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SUMMARY All gastrointestinal tract biopsy specimens from 190 patients positive for HIV-1 or with AIDS were reviewed to assess the prevalence of cytomegalovirus (CMV) infection, morphology of infected cells, and the associated histopathological features. Eighteen patients (10 (7 7%) of 129 HIV antibody positive and eight (13a1%) of 61 with AIDS) had CMV identified in 35 biopsy specimens from the following sites: oesophagus (n = 3); stomach (n = 6); small intestine (n = 4); colorectum (n = 18) and perianal area (n = 4). Eleven patients had CMV alone as the potential cause of symptoms and in seven there were coexistent pathogens or Kaposi's sarcoma. The appearance and type of infected cells at different sites was highly variable. Immunocytochemical techniques and electron microscopic examination were performed to confirm the presence of CMV antigen and CMV virus particles and to exclude the possibility of an adenovirus producing similar cytopathic changes.It is important to recognise the different morphological forms of infected cells, and the use of immunocytochemical techniques is recommended in patients at risk for CMV or in whom CMV infection is suspected.

Efficacy and tolerability of otelixizumab was similar to DEFEND-1. The 3.1-mg dose was non-efficacious in adults and adolescents. Further investigation of the mechanism of action seen at higher doses and therapeutic window is required. Clinical Trials Registry No: NCT 00763451.

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1945-65 cohort then most of the women in the 1980-4 cohort will die from causes other than breast cancer.We conclude that breast carcinomas diagnosed in the 1980s have a smaller primary tumour size, fewer axillary metastases, and more favourable histological features and are associated with better prognosis than cancers diagnosed a few decades ago. Improved survival with breast cancer can at least partially be explained by detection of increased numbers of small carcinomas with favourable histological characteristics. Denmark, 1943-1982. Int3 Cancer 198841:46-51. 3 Pollack ES, Horm JW. Trends in cancer incidence and mortality in the United States, 1969-76. 7 Natl Cancer Inst 198064:1091-103. 4 Adami H-O, Sparen P, Bergstrom R, Holmberg L, Krusemo UB, Ponten J.Increasing survival trend after cancer diagnosis in Sweden: 1960Sweden: -1984 J Natl Cancer Inst 1989;81:1640-7. 5 Toikkanen S, Joensuu H. Prognostic factors and long-term survival in breast cancer. APMIS 1990;98:1005-14. 6 Toikkanen S, Joensuu H, Klemi P. BMJ 1991;303:158-60 Insulin dependent diabetes in childhood and material deprivation in northern England, 1977-86Abstract Objective-To determine the incidence of insulin dependent diabetes in the Northern region of England in children less than 16 years old in the period 1977 to 1986 and to relate the incidence data to an index of deprivation.Design-Retrospective analysis of hospital case records identified from the regional health authority's computer; validation of the primary source with hospital clinic registers and community paediatric registers.Setting-Northern region, excluding South Cumbria District Health Authority (659 300 children under 16 in 1981).Patients-All children diagnosed with insulin dependent diabetes before the age of 16 and resident in the region at time of diagnosis.Main outcome measures-Incidence rates for the 10 year period and analysis of incidence rates within categories of deprivation.Results-919 incident cases were identified. The validation procedure covered 54% of all cases identified and gave 95% completeness of ascertainment. The average annual incidence over the 10 year period was 14-8/100 000 for girls and 13-4/100 000 for boys. The annual incidence for the most and least deprived areas of the region was 18-7/100 000 (95% confidence interval 16-2 to 21-5) for boys and 7/100000 (5.6 to 8.8) for girls. There was a highly significant trend (p<0-001) of decreasing incidence with decreasing level of deprivation.Conclusions-In the north of England the incidence of childhood diabetes is related to material deprivation.

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The efficacy and safety of recombinant human interferon gamma (rIFN-gamma) in the reduction of opportunistic disease in patients with advanced HIV-1 infection are assessed. A 12-month double-blind, placebo-controlled, multicenter, Phase III trial of rIFN-gamma in HIV-positive patients with CD4 < 100 x 10(9)/liter on stable antiretroviral therapy. Eighty-four patients were allocated treatment on a 1:1 basis to rIFN-gamma or placebo. Patients received rIFN-gamma 0.05 mg/m(2) or 0.9% saline subcutaneously three times weekly for 48 weeks (optional extension to 18 months). The primary end point was the incidence of opportunist infections (CDC categories B/C). Secondary end points included mortality, immunological, and virological parameters. Patients on placebo had a mean of 3.45 opportunist infections (OIs) in the first 48 weeks. Patients treated with rIFN-gamma had a mean of 1.71 OIs (p = 0.04). However, the model showed overdispersion and the inclusion of a dispersion factor raised the p value to 0.13. rIFN-gamma appeared to have a particular effect on the incidence of Candida, herpes simplex, and cytomegalovirus infections. Three-year survival in the rIFN-gamma arm was 28% compared to 18% in the placebo group (not significant). rIFN-gamma-associated side-effects of headache, fatigue, rigors, influenza-like symptoms, depression, myalgia, and granulocytopenia were reversible. There was no evidence for HIV activation. Although not significant, the trend towards decreased opportunistic infections and increased survival warrants consideration of further trials of rIFN-gamma. The study gives additional information on the safety profile of this cytokine.