Genital ulceration as a risk factor for human immunodeficiency virus infection.

Among 115 heterosexual men who presented with genital ulcers to a sexually transmitted disease clinic in Nairobi, Kenya, the prevalence of serum antibody to HIV was 16.5%. A past history of genital ulcers was reported by 12 (63%) of 19 men with antibody to HIV versus 30 (31%) of 96 without antibody (P = 0.008). HIV infection was also positively associated with lack of circumcision, but was not associated with the etiology of the current genital ulcer. Logistic regression analysis (adjusted for age, number of recent sex partners, recent prostitute contact, circumcision, tribal ethnic identity, past history of urethritis, and current diagnoses) confirmed only the association between prior history of genital ulcer disease and HIV infection; (P = 0.04, odds ratio 2.35, 95% confidence limits, 1.01-5.47). The incidence of genital ulcers, particularly chancroid, is much higher in parts of Africa than in Europe or North America. This may contribute to the increased risk of heterosexual transmission of HIV in Africa. Aggressive control of chancroid and syphilis may offer one very feasible approach to reducing transmission of HIV in this region.

Effects of the antiprogesterone steroid RU 486 during midluteal phase in normal women.

UNLABELLED: The antiprogesterone steroid RU 486 (17 beta-hydroxy-11 beta-4-dimethyl-aminophenyl)17 alpha(1-propynyl)estra-4,9-dien-3-one) was given orally to 32 normally cycling women for 4 days, starting on the fourth day of the luteal phase. Uterine bleeding occurred on the third day of RU 486 administration in all 14 women treated with 100 mg/day, in 7 of the 8 women treated with 50 mg, and in 8 of 10 women receiving 25 mg/day. Premature luteal regression induced by RU 486 occurred in 8 women treated with 100 mg/day, in 3 treated with 50 mg, and in 2 receiving 25 mg/day. Plasma LH was measured every 15 min from 0800-1200 h for 5 days in 17 women. Mean LH levels decreased and pulsatile release disappeared in 7 of the 8 women treated with 100 mg, in 2 of 4 receiving 50 mg, and in 1 of 5 treated with 25 mg. RU 486 had no effect when given to 5 women with anovulatory cycles for 4 days starting on day 18 of the cycle. IN CONCLUSION: 1) RU 486, given to normally cycling women at midluteal phase, provokes uterine bleeding. 2) This effect occurs whether or not luteal regression is induced by the compound, indicating that RU 486 acts directly upon the endometrial tissue, very likely at the progesterone receptor level. 3) The drug may impair simultaneously or separately luteal function and gonadotropin secretion in a dose-dependent manner. 4) The lack of antiglucocorticosteroid activity, at the dosage of 100 mg/day, suggests that RU 486 may be useful for fertility control.

PIP: The antiprogesterone steroid RU 486 (17beta-hydroxy-11beta-4-dimethyl-aminophenyl)17alpha(1-propynyl)estra-4,9-dien-3-one) was given orally to 32 normally cycling women for 4 days, starting on the 4th day of the luteal phase. Uterine bleeding occurred on the 3rd day of RU 486 administration in all 14 women treated with 100 mg/day, in 7 of the 8 women treated with 50 mg and in 8 of 10 women receiving 25 mg/day. Premature luteal regression induced by RU 486 occurred in 8 women treated with 100 mg/day, in 3 treated with 50 mg, and in 2 receiving 25 mg/day. Plasma LH was measured every 15 minutes from 0800-1200 hours for 5 days in 17 women. Mean LH levels decreased and pulsatile release disappeared in 7 of 8 women treated with 100 mg, in 2 of 4 women receiving 50 mg, and in 1 of 5 treated with 25 mg. RU 486 had no effect when given to 5 women with anovulatory cycles for 4 days starting on day 18 of the cycle. The following were conclusions drawn. 1) RU 486, given to normally cycling women at midluteal phase, provokes uterine bleeding. 2) This effect occurs whether or not luteal regression is induced by the compound, indicating that RU 486 acts directly on the endometrial tissue, very likely at the progesterone receptor level. 3) The drug may impair simultaneously or separately luteal function and gonadotropin secretion in a dose-dependent manner. 4) The lack of antiglucocorticosteroid activity, at a dosage of 100 mg/day, suggests that RU 486 may be useful for fertility control.

The use of two estrogen preparations (a combined contraceptive pill versus conjugated estrogen cream) intravaginally to treat urogenital symptoms in postmenopausal Thai women: a comparative study.

OBJECTIVE: To determine whether the combined contraceptive pill used intravaginally was as effective as the standard conjugated estrogen cream for the treatment of urogenital symptoms in postmenopausal Thai women. SUBJECTS AND METHODS: In a randomized clinical trial, 40 postmenopausal women with urogenital symptoms were randomly allocated to two treatment groups for 8 weeks. The first group (n = 20) received a combined contraceptive pill by the vaginal route, one tablet per week at bedtime for 8 weeks. Each tablet contained 250 microg levonorgestrel plus 30 microg ethinyl estradiol. The second group (n = 20) was given 1 gm of an intravaginal conjugated estrogen cream at bedtime, three times in the first week, twice in the second week, and then once a week for the next 6 weeks (1 gram of conjugated estrogen cream contained 0.625 mg conjugated equine estrogens). Subjects were questioned about their urogenital symptoms, and vaginal cytologic smears, vaginal bacterial cultures, and urine cultures were performed before treatment and after 2, 4, and 8 weeks of therapy. RESULTS: The vaginal pH and the proportion of the fecal type bacteria decreased in both groups, with no statistically significant difference between the groups. The karyopyknotic index and the maturation index were improved during treatment in both groups. An increase in the proportion of lactobacilli were recorded in both groups after therapy, with no significant difference between the two groups. No significant changes were observed in urinary bacteria. The therapy (combined contraceptive pill and estrogen cream) had a marked effect on urogenital symptoms (vaginal dryness, dyspareunia, urinary frequency, and urinary urgency), with impressive improvement comparably in both groups. CONCLUSIONS: A combined contraceptive tablet administered vaginally once a week can alleviate urogenital symptoms in Thai postmenopausal women as effectively as the vaginal estrogen cream. However, the pills are much less expensive and are easily obtained in developing countries.

PIP: A randomized clinical trial conducted in Bangkok, Thailand, investigated whether intravaginal use of a combined oral contraceptive (OC) is as effective for the treatment of urogenital symptoms in postmenopausal women as the standard regimen of conjugated estrogen cream. 40 postmenopausal women (mean age, 54 years) with urogenital symptoms related to estrogen deficiency were allocated to one of two treatment groups for 8 weeks. The first 20 women received one OC (250 mcg of levonorgestrel and 30 mcg of ethinyl estradiol) per week; the remaining 20 women were given estrogen cream (0.625 mg conjugated equine estrogens) at bedtime 3 times in the 1st week, twice in the 2nd week, and weekly for the last 6 weeks. Vaginal pH and the proportion of fecal-type bacteria decreased, the karyopyknotic and maturation indices improved, and the proportion of vaginal colonization with lactobacilli increased in both groups, with no significant differences between treatments. Also recorded in both groups were impressive improvements in vaginal dryness, dyspareunia, urinary frequency, and urinary urgency. No significant changes were observed in urinary bacteria. Combined OCs are less expensive than vaginal estrogen cream and more readily available in developing countries. Since they are as effective as the cream at alleviating urogenital symptoms in postmenopausal women, their use for this purpose merits consideration.

Genitourinary tuberculosis: review of 102 cases.

PIP: Clinical presentations, laboratory features, and responses to therapy of 102 patients treated at an army medical center for genitourinary tuberculosis between January 1961 and September 1972 are described. During that time, a total of 3109 patients had been treated for tuberculosis of all types. The study group included 72 men aged 18-59 with a mean age of 29, and 31 women aged 17-66, with a mean age of 31. There was often a latent period of 20 years or more between infection with the tubercle bacillus and the expression of genitourinary tuberculosis. The principal means of diagnosis was isolation of Mycobacterium tuberculosis from urine, obtained in 80%, or sputum, obtained in 38%. M. tuberculosis was not cultured in 13 patients. In patients with negative cultures, diagnosis was made by combinations of positive tuberculin skin test, caseating granulomata on biopsy, characteristic changes in the excretory urogram, characteristic bladder lesions on cystoscopy, and the presence of sterile pyuria or microscopic hematuria. A wide variety of signs and symptoms were encountered as was a high frequency of involvement of other organ systems. The most common laboratory abnormalities were pyuria, albuminuria, and hematuria. 75% of patients had an abnormal chest roentgenogram on admission. 88% of patients tested had positive skin tests and 63% tested had abnormal excretory urography. 16% showed renal calcification. Only 1 nephrectomy was done in the latter 5 years of the study, for hypertension. 2 women and 6 men had hypertension, but 1 woman and 2 men had nontuberculous renal disease which could have caused the hypertension. The evidence from the series is that infectivity of genitourinary tuberculosis is low. There was only 1 initial treatment failure, in a 47-year old man with active pulmonary and renal tuberculosis caused by an isoniazid-resistant organism. 2 men, only 1 of whom had had genitourinary disease originally, had recurrences of tuberculous disease after prematurely discontinuing medication.^ieng

Menstruation-related periodic hypersomnia: a case study with successful treatment.

A 16-year-old girl suffered from 1 to 2-week periods of hypersomnia associated with each menstruation. Serum hormone levels were normal. CSF concentrations of homovanillic acid and 5-hydroxyindolacetic acid were lower in hypersomniac than in symptom-free phases. 3-methoxy-4-hydroxyphenylethylene glycol was not affected. The sleep periods occurred only in connection with ovulatory menstrual cycles. When ovulation was inhibited by a combination of ethinylestradiol and lynestrenol, an oral contraceptive pill, the hypersomnia ceased. Thus, the hypersomnia seemed to be linked to the occurrence of ovulatory menstruations.

PIP: A 16-year old girl who had undergone normal pubertal development at 13 years 8 months began to menstruate with moderate or severe dysmenorrhea and 1 to 2 weeks of hypersomnia at 16 years 2 months. She was without symptoms between hypersomniac phases. The patient was followed for 3 years, in the hospital for 31 days and as an outpatient thereafter. Examination, including neurologic and gynecologic status, was normal. Serum levels of follicle stimulating hormone, luteinizing hormone, estradiol, and progesterone were normal. CSF concentrations of homovanillic acid and 5-hydroxyindolacetic acid were lower in her hypersomniac than in symptom-free phases. 3-methoxy-4-hydroxyphenylethylene glycol was not affected. The sleep periods occurred only in connection with ovulatory menstrual cycles. Inhibition of ovulation with the oral contraceptive pill Lyndiol, which contains a combination of 50 mcg ethinyl estradiol and 2.5 mg lynestrenol, led to a cessation of the hypersomnia. When treatment was discontinued, the patient had 2 cycles without ovulation and no sleep periods, but ovulation and periodic hypersomnia occurred regularly thereafter. Reinstitution of the contraceptive pill controlled the symptoms. Discontinuation of the treatment was tested 2 more times for 3 months each, and the ovulatory cycles were again accompanied by sleep periods.

Serologic association of human herpesvirus eight with posttransplant Kaposi's sarcoma in Saudi Arabia.

BACKGROUND: This study investigates the association between human herpesvirus eight (HHV8) and Kaposi's sarcoma (KS), the most common cancer occurring in renal transplant recipients in Saudi Arabia. METHODS: A cross-sectional study of seroreactivity to HHV8 antigens in posttransplant KS patients from a tertiary care hospital in Riyadh, Saudi Arabia, and in control subjects without KS was conducted. Seroreactivity rates were determined using immunoblotting assays to detect antibodies to two lytic cycle HHV8 antigens: p40, an antigen found in infected cells, and sVCA, an HHV8-encoded small viral capsid antigen expressed in Escherichia coli. RESULTS: Antibodies to HHV8 p40 and sVCA were present in a significantly higher proportion of renal transplant patients with KS (13 of 14 patients) compared to renal transplant patients without KS (5 of 18; P<0.001) and compared to other control individuals (6 of 44; P<0.001). HHV8 seroreactivity was more common among patients with renal failure (28%) than among other control groups (7%). CONCLUSIONS: The serologic results provide evidence of a strong association between HHV8 and posttransplant KS in Saudi Arabia.

PIP: In Saudi Arabia, Kaposi's sarcoma occurs in 4.1% of renal transplant recipients and accounts for 70% of malignancies in this group. Human herpes virus 8 (HHV8) has been identified in the DNA of many of these patients. The association between HHV8 and Kaposi's sarcoma was investigated further in post-renal transplant Kaposi's sarcoma patients from a tertiary care hospital (King Faisal Specialist Hospital and Research Center) in Riyadh, Saudi Arabia (n = 14), and non-Kaposi's sarcoma controls with renal transplant (n = 18), chronic renal failure (n = 14), other cancers that did not affect renal function (n = 15), and healthy volunteers (n = 15). The median time from transplant to Kaposi's sarcoma was 13 months. A serum sample was assumed to have antibodies to HHV8 if antibody to either p40 or sVCA was detected. The prevalence of HHV8 seroreactivity was 13/14 (93%) in cases, 5/18 (28%) in renal transplants without Kaposi's sarcoma, and 11/62 (18%) in the aggregate control group. HHV8 seroreactivity was significantly more common (p 0.001) among transplant patients with Kaposi's sarcoma than those without this cancer (odds ratio, 33.80; 95% confidence interval, 2.96-904). These findings suggest an etiologic link between HHV8 and Kaposi's sarcoma presumably due to immunologic or cellular factors that influence host-virus interactions.

Presence of serotonin in the rat vas deferens: its influence on contractile responses.

Serotonin has been detected in the rat vas deferens. Increase in the serotonin concentration by exposure of the rat vas deferens to L-tryptophan occurs in vitro. p-chlorophenylalanine partly blocks the increase in serotonin concentration induced by tryptophan in vitro but not in vivo. Chronic sympathetic denervation induces an increase in 5-HT concentration. Responses of the vas deferens to transmural stimulation are depressed by pretreatment of rats with p-chlorophenylalanine, and the depression is reversed by incubation in vitro with 5-hydroxytryptophan or serotonin. Serotonin can enhance the response to transmural stimulation at low concentrations but has no effect at higher concentrations. Physostigmine-induced enhancement of the response to stimulation is depressed only by higher concentrations of serotonin. The results raise the question whether endogenous serotonin can act as a modulator of neurotransmission in the rat vas deferens.

PIP: Various experiments were conducted to evaluate the influence of serotonin (5-HT) on contractile responses of the rat vas deferens in vitro and in vivo. In vitro exposure of the vas deferens to L-tryptophan increased serotonin concentration. p-Chlorophenylalanine partially blocked this increase in vitro but not in vivo. The concentration of 5-HT was also increased by chronic sympathetic denervation. Pretreatment with p-chlorophenylalanine depressed the contractile response to transmural stimulation, while incubation with 5-hydroxytryptophan or serotonin reversed this effect. Low, but not high, concentrations of serotonin enhanced the response to transmural stimulation. However, only high concentrations of serotonin depressed the physostigmine-induced enhancement of the contractile response to transmural stimulation. The results suggest that endogenous serotonin may modulate neurotransmission in the rat vas deferens.

Sexual behaviour of neonatally castrated rats injected during infancy with oestrogen and dihydrotestosterone.

Male rats were castrated on the day of birth (day 1) and injected with either testosterone, dihydrotestosterone, a synthetic oestrogen (RU 2858 + dihydrotestosterone, or oil from days 1 to 5. The aromatizable androgen, testosterone, and RU 2858 suppressed both cyclic gonadotrophin secretion, indicated by the absence of corpora lutea from implanted ovarian grafts, and the behavioural response to oestradiol benzoate + progesterone injections in adulthood. The 5alpha-reduced androgen, dihydrotestosterone alone did not affect gonadotrophin secretion or female receptive behaviour, but like testosterone, it increased penis development in response to testosterone propionate, and this was positively correlated with copulatory efficiency, i.e. the ratio of intromission to mount frequencies. Nevertheless, ejaculation only occurred among animals that had received testosterone or RU 2858 + dihydrotestosterone. The results support the concept that during the preinatal period, neural conversion of androgens to oestrogens is important both for the suppression of female gonadotrophin secretion and behaviour patterns as well as for the organization of male behaviour patterns. The 5alpha-reduction of unsaturated C19-steriods to dihydrotestosterone in peripheral tissues is also required to complete the development of the male genital tract.

PIP: Experiments were carried out to compare the masculine sexual behavior of male rats castrated on the day of birth (Day 1) and injected with testosterone (an aromatizable androgen), dihydrotestosterone (a nonaromatizable androgen), or an estrogen. Litters of Sprague-Dawlet rats were castrated under cryoanesthesia on Day 1 and assigned to 1 of 5 treatment groups: Group 1 received 50 mcg testosterone, Group 2 received 50 mcg dihydrotestosterone, Group 3 received RU 2858, Group 4 received 50 mcg dihydrotestosterone plus 1 mcg RU 2858, and Group 5 was given .05 ml oil. During Week 5 an ovary from a prepubertal female rat was transplanted under the left kidney capsule of each rat. Each rat was given 20 mcg estradiol benzoate per kg followed by .5 mg progesterone. Sexual receptivity was assessed. The aromatizable androgen, testosterone, and RU 2858 suppressed both cyclic gonadotropin secretion and the behavioral response to estradiol benzoate plus progesterone injections. Gonadotropin secretion or female receptive behavior was unaffected by dihydrotestosterone, but it increased penis development in response to testosterone propionate which was positively correlated with copulatory efficiency. Ejaculation only occurred in those animals that had recived testosterone or RU 2858 plus dihydrotestosteorne. During the perinatal period natural conversion of androgens to estrogens is needed for the suppression of gonadotropin secretion and behavior and for the development of male behavior patterns.

Effect of benzo(a)pyrene and chlorpromazine on aryl hydrocarbon hydroxylase activity from rat tissues.

PIP: The effects of 3,4-benzo(a)pyrene (BP) and chlorpromazine (CP) on th e distribution and relative levels of aryl hydrocarbon hydroxylase (AHH) in rat tissue were studied in vitro. The metabolism of AHH in BP-treated lymph node, lung, prostate, kidney, salivary glands, liver, spleen and mammary gland was markedly increased, while only lung, liver, and kidney tissue showed a marked increase in CP experiments. Prior to treatment, the metabolism of polycyclic hydrocarbons occurred primarily in the liver. However, kidney and lung tissues became much more important in metabolizing these hydrocarbons after exposure to BP or CP. The importance of AHH activity in protective tissues of entry into the body is discussed.^ieng

Renomedullary interstitial cell tumor (formerly fibroma of renal medulla).

PIP: The renal medulla appears to exert an endocrine-like antihypertensive action. The main candidate for exertion of this action is the renomedullary interstitial cell. Accordingly, a search for hyperplasia or adenomatous transformation of this cell was conducted. Many fibromas of the renal medulla, previously considered as hamartomas, seemed to be composed of tumorous transformations of renomedullary interstitial cells. These tumors were small (1-7 mm), smoothly outlined, and gray or yellow. By light microscopy they contained lipid-laden cells (oil red O and Sudan black B positive), collagen, and much acid mucopolysaccharide. Semithin sections stained with toluidine blue revelaed many cells having the features of the renomedullary interstitial cell. Noteworthy were toluidine blue positive droplets, clear vacuoles, and elongated processes. By electron microscopy, the similarity of most cells to the renomedullary interstitial cell was evident. The striking features were electron dense osmiophilic droplets, cisternae, cytoplasmic processes, and positive tropism toward blood vessels. It is proposed that the fibroma of the renal medulla be renamed the "renomedullary interstitial cell tumor".^ieng

Structure of a radiate pseudocolony associated with an intrauterine contraceptive device.

Transmission electron microscopy of a radiate pseudocolony associated with an intrauterine contraceptive device (IUCD) showed central bundles of extracellular fibers averaging 35 nm in diameter, surrounded by layered mantles of electron-dense, amorphous granular material. No bacterial, viral, or fungal structures were present. X-ray microanalysis revealed copper, sulfur, chloride, iron, and phosphorus; no calcium was found. It is postulated that these structures and histologically identical non-IUCD-associated granules from the female genital tract, as well as similar structures from other body locations, including those reported in colloid cysts of the third ventricle, are of lipofuscin origin.

Scanning electron microscopy, x-ray diffraction, and electron microprobe analysis of calcific deposits on intrauterine contraceptive devices.

Deposits found intrauterine contraceptive devices (IUDs) were studied by scanning electron microscopy, x-ray diffraction, and energy dispersive x-ray microanalysis. All seven devices, including five plastic and two copper IUDs, were coated with a crust containing cellular, acellular, and fibrillar material. The cellular material was composed of erythrocytes, leukocytes, cells of epithelial origin, sperm, and bacteria. Some of the bacteria were filamentous, with acute-angle branching. The fibrillar material appeared to be fibrin. Most of the acellular material was amorphous; calcite was identified by x-ray diffraction, and x-ray microanalysis showed only calcium. Some of the acellular material, particularly that on the IUD side of the crust, was organized in spherulitic crystals and was identified as calcium phosphate by x-ray microanalysis. The crust was joined to the IUD surface by a layer of fibrillar and amorphous material. It is suggested that the initial event in the formation of calcific deposits on IUD surfaces is the deposition of an amorphous and fibrillar layer. Various types of cells present in the endometrial environment adhere to this layer and then calcify. Thus, the deposition of calcific material on the IUDs is a calcification phenomenon, not unlike the formation of plaque on teeth. Hum Pathol 16:732-738, 1985.

Health behavior and urinary tract infection in college-aged women.

We conducted a case-control study to examine the associations between various behavioral risk factors and urinary tract infection among college-aged women. Cases were collected from a University Health Service, and were compared to Health Service controls and to a population-based control group. Sexual intercourse, diaphragm use, and urinating after sexual intercourse were each associated with urinary tract infection (UTI). The magnitude of the association of diaphragm use with UTI was reduced when urination habits around sexual intercourse were considered.

PIP: 468 women using the University of Michigan Health Service because of urinary symptoms, completed questionnaires regarding medical history, stress, clothing, diet, sexual activity, and birth control method during the previous 4 weeks. 1484 potential Health Service controls without urinary symptoms were selected as well as 115 student-population -based controls. Urinary tract infection (UTI) criteria were 100,000 colonies of bacteria/ml urine and 10,000 colonies of a single bacteria/ml urine. After exclusions, the sample numbered 1641 women: 237 UTI cases, 1296 Health Service controls, and 108 student-population controls with an average age of 21.9 years. 63.2% of cases, 36.4% of Health Service controls, and 25.2% of population controls reported previous UTIs. UTIs significantly increased with the frequency of sexual intercourse. There was a weak link between a new sexual relationship in the prior 4 weeks and UTI and no association between multiple partners and UTI. Women without UTI used a diaphragm with spermicides (DIS) 8 times more often than oral contraceptives (OCs) compared to controls. Women who had had 1 or 2 UTIs used the DIS twice as often as OCs. Cases were more likely never of rarely to urinate after intercourse than controls. Always urinating before or after intercourse tended to protect against UTI. The odds ratio (OR) among women without UTI using a D/S urinating only before was 3.4, less than the OR of 9.5 associated with constant urination habits. The OR with D/S use before and after. Vitamin C appeared to protect against UTI, and the stress scale was somewhat linked to UTI. Sexual intercourse, D/S use, and urinating after sex (among women without previous UTI incidence) were associated with UTI.

Standard therapy for tuberculosis 1985.

PIP: Numerous clinical trials of chemotherapy for tuberculosis conducted throughout the world over the past 4 decades have established 2 basic principles of treatment: effective treatment requires the initial concomitant administration of at least 2 drugs to which the patient's organisms are susceptible; and cure of tuberculosis requires that treatment continue beyond the time of sputum conversion and amelioration of symptoms. The treatment of tuberculosis was revolutionized in the late 1960s with the introduction of rifampin. Shorter regimens of 6-9 months in duration became possible. Scores of trials of short-course chemotherapy have been conducted, and more are planned. The goals of the new treatment regimens are to achieve effective sterilization of the tuberculous lesion in the shortest time possible. A table lists drugs now in use in the US and Canada and gives the usual doses, common side effects, and important interactions among drugs. Chemotherapeutic regimens acceptable for use in the US and Canada are well-defined combinations of drugs which must be regularly administered in the recommended dosages and rhythm for a specific time period. Regimens should be highly effective, i.e., a relapse rate of less than 5%, and have a low risk of toxic effects. Regimens also should be acceptable to patients and applicable on a community-wide basis. The regimens recommended meet these criteria and are backed by well-conducted clinical trails. A 9-month regimen consisting of isoniazid and rifampin throughout, usually supplemented in the initial phase by ethambutol, streptomycin, or pyrazinamide, is a well-tolerated regimen which will cure virtually all patients with susceptible organisms. The initial daily phase may last 2-8 weeks; the continuation phase may be administered daily or twice weekly. These regimens have an overall bacteriologic relapse rate of between zero and 4%. When 4 drugs -- isoniazid, rifampin, pyrazinamide, and either ethambutol or streptomycin -- are given under close during supervision during the initial 2 months of daily or "induction" therapy, followed by an additional 4 months of isoniazid and rifampin, the results have been excellent. Where primary resistance to isoniazid or streptomycin is suspected, the patient should be placed on 1 of the following 3 regimens: isoniazid, rifampin, and ethambutol; isoniazid, rifampin, pyrazinamide, and streptomycin; or isoniazid, rifampin, pyrazinamide, and ethambutol. Short-course chemotherapy for extrapulmonary tuberculosis and chemotherapy of tuberculosis in children are reviewed along with several conditions which affect therapy -- tuberculosis during pregnancy, renal and hepatic disease, cancer and other conditions associated with immunosuppression, and drug interaction.^ieng

Actinomyces odontolyticus isolated from the female genital tract.

Actinomyces odontolyticus was isolated from genital tract specimens from 4.8% of 561 women fitted with intrauterine contraceptive devices and from 4% of 101 women with pelvic inflammatory disease and 1.8% of 525 women without pelvic inflammatory disease who were not known to be intrauterine contraceptive device wearers. The strains were isolated by prolonged anaerobic incubation of blood agar, with or without added 5% metronidazole or 1% neomycin. A odontolyticus has not been previously reported in cervico-vaginal specimens, and possible reasons for this are discussed.

Primary vulvar neoplasia: a review of in situ and invasive carcinoma, 1935-1972.

This survey reports the past 38 years of experience with 192 cases of carcinoma of the vulva seen and treated at the Johns Hopkins Hospital. The review stresses the increased incidence of in situ neoplasia and the importance of individualization of therapy. Also the changing concepts in terminology (eg, the leukoplakic vulvitis of the past is the dystrophy of the present) suggest that the precursory alterations of previous discussions must be reviewed in the light of such an altered nomenclature. Features of epidemiologic and histologic importance are discussed.

PIP: Vulvar neoplasia as seen at the Johns Hopkins Hospital during a 38-year period (1935-1972) is reviewed. Of 1385 tissue specimens, 1053 were benign and 332 were malignant lesions. Of the malignant lesions, 246 were squamous cell carcinoma, both in situ and invasive. Of these, 192 were treated and followed and are reported on. There were 71 cases of in situ and 121 of invasive cancer. Of the patients, 64% were white and 36% were nonwhite, which corresponds to the patient population treated at the hospital. Ages of patients ranged from 21 to 86 years, with a median of 50 years. Of those with invasive cancer, 75% were postmenopausal and none was under the age of 30 years. There was a 29% incidence of nulliparity and a 64% incidence of obesity. Diabetes was noted in 64%. Syphilis was discovered in 26%. These patients had a high risk of being exposed to other venereal infections, particularly herpes which is suspect as a precursor of neoplasia. Vurrucous carcinoma are also likely to be of viral origin. Other malignancies were also present in 20% of patients. There was 1 case of chronic clyphocytic leukemia. Presenting symptoms were a lump, a white patch, pruritus, or bleeding. Pruritus was present in 46%. A leukoplakialike appearance was noted in most of the in situ lesions. Multicentric foci of origin were demonstrated in 35%, mostly in the in situ cases. Of the invasive cancers 60% were well differentiated and 11% were verrucous. Multiple histologic patterns were present in many cases. In 167 patients (67%), the initial treatment was surgical. Postoperative radiation was used in 30% of those with invasive cancer. Local recurrences followed in 22%. In those with multicentric foci the recurrence rate was 48%. 44 patients were known to have died, mostly from other causes. Survival was directly related to the stage of the disease at the time of initial diagnosis and treatment.

Anovular corpus luteum in a woman taking an oral contraceptive.

PIP: When laparatomy was performed on 3 women treated with a combination-type oral contraceptive (5 mg lynestrenol, 150 MCG mestranol), an anovular corpus luteum was found in 1 ovary. Dating from the start of oral therapy, the times of the operations were Day 24, Cycle 1; Day 24, Cycle 2; and Day 23, Cycle 3 (anovular corpus luteum). The anovular corpus luteum was 6.5 mm long and 3.0 mm wide and had undergone considerable regression, about 3/4 of it having been converted into an avascular hyalinized mass. An unejected ovum, contour slightly altered and size approximately equal to that of ova in ovulation-ripe Graafian follicles, was situated in the center of the hyaline mass. The unejected ovum was the first one to be observed in a completely developed corpus luteum. The membrane pellucida was wider than usual, but the nucleus, nucleolus, and corona radiata cells surrounding the ovum had undergone little change. Hormone administration may have favorably influenced conditions of metabolism within the hyaline mass. Alterations in the anovular corpus luteum were compared with those found in the second treatment cycle in a corpus luteum formed during the first treatment cycle. The anovular corpus luteum was concluded to be the regressing corpus luteum of the first treatment cycle and approximately 65 days old.^ieng

Effect of anovulatory drugs on the human urinary tract and urinary tract infections.

PIP: Over a 1-year period, 44 women using either Demulen, Deladroxate or the Lippes loop were studied at the University of Pennsylvania for urinary tract disorders. Monthly catheterized urine specimens were cultured and examined cytologically. Excretory urograms and serum creatinine examinations were performed 1 month prior to and 6 and 12 months after contraceptive initiation. No effect on the urinary tract was observed by X-ray studies. All serum creatinines remained normal. Urine sediments showed cytologic patterns consistent with phase of cycle. Incidence of asymptomatic bacteriuria was 6.8% initially and 11% during the course of study. Only 1 Demulen patient developed asymptomatic tract infection. Urographic abnormalities were found in a certain percentage of women of reproductive age irrespective of contraceptive use. Study results, are confirmed by urograms of family planning clinic patients, indicate that estrogen-progestogen contraceptives appear to have little significant effect on human tract anatomy or infection rate.^ieng

The impact of control measures on urinary schistosomiasis in primary school children in northern Cameroon: a unique opportunity for controlled observations.

As part of a program to integrate schistosomiasis control into the primary health care system in northern Cameroon, an unexpected opportunity to undertake a controlled evaluation of the impact of interventions was recognized. Inadvertently, a large part of Mindjil, one of four assessment villages, had been essentially excluded from the program, creating a unique natural control. The prevalence of infection with Schistosoma hematobium in school-aged children was 7% in the areas where the control program was implemented, and 71% in the excluded areas (P < 0.0002). High intensity infection was 1% and 26% in the two areas, respectively (P < 0.0002). Children in the school where the control interventions were implemented had a significantly lower prevalence of infection with Schistosoma hematobium (P < 0.005). Subjects in intervention areas demonstrated greater knowledge about the transmission of schistosomiasis than those in the control area. This study documented and quantified program impact in a controlled manner not usually possible in field studies and also illustrated how unrecognized intracultural diversity (within culture differences) in target populations may effect disease control programs in communities.

Malignant hypertension in young women is related to previous hypertension in pregnancy, not oral contraception.

Previous studies have suggested that one-third of women of childbearing age who develop malignant phase hypertension (MHT) are likely to be taking oral contraceptives (OC). We surveyed 104 women with a history of MHT. None of the 65 aged > 45 years were taking OC or other sex hormones. Thirty-nine (mean age 34.9 years, SD 8.0) were aged 15-44 years at presentation: 22 Caucasian, 10 Black/Afro-Caribbean and seven Indo-Asian. Of these 39, 22 had a history of hypertension in pregnancy (group 1), and 17 did not (group 2). Three of group 1 also had a history of OC-induced hypertension. None were pregnant, but one was taking an OC at presentation with MHT. Blood pressures at presentation and follow-up, and mean serum urea and creatinine at presentation were similar between groups, as was median survival (96 vs. 47 months, Lee-Desu statistic 0.75, p = 0.38). There was a trend towards poorer renal function at follow-up in group 1 patients, with higher mean serum urea and creatinine levels. The causes of death were renal failure (5), stroke (4) and heart disease (2). The OC was not a common cause of MHT-amongst our sample of women of childbearing age, but a past history of hypertension in pregnancy was important. Such patients also had a longer duration of hypertension and poorer renal function at follow-up.