Vibrio vulnificus septicaemia in Japan: an estimated number of infections and physicians' knowledge of the syndrome.

Questionnaire surveys were implemented to study the incidence and physicians' knowledge of Vibrio vulnificus infections in Japan. Registered emergency physicians were selected by stratified random sampling for a questionnaire survey. A total of 235 out of 386 physicians (61%) responded to the questionnaire and 12 V. vulnificus septicaemia cases were reported from 10 respondents. The annual estimated number of V. vulnificus septicaemia was calculated as 425 (95 % CI 238-752). The study also revealed that only 15.7 % (95 % CI 11.3-21.0) of responding physicians had a basic knowledge of V. vulnificus infection. Education for both physicians and people in the high-risk group for developing the infection (e.g. immunocompromised, chronic liver disease) will be necessary for the prevention, early diagnosis and appropriate treatment of the disease.

Effect of long-term, low-dose acyclovir suppressive therapy on susceptibility to acyclovir and frequency of acyclovir resistance of herpes simplex virus type 2.

We have examined the susceptibility to acyclovir and frequency of acyclovir-resistant viruses in herpes simplex virus type (HSV) 2 clones isolated directly from genital lesions of 11 patients who had taken suppressive therapy (200 mg/day) for 1-9 years and 15 patients naive to acyclovir. Suppressive therapy significantly reduced the incidence of recurrence and the severity of the skin lesions. HSV samples from genital lesions were directly inoculated into Vero cells, and viral clones were isolated in the absence and presence of 10 microg/ml acyclovir. Five-hundred-and-ninety-two clones, isolated in the absence of acyclovir, were subjected to the acyclovir susceptibility test, and 155 clones isolated in the presence of acyclovir were analysed for the mechanisms of resistance to acyclovir. There were no significant differences in the susceptibility to acyclovir, the frequency of acyclovir-resistant virus and the ratio of thymidine kinase-deficient viruses in acyclovir-resistant viruses between the two groups. The frequency of acyclovir-resistant clones was about three per 10000 plaque forming units (PFU), and genital lesions contained up to 3x10(6) PFU of replicating virus in the specimens from the patients with genital herpes with or without acyclovir-suppressive therapy. Thus, the low dose of acyclovir suppressive therapy did not affect the susceptibility to acyclovir or increase the frequency of acyclovir-resistant viruses in the genital lesions.

Paget's disease arising near a male areola without an underlying carcinoma.

We report a 56-year-old man with Paget's disease occurring near the left areola without any underlying breast carcinoma. Histologically, there was no evidence suggesting continuity with a lactiferous duct, accessory breast, or microscopic gynecomastia. We review previous case reports of Paget's disease occurring in unusual sites and discuss their nomenclature from the histogenetic point of view.

Biological effects of air pollution in São Paulo and Cubatão.

Rats were used as biological indicators of air quality in two heavily polluted Brazilian towns: São Paulo and Cubatão. They were exposed for 6 months to ambient air in areas where the pollution was known to be severe. The following parameters were studied and compared to those of control animals: respiratory mechanics, mucociliary transport, morphometry of respiratory epithelium and distal air spaces, and general morphological alterations. The results showed lesions of the distal and upper airways in rats exposed in Cubatão, whereas the animals from São Paulo showed only alterations of the upper airways but of greater intensity than those observed in the Cubatão group. There are both qualitative and quantitative differences in the pollutants of these places: in São Paulo automobile exhaust gases dominate and in Cubatão the pollution is due mainly to particulates of industrial sources. The correlation of the pathological findings with the pollutants is discussed and it is concluded that biological indicators are useful to monitor air pollutions which reached dangerous levels in São Paulo and Cubatão.