Accessing an understudied population in behavioral HIV/AIDS research: low income African American women

Most HIV/AIDS behavior research involving African American women has focused on traditional high risk populations, such as those in drug treatment centers, STD clinics, and hospitals. Few studies have examined the health needs and behaviors of African American women in the general population (i.e., working mothers and homemakers). The Parent Health Project examined beliefs and concepts of illness, including AIDS, of low income African American mothers of young children. We used a variety of methods of community outreach and recruitment strategies to gain access and trust from these African American women, including (1) recruitment of women who had children in a related research project, (2) subject reimbursement, and (3) culturally sensitive community based outreach. Of approximately 200 women contacted, 147 (74%) agreed to participate in a two-hour face-to-face interview about concepts of health and illness. Through our efforts, we were able to gain access to a population generally not studies in HIV/AIDS research. We were also exposed to a number of issues, concerns and behaviors faced by women not classified as high risk, yet who are at risk as a result of their own and/or their sexual partner's(s) risk behaviors.     

Human rabies postexposure prophylaxis during a raccoon rabies epizootic in New York, 1993 and 1994.

We describe the epidemiology of human rabies postexposure prophylaxis (PEP) in four upstate New York counties during the 1st and 2nd year of a raccoon rabies epizootic. We obtained data from records of 1,173 persons whose rabies PEP was reported to local health departments in 1993 and 1994. Mean annual PEP incidence rates were highest in rural counties, in summer, and in patients 10 to 14 and 35 to 44 years of age. PEP given after bites was primarily associated with unvaccinated dogs and cats, but most (70%) was not attributable to bites. Although pet vaccination and stray animal control, which target direct exposure, remain the cornerstones of human rabies prevention, the risk for rabies by the nonbite route (e. g., raccoon saliva on pet dogs' and cats' fur) should also be considered.     

Odontogenic myxoma

The odontogenic myxoma is an uncommon tumor that has the potential for extensive bony destruction, extension into surrounding structures, and a relatively high recurrence rate. Treatment often requires bone resection. The bland histologic features of a monotonous proliferation of a loose, mesenchymal fibrous tissue that lacks atypia may easily lead to a misdiagnosis. The primitive dental pulp, the dental papilla, and the tooth follicle are histologically similar to myxoma. These soft tissue fragments often separate from extracted developing teeth that are submitted to the pathologist and may easily be misinterpreted as an odontogenic myxoma. The pathologist must have good clinical and radiographic correlation to avoid a misdiagnosis and to prevent unnecessary additional surgery.     

Mediastinal evaluation utilizing the reverse Trendelenburg radiograph

When thoracic aortic rupture is suspected, a 45-degree reverse Trendelenburg (RT) anteroposterior (AP) chest radiograph should place the mediastinal structures in a more appropriate position and allow a more accurate evaluation than a supine AP radiograph. One hundred ninety-one consecutive hemodynamically stable adult patients with major blunt thoracic trauma were initially evaluated for mediastinal abnormalities associated with aortic disruption by both supine AP chest radiograph and an AP chest radiograph with the patient in 45-degree RT position. One hundred four patients underwent contrast aortography based on mediastinal abnormalities detected on the supine AP chest radiograph. Twenty of these patients had abnormal aortograms demonstrating traumatic aortic disruption confirmed at surgery. Supine and RT chest radiographs were retrospectively compared in a blinded fashion to evaluate their specificity and positive predictive value for detection of traumatic thoracic aortic rupture. If RT chest radiographic findings had been used to determine the need for further assessment, 29 angiograms (26%) would have been eliminated, specificity would have increased from 52 per cent to 69 per cent, and positive predictive value would have increased from 19 per cent to 27 per cent. Both supine and RT chest radiographs demonstrated mediastinal widening in all 20 patients with abnormal aortograms, with no missed thoracic aortic disruptions (100% sensitivity). This study indicated that the RT chest radiograph may be used instead of the standard supine radiograph as the initial screen for mediastinal evaluation, maintaining a high sensitivity and eliminating the cost and morbidity of many unnecessary aortograms.     

MR imaging of human brain at 3.0 T: preliminary report on transverse relaxation rates and relation to estimated iron content

PURPOSE: To determine the transverse relaxation rates R2 and R2' from several gray matter regions and from frontal cortical white matter in healthy human brains in vivo and to determine the relationship between relaxation rates and iron concentration [Fe]. MATERIALS AND METHODS: Six healthy adults aged 19-42 years underwent thin-section gradient-echo sampling of free induction decay and echo magnetic resonance (MR) imaging at 3.0 T. Imaging covered the mesencephalon and basal ganglia. RESULTS: Relaxation rates (mean +/- SD) were highest in globus pallidus (R2 = 25.8 seconds-1 +/- 1.1, R2' = 12.0 seconds-1 +/- 2.1) and lowest in prefrontal cortex (R2 = 14.4 seconds-1 +/- 1.8, R2' = 3.4 seconds-1 +/- 1.1). Frontal white matter measurements were as follows: R2 = 18.0 seconds-1 +/- 1.2 and R2' = 3.9 seconds-1 +/- 1.2. For gray matter, both R2 and R2' showed a strong correlation (r = 0.92, P < .001 and r = 0.90, P < .001, respectively) with [Fe]. Although the slopes of the regression lines for R2' versus [Fe] and for R2 versus [Fe] were similar, the iron-independent component of R2' (2.2 seconds-1 +/- 0.6), the value when [Fe] = 0, was much less than that of R2 (12.7 seconds-1 +/- 0.7). CONCLUSION: The small iron-independent component R2', as compared with that of R2, is consistent with the hypothesis that R2' has higher iron-related specificity.     

Children with congenital pulmonary lymphangiectasia: after infancy

OBJECTIVE: The objective of this original report is to describe the characteristic chest imaging findings in children with primary congenital pulmonary lymphangiectasia who survive infancy. CONCLUSION: In children with primary congenital pulmonary lymphangiectasia, increased interstitial markings decrease over time and increased hyperinflation is associated with persistent patchy areas of ground-glass opacity.     

Microangiopathy of the brain and retina with hearing loss in a 50 year old woman: extending the spectrum of Susac's syndrome

A 50 year old woman presented with a subacute onset of vertigo and diplopia followed by an encephalopathy with confusion, spasticity, ataxia, myoclonus, and multiple branch retinal arteriolar occlusions and unilateral sensorineural deafness. Brain biopsy confirmed multiple microinfarcts with no vasculitis. After the procedure she had a right iliofemoral deep vein thrombosis and was found to be heterozygous for the factor V Leiden mutation. She was treated with anticoagulants and made a marked recovery with no relapses 6 months after presentation. This case extends the age range at which Susac's syndrome can present, and raises the possibility that the condition may be associated with abnormalities of coagulation.     

Trans-axillary first rib excision for thoracic outlet syndrome

AIM: Thoracic outlet syndrome (TOS) is a clinical diagnosis treatable by excision of the first rib. This study was undertaken to assess the alleviation of symptoms following trans-axillary rib excision in patients with a diagnosis of TOS suggested by a positive Elevated Arm Stress Test and, by inference, to estimate the prevalence of the syndrome. METHOD: A retrospective review of trans-axillary first rib excision was performed. No referrals were accepted from outwith the catchment area of our hospital. Post-operative symptomatic improvement was accepted as a confirmation of correct pre-operative diagnosis. RESULTS: Over six years, 52 rib resections were performed in 46 patients, mean age (+/- S.D.) 38.8 (+/- 10.6) years. The indications for surgery were principally neurological symptoms (n = 42 excisions), arterial compromise (n = 5) and venous compromise (n = 5). Symptoms had been present for a mean of 15.8 months prior to surgery. The median follow-up after surgery was 33 months. 42 patients (48 resections) showed immediate improvement in symptoms following surgery, although symptoms recurred in three patients (4 resections) between 6 and 8 months post-operatively. In the final two years of this study, 20 resections resulting in symptomatic improvement were performed, suggesting a prevalence for TOS of at least 10 per 100,000 per year. CONCLUSIONS: Thoracic outlet decompression was performed more frequently in this series than many previous reports, suggesting that TOS may be under-diagnosed.