Mucocutaneous manifestations in 22 consecutive cases of primary HIV-1 infection

Summary Twenty-two consecutive patients presenting with symptomatic human immunodeficiency virus 1 (HTV-1) seroconversion were studied. Most of the patients had a glandular fever-like illness.
All patients had fever and pharyngitis, and eight of them also suffered from ulcers of the oral, genital or anal mucosa. Uniform skin eruptions were observed in 17 of the 22 patients. The exanthem consisted of varying numbers of macular or maculopapular lesions that were oval or rounded in shape, ranging from a few millimetres to 1 cm in diameter. The lesions were distributed on the upper thorax in all cases, and were particularly profuse in the collar region. The face forehead and scalp were involved in most cases, but the eruption was sparse or absent at the periphery of the extremities. In the majority of patients, the exanthem appeared after 2 or 3 days of fever. The exanthem developed during the first day, persisted for 5-8 days, and then cleared concurrently with the general recovery of the patients.
Histopathological studies of skin punch biopsy specimens from four patients showed a sparse lymphocytic cell infiltrate distributed around vessels of the dermal superficial plexus. The infiltrates predominantly consisted of equally represented T-helper/inducer and T-suppressor/cytotoxic cells. A vacuolar aberration of basal layer cells was found in two of the four eases studied histologically. The microscopic findings correspond to the histopathological patterns seen in toxieodermia and in the interface dermatitis of morbilliform viral exanthems. The exanthem is a frequent and characteristic sign of primary HTV infection, which is further indicated if mucosal ulcers are present.     

Cardiovascular collapse associated with beta blockade in thyroid storm.

We describe three cases of thyroid storm who developed sudden cardiorespiratory arrest soon after the administration of propranolol orally. CASE 1: A 43 years old Chinese lady presented with complaints of fever and chills. She had a urinary tract infection and also had signs of overt thyrotoxicosis. She was diagnosed to have thyroid storm and was started on oral propranolol, carbimazole and intravenous hydrocortisone and ceftriaxone. Soon after propranolol was given orally she developed an asystolic cardiorespiratory arrest. CASE 2: A 72 years old Chinese gentleman presented with confusion, fever and rapid atrial fibrillation. He was diagnosed to have thyroid storm and was started on oral propranolol, carbimazole and intravenous hydrocortisone and ceftriaxone. He developed a cardiorespiratory arrest about 6 hours after commencement of therapy. CASE 3: A 48-year-old Chinese gentleman presented with complains of dyspnoea and palpitations. He was diagnosed to have thyroid storm and was started on oral propranolol, carbimazole, intravenous hydrocortisone and antibiotics. About 12 hours after admission, he developed a cardiorespiratory arrest. All three patients developed cardiorespiratory arrest soon after the administration of propranolol orally. We conclude that in selective patients who have low output cardiac failure in association with severe thyrotoxicosis, it maybe advisable to avoid use of a beta blocker. A safer alternative is the use of ultra short-acting beta-blockers, such as intravenous esmolol, with extreme caution.     

METHOTREXATE AND PREDNISOLONE TREATMENT OF A CHILD WITH PSORIATIC ARTHRITIS

ABSTRACT: Björksten, B. and Bäck, O. (Department of Paediatrics and Dermatology University Hospital, Umeå, Sweden) Methotrexate and prednisolone treatment of a child with psoriatic arthritis. Acta Paediatr Scand, 64:664, 1975–A case of severe psoriasis and psoriatic arthritis in a child is presented. Only one detailed report has been published previously. The result of treatment with prednisolone and methotrexate was encouraging.     

脑脊液在多发性硬化诊断和研究中的意义

尽管近年来神经影像学技术如头颅ＣＴ和ＭＲＩ的长足进步，为多发性硬化（ＭＳ）临床诊断提供了有力的手段，但脑脊液（ＣＳＦ）检查在ＭＳ临床和研究方面的重要作用仍然是其他方法无法取代的。它不仅为ＭＳ的诊断和鉴别诊断提供依据，而且ＣＳＦ中免疫细胞和免疫分子的变...     

Postoperative infections following autologous and homologous blood transfusions

Perioperative homologous blood transfusion has been linked to immune suppression and increased risk of postoperative infection. Autologous blood transfusion may not be associated with increased risk of infection because it presumably is not immunosuppressive. Fifty recipients of preoperatively donated autologous blood were matched to 50 recipients of homologous blood who underwent the same procedure, and the hospital course was reviewed for evidence of postoperative infection in both groups. Postoperative leukocytosis and febrile episodes were more common in homologous blood recipients (17 and 6 vs. 12 and 4, respectively). Sixteen percent of the 50 homologous blood recipients had positive cultures, as compared to 4 percent of the 50 autologous blood recipients (p less than 0.05). This study suggests that the association of blood transfusion with infection may be partially abrogated by the use of autologous blood.