Use of paper-absorbed fingerstick blood samples for studies of antibody to human immunodeficiency virus type 1 in intravenous drug users

The suitability of paper-absorbed (PA) fingerstick blood specimens for antibody testing of human immunodeficiency virus type 1 (HIV-1) was examined in two populations of intravenous drug users (IVDU): 393 persons from a drop-in counseling and testing clinic and 145 from a methadone treatment clinic. From the first group, the same 66 immunoblot-confirmed enzyme immunoassay (EIA)-positive specimens were identified in sera from venipuncture and parallel fingerstick PA specimens. The latter had slightly higher EIA mean background levels resulting in 10 immunoblot-negative EIA-positive samples versus 6 in the sera group. HIV-1 seroprevalence was 17% of 393 from the drop-in clinic. By category of IVDU, the rates were 34% and 14% for active and recovering IVDU, respectively (P less than .001), and 36% in black and Latino compared with 13% in white IVDU (P less than .002). Of the 145 participants in the methadone program, 39% had antibody to HIV-1: 49% for blacks and Latinos compared with 30% in whites (P less than .01). The data indicate that antibody testing for HIV-1 by PA is equivalent to the serum antibody assay of venipuncture specimens. The fingerstick method appears to have greater use for serosurveys and screening programs because of convenience, safety, and ease of storage, transport, and processing of samples.     

Optimal needle size for renal biopsy: in vitro and in vivo evaluation

To evaluate the success and complication rates of small (16- and 18- gauge) needles in biopsy of the kidney, the authors performed in vitro biopsy in a cadaveric kidney and in vivo renal biopsy in 141 patients. Best results were obtained with a 16-gauge modified Menghini needle. In vitro, 9.7 +/- 5.7 (mean +/- standard deviation) glomeruli were retrieved, and the average length of tissue cores was 17.8 mm +/- 8.2. In vivo, 10.63 +/- 6.64 intact glomeruli were retrieved, and a definitive histologic diagnosis was achieved in 86% of patients. The frequency of major complications with this needle was 3.5%, and of minor complications, 5.8%. No major complications occurred after biopsy was performed with 18-gauge needles of the same design. However, the retrieval rate of glomeruli with these smaller needles was insufficient. An 18-gauge needle with two cutting edges yielded tissue cores of 11.0 mm +/- 3.5 in length. In vitro, 6.6 +/- 2.3 glomeruli were retrieved; in vivo, 9.92 +/- 6.65. A definitive histologic diagnosis was achieved with this needle in 75% of patients, and rates of 7.1% for major complications and 10.7% for minor complications were encountered.     

Liver Damage in Long-Term Anticonvulsant Therapy: A Serological and Histological Study

The prevalence of liver damage in patients receiving long-termanticonvulsant therapy was determined, using a new marker ofliver disease, the serum F protein concentration. Abnormal serumF protein concentrations were detected in 50 per cent of 34patients receiving anticonvulsant therapy. A retrospective analysisof post-mortem liver samples showed common histological abnormalitiesin three out of seven patients who had died whilst receivinganticonvulsant therapy. These changes were not seen in controlpatients. We suggest that chronic anticonvulsant therapy maycause significant hepatocellular damage.     

CC5 Incremental Cost-Effectiveness Analysis Comparing 4-Layer Bandage System with and Without Apligraf™ for the Outpatient Treatment of Venous Leg Ulcers

Apligraf™ is full thickness manufactured living skin equivalent indicated for the treatment of venous leg ulcers (VLU).
OBJECTIVE: To undertake a model-based retrospective cost-effectiveness analysis (CEA), from a societal and health care perspective, of the outpatient treatment of VLU with the 4-layer high-compression bandage system with and without one application of Apligraf™.
METHODS: Because no prospective head-to-head study of this comparison had yet been undertaken, a computer-based model was developed. The model represented the clinical consequences of the two approaches (ulcers healed, time to heal, ulcer recurrence, infections, complications) and the costs associated with these consequences over two analytic horizons, 3 months and 6 months. Data for the 3-month model was estimated based on two published studies and clinical experience by a panel of seven physicians from across Canada. The panel used an interactive modified Delphi approach culminating in a facilitated group meeting. Data for the 6-month model was extrapolated from the shorter model using several different plausible assumptions.
RESULTS: Over 3 months the use of Apligraf increased costs by $304 and $316 from the societal and the health care perspectives, respectively, provided clinical benefits of 22 ulcer days averted (UDA), and a C/E ratio of $14/UDA for each perspective. Over 6 months the C/E ratio was below $5/UDA for the societal and health care perspectives. Sensitivity analysis indicated that the model was relatively robust. Subgroup analyses suggested that Apligraf is particularly cost-effective in patients with long-standing ulcers.
CONCLUSION: The model suggests that Apligraf is cost-effective in treating VLU, particularly when longer analytic horizons are considered. Confirmation of this finding in a prospective study is encouraged.     

Cefazolin as empiric therapy in hemodialysis-related infections: efficacy and blood concentrations

Concern about the increasing incidence of vancomycin-resistant organisms has tempered the enthusiasm for indiscriminate vancomycin use. Cefazolin has an antibacterial activity profile similar to vancomycin against most pathogens encountered in the hemodialysis (HD) population. We evaluated the clinical efficacy and serum concentrations that were achieved during empiric cefazolin use. Fifteen consecutive HD patients (five, conventional HD; five, high-efficiency HD; and five, high-flux HD) with suspected or documented infections warranting antibiotic intervention, including access-related, respiratory tract, urinary tract, or wound infections, were enrolled. Each patient received intravenous cefazolin (20 mg/kg actual body weight rounded to the nearest 500-mg increment [range, 1 to 2 g]) after each dialysis treatment for at least three doses. Cefazolin concentrations were obtained before and immediately after the next three consecutive dialysis treatments. Thirteen patients were evaluated for efficacy and all 15 were evaluated for toxicity and cefazolin blood concentrations. All patients showed at least a short-term (3-week) clinical resolution of infection with cefazolin treatment. No central nervous system toxicities were noted and no other adverse events were expressed by the patients during the course of cefazolin treatment. Predialysis cefazolin concentrations, as determined by high-performance liquid chromatography, were 70.2 +/- 42.7 (conventional HD), 45.6 +/- 18.9 (high-efficiency HD), and 41.6 +/- 23.9 mg/L (high-flux HD) over the three dialysis sessions. Cefazolin at doses of approximately 20 mg/kg administered post-HD appears to be a safe and effective empiric therapy and yields predialysis cefazolin concentrations of 2.5 times or greater than those considered to be the minimum inhibitory concentration breakpoint (16 mg/L) for susceptible organisms. These data support the broader use of cefazolin for empiric treatment in the HD population, allowing vancomycin to be reserved for confirmed resistant organisms.     

Benign sclerosing pneumocytoma of lung (sclerosing haemangioma)

The clinical and histopathological features of 14 cases of so-called sclerosing haemangioma of the lung are described. All developed in Hong Kong Chinese women. Histochemical and ultrastructural study of these tumours indicates an epithelial origin. The term benign sclerosing pneumocytoma is suggested as being more appropriate for this unusual tumour.