Mycobacterium xenopi pulmonary infection in an HIV infected patient under highly active antiretroviral treatment.

Highly active antiretroviral therapy (HAART) is responsible for a striking reduction in AIDS related morbidity and mortality by partly restoring immune function. However, HAART can also precipitate the development of clinically apparent opportunistic infections in patients with latent infections. We report a case of an HIV infected patient who developed granulomatous nodular and cavitatory lesions of the lungs due to Mycobacterium xenopi as a manifestation of the immune restoration syndrome.

Mycobacterium xenopi pulmonary infection in an HIV infected patient under highly active antiretroviral treatment.

Highly active antiretroviral therapy (HAART) is responsible for a striking reduction in AIDS related morbidity and mortality by partly restoring immune function. However, HAART can also precipitate the development of clinically apparent opportunistic infections in patients with latent infections. We report a case of an HIV infected patient who developed granulomatous nodular and cavitatory lesions of the lungs due to Mycobacterium xenopi as a manifestation of the immune restoration syndrome.

Clinical and biological impact of antiretroviral therapy with protease inhibitors on HIV-related Kaposi's sarcoma.

OBJECTIVE: To evaluate the clinical and biological impact of protease inhibitors on HIV-associated Kaposi's sarcoma. DESIGN AND SETTING: A cohort of 10 patients included prospectively from April 1996 to June 1997 were studied in one institutional centre after initiation of protease inhibitors. PATIENTS AND METHODS: All patients but one (stable disease) had progressive Kaposi's sarcoma. Three out of 10 patients had stopped specific chemotherapy for Kaposi's sarcoma for more than 4 weeks, three were still under chemotherapy, and four had never received specific treatment of Kaposi's sarcoma. Plasma HIV viral load, human herpesvirus (HHV)-8 viraemia in peripheral blood mononuclear cells (PBMC), and CD4 cell count were sequentially assessed from the beginning of therapy. For six patients, a semiquantitative evaluation of HHV-8 viral load in the Kaposi's sarcoma lesions was performed during treatment using polymerase chain reaction. RESULTS: After initiation of HIV triple therapy with protease inhibitors, we observed six complete responses, two partial responses, and two patients with progressive disease. All patients had undetectable plasma HIV viral load within 2 months of treatment. Undetectable HHV-8 viraemia in PBMC occurred in seven out of eight patients with partial or complete response and in none of the progressive patients. A decrease or negation of HHV-8 viral load in Kaposi's sarcoma lesions was observed in two complete responders. CONCLUSION: Our results suggest that antiviral therapy with protease inhibitors are clinically efficient in HIV-associated Kaposi's sarcoma and that there exists a correlation between clinical response and negation of HHV-8 viraemia.

Mesalamine in Crohn's disease with steroid-induced remission: effect on steroid withdrawal and remission maintenance, Groupe d'Etudes Thérapeutiques des Affections Inflammatoires Digestives.

BACKGROUND & AIMS: Steroid dependence and early relapse are frequent after a prednisolone-induces remission in Crohn's disease. The aim of this trial was to test whether mesalamine started at the onset of steroid tapering increases the rate of weaning from prednisolone and reduces the relapse rate after prednisolone cessation. METHODS: One hundred fifty patients with active Crohn's disease were administered oral prednisolone (1 mg.kg(-1). day(-1)) x 3-7 weeks; 129 patients went into clinical remission and were randomized to Pentasa (4 g . day(-1)) or placebo, administered until weaning and for 1 year thereafter. RESULTS: Groups were similar for clinical and biological items collected initially. Weaning failure rate was 30% and 12% in the placebo and mesalamine arms, respectively. At the end of the trial, 9 of 36 patients administered placebo and 14 of 48 administered mesalamine were in remission. Both groups had similar time to relapse curves in the postweaning year; after adjusting for risk factors (high Crohn's Disease Activity Index, white blood cell count of >9 x 10(9) /l-1 at weaning, and use of a medical treatment in the month before inclusion), Pentasa was found to be superior to placebo. CONCLUSIONS: After a prednisolone-induces remission in Crohn's disease, mesalamine facilitates steroid withdrawal and, during the postweaning year, may reduce the relapse rate in certain patient subgroups.

[Effect of smoking on relaxation and filling behavior of the left ventricle in healthy probands. An echocardiography study]. / Einfluss des Zigarettenrauchens auf Relaxation und Füllungsverhalten des linken Ventrikels bei Herzgesunden. Eine echokardiographische Untersuchung.

UNLABELLED: To examine the impact of acute nicotine consumption echocardiographic examination was performed in 22 healthy subjects (nine women, 13 men, 20 to 50 cigarettes/day over a minimum of five years) without any evidence of organic heart disease (normal 2D and Doppler echo, normal ECG at rest and during exercise) aged 20 to 51 years (mean +/- SD: 37 +/- 9 years) before and after cigarette smoking (0.9 mg nicotine). Left ventricular filling parameters were derived by transmitral pulsed Doppler ultrasound with the flow profile along the mitral valve being characterized by the early diastolic (E-wave) and late diastolic (A-wave) inflow into the left ventricle. The isovolumetric relaxation period was determined by simultaneous M-mode registrations over the aortic and mitral valve. During smoking the early diastolic peak velocity decreased from 56 to 52 cm/s (p less than .01) and the early diastolic flow integral fell from 64 to 56 mm (p less than .01). The A/E ratio of the peak velocities rose from 68 to 82% (p less than .001), the A/E ratio of the flow integrals increased from 46 to 56% (p less than .001) and the atrial contribution to ventricular filling rose from 33 to 36% (p less than .001). Furthermore during cigarette smoking the isovolumetric relaxation period rose from 70 to 77 ms (p less than .001). - CONCLUSION: In healthy subjects cigarette smoking causes an increase of the atrial contribution to ventricular filling and the isovolumetric relaxation period. Thus, acute nicotine consumption significantly impairs the energy-consumpting process of early diastolic relaxation, independently of its role as a risk factor for atherosclerosis.

[Noninvasive detection by Doppler and M-mode echocardiography of acute rejection reaction after heart transplantation: preliminary results of a prospective study]. / Nichtinvasive Erfassung der akuten Abstossungsreaktion nach Herztransplantation mittels Doppler- und M-Mode-Echokardiographie: Vorläufige Ergebnisse einer prospektiven Untersuchung.

Diagnosis of acute cardiac allograft rejection is still based on the results of endomyocardial biopsy. The objective of this study was to evaluate changes of left ventricular (LV) diastolic function associated with rejection using Doppler and M-mode echocardiography. The study patients, consisting of 29 cardiac allograft recipients (12 female, 17 male) aged 27 to 58 (mean 41) years, were classified into two groups on the basis of histopathologic findings: 13 patients without rejection (mean age 40 years) and 16 patients with moderate to severe allograft rejection (mean age 42 years) at myocardial biopsy. All patients underwent serial echocardiographic examination 4-10 weeks after transplantation and 8 +/- 2 days later on the day of myocardial biopsy. Twenty-five healthy volunteers (11 female, 14 male; mean age 39 years) served for assessing normal values. Echocardiographic assessment included peak velocity (PEV), pressure half-time (PHT), velocity-time integral (VTI-E) of early mitral flow (E-wave), and isovolumic relaxation period (IVRP). In transplant recipients, significantly higher values as compared to normals were found for PEV (72 vs 55 cm/s; p less than 0.01), PHT (51 vs 42 ms; p less than 0.001), VTI-E (71 vs 56 mm; p less than 0.001), and IVRP (91 vs 73 ms; p less than 0.001). During rejection, heart rate increased significantly from 78 to 93 beats/min (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Amitriptyline-induced prolonged cholestasis.

We report the case of a patient in whom amitriptyline administration for 5 wk was followed by prolonged cholestasis. Jaundice and pruritus lasted 19 and 20 mo, respectively. Three liver biopsies were performed at different stages of the disease showing the course of liver lesions. Cholestasis initially located in the region of the hepatic venule came to be associated with the progressive development of portal tract lesions consisting of inflammatory infiltration, fibrosis, and disappearance of interlobular bile ducts. Amitriptyline hydroxylation and dextromethorphan O-demethylation are deficient in subjects with the poor metabolizer phenotype of debrisoquine. Drug oxidation phenotyping with dextromethorphan showed that this patient had the extensive metabolizer phenotype. This observation demonstrates that amitriptyline can induce prolonged cholestasis and suggests that the susceptibility to develop liver injury while taking this drug may not be related to a genetic deficiency of its hydroxylation.

Fluorouracil (F), Adriamycin (A), and cisplatin (P) (FAP): combination chemotherapy of advanced esophageal carcinoma.

Twenty-one patients with advanced epidermoid carcinoma of the esophagus were treated with a combination of 5-fluorouracil (F) 600 mg/m2 day 1 and day 8; Adriamycin (A) 30 mg/m2 day 1; and cisplatin (P) 75 mg/m2 day 1 (FAP) with hydration and mannitol-induced diuresis. Each course was repeated every 4 weeks. All 21 patients are evaluable for response: 7 patients had an objective response (33%). Two of these responses were complete remissions according to negative endoscopic and pathologic results; five patients had a partial response; all 7 responding patients had metastasis prior to treatment. Median survival of the 21 patients was 8 months. Median survival of 9 months for responders is superior to 4.5 months for nonresponders. No severe myelosuppression or nephrotoxicity was observed. This FAP regimen is useful in the treatment of advanced esophageal tumors.

[Treatment of advanced epidermoid carcinoma of the oesophagus with combined 5-fluorouracil, adriamycin and cis-platinum (FAP)]. / Traitement de cancers épidermoïdes évolués de l'oesophage par l'association 5 fluoro-uracile, adriamycine et cis-platinum (FAP). Analyse préliminaire de 21 cas.

Twenty-one patients with advanced, inoperable epidermoid carcinoma of the oesophagus were treated with combined 5-fluorouracil (F, 600 mg/m2, days 1 and 8), adriamycin (A, 30 mg/m2, day 1) and cis-platinum (C, 75 mg/m2, day 1), together with hydratation and mannitol-induced diuresis. Each course was repeated after 4 weeks. Response could be assessed in all 21 patients and was objective in seven (33%), who had metastasis prior to treatment. Two of these 7 patients went into complete remission confirmed by negative endoscopy and pathology; 5 showed partial response. Median survival of the 21 patients was 8 months; it fell to 4.5 months in non-responders and rose over 9 months in responders. Three patients survived for more than 16 months. No severe bone marrow depression or nephrotoxicity was observed. The 3-drug combination appeared to be more effective than the additive effects of each drug given separately. It is concluded that the FAP regimen is useful in the treatment of advanced oesophageal tumours.