A 57-year-old man presented with a three-month history of cream-yellow papules of 2 to 3 mm on the pulps of his fingers on both hands (Panel A) and on his right elbow (Panel B). Ten months earlier he had undergone bilateral lung transplantation and had since been receiving multiple medications, including cyclosporine and furosemide. The serum uric acid level was 10.2 mg per deciliter (607 µmol per liter). A lesion was scraped with a scalpel with a 15 blade and smeared onto a glass slide. Polarizing microscopy revealed multiple needle-shaped crystals that were bright yellow (Panel C) and were not birefringent. Films of both hands showed soft-tissue swelling and erosive bony changes in the wrists and interphalangeal joints. Treatment with colchicine and allopurinol was started. Three months later, there had been minimal improvement.

Background: Retinoblastoma (RB) is the most common primary intraocular malignancy of childhood. Magnetic resonance imaging (MRI) of the orbit and brain is the preferred imaging modality to diagnose and define extent of disease as well as to assess response to therapy. Sometimes, it may be difficult to differentiate the presence of active residual disease from therapy-related changes based on posttreatment completion MRI. Materials and Methods: RB patients who completed treatment between January 2017 and October 2019 were retrospectively analyzed. We evaluated the utility of F-18-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) to predict active disease in RB patients who continued to have residual disease on MRI at completion of treatment. Results: Out of the 89 patients who completed treatment, dilemma regarding remission status was present in 11 children. All 11 patients underwent FDG-PET-CT. None of them had evidence of metabolically active disease in the orbit, optic nerve, brain, or rest of the body. After a median follow-up of 24 months, no children developed any evidence of disease progression in the form of local or distant relapse. Conclusion: Our results showed that in MRI doubtful cases, a nonavid FDG-PET is reassuring in avoiding further therapy as long as close follow-up can be ensured. FDG-PET-CT may emerge as a useful functional modality to predict disease activity in RB.

No abstract

Since the introduction of the first antiretroviral agent, zidovudine (AZT) in 1987, much progress has been made in the chemotherapy of the human immunodeficiency virus (HIV). Currently nine antiretroviral agents are approved for the treatment of individuals infected with HIV or with the acquired immune deficiency syndrome (AIDS). These medications are routinely divided into three categories: nucleoside analogues, non-nucleoside analogues, and most recently, protease inhibitors. As our knowledge of the pathogenesis of HIV increases, new antiretroviral agents become available, and advanced techniques develop to more accurately assess the degree of viral burden in an individual's blood, recommendations regarding treatment initiation and choice of antiviral agents are continually changing. The current general consensus is to "hit early" and "hit hard." Early initiation of treatment with multidrug therapy in all individuals infected with HIV is recommended by most experts with the common goal of reducing viral load to a nondetectable level. Numerous studies have shown the increased efficacy of multidrug therapy over monotherapy, however trials are still continuing to determine combination therapies which will provide the maximum benefit.