The purpose of this article is to examine the prevalence, degree, and natural course of pupillary neuropathy (PANP), cardiovascular autonomic neuropathy (CANP), and sensorimotor neuropathy (SNP) and to study the impact of disease stage and medication on neuropathy in 61 consecutive patients with HIV. PANP, CANP, and SNP were assessed by standardized test procedures. Overall prevalence of PANP, CANP, and SNP were 66%, 15%, and 15%, respectively. The maximal pupillary area (pupillary measure, p <0.0001) and the lying-to-standing ratio (cardiovascular measure, p <0.0001) were abnormal as compared with control subjects. The changes in CD4+ T-lymphocytes and respiratory sinus arrhythmia percentile during 2 years of follow-up correlated significantly (r = 0.758, p = 0.007). Patients with CANP were more often in an advanced disease stage than patients without CANP (p = 0.004). SNP, but not PANP or CANP, was associated with the intake of the neuropathogenic drugs dideoxycytidine, dideoxyinosine, and 2',3' didehydro-2',3' dideoxythymidine (p <0.05). Autonomic and sensorimotor neuropathy are frequent in patients with HIV, and progression of CANP may put patients at risk for unexpected cardiorespiratory arrest.
For the diagnostic evaluation of infertility it is crucial to obtain information on potential abnormalities of the uterus or the fallopian tubes. At present, the following diagnostic methods are available: CO2-pertubation, hysteroscopy, hysterosalpingography (HSG) and chromolaparoscopy (CLP). For the latter procedure, general anaesthesia is required. In a clinical trial 103 patients from our infertility clinic were examined for fallopian tube patency using the contrast agent SH U 454 (Echovist). The new technique hystero-contrast sonography (Hy-Co-Sy) was carried out in an outpatient setting without requiring general anaesthesia. Informed consent was obtain from all patients. A Foley catheter was inserted into the uterine cavity, the balloon was inflated and the contrast medium injected. Distribution of the contrast agent as well as the uterine cavity, the fallopian tubes as well as in the pouch of Douglas was then observed by sonography. In addition to Hy-Co-Sy, 58 patients underwent HSG or CLP. Hy-Co-Sy findings could confirmed by HSG and CLP in 90.6% and 91.6%, respectively. Patients were asked to describe their discomfort on a scale of one to hundred. The average time required for the assessment to tubal patency was 9 minutes. Within 12 months of the Hy-Co-Sy study, 23 out of 60 patients (38.3%) became pregnant. Our study shows that Hy-Co-Sy is a valuable and reliable procedure to assess the uterine cavity and the fallopian tubes in patients undergoing treatment for infertility. The procedure can be performed safely in the office without the need for general anaesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)
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