The utility of bone-marrow examination in HIV-infected adults in South Africa.

We retrospectively reviewed a consecutive case series of 257 adults with HIV infection who had undergone a bone-marrow examination with trephine bone biopsy, to assess the diagnostic usefulness of bone-marrow examination and evaluate possible predictors of a diagnostic examination. Bone-marrow examination was positive in 97 (38%) patients and gave a unique diagnosis in 61 (24%). The diseases were tuberculosis (83 patients), Mycobacterium avium complex infection and cryptococcosis (four patients each), and haematological malignancies (eight patients). The yield of the examination was significantly increased, by univariate analysis, in patients with wasting, oral thrush, leukopenia, CD4< or =100/mm3, and granuloma formation on histopathology. Granulomata were present in 113 (44%) patients, of whom 28 (25%) had no specific cause identified. Granulomata occurred in 22 (25%) of 89 patients with CD4 >100/mm3 compared to 36 (51%) of 70 patients with CD4< or =100/mm3 (OR 0.3; 95%CI 0.15-0.62). Of 48 patients with CD4 <50/mm3, 25 had granulomata, including 15 with caseation necrosis. The yield of bone-marrow examination was considerable in our setting. Expanding access to modern blood culture techniques for mycobacteria to primary care level could limit the number of bone-marrow examinations required.

Primary fallopian tube adenocarcinoma in situ associated with adjuvant tamoxifen therapy for breast carcinoma.

We report the first case of primary fallopian tube adenocarcinoma in situ in a patient who had received antiestrogen tamoxifen as adjuvant therapy for breast carcinoma. Clinical and in vivo animal model studies, referable to the possible estrogen agonist effect of tamoxifen on the female genital tract, are also reviewed.

Recalcitrant vulvodynia. A clinicopathological study.

This study is an analysis of 26 women with burning vulva syndrome. They seldom had frankly abnormal physical findings, and application of acetic acid and colposcopically directed biopsy are therefore mandatory. Histopathological study showed characteristic features of human papillomavirus (HPV) in 20 patients (77%). HPV has been shown to be a cause of vulvar vestibulitis syndrome and was an associated problem in 3 of the 5 patients who had essential or dysaesthetic vulvodynia. The latter is similar to causalgia, with a poor prognosis for resolution. Single patients had the following specific conditions: lichen planus, lichen sclerosus, mature neuroma and chronic candidiasis. The study shows that vulvodynia is a multifactorial problem for which management strategies have evolved over the course of time. Although interferon-alpha-2b offers much promise for the treatment of vulvodynia caused by subclinical HPV infection, the complete cure rate was only 58%. Overall 38% of patients still experience their problem, which indicates that they should be discouraged from going from physician to physician in the hopes of finding a 'cure'.

Involvement of the appendix in ovarian epithelial cancer--an update.

Appendicectomy was performed at the time of primary definitive surgery in 60 of 102 patients with epithelial ovarian cancer at Johannesburg Hospital over a 9-year period (January 1979-December 1987). Metastases were present in 37 of the 46 (80.4%) appendices removed from patients with advanced disease (stage III or IV) and in only 1 of the 14 patients (7.1%) with early disease. Metastases were not limited to serosal implants and included vascular and lymphatic space involvement, chronic obliterative appendicitis and almost complete replacement of the appendix by adenocarcinoma. The role of appendicectomy in the surgical management of epithelial ovarian cancer is discussed.