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Primary Effusion Lymphoma is an unusual entity and it has been described as a subset associated with human herpes virus 8 infection in homosexual males with AIDS. Its inclusion as a new entity in the Revised European-American Lymphoma Classification has been recommended. The case in which it is presented is a 47-year-old man, diagnosed with AIDS two years ago, who came with Kaposi's sarcoma. Nowadays, he has a right pleural effusion and a thoracentesis has been carried out. We obtain 10 ml of haemorrhagic fluid which is processed by standard methods. The morphologic study reveals a non-Hodgkin's lymphoma of high-grade. The immunophenotypic study shows a lymphoid neoplasm of indeterminate lineage and high proliferation index. It confirms the HHV-8 in the neoplastic cells by PCR. The diagnosis is a non-Hodgkin's lymphoma of high-grade compatible with Primary Effusion Lymphoma.

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OBJECTIVE: To analyze the influence of anti-retroviral therapy (ART) and prophylaxis against opportunist disease on survival of patients with AIDS. PATIENTS AND METHODS: Study of AIDS patients diagnosed from January 1996 to October 1997 in a Madrid hospital. An analysis was made of demographic, clinical, and immunological data, as well as ART and prophylaxis against Pneumocystis carinii pneumonia (PCP) and tuberculosis (TB). Both univariate and multivariate analyses were performed, as well as Kaplan-Meier curves. RESULTS: A total of 205 patients were included in the study (83% male) with a median age of 34 years. ART, PCP prophylaxis, and TB prophylaxis were received by 147 (72%), 141 (69%) and 22 (11%) patients, respectively. Among individuals on ART, the likelihood of survival at 12 and 22 months since diagnosis of AIDS was made was 79% and 76%, respectively, and among non treated individuals 54% and 54%, respectively (p < 0.05). ART was associated with a 57% decrease in death risk, and regarding PCP prophylaxis, no benefit on survival was found. CONCLUSIONS: ART was significantly associated with a lower risk of death among AIDS patients. The survival rate was not increased with PCP prophylaxis.

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Objetivo. Analizar la influencia del tratamiento antirretrovírico (ARV) y de la profilaxis para enfermedades oportunistas en la supervivencia de pacientes con síndrome de la inmunodeficiencia adquirida (SIDA).Pacientes y métodos. Estudio de seguimiento de los casos de SIDA diagnosticados entre enero de 1996 y octubre de 1997 en un hospital de Madrid. Se analizaron datos demográficos, clínicos, inmunológicos, tratamiento ARV y profilaxis para neumonía por Pneumocystis carinii (NPC) y tuberculosis (TB). Se realizó un estudio univariado, multivariado y curvas de Kaplan-Meier. Resultados. Se incluyeron 205 pacientes (83 por ciento varones); mediana de edad: 34 años. Recibieron tratamiento ARV 147 (72 por ciento), profilaxis para NPC 141 (69 por ciento) y profilaxis para TB 22 (11 por ciento). En los pacientes con tratamiento ARV la probabilidad de supervivencia a los 12 y 22 meses del diagnóstico de SIDA fue de 79 por ciento y 76 por ciento, y en los no tratados de 54 por ciento y 54 por ciento, respectivamente (p < 0,05). El tratamiento ARV se asoció con una reducción del riesgo de muerte del 57 por ciento, sin encontrarse beneficio independiente en la supervivencia en relación con la profilaxis para NPC. Conclusiones. El tratamiento ARV se asocia significativamente con un menor riesgo de muerte en los pacientes con SIDA. La profilaxis para NPC no incrementó la supervivencia (AU)

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BACKGROUND: Primary cavity-based lymphomas (PCBL) represent and uncommon group on non-Hodgkin lymphomas associated with AIDS. They present as malignant effusions with no bone marrow or lymph node involvement, although some cases with bone marrow infiltration at advanced stages have been reported. Tumoral cells are monoclonal and are occasionally infected with human herpesvirus type-8 (HHV-8). PATIENTS AND METHODS: The clinical and evolutive characteristics of six HIV-positive patients with PCBL were analysed. In three of them the presence of genetic sequences of HHV-8 in peripheral blood lymphocytes and lymphomatous effusions was investigated by PCR. RESULTS: The mean age of patients was 37 years and 5 were males. The only female patient had been drug abuser, four males were homosexuals and the other promiscuous heterosexual. The mean CD4+ lymphocyte count was 84 x 10(6)/l (range: 20-180) and all of them had been diagnosed of AIDS. The presentation forms were as pericardial effusion in one case, pleural effusion in three and tumoral ascites in two. Two of the male patients had also Kaposi sarcoma (KS). At diagnosis none of them had infiltration of the bone marrow nor lymphadenopathy. Most malignant cells had immunoblastic traits. The effusions had the characteristics of an exudate and the mean value of lactate dehydrogenase (LDH) was 5,255 IU/l (range: 1,500-11,483). In the three cases investigated there was HHV-8 DNA in the lymphocytes present in the lymphomatous effusion and in peripheral blood. The mean survival after diagnosis was 89 days (7-240). The female patient died without therapy seven days after admission and the five male patients were treated with chemotherapy with a poor response. CONCLUSIONS: HIV-related PCBL associated or not with KA appear in severely immunodepressed patients, their behaviour is very aggressive and its clinical course fatal in a short period of time. The are often associated with KS and HHV-8 seems to be the involved causative agent.

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We report two cases of hyperthyroidism clinically associated to edema, in which no usual causes for the latter were found. Correction of the hyperthyroidism state was associated with complete resolution of edema. The fact that one of the cases consisted of a farmacologically induced hyperthyroidism points to a direct effect of the thyroid hormone itself as the origin of this complication. The de novo occurrence of edema can be due to thyroid hyperfunction as the only underlying cause, the presence of other associated factors such as heart failure, hypoproteinemia or dermopathy not being necessary for its development.

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Thirty nine cases of liver abscess--33 pyogenic (LAP) and 6 amebic (LAA)--attended in our hospital between 1980 and 1994, were reviewed. Mean patient age was 55.66 years (LAP) and 35.83 years (LAA), while the relation male/female was 2.3:1 and 5:1 respectively. The most usual underlying pathology in LAP was bile duct disease (39.39%). Four patients with LAA had travelled to endemic areas. Fever was the most frequent clinical finding (71.79%). Echography and/or CT scan confirmed the diagnosis in 32 patients (82.05%), with a sensitivity of 86.66 and 95.65% respectively. Positive cultures were found in 74.35% (39.13% polymicrobials), being E. Coli and K. Pneumoniae the most frequently isolated bacteria. In LAP pus cultures were positive in 73% and blood cultures in 55%. Diagnosis of LAA was made by wet mount smears/serology (3/3). Percutaneous drainage was performed in 41.02%, surgical drainage in 48.71 and 15.38% (all with LAP) received antibiotics exclusively. Four patients died (3 with LAP and 1 with LAA).

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