Localized Kaposi''s sarcoma in a patient with pemphigus vulgaris

We report the case of a patient with a 13-year history of pemphigus vulgaris (PV) treated with immunosuppressive agents, prednisone and mycophenolate mofetil who had developed lesions of Kaposi's sarcoma (KS) on a sole plaque of PV that had been previously treated with intralesional injections of steroids. The lesions were surgically removed and polymerase chain reaction (PCR) demonstrated human herpesvirus-8 (HHV-8) DNA. There were neither recurrences nor later dissemination of KS following gradual decrease of the immunosuppressive therapy. We suggest that the treatment with intralesional steroids may have influenced the local reactivation of a latent infection of the virus, determining the appearance of this localized KS.     

Experimentally induced ileal ulcers in rats. A model to study non-specific inflammatory bowel disease

A surgical technique was used to establish chronic intestinal ulcers in Sprague-Dawley rats. A 2-cm-long segment of the distal ileum was excised and left attached on the mesentery. The ileum was reanastomosed. The excluded ileal segment formed a 'cyst' of various sizes. Initially, the anastomoses healed well, but after 6-8 weeks para-anastomotic ulcers developed in more than 50% of the rats. Histopathology showed a chronic inflammatory reaction with a predominance of mononuclear cells and increased numbers of eosinophilic granulocytes. The surface of the ulcers was covered with bacteria. Penetrating ulcers with fistula formation occurred. It is concluded that this experimental model may be useful for time sequential studies of the development of chronic and ulcerative ileitis. It may also be used to study the effect of medical and surgical regimens for the treatment of non-specific chronic inflammatory bowel disease.     

Use of sonography to evaluate carotid atherosclerosis in the elderly. The Cardiovascular Health Study. CHS Collaborative Research Group

Carotid sonography is being performed on more than 5,000 participants in the Cardiovascular Health Study, a prospective, multicenter study of cardiovascular disease in men and women aged 65 years and older. The sonographic methods used to examine and measure the extracranial carotid arteries are described. Initial validation studies were performed on 61 subjects with a mean age of 68.6 years. Analysis of within- and between-sonographer differences and between-reader differences were performed for selected variables. In general, the mean absolute differences for within- and between-sonographer comparisons were small, with even less variability between readers. Variability was less for the common carotid artery than for the internal carotid artery. These data suggest that carotid sonography is a reliable and reproducible method for use in the study of carotid atherosclerosis in population studies.     

Parathyroidectomy for hyperparathyroidism associated with renal disease.

Between 1969 and 1993, 123 patients were accepted in this unit for surgery for refractory hyperparathyroidism associated with chronic renal failure. Subtotal parathyroidectomy was the procedure of choice. At operation, four or more parathyroids were identified in 75% of patients. Methylene blue localised additional parathyroids in 32% of initial explorations in which it was used. Coincidental thyroid pathology was found in 8.3%, including papillary carcinoma in 2.4%. No further parathyroid surgery was required in 90% of patients at a mean of 6.6 years after operation. Reoperation (10%) was more likely to be required (14.3%) when less than four glands were found than when four or more were found (8.5%). Patients continuing on dialysis were more likely to need reoperation than those with functioning renal transplants.     

FEASIBILITY OF CONDUCTING CARDIOVASCULAR OUTCOME RESEARCH IN AUSTRALIAN GENERAL PRACTICE: RESULTS FROM THE ANBP2 PILOT STUDY

1. The present study aimed to determine the feasibility of conducting a 5 year cardiovascular outcome trial of the treatment of 6000 elderly hypertensive patients in Australian general practices. 2. General practitioners (GPs) were invited to participate by mail and personal follow-up. Patient records were reviewed to identify subjects for a blood pressure (BP) screening programme. Blood pressure was measured on three occasions and eligible subjects were included if the average BP was 160 mmHg systolic or 90 mmHg diastolic if systolic BP was 140 mmHg. 3. Seven hundred and forty-one GPs were approached and 89 were enrolled in the study (12% of mail invites and 75% of those receiving a personal contact). In 16 practices where screening was completed, 82 000 records were reviewed to identify 4% patients eligible for screening. Twenty-two per cent of eligible subjects attended screening. Of 1938 subjects screened, 180 (9%) had BP 5=160/90 mmHg. Forty-seven percent of subjects (n = 916) were receiving antihypertensive therapy and 184 (20%) were withdrawn from therapy. One hundred and sixteen (63%) of these subjects had BP return to study entry levels within 6 weeks. Fifty-seven newly diagnosed and 81 previously treated subjects were randomized (7% of the screened population). 4. Based on the high participation rate of GPs, the response rate of patients to attend a BP screening programme and the 7% randomization to screening ratio for entry into the study, the ANBP2 pilot study has demonstrated that it is feasible to recruit subjects from Australian general practices to a cardiovascular outcome trial.     

Influence of position along the medial-lateral axis of the superior colliculus on the topographic targeting and survival of retinal axons.

Topographic order in the rat retinocollicular projection emerges from an initially diffuse projection during an early postnatal remodeling period that is coincident with the period of naturally occurring ganglion cell death. Here, we examine the relationship between a retinal axon's position along the medial-lateral axis as it enters the superior colliculus (SC) and its ability to form an appropriately positioned arbor and survive the remodeling period. At E18-E19, prior to map remodeling, axons labeled with focal DiI injections in the periphery of temporal, nasal, superior or inferior retina are widespread along the medial-lateral SC axis. At P12, after remodeling, the distributions of axons remain widespread over the medial-lateral SC axis relative to the positioning of their terminal arborizations, and resemble the distributions labeled at E18-E19, with the exception that the small proportion of axons most widely mispositioned along the medial-lateral SC axis are less frequent. These data indicate that the most widely mispositioned retinal axons are preferentially eliminated, but that a high proportion of retinal axons mispositioned along the medial-lateral axis as they enter the SC can correct their position, form topographically appropriate arbors, and survive the remodeling period.     

SELECTIVE IgA DEFICIENCY PRESENTING WITH HYPERSPLENISM

SUMMARY A young patient presenting with splenomegaly and hypersplenism was inadvertently found to have selective IgA deficiency. There were no symptoms of immunodeficiency and the patient responded well to splenectomy, with return of blood counts to normal without adverse effects. No other cause for the hypersplenism was found. We postulate selective IgA deficiency as a cause of splenomegaly and hypersplenism.