Pentoxifylline to treat Mycobacterium avium complex exacerbation in late-stage HIV infection.
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AIDS-Related Opportunistic Infections↗
Biomedical subjects
M J Boyle
Publications and source records attributed to M J Boyle.
Management of low-grade squamous intraepithelial lesions during pregnancy.
OBJECTIVE: Our purpose was to determine whether prenatal colposcopy is beneficial in pregnant women with squamous atypia, atypical squamous cells of undetermined significance, or low-grade squamous intraepithelial lesions on an initial screening Papanicolaou smear. STUDY DESIGN: A retrospective chart review identified a cohort of pregnant patients referred to the colposcopy clinic at Carolinas Medical Center between October 1991 and December 1994 with squamous atypia, atypical squamous cells of undetermined significance, or low-grade squamous intraepithelial lesions. Results of the colposcopic examination, cervical biopsy specimens, postpartum evaluation, and postpartum treatment were recorded. Descriptive statistics were used to tabulate numbers and percentages for all variables with 95% confidence intervals to determine disease progression. RESULTS: Prenatal colposcopy was performed on 253 women during the study period. The colposcopic impression was normal or consistent with low-grade squamous intraepithelial lesions in 235 (93%) of the women. Of the 67 women who had a cervical biopsy, 6 had a histologic diagnosis of high-grade squamous intraepithelial lesions. Postpartum Papanicolaou smears were obtained in 224 patients; 71 (32%) were normal, 145 (65%) were unchanged, and 8 (3%) showed high-grade squamous intraepithelial lesions. Of the 69 patients who had a postpartum cervical biopsy, 4 were found to have high-grade squamous intraepithelial lesions. Eight of the 10 women with biopsy-proved high-grade squamous intraepithelial lesions were compliant with treatment after delivery. Histologic examination of the cervix with tissue obtained by either loop conization or cold knife conization showed no evidence of invasive carcinoma. CONCLUSION: Squamous atypia, atypical squamous, cells of undetermined significance, or low-grade squamous intraepithelial lesions on a Papanicolaou smear in a pregnant patient does not require colposcopic evaluation during pregnancy. Progression of low-grade dysplasia to carcinoma during pregnancy is unusual, and no patient in this study was found to have invasive cancer.
Adolescent↗
Experience using the Quinton Permcath for haemodialysis in the Irish Republic.
BACKGROUND: The Quinton Permcath has been widely used for temporary vascular access in patients requiring haemodialysis. Placement under direct vision into the internal jugular vein minimizes the complication rate. This access modality is being used more and more for long-term access in the elderly and in patients where other access modalities are unavailable or have failed. METHODS: We reviewed the results of 50 central venous Permcaths inserted under direct vision in 61 patients, over a 4-year period. The overall survival and complication rates are estimated. A detailed description of the catheter insertion and removal is provided. RESULTS: Seventy-six per cent of patients were successfully managed using the Permcath for a median duration of 105 days. In addition, nine patients (18%) had catheters functioning without complications for over 1 year. Twenty-six (42.6%) catheters were removed for complications. Seven patients had a single and two had second catheter reinsertion during the course of the study. CONCLUSIONS: The Quinton Permcath remains a reliable method for short-term vascular access. When other access modalities are unavailable, it may offer a valuable alternative for long-term haemodialysis.
Adolescent↗
Managing HIV. Part 3: Mechanisms of disease. 3.6 How HIV promotes malignancies.
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Cytokines↗
Managing HIV. Part 2: Phases of disease. 2.1 Primary HIV infection.
The most important principle in managing primary HIV infection is not to miss the diagnosis. It presents an early opportunity for counselling and education aimed at maximising quality of life and minimising the risk of transmitting HIV (particularly high during the viraemia of primary infection).
Adult↗
The human HIV/peripheral blood lymphocyte (PBL)-SCID mouse. A modified human PBL-SCID model for the study of HIV pathogenesis and therapy.
PBL from HIV-infected patients were engrafted into CB-17 SCID mice to develop a novel small animal model for the study of HIV pathogenesis and therapy. Engraftment was achieved in 84% of mice, with human Ig (hu-Ig) levels and total human mononuclear cell recovery by peritoneal wash similar to those in control hu-PBL-SCID mice engrafted with uninfected donor cells. The hu-Ig produced by hu-HIV/PBL-SCID mice had broad reactivity against HIV. Virus could be detected in 98% of mice by polymerase chain reaction and/or viral coculture. Viremia was first detected by quantitative polymerase chain reaction on day 7 (approximately 10,000 copies of viral RNA/ml of plasma) and persisted through day 17. Quasispecies analysis of amplified, cloned, proviral DNA of the V3 region of the env gene showed that nucleotide sequences from hu-HIV/PBL-SCID mouse peritoneal wash cells on day 17 were not significantly changed from those derived from donor PBL at the time of injection. Relative to human CD4+ T cell recovery by peritoneal wash in control hu-PBL-SCID mice (CD4 = 19 +/- 2%; n = 40), severe CD4+ lymphocyte depletion (CD4 = 5 +/- 0.5%; n = 59; p < 0.001) was observed in untreated hu-HIV/PBL-SCID mice 18 to 25 days after engraftment. Treatment with 2'-beta-fluoro-2',3'-dideoxyadenosine, a nucleoside analogue, significantly reduced CD4+ T cell depletion (CD4 = 13 +/- 1; n = 59; p < 0.001) and the frequency of virus isolation (70%; p = 0.015) in the hu-HIV/PBL-SCID model. Boosting hu-Ig levels in the mice by injection of purified donor Ig with neutralizing activity did not affect the frequency of CD4+ lymphocyte recovery or virus isolation. The administration of a mAb to TNF had minimal effects. These studies demonstrate that PBL from HIV-infected donors can engraft SCID mice; that HIV can be detected in the spleen, peritoneal wash cells, and blood of these mice; that HIV infection within the model results in rapid CD4+ T cell depletion; and that anti-retroviral therapy is effective in improving CD4+ T cell recovery and reducing the frequency of virus isolation. The hu-HIV/PBL-SCID mouse model thus represents a potentially useful model in which to study HIV pathogenesis and therapy.
Amino Acid Sequence↗
The effects of circuit and humidifier type on contamination potential during mechanical ventilation: a laboratory study.
BACKGROUND: This study was undertaken because of concerns that ventilator humidifiers could be exacerbating the problem of nosocomial pneumonia in patients receiving mechanical ventilation. METHODS: Four different brands of humidifiers were used in conjunction with a siemens Servo 900B mechanical ventilator (Siemens Life Support Services, Solna, Sweden). In the first part, the ventilator was operated with humidifiers filled with contaminated water at room temperature. The viability of airborne particles and the effect of flow rates on the number of particles produced were assessed. In the second part, we measured the effect of time and temperature on bacterial survival in humidifier chambers. Because only bubble-through humidifiers were determined to produce infectious particles, the speed with which a contaminated bubble-through humidifier could infect circuit condensate was also determined. Aliquots of chamber water and circuit condensate, as well as air samples and distal circuit swabs, were cultured. RESULTS: Humidifiers other than bubble-through humidifiers did not produce aerosols. Particle production by bubble-through humidifiers varied directly with flow rate (R2 = 0.91). Chamber temperatures did not affect chamber colony counts except in bubble-through humidifiers. Although chamber colony counts in bubble-through humidifiers decreased with time, organisms remained viable throughout the study. When bubble-through humidifiers were heated, both condensate and effluent gas became heavily contaminated within minutes of flow initiation. CONCLUSIONS: Bubble-through humidifiers produce aerosols that readily contaminate both circuit condensate and effluent gas. Avoiding bubble-through humidifiers should improve patient safety while allowing changes in practice that can result in significant cost savings.
Aerosols↗
Expression of cytokine genes in T cell leukemias.
Normal T cells secrete cytokines which have important effects on a wide range of other cells. In the present study, the expression of IL-2, IL-4, IL-5, IL-10 and IFN-gamma was assessed in PBMC from 3 cases of T cell leukemia, using reverse transcription and polymerase chain reaction (RT-PCR). The major difference between the leukemia cases and control PBMC samples was that, without in vitro stimulation, IFN-gamma was much more readily detected in 2 of the leukemia cases. IL-2 and IL-5 mRNA were also detected in 2 of the patients but not in the other samples. IL-4 mRNA was not detected in any unstimulated sample, whereas IL-10 was always present. After polyclonal stimulation in vitro, mRNA for all these cytokines was detected in all samples. Thus cytokine expression, particularly of IFN-gamma, may be more prominent in PBMC from adult T cell leukemia cases than in controls.
Adult↗
Accuracy of duplex versus angiography in patients undergoing carotid surgery.
The operative findings of 23 carotid arteries were compared with pre-operative duplex scans and angiography. Both duplex and angiography had a high degree of accuracy in detecting haemodynamically significant lesions of 50-99% (88 and 92%, respectively). Their accuracy, however, in correctly predicting the grade of stenosis was significantly lower; 30 and 48%, respectively (P < 0.001). They each exhibited an accuracy of 70% and 78%, respectively, in the detection of ulceration. Overall, both duplex and angiography displayed an accuracy of 87% in indicating the proper management course. The combination of both investigations increased this accuracy to 94.6%. In severely stenotic lesions, duplex to rule out occlusion was not reliable. On statistical analysis, there was no difference between duplex and angiography in predicting haemodynamically significant lesions of 50-99%, estimating the grade of stenosis, the detection of ulceration, or indicating the proper management course. In most situations, duplex alone equalled the accuracy of angiography in the pre-operative assessment of patients for carotid surgery. For stenotic lesions of > 90%, however, we recommend supplemental angiography to rule out occlusion.
Carotid Arteries↗
Blood serum levels of PCDFs and PCBs in Yu-Cheng children peri-natally exposed to a toxic rice oil.
Children secondarily exposed through their mothers to a toxic rice oil containing PCDFs and PCBs in the Yu-cheng incident have shown developmental delay even a decade after the incident. Forty-five serum samples were collected from these children in February 1991 ad small amounts analyzed for their contaminant content using sample enrichment and isotope dilution mass spectrometry. In about one-half the samples, detectable levels of PCDFs and PCBs could still be determined with average values for 2, 3, 4, 7, 8-PnCDF and 1, 2, 3, 4, 7, 8-HxCDF of 300 and 620 ng/kg serum lipid, respectively. The mean of the total PCBs on a whole weight basis was 7.5 micrograms/kg. These concentrations of PCDFs and PCBs are still 10 to 25 times higher than those from a matched control population. Although the serum levels did not correlate with developmental delays, those for the two PCDFs but not the total PCBs correlated with duration of breast feeding indicative of postnatal exposure. The results of this study suggest that estimation of past prenatal exposure of children to PCDFs is best carried out using current mother and not current child blood concentrations.
Adult↗
The effect of heated wire circuits on humidification of inspired gases.
We performed this study to determine the effect of heated wire circuits on humidity delivered by several humidifiers commonly used during anesthesia. Humidifier bases from three manufacturers with several humidifying chambers for each base were tested using both heated and unheated circuits. Delivered humidity and circuit temperature were measured at the distal end of the circuit. Each chamber was tested under both continuous flow (CF) and intermittent flow (IF) conditions. IF was provided by a Servo 900 B ventilator. Adjustments of flow and volume were made for pediatric chambers. At 90 L/m CF, humidifier performance was unsatisfactory with both heated and unheated circuits. At 15 and 45 L/m CF, both distal circuit temperature (DCT) and humidity were within acceptable limits; unheated circuits delivered more humidity than heated circuits (P < 0.05). Relative humidity was lower at 45 L/m CF than at 15 L/m (P < 0.05). During IF while all chambers provided satisfactory humidity, humidity was greater when unheated circuits were used. We conclude that when heated circuits are used, humidifying systems may fail to deliver 100% humidity to patients.
Adult↗
Subtypes of Epstein-Barr virus (EBV) in Hodgkin's disease: association between B-type EBV and immunocompromise.
Epstein-Barr virus (EBV) has been associated with Hodgkin's disease (HD) in up to 50% of cases, but the subtype of EBV involved has only recently been studied. In this report, biopsy samples from 30 patients with HD were assessed for EBV sequences using both the polymerase chain reaction (PCR) and in situ hybridization (ISH). EBV sequences were localized to the malignant Reed-Sternberg cells and their mononuclear variants (Hodgkin's cells) in 9 of the 30 cases, with 7 demonstrating A-type and 2 B-type EBV sequences. Both of the patients with B-type EBV-associated HD had features to suggest pre-existing immune compromise: one was infected with human immunodeficiency virus (HIV) and had severe CD4+ T-lymphocyte depletion; the other was a debilitated elderly patient with dementia. A previous study suggested that A-type EBV alone is associated with HD and the finding of predominantly A-type EBV in the present series is in keeping with this report. The presence of B-type EBV in the HD of patients with pre-existing immunodeficiency, taken together with the recent report that B-type EBV occurs in HIV-associated non-Hodgkin's lymphoma, suggests that B-type EBV may be an important human pathogen in immunocompromised patients.
Actins↗
HIV seroconversion illness.
HIV seroconversion is associated with characteristic clinical findings which reflect the first interaction of HIV with the host immune system. Recognition of the characteristic clinical illness associated with HIV seroconversion helps to establish an early diagnosis and obviates the need for further investigation or empiric therapy. It may also afford a unique opportunity to institute counselling to prevent the further spread of HIV in the community.
Adult↗
15 AU81, a prostacyclin analog, potentiates immunosuppression and mitigates renal injury due to cyclosporine.
15 AU81, a synthetic prostacyclin analog, inhibits human mixed lymphocyte culture responses in a dose-dependent manner at concentrations within a range [0.1 to 10.0 micrograms/ml] similar to that of cyclosporine, methylprednisolone, antilymphocyte serum, and prostaglandin E1 and E2 analogs. Using the median-effect analysis to dissect immunosuppressive interactions, 15 AU81 and cyclosporine were shown to produce synergistic effects on human peripheral blood lymphocyte activation upon phytohemagglutinin or anti-CD3 monoclonal antibody stimulation. In vivo, 15 AU81 potentiated the effect of cyclosporine to prolong the survival of rabbit renal allografts using concentrations of each agent that were individually ineffective. Furthermore, addition of 15 AU81 mitigated functional damage of rabbit kidneys due to high-dose cyclosporine therapy. These observations suggest that the addition of 15 AU81 may broaden the therapeutic window of cyclosporine by potentiating immunosuppression and mitigating nephrotoxic effects.
Animals↗
Increased expression of interferon-gamma in hyperplastic lymph nodes from HIV-infected patients.
Polyclonal B cell activation is characteristic of HIV infection and occurs in the presence of severe CD4+ lymphocyte depletion. In contrast, CD4+ lymphocytes are the dominant T cell in the reactive lymphoid tissues of patients not infected with HIV. In this study, lymph node biopsies from eight HIV-infected patients with persistent generalized lymphadenopathy syndrome (PGL) were assessed for IL-1 beta, IL-2, IL-4, IL-6, IL-10, interferon-gamma (IFN-gamma) and tumour necrosis factor-beta (TNF-beta) gene expression using the polymerase chain reaction (PCR). The cytokine gene expression of two cases of reactive adenopathy in patients not infected with HIV was assessed for comparison. IFN-gamma was expressed much more strongly in the PGL samples than in control reactive lymphoid tissues, whereas the other cytokines were expressed to a similar extent in both types of tissues. IFN-gamma may have an important role in maintaining the adenopathy of HIV-infected patients. Expression of cytokines such as IL-2, IL-4 and IL-10 in HIV nodes may be adequate to allow the recruitment of naive B cells to the reactive process.
AIDS-Related Complex↗
The role of Epstein-Barr virus subtypes in human immunodeficiency virus-associated lymphoma.
High grade B cell non-Hodgkin's lymphoma (NHL) is an increasingly important problem in individuals infected with the human immunodeficiency virus (HIV). Fifty percent of these tumours harbour the Epstein-Barr virus (EBV) and there is an equal frequency of EBV A and B-subtypes in the tumours. This contrasts with the recent report that only A-type EBV is associated with Hodgkin's disease. Such studies are challenging the traditional models of EBV-associated lymphomagenesis and showing the way for further studies in this field. This article reviews the studies of EBV subtypes in HIV-associated NHL and uses this new knowledge to discuss the role of EBV in lymphomagenesis.
Antigens, Viral↗
Update on HIV and neoplastic disease.
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HIV Infections↗
HIV and malignancy.
Although a number of tumors in patients infected with the human immunodeficiency virus have been reported, Kaposi's sarcoma and non-Hodgkin's lymphoma remain the two principal malignancies. This article provides an Australian perspective of the recent advances in research into malignancy in HIV-infected persons.
Australia↗