diuretics in patients with chronic renal insufficiency

Furosemide and bumetanide share a number of characteristics including reduced natriuretic effects in azotemic patients. It has been presumed that this condition affects each drug equally. Previous studies, however, suggest dissimilar pathways of delivery to their sites of action. Though not rigorously tested, this potential disparity might cause them to differ when used in azotemia. We, therefore, assessed the pharmacokinetic and pharmacodynamic characteristics of intravenously administered furosemide and bumetanide in ten adult patients with stable, chronic renal insufficiency (mean creatinine clearance = 14.1 +/- 2.0 ml/min/1.73 m2) in a randomized, cross-over study during controlled sodium intake. Our goals were to assess differences in diuretic effectiveness and in so doing to determine the dose required to produce a maximal response. The mean diuretic doses of 172 and 4.3 mg for furosemide and bumetanide, respectively (ratio = 40:1) were sufficient to produce a maximum response. Despite similarities in maximal fractional excretion of sodium (18.2 +/- 2.6% with furosemide vs. 19.4 +/- 4.5% with bumetanide, P = 0.687) demonstrating an equal tubular responsiveness to both drugs, overall response as quantified by cumulative natriuresis in the initial eight hour period was 52% greater with furosemide (108 +/- 17 vs. 71 +/- 7 mEq; P = 0.042). The difference in total excreted sodium was accounted for by a preserved nonrenal clearance of bumetanide (113 +/- 12 compared to 53 +/- 5 ml/min for furosemide, P = 0.001) which resulted in relatively less bumetanide in serum available to be delivered into the urine.(ABSTRACT TRUNCATED AT 250 WORDS)