Cutaneous tuberculosis.
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Antitubercular Agents↗
Biomedical subjects
R R MacGregor
Publications and source records attributed to R R MacGregor.
Increased plasma tryptophan in HIV-infected patients treated with pharmacologic doses of nicotinamide.
OBJECTIVE: Decreased plasma tryptophan in persons infected with human immunodeficiency virus (HIV) was first reported over a decade ago, and this observation has since been confirmed by many groups. Before this study, only zidovudine (an antiviral medication) had been reported to reverse plasma tryptophan depletion in HIV-infected persons. Starting with the hypothesis that HIV induces a pellagra-like state and that plasma tryptophan in HIV-infected patients is decreased as a known biochemical correlate of pellagra, we predicted that niacin therapy would reverse plasma tryptophan depletion as it does in pellagra. METHODS: After receiving approval from the institutional review board, we treated HIV-infected patients for 2 mo with high-dose niacin in the form of oral nicotinamide. RESULTS: There was an average 40% increase in plasma tryptophan (P = 0.01) in the four HIV-infected individuals who completed the 2-mo protocol. This finding was specific in that four other amino acids, which have been shown to have significant plasma concentration alterations during HIV infection (i.e., cystine, methionine, taurine, and lysine), showed no significant change with nicotinamide therapy. CONCLUSIONS: There were no adverse side effects attributable to this treatment. The effects of high-dose nicotinamide treatment on morbidity or mortality in HIV-infected persons are yet to be determined. This report marks the first successful use of a vitamin to reverse this HIV-induced metabolic abnormality.
Amino Acids↗
Mycobacterial infections in renal transplant recipients: report of five cases and review of the literature.
Five cases of mycobacterial disease in renal transplant recipients at the Hospital of the University of Pennsylvania were studied. In addition, another 42 cases reported in the literature were reviewed. Disseminated tuberculosis was common, accounting for 20 of the 47 cases. Infection with nontuberculous mycobacteria was also common, accounting for 16 cases. In two cases, a tuberculin nonreactor developed tuberculosis after receiving a transplant from a donor who was a reactor; these cases may represent reactivation tuberculosis in the transplanted kidney. A number of cases appeared preventable. For example, two patients at the Hospital of the University of Pennsylvania had evidence of previous tuberculosis but had not received isoniazid prophylaxis. On the basis of a survey of 26 transplantation centers, it was estimated that the minimal tuberculosis rate among renal transplant recipients is 480 cases per 100,000, vs. 13.1 per 100,000 in the general population.
Adolescent↗
Persistent meningeal inflammation associated with intrathecal gentamicin.
A 30-year-old woman was treated with intraventricular gentamicin for Klebsiella meningitis. Cultures became sterile, but meningeal inflammation, associated with high central spinal fluid gentamicin levels, persisted until gentamicin was discontinued.
Adult↗
The intracellular pathway for parathormone biosynthesis and secretion.
The initial translation product of parathormone messenger RNA--preproparathormone--is larger than parathormone. Two amino terminal peptide segments of the peptide chain are removed sequentially to form the 84-amino acid hormone. The first cleavage, the removal of a 25-amino acid extension from preproparathormone, occurs in the rough endoplasmic reticulum, and results in the formation of proparathormone. This peptide moves via an energy-dependent mechanism to the Golgi region of the cell where a specific converting enzyme cleaves a basic hexapeptide segment yielding parathormone itself. A part of the newly formed hormone then is enclosed within prosecretory vesicles, transported to the cellular membrane and secreted. Another portion is stored in mature secretory vesicles and is subject to subsequent secretion. The moment to moment control of parathormone secretion by calcium resides at the plasma membrane, but a tightly coupled response at the level of intracellular hormone degradation is also necessary in order to control intracellular hormone levels in the face of rapid changes in secretory rate. Three major secretory products are released from the parathyroid under the control of extracellular calcium: (1) parathormone, (2) a large protein--"parathyroid secretory protein"--whose function is unknown, and (3) peptide fragments of parathormone. Secretion of hormonal fragments adds to the population of parathormone immunoreactivity in the blood. These fragments appear to be similar if not identical to those formed by peripheral metabolism of parathormone in the liver and kidney.
Calcium↗
Results of combined amphotericin B-5-fluorcytosine therapy for prosthetic knee joint infected with Candida parapsilosis.
A prosthetic knee joint became infected with Candida parapsilosis, apparently introduced by arthrocentesis. The infection was quite indolent, present for several months before treatment. Although the joint fluid contained antibiotic concentrations in excess of the organism's minimum inhibitory concentration, medical therapy failed, and cure required removing the prosthesis and fusion of the knee.
Amphotericin B↗
Limitations of AIDS reporting under favorable circumstances.
To assess completeness of acquired immunodeficiency syndrome (AIDS) reporting by a consortium of Philadelphia physicians, we compared the consortium's patient data base to AIDS case reports received by the Philadelphia Department of Public Health (PDPH). Several circumstances favored better than ordinary reporting. Consortium physicians were highly motivated, specialized in the care of patients with human immunodeficiency virus disease, had worked with PDPH physicians for years, and knew beforehand about the plan to compare data bases. Of 295 patients in the consortium data base diagnosed with AIDS at least nine months prior to this study, 267 (90.5%) had been reported to the PDPH and 28 (9.5%) had not. Only two of the missed reports were deliberately withheld, each in response to the patient's request. Reporting completeness increased with the time elapsed since diagnosis, varied by practice from 70% to 100%, and was unrelated to patient demographic, insurance status, or occupational characteristics. AIDS reporting for patients in health care occupations (11/13 = 85% reported) was not significantly different from reporting for patients in other occupations (256/282 = 91% reported). We conclude that, under conditions favorable to reporting, approximately 10% of AIDS patients are not reported; the only patient characteristic that predicts reporting is the time elapsed since diagnosis; and nearly all reporting failures are inadvertent.
Acquired Immunodeficiency Syndrome↗