Roberta A. Monson

Idiopathic CD4+ T-Lymphocytopenia -- An Analysis of Five Patients with Unexplained Opportunistic Infections

BACKGROUND Although patients with idiopathic CD4+ T-lymphocytopenia and serious opportunistic infections have been described previously, the clinical and immunologic features of this condition have not been well defined. METHODS We studied in detail five patients with idiopathic CD4+ T-lymphocytopenia. The studies included serologic testing, culture, and polymerase chain reaction for the human immunodeficiency virus (HIV) types 1 and 2, serologic testing for the human T-cell lymphotropic virus (HTLV) types I and II, lymphocyte phenotyping, immunoglobulin quantitation, and lymphocyte-transformation assays, as well as attempts to isolate a retroviral agent. The results were compared with those in HIV-infected persons matched for CD4+ T-cell counts and with those in normal controls. We also studied the spouses of patients and the blood donors for one patient. RESULTS In these five patients, there was no evidence of either HIV or HTLV infection. All the patients had both low percentages and low counts of CD4+ T cells, with relative increases in percentages, but not counts, of CD8+ cells. Numbers of B cells and natural killer cells were generally normal. As compared with HIV-infected persons, our patients had lower percentages and counts of CD8+ cells and more lymphopenia. CD4+ counts were relatively stable over time. Instead of the high immunoglobulin levels seen in HIV infection, these patients had normal or slightly low levels of immunoglobulins. The lymphocyte-transformation response to mitogens and antigens was depressed. Results in spouses and blood donors were normal. CONCLUSIONS Idiopathic CD4+ T-lymphocytopenia differs from HIV infection in its immunologic characteristics and in its apparent lack of progression over time. Nothing about the immunologic or viral-culture studies performed in these patients or about their family members or blood donors suggests that a transmissible agent causes this condition.

Somatization Disorder in Primary Care

The dilemma of the patient presenting with multiple somatic symptoms is a common one for the general physician. The patient may have a confusing, subtle presentation of a systemic illness, which th...

Somatization disorder in men

Somatization disorder is thought to be rare in men. This paper reviews five previously reported cases of somatization disorder in men and reports nine new cases referred from primary care physicians. These men have most of the associated features of the disorder, are of lower socioeconomic status, and have other significant psychiatric diagnoses. Eight of the nine men had a dramatic precipitating event at the onset of their illness. This diagnosis appears to be applicable to men and needs to be considered in men with multiple, recurrent unexplained medical symptoms.

Similarities of a general medicine clinic in a teaching hospital to internal medicine practice. Clinic compared with private practice.

The authors undertook this study to determine whether a general medicine clinic in a teaching hospital provided an experience similar in content to that in the office of a general internist. Data on all patient visits to the university clinic during 1979 were collected. Analyses of 4856 visits revealed significant differences (p<0.001) in duration of visit, admission rate, and referral rates between the clinic and internists studied by the National Ambulatory Medical Care Survey (NAMCS). However, the 12 most common problems seen in the clinic were among the 15 most common problems seen by NAMCS physicians despite some differences in the prevalence of certain diagnoses. Knowing the relative prevalence of specific diagnoses in this setting helps teach cost-benefit principles of ordering diagnostic studies designed to detect uncommon problems. This study supports the value of a teaching hospital ambulatory care experience as preparation for the practice of general internal medicine.