The global distribution of human immunodeficiency virus type 2 (HIV-2) infection

We reviewed published reports of infection with human immunodeficiency virus type 2 (HIV-2) to provide a picture of its geographic distribution, pathogenicity, modes of transmission, and risk to the blood supply. Since the first reports in 1986, 627 HIV-2-seropositive persons have been reported; 604 of these were in natives of West Africa. Acquired immunodeficiency syndrome (AIDS) had developed in 42 patients, while 8 patients had AIDS-related complex. Transmission by sexual intercourse was the usual reported mode of spread. The modes of transmission of HIV-2 are thought to be the same as those for HIV-1, but perinatal transmission and transmission by sharing of needles among intravenous drug abusers have not yet been reported. The virus has not been identified in blood donors in the United States or West Germany, but two HIV-2-infected blood donors were reported in France. Further epidemiologic studies are needed to define the spectrum of disease, modes of transmission, and risk of HIV-2 to the blood supply.     

Venepuncture: the medicolegal hazards.

Venepuncture is commonly regarded as a trivial procedure allocated to the most junior medical staff. The result of this policy is that junior doctors are required to perform a minimally invasive procedure on consenting patients without any structured venepuncture training or assessment. Consequently, inexperienced doctors may perform multiple and sometimes unnecessary, venepunctures, which could damage essential venous access, eg, in the diabetic or renal patient. We review the medicolegal position and suggest that structured venepuncture training is essential and argue that unskilled treatment may be regarded by the Courts as demonstrating the mens rea of assault in the form of recklessness.     

Evaluation of phenobarbital/{beta}-naphthoflavone as an alternative S9-induction regime to Aroclor 1254 in the rat for use in in vitro genotoxicity assays

A series of bacterial mutation, mammalian cell (L5178Y) genemutation and in vitro cytogenetic assays were performed to comparethe efficacy of using S9 fractions prepared from rats inducedwith a combination of pheno-barbital (PB) and ß-naphthoflavone(ßNF), with S9 fractions from rats treated with thegeneral enzyme inducer Aroclor 1254. Although some quantitativedifferences in the magnitudes of the mutagenic/clastogenic effectswere observed between the two induction regimes, no qualitativedifferences were observed. The use of a combined PB/ßNFinduction regime using oral dosing is therefore considered tobe a suitabole substitute for Aroclor 1254. ¹To whom correspondence should be addressed     

Six-year prospective audit of chest reopening after cardiac arrest.

OBJECTIVE: To identify which patients benefit from chest reopening after cardiac arrest. SETTING: Cardio-thoracic hospital undertaking full range of adult cardio-thoracic surgery. METHODS: In-hospital arrests were prospectively audited over a 6-year period. Information was collected for every patient whose chest was reopened following cardiac arrest: location of arrest, type of arrest, specialty, time since surgery, time to chest reopening, location of chest opening, surgical findings on reopening, time to cardiopulmonary bypass (if used) and patient outcomes. Exclusions: Arrests in theatre and chest openings for reasons other than cardiac arrest. RESULTS: There were 818 confirmed in-hospital arrests following 'cardiac arrest calls'. Chest reopening was undertaken in 79 surgical patients. Overall survival to discharge was 20/79 (25%). Favourable determinants of outcome were: arrest on intensive care unit (ICU), arrest within 24 h of surgery and reopening within 10 min of arrest. Nineteen of 58 (33%) chest openings following arrests on the ICU survived to discharge compared to one of 21 (5%) patients whose initial arrest was outside the ICU (P=0.017). One of nine ward arrests scooped to ICU for chest reopening survived whereas all 12 patients reopened on the ward died. Fifteen of 40 patients (38%) reopened within 24 h surgery survived compared to five of 39 patients where reopening was undertaken more than 24 h after surgery (P=0.02). Fourteen of 29 (48%) patients opened within 10 min of arrest survived to discharge compared to six of 50 (12%) patients where time to reopening was more than 10 min (P=<0.001). Seven of 22 patients (32%) patients where emergency bypass was utilised survived to discharge. CONCLUSION: This study strongly confirms the benefit of chest reopening after cardiac arrest in the cardiac surgical ICU. Patients who arrest within 24 h of surgery and in whom reopening is instituted within 10 min are particularly likely to benefit. The value of chest reopening in arrests outside the ICU remains unresolved. All patients reopened on the ward died, suggesting that this practice should be discontinued. Early 'scoop and run' resulted in one solitary survivor though it should probably be restricted to patients who arrest within 72 h of surgery as surgically remediable problems are unlikely after this time.     

In vitro calcification of bioprosthetic heart valves: report of a novel method and review of the biochemical factors involved.

The lifetime of bioprosthetic heart valves is limited by primary tissue failure and calcification of the valve leaflets. There are indications that synthetic elastomeric materials may also be subject to this problem. The mechanism of calcification is not known, but it is of interest that calcification can be induced in tissue even in the absence of cellular mechanisms, outside the body. Many hypotheses relate to inhibitory or promotory factors rather than primary instigators of calcification and none has led to a satisfactory solution of the problem. The study of calcification in replacement valves generally utilises in vivo test methods i.e. complex biologic systems. This creates difficulty in defining the primary factors involved. The use of in vitro test methods, including a novel fatigue tester method, has been reviewed. Various test media have been used, including simple salt solutions (allowing definition and controlled modification of the calcification medium) and bovine plasma. Comparison of static and dynamic in vitro methods with the rat subcutaneous implant model indicated a lower degree of calcification in vitro: the calcification achieved was, however, significantly greater than similar material not subject to calcification processes. Dynamic in vitro tests produced greater calcification than static in vitro tests. Porcine aortic valve material, in static tests, behaved similarly to bovine pericardium. In vitro calcification testing has a useful role to play in the economic screening of new materials or modifications of existing materials prior to in vivo testing. It may also aid the definition of the mechanism of calcification and hence the development of solutions to the problem.     

Craniofacial form in class III cases.

Lateral skull cephalograms from 50 patients who subsequently had surgical correction of their Class III malocclusion were analysed using a complete linkage cluster analysis based on skull shape. Five subgroups were identified and are described. All subjects had a degree of mandibular prognathism while only 14 per cent had maxillary retrognathism. An increased lower face height was found in 58 per cent.