Intestinal function is poorly defined in patients with HIV infection. Absorptive capacity and intestinal permeability were assessed using 3-O-methyl-D-glucose, D-xylose, L-rhamnose, and lactulose in 88 HIV infected patients and the findings were correlated with the degree of immunosuppression (CD4 counts), diarrhoea, wasting, intestinal pathogen status, and histomorphometric analysis of jejunal biopsy samples. Malabsorption of 3-O-methyl-D-glucose and D-xylose was prevalent in all groups of patients with AIDS but not in asymptomatic, well patients with HIV. Malabsorption correlated significantly (r = 0.34-0.56, p < 0.005) with the degree of immune suppression and with body mass index. Increased intestinal permeability was found in all subgroups of patients. The changes in absorption-permeability were of comparable severity to those found in patients with untreated coeliac disease. Jejunal histology, however, showed only mild changes in the villus height/crypt depth ratio as compared with subtotal villus atrophy in coeliac disease. Malabsorption and increased intestinal permeability are common in AIDS patients. Malabsorption, which has nutritional implications, relates more to immune suppression than jejunal morphological changes.

The aim of this study was to assess the usefulness of tuberculin skin testing as an indicator of tuberculous infection in an Irish human immunodeficiency virus (HIV) infected population, Between February and September 1988, 38 consecutive HIV positive patients were recruited into the study, A skin test score was derived for each patient using the Multitest system; which includes tuberculin and six other microbial. antigens, At review date in January 1991 after a mean follow-up period of 22, months (range 6-34), ten patients had died, three were lost to follow-up, and 25 were alive, Eleven patients were tuberculin positive on entry into the study,one of these developed tuberculosis, Twenty seven patients were tuberculin negative, three of these developed tuberculosis, Twenty-three patients were known to have received BCG eight of these gave a positive tuberculin test, and three developed tuberculosis. Twelve patients were known or suspected not to have received BCG, two of these were tuberculin positive and one developed tuberculosis. There was a strong negative correlation between Multitest score and advanced HIV infection (R=-0.7 p<0.001), We conclude that tuberculin skin test status and BCG vaccination had no relationship to the development of tuberculosis in the population we studied.

C-erB-2 oneoprotein expression detected immunohistochemically in primary breast cancer is a potent poor prognostic variable for patients including Irish women t.2.Also primary C-erB-2 expression indicates hormone resistance in recurrent breast cancer and relative tumour resistance to low intensity chemotherapy with mitoxanthrone (data in press).Forty young women (median age 41 years) had staining for C-erB-2 in their primary tumonrs; 11 showed positive staining and 29 did not.All subsequently had recurrences of breast cancer and were then given intensiv e chemotherapy with doxombicin 40 mg/m 2 intravenously and ifosfamide/ mesna 5 g/m 2 by intravenous infusion over 24 hours, with mesna alone for 8 hours.Cycles repeated at 21 day intervals to a total of 4 cycles in patients with responsive tumours.Response rates in recurrences (82% C-erB-2+VE vs 72% C-erB-2-ve) median response durations, and post-treatment survival were no different between patients on the basis of primary turnout C-erB-2 expression.This strongly suggests that young women with operable breast cancer and expression of C-erB-2 should be selected for intensive doxombicin based nee-adjuvant/adjuvant chemother apy.

Birefringent pulmonary talc granuloma are often found in lung biopsies from intravenous drug abusers (IVDA) but their clinico-pathological significance remains undefined.

OBJECTIVE--To determine whether central serotonin receptors are involved in the pathophysiology of non-ulcer dyspepsia. DESIGN--Between subjects study of solid phase gastric emptying and prolactin response to buspirone challenge. SUBJECTS--12 patients fulfilling criteria for non-ulcer dyspepsia and 12 age and sex matched controls. MAIN OUTCOME MEASURES--Solid phase gastric emptying measured by scintigraphic assessment of the movement of a standard meal labelled with technetium-99m and indium-111; responsiveness of central serotonin 1A receptors measured by the prolactin release following challenge with oral buspirone 60 mg. RESULTS--Solid phase gastric emptying was significantly delayed in the patients with non-ulcer dyspepsia (t 1/2 = 90.6 (SD 14.5) minutes in patients and 54.6 (10.7) minutes in controls; 95% confidence interval 24.7 to 46.7 minutes, p < 0.001). Prolactin release was significantly greater in patients compared with controls (1272.7 (1039.9) mU/l v 292.9 (136.1) mU/l; 352.1 to 1607.5 mU/l, p < 0.01). Gastric emptying and prolactin release were significantly correlated (r = 0.59, p = 0.04) in the patients but not in the controls (r = 0.23). CONCLUSION--Central serotonin 1A receptors may have a role in the pathophysiology of non-ulcer dyspepsia of the dysmotility subtype.

Methyltertbutyl ether (MTBE) administered by percutaneous transhepatic catheter rapidly dissolves radiolucent cholesterol gall bladder stones. However, complete dissolution and clearance of non-cholesterol debris is essential to prevent recurrence. In this study we analysed 25 consecutive patients with reference to efficacy and recurrence based on the presence or absence of non-cholesterol stone fragments after dissolution. Placement of the catheter was successful in 24 patients, one patient requiring cholecystectomy for bile peritonitis. MTBE was infused and aspirated continuously, four to six cycles per minute, resulting in rapid stone dissolution (median six hours; range 4-23 hours for solitary stones and median seven hours, range 4-30 hours for multiple stones). In 18 patients who had complete dissolution, four (22%) had recurrent stones within six to 18 months. Five patients had residual debris which failed to clear completely despite bile acid treatment. One patient with an incomplete rim of calcium in a large stone did not respond to MTBE treatment. A further patient required cholecystectomy for symptomatic recurrence. There were no serious side effects observed. MTBE treatment is a rapid, safe, and effective treatment for patients who refuse surgery or who for medical reasons cannot undergo cholecystectomy. The results of this study confirm that complete dissolution of all fragments is essential and may prevent recurrence.

Twenty‐four patients who had undergone orthotopic liver grafting and had received cyclosporin (CSA) for period up to years were evaluated for evidence of nephrotoxicity using 99mTc‐DTPA scanning and, in some cases, renal biopsy. Abnormalities of the Tc‐DTPA renal scan were apparent in all but one and, when a renal scan score was used to assess the degree of functional renal impairment, a correlation with duration of CSA use was apparent over the first 2 years. Reduction in renal perfusion, as assessed by the perfusion index method, was in general found earlier, preceded a rise in serum creatinine and did not correlate with duration of CSA therapy. Serum creatinine, was elevated in 14 of the 24 patients at time of scanning and hypertension had developed in 8 (33%). Patients switched to CSA after an initial period of Prednisolone and Azathioprine tended to have better renal function overall including less reduction in blood flow. Renal histology in 6 patients showed features of glomerulosclerosis and arteriopathy, changes similar to those observed in ischaemia. Thus, the changes of CSA toxicity are compatible with the concept that the renal impairment is consequent upon the early reduction in renal blood flow which may be an important factor in the renal damage found.