Jean Dormont

Disclosure of HIV seropositivity

Deciding whether or not to disclose ones HIV-positive status to another person is an important decision: the way each person experiences and copes with the illness is reflected in this choice. We conducted a study of 174 patients (29.3% of women) to examine how the decision to disclose or conceal was made, as well as its subjective and social consequences. We discovered that only 3.5% of the individuals remained silent about their illness. Most spoke about it, regardless of how they had been infected or of the advice they had received to be discrete. The confession often did not bring them the relief they sought. Revealing ones HIV-positive status is not a sign of social responsibility, or of a special trust in someone, but rather a compulsive act to release suppressed tension. Individuals who do not confess need attention; their silence is a sign of their inability to adapt to their illness, as well as of their self-imposed exclusion from society.

Immediate effects of captopril in acute left ventricular failure secondary to myocardial infarction.

Abstract. In eight patients with acute left ventricular failure secondary to myocardial infarction the haemo‐dynamic effects of captopril (25 mg), an orally active converting enzyme inhibitor, were measured. Haemo‐dynamic modifications were maximal at 60 min and lasted for 2–3 h. Pulmonary wedge pressure fell from 23–5± 4.9(mean ± SD)to 16–8 ± 4.7 mmHg(P<0–01), cardiac output rose from 3–24 ± 1 to 4–05 ± 0–91 1/min (P<001). Systemic vascular resistance decreased from 27–34 ± 3–81 to 17.52 ± 1–65 mmHg min 1‐1 (P<001). Mean arterial pressure fell from 89.6 ± 13.9 to 75.7±0 16.3 mmHg (P<0001) while heart rate was not significantly modified. Six patients who had high pretreatment plasma renin activity values responded by a decrease in ventricular filling pressure and/or an increase in cardiac output. One patient with normal initial plasma renin activity value showed similar haemodynamic effects. These data suggest that in the short term captopril is a vasodilator with both arterial and venous effects and improves cardiac function in acute left ventricular failure secondary to myocardial infarction.

10 Pancreatic lesions in HIV-infected patients

The pancreas is frequently involved during HIV infection, especially by disseminated infections or neoplasms. These lesions are generally asymptomatic and are discovered at autopsy. However, hypoglycaemia secondary to massive pancreatic infiltration by a tumour or tuberculous necrosis may occur. The most important cause of pancreatic dysfunction in HIV-infected patients is a drug toxic effect (intravenous pentamidine, didanosine, zalcitabine). Hypoglycaemia, which may or may not be followed by diabetes, can develop during intravenous pentamidine therapy. In cases with increased serum amylase and/or lipase levels, potentially toxic drugs must be promptly discontinued to avoid major pancreatic involvement.