Communication about safer sex and serostatus disclosure in HIV-positive adolescents with haemophilia.

OBJECTIVES: To assess the attitudes, beliefs and feelings of adolscents and young men with severe haemophilia with respect to discussing safer sex and disclosing their human immunodeficiency virus (HIV) seropositivity to potential sex partners. METHODS: Fifty-nine males with haemophilia from throughout the US answered open-ended questions. RESULTS: Talking about avoidance of transmitting AIDS and disclosing one's seropositivity was beneficial, moral and wise. Nevertheless, this was exceedingly, difficult, unpleasant, and fraught with fear of rejection and alienation. Communication was approved by family, friends, and health-care providers. Facilitators of communication were: knowledge and an accepting attitude about persons with HIV, a supportive person to assist with discussion, and environmental cues. CONCLUSION: This first report of HIV-infected adolescents and young adults reveals that although they endorse discussing safer sex and disclosing their HIV seropositivity, they are painfully aware of the social and interpersonal risks of such extremely difficult communications.

Effect of acidosis and hypoxia on intestinal blood flow of sheep fetus.

In sheep fetuses 110-130 days of age acidosis (blood pH 6.95; produced by infusion with 1.1 M lactic acid) significantly lowered blood flow (ml/min/100g) to the full thickness wall of the jejunum from 135 +/- 11 to 93 +/- 14 and in the full thickness wall of the ileum from 122 +/- 13 to 95 +/- 11. The decrease was mainly due to the decline in blood flow to mucosa of the segment, where flow decreased from 182 +/- 20 to 83 +/- 14 in the jejunum and from 130 +/- 10 to 107 +/- 9 in the ileum. Fetal hypoxemia (PaO2 of 14.9 mm Hg; induced by allowing ewes to breath 11.1% O2 and 88.9% nitrogen) reduced blood flow only to the jejunal mucosa from 142 +/- 14 to 99 +/- 16. The reduction in blood flow to the full thickness wall of the jejunum and the ileum did not change significantly from the control period, when PaO2 was 25 mm Hg.

Large cell lymphoma complicating acute lymphoblastic leukemia.

Non-Hodgkin's lymphoma (NHL) is a very rare complication of acute lymphoblastic leukemia (ALL). We present the pathologic, clinical, immunologic, and ultrastructural features of the third reported example of NHL following successfully treated ALL. This white girl developed ALL with predominantly L1 cells at 3.5 yr of age. The lymphoblasts were terminal deoxynucleotidyl transferase (TdT) positive and were non-B, non-T cells. She achieved a complete remission with standard induction therapy and has remained in continuous complete remission. Four and one-third years after the onset of ALL, she developed multifocal, pleomorphic large cell lymphoma of the small bowel, which resulted in episodes of intussusception and obstruction. These pleomorphic and frequently multinucleated lymphoma cells lacked TdT, common ALL antigen, and all tested markers of B cell, T cell, and histiocyte differentiation. Following three small bowel resections, systemic multiagent chemotherapy, and abdominal irradiation, she is currently free of disease.

Prognostic significance of terminal transferase activity in childhood acute lymphoblastic leukemia: a prospective analysis of 164 patients.

Whether the level of terminal deoxynucleotidyl transferase (TdT) activity in mononuclear cells from bone marrow and peripheral blood has prognostic significance has been analyzed prospectively in 164 children with T and non-T, non-B marked acute lymphoblastic leukemia (ALL). TdT was measured at diagnosis to assess its value as a predictor of duration of remission and length of survival. It was measured repeatedly during remission to assess whether it could predict relapse. Ninety-seven percent of the children achieved a complete remission of their disease, and 40% relapsed during the study. The level of TdT activity in blasts at diagnosis varied 1000-fold from patient to patient. There was no statistically significant relationship between TdT activity in cells at diagnosis and the achievement of complete remission, the duration of remission, or length of survival. TdT activity was significantly increased in the bone marrow of 65% of patients at the time of marrow morphological relapse, but was rarely increased in marrow from patients with isolated testicular or central nervous system relapse. Wide fluctuations in TdT activity were characteristically seen in mononuclear cells from the marrow and peripheral blood of patients with ALL at all stages of their disease. An isolated high value of TdT activity in the bone marrow or peripheral blood cannot be taken as evidence of impending relapse. Quantitative measurements of TdT activity alone on mononuclear cells from bone marrow and peripheral blood are helpful in differential diagnosis, but cannot guide therapy of children with ALL.