Changing testicular histology in AIDS: its implication for sexual transmission of HIV.

OBJECTIVES: The understanding of testicular histology in acquired immunodeficiency syndrome (AIDS) is essential, because the sexual route is one of the main means of transmission of the human immunodeficiency virus, which is localized primarily in the germ cells of the testes. It is important to determine whether any changes have occurred in the testicular histologic patterns in the course of the AIDS epidemic. METHODS: One hundred forty testicular specimens were available from AIDS autopsies during the AIDS epidemic (1981 to 1998). The epidemic was divided into pre-zidovudine (pre-AZT) therapy (1981 to 1987) and antiviral therapy (1988 to 1998) periods; the latter period was further subdivided on the basis of the particular treatment used. Testicular histology was evaluated and correlated with patient age, CD4 T-cell counts, and pathologic findings in other parts of the body. RESULTS: Testicular histologic findings were categorized into three groups: hypospermatogenesis (group S), spermatogenic arrest (group A), and Sertoli cell only (group O). The percentage of AIDS patients with group S histologic findings remained constant throughout the study period: 26% in the pre-AZT and 28% in the antiviral therapy periods. However, there was a reversal in the percentages of patients in groups A and O: group A decreased from 48% (pre-AZT) to 28% (antiviral) and group O increased from 26% (pre-AZT) to 44% (antiviral). There was no correlation between testicular histologic results and patient age or CD4 count. Opportunistic infections and testicular neoplasms were also identified. CONCLUSIONS: This study demonstrates that current therapy and prolongation of survival in AIDS patients are associated with a shift in the histologic findings of testes toward a more pronounced loss of germ cells. However, 28% of patients still show significant spermatogenesis at the time of death from AIDS and this subgroup cannot be identified by age or CD4 T-cell counts. The presence of large numbers of residual germ cells in these patients suggests that they may continue to be infectious throughout their disease course.

Cardiac hemangioma. A case report and discussion.

A cardiac hemangioma is a rare form of primary cardiac tumor. To our knowledge, only 34 cases of cardiac hemangioma have been discussed in the literature at the time of this writing. We report the case of a patient who presented with 1 episode of exertional dyspnea. The medical history, physical exam, work-up, surgical approach, and outcome are discussed. Other published reports on this topic are also reviewed.

A review of revision functional endoscopic sinus surgery.

For some patients, traditional or functional endoscopic sinus surgery (FESS) fails to relieve persistent or recurrent sinus disease. This subset of patients may require revision surgery. The objective of this study was to define and evaluate which features of sinus disease and prior treatment were characteristic of patients requiring revision FESS. Within a series of 295 consecutive FESS procedures, 43 patients who had prior sinus surgery and required revision FESS were studied and followed for a mean 14.1-month period. The characteristics of 13 patients with persistent disease following revision FESS and the potential technical risks and complications encountered were also evaluated. This study concludes that revision FESS is a safe technique that was effective in 69.8% of the patients, and that certain factors may predict a poor surgical outcome.