Spontaneous sputum examination for early diagnosis of pneumocystis carinii in Ugandan AIDS patients

Whereas pneumocystis carinii pneumonia (PCP) is one of the major complications and causes of death in patients with the Acquired Immunodeficiency Syndrome (AIDS); patients show that mycobacterium tuberculosis (MTB) is a commoner cause of HIV-associated pneumonia than PCP. Most methods used to diagnose PCP entail invasive and expensive techniques which are beyond the facilities available in developing countries. This study was therefore designed to evaluate spontaneous sputum examination as a cheaper method for the diagnosis of PCP. Sputum specimens collected in 1987 from 54 AIDS patients in Mulago Hospital were stained using a modified Gram stain and read by a competent technician. None of the 54 slides contained evidence of pneumocystis carinii. These results were consistent with other studies in Africa which show that PCP is rare among AIDS patients. [abstract terminated]

Arterial intimal embrittlement. A possible factor in atherogenesis.

Sections of aorta, coronary artery, basilar artery and vena cava were collected at autopsy. Macroscopically normal intimal specimens were removed by stripping. Intimal collagen was measured as hydroxyproline. Intimal film embrittlement was measured in vitro by a bursting volume distensibility test developed in our laboratory. There was an average increase of over 100% in the collagen content of apparently lesion-free human arterial intima on aging over a fifty-year period. This includes an increase of 113% for aortic intima, 49% increase for coronary artery intima, and an increase of 158% in collagen in basilar artery intima. In contrast the collagen level in the vena caval intima decreases on aging, by 42% in fifty years. The large increase in collagen in arterial intima is accompanied by a large increase in intimal embrittlement. The decreasing collagen content of the venous intima on aging results in increased distensibility. Increased aortic intimal film embrittlement (lower distensibility) correlates with age (R = 0.699), but even better with intimal collagen (R = 0.911), suggesting that aortic intimal collagen level is a more important determinant of intimal embrittlement than age. Men, older than 55, have significantly higher aortic intimal collagen levels than women. Embrittlement of arterial intima should make it more susceptible to injury under the pulsatile pressure of the blood. Decreased venous intimal collagen and greater distensibility on aging could be factors in the development of venous valvular insufficiency and varicose veins. However, our study of veins was performed primarily as a control in this instance. Fundamental elements in the atherogenic process are increased intimal collagen, increased intimal brittleness, endothelial injury, followed by intimal cell proliferation. In the vena caval intima on aging there is decreased collagen, increased intimal distensibility, no injury due to increased pulse or blood pressure, and, therefore, no cell proliferation and no intimal lesion.