Cytomegalovirus esophagitis in patients with AIDS. A clinical, endoscopic, and pathologic correlation.

Objective: To examine the clinical presentation, endoscopic features, laboratory diagnosis, and outcome of cytomegalovirus esophagitis in patients with the acquired immunodeficiency syndrome (AIDS).

Design: Retrospective review of endoscopy records and esophageal biopsy material from patients with AIDS during the 24-month period from 1986 to 1988.

Setting: Urban medical center, central receiving county hospital.

Detection of HIV in enterochromaffin cells in the rectal mucosa of an AIDS patient.

The human immunodeficiency virus (HIV) was detected by in situ hybridization in the bowel crypt and lamina propria in the rectal mucosa of an acquired immune deficiency syndrome (AIDS) patient. More infected cells were noted in the crypts than the lamina propria. The enterochromaffin cell was one cell type showing the presence of virus.

Human immunodeficiency virus detected in bowel epithelium from patients with gastrointestinal symptoms.

Infectious human immunodeficiency virus (HIV) was recovered from two out of four bowel biopsy specimens from acquired immunodeficiency syndrome (AIDS) patients with chronic diarrhoea of unknown aetiology. In-situ hybridisation of biopsy specimens from rectum and duodenum of other AIDS patients with gastrointestinal complaints showed the presence of HIV-infected cells in both the base of the bowel crypts and the lamina propria. The type(s) of epithelial cell(s) infected could not be determined definitively.

Hepatic disease in patients with the acquired immune deficiency syndrome (AIDS).

The spectrum of liver disease in patients with acquired immune deficiency syndrome (AIDS) and the clinical impact of diagnostic percutaneous liver biopsy in this population were evaluated by a retrospective review of hepatic histology, clinical features and laboratory data in 85 patients (26 biopsies, 59 autopsies). Only 1 (3.8%) biopsy and 9 (15%) postmortem livers were histologically normal.

Streptokinase alters myocardial creatine kinase depletion after ischaemia and reperfusion in rabbits.

The efficacy of streptokinase as an intracoronary thrombolytic agent is well-recognized. The effect of streptokinase, distinct from its thrombolytic action, on ischaemic myocardium distal to an area of coronary artery occlusion when reperfusion occurs has not been well-defined. In order to do this, myocardial creatine kinase depletion and the histopathology of infarctions produced in rabbits after 1 h of circumflex coronary artery occlusion and mechanical release of the occlusion were assessed.

Antibody to the retrovirus associated with the acquired immunodeficiency syndrome (AIDS). Presence in presumably healthy San Franciscans who died unexpectedly.

We performed autopsies and serologic tests in 189 subjects (152 men and 37 women) between 20 and 50 years of age with no history of immunosuppression who died unexpectedly and whose bodies were referred to the San Francisco coroner's office. Forty-eight of the 88 single men for whom addresses were available lived in areas of the city with a high incidence of the acquired immunodeficiency syndrome (AIDS). In addition, 36 of the subjects (30 men) were intravenous drug abusers.

Cytomegalovirus colitis. Report of the clinical, endoscopic, and pathologic findings in two patients with the acquired immune deficiency syndrome.

We report 2 homosexual patients with the acquired immune deficiency syndrome and histopathologic evidence for cytomegalovirus colitis. In each case, the initial endoscopic impression was Kaposi's sarcoma but the appropriate diagnosis was made by histologic demonstration of a cytomegalovirus vasculitis. Clinical manifestations may include diarrhea, abdominal pain, and hematochezia.

Impact of preshunt liver histology on survival following portasystemic shunt surgery for bleeding esophageal varices.

To determine the value of liver histology in predicting one-year survival after protal venous decompression, eight hepatic histologic features were evaluated prospectively in 53 patients. The presence of panlobular fat and of alcoholic hyaline were the only individual features having a significant correlation with outcome. When the predictive power of these histologic features was compared by linear logistic regression analysis to that of 28 clinical and laboratory variables, panlobular fat was the best single predictor, followed in sequence by admission prothrombin time, alcoholic hyaline, admission hematocrit, and Child's C classification.

Closed-chest electrode-catheter technique for His bundle ablation in dogs.

A modified quadripolar electrode catheter that had two-thirds of the distal surface insulated with high-voltage plastic was inserted in 10 dogs. After a His bundle potential had been recorded, a synchronized direct-current electrical discharge was delivered between the electrodes showing the largest His bundle deflection using a standard direct-current defibrillator, and a metallic plate was positioned over the dog's back. Complete atrioventricular (AV) block was induced in 9 of 10 dogs, which were followed for 3 mo before being killed.

Spontaneous delayed splenic rupture--case report of a five-year interval between trauma and diagnosis.

A 27-year-old white man was admitted in shock with a tender distended abdomen 5 years following significant thoraco-abdominal trauma. Immediately following resuscitation he had an emergency exploratory laparotomy because of his critical condition. At operation 3 liters of old and fresh blood were present intraperitoneally and the spleen was ruptured.

Effects of intravascular clotting on the activation of the complement system: The role of the platelet.

Total hemolytic complement activity and the third component of complement were found to be significantly depressed in vivo in rabbits following the induction of disseminated intravascular coagulation by both thrombin and thromboplastin. Production of severe thrombocytopenia by the administration of platelet antiserum prior to the infusion of thrombin or thromboplastin partially prevented complement activation. The data show that, when clotting is triggered, complement activation takes place and that platelets are required to some extent for this reaction.

The effect of shock on the inflammatory response. A reevaluation of the role of platelets in the active arthus reaction.

The active Arthus reaction can be inhibited by hypovolemic shock or the infusion of catecholamines. A reevalution of previous work with platelet antiserum indicates that shock rather than thrombocytopenia was responsible for preventing the active Arthus reaction. Immunofluorescent studies of the inhibited Arthus sites reveal that immune precipitates are not present in the extravascular tissues.

The participation of the platelet in the vascular response to endotoxemia in the rabbit eye.

Platelet depletion by a specific goat antirabbit platelet antiserum profoundly affected the response of the ocular blood vessels to intravenous endotoxin. The altered permeability of the vessels of the iridial portion of the ciliary processes in the thrombocytopenic animals was reduced by 50% at 1(1/2) hours and by 30 to 58% at 4 hours after endotoxin administration. Intravascular fibrin at the 4-hour period could be eliminated by a properly timed platelet depletion.

Corticosteroids and the generalized Shwartzman reaction. Mechanisms of sensitization in the rabbit.

An analysis of the effects of adrenal cortical steroids on the response of the vascular system to bacterial endotoxin has shown that glucocorticoids (cortisone, triamcinolone) are capable of preparing the system for the generalized Shwartzman reaction. On the other hand, the mineralocorticoid desoxycorticosterone acetate does not have this capability. The mechanism of preparation by glucocorticoids has been studied.

The requirement for platelets in the active Arthus reaction.

The active Arthus reaction was completely inhibited in rabbits made thrombocytopenic with platelet antiserum. Platelets or some platelet factor is necessary for the development of immune vasculitis in this model. Since the classic Arthus reaction depends on the union of extravascular antigen with intravascular antibody, it is probable that the missing platelet factor is an agent that alters vascular permeability.

The role of the platelet in the generalized Shwartzman reaction.

Rabbits were injected with an antiplatelet serum to produce selective thrombocytopenia without inducing a significant alteration of their leukocyte counts. Thrombocytopenic levels persisted for 8 hr after the injection of platelet antiserum. During this time, the generalized Shwartzman reaction could not be provoked with the second injection of endotoxin.