Disproportional impact of the revised AIDS surveillance definition on the AIDS incidence among drug users compared to homosexual men

The impact of changes in 1993 of the old 1987 WHO/CDC AIDS casedefinition was studied in a cohort of 153 HIV-infected injectiondrug users (IDUs) and 502 HIV-infected homosexual men in Amsterdam.It appeared that the extension in Europe of the old AIDS definitionto also include recurrent pneumonia, pulmonary tuberculosisand invasive cervical neoplasia, strongly increases the numberof persons diagnosed with AIDS among IDUs, but will hardly influencethe AIDS incidence among homosexual men. As recurrent pneumoniaand pulmonary tuberculosis are present among drug users withhigh CD4 cell counts, the incidence of these diseases may partlybe determined by environmental factors. The extension of theold 1987 AIDS definition in the USA with CD4 count <200 cells/mm³In addition to the 3 above-mentioned diseases, will also havea larger impact on drug users than on homosexual men.     

Differential Expression of DRw52-Like Determinants Detected by Monoclonal Antibodies

The reactivity of three monoclonal antibodies (MoAb) directed against DRw52-like determinants was studied in relation to the reactivity of an anti-DR MoAb using fluorescence-activated cell sorter (FACS) analysis. The MCS-7 MoAb reacted with all DRw52+ cells and in addition with DR2+, DR4+, and a DR7+ cell. Both the I-LR2 and the 7.3.19.1 MoAb reacted with DR3+, DR5+, and DRw6+ cells only. However, whereas the 1-LR2 MoAb reacted strongly with all those cells compared with the anti-DR MoAb, the 7.3.19.1 MoAb reacted strongly with DR3+ cells only, and somewhat less with DR5+ and DRw6+ cells. The implications of this for the location of DRw52-like determinants on DR beta chains is discussed.     

Phenotypical and Functional Characterization of Small Intestinal TcRγδ+ T Cells in Coeliac Disease

Increased numbers of TcR gamma delta + T cells are present in the small intestinal epithelium of patients with coeliac disease (CoD). Their function, however, is unknown. In order to facilitate detailed functional studies, intestinal gamma delta T cells have been isolated from small intestinal biopsies of patients with CoD (n = 18) and controls (n = 14). As expected, increased numbers of V delta 1+ TcR gamma delta + T cells were detected in freshly isolated intraepithelial cell suspensions (IEL) from CoD patients. Also, in the in vitro expanded IEL T-cell populations from CoD patients the numbers of V delta 1+ TcR gamma delta + T cells were increased compared with similar cell cultures from control patients. From IEL cultures derived from six CoD patients, 107 T-cell clones were generated by limiting dilution and analysed. Sixty of these clones were either CD4 or CD8 positive TcR alpha beta + clones. The remaining 47 clones expressed the TcR gamma delta. Further phenotypical analysis of the gamma delta T-cell clones indicated that the TcR gamma delta + T-cell population in the small intestinal epithelium of CoD patients is heterogeneous: four TcR gamma delta phenotypes could be detected and, although the majority of the TcR gamma delta + T cells were CD4 CD8, gamma delta T-cell clones expressing either a CD8 alpha alpha homodimer, a CD8 alpha beta heterodimer or CD4 were also identified. In contrast to the TCR alpha beta + IEL, most TcR gamma delta + IEL were CD5 negative. Furthermore, biochemical analysis indicated that the increase in V delta 1+ gamma delta T cells in the small intestinal epithelium of CoD patients was not the result of a monoclonal expansion. The small intestinal epithelium-derived gamma delta T-cell clones were functional in vitro since the majority of these clones were able to lyse target cell lines such as K562. Molt4 and Daudi. These novel findings therefore indicate that the gamma delta T cells in the small intestine of CoD patients represent a heterogeneous population and that such cells are functional in vitro. The isolation and the in vitro propagation and cloning of these cells may open new avenues for the study of the putative immune mechanisms leading to coeliac disease.     

LYME PERICARDITIS LEADING TO TAMPONADE

We report the case of a 62-yr-old man who presented with Lymepericarditis leading to cardiac tamponade shortly followed byan arthritis. IgM and IgG antibodies to Borrelia burgdorferiwere demonstrated in serum by indirect immunofluorescence. Borreliaburgdorferi was demonstrated and identified in pericardial fluidby indirect immunofluorescence using serum from a patient withproven Lyme disease and by a monoclonal antibody immuno-goldsilver stain. Spirochetes were also found in synovial biopsiesusing a silver stain. The tamponade was treated with pericardiocentesis;the arthritis was treated with intravenous ceftriaxone (2 gonce daily) for 14 days. The patient recovered completely withindays of commencing treatment. This case report demonstratesthat borrelial infection may lead to pericarditis and cardiactamponade. KEY WORDS: Borrelia burgdorferi infection, Arthritis, Pericarditis, Tamponade     

Modifications of the urethral rest and stress profiles after different types of surgery for urinary stress incontinence

Summary. Full urodynamic assessment, including urethral profiles at rest and under stress, using microtransducers, was made before and at least 6 months after surgery for urinary stress incontinence in 86 patients. Cure was assessed objectively. Procedures compared were Burch colposus-pension, Pereyra urethrovesical suspension and anterior colporrhaphy. The Burch colposuspension increased the pressure transmission ratio more efficiently than the vaginal operations and the cure rate was 91%. Only 50% of Pereyra operations were successful and success was related to an increase in the functional urethral length and in the pressure transmission ratio. The success rate for anterior colporrhaphy was 57% and was associated with a significant decrease in the maximal urethral closure pressure and the continence area. The prognostic value of the urethral profiles at rest and under stress and the therapeutic implications are discussed.     

Ventricular Arrhythmias in Apparently Healthy Subjects

While it is assumed that the normal heart does not predispose to serious arrhyilimias, several conditions are now being recognized as being associated with short-lasting ventricular arrhythmias. It also becomes clear that idiopathic VT (or repetitive monomorphic VT) sometimes exists on the background of a compromised heart. Whether this dysfunction is due to the arrhythmia or vice versa is not evident. Finally, VF occurs in patients who, at a first glance, have no apparent heart disease, and it is then called idiopathic VF. These complex electrical abnormalities probably reflect disorders, which often are genetically determined. Recognition of these syndromes, often characterized by abnormal repolarization or a disturbed autonomic function is possible if appropriate techniques are used.     

Ketamine as analgesic for total intravenous anaesthesia with propofol

A prospective study of 18 patients who underwent noncardiac surgery was performed to study the use of ketamine as an analgesic during total intravenous anaesthesia with propofol. A comparison was made with the combination propofol/fentanyl. The propofol/ketamine combination resulted in haemodynamically stable anaesthesia without the need for additional analgesics. Postoperative behaviour was normal in all patients and none of the patients reported dreaming during or after the operation. Propofol seems to be effective in eliminating side effects of a subanaesthetic dose of ketamine in humans. We recommend the propofol/ketamine combination for total intravenous anaesthesia for surgery when stable haemodynamics are required.     

Screening for breast cancer in Catalonia: Which policy is to be preferred?

Background: the effects and costs of different policies forbreast cancer screening in Catalonia (Spain) were analysed,to give a basis for setting priorities and deciding on the introductionof a screening programme. Methods: the MISCAN (MIcrosimulationSCreening ANalysis) model of the natural history of breast cancerwas used. The epidemiology of breast cancer in Catalonia andthe demography of the Catalan population was taken into accountas well as the results on mortality reduction from a Swedishoverview of breast cancer screening trials. Results: the reductionin breast cancer mortality in the total female population dueto a screening programme for the age group 50–64 yearswould be 16, 12 and 9%, with screening intervals of one, twoand three years respectively. The cost-effectiveness ratios(CE ratios) for these scenarios were 924,000, 730,000 and 719,000pesetas (P_t) per life-year gained respectively (5% discounting).The most cost-effective screening scenario is the one in whichwomen aged 50–69 years are screened with an interval ofthree years with a mortality reduction of approximately 12%in the total female population (CE ratio = 694,000 P_t). Screeninguntil the age of 69 years (two year interval) was almost ascost-effective as screening the age group 50–64 yearswith a two year interval, with a reduction in breast cancermortality of 15%. Extension to under the age of 50 years resultedin diverging results depending on the assumptions for improvementin prognosis for younger women (40–49 years). Conclusion:if the extension of a two yearly screening programme for womenaged 50–64 years is considered (mortality reduction of12%), extension to older women would be more advisable, basedon proven benefits and costs, than extension to younger agegroups.