Cannabis laws: an analysis of costs

There is evidence that the use of cannabis is increasing in Australia, with stable black-market prices, despite the 9-year National Campaign Against Drug Abuse, increasing expenditure to enforce the laws against cannabis use, and the seizure of large plantations of cannabis plants. Recent government data are used to estimate the conservative cost of drug-law enforcement against cannabis use as being $329m in 1991-92. Alternatives to the existing regime are examined, including expiation, decriminalization, and legalization.     

Treatment of infected left ventricular assist device using antibiotic-impregnated beads

There is no well-established therapy for treating infections of heart-assist or artificial heart devices, a serious problem with life-threatening consequences. We used a promising new approach in which antibiotic-impregnated polymethylmethacrylate beads were placed around an implanted left ventricular assist device to control an external blood pump infection in a bridge-to-transplant patient. In this case report, we describe the potential of antimicrobial-impregnated polymethylmethacrylate beads for in situ control of infections involving external surfaces of cardiovascular devices.     

Papillary clear cell adenocarcinoma of the groin arising from endometriosis

A 67-year-old woman presented with rapidly enlarging right anterior thigh mass. Clinical impression was of a primary sarcoma, but the histologic analysis of an incisional biopsy specimen showed adenocarcinoma with clear cell differentiation. Initially thought to be a metastasis, the malignant tumor appears to have arisen from extraabdominal endometriosis of the right groin. This case shows clinical, radiographic, and histologic findings that may help the orthopaedic surgeon recognize an unusual complication of extrapelvic endometriosis.     

Long-term effects of finasteride on prostate tissue composition

OBJECTIVES: To determine the long-term effects of finasteride treatment on prostate tissue composition; to relate these effects to clinical outcomes; and to test the hypothesis that finasteride exerts a selective or preferential action on the transition zone. METHODS: Nineteen men with symptomatic benign prostatic hyperplasia (BPH) who completed a 6-month double-blind trial of finasteride were enrolled in a 24-month open-label extension study of drug responders. Magnetic resonance imaging and prostate biopsy for morphometric analysis were performed together 70 times: at baseline (n = 19), after treatment periods of intermediate duration (6 to 18 months, n = 32), and after long-term drug treatment (24 to 30 months, n = 19). At baseline, prostate volume averaged 51 cc, of which 57% was transition zone. RESULTS: Decreases in symptom score, dihydrotestosterone and prostate-specific antigen levels, and prostate volume occurred at 6 months (P <0.01), stabilized, and were maintained without further long-term decreases. Prostate epithelium contracted progressively from baseline (19.2% tissue composition; 6.0-cc volume; 3.2 stroma/epithelial ratio) to intermediate (12.5%, 3.3 cc, and 5.6, respectively) to long-term treatment (6.4%, 2.0 cc, and 17.4, respectively, P <0.01 for all). Percent epithelial contraction was similar in the peripheral and transition zones (P = NS). The transition zone remained a relatively constant proportion (53% to 58%) of whole-prostate volume from baseline to long-term observation. CONCLUSIONS: Long-term finasteride treatment (24 to 30 months) results in a marked involution of the prostate epithelium, which continues to progress for many months after clinical effects stabilize. The effect on the epithelium is similar in the peripheral and transition zones for both morphometric and volumetric changes. Progressive contraction of the prostate epithelium appears to constitute the underlying mechanism for sustained action of finasteride.     

The riddle of oral sex

Oral sex continues to be a source of confusion in determining its risk for HIV transmission. Educator Dave Nimmons concludes that oral sex offers a possible, but very low, risk of HIV infection and states that much of the concern about oral sex and HIV prevention centers around two dozen cases of single occurrences of oral transmission from all over the world. Many researchers believe that knowledge about this small number of cases facilitates informed decisions about risk and demonstrates under which conditions transmission is possible. There is concern, however, that because a single case can personalize an issue, it can have a more powerful effect on an individual's imagination than a study with many participants. To reduce HIV transmission risk, researcher Paul O'Malley suggests avoiding trauma to the mouth and throat, especially vigorous or prolonged oral sex, avoiding oral sex when infections or abrasions in the mouth and throat are present, and avoiding the use of stimulant substances that dull sensation. At the Vancouver conference, there was little disagreement from a panel of experts that oral sex is an extremely low-risk activity. Researcher Traux presented results from a multivariate analysis of risk assessment data from HIV-antibody testing interviews and found that anal sex and drug use were associated with increased seroprevalence and oral sex was not. Interestingly, there was no statistically significant difference in seroprevalence rates between people who used condoms during oral sex and those who did not. The panels also discussed a recent study in which six out of seven rhesus monkeys became infected with simian immunodeficiency virus (SIV) after it was dabbed on the back of their mouths. Effective counselors and educators can work to raise consciousness about the actual risk of transmission from oral sex, determine whether an individual can increase or decrease this risk, determine the meaning of oral sex in a person's life, and the extent to which the person is comfortable taking any risk.