The clinical and histological features of three HIV1-positive patients are reported of whom two showed persistent focal lesions on serial chest X-rays without any demonstrable lesion on repeated bronchoscopies. The third patient presented with recurrent pneumothorax. By thoracoscopy peripheral lung tissue was obtained in all cases, showing localized histomorphological findings compatible with a prolonged interstitial reaction around Pneumocystis carinii (PC) organisms and their breakdown products. Based on the finding of foreign body granulomas and an increased number of alveolar macrophages, we propose a hypothetical pathway for the development of this unusual reaction to PC infection focusing on the possible secretion of tumor necrosis factor alpha by activated macrophages. By this model the unusual features of PC infection in our patients and in the literature could be explained. Furthermore, in these cases possibly an additional oral or intravenous treatment might be indicated.

AIDS-Related Opportunistic Infections↗

PubMedDate not supplied

Bone marrow hypoplasia and fibrosis following interferon treatment.

Interferon treatment is known to cause hematologic changes such as thrombocytopenia, anemia and granulocytopenia or combinations thereof. Patients previously treated with chemotherapeutic drugs followed by alpha interferon treatment developed even more severe pancytopenia and aplasia. Case reports of two patients who received treatment with alpha interferon 2a are reported here. Both patients were previously treated with chemotherapy, but with a long interval before starting IFN administration. Patient one developed life-threatening bone marrow hypoplasia and aplasia after interferon treatment and died. Patient two showed similar but less severe changes in bone marrow, i.e. thrombocytopenia, mild leukopenia and anemia. The clinical course of both patients was followed by routine peripheral blood tests and bone marrow biopsies and permit some reflection on the pathogenesis of marrow hypoplasia. Myelosuppressive effects of interferon treatment are discussed in the context of chemotherapy effects, cytokine actions and potential additional influences of herpesvirus infections.

Adult↗

PubMedDate not supplied

[Endoscopic treatment of perforating veins--current data].

Blind dissection of incompetent perforators is common practice for vein surgeons. Since many years some of them have been trying to do this endoscopically by means of the proctoscope or other endoscopes used for different purposes. At present however several surgeons are developing special instruments for this type of endoscopy. Lately some of these surgeons came together to work up their experiences and to study the probable future of the method. It permits the diagnosis and at the same time the treatment of incompetent perforators. It allows the healthy ones to be spared. All this can be done from a small incision distant to the site of the perforators where the skin often presents with trophic changes. However general or regional anesthesia as well as the bloodless limb technique are prerequisites. As any endoscopy also this one has its specific dangers and complications and therefore has to be learned and performed carefully.

Angioscopes↗

PubMedDate not supplied

[Superiority of pantoprazole over ranitidine in the treatment of duodenal ulcer. Mexican clinical experience. Mexican Study Group of Pantoprazole++ in Duodenal Ulcer].

BACKGROUND: Pantoprazole is a new Proton Pump Inhibitor that has demonstrated to be superior to ranitidine in the healing of the acid related diseases. AIMS: To compare efficacy and tolerability of oral treatment with pantoprazole vs. ranitidine in outpatients with endoscopically confirmed florid duodenal ulcers in Mexican patients. METHODS: Prospective, multicentric, balanced, randomized, double blind, parallel group comparison clinical trial. Each patient received 40 mg pantoprazole plus placebo or 300 mg ranitidine plus placebo once daily for 2 weeks; if patients had not healed endoscopically by then, treatment was continued for two more weeks, with a final endoscopy. RESULTS: 163 protocol-correct patients were analyzed: 82 for pantoprazole group and 81 for ranitidine group. Healing rates at week 2 were 72% for pantoprazole and 51% for ranitidine (p < 0.01) and correspondingly 95 and 86% at week 4. The percentage of patients suffering from pain declined faster in the pantoprazole group. Both products were well tolerated and safe. CONCLUSIONS: Pantoprazole is well tolerated and significantly superior to ranitidine in florid duodenal ulcers healing.

2-Pyridinylmethylsulfinylbenzimidazoles↗