Successful removal of the largest reported intrathoracic lipoma with bilateral extension: a case report.

BACKGROUND: Unlike subcutaneous lipomas, thoracic cavity lipomas are extremely rare and can develop to be quite large without causing any symptoms. However, managing massive lipoma that involves both chest cavities is usually challenging, especially when considering the approach for excision. CASE: We report our experience of surgical management of a case of a 46-year-old male with huge intrathoracic lipoma that extends bilaterally and is known to be the largest of such kind. The tumor was resected successfully using median sternotomy. Histological analysis confirmed features of lipoma. CONCLUSION: To remove a bilateral intrathoracic lipoma, various surgical approaches have been documented. In our experience, a median sternotomy allows better exposure, which aids in complete surgical extirpation resulting in the prevention of recurrence.

A Case of Massive Pleural Effusion: Pleurodesis by Bleomycin.

Malignant pleural effusion is a common complication of primary and metastatic pleural malignancies. Pleurodesis for the management of malignant pleural effusion is intended to achieve symphysis between parietal and visceral pleura, and to prevent relapse of pleural effusion. Many chemical agents are tried to induce inflammation and damage of the pleural mesothelial layer to achieve this symphysis. Hemorrhagic pleural effusion, especially in the right hemithorax commonly occurs as presentation of primary and metastatic pleural malignancies. This case reports massive right-sided hemorrhagic pleural effusion as the sole manifestation of primary lung cancer in a 45 year old man. Patient attended our department of thoracic surgery complaining of cough, shortness of breath and right sided chest pain. A chest X-ray and chest computer tomography (CT) radiograph shows right sided massive pleural effusion. Right sided tube thoracotomy done. Pleural fluid study was done. Fluid for cytopathology was positive for malignant cell. Computed tomography guided fine needle aspiration cytology from right lung lesion was also done. Diagnosis was as small cell carcinoma. Pleural effusion resolved after 9(th) post operative day of chest tube insertion. Bleomycin pleurodesis was done. Day after pleurodesis intra thoracic tube was removed and patient was discharged from hospital on 10(th) Post operative day with an advice to attend the oncology department for further treatment. The protocol of tube thoracostomy and chemical pleurodesis was almost always successful in giving symptomatic relief of respiratory distress for a considerable period of time. However, chemical pleurodesis is not possible in all cases of malignant pleural effusion because it has got potential complication including death.

Pemphigus vulgaris in pregnancy: analysis of current data on the management and outcomes.

OBJECTIVES: The occurrence of pemphigus vulgaris (PV) during pregnancy is rare. The purpose of this review was to describe management of PV in the mother, and report maternal and perinatal outcomes associated with the disease. DATA SOURCES: A search of PubMed was conducted using the phrases "pemphigus and pregnancy" and "neonatal pemphigus." The bibliographies of retrieved articles were also searched for relevant reports. Only articles in English and in which the diagnosis of pemphigus had been made on the basis of histology or immunopathology were included. TABULATION, INTEGRATION, AND RESULTS: In 38 reports, pregnancies from 49 women with PV were described. Among the 40 patients in whom clinical profiles were provided, 33 had active disease and 7 were disease free. Prednisone was used in 37 of 49 (75%) patients with doses ranging from 5 to 300 mg/day (mean 152.5 mg). Concomitant therapies included plasmapheresis, plasma exchange, and dapsone in 1 patient each, and azathioprine in 5. Of the 44 live births, 20 (45%) neonates had PV lesions at birth and 24 (55%) were lesion-free. Five stillbirths were reported. In all neonates, PV lesions resolved within 1 to 4 weeks, either spontaneously or with mild topical corticosteroids treatment. Of the 5 intrauterine deaths, 1 was due to umbilical cord prolapse, 1 attributed to placental dysfunction, and 1 to cytomegalovirus pneumonitis. In the remaining 2, the cause was unknown. One neonate died 2 days after delivery due to meconium aspiration syndrome. Thus the aggregate perinatal mortality rate was 12% (6/49). CONCLUSIONS: The outcome of pregnancies complicated by pemphigus is generally good, but achieving good outcomes likely depends on the collaborative efforts of the dermatologist and obstetrician. The available data suggest that the rate of perinatal mortality is increased, but these data may be subject to publication bias. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this educational activity, the participant should be better able to describe appropriate medical therapies for pemphigus vulgaris complicating pregnancy, and plan the management of pregnancies complicated by pemphigus vulgaris.

Effects of interpregnancy interval and outcome of the preceding pregnancy on pregnancy outcomes in Matlab, Bangladesh.

OBJECTIVE: To estimate the effects on pregnancy outcomes of the duration of the preceding interpregnancy interval (IPI) and type of pregnancy outcome that began the interval. DESIGN: Observational population-based study. SETTING: The Maternal Child Health-Family Planning (MCH-FP) area of Matlab, Bangladesh. POPULATION: A total of 66,759 pregnancy outcomes that occurred between 1982 and 2002. METHODS: Bivariate tabulations and multinomial logistic regression analysis. MAIN OUTCOME MEASURES: Pregnancy outcomes (live birth, stillbirth, miscarriage [spontaneous fetal loss prior to 28 weeks], and induced abortion). RESULTS: When socio-economic and demographic covariates are controlled, of the IPIs that began with a live birth, those < 6 months in duration were associated with a 7.5-fold increase in the odds of an induced abortion (95% CI 6.0-9.4), a 3.3-fold increase in the odds of a miscarriage (95% CI 2.8-3.9), and a 1.6-fold increase in the odds of a stillbirth (95% CI 1.2-2.1) compared with 27- to 50-month IPIs. IPIs of 6-14 months were associated with increased odds of induced abortion (2.0, 95% CI 1.5-2.6). IPIs > or = 75 months were associated with increased odds of all three types of non-live-birth (NLB) outcomes but were not as risky as very short intervals. IPIs that began with a NLB were generally more likely to end with the same type of NLB. CONCLUSIONS: Women whose pregnancies are between 15 and 75 months after a preceding pregnancy outcome (regardless of its type) have a lower likelihood of fetal loss than those with shorter or longer IPIs. Those with a preceding NLB outcome deserve special attention in counselling and monitoring.

Treatment of pemphigus vulgaris: current and emerging options.

BACKGROUND: Pemphigus vulgaris is a rare, chronic, autoimmune mucocutaneous blistering disease. The disease can progress to involve the skin and multiple mucosae. Pemphigus vulgaris can be associated with a high morbidity and significant mortality rate. Treatment of the condition can be challenging. Conventional therapy primarily consists of systemic corticosteroids and immunosuppressant agents. In some patients with pemphigus vulgaris, these agents fail to provide an effective clinical response or have significant adverse effects. METHODS: We evaluated data on 792 patients with pemphigus vulgaris retrieved from PubMed, covering the period 1973-2004. Only patients reported in the English literature were included in this review. Recently, several new therapeutic agents and treatment modalities have been described for the treatment of patients with pemphigus vulgaris. Some therapeutic agents that were used in the past and abandoned have recently regained favor. This review focuses on the therapeutic uses of dapsone, methotrexate, mycophenolate mofetil, chlorambucil, dexamethasone-cyclophosphamide pulse therapy, immunoablative therapy with cyclophosphamide, plasmapheresis, and extracorporeal photochemotherapy. Newer agents, such as intravenous immunoglobulin (IVIg) therapy and rituximab (an anti-CD20 chimeric monoclonal antibody), are also discussed. RESULTS AND CONCLUSIONS: Among the oral agents, dapsone may be considered a first-line agent. This is primarily because the risk of potentially fatal adverse effects with this drug is lower than that associated with other available chemotherapeutic agents. In patients who are refractory to oral agents, alternative treatments have been used to prevent further disease progression. Recently, the use of IVIg therapy, with a defined protocol, has been reported to be beneficial. This therapy is promising since it may allow for discontinuation of all other therapies and is safe. The adverse effects from IVIg therapy are minimal. Furthermore, compared with other therapies, it provides a better quality of life.

Pregnancy spacing and maternal morbidity in Matlab, Bangladesh.

OBJECTIVE: The study examines the relationship between pregnancy spacing and seven measures of maternal morbidity in Matlab, Bangladesh. METHOD: The study analyzes maternal morbidity data on 11,122 women who visited a health center during their third trimester of pregnancy between 1996 and 2002. Adjusted odds ratios were obtained through logistic regression analysis to assess the effects of pregnancy intervals of differing lengths while holding constant other influences (six variables) on maternal morbidity. RESULTS: After controlling these variables, pre-eclampsia and high blood pressure are significantly more likely for women with preceding inter-pregnancy intervals of less than 6 months or 75 months or more compared to those with intervals of 27-50 months. Premature rupture of membranes is significantly more likely following inter-pregnancy intervals of 6-14 months, and edema is significantly more likely following inter-pregnancy intervals over 50 months. CONCLUSION: Short and long inter-pregnancy intervals are associated with increased incidence of some maternal morbidities.

Pregnancy spacing and maternal morbidity in Matlab, Bangladesh.

OBJECTIVE: The study examines the relationship between pregnancy spacing and seven measures of maternal morbidity in Matlab, Bangladesh. METHOD: The study analyzes maternal morbidity data on 11,122 women who visited a health center during their third trimester of pregnancy between 1996 and 2002. Adjusted odds ratios were obtained through logistic regression analysis to assess the effects of pregnancy intervals of differing lengths while holding constant other influences (six variables) on maternal morbidity. RESULTS: After controlling these variables, pre-eclampsia and high blood pressure are significantly more likely for women with preceding inter-pregnancy intervals of less than 6 months or 75 months or more compared to those with intervals of 27-50 months. Premature rupture of membranes is significantly more likely following inter-pregnancy intervals of 6-14 months, and edema is significantly more likely following inter-pregnancy intervals over 50 months. CONCLUSION: Short and long inter-pregnancy intervals are associated with increased incidence of some maternal morbidities.

Influence of intravenous immunoglobulin therapy on autoantibody titers to desmoglein 3 and desmoglein 1 in pemphigus vulgaris.

Pemphigus vulgaris (PV) is an autoimmune mucocutaneous blistering disease. Recently, patients with mucosal involvement have been described to have autoantibodies to desmoglein 3 (dsg), while patients with mucocutaneous disease have autoantibodies to dsg 1 and dsg 3. The objective of this study was to prospectively analyze, over a 24-month period, the influence of intravenous immunoglobulin (i.v.Ig) therapy on autoantibody titers to dsg 3 and dsg 1, in two groups of patients with severe PV. Group A consisted of 11 patients with mucocutaneous involvement and group B consisted of 10 patients with only mucosal involvement. Levels of autoantibodies to dsg 3 and 1 were measured by ELISA, at monthly intervals. Prior to therapy initiation, group A patients' sera showed a high ELISA index value of both dsg 3 and 1 antibodies, while group B patients had a high index value to only dsg 3. During i.v.Ig therapy, a progressive decline in the ELISA index values was observed in all patients. After the initiation of i.v.Ig therapy, in group A, a statistically significant reduction (p < 0.05) in ELISA index value to dsg 3 and 1 was detected after four and five months, respectively. In Group B, a significant decline in the mean autoantibody titer values to dsg 3 (p < 0.05) was observed after six months of i.v.Ig therapy. Group A patients had a negative ELISA index value to dsg 3 and 1 after a mean period of 21 and 20 months, respectively. Group B patients had a negative dsg 3 score after a mean period of 22 months. These results indicate that autoantibody titers to dsg 3 and 1, as measured by ELISA, can be used to monitor the serological response to treatment in PV patients. A sustained serological remission is observed in patients treated with i.v.Ig therapy. .

Prevalence of erectile dysfunction and its correlates among men attending primary care clinics in three countries: Pakistan, Egypt, and Nigeria.

The prevalence and correlates of erectile dysfunction (ED) in developing countries are largely unknown. Our objectives were to determine the prevalence and associated factors of ED in three countries (Pakistan, Egypt, Nigeria) that represent very different cultures. Men 35-70y of age seeking primary medical care answered a structured questionnaire adapted to reflect local cultures. Degree of ED was categorized as 'none,' 'mild,' 'moderate,' or 'complete.' The age-adjusted prevalence rates of ED among men attending primary care clinics was 57.4% in Nigeria, 63.6% in Egypt, and 80.8% in Pakistan. Older age, diabetes, peptic ulcers, prostate disease, depression-related symptoms, and caffeine consumption were independently associated with increased prevalence of ED, whereas being moderately active to very active at work (hard physical labor) and during leisure time (strenuous exercise) was associated with half the prevalence of moderate-to-complete ED. Our multicultural study demonstrates that in every country studied, high proportions of men older than age 35 have some degree of ED (57-81%). Both severity and prevalence increase consistently with age. Factors associated with ED are similar, but their distribution differs across countries.

Purification and characterization of three galactose specific lectins from mulberry seeds (Morus sp.).

Three lectins were extracted and purified from mulberry seeds by gel filtration of 100% ammonium sulfate saturated crude protein extract followed by ion-exchange chromatography on DEAE and CM-cellulose. The lectins were found to be homogeneous as judged by polyacrylamide disc gel electrophoresis. The molecular masses of the lectins as determined by gel filtration were 175 000 for MSL-1, 120 000 for MSL-2 and 89 500 for MSL-3. MSL-1 is dimer in nature, with the two monomers held together by disulfide bond(s), while MSL-2 and MSL-3 contain four nonidentical subunits that are held together by nonionic hydrophobic interactions. The lectins agglutinated rat red blood cells and this agglutination was inhibited specifically by galactose, methyl-alpha-d-galactopyranoside, methyl-beta-d-galactopyranoside, lactose and raffinose. The lectins MSL-1, MSL-2 and MSL-3 contained 5.7, 5.4 and 4.5% neutral sugars, respectively, and the sugar composition of the lectins was glucose and mannose for MSL-1 and galactose for both MSL-2 and MSL-3. The lectins exhibited strong cytotoxic effect in brine shrimp lethality bioassay.

Do better family planning services reduce abortion in Bangladesh?

BACKGROUND: Fertility decline is often associated with an increase in contraception and abortion, but the causal relations are difficult to examine with non-experimental data. We aimed to assess the effects of family planning services on abortion rates in two similar areas. METHODS: We examined trends in overall abortion rates and rates for intended and unintended pregnancies in two similar areas typical of rural Bangladesh. We analysed Matlab Demographic Surveillance System (DSS) data on pregnancy outcomes between 1979 and 1998 in these areas, matching them to survey data on fertility preferences, which enabled us to identify pregnancies as intended or unintended. FINDINGS: Abortion rates were significantly lower in the area with better family planning services compared with the comparison area (1984-86, 2.2 vs 5.2; 1996-98, 2.3 vs 6.8). Abortion of unintended pregnancies is similar in both areas, but the higher levels of contraceptive use in the treatment area have led to lower levels of unintended pregnancy and abortion. The likelihood that an unintended pregnancy will be aborted has increased in both areas but the decrease in unintended pregnancies was sufficiently large in the treatment area to offset this increase. INTERPRETATIONS: Abortion may increase during the fertility transition in less-developed countries as the desire to limit family size increases unless there is widespread availability of quality family planning services.

The effect of divorce on infant mortality in a remote area of Bangladesh.

The process of divorce is usually lengthy and hazardous, and can start quarrels that can lead to the abuse of women and their children. This study examines the effects of divorce on neonatal and postneonatal mortality of babies born before and after divorce in Teknaf, a remote area of Bangladesh. The longitudinal demographic surveillance system (DSS) followed 1,762 Muslim marriages in 1982-83 for 5 years to record divorce, deaths of spouse, emigration and births. It recorded 2,696 live births during the follow-up period, and their survival status during infancy. Logistic regression models were used to estimate the effect of divorce on neonatal and postneonatal mortality, controlling for maternal age at birth, parity, sex of the child and household economic status. The odds of neonatal and postneonatal deaths among babies born after divorce or less than 12 months before mothers were divorced were more than double the odds of those born to mothers of intact marriages. The odds of postneonatal deaths were two times higher among babies born more than 12 months before divorce happens than their peers. The high mortality of infants born before and after mothers were divorced may reflect how abusive marriage and divorce increase the vulnerability of women and children in rural Bangladesh. Divorce and abuse of women are difficult and intractable social and health problems that must be addressed.

Characterization of tumor vaccines during product development.

The term tumor vaccines encompasses a wide variety of diverse agents capable of interacting with the immune system to produce local inflammation, delayed type hypersensitivity reaction and/or tumor regression and, hopefully, a therapeutic effect. These vaccines may be grouped into the following general areas: (1) Cell-based vaccines such as manipulated tumor cells, activated peripheral blood or bone marrow-derived lymphocytes, dendritic cells or other antigen presenting cells (APC) and gene-modified tumor cells or other cells engineered to express cytokines, growth factors or tumor antigens. (2) Antigen preparations, such as synthetic peptides, purified antigens and tumor cell lysates. (3) Viral and plasmid vectors expressing therapeutic genes. (4) Liposome containing antigen, peptides, plasmids encoding tumor antigens. While no tumor vaccine has been licensed by the FDA, numerous clinical trials are ongoing and some products have advanced to Phase III pivotal stages of development. However, as with many novel products, major regulatory and scientific issues associated with clinical use of tumor vaccines remain to be addressed. In this paper, we address issues associated with different types of tumor vaccines and provide recommendations for the characterization of these vaccines at various stages of development.

Improved indicators of infant mortality for integrated primary healthcare programmes.

Mortality and fertility rates are decreasing rapidly in many developing countries. It is argued that the indices commonly used as measures of these changes, i.e. infant mortality rate and fertility rate, ignore the interaction between mortality and fertility, and do not reflect their combined impact in lowering overall infant mortality. The paper proposes new indicators of infant mortality, termed fertility-adjusted infant mortality ratio (FIMR), age-specific, fertility-adjusted IMR (AFIMR), and total infant mortality ratio (TIMR) that are more sensitive to rapid demographic changes. These indicators include the combined effects of changes in both fertility and infant mortality rates on overall infant mortality in a region and appear to measure the effects of integrated health programmes better. Further, these conceptualize the mother-infant pair as an appropriate unit with which to monitor mortality, and may be used for guiding allocation of resources intended to lower infant mortality. The application and usefulness of these indicators have been illustrated, using one hypothetical example and empirical data from the maternal-child health and family-planning programme in Matlab, Bangladesh, as well as data from white and black population groups in the U.S.A. The results of these examples demonstrate that the new indicators are more sensitive than traditional measures when describing infant mortality, and may better reflect the perception in infant mortality status in the community.

Preference for children and subsequent fertility in Matlab: does wife-husband agreement matter?

This study examines wife-husband preference for children and subsequent fertility for a period of 5 years in the treatment and comparison areas of Matlab, Bangladesh. The two data sets used were: the In-depth Survey (1984) and the Demographic Surveillance System (1984-89). In the case of wives' preferences for children, subsequent childbearing was 13.8% higher than desired in the treatment area and 44.7% higher than desired in the comparison area. After controlling for all variables in the model, the likelihood of giving birth was 1.78 times higher for wives who wanted no more children, but whose husbands did want more, compared with couples where neither husband nor wife wanted more children. For couples where the wife wanted more, but the husband did not want more children, the likelihood of giving birth was 0.63 times that of couples where both the husband and wife wanted more children. This finding suggests that to enhance the decline in fertility in these two areas of Matlab, it will be necessary to motivate both wives and husbands to cease childbearing.

PIP: This study examined the effect of differences between husbands and wives desire for children and subsequent childbearing (SC) in the treatment and comparison areas of Bangladesh. Data were obtained from the 1984 In-Depth Survey (IDS) and the 1984-89 Demographic Surveillance System. The data subset excluded women who were unmarried, aged over 45 years, pregnant, or had out-migrated or died. Analysis was bivariate and multivariate. This study did not account for husbands or wives that genuinely change their minds about SC. 50.1% of wives wanted more children in the treatment area; 57.0% had SC. 41.8% in the comparison area wanted more children; 60.5% had SC. Among wives who wanted more children, 20.1% in the treatment area and 15.8% in the comparison area did not have SC. Among women who did not want more children, 34.1% and 43.5%, respectively, had SC. When SC was limited to 3 years of follow-up, SC was 14.9% lower than desired in the treatment area, rather than 14.1% higher in the 5-year follow-up, and 12.2% higher than desired in the comparison area (44.9% higher in the 5-year follow-up). When both husband and wife wanted more children, or if the husband's desires were unknown, SC was higher in both areas. If both the husband and wife wanted no more children, or if the wife wanted no more and husband's desire was unknown, SC was lower. Multivariate findings reveal that husband's agreement with the wife was related to SC. When the husband wanted more and the wife did not, the odds of SC were 1.8 times that of couples who did not want more. Muslims had higher SC; treatment areas had lower SC.

Health behavior, perceptions, practices, and decision making: sub-national and socio-demographic differentials in Bangladesh, 1995.

The study examines health behavior, perceptions, practices, and decision making using data from the 1995 Health and Demographic Survey conducted by the Bangladesh Bureau of Statistics. Knowledge about causes of diarrhea and food contamination were higher than knowledge about causes of nightblindness and worm infestation but this knowledge is inadequate. The household's economic condition and the respondent's education were found to be positively associated with disease knowledge and food contamination; the same is also true for health behavior and practices. Sub-national variation in disease knowledge and food contamination exists but did not correspond always with the health behavior and practices. Decisions regarding treatment of disease were made by the husband and wife together in two-thirds of the cases, however, it was not uniform across socio-demographic and sub-national categories.

Detection of human herpesvirus 6 sequences in lymphoma tissues by immunohistochemistry and polymerase chain reactions.

We have analyzed one Hodgkin's and six non-Hodgkin's lymphomas for the presence of human herpesvirus 6 (HHV-6) and Epstein-Barr virus (EBV) DNA by polymerase chain reaction (PCR) and antigens by immunohistochemistry. A large cell B-cell lymphoma and a T-cell lymphoma were positive for HHV-6 antigens by immunohistochemistry. Using PCR primers from the HHV-6 ZVH14 transforming DNA segment, all seven tumors were positive. EBV DNA was not detected by PCR using sequences from EBV internal repeat-3 region as primers. The data suggest an etiologic involvement of HHV-6 in some human lymphomas. Although all seven of the lymphoma tissues examined contained HHV-6 DNA, expression of HHV-6 antigens was observed in only two cases, suggesting that expression of proteins was not required for transformation.

Reproductive preferences in Matlab, Bangladesh: levels, motivation and differentials.

PIP: This study provides evidence that aspirations for a smaller family and poverty both determined the reduction in family size preferences in the Matlab area of Bangladesh. Data are obtained from a variety of data sets: the 1990 Knowledge, Attitude, and Practice Survey; the 1982 Socioeconomic Survey; and the 1991 Qualitative Survey. Both treatment and nontreatment areas of Matlab experienced a fertility decline during 1976-90, from 6.9 to 3.6 children/woman in the treatment area and from 7.2 to 5.2 in the control area. In this study, multiple classification analysis and logistic regression analysis were conducted. Findings indicate that mean desired family sizes were similar in both areas and slightly higher in the treatment area. Desired family size declined during 1975-90. Most of the decline probably occurred prior to 1985. Findings from qualitative interviews indicate that most women reported that the smaller desired family size was related to the direct economic cost of children. Women also reported that family planning was now available and that in the past there were more resources for caring for large families. Mothers-in-law were open to informing their daughters-in-law about the desire for small families. This motivation for a small family among older and younger women was not present 10 years ago. Findings reveal that desired family size did not vary by age, family size, socioeconomic group, or existence of the Family Planning and Health Services Program.^ieng

Human herpesvirus-6-associated malignant lymphoma in a bone marrow transplant recipient.

BACKGROUND: Human herpesvirus-6 (HHV-6), the sixth member of the herpesvirus family, can infect and replicate in human hematopoetic cell lines and can cause various illnesses in humans. HHV-6 has been suggested to be linked to various lymhoproliferative disorders. In vitro studies have demonstrated the oncogenic potential of HHV-6. The role of HHV-6 in human lymphomas needs to be examined. OBJECTIVE: To determine the involvement of HHV-6 in an immunoblastic lymphoma which developed in a bone marrow transplant patient, who had HHV-6 viremia. STUDY DESIGN: Paraffin-embedded lymphoma tissues were examined for the presence of HHV-6 by immunohistochemistry, PCR and in-situ hybridization. This is a case report investigation. RESULTS: An acute myelogenous leukemia patient received an allogeneic bone marrow transplant. He developed human herpesvirus-6 (HHV-6) viremia approximately 6 weeks after transplantation and HHV-6 was concurrently isolated from his bone marrow. Soon afterward, a large cell immunoblastic lymphoma was diagnosed. Complications of this tumor subsequently resulted in the patient's death. Periaortic lymph nodes and tumor cells infiltrating the liver and kidneys showed the presence of HHV-6 by immunohistochemistry and polymerase chain reaction (PCR). Southern blot analysis of the PCR amplified DNAs confirmed the presence of transforming pZVH14 DNA sequences of HHV-6 in the tumor tissues. Lymph nodes of 6 immunologically intact individuals were negative for HHV-6 by immunohistochemistry and PCR analysis. Tumor tissues were negative for EBV DNA by in situ hybridization with DNA probes specific for the EBV EBER RNAs. CONCLUSION: Our data suggest that HHV-6 may be involved in the pathogenesis of some immunoblastic lymphomas.

Identification and characterization of a human herpesvirus 6 gene segment capable of transactivating the human immunodeficiency virus type 1 long terminal repeat in an Sp1 binding site-dependent manner.

The human immunodeficiency virus type 1 (HIV-1) long terminal repeat (LTR) is transactivated by various extracellular signals and viral cofactors that include human herpesviruses. These transactivators are capable of transactivating the HIV-1 LTR through the transactivation response element, NF-kappa B, or other regulatory binding elements. Human herpesvirus 6 (HHV-6) is a potential cofactor of HIV-1. Here, we report that an HHV-6 gene segment, ZVH14, which can neoplastically transform NIH 3T3 and human keratinocytes, is capable of transactivating HIV-1 LTR chloramphenicol acetyltransferase constructs in an Sp1 binding site-dependent manner. Transactivation increased synergistically in the presence of multiple Sp1 sites and was dramatically reduced by cotransfection with oligomers designed to form triplex structures with HIV-1 LTR Sp1 binding sites. HIV-1 LTR NF-kappa B sites were not essential for ZVH14-mediated transactivation. A putative open reading frame in ZVH14, B115, which may encode a highly basic peptide consisting of 115 amino acid residues, showed transactivation capacity similar to that of ZVH14. This open reading frame also transactivated the HIV-1 LTR in an Sp1 site-dependent fashion in African green monkey kidney cells and human T cells. These data suggest that HHV-6 may stimulate HIV-1 replication via transactivation of Sp1 binding sites present in the HIV-1 promoter.