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Early diagnosis of persons infected with human immunodeficiency virus (HIV) through diagnostic testing and screening is a critical priority for individual and public health. Emergency departments (EDs) have an important role in this effort. As EDs gain experience in HIV testing, it is increasingly apparent that implementing testing is conceptually and operationally complex. A wide variety of HIV testing practice and research models have emerged, each reflecting adaptations to site-specific factors and the needs of local populations. The diversity and complexity inherent in nascent ED HIV testing practice and research are associated with the risk that findings will not be described according to a common lexicon. This article presents a comprehensive set of terms and definitions that can be used to describe ED-based HIV testing programs, developed by consensus opinion from the inaugural meeting of the National ED HIV Testing Consortium. These definitions are designed to facilitate discussion, increase comparability of future reports, and potentially accelerate wider implementation of ED HIV testing.

Seven patients with Parkinson's disease and three patients with progressive supranuclear palsy underwent adrenal medullary transplant to the caudate nucleus for treatment of their neurologic disease. Preoperative nutritional assessment demonstrated that a significant number of the Parkinson's patients had mild to moderate nutritional depletion. Motility problems, manifest by dysphagia and delayed gastric emptying causing problems over a number of years, were probably responsible. Of the 10 patients studied, 6 were studied by videofluoroscopy. All patients had variable dysphagia of variable servility with or without aspiration. Etiologic factors included the basic underlying neurologic disease, delay in resumption of anti-parkinsonian medications, use of metoclopramide, and postoperative medical complications leading to a debilitated clinical state.

Large cell calcifying Sertoli tumor of the testis was found in a 16-year-old boy who had presented with gynecomastia. Serum estrogen level, which had been elevated preoperatively, returned to normal following orchiectomy. Charcot-Bottcher crystalloids are demonstrated in the neoplastic Sertoli cells.

Fifty-six Brenner tumors of 51 patients were analyzed. The incidence of bilaterality was 9.8%. Most tumors were smaller than 2 cm, and constituted incidental finding. Most of the patients were 30-49 years old (mean 49.7, main 44). A high incidence of associated malignant neoplasms was noticed among the patients with Brenner tumor but was considered coincidental. No evidence of hormone secretion by the tumor was found. Out of 31 tumors, 27 occupied the cortex. Urothelial metaplasia of the ovarian surface epithelium was demonstrated in one case, and continuation of the Brenner column with the surface of ovary in another. There were 12 cases of mixed Brenner tumor in this series (21.1%). The most frequent associated constituents of the mixed Brenner tumors are mucinous cystadenomas. These tumors represent a single mixed neoplasm originating in a multipotential celomic cell which proliferates and differentiates into several mullerian forms. The histogenesis of medullary and hilar Brenner tumors can be explained on the basis of celomic metaplasia. Uncertainty persists in explaining the histogenesis of Brenner tumors mixed with mature cystic teratoma.

A case of low-grade ovarian stromal sarcoma in a postmenopausal woman is described. Although pelvic recurrences of the tumor followed 5 and 7 years after the original surgery, the patient has remained well and without evidence of tumor 3 years since the last operation. Histopathologic, electronmicroscopic, and hormonal studies are described. There was evidence of estrogenic stimulation by the theca elements of the tumor in this patient. Cases previously reported in the world literature as malignant thecoma were analyzed, and most of them were considered inadequately documented; indeed most of them were probably either sarcomatoid granulosa cell tumors, stromal sarcomas, or fibrosarcomas. If a thecoma ever becomes malignant, the tumor cells dedifferentiate so that they cannot be recognized any longer as theca cells; instead, they proliferate as a stromal sarcoma or fibrosarcoma. It is proposed, therefore, that the term "malignant thecoma" not be used. On the other hand, very rare malignant ovarian stromal tumors do exist, consisting of undifferentiated stromal cells, fibroblasts, and theca cells, which can show evidence of hormonal activity.

The authors describe two mucinous ovarian tumors that were hormonally active due to Sertoli-Leydig elements within the septal stroma. Carcinoid was also present in each case. The mesenchymal stromal cells within the septa of the mucinous tumors have undergone neoplastic proliferation with the Sertoli and Leydig differentiations, leading to the formation of arrhenoblastoma. The carcinoid component of these tumors is thought to have originated from argentaffin cells of the "intestinal" mucinous epithelium.

A case-control study was undertaken to investigate the effects of intrauterine contraceptive devices (IUDs) on the histology of cervical epithelium. Ninety-one women who had used IUDs for 2--13 years were case subjects and were compared with the same number of women who had never used any form of contraception (control subjects). Two subgroups were investigated, group A and group B. Group A consisted of 53 IUD users and 53 controls coming to family planning and gynecology clinics, and group B consisted of 38 IUD users and 38 controls from dysplasia clinics. Cervical cytology and colposcopically directed cervical biopsies were taken in all women. There was no difference between IUD users and control subjects in the proportion or the severity of dysplasia in either group A or group B. There was no evidence of an increase in the prevalence or severity of dysplasia with prolonged IUD use.

An exceedingly rare ovarian neoplasm composed of mixed thyroid and Brenner tumor is reported. Review of the literature yielded only one well-documented case previously described. Although the possibility of a "collision" of two different tumors cannot be completely discarded, a possibility of an endodermal teratoma (thyroid-urothelium) is also proposed.

A case of a malignant undifferentiated germ cell tumor in situ of an undescended testis diagnosed by needle biopsy is described. Four similar cases have been so far recorded in the literature, all of them in the infertile men with normally descended descended testes. Two of them developed embryonal carcinoma of testis 4 1/2 later and one had a concomitant seminoma. In a high-risk group of patients (atrophic testis, cryptorchidism), a needle biopsy of a testicle may discover malignancy in its very early phase of development (Stage 0), at which time an orchiectomy alone may be a curative treatment.