- Email: [email protected]
Kaposi's sarcoma and new herpesvirus
Ankum and Van der Veen are not in a success of their management strategies.
position
to
judge the
*Sven Nielsen, Mats Hahlin Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital,
University of Gothenburg, S-41345 Gothenburg, Sweden 1
2
3
4
Rulin MC, Bornstein SG, Campbell JD. The reliability of ultrasonography in the management of spontaneous abortion, clinically thought to be complete: a prospective study. Am J Obstet Gynecol 1993; 168: 12-15. Kurtz AB, Shlansky-Goldberg RD, Choi HY. Detection of retained products of conception following spontaneous abortion in the first trimester. J Ultrasound Med 1991; 10: 387-95. Hahlin M, Sjoblom P, Lindblom B. Combined use of progesterone and human chorionic gonadotrophin determinations for differential diagnosis of very early pregnancy. Fertil Steril 1991; 55: 492-96. Thorburn J, Bryman I, Hahlin M. Distinction between early normal intrauterine pregnancies and pathological pregnancies by means of a logistical model. Hum Reprod 1992; 7: 120-22.
Kaposi’s
sarcoma
and
new
herpesvirus
SiR-Several workers (Huang and Dupin and their colleagues, March 25, pp 759 and 761; and ref 1) have detected human herpes virus (HHV)-like sequences after PCR amplification in patients with HIV-related Kaposi’s sarcoma (KS) and from classic or endemic KS. HHV is suspected to be involved in the pathogenesis of the various types of the disease. We have done skin biopsies in 16 patients. 14 were HIV negative (1 immunosuppressed patient, 10 classic KS, and 3 endemic KS) and 2 had AIDS-associated KS. Homologous normal skin (distant to any lesion) was obtained in 9 HIVnegative patients. Peripheral blood mononuclear cells (PBMC) were available for 5 patients with classic KS. KSderived cell cultures were seeded after mechanical and enzymatic dissociation of skin tumours from 9 HIV-negative patients and from 1 patient with HIV-related KS in Dulbecco’s modified Eagle’s medium supplemented with 15% fetal calf serum, 100 )g/mL fibroblast growth factor-a, and 90 )ig/mL heparin. These cultures were tested at various passages after seeding. Normal skin from reduction mammoplasties and 2 human breast cancer cell lines were negative controls. PCR amplification of HHV-like sequences was done with KS 330233 primers under the conditions described by Chang and co-workers with minor modifications. KS 330,33 sequences were detected in KS lesions from all patients tested (n=16) and in normal
- =negative, +=positive, ND=not done.
Table: Patients’ characteristics and PCR results for HHV-like virus sequences.
1180
skin in only 3 of 9 patients, but were not detected in PBMC from the 5 patients tested (table). Only 3 of 6 primary cultures were positive. Of these 3 positive samples, 2 remained positive until the second passage. 4 other cultures were negative at the second passage. All cell cultures were negative at the third passage (n=8) and at the fourth passage (n=9). Thus we have detected HHV-like DNA sequences in both HIV-negative and HIV-positive KS but not in two-thirds of homologous normal distant skin. These data are similar to those reported by Chang’ and Huang and their colleagues, but contrast with those of Dupin and co-workers, who detected these sequences in 5 of 6 normal homologous skin samples. Such discrepancies could be related to the site of biopsy since Dupin examined normal skin adjacent to KS lesions whereas we analysed normal skin distant from lesions. Rapid loss of the viral sequences in culture suggests two possibilities-a cytopathic effect of the virus towards recipient cells and disappearance of the virus reservoir, or the necessity of specific cofactors for the maintenance of the infected cells in culture.
homologous
*C Lebbé, P de Crémoux, M Rybojad, C Costa da Cunha, P Morel, F Calvo Departments of *Dermatology and Pharmacology, Hôpital Saint-Louis, 75010 Paris, France
1
Chang Y, Cesarman E, Pessin MS, et al. Identification of herpesviruslike DNA sequences in AIDS-associated Kaposi’s sarcoma. Science 1994; 26: 1865-69.
Sex in adolescents SIR-I
happened on the viewpoint by Genuis and Genuis (Jan 28, p 240) on adolescent sexual involvement while attending a Canadian national meeting on the epidemiology of sexually transmitted diseases. Delegates were somewhat surprised at that session to learn of the epidemic of sexually transmitted diseases in North America and that rates of various conditions were "soaring". Perhaps we were surprised because the statement runs contrary to virtually all factual data collected from the northern half of that continent (in which, by their byline, Genuis and Genuis are domiciled). Rates of gonorrhoea and syphilis in Canada have plummeted by as much as 10-fold in most Canadian jurisdictions since 1982.’= Indeed, the incidence of these conditions is now at its lowest point since surveillance began in British Columbia. Rates of chlamydia have also been consistently declining for 3 years and there is good evidence that the burden of infection from pelvic inflammatory disease is also dropping. Although the frequency of warts and herpes are not monitored on a population level, most clinics are reporting a stable or declining number of related client visits. Even teenage pregnancy, which is sometimes intentional, is on the decline in many areas.’3 It is unfortunate that a rather lax interpretation of fact and consequent cavalier dismissal of existing educational and technological approaches to disease control have probably damaged some otherwise valid points put forward by Genuis and Genuis. Nobody should argue against the fact that abstinence is the only certain defence against sexually transmitted disease and unwanted pregnancy. Certainly, encouraging adolescents to delay the onset of sexual activity is a most worthy effort. But the expectation that adolescents refrain from sex is very recent historically. Adolescents have mostly behaved reproductively as adults. Even the cleverest of educational programmes aimed at delaying sexual onset will fail in their attempt to undo 2 million years of genetic programming in every last student.
position
to
judge the
*Sven Nielsen, Mats Hahlin Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital,
University of Gothenburg, S-41345 Gothenburg, Sweden 1
2
3
4
Rulin MC, Bornstein SG, Campbell JD. The reliability of ultrasonography in the management of spontaneous abortion, clinically thought to be complete: a prospective study. Am J Obstet Gynecol 1993; 168: 12-15. Kurtz AB, Shlansky-Goldberg RD, Choi HY. Detection of retained products of conception following spontaneous abortion in the first trimester. J Ultrasound Med 1991; 10: 387-95. Hahlin M, Sjoblom P, Lindblom B. Combined use of progesterone and human chorionic gonadotrophin determinations for differential diagnosis of very early pregnancy. Fertil Steril 1991; 55: 492-96. Thorburn J, Bryman I, Hahlin M. Distinction between early normal intrauterine pregnancies and pathological pregnancies by means of a logistical model. Hum Reprod 1992; 7: 120-22.
Kaposi’s
sarcoma
and
new
herpesvirus
SiR-Several workers (Huang and Dupin and their colleagues, March 25, pp 759 and 761; and ref 1) have detected human herpes virus (HHV)-like sequences after PCR amplification in patients with HIV-related Kaposi’s sarcoma (KS) and from classic or endemic KS. HHV is suspected to be involved in the pathogenesis of the various types of the disease. We have done skin biopsies in 16 patients. 14 were HIV negative (1 immunosuppressed patient, 10 classic KS, and 3 endemic KS) and 2 had AIDS-associated KS. Homologous normal skin (distant to any lesion) was obtained in 9 HIVnegative patients. Peripheral blood mononuclear cells (PBMC) were available for 5 patients with classic KS. KSderived cell cultures were seeded after mechanical and enzymatic dissociation of skin tumours from 9 HIV-negative patients and from 1 patient with HIV-related KS in Dulbecco’s modified Eagle’s medium supplemented with 15% fetal calf serum, 100 )g/mL fibroblast growth factor-a, and 90 )ig/mL heparin. These cultures were tested at various passages after seeding. Normal skin from reduction mammoplasties and 2 human breast cancer cell lines were negative controls. PCR amplification of HHV-like sequences was done with KS 330233 primers under the conditions described by Chang and co-workers with minor modifications. KS 330,33 sequences were detected in KS lesions from all patients tested (n=16) and in normal
- =negative, +=positive, ND=not done.
Table: Patients’ characteristics and PCR results for HHV-like virus sequences.
1180
skin in only 3 of 9 patients, but were not detected in PBMC from the 5 patients tested (table). Only 3 of 6 primary cultures were positive. Of these 3 positive samples, 2 remained positive until the second passage. 4 other cultures were negative at the second passage. All cell cultures were negative at the third passage (n=8) and at the fourth passage (n=9). Thus we have detected HHV-like DNA sequences in both HIV-negative and HIV-positive KS but not in two-thirds of homologous normal distant skin. These data are similar to those reported by Chang’ and Huang and their colleagues, but contrast with those of Dupin and co-workers, who detected these sequences in 5 of 6 normal homologous skin samples. Such discrepancies could be related to the site of biopsy since Dupin examined normal skin adjacent to KS lesions whereas we analysed normal skin distant from lesions. Rapid loss of the viral sequences in culture suggests two possibilities-a cytopathic effect of the virus towards recipient cells and disappearance of the virus reservoir, or the necessity of specific cofactors for the maintenance of the infected cells in culture.
homologous
*C Lebbé, P de Crémoux, M Rybojad, C Costa da Cunha, P Morel, F Calvo Departments of *Dermatology and Pharmacology, Hôpital Saint-Louis, 75010 Paris, France
1
Chang Y, Cesarman E, Pessin MS, et al. Identification of herpesviruslike DNA sequences in AIDS-associated Kaposi’s sarcoma. Science 1994; 26: 1865-69.
Sex in adolescents SIR-I
happened on the viewpoint by Genuis and Genuis (Jan 28, p 240) on adolescent sexual involvement while attending a Canadian national meeting on the epidemiology of sexually transmitted diseases. Delegates were somewhat surprised at that session to learn of the epidemic of sexually transmitted diseases in North America and that rates of various conditions were "soaring". Perhaps we were surprised because the statement runs contrary to virtually all factual data collected from the northern half of that continent (in which, by their byline, Genuis and Genuis are domiciled). Rates of gonorrhoea and syphilis in Canada have plummeted by as much as 10-fold in most Canadian jurisdictions since 1982.’= Indeed, the incidence of these conditions is now at its lowest point since surveillance began in British Columbia. Rates of chlamydia have also been consistently declining for 3 years and there is good evidence that the burden of infection from pelvic inflammatory disease is also dropping. Although the frequency of warts and herpes are not monitored on a population level, most clinics are reporting a stable or declining number of related client visits. Even teenage pregnancy, which is sometimes intentional, is on the decline in many areas.’3 It is unfortunate that a rather lax interpretation of fact and consequent cavalier dismissal of existing educational and technological approaches to disease control have probably damaged some otherwise valid points put forward by Genuis and Genuis. Nobody should argue against the fact that abstinence is the only certain defence against sexually transmitted disease and unwanted pregnancy. Certainly, encouraging adolescents to delay the onset of sexual activity is a most worthy effort. But the expectation that adolescents refrain from sex is very recent historically. Adolescents have mostly behaved reproductively as adults. Even the cleverest of educational programmes aimed at delaying sexual onset will fail in their attempt to undo 2 million years of genetic programming in every last student.