Search

Therapy trials have demonstrated efficacy of α interferon in AIDS with Kaposi Sarcoma; have strongly suggested efficacy of DTC and isoprinosine in ARC; and are suggestive for efficacy of imreg, ampligen, thymopentin, and thymostimulin in ARC. Many other substances are under evaluation. No immunotherapeutic agent has been useful in AIDS with opportunistic infections, although many combined trials with AZT are beginning. The preclinical and clinical data indicate that without the presence of a functioning thymus, new T cells cannot be produced thus immunorestorative treatments with thymomimetic biologicals (thymic hormones and IL2) or drugs (DTC and isoprinosine) in HIV disease should be administered prior to the thymic destruction characteristic of AIDS. Combinations of agents may be useful. New agents and strategies may derive from recent data indicating that interleukins and pituitary-derived hormones and factors play a critical role in T cell and thymus development.

A patient in whom chronic paraldehyde ingestion was associated with metabolic acidosis is presented. This case differs from the six previously recorded cases in coincident ethanol ingestion and in the degree of hyperacetaldehydemia. A false-positive nitroprusside reaction secondary to hyperacetaldehydemia was demonstrated to be the basis of "pseudoketosis." The acidosis could not be attributed to the accumulation of any organic acids measured. We offer a mechanism for explaining the observed acidosis which involves a negative feedback system characterized by nicotinamide dinucleotide (NAD) depletion, by acetaldehyde accumulation and by inhibition of NAD restoration. The possible role of acidosis and of acetaldehyde in the production of tissue toxicity is discussed.

Adult rabbits were injected intravenously with heat killed Mycobacterium bovis strain Bacillus Calmette-Guerin (BCG) suspended in oil. As reported previously (1) the rabbits develop a strong infiltration of mononuclear cells which can easily be demonstrated in the lungs 40-50 days post-sensitization. Cells lavaged from these lungs consists of about 82% macrophages, 14% lymphocytes, 3% polymorphonuclear leukocytes and 1% giant cells. Within five to six hours after in vitro cultivation with heat-killed BCG, the macrophages which have already attached to the plastic substrate form clusters apparently by migration. When the mixed population of lavaged cells is cultured for 24 hours many macrophages seem to fuse to form multinucleated giant cells (MGC), whereas cells collected from unsensitized rabbits do not form significant numbers of MGC. A typical MGC containing at least 35 nuclei in the central area of the syncytium is shown in Fig. 1. The mechanism involved in this cell fusion process is not understood.

Deep coma resulting from barbiturate overdose was studied in 50 patients. The length of coma correlated with depth of coma and serum barbiturate level except in those patients with drug addiction and hepatic or renal disease. The complications of pneumonia, bleeding of the gastrointestinal tract, urinary tract infections, and thrombophlebitis were common; however, all patients survived. Treatment was instituted on a rotation basis with supportive care alone, mannitol diuresis, or peritoneal dialysis. Using length of coma, the slope of disappearance of serum barbiturate value, and clearance data as indicators of the effectiveness of treatment, we found that the three treatment forms did not differ. Supportive care alone was associated with less local and systemic morbidity and appears to be the best method of reducing morbidity and mortality in patients with barbiturate overdose.

HumanFasciola hepaticainfection is a rare entity involving infestation of the liver and biliary tree with adult flukes, which can result in hepatitis, cirrhosis, and biliary tract inflammation, obstruction, and lithiasis. The patient had the typical diagnostic tetrad of fever, eosinophilic leukocytosis, tender hepatomegaly, and fluke ova in the stools. Treatment consists of emetine hydrochloride administration for hepatic involvement and common duct exploration for removal of flukes, with cholecystectomy for associated cholelithiasis. The combination of medical and surgical therapy can be expected to produce an arrest of this infection.