Cryptococcal pneumonia simulating chronic eosinophilic pneumonia.

We report two cases of cryptococcal pneumonia in which the roentgenographic picture closely mimicked that for chronic eosinophilic pneumonia. Caution in use of corticosteriods based on this roentgenographic pattern is stressed.

Lack of selectivity of protoporphyrin IX fluorescence for basal cell carcinoma after topical application of 5-aminolevulinic acid: implications for photodynamic treatment.

Clinical trials of topical ALA in photodynamic therapy (PDT) of basal cell carcinoma (BCC) show significant recurrence rates. Exogenous 5-aminolevulinic acid (ALA) is converted by intracellular enzymes to photoactive protoporphyrin IX (PpIX) in human tissues. PpIX generates cytotoxic singlet oxygen when irradiated with visible light in the 400-640 nm range. To evaluate variability and heterogeneity in PpIX production by tumors in such trials, and to assess the usefulness of PpIX for marking skin tumors, we measured PpIX fluorescence distribution in BCC after topical application of 20% ALA cream. ALA cream was applied under occlusion for periods ranging from 3 to 18 h (average 6.9 h, SD 4 h) to 16 BCCs. ALA conversion to PpIX in the BCCs was assessed by in vivo photography, ex vivo video fluorescence imaging, and fluorescence microscopy. External macroscopic PpIX fluorescence, as assessed by in vivo and ex vivo imaging, correlated with the clinical presence of BCC. Examination by a digital imaging fluorescence microscope revealed inter- and intratumor fluorescence variability and heterogeneity. PpIX fluorescence corresponding to full tomor thickness was found in six superficial and four nodular tumors, and partial-thickness fluorescence was observed in five nodular tumors, but no PpIX fluorescence was observed in some areas of superficial, nodular and infiltrating tumors. In a significant number of nodular and infiltrating BCCs, topical ALA appeared to provide little or no PpIX in deep tumor lobules. In addition, no selectivity for tumor tissue versus normal epidermis was seen. The grossly brighter external PpIX fluorescence over tumors may be due, therefore, to enhanced penetration through tumor-reactive stratum corneum and to the tumor thickness.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of the carbon dioxide laser plume for simian immunodeficiency virus.

To determine the viability of the immunodeficiency virus in the laser plume after carbon dioxide (CO2) laser irradiation, multiple samples of culture medium containing concentrated simian immunodeficiency virus (SIVMAC at 1000 TCID50 cultured from HUT 78 cells) were irradiated with a continuous-wave CO2 laser at variable irradiances (from 400 W/cm2 for 5 seconds to 1600 W/cm2 for 300 seconds). The resultant plume was collected and cultured for the presence of SIV. A positive control consisted of handling an infected specimen identically to the test specimens, with the exception of CO2 laser irradiation. All test cultures remained negative over an 8 week incubation period, while the control was positive for viable SIV within 7 days. These results suggest that SIV is not viable in the laser plume after CO2 laser irradiation. Further investigation is necessary before extrapolating these results to the human immunodeficiency virus (HIV).

Farmer's lung serologies. An early manifestation of acute histoplasmosis.

Three cases of acute histoplasmosis demonstrated, in addition to the usual serologic findings, strongly positive precipitins against farmer's lung antigens. Twelve additional serums from patients with acute histoplasmosis were subsequently studied. Forty percent of these patients demonstrated positive precipitins against organic dust antigens.

Wasp sting anaphylaxis with cerebral infarction.

A cerebral infarction occurred in a 37-year-old man following wasp stings. Computerized axial tomography documented the neurologic lesion.

T lymphocytes in children with allergic respiratory disease.

The role of T lymphocytes in atopic disease is of considerable importance because animal studies indicate that cells of this lymphoid series may influence reaginic antibody response. T lymphocyte subpopulations were studied in a group of 76 children with allergic respiratory disease. There was no statistical difference between atopic children with asthma and those with allergic rhinitis as compared with an age-matched control population of 20 non-atopic children in terms of levels of active T lymphocytes or total T lymphocytes. The results of this study do not support the concept of a T cell immunodeficiency in children with allergic respiratory disease.

Complement component analysis in angiodema. Diagnostic value.

Complement component analysis is valuable for differentiating the various types of angioedema. Patients with hereditary angioedema have decreased levels of C1 esterase inhibitor and C4 in the presence of normal amounts of C3 and C1q. Acquired C1 esterase inhibitor deficiency secondary to malignant disease is also manifested by depressed C1 esterase inhibitor and C4, but decreased C1q levels distinguish it from hereditary angioedema. Normal values for these complement components are found in persons with allergic angioedema.

Hereditary angioedema with 14-year remission.

The concept that hereditary angioedema assumes a benign form in some families is supported by documented disease in a 37-year-old man who had had recurrent attacks for one year but has been without symptoms for 14 years. Although numerous members of the patient's family have been affected during the past five generations, known causes of death have not been directly related to angioedema.