Biomedical subjects
Publications and source records attributed to E Pujol.
We report the first case of IgA-kappa multiple myeloma presenting as a myelomatous and eosinophilic pleural effusion with increased adenosine deaminase activity. In a review of the literature, 80 percent of myelomatous pleural effusions are due to IgA multiple myeloma.
HIV infection is a predisposing factor for pneumococcic infection. While pneumonia is the most frequent location, other locations (articular, meningeal, endocardiac, etc) have been less frequently described. Among the articular infections described in patients with HIV infection, the sternoclavicular affection is extremely rare and it usually develops in association with parenterally drug addiction, being Staphylococcus aureus and Pseudomonas aeruginosa the most frequently germs involved. We describe the first case of sternoclavicular arthritis by Streptococcus pneumoniae in a patient with HIV infection. In our case, the chronic hepatopathy associated to alcohol consumption is a predisposing factor related to the pneumococcic infection. Our case suggests the need to formally investigate the HIV infection in young patients with invasive pneumococcic infection.
Hodgkin's disease (HD) is not currently accepted as an AIDS diagnostic criterion by the Centers for Disease Control (Atlanta), although there are reports on a higher incidence of the disease in HIV infected patients, with the special feature of a marked clinical and histological aggressiveness. A review of the literature was made and a total of 54 cases of HD compiled of patients with HIV infection. The relationships between the absolute counts of CD4 and the CD4/CD8 ratio with histopathology and with the stage at diagnosis was investigated. No significant differences were found between the absolute counts of CD4 and CD4/CD8 ratio with the clinical stage of disease, histopathologic subgroup or presence of B symptoms in HD. Nevertheless, lower CD4 counts were observed in more advanced clinical stages and in patients with B symptoms; the highest CD4/CD8 ratios were observed in patients with more advanced disease. It is hypothesized that immunological disturbances caused by HIV would lead to more aggressive histological lesions and more advanced stages of HD in HIV-positive patients. Thus, the inclusion of HD as a diagnostic criterion of AIDS would be warranted.
The incidence of adult Wilms' tumor is difficult to determine but the lesion is rare. The prognosis is poorer than in children, but in adults is often diagnosed at a higher clinical stage and with an unfavorable histologic type. There may be other reasons for the poor prognosis as well. A 33-year-old woman with metastatic disease (bilateral kidney tumors, pulmonary and multiples lymph nodes metastases) is described. Treatment with chemotherapy consisted of doxorubicin, ifosfamide and etoposide which resulted in complete remission that persisted for only three months. The factors that probably contributed to rapid progression included un favorable histology (predominant nodular blastematous elements which were anaplastic) and advanced disease. The precise histologic diagnosis was late precluding to plan the correct treatment.
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Antibodies to HTLV-I/II were investigated in sera from 7521 individuals living in Spain. They were classified in four major groups: a) subjects at high risk of retroviral infections e.g. parenteral drug addicts, homosexuals, prostitutes, and multiple-transfused individuals; b) patients suffering illness associated with HTLV-I in endemic regions; c) immigrants from endemic areas; and d) blood donors. Sera were collected from 1984 to December 1991. Repeatedly reactive ELISA was found in 211 samples (2.8%), but Western blot only confirmed the presence of HTLV-I/II antibodies in 23 samples (0.30%), corresponding to eight (0.25%) out of 3207 drug abusers, six (0.72%) out of 894 immigrants (five Africans and one South American), three (0.41%) out of 727 patients with HTLV-related diseases (one woman with HTLV-I associated myelopathy had received blood transfusions in an endemic area), four (0.54%) out of 793 prostitutes, one multiple-transfused native woman, and one (0.16%) out of 603 native seamen. The Western blot antibody pattern confirmed HTLV-II infection instead of HTLV-I in nine (39%) subjects. The remaining 14 (61%) HTLV-reactive samples were interpreted as HTLV-I seropositive, most of which were from immigrants. None of 857 blood donors analysed was reactive for HTLV antibody. These results suggest that both HTLV-I and HTLV-II are present in Spain, although at a low rate and mostly restricted to individuals coming from endemic areas, drug addicts, and prostitutes. Furthermore, diseases related to HTLV-I (particularly lymphoproliferative disorders, and subacute myelopathies) seem to be rarely associated with these viruses in Spain, a non-endemic area.
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A simple and rapid in vitro chemical solubility test applicable to industrial uranium trioxide (UO3) was developed together with two in vitro cellular tests using rat alveolar macrophages maintained either in gas phase or in alginate beads at 37 degrees C. Industrial UO3 was characterized by particle size, X-ray, and IR spectra, and chemical transformation (e.g., aging and hydration of the dust) was also studied. Solvents used for the in vitro chemical solubility study included carbonates, citrates, phosphates, water, Eagle's basal medium, and Gamble's solution (simulated lung fluid), alone, with oxygen, or with superoxide ions. Results, expressed in terms of the half-time of dissolution, according to International Commission on Radiological Protection (ICRP) classification (D,W,Y), varied for different hydration states of UO3, showing a lower solubility of hydrated UO3 in solvents compared to basic UO3 or UO3 heated at 450 degrees C. Two in vitro cellular tests on cultured rat alveolar macrophages (cells maintained in gas phase and cells immobilized in alginate beads) were used on the same UO3 samples and generally showed a lower solution transfer rate in the presence of macrophages than in the culture medium alone. The results of in vitro chemical and cellular tests were compared, with four main conclusions: a good reproducibility of the three tests in Eagle's basal medium the effect of hydration state on solubility, the classification of UO3 in terms of ICRP solubility criteria, and the ability of macrophages to decrease uranium solubility in medium.
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In order to assess the efficacy and the toxicity of zidovudine in AIDS patients, we have studied, prospectively, 117 patients that were treated with this drug, in several andalusian hospitals between January 1988 and June 1990. Initial dose of the drug was 200 mg every 4 hours. Mean survival was 100% at 6 months and 66.5% at 23 months. Survival at 19 months was higher in ADVP (77%) than in non-ADVP (48%). A positive influence on weight. Karnofsky index and number of opportunistic infections during the six first months of treatment was recorded, benefit that was lost progressively from that moment onwards. Main adverse effects were hematological, 10.1% of the patients requiring transfusions due to hemoglobin lower than 6.5 gr%. The more frequent cause to stop therapy was severe neutropenia (less than 500 neutrophils per mm). We consider that the beneficial effect of zidovudine is only transient, diminishing gradually when the treatment is prolonged. At present doses adverse effects are moderate not being present in most of the patients.
In the past 4 years we have treated four patients with a total of 19 fetal liver infusions (FLI). Two cases of refractory anemia with excess blasts in transformation (RAEB-t) were conditioned with cyclophosphamide and total body irradiation (1400 cGy) and were treated with FLI. In spite of such intensive conditioning, one patient recovered autologous hemopoiesis 3 weeks later, remaining in remission 4 years after this procedure. The second patient died with aplastic marrow on day 154, and the third suffered from severe aplastic anemia refractory to several types of conventional treatment. After FLI and without previous conditioning therapy a partial fetal engraftment was documented. This was transient and followed by autologous hemopoietic recovery and cure of the disease. The fourth patient had bone marrow failure in the setting of a severe pneumonia following autologous bone marrow transplantation. Ten days after FLI the hematological parameters dramatically improved and the pneumonia resolved. Autologous reconstitution of hemopoiesis was demonstrated. These experiences suggest that FLI might stimulate autologous hemopoiesis. This therapeutic approach may be useful to treat bone marrow failure when there is no response to first-line therapy. In hematologic malignancies with an indication for stem cell transplantation, other sources such as allogeneic or autologous bone marrow seem preferable to fetal liver cells.
We report the results of the epidemiological and serological studies concerning HIV-1 and HIV-2 infections carried out in a group of 203 seamen who visited the sub-Saharan area (west coast of Africa). The following risky practices were detected: history of drugs abuse 8 (3.9%), transfusion 3 (1.5%), use of parenteral medicines in Africa 80 (39.4%), surgery in Africa 41 (20%), tattoos 18 (8.9%). Sexual behavior: stable couple 180 (88.7%), number of sexual couples 4.2 +/- 6, contacts with prostitutes 108 (53%), contacts with prostitutes in Africa 83 (40.9%), others heterosexual contacts 58 (28.6%), homosexual 1 (0.5%), history of VD 34 (16.7%), 94% of the seamen never (or occasionally) used the preservative with theirs couples and 73% of them didn't use it with others contacts. Four seamen were HIV-1 (+): contacts with prostitutes in Africa 2, use of parenteral medicines in Africa 1 and drugs abuse 1. We observed a high prevalence of risky practices associated with HIV-1 infection between seamen population. It is interesting to remark the importance of heterosexual transmission and the use of parenteral medicines.
The aim of this paper is to ascertain the spread pattern of HIV-2 in patients at risk in an area of frequent contact with sub-Saharan Africa and evaluate the seric marker of HIV-2 infection. 606 serum samples from 524 patients were analysed. 445 patients were intravenous drug users (IDU), 17 used inhaled drugs, 26 had HIV-2 (+)partner, and others 36 high-risk practice. The ser were analysed for HIV-1 and HIV-2, using ELISA, Western blot (LAVBLOT 1, LAVBLOT 2) and specific synthetic peptides such as gp 41 and gp 36 (PEPTI-LAV 1-2). 245 out of 524 (47%) patients were HIV-1 (+). 65 out of 524 (12.4%) were Elavia-2 and HIV-1 (+). All samples tests using Western blot 1, confirmed the results of the ELISA (2 protein of the membrane). The Western blot of HIV-2 Elavia-2 (+) in 2/53 showed two proteins of the membrane and 26/53 one protein of the membrane and several of the core. The PEPTIL-LAV 1-2 was HIV-1 positive in 77/77 HIV-1 serum samples and in 10 HIV-2 positive, however, in all cases the HIV-2 reactivity was lower than HIV-1, allowing the orientation of the diagnosis towards the HIV-1 positive serum. In spite of the frequent contact with Africa, the spread of HIV-2 in the south of Spain is still quite insignificant. The Western blot of HIV-2 gives a high proportion of double reactivity, including those cases with restrictive criteria to be positive. PEPTI-LAV 1-2 has proved most useful in the diagnosis orientation in the cases of crossed reactivity between HIV-1 and HIV-2.
In order to assess if HTLV-1 retrovirus had penetrated in a group of sailors that often travel to endemic areas for HTLV-1 infection (West coast of sub-Saharan Africa) we have performed the following study. A total of 499 sera samples from sailors traveling to Africa during the last five years were studied. The presence of HTLV-1 antibodies was determined using an enzyme-linked immunosorbent assay (ELISA, Dupont HTLV-1). Positive ELISA test results were further confirmed using a Western blot technique. In all patients the presence of HIV-1 and HIV-2 antibodies was also tested using ELISA and Western blot techniques. Using ELISA we find 7 positive sera to HTLV-1 (1.4%) but only one sera sample (0.2%) was also positive by Western blot analysis. We conclude that HTLV-1 infection is entering a population group traveling to endemic areas. The possibility of heterosexual transmission of the virus in our environment has to be taken into account.
The aim of this study is to detect the presence of HTLV-1 in a high-risk population in west Andalusia. We studied 267 samples of serum from 255 patients: 179 of these patients being intravenous drug-users, 14 had ADVP sexual partners, 16 were inhalation drug-users, 4 were hemophiliacs, 9 had other high-risk habits and 25 hematological patients afflicted with leukemia or lymphoma. All of them were tested for antibodies against HTLV-1 by means of an in vitro qualitative ELISA technique (ELISA Du Pont HTLV-1). The positive results were confirmed by the Western blot technique. Additionally, the p24 antigen and the antibodies against VIH-1 and VIH-2 (ENV/CORE) were analysed, except in the 25 hematological patients. We found 20 serum samples positive to HTLV-1 by ELISA (7.4%), but only 1 (0.3%) was confirmed by the Western blot technique. The prevalence of VIH-1 was 46%; 9% had p24 VIH antigen and 26% had false positive ELISA to VIH-2. We found a statistically significant relationship (p = 0.0005) between positive ELISA to HTLV-1 and antibodies against VIH. We conclude that HTLV-1 has penetrated into the high-risk population of west Andalusia , although not yet to a great degree, and point out the need for seric epidemiological surveillance to prevent the spread of the retrovirus in these groups.
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