A comparison of the cytology of endomyocardial biopsy washings from heart transplants with biopsy histologic study and peripheral blood lymphocyte counts

Cytospin preparations of endomyocardial biopsy washings were examined on 117 occasions from 13 heart transplant recipients and categorized according to the pattern of cell types observed. Twenty-nine percent of samples were acellular, a further 10% too bloodstained for analysis, and 61% were cellular. Eight lymphocytic samples were found and in all cases there was at least grade 1B rejection (four grade 1B, three grade 2, and one grade 3A) on histologic study. However, histologic study showed at least 1B rejection in 48% of cases when cytospins showed mixed inflammatory cells, 33% of cases when cytospins were histiocytic and in 35% when cytospins were bloodstained or acellular. Furthermore 16 of these rejection episodes with nonlymphocytic cytospins were grade 2. Although the recovery of a lymphocytic cytospin was specific for rejection, the sensitivity of the test was poor. Even when the sample is adequate, this method of biopsy washings will predict only one third of cases of significant acute rejection (grade 2 or worse). The large proportion of unsuitable samples also severely limits the utility of endomyocardial biopsy washings for the diagnosis of rejection. Histiocytic cytospins were seen in 63% of samples when previous biopsy sites were reported on histologic study and also in all three samples when histologic study showed ischemic injury. A mixed inflammatory cell pattern was seen to a lesser extent (31% of samples) in relation to previous biopsy sites. High peripheral blood lymphocyte counts were found when endomyocardial biopsy washings were lymphocytic or mixed inflammatory and also when histologic study showed endocardial lymphocytic infiltration (Quilty effect).

Recruitment of primary care physicians to care for patients with human immunodeficiency virus infection in a large northwestern county

BACKGROUND

We evaluated an initiative to recruit and to educate physicians to care for persons with human immunodeficiency virus (HIV) infection in King County, Washington, and to refer patients to them through a centralized telephone referral service (the acquired immunodeficiency syndrome [AIDS]/HIV Care Access Project).

METHODS

Six physicians trained in AIDS care recruited primary care physicians in clinics throughout King County; the physician cohort was monitored for behavior in accepting referrals during the ensuing year.

RESULTS

Of 250 primary care physicians contacted initially, 79 of 120 who met with AIDS-trained physicians were willing to accept patient referrals. Willingness was not related significantly to age, sex, years in practice, or specialty, but was related to level of experience with HIV/AIDS care and current practice. The recruitment initiative increased the physicians available to the telephone referral service by 93% (from 85 to 164). More physicians (41) joined the referral service in the ensuing year, during which 647 patient referrals were made to these 205 physicians (median referral rate of one patient per quarter). Four physicians requested cessation of referrals, however, two later asked for referrals to continue.

CONCLUSION

The recruitment initiative was successful in increasing the number of primary care physicians available to accept patients with HIV infection into their practices (thereby reducing the burden of HIV referrals on a small pool of providers), and in establishing a county-wide telephone service to coordinate these referrals. The initiative was self-sustaining, with an ongoing influx of new providers willing to take referrals.

Viremia and virus measurements of rabbit pox in CV-1 cells

Rabbit pox virus (RPV) produced cytopathic effect (CPE) in five types of cells grown in tissue cultures. The CPE on CV-1 cells was characterized by cell fusion and lysis. The CV-1 line is a useful and sensitive cell culture for measuring concentrations of RPV in blood and tissues of infected rabbits. Viremia was detected between the 2nd and 4th days after parenteral infection. By the 6th and 7th days, the concentration of RPV in various tissues ranged from 10(5-3) to 10(8-5) TCID(50)/g. Cross-reactivity was demonstrated by the fluorescent-antibody technique between rabbit pox, vaccinia, and monkey pox viruses.