Determinants of HIV infection and recent risk behaviour among injecting drug users in Berlin by site of recruitment

This study investigated differences in prevalence and determinants of HIV infection, and in recent risk behaviour (previous 6 months) among injecting drug users (IDUs) who are in contact with different types of services for IDUs in Berlin. Participants (n = 557) were recruited from drug-free long-term treatment centres, a storefront agency and a syringe exchange bus. HIV seroprevalence was lowest (3.9%) at the treatment centres, and highest among IDUs at the storefront agency (20.7%). In logistic regression, independent risk factors for HIV infection were duration of injecting drug use, borrowing syringes in prison, sex with HIV-positive partners, and prostitution. Syringe sharing in prison was the most important independent determinant of HIV infection among all three subpopulations of IDUs. Participants entering long-term treatment were most likely, and IDUs at the syringe exchange bus were least likely to have borrowed and passed on syringes in the previous 6 months. In logistic regression, site of recruitment was independently associated with recent borrowing of syringes, but not with condom use. Injection of drugs other than heroin only, and injecting in prisons, were also independent predictors of recent borrowing. The results indicate that IDUs entering treatment form an important target group for health education. There is a need for AIDS prevention measures in prisons. The comparatively low levels of recent injection risk behaviour among IDUs at the syringe exchange bus suggest that this type of intervention may be effective in harm reduction.     

Onychomadesis: A Rare Side‐Effect of Valproic Acid Medication?

Abstract: Valproic acid (VPA) is frequently used as an antiepileptic drug. Several side effects are known. We report on a child with onychomadesis as a possible side‐effect of treatment with VPA. Normal nail growth was observed after stopping VPA. The pathomechanism of onychomadesis due to VPA treatment remains unclear.     

The Comparison of Balloon versus Rotational Angioplasty (COBRA) Study Protocol: A Prospective Randomized Study

The Comparison of Balloon versus Rotational Angioplasty (COBRA) study is a prospective, randomized study to compare short- and long-term effects of PTCA and high speed PTCRA (or rotablation) in patients with complex coronary stenoses. Patients with angiographically defined complex coronary stenoses (> 70% diameter reduction) are included in the study. The trial has recruited 501 patients who will have detailed follow-up for 6 months. The primary end points are: (1) procedural success, defined as angiographically proven residual stenoses < 50% and stenosis reduction of ± 20% in absence of new myocardial infarction, emergency CABG, or death; (2) 6-month restenosis in the treated segment; and (3) major cardiac events during the follow-up period. Additionally, improved exercise tolerance will be scored. The final results of the study are expected by late 1997.     

The IgG isotypes of specific antibodies in patients with American cutaneous leishmaniasis; relationship to the cell-mediated immune response

American cutaneous leishmaniasis (ACL) presents a spectrum of clinical and immunological manifestations. Since the nature of the cellular response appears to play a fundamental role in determining the characteristics of the immunoglobulin isotype of specific antibody responses, we have compared the relative levels of specific antibodies of the four IgG isotypes against Leishmania in sera from patients with different clinical manifestations of ACL. Using a specific antibody capture assay, significant levels of antibodies of the IgG1, 2 and 3 isotypes were detected in localized cutaneous leishmaniasis (LCL); the average level of IgG4 antibodies was low and they were not detected in 10/20 sera. Sera from muco-cutaneous leishmaniasis (MCL) gave a comparatively strong IgG1 response. Sera from diffuse cutaneous leishmaniasis (DCL), the rare form characterized by antigen-specific anergy of cell-mediated immunity, showed highly significant levels of IgG4 antibodies compared to antibody levels of this isotype in the other groups; IgG1 and IgG2 levels were also elevated. Based on other studies of the relationship between the IgG isotype response and cell-mediated immunity, these results confirm a Th1-like CD4⁺ T cell response in LCL and MCL and a significant Th2-like response in DCL.     

Ostial Left Main Stem Stenting After Cutting Balloon Angioplasty

Despite major improvements in equipment and operator technique over the past two decades, percutaneous revascularization has only been used cautiously in patients with left main stem stenosis. A 73-year-old man presented with a history of multiple risk factors and previous cardiac surgery and was admitted with acute chest pain. Cardiac catheterization showed 80% left main stenosis, which was dilated by a cutting balloon and stented with an uneventful postprocedure course. The patient remained free of symptoms at 6-months follow-up. Stenting after cutting balloon angioplasty of left main stenosis is a feasible and effective procedure in patients who are unsuitable for CABG.     

Atrial Fibrillatory Wall Motion and Degree of Atrial Remodeling in Patients with Atrial Fibrillation: A Tissue Velocity Imaging Study

Introduction: The atrial fibrillation cycle length (AFCL) and the intracardiac atrial electrogram morphology may be used to characterize atrial fibrillation (AF). However, assessment of these parameters requires an invasive electrophysiological study. We assessed clinical and electrophysiological correlates of noninvasive tissue velocity imaging (TVI) of the right and left atrial myocardial fibrillatory wall motion. Methods and Results: We performed an electrophysiological study in 12 patients with AF referred for His bundle ablation. Using atrial electrograms, we determined the AFCL (AFCL‐egm) and electrophysiological AF type. Simultaneously, transthoracic echocardiography was performed. We used the TVI traces to determine the cycle length of the atrial fibrillatory wall motion (AFCL‐tvi) and atrial fibrillatory wall velocities (AFV‐tvi). AFCL‐tvi matched very well with AFCL‐egm (r²= 0.98; P < 0.001), both in the left and right atrium. Patients with permanent AF had shorter AFCL‐tvi (155 ± 15 ms vs 216 ± 23 ms; P < 0.001), higher AFCL‐tvi variability, and lower AFV‐tvi compared to patients with paroxysmal AF. Three electrophysiological AF types were found based on the morphology of the electrograms and these related to specific TVI patterns. Conclusion: TVI of the atrial fibrillatory wall motion may enhance noninvasive characterization of atrial remodeling in patients with atrial fibrillation.     

Coronary Stenting with the Sirolimus-Eluting Stent in Clinical Practice: Final Results from the Prospective Multicenter German Cypher Stent Registry

Aims: Drug-eluting coronary stents (DES) have gained widespread use for the treatment of coronary artery disease. However, because of safety concerns and frequent "off-label" use data from "real life," registries are necessary to monitor indications and outcome of DES in daily clinical practice.
Methods and Results: We evaluated data from the German Cypher Stent Registry. A total of 10,894 patients treated with at least one sirolimus-eluting stent (SES) at 152 hospitals were included. Follow-up at a median of 6.4 months was available in 10,006 patients (92%). Median age was 64.8 years and 75.5% were male. Per lesion a mean of 1.09 ± 0.41 SES were implanted with a mean length of 21.1 ± 11.5mm. During follow-up, death rate was 1.8% and the rates of myocardial infarction or stroke were 2.1% and 0.5%. Any target vessel revascularization (TVR) was performed in 8.0% of patients. Independent predictors for death, myocardial infarction, or stroke were: cardiogenic shock, acute coronary syndromes, reduced left ventricular function, renal insufficiency, diabetes mellitus, advanced age, three-vessel disease, degree of stenosis, and prior myocardial infarction. Predictors for a TVR were: two- or three-vessel disease, target vessel = coronary bypass, advanced age, stent diameter, ostial lesions, indication in-stent restenosis, renal failure, and target vessel = left anterior descended artery.
Conclusions: These results demonstrate that SES use in clinical practice is safe and effective. The main predictors of clinical events during follow-up are clinical parameters whereas as predictors of TVR mainly are angiographic parameters. (J Interven Cardiol 2010;23:18–25)