P. Dujardin

Visceral leishmaniasis and HIV-1 co-infection in southern France

Between 1986 and 1993 visceral leishmaniasis (VL) was diagnosed in 50 adult patients with human immunodeficiency virus type 1 (HIV-1) infection (8 females, 42 males: 31 intravenous drug users, 11 homosexual or bisexual men, 6 heterosexual individuals, 2 blood recipients) from 5 hospital centres in southern France. Diagnosis of VL was by demonstration of Leishmania and isolation of promastigotes by culture in Novy-McNeal-Nicolle medium. Leishmania isolates were identified by their isoenzyme profile in 28 patients. All the patients were immunocompromised when VL was diagnosed. Their median CD4 cell count was 25 x 10(6) (0-200). However, only 21 patients (42%) fulfilled the 1987 CDC criteria for the acquired immune deficiency syndrome before VL developed. Fever (84%), splenomegaly (56%), hepatomegaly (34%), and pancytopenia (62%) were the most common presenting features. Clinical signs were lacking in 10% of patients. Anti-leishmanial antibodies were detected by indirect immunofluorescence or enzyme-linked immunosorbent assay in 26/47 cases (55%). Combining these techniques with Western blotting (WB) gave a positivity rate of 95%. Amastigotes were demonstrated in bone marrow aspirates in 47 cases (94%). Unusual sites for parasites were found in 17 patients (34%), mainly in the digestive tract but also skin and lung. Viscerotropic L. infantum zymodeme MON-1 was characterized in 86% of cases. Dermotropic zymodemes MON-24, MON-29, MON-33, and a previously undescribed zymodeme MON-183, were isolated from 4 patients. The response rate to pentavalent antimony was 50% and to amphotericin B 100%, but clinical relapses were noted in both groups. In endemic areas, VL should be considered as a possible opportunistic infection in HIV-infected patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Non‐excretory Multiple Myeloma

Summary. The clinical and laboratory features in five patients with non‐excretory myeloma are described including plasma cell immunofluorescence and, in two cases, ultrastructure. Findings are compared with those in similar patients previously reported, and those in excretory disease. Clinical, haematological and biochemical features were similar to those found in excretory myeloma, showing differences only in relation to the absence of serum or urinary monoclonal immunoglobin. Cellular cytological and ultrastructural features allowed no differentiation from excretory cells. Within this non‐excretory group distinction between secretory and non‐secretory myeloma cells is possible on the basis of immunofluorescence. Differing patterns of intermittent excretion occurred in three of these patients.

Ticlopidine and severe aplastic anaemia.

positive for CDI 3 . CD3 3 and HLA-DK. with CD34 expression occurring in all but one patient (Table I). Cytogenetic analysis was abnormal in all patients, although no single abnormality prevailed (Table I). No patient gave a history of suspicious chemical or toxin exposure. Three patients received standard MKC-AML 10 or 11 trial chemotherapy. two received a similar anthracycline, cytosine combination while the sixth. on account of age, received subcutaneous cytosine and oral thioguanine only. Two patients entered remission, one lasting 2 years before relapsing with resistant disease, while the second is alive and well 7 months post AML 10 chemotherapy (without ABMT). All four patients who failed to enter remission died within 10 weeks of presentation. It is noteworthy that the patient who is alive at 7 months entered remission after one course of chemotherapy (DAT 3 + 10). was negative for CD34 and had the lowest white cell count at presentation. Interestingly, CD34 expression has been shown to have independent prognostic significance in AML and is associated with resistance to remission induction chemotherapy (Geller et al, 1990). In conclusion, our experience with AML-MO. albeit small, reveals certain trends: ( i ) poor remission rates with associated poor survival, ( i i ) a high incidence ofcytogenetic abnormality (lOOO/,). and ( i i i ) most cases express CD34. Clearly additional patients need to be studied to contirm these tindings, and also

Impact of HAART-related side effects on unsafe sexual behaviours in HIV-infected injecting drug users: 7-year follow up.

Objective: To investigate the impact of non-lipodystrophy HAART-related side effects on unprotected sexual behaviours among HIV-infected drug users. Designand participants: HAART-treated patients who reported having occasional partners during the follow-up period after HAART initiation were selected among patients of the MANIF 2000 cohort of HIV-infected drug users. Methods: Visits where patients reported unsafe sexual behaviours with occasional partners were compared to visits where they reported safe sexual behaviours using a logistic model based on Generalized Estimating Equations. Results: One-hundred and ninety-two HAART-treated patients reported occasional sexual partners at least once during follow-up, accounting for a total of 464 visits. Among these 192 patients, 134 (70%) declared at least once unsafe sexual behaviours with occasional partners. During follow-up, three or more HAART-related side effects were reported in 273 of the 464 visits. When comparing visits where patients reported unsafe sexual behaviours with occasional partners (n = 249) with those where they reported safe sexual behaviours (n = 215), experiencing three or more HAART-related side effects was significantly associated with unsafe sex after adjustment for cofactors such as injecting drug status, reporting more than two sexual partners and having sex more than once a week. Conclusions: Perceived side effects play a role in determining unsafe sexual behaviours. HIV prevention interventions must consider the negative impact of HAART-related side effects on sexual risk-taking behaviours. Drug maintenance programs contribute to sexual risk reduction among drug injecting patients.

MACOP-B Chemotherapy for the Treatment of High-Grade Lymphomas in Patients with HIV-1 Infection

Recent studies showed that patients with non-Hodgkins lymphoma (NHL) with human immunodeficiency virus type 1 (HIV-1) infection may benefit from an intensive chemotherapeutic regimen. We report on our experience in the treatment of NHL-associated HIV-1 infection, with excellent prognostic factors, with MACOP-B regimen.

Interferon and Delta Hepatitis

Excerpt To the Editor:Aach (1) states that interferon is the most promising antiviral agent for treating patients with chronic type B viral hepatitis. For patients at risk for infection with human ...

Accidents systémiques des bêta-bloquants en collyres: à propos de six observations

Six cases of systemic reactions to topical treatment with beta-blocking eyedrops are reported, bradycardia and faintness due to an overdosage of ophthalmic timolol; decompensated heart failure one month after the prescription of carteolol eyedrops: bronchospasm after two weeks of treatment with metipranolol eyedrops; crippling Raynauds phenomenon of otherwise unknown origin, which had begun with timolol eyedrops, continued with carteolol eyedrops and regressed after discontinuation of ophthalmic beta-blockers; aggravation of an anaphylactoid shock in a patient treated with ophthalmic timolol, and myocardial infarction possibly due to the abrupt withdrawal of timolol eyedrops. It cannot be overstressed that the rules governing the prescription of oral beta-blockers also apply to ophthalmic preparations of these drugs: respect of contra-indications, strict adherence to the dosage recommended, gradual drug withdrawal and regular supervision. Only controlled studies and long-term follow-up will be able to demonstrate differences in safety between the five beta-blockers commercialized as eyedrops in this country.

Un cas de cryptococcose neuroméningée chez un patient non sidéen

Summary A case of meningitis due to cryptococcus was diagnosed in a 22 years old woman. The diagnosis was assessed by the presence of cryptococcus in the cerebrospinal fluid. The evolution was favourable with fluconazole therapy. There was no identified risk factor and particularly, the serology for HIV was always negative 29 months later.

Lymphome malin et polyarthrite rhumatoïde traitée par méthotrexate

It is actually possible that the mild immunosuppression that occurs with methotrexate therapy places patients with rheumatoid arthritis at added risk for developing lymphoproliferative diseases. So we describe a new case.

Polycythemia secondary to hepatic hemangioma with abnormal secretion of erythropoietin

A 37-year-old man was admitted for asymptomatic polycythemia. On examination, blood pressure was 140/90 mm Hg. The left lobe of the liver was enlarged and the spleen and the kidneys were not palpable