Disseminated cutaneous cryptococcosis. Comparison of clinical manifestations in the pre-AIDS and AIDS eras.

A review of the literature suggests some differences in the cutaneous manifestations of cryptococcosis present in patients in the pre-acquired immunodeficiency syndrome (AIDS) era compared with those manifestations that are present in today's AIDS era. In both periods, cutaneous manifestations can precede and be the sole clue to disseminated cryptococcal infection. Today, cutaneous cryptococcal involvement is often mistaken for molluscum contagiosum or Kaposi's sarcoma. We describe a patient with disseminated cryptococcosis who presented with skin lesions mimicking molluscum contagiosum, and who was subsequently shown to have AIDS.

New pathogens in pneumonia.

It appears that many commonly recognized syndromes such as the ARDS may well be caused by agents that have only recently emerged as respiratory pathogens. HPS represents one such entity. It appears likely that the increasing pressure of antibiotic use as well as the reemergence of certain pathogens will continue to challenge the clinician. Paramount to the identification and treatment of unusual pneumonias will be the degree with which an effort is made to make an etiologic diagnosis through sputum examination, transtracheal aspirate, bronchoscopy, or lung biopsy. Although pneumococcal pneumonia is the most common community-acquired pneumonia seen by practicing physicians, in all likelihood from time to time a physician will encounter pneumonia caused by one of the unusual pathogens described in this article or else by an altogether new pathogen.

Purchasing prescription medication in Mexico without a prescription. The experience at the border.

Prescription medication can often be purchased in Mexico without a physician's prescription. United States residents living along the border may have access to dangerous medications by crossing the border and purchasing them in Mexican pharmacies. We sought to determine the extent and frequency of this behavior in a sample of our ambulatory clinic population. Patients from the Texas Tech University Internal Medicine Clinic were surveyed to collect information about their use of medications, use of alternative sources of health care in Mexico, and purchasing of prescription medication in Juarez, Mexico. More than 80% of patients stated they had purchased prescription-type medication at a pharmacy without a physician's prescription. The most common reasons for buying prescription medication in Mexico were because it was less expensive or because a prescription was not necessary. These data indicate a potential for US residents along the border to take medications in an unregulated manner, a practice that could pose problems for health care providers on both sides of the border.

Upper airway obstruction as the sole manifestation of rheumatoid arthritis.

A 51-year-old woman with a history of rheumatoid arthritis (RA) suddenly developed laryngeal stridor. Rheumatoid factor was positive and the erythrocyte sedimentation rate was elevated, but she had no evidence of acute peripheral arthritis at this time. A flexible laryngoscopy revealed cricoarytenoid arthritis which was the sole clinical manifestation of active RA. Involvement of the cricoarytenoid joints must be considered in patients with RA with laryngeal stridor even in the absence of active peripheral arthritis.

Neurocysticercosis: focus on intraventricular disease.

Intraventricular neurocysticercosis is of concern because it is associated with a poorer prognosis than is parenchymatous disease. Frequently, associated hydrocephalus occurs, which may recur after treatment. We report on 11 patients with intraventricular cysticercosis (from a larger case series of 33 patients) and evaluate clinical presentations, neuroimaging findings, and responses to treatment, especially of ventricular disease. Intraventricular cysticercosis represented 33% of our cases. Seven patients presented with increased intracranial pressure; four required ventriculoperitoneal shunting. Parenchymatous symptomatic cysticercosis is largely a result of the host inflammatory response, presenting in our series with epileptic seizures in 73% of the patients (tonic clonic generalized seizures occurred in 64% and partial simple seizures in 9%). The prognosis for parenchymatous inflammatory disease is good. We advocate the use of anthelmintic treatment with albendazole in all cases of intraventricular cysts, and if hydrocephalus occurs, then shunt procedures or ventriculostomy is necessary. These patients must be monitored closely for recurrent hydrocephalus.

Cerebral arterial thrombosis as a complication of paroxysmal nocturnal hemoglobinuria.

Venous thrombosis is a frequent complication in patients with paroxysmal nocturnal hemoglobinuria (PNH). However, arterial thrombosis is rare, and cerebral arterial thrombosis has been reported only in postmortem studies. We discuss the case of a PNH patient in whom both clinical and neuroimaging findings were compatible with cerebral arterial and venous thrombosis.

Medicine residents' practices in cancer screening in a Hispanic population.

Cancer screening is a valuable intervention to reduce breast cancer mortality and the incidence of invasive cervical carcinoma. We conducted a retrospective survey to determine the residents' compliance with use of mammography and Pap smear in Hispanic women. A total of 280 charts that met the inclusion criteria were reviewed. According to the guidelines, 784 mammograms and 714 Pap smears were indicated. The residents' compliance with mammography was 10.6% (+/- 9.16) and with Pap smear, 6.6% (+/- 7.68). The study demonstrates an unacceptable level of cancer screening practice by the medicine residents caring for this Hispanic population.

Prevalence of associated infections in community-acquired spontaneous bacterial peritonitis.

OBJECTIVES: The frequency with which other infections occur in association with spontaneous bacterial peritonitis is not known, but has implications for both pathogenesis and management. Spontaneous bacterial peritonitis that occurs in hospitalized patients is mainly a nosocomial infection, the study of which must take into account multiple confounding factors. We conducted a prospective study to compare the clinical features and the frequency of associated infections in patients with community-acquired spontaneous bacterial peritonitis to those of cirrhotic patients with ascites but without spontaneous bacterial peritonitis. Previous studies of spontaneous bacterial peritonitis have not found an infection consistently present at some other site, but those studies did not separate community-acquired from hospital-acquired spontaneous bacterial peritonitis. METHODS: Over a 5-yr study period, 176 cirrhotic patients with ascites were enrolled and were followed. There were 68 patients who had 83 admissions with spontaneous bacterial peritonitis and 108 patients with 124 admissions without spontaneous bacterial peritonitis. Of the 68 patients with spontaneous bacterial peritonitis, 56 had single episodes of peritonitis and 12 had 27 episodes of recurrent bacterial peritonitis. All episodes of spontaneous bacterial peritonitis were diagnosed within 24 h of admission. All subjects had cultures of ascitic fluid, blood, and urine. RESULTS: Patients with spontaneous bacterial peritonitis were more often symptomatic than the nonspontaneous bacterial peritonitis patients. Ascites cultures were positive in 63 (76%) episodes of spontaneous bacterial peritonitis. The frequency of bacteremia in the spontaneous bacterial peritonitis group was significantly higher than that of the nonspontaneous bacterial peritonitis (56.6% vs. 4.8%, p < 0.0001). Bacteriuria occurred in 51 episodes of spontaneous bacterial peritonitis compared with only nine in nonspontaneous bacterial peritonitis patients (61.4% vs. 7.3%, p < 0.0001). Bacteriuria was observed even more often in recurrent bacterial peritonitis patients than in single episode bacterial peritonitis patients (77.8% vs. 53.6%, p < 0.0001). Most patients with bacteriuria had no urinary tract symptoms. There was no significant difference between the frequency of pneumonia in spontaneous bacterial peritonitis patients compared with nonspontaneous bacterial peritonitis patients (8.4% vs. 10.5%, p = 0.17). CONCLUSIONS: Asymptomatic bacteriuria occurs often in association with community-acquired spontaneous bacterial peritonitis.

Comparison of bowel patterns in Hispanics and non-Hispanic whites.

Survey questionnaires can be used to characterize normal bowel habits and the prevalence of bowel dysfunction. To determine whether ethnic and sex-related differences in bowel patterns exist between Hispanics and non-Hispanics whites, we conducted a survey of a nonpatient population in El Paso, on the U.S.-Mexico border. A forced-choice, self-report questionnaire was distributed to 1014 subjects and returned by 1000. Data from the 905 Hispanic and non-Hispanic white subjects were compared. Stool frequency was analyzed by multiple linear regression, and bowel dysfunction variables were analyzed by stepwise logistic regression, in ethnic and sex groups. Data were also analyzed controlling for age, socioeconomic status, dietary factors, and use of laxatives. There was a significant sex difference in mean number of stools per week reported (P < 0.0001): Hispanic males greater than Hispanic females (8.6 vs 7.5) and non-Hispanic white males greater than non-Hispanic white females (9.3 vs 7.2). The frequency of irritable bowel syndrome-type symptoms was greater in females than in males (23.4% vs 9.6%, P < 0.001) and was less in Hispanics than non-Hispanic whites (16.9% vs 21.8%, P < 0.05), but a significant ethnic difference was not found after controlling for covariates. Additionally, females reported more alternating bowel pattern (44.0% vs 28.5%, P < 0.001) and constipation (25.5% vs 12.4%, P < 0.01) than males, and non-Hispanic white females more abdominal pain than the other subgroups (P < 0.05). Ethnic differences in dietary factors that may be relevant to bowel function were identified.(ABSTRACT TRUNCATED AT 250 WORDS)

Rapid response of AIDS-related bacillary angiomatosis to azithromycin.

A 28-year-old male with AIDS and a CD4 cell count of 100/mm3 presented with fever, hepatosplenomegaly, weight loss, and multiple, polypoid, angiomatous lesions on his face. It was determined by means of biopsy that the lesions were due to bacillary angiomatosis. The patient was treated with oral azithromycin (1 g daily as a single dose). Rapid resolution of the skin lesions was noted. After 1 week of therapy, diminution in the size of the liver and spleen was noted. The only significant side effect noted was diarrhea, which was controlled with symptomatic therapy.

Health-care-seeking behaviors related to bowel complaints. Hispanics versus non-Hispanic whites.

Health-care-seeking behaviors related to bowel complaints may vary between ethnic groups. A survey of a nonpatient population in El Paso, Texas, was conducted in order to examine differences in health care behavior related to bowel dysfunction, and in the perception of health and bowel function, in Hispanics and non-Hispanic whites. Data from 905 subjects who were either Hispanic (580) or non-Hispanic white (325) given a forced-choice, self-report questionnaire were used for analysis. Data on health care behavior variables were studied using logistic regression, in ethnic and gender groups, controlling for age and socioeconomic status. A log-linear analysis was applied to health perception variables in ethnic and gender groups. Hispanics were less likely than non-Hispanic whites to have seen a physician for bowel symptoms (P < 0.02). Of the subjects with symptoms compatible with irritable bowel syndrome, Hispanics were less likely to have seen a physician (P < 0.05). More Hispanics reported buying folk remedies (P < 0.001), and herbal teas were taken more often to maintain good bowel function (P < 0.02) and to treat bowel problems (P < 0.005). Additionally, Hispanics had a poorer perception of their health in general (P < 0.001), reported more concern about their health (P < 0.02), more concern about bowel function (P < 0.001), and more time spent attending to bowel function (P < 0.001). Therefore, data on health-care-seeking behaviors related to bowel dysfunction showed that Hispanics were less likely than non-Hispanic whites to seek health care for bowel complaints and that Hispanics were more likely to self-medicate with folk remedies to maintain good bowel function. The perception of health and bowel function is in part determined by ethnic differences.

Profile of HIV disease in an American border city.

A previous study on patterns of migration of HIV-infected persons suggested that most patients in a rural setting in eastern Tennessee acquired their disease in an urban area, typically during a period of prolonged residence. Disease and disability were the most common reasons for returning to their hometown. We studied our urban, border-city HIV clinic population to see whether similar patterns of migration were discernible. Fifty-one of the 103 patients studied lived outside the El Paso/Juarez area when they contracted HIV infection. The major reason cited for returning home was a desire to return to family (25%). Those who returned and those who had never left showed no statistically significant difference in age, race, or risk factors. This study suggests that migration of HIV-infected patients back to their hometown does not appear to be an exclusively rural phenomenon.

Inibicao latente, um modelo experimental de Esquizofrenia / Latent inhibition, an experimental model of schizophrenia

Um dos modelos comportamentais mais utilizados na avaliacao de drogas antipsicoticas é o da pre-exposicao ao estímulo a ser condicionado, ou inibiçäo latente(LI). Na LI, a exposiçäo prévia a um estímulo sem consequencia retarda a aprendizagem, quando esse mesmo estímulo, numa fase posterior, é pareado com um reforçador. Neste artigo é feita, preliminarmente, uma revisäo da utilizaçäo da LI como modelo animal para avaliaçäo de drogas antipsicóticas, e de seu fundamento neuroquímico. A seguir, discutem-se os processos comportamentais implicados na pré-exposiçäo, e que explicariam o desempenho na fase de condicionamento. Duas teorias principais säo examinadas, à luz dos paradigmas respondentte e operante do comportamento: 1) a de Mackintosh, que considera que a aprendizagem deirrelevancia do estímulo ocorre quando esse näo sinaliza nenhuma mudança em um reforçador específico, e 2) a de Lubow, que defende a existencia de uma hipotética resposta de atençäo que decresceria aao longo de repetidas exposiçöes ao estímulo, o que diminuiria sua futura associabilidade quando na funçäo de estímulo condicional