Acquired immunodeficiency syndrome. Cerebrospinal fluid findings in patients before and during long-term oral zidovudine therapy.

Fifty-two patients with acquired immunodeficiency syndrome were enrolled in this study to evaluate the relationship between cerebrospinal fluid (CSF) zidovudine concentrations and neurologic and human immunodeficiency virus (HIV) culture findings. Paired HIV-CSF culture and neurologic measurements were available in 30 and 45 patients, respectively. Twenty-nine patients were assessable for zidovudine CSF concentrations. Patients underwent lumbar puncture and neurologic testing before and after 8 weeks or more of oral zidovudine therapy (600 to 1500 mg/d). After 8 weeks of therapy, the frequency of HIV isolation from CSF cultures was unchanged. Significant neurologic improvement by examination was noted in 61.5% (32/52) of the patients. The median CSF zidovudine concentration among 29 patients was 0.047 mg/L (range, 0.015 to 0.198 mg/L). No correlation between CSF zidovudine concentration, cumulative dose, or HIV isolation from CSF and persistence or resolution of neurologic symptoms or signs was observed. The mechanisms by which zidovudine improves neurologic function are unclear and appear unrelated to direct clearance of virus from CSF.

Recovery of human immunodeficiency virus type 1 from semen: minimal impact of stage of infection and current antiviral chemotherapy.

Because exposure to semen is important for the sexual transmission of human immunodeficiency virus type 1 (HIV), the relationship of stage of infection and antiviral chemotherapy to isolation of HIV from semen was investigated. Whereas HIV was isolated from peripheral blood mononuclear cells of all seropositive persons tested, it was isolated from semen in only 11 (32%) of 34 men, including 3 of 6 who were studied sequentially over time. HIV was isolated from 6 (32%) of 19 semen specimens from 14 asymptomatic persons (Centers for Disease Control [CDC] class II or III) and from 10 (28%) of 36 semen specimens from 20 symptomatic patients (CDC class IV). Isolation of HIV from semen did not correlate with CD4+ or CD8+ T lymphocytes counts or zidovudine therapy. Seropositive men may shed HIV in semen early in the course of infection, and zidovudine therapy seems to have no effect on the recovery of HIV and, thus, on the potential for sexual transmission of HIV.

Indications for angiography in extremity trauma.

The angiograms of 119 extremities of patients with gunshot wounds (65), lacerating injuries (17), and blunt trauma (29) were retrospectively evaluated and correlated with clinical history. Indications for angiography were decreased or absent pulse or blood pressure, cold limb, bruit or murmur, uncontrolled bleeding or increasing hematoma, neurologic deficit, and proximity of the injury to vascular structures. Angiographic findings were compared with preprocedure clinical assessment. Angiograms performed only because of proximity of the wound/injury to major vessels showed no major arterial injuries. However, angiograms performed for one or more of the other indications demonstrated significant vascular abnormalities in 44% of gunshot wounds, 80% of knife injuries, and 67% of blunt trauma. Of the indications for arteriography, pulse abnormalities or cold limbs were most often associated with significant angiographic findings, positive studies occurring in 74% of cases. Despite the differences in mechanism of injury, physical examination is sensitive and effective in predicting which patients will have negative angiographic studies after each of the three forms of trauma.

Assignment of the H-Y antigen gene to the short arm of chromosome Y.

We have presented two cases strongly suporting a Y chromosome short-arm location for the H-Y antigen gene. The first case was HY antigen-positive with an isochromosome for the short arm of the Y with no long arm of the Y being present. The other case was H-Y antigen-negative in fibroblasts from an individual with a 46,X,i(Yq) karyotype with no short arm of the Y present. The two cases presented also confirmed previous reports that the testicular forming gene is also located on the short arm of chromosome Y.