Interferon-beta-1b and interferon-gamma have similar inhibitory effects on apolipoprotein-E production in the monocyte/macrophage.

Apolipoprotein-E (Apo-E) is the major lipid carrier in the brain, and is therefore important in the recyding of lipids and cholesterol to regenerating neurons during the remission phase of multiple sclerosis (MS). Interferon (IFN)-gamma has been shown to inhibit Apo-E production by a mainly post-transcriptional method in a macrophage cell line, and reduced Apo-E in cerebrospinal fluid is noted during the remission phase in patients. IFN-beta-1b is a recombinantly produced, anti-inflammatory cytokine, which has been shown to reduce the severity of MS relapses and reduce relapse rate. We have examined the effects of IFN-gamma and IFN-beta-1b on the production of Apo-E mRNA, cellular protein and secreted protein in primary monocytes derived from donor blood. IFN-beta-1b does not relieve the dose-dependent inhibition of Apo-E seen with IFN-gamma at up to 100 U/ml in these cells, and when used alone inhibits Apo-E production in a dose-dependent manner. This inhibition by IFN-beta-1b was seen to be at a transcriptional level, and dose dependent up to 100 U/ml. Apo-E genotype, which has also been linked to failure to recover from MS relapses, did not affect this inhibition. The mode of action of IFN-beta-1b in MS is therefore not thought to be through modification of Apo-E production.

Delavirdine in combination with zidovudine in treatment of human immunodeficiency virus type 1-infected patients: evaluation of efficacy and emergence of viral resistance in a randomized, comparative phase III trial. The M/3331/0013B Study Group.

We compared the activity of delavirdine (DLV) plus zidovudine (AZT) (n = 300) with that of AZT (n = 297) against human immunodeficiency virus type 1 in a randomized, double-blind, placebo-controlled trial. DLV exerted a transient antiviral effect, and mutations for resistance to DLV were found in more than 90% of subjects at week 12. The K103N mutation, which confers nonnucleoside reverse transcriptase inhibitor cross-resistance, was found in 85% of the patients.

Acalculous nontyphoidal salmonellal cholecystitis requiring surgical intervention despite ciprofloxacin therapy: report of three cases.

Nontyphoidal salmonellal cholecystitis is a rare complication of nontyphoidal salmonellal enterocolitis. We describe three patients with this complication who were hospitalized in a regional infectious disease unit at Ruchill Hospital, Glasgow, Scotland, over a period of 12 months. All three patients were receiving ciprofloxacin therapy before the episodes of cholecystitis became clinically evident, and all required surgical intervention.

The efficacy of dental sealants for an adult population.

A 1-year pilot study was conducted to determine the retentive capacities of dental sealants on adult teeth. It proposed to utilize the knowledge and experience gained in sealant application, as a means of attacking the problem of the increase in restored teeth at risk in the aging population. Eighty patients aged 30-50 had Delton tinted sealant applied on one to four contralateral nonhomologous, first or second, acceptable molar pairs. Fifty-five patients completed the evaluation at 1 year, with a 68% retention for 250 teeth: teeth listed as sound, 94.1%; IC and IC-amalgam, 93.7%, and amalgam, 44.9%.

Lactate dehydrogenase levels during MACOP-B chemotherapy for non-Hodgkin's lymphoma.

Lactate dehydrogenase (LD) levels rose consistently during MACOP-B chemotherapy for intermediate and high-grade non-Hodgkin's lymphoma (NHL). Levels peaked at week nine and fell to normal within six weeks of completion of therapy. Isoenzyme patterns, studied prospectively in seven patients, showed a parallel rise in LD1 and LD2 suggesting a source other than tumour tissue for the rise in total LD. In the absence of evidence of myocardial or renal damage, haematopoietic tissue was the most likely source. With no evidence of haemolysis, normal serum levels of vitamin B12 and folate and normal red cell folate, dyserythropoiesis was considered to be the underlying mechanism. A rising mean corpuscular volume further reinforced this suggestion. Intensive use of methotrexate along with co-trimoxazole as prophylaxis against pneumoycystis carinii is considered the most likely cause of marrow dysfunction. Failure to recognise that rising LD levels during such therapy is treatment-related, rather than of tumour origin, may lead to inappropriate change or abandonment of therapy.

Disseminated gonococcal infection associated with deficiency of the second component of complement.

A case of C2 deficiency presenting with disseminated gonococcal infection is described. The predisposition of C2-deficient individuals to infection in addition to the commoner problem of immune complex diseases is noted. Attention is drawn to the absence of documented cases of gonococcal infection associated with C2 deficiency. No other homozygous C2 deficient family members were identified. Lifelong penicillin prophylaxis was recommended for the patient.

Domiciliary nebulized pentamidine for secondary prophylaxis against Pneumocystis carinii pneumonia.

The viability of a programme for delivering aerosolized pentamidine within the patient's home setting for the secondary prophylaxis of Pneumocystis carinii pneumonia (PCP) has been explored with seven homosexual AIDS patients, the major objectives being the assessment of the safety and acceptability of the treatment and the discovery of the most suitable care setting (home, ward, outpatient clinic) for the administration of therapy. It is concluded that a domiciliary prophylaxis programme is a viable alternative.

Hepatitis B in adolescence and middle-age.

In 1983 304 serum samples, and in 1984 432 serum samples submitted to the Hepatitis Reference Laboratory, Ruchill Hospital, Glasgow were found to be positive for HBsAg by radio-immunoassay. Of these, 37 in 1983 and 50 in 1984 were from persons less than 18 years, while 38 and 46 respectively were from persons greater than 39 years. This increase from 1983 to 1984 was due to more acute infections among males. In males less than 18 years, infections were related to drug abuse, whereas in men greater than 39 years sexual transmission appeared to be the main source. Women greater than 39 years may be at increased risk of infection from other members of the household. A finding of HBsAg in a person greater than 39 years is likely to be from an acute infection as from a carrier.