Respiratory papillomatosis is a rare and often severe disease, usually localized in the larynx. It may cause respiratory distress and even life-threatening obstruction of the airways. Treatment is generally based on the evaporation of the lesions with a CO2 laser, but microsurgery, cytotoxic and/or cytostatic drugs, interferons, and vaccines are also used. Cidofovir [(S)-1-(3-hydroxy-2-phosphonylmethoxypropyl)cytosine] (HPMPC) was shown to suppress the growth of tumors induced by rabbit papillomavirus as well as human papillomavirus (HPV). The efficacy of cidofovir was assessed in 17 patients with severe respiratory papillomatosis. Cidofovir at a concentration of 2.5 mg/ml was injected directly in the different laryngeal papillomatous lesions during microlaryngoscopy under general anesthesia. Biopsies were taken before the treatment was started both for anatomopathology and viral typing. HPMPC kinetics in serum was monitored in three patients, the drug levels being determined by high-performance liquid chromatography. Complete disappearance of the papillomatosis was observed in 14 patients. Four patients relapsed and were successfully treated again with cidofovir. Of the three remaining patients, one progressed while under treatment with cidofovir, after an initial marked response. One patient had a partial remission and remained stable for more than 1 year after the last injection. He had a very aggressive and extensive disease originally. Finally, one patient was lost to follow-up after four injections. Intratumoral injections of cidofovir for the treatment of severe laryngeal papillomatosis is a powerful new therapeutic approach for this disease. Treatment was well tolerated, and no significant side effects were noted.

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An 8-year-old patient with severe recurrent respiratory papillomatosis and pulmonary spread was treated by systemic administration of cidofovir in association with laser treatment for tracheal lesions. Complete disappearance of the lesions in the pharynx and larynx and a significant yet incomplete regression in the bronchi and lung parenchyma were observed without deleterious side effects. This is the first case report of systemic use of cidofovir to treat recurrent respiratory papillomatosis.

According to several follow-up studies in the literature, anorexia nervosa has to be considered as an affection with a grave prognosis. We have studied the outcome in a group of 32 female patients who could be considered as homogeneous in a number of aspects. The following five criteria, on which the delineation of the syndrome is based, were realized in all the patients: considerable weight loss; limited food intake; amenorrhea; juvenile age of onset; absence of primary organic or specific psychotic disorder. All of them presented a serious symptomatology and had undergone some previous treatment under the form of ambulatory psychotherapy and/or forced feeding. They all received, during their admission in the same hospital, the same form of combined intensive medical and psychotherapeutic treatment. All of them maintained regular psychotherapeutic contacts with the same psychiatrist. According to the outcome, the patients could be categorized into three groups: the cured, the improved, the unimproved. In order to circumscribe some prognostic elements, we have compared a number of clinical, family and personality variables in these groups. As favorable clinical factors can be mentioned: younger age at admission and shorter duration of the illness. Manifestations of impulsive behavior (automutilation, kleptomania, fugues, etc...) and suicide attempts are unfavorable. No definite family factors can be defined, although the absence of psychological interaction with the father seems to be unfavorable. A better prognostic outcome is offered by the following personality characteristics, determined by psychological testing: lower neuroticism and higher self-defensiveness on the ABV; a lower general profile and especially a lower score on the schizophrenia scale of the MMPI; less pronounced tendencies to infantile regression, passivity and sexual repression as these are expressed in the TAT.