Unexpected outcome after partial epididymectomy for chronic testicular pain.

Cancer of the testis is uncommon in young males. It can present in unusual ways. We are presenting a case of testicular cancer presenting as an epididymal lesion that was diagnosed after epididymectomy.

Impact of HIV type 1 subtype on drug resistance mutations in Nigerian patients failing first-line therapy.

A diverse array of non-subtype B HIV-1 viruses circulates in Africa and dominates the global pandemic. It is important to understand how drug resistance mutations in non-B subtypes may develop differently from the patterns described in subtype B. HIV-1 reverse transcriptase and protease sequences from 338 patients with treatment failure to first-line ART regimens were evaluated. Multivariate logistic regression was used to examine the effect of subtype on each mutation controlling for regimen, time on therapy, and total mutations. The distribution of HIV-1 subtypes included CRF02_AG (45.0%), G (37.9%), CRF06_cpx (4.4%), A (3.6%), and other subtypes or recombinant sequences (9.2%). The most common NRTI mutations were M184V (89.1%) and thymidine analog mutations (TAMs). The most common NNRTI mutations were Y181C (49.7%), K103N (36.4%), G190A (26.3%), and A98G (19.5%). Multivariate analysis showed that CRF02_AG was less likely to have the M41L mutation compared to other subtypes [adjusted odds ratio (AOR) = 0.35; p = 0.022]. Subtype A patients showed a 42.5-fold increased risk (AOR = 42.5, p = 0.001) for the L210W mutation. Among NNRTI mutations, subtype G patients had an increased risk for A98G (AOR = 2.40, p = 0.036) and V106I (AOR = 6.15, p = 0.010), whereas subtype CRF02_AG patients had an increased risk for V90I (AOR = 3.16; p = 0.003) and a decreased risk for A98G (AOR = 0.48, p = 0.019). Five RT mutations were found to vary significantly between different non-B West African subtypes. Further study to understand the clinical impact of subtype-specific diversity on drug resistance will be critically important to the continued success of ART scale-up in resource-limited settings.

Zinc supplementation to HIV-1-infected pregnant women: effects on maternal anthropometry, viral load, and early mother-to-child transmission.

OBJECTIVE: To examine the effect of zinc supplementation to HIV-1-infected pregnant women on viral load, early mother-to-child transmission of HIV (MTCT), and wasting. DESIGN: Double-blind placebo-controlled randomized clinical trial. SETTING: Antenatal clinic in Dar es Salaam, Tanzania. SUBJECTS: Four hundred HIV-1-infected pregnant women. METHODS: Women 12-27 weeks of gestation were randomly assigned to receive a daily oral dose of 25 mg zinc or placebo from the day of the first prenatal visit until 6 weeks postdelivery. Weight and mid-upper arm circumference (MUAC) were measured monthly. HIV status of the babies was assessed at birth and at 6 weeks postpartum. Viral load was assessed in a random sample of 100 women at baseline and at the end of the study. RESULTS: Zinc had no effects on maternal viral load or early MTCT. Supplementation was related to a significant threefold increase in the risk of wasting (reaching a MUAC value <22 cm) during an average 22 weeks of observation (RR=2.7, 95%CI=1.1, 6.4, P=0.03), and to a 4 mm decline in MUAC during the second trimester (P=0.02). CONCLUSIONS: Zinc supplementation to HIV-infected pregnant women offers no benefits on viral load or MTCT. The clinical relevance of an apparent decrease in MUAC associated with zinc supplementation is yet to be ascertained. These findings together with the lack of effect on fetal outcomes (reported previously) do not provide support for the addition of zinc supplements to the standard of prenatal care among HIV-infected women.

Differences in perinatal transmission among human immunodeficiency virus type 1 genotypes.

OBJECTIVE: To determine whether genotypes from human immunodeficiency virus type 1 (HIV-1) subtypes A, C, or D or intersubtype recombinants have the same probability of being transmitted from mother to child. METHODS: We determined the HIV-1 genetic subtype and maternal risk factors of 51 matched transmitting and nontransmitting mothers from Tanzania. The HIV-1 gag (p24-p7) and env (C2-C5) nucleotide sequences were used for genotype classification, and matched logistic regression analysis was used to assess differences among genotypes. RESULTS: Mothers infected with HIV-1 subtype A (odds ratio, 3.8; 95% CI, 0.8-24.7%), HIV-1 subtype C (odds ratio, 5.1; 95% CI, 1.3-30.8%), or HIV-1 intersubtype recombinant viruses (odds ratio, 5.3; 95% CI, 1.2-33.4%) were more likely to transmit HIV-1 to their infants than mothers infected with HIV-1 subtype D. Lower CD4 cell counts at enrollment were associated with transmission, but CD4 cell counts within each genotype did not explain differences in transmission among HIV-1 genotypes. CONCLUSION: We have shown that HIV-1 genotypes might be associated with differential risk for vertical transmission. These findings provide the first evidence that HIV-1 genetic subtypes may play a role in rates of vertical transmission in an African setting.

Diversity of the HIV-1 long terminal repeat following mother-to-child transmission.

A study of the human immunodeficiency virus Type 1 (HIV-1) 5' long terminal repeat (LTR) was performed to determine the extent of variation found within the LTR from 19 mother-infant pairs in Tanzania and to assess whether the LTR is useful in distinguishing maternal sequences that were transmitted to infants. HIV-1 subtypes A, C, and D as well as intersubtype recombinant LTR sequences were detected in mothers and infants. The LTR subtype was 100% concordant between mothers and their infants. Diversity calculations showed a significant reduction in LTR variation in infants compared to their mothers. However, the overall magnitude of LTR variation was less than that found in the env gene from the same individuals. These data suggest a selective constraint active upon the 5' long terminal repeat that is distinct from immune selective pressure(s) directed against HIV-1 structural genes. Detection of maternal LTR variants that were transmitted to infants may yield important information concerning nonstructural determinants of HIV-1 transmission from mother to infant.

Emerging recombinant human immunodeficiency viruses: uneven representation of the envelope V3 region.

OBJECTIVE: To determine whether the envelope V3 region from HIV-1 subtypes A, C or D had the same probability of being present in intersubtype recombinant genomes. MATERIALS AND METHODS: The envelope C2-C5 and the gag p24-p7 regions from one hundred infants infected perinatally in Tanzania were compared using phylogenetic and recombination analysis. Exact binomial and Fisher's exact tests were used to assess if various genomic regions were more likely to be overrepresented in intersubtype recombinants. RESULTS: Of one hundred HIV-1 positive infants analyzed, twenty-two (22%) showed exclusively subtype A sequence in gag and env. Subtype C accounted for twenty-two infants (22%) whereas nineteen infants (19%) were infected by HIV-1 subtype D. Intersubtype recombinant genomes accounted for thirty-seven infections (37%). The V3 region from subtype A was found in all fifteen A-D recombinants (P = 0.00003) and the V3 region from subtype C was found in all twelve C-D recombinants (P = 0.0002). Conversely, subtype D gag sequences were preferentially represented in the gag of A-D recombinants (P = 0.0003) as well as C-D recombinants (P = 0.002). In A-D recombinants, the V3 region of subtype A was generally surrounded by subtype A C3-C5 sequences. In contrast, the V3 region from subtype C was surrounded by subtype D C3-C5 sequences in C-D recombinants. Significant differences were not found in the number of subtype A or subtype C sequences in A-C recombinants. CONCLUSION: We have shown that several recombinant HIV-1 viruses have been generated and efficiently transmitted to infants in Tanzania. The recombination patterns showed that the V3 region of subtypes A or C was always selected in A-D and C-D recombinants. This selection suggests that the fitness of subtype D-V3 in perinatal transmission may be reduced with respect to V3 from subtype A and/or subtype C. The elevated number of recombinants transmitted perinatally suggests that co-infection or super-infection by two HIV-1 subtypes is not uncommon in this population.

[Laparoscopic pelvic lymph node dissection for clinical staging of prostate cancer: encouraging preliminary results]. / Laparoscopische bekkenklierdissectie voor klinische stadiëring bij prostaatcarcinoom: gunstige eerste ervaringen.

OBJECTIVE: To evaluate the results of the first 72 laparoscopic pelvic lymph node dissections in patients with prostate cancer. DESIGN: Retrospective study of records. SETTING: Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands. METHOD: A retrospective study of records provided data on 72 patients with prostate cancer staged by laparoscopic lymph node dissection in the period 1993-1997. Per- and postoperative complications, operation time, number of removed lymph nodes, pathology result and duration of hospital stay were assessed. A comparison was made between the first series of 36 patients and the second series. RESULTS: In 9 patients the laparoscopic approach was converted to a laparotomy. This occurred six times in the first series of 36 patients and three times in the second series. The postoperative course was complicated six times in the first and four times in the second series. With increasing experience the mean operation time decreased from 140 min to 114 min in the second series (p < 0.0001). The mean number of nodes removed was equal in both series (7.5). Lymph node metastases were found in 20 patients (28%). Hospital stay was 2.9 days in the first series and 2.2 days in the second series (not significant). CONCLUSION: Laparoscopic pelvic lymph node dissection is a minimally invasive method for staging patients with prostate cancer. This staging procedure is of great benefit in patients scheduled for treatment with curative intent because of its accuracy and low morbidity. With increasing experience operation time, hospital stay and number of complications decrease.

Sensate osteocutaneous fibula flap: anatomic study of the innervation pattern of the skin flap.

BACKGROUND: For oromandibular reconstructions, an osteocutaneous fibula flap provides sufficient bone and pliable skin. Sensory reinnervation could possibly prevent problems in mastication and deglutition. METHODS: In this anatomic study, 33 cadaver limbs were microsurgical dissected. We investigated the lateral sural cutaneous nerve (LSCN), which supplies sensation to the skin of the lateral lower leg, in relation to the fibula skin flap. The fibula is vascularized by the peroneal vessels via the posterior intermuscular septum. Therefore, the posterior septum determines the center line of the flap design. RESULTS: The LSCN runs in 74% of the dissections posterior to the posterior septum, whereas an anterior branch was seen in 26%. In 54% of the dissections, the distance to the posterior septum was within 3 cm from the septum, whereas in 86%, the distance was found to be within 4 cm. CONCLUSION: The skin flap should be designed more posteriorly to achieve maximal reinnervation.

Tropical spastic paraparesis on the Caribbean coast of Colombia.

Tropical spastic paraparesis (TSP) is a retroviral disease characterized predominantly by a chronic myelopathy and progressive leg weakness. Four patients from the northern coast of Columbia with chronic spastic paraparesis and serum positivity for antibodies to human T cell lymphotropic virus type 1 by enzyme-linked immunosorbent assay and Western blot are reported. All patients had mixed ethnic origins (white, black, and amerindian). This is the first report of TSP on the Caribbean coast of Colombia. This study extends the geographic boundaries of TSP in the Caribbean basin.

Preparation and characterization of soluble conjugates of defined molecular sizes prepared by linkage of pepsin and carboxypeptidase A to dextrans.

Soluble conjugates of pepsin and carboxypeptidase A were prepared by covalent linkage of the enzymes to an amino derivative of dextran. By fractionating the dextran derivatives before and after enzyme coupling, three conjugates, with median Stokes radii between 4.0 and 11.7 nm and with a range of 25% of the median, were prepared from each enzyme. The pepsin and carboxypeptidase A conjugates contained about 35% and 3% protein, respectively. Both types had specific activities close to those of the native enzymes and were stable at -20 degrees C. The pH-activity curve was unaffected by linkage of either enzyme to dextran. The stabilities at 30 degrees C of pepsin at pH 6-7 and carboxypeptidase A at pH 3.5-9.0 were increased by linkage to dextran. No significant amount of unbound enzyme was released from either type of conjugate in skim milk. The molecular sizes, deduced from the intrinsic viscosities and the diffusion coefficients of all conjugates, were close enough to the Stokes radii to indicate that the molecules were approximately spherical. Physical measurements also indicated that the molecules were dextranlike and highly hydrated.