Perforation of the colon in high-dose corticosteroid therapy of pemphigus.
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Biomedical subjects
Publications and source records attributed to M A Conant.
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Perioral leukoderma simulating vitiligo developed in a 25-year-old woman. A patch test to cinnamic aldehyde was positive; depigmentation was observed at the patch test site three months after initial application. No changes in pigmentation occurred from a concomitant allergic patch test reaction to neomycin sulfate; only hyperpigmentation occurred at the site of an irritant patch test reaction to nonanoic acid. A toothpaste containing cinnamic aldehyde was implicated; perioral hypopigmentation resolved when a toothpaste without cinnamic aldehyde was substituted. A repeated patch test to cinnamic aldehyde again showed depigmentation at the patch test site three months after application.
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A patient with chronic cyclitis developed hyperemia of the episcleral and bulbar conjunctival vessels after retrobulbar injections of methylprednisolone acetate suspension. Intradermal testing revealed the responsible allergen to be methylprednisolone acetate; hypersensitivity could not be demonstrated by patch testing, despite use of increased concentrations.
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The relationships among stressful life experience, mood, helper-inducer (CD4+) and suppressor-cytotoxic (CD8+) T cells and genital herpes simplex virus (HSV) recurrence were investigated prospectively in 36 patients with recurrent HSV. The following factors were measured monthly for six months: stressful life experience (including current acute and ongoing stressors, residual effects of previous stressors, and anticipation of future stressors), negative mood, health behaviors, other possible HSV triggers, HSV recurrences, and the proportion of CD4+ and CD8+ cells (in half the sample). Results averaging monthly scores over the six-month study period indicated that: 1) subjects with high levels of stressful experience had a lower proportion of both CD4+ and CD8+ cells, 2) subjects with high levels of depressive mood, anxiety, or hostility had a lower proportion of CD8+ cells, and 3) subjects with high levels of depressive mood who did not report many symptoms of other infections had a higher rate of HSV recurrence. A model is proposed linking depressive mood, CD8+ cells, and HSV recurrence.
The incidence of genital herpes simplex infections has risen at a rapid rate over the past 20 years. Sexually active young adults ask whether condoms will effectively block the transmission of herpes simplex virus from one individual to another. Using a laboratory plunger model to stimulate human coitus, the authors have shown that high concentrations of HSV-2 did not cross the latex or natural membrane condoms that were tested. We have also shown that high concentrations of HSV-2 left in contact with a condom for 8 hr does not penetrate the barrier. This study gives good indirect evidence that condoms block the transmission of herpes simplex virus.
The AIDS epidemic continues to spread at a rapid rate with a doubling of the number of reported cases every 9 to 12 months. The impact of AIDS in the workplace is just beginning to be felt and the number of disabled workers will increase substantially over the next few years. Employees who have been infected with the AIDS retrovirus can be allowed to work without risk to fellow employees. The CDC has published recommendations for preventing the transmission of AIDS in the workplace.
We surveyed 454 men in November 1983 and in May 1984 regarding their sexual practices during the month before the survey. In the 1983 survey, we also asked for reports about sexual behavior during the same month 1 year prior to the survey. The sample consisted of men recruited as they left bath-houses and bars, men who had not used bars or baths for meeting sexual partners for 2 months prior to the November 1983 survey, and men in committed primary relationships with another man. We found substantial changes in reported sexual behavior with persons other than a primary partner. The average number of male partners declined from 6.3 in November 1982 to 3.9 in May 1984. Receptive anal intercourse without condom declined from 1.9 to 0.7, oral-anal contact declined from 1.1 to 0.3, and swallowing semen declined from 2.8 to 0.7 in terms of the number of times that the respondent engaged in the act in the last month. These same changes did not occur in relation to sex with a primary partner. Only one variable, namely, increased length of time since the first homosexual experience, distinguished persons maintaining few sexual partners from those increasing the number of sexual partners from November 1983 to May 1984. Four variables distinguished those retaining high numbers of sexual partners from those lowering the number of sexual partners, namely, ability to remember a visual image of AIDS deterioration, age, relationship status, and length of time since first homosexual experience.
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BACKGROUND: Clinicians caring for patients who have acquired immunodeficiency syndrome (AIDS) need to be aware of the wide variety of infectious diseases that can occur. Although Pneumocystis carinii pneumonia (PCP) is the most common AIDS-defining infection, other opportunistic infections associated with advanced immunodeficiency can develop after an initial diagnosis. METHODS: To ascertain AIDS-defining opportunistic infections that developed at the time of or after an AIDS diagnosis, and intensive chart review was conducted for 45 homosexual men with AIDS who died from 1990 through 1992. Time to death after first occurrence of these infections was also determined. RESULTS: The most common opportunistic infection occurring as the initial AIDS-defining illness was PCP (31 percent). The most common opportunistic infection occurring as a secondary disease was cytomegalovirus (CMV) disease (40 percent), followed by disseminated Mycobacterium avium complex (33 percent) and invasive candidiasis (31 percent). Each of these latter infections was associated with a poor prognosis (median time to death < or = 8 months). CONCLUSIONS: Diseases caused by CMV, disseminated M. avium complex, and invasive candidiasis were uncommon presenting manifestations of AIDS but were common secondary diseases that tended to be associated with limited survival. With increasing survival and a declining incidence of PCP as a result of medical therapy, other severe opportunistic infections might become increasingly recognized.