Epstein-Barr virus-carrying B cells in the blood during acute infectious mononucleosis give rise to lymphoblastoid lines in vitro by release of transforming virus and by proliferation.

In accordance with earlier studies, we detected higher numbers of Epstein-Barr virus (EBV)-carrying lymphocytes (B-EBV) in the blood of acute infectious mononucleosis (IM) patients and higher amounts of transforming EBV particles in the saliva compared to healthy seropositive individuals. B cells grew in cultures seeded with the low and high density IM lymphocytes. The majority of B cells which grew acquired the infection in vitro (2-step outgrowth), because addition of virus neutralizing antibodies considerably reduced the emergence of lymphoblastoid cell lines (LCLs). Only the minority of the explanted B-EBV cells proliferated. The antiviral drug phosphonoformate (PFA) did not influence the frequency of 2-step LCLs in the IM cultures. This may indicate that a large proportion of EBV carrying B cells have already entered the viral productive cycle in vivo and passed the PFA-sensitive stage at the time of explantation. Earlier experiments with blood of healthy seropositive individuals showed an inhibitory effect of PFA on the generation of LCLs. One healthy individual who entered this study as a control, probably had a reactivated EBV infection as judged by the anti-EA activity in his serum and the high level of virus in his saliva. He had antibodies against EBV nuclear antigens (EBNA), and therefore he did not have a primary infection at the time of the test. Judged by the number of wells with B cell growth, the frequency of virus-carrying B cells in his blood was low. It seems that anti-EBV immunity can control the number of infected B cells in the blood, but does not influence the virus load in the epithelial cells.

Diagnostic fiberoptic bronchoscopy and protected brush culture in patients with community-acquired pneumonia.

A model for performing fiberoptic bronchoscopy as a supplement to noninvasive diagnostic methods, in patients with community-acquired pneumonia, was prospectively studied. Twenty-four patients underwent bronchoscopy, seven pilot patients and 17 of 277 (6 percent) consecutive patients with CAP. Indications for FOB were early therapy failure (less than or equal to 72h)(n = 7), late therapy failure (greater than 72h)(n = 11), or before start of antibiotic therapy in severely ill or immunocompromised patients (n = 6). Samples were obtained by aspiration of bronchial secretion and with a protected brush catheter from which quantitative cultures with a detection level of 10(4) colony forming units per ml were performed. Results concluded that FOB, with the use of quantitative PB-cultures, offered a safe and specific diagnostic tool, which on special indications, can be of great value in the management of patients with CAP.

Experience of a permanent ventilation and drainage system in the management of purulent maxillary sinusitis.

Fifty patients with purulent maxillary sinusitis, 11 patients with pressure-induced maxillary pain, and 14 patients undergoing maxillary sinus surgery were treated with a new type of permanent ventilation and drainage tube. With use of local anesthesia and as an office procedure, an inferior meatus antrostomy was performed with a circular-bore trephine, and a medical-grade, x-ray-dense silicone tube was inserted to secure the ventilation and drainage. Experience of 14 months of clinical use demonstrated a high success rate (92%) in cases of recurrent and chronic purulent sinusitis. All patients with pressure-induced pain were free from symptoms throughout the observation time. Only a few minor complications were observed. Among the advantages of the method is a more aggressive and early treatment in cases of purulent maxillary infections, possibly prior to the development of irreversible mucosal damage.

Permanent indwelling tubes in benign oesophageal stricture.

Permanent intubation of benign oesophageal stricture seems to be rather frequently used, but there are few reports on indications and results. The limited experience from 9 intubations in 7 patients presented, is not encouraging. Massive gastro-intestinal bleeding, peptic reflux and tube migration were seen, and 4 of the tubes had to be sacrificed within 6 weeks. Two patients only had full and lasting benefit of the treatment without serious tube complication. Indwelling tubes should be considered in benign strictures only as an alternative to gastrostomy, particularly in those patients feeling strong aversion to permanent stomy.

Sultamicillin versus amoxicillin in the treatment of tonsillitis and pharyngitis: a European multicenter study.

In this multicenter open, comparative study, 135 patients were treated with sultamicillin (67 subjects; 500 mg every 12 h) or amoxicillin (68 subjects; 500 mg every 8 h) for 10 d. Of the pathogens isolated pre-treatment, 24 of 29 (including 4 of 6 resistant strains) in the sultamicillin group were eradicated at the end of treatment, as were 17 of 22 in the amoxicillin group. At follow-up, the figures were 17 of 25 and 16 of 19, respectively. Clinical success was achieved in 55 of 55 sultamicillin and 40 of 43 amoxicillin patients at the end of treatment, and in 40 of 42 and 29 of 31, respectively, at follow-up. Overall success was recorded in 20 of 25 and 15 of 23 sultamicillin, and 14 of 19 and 13 of 17 amoxicillin patients at the two assessments. Side effects were reported for 21 sultamicillin patients, 1 of whom withdrew because of diarrhea, and 15 amoxicillin patients, 4 of whom withdrew because of rash. One sultamicillin and 4 amoxicillin patients developed minor abnormalities in laboratory safety parameters.

Evaluation of some prognostic factors in small squamous cell carcinoma of the mobile tongue: a multicenter study in Sweden.

In a retrospective study of 58 patients from all over Sweden, treated for small squamous cell carcinoma of the mobile tongue (T1N0M0), different prognostic factors were evaluated. A partial glossectomy was performed as primary treatment in all patients. The cancer recurred in 28 (38%) of 58 patients. One of 7 patients with only local recurrence, and 9 of 14 with recurrence in the neck died of their disease. The relative survival rate was 77%. Of the prognostic factors tested, tumor thickness was found to be the most significant. In patients with tumor thickness was found to be the most significant. In patients with tumor thickness exceeding 10 mm, recurrences occurred in 58% (P less than 0.0048), and 87% (P less than 0.0164) died of their cancer. This represents a statistically significant higher degree when compared with tumor thickness of less than 10 mm. Elective treatment of the neck nodes is recommended in epidermoid cancer of the mobile tongue when tumor thickness exceeds 10 mm, even in stage I tumors (i.e., the surface extension diameter is smaller than 20 mm at most).