Skin diseases disclosing human immunodeficiency virus infection in Mali

BACKGROUND: Ultrafiltration failure (UFF) is a complication of peritoneal dialysis (PD) treatment that occurs especially in long-term patients. Etiological factors include a large effective peritoneal surface area [measured as high mass transfer area coefficient (MTAC) of creatinine], a high effective lymphatic absorption rate (ELAR), a large residual volume, or combinations. OBJECTIVE: The prevalence and etiology of UFF were studied and the contribution of transcellular water transport (TCWT) was analyzed. A new definition of UFF and guidelines for the analysis of its etiology were derived from the results. SETTING: Peritoneal dialysis unit in the Academic Medical Center in Amsterdam. DESIGN: Cross-sectional study of standard peritoneal permeability analyses (4-hr dwells, dextran 70 as volume marker) with 1.36% glucose in 68 PD patients. Patients with negative net UF (change in intraperitoneal volume, dIPV < 0 mL) were analyzed further using 3.86% glucose, whenever possible. RESULTS: Among 68 patients (duration of PD 0.3-178 months), 39 had negative net UF with 1.36% glucose. These patients had greater MTAC creatinine and glucose absorption, and higher ELAR (p < 10(-4)) than the patients with positive UF. dIPV and transcapillary UF rate (TCUFR) were lower (p < 10(-5)). Twenty of these patients could be studied using 3.86% glucose. dIPV was greater than 400 mL/4 hr in this test in 12 patients, implying that no clinically important UFF was present. Ultrafiltration failure (dIPV < 400 mL) was found in 8 patients, giving a prevalence of 23%. This last group had been treated with PD for a longer period (p = 0.03), had higher ELAR (p = 0.07), but lower residual volume (p = 0.03), and lower TCUFR (p = 0.01). Ultrafiltration failure was associated with a high MTAC creatinine in 3 patients, a high ELAR in 4 patients, and a combination of factors in one. As an additional possible cause, TCWT was studied, using the sodium gradient in the first hour of the dwell, corrected for diffusion (dNA). Five patients had dNA > 5 mmol/L, indicating normal TCWT. The 3 patients with dNA < 5 mmol/L tended to be treated longer (p = 0.19) and had lower TCUFR (p = 0.04). A smaller difference was found between dIPV 3.86% and 1.36% (p = 0.04) compared to the dNA > 5 mmol/L group, but no differences were present for MTAC creatinine, ELAR, residual volume, or glucose absorption. CONCLUSIONS: In addition to known factors, impairment of TCWT can be a cause of UFF. A standardized dwell with 1.36% glucose overestimates UFF. Therefore, 3.86% glucose should be used for identification of patients with UFF, especially because it provides additional information on TCWT. Ultrafiltration failure can be defined as net UF < 400 mL/4 hr with 3.86% glucose during a 4-hour exchange.     

The impact of a family planning multimedia campaign in Bamako, Mali

An integrated multimedia campaign featuring family planning messages saturated the 900,000-person city of Bamako, Mali, for three months during the spring of 1993. With traditional theater and music, family planning messages were repeatedly broadcast on radio and television that conveyed information about modern contraceptive methods, the need for male sexual responsibility, the health and economic advantages of family planning, the need for communication between spouses, and that Islam, the predominant faith of Mali, does not oppose family planning. A separate sample pretest-post-test quasi-experimental research design was used to evaluate the effects of the campaign and exposure to specific messages on changes in contraceptive knowledge, attitudes, and practice. Results indicate a high level of exposure to and agreement with the messages. A dramatic drop was found in the proportion of men and women who believe that Islam opposes family planning. Logistic regression results indicate that contraceptive knowledge and use and more favorable attitudes toward family planning are positively associated with intensity of exposure to the project interventions, after controlling for relevant variables.     

The cost of the surgical treatment of cataracts at the African Institute of Tropical Ophthalmology (Bamako, Mali)

In developing countries, cataracts are a serious public health problem. There are a large number of patients, an estimated 3 millions in Africa alone, awaiting operations. However, the number of surgical interventions is small for a variety of reasons, including the cost. To try to reduce the cost of surgery, we analysed the various elements involved at the African Institute of Tropical Ophthalmology (AITO) in Bamako (Mali). The route followed by the patient, from contact with the health service through to post-operative health care was analysed in terms of individual jobs, supplies and equipment required. The unit cost of each of these elements was assessed using an adapted calculation method. The results show that the cost of the removal of the lens at the AITO is 15,200 FCFA (or $56). Installing an intra-ocular lens significantly improves the outcome for a similar cost (16,500 FCFA or $60). The relative costs of various elements were as follows: food, 32%, the suture, 12%; and equipment only 13%. Thus, to reduce the overall cost of surgery for cataracts, ambulatory surgery should be organised, with efforts to reduce the costs of suture. High quality equipment should be used, because its life-span is such that it can be amortised over a long period.     

Skin diseases associated with chronic hepatitis C

The authors are discussing hepatic and extrahepatic pathologic processes caused by hepatitis C virus (HCV) infection and they focus their interest to the skin disorders appearing in the presence of chronic, active HCV infections. The trigger of the immunologic processes leading to dermatologic manifestations are the activated T cells (CD8 + cytotoxic T lymphocytes), cytokins, and also the expansion of certain B cells. Pathologic immunologic phenomena may initiate various dermatologic manifestations. Immunoglobulins, immuncomplexes generated by the disease itself are manifested as various forms of cutan vasculitis. In the present series of patients (pts), HCV related skin disorders known from the literature were diagnosed in eleven cases and they were representing 7 different disease entities. These were palpable purpura (3 pts), urticaria, prurigo and alopecia areata (2-2 pts), lichen ruber planus, pruritus and vitiligo (1-1 patient respectively). The case reports of 2 pts, one with palpable purpura (vasculitis purpurica), one with prurigo and vitiligo are presented in details.     

Adhesion molecules in kidney diseases (part I)

Adhesive molecules are (glyco)proteins of the cellular membranes. All of them have their extramembranous, transmembranous and intracytoplasmatic parts. As receptor molecules, their extracellular parts bind the specific ligand. The ligand can be found on the surface of the other cell or in the extracellular matrix (basal membranes). The following families of adhesion molecules are: cadherins, selectins, integrins and members of immunoglobuline supergene family. Different members of the same family could have different times (in ontogenesis, in adult form) and space distribution (in different tissues, different tissue structures). The contact between the cells and basal membranes with these molecules is important for cell division, maintaining the tissue architecture, polarization and function of cells, migration of cells, endo- and exo-cytosis as well as for maintaining the structure and function of basal membranes. As above stated all this is important in the occurrence morphogenesis, haemostasis, inflammation, malignant cell transformation and metastasis. This knowledge is important for the better understanding of renal diseases.     

Antibodies to neuromediators in allergic diseases (pollinosis)

Sera from 33 pollinosis patients aged 16-33 have been examined for autoantibodies to neuromediators serotonin and catecholamine, serum samples from 21 healthy subjects served controls. Antibodies to dopamine and norepinephrine (43.0 +/- 4.0, 35.0 +/- 0.0 rel. units) have been detected in 81.8% and 69.7% of the pollinosis patients, respectively. Serotonin antibodies (54.6 +/- 6.0 rel. units) occurred in the patients 3.8 times more frequently than in healthy subjects. Antibodies to neuromediators in quantities within 12.0 rel. units were recorded in 9.5-38.0% of the controls. It is suggested that induction of neuromediator antibodies synthesis may represent a compensatory mechanism of neuromediator metabolism control in pollinosis.     

Adhesion molecules in kidney diseases (part II)

Different adhesion molecules are involved in the maintenance of tissue architecture, morphogenesis, immunosurveillance, inflammation, tumour growth, etc. Thus, this review will be directed to the role of cadherins, selectins, integrins and members of the immunoglobuline supergene family in the pathogenesis of glomerulonephritis, acute renal failure, reaction of renal rejection, development of renal tumours, their invasion and metastases. A better understanding of the role of adhesion molecules in nephropathology may provide new aspects of treatment of different forms of renal diseases including tumours.     

Ultrasonic diagnosis in diseases of kidneys (author's transl)

The diagnostic value of echoscopy and echography in kidney disease is presented and illustrated. Ultrasound examination is primarily used for the differentiation of cystic and solid lesions of the kidney. Our personal experience and the recent literature on this problem is reviewed. Based on the overall diagnostic accuracy of more than 90%, a procedure to investigate space occupying lesions of the kidney is suggested. The indication for ultrasound scans in obstructive kidney disease and the unilateral nonexcreting kidney is briefly discussed.     

Phase-II-study with vindesine (desacetyl-vinblastine-amide-sulfate) in advanced malignant diseases

53 patients with advanced and measurable cancerr were treated with vindesine in doses of 3 mg/m2 (pretreated) and 4 mg/m2 (non pretreated) i.v. once weekly. 48 patients are evaluable for response: of 14 patients with squamous cell carcinoma of the lung, 1 partial remission (PR), 1 minor response (MR) and 1 no change (NC) were observed. In 5 patients with large cell carcinoma of the lung: 1 NC. In 3 with adenocarcinoma of the lung: 1 MR. One patient with nasopharyngeal carcinoma had progressive disease. Stable disease was observed in a patient with carcinoma of the tongue and in a patient with adenocarcinoma of the esophagus. Four patients with colorectal carcinoma had progressive disease. One MR was observed in a patient with breast cancer, while all of the other 3 patients had progressive disease. One carcinoma of the penis was stable. One MR was observed in a patient with Hodgkin's disease. One PR was observed in a case with no-Hodgkin's lymphoma. A patient with acute leukemia had progressive disease. Among 9 patients with malignant melanoma, 3 had an MR and 1 patient had stable disease. A patient with fibrosarcoma had progressive disease. Observed toxicity included leukopenia, thrombocytopenia, anemia, paresthesias, constipation, jaw pain, nausea, stomatitis, alopecia, loss of taste, pruritus and skin rash, weakness and fatigue.     

International classification of diseases (tenth revision)

Today, when the number of high-risk patients is increasing, special attention should be paid to polyresistant gram-positive microorganisms staphylococci and enterococci, whose role in infective complications and septic states is increasing. The author analyzes published reports on the rate of isolation of methicillin-resistant staphylococci (MRS) and enterococci in different countries and relationship of this parameter with antibiotic policy. Special attention is paid to unjustified wide use of third-generation cephalosporines and their role in selection of polyresistant bacteria. The rate of MRS isolation vs. all other staphylococci at intensive care wards for newborns is as high as 63.9%. The incidence of coagulase-negative staphylococci (most often S. epidermidis) in clinical material (blood, cerebrospinal fluid, urine) from high-risk patients increased 2-3 times during two recent years. Glycopeptides vancomycin and teicoplanine are drugs of choice for the treatment of infections caused by such microorganisms (sepsis, endocarditis, osteomyelitis, pneumonia, etc.). These drugs should be listed among obligatory antibiotics for resuscitation and intensive care wards as life-saving drugs.     

Ryanodine receptors and their role in genetic diseases (review)

The field of protein structure prediction is evolving rapidly and in the last few years a number of new methods have been developed and evaluated. However, comparative modeling, or modeling by homology, is still the method of choice when the unknown protein shares any significant sequence similarity with a protein of known structure. The accuracy of the method is highly dependent on the degree of similarity between the target protein and that used as a template. Nevertheless, careful consideration of all the steps performed in the modeling procedure allows useful information to be obtained also from a model based on very low sequence identity.     

Tumorous diseases of the lymphatic system (in 2 parts)

Diagnostic approaches in the management of Hodgkin's Disease and Non Hodgkin Lymphomas are discussed. The importance of recent histological classifications in Non Hodgkin Lymphomas is emphasized particularly with respect to the differentiation between lymphomas of "low grade" and "high grade" malignancy. Complication in the course of treatment in these patients are reviewed and the therapeutic implications of particular organ involvement are summarized.