Clinical significance of serum hepatitis C virus (HCV) RNA as marker of HCV infection.

We have evaluated the clinical significance of hepatitis C virus (HCV) RNA determination by analyzing a group of 221 hospitalized patients with abnormal liver function tests. Serum HCV RNA was detected by "nested" PCR amplification followed by nonisotopic hybridization. Of the 200 (90.5%) patients with anti-HCV-positive enzyme-linked immunosorbent assay results, 152 (76%) were RIBA reactive, 47 (23.5%) had indeterminate results, and 1 (0.5%) was nonreactive. Of the 180 (90%) patients positive for anti-HCV and HCV RNA, 138 (76.7%) were RIBA reactive and 42 (23.3%) were RIBA indeterminate. The pattern of RIBA reactivity did not correlate with the presence of HCV RNA. Elevated alanine aminotransferase levels were associated neither with the presence of viremia nor with the RIBA pattern. Histological findings consistent with non-A non-B hepatitis correlated with the presence of HCV RNA but not with the RIBA pattern. HCV RNA was detected in 11 of 21 (52.4%) anti-HCV-negative patients. These 11 patients were either immunosuppressed or in the prodromic phase of acute hepatitis C. Circulating HCV RNA can therefore be described as being predictive of virus-induced liver damage in anti-HCV-positive patients and may be useful in the diagnosis of HCV infection in anti-HCV-negative immunosuppressed patients or in those with early acute infection.     

Experimental determination of the kinetics of calcium-binding with chondroitin sulphate and the effects of uric acid on this process

Summary The calcium-binding kinetics of chondroitin sulphate C (CS) have been determined using equilibrium analysis including ⁴⁵Ca. There is a linear relationship between the extent of the Ca binding and the concentration of CS present. 1 mol CS disaccharide unit binds 0.757 mol Ca. Scatchard plots of the data have revealed a single constant of dissociation (K _D =1429). In the presence of urate ions, and dependent on the pH value, the ability of CS to bind Ca may be impaired by as much as 31%. These measurements have supported the theory that urate ions interact with the GAGs in urine.     

Physicians' attitudes toward breast self-examination: a pilot study

Recent case control studies suggest that breast self-examination (BSE) is efficacious in the early clinical diagnosis of breast cancer. Population studies also indicate that adoption of this behavior depends largely on physicians. This pilot study was designed to determine whether physicians' attitudes on this subject could be obtained through a mail questionnaire. The results show that a self-administered mail questionnaire can be used successfully in physician studies. Although questionnaire length does affect response rates (78% one page, 69% four page, and 57% eight page), it does not affect either respondent characteristics or question response.     

Cardiovascular parameters and scoring systems in the evaluation of response to therapy in sepsis and septic shock

Summary In 47 medical and postoperative ICU patients with 57 episodes of sepsis and septic shock, cardiovascular parameters including systemic vascular resistance (SVR), cardiac index (CI), stroke volume index (SVI), left ventricular stroke work index (LVSWI) as well as six scoring systems (APACHE II, Elebute, Goris, HIS, SAPS and SSS) were studied regarding their usefulness in the assessment of disease progression and evaluation of response to supplemental sepsis therapy (immunoglobulins, plasmapheresis). Among the hemodynamic parameters, only a prompt SVR improvement significantly discriminated between ultimate survivors and nonsurvivors. Thus, an increase in SVR (>160 dyn*cm^–5*sec, within days 0 to 4, persisting for >24 hours) can serve as a prognostically validated response criterion (responders/non-responders: 26/31; mortality: 27% vs. 77%). Non-invasively, the APACHE II score was best suited (specificity: 88%, sensitivity: 67%) to classify hemodynamically defined responders to supplemental sepsis treatment (score-reduction 4 on day 4 after onset of therapy).

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Herz-Kreislauf-Parameter und Score-Systeme in der Beurteilung des Therapieerfolges bei Sepsis und septischem Schock

Zusammenfassung Bei 47 internistischen sowie postoperativen Intensivpatienten mit insgesamt 57 Episoden von Sepsis und septischem Schock wurden Herz-Kreislauf-Parameter inklusive systemischer Gefäßwiderstand (SGW), Herzindex, Schlagvolumenindex und linksventrikulärer Schlagarbeitsindex sowie sechs Score-Systeme (APACHE II, Elebute, Goris, HIS, SAPS und SSS) in ihrer Wertigkeit zur Beurteilung des Krankheitsverlaufes sowie des Ansprechens auf additive Sepsistherapie (Immunglobuline, Plasmapherese) untersucht. Von den hämodynamischen Parametern diskriminierte nur der — prompt nachweisbare — Anstieg des SGW signifikant zwischen letztlich überlebenden und nicht überlebenden Patienten. Ein Anstieg des SGW (>160 dyn*c^m–5*s innerhalb von vier Tagen, länger als 24 Stunden anhaltend) kann somit als prognostisch validiertes Responder-Kriterium dienen (Responder/Non-Responder: 26/31; Letalität: 27% vs. 77%). Nichtinvasiv erwies sich der APACHE II Score (Kriterium: Score-Abfall 4 bis zum Tag 4 nach Therapiebeginn) zur Klassifizierung der hämodynamisch definierten Therapie-Responder bei additiver Sepsistherapie am besten geeignet (Spezifität: 88%, Sensitivität 67%).

     

Cost-effectiveness of a post-exposure HIV chemoprophylaxis program for blood exposures in health care workers.

We performed a cost-effectiveness analysis of a post-exposure chemoprophylaxis program for health care workers who sustained exposures to blood. We analyzed a program of (1) treatment with zidovudine alone versus no treatment and (2) treatment with three-drug therapy versus no treatment. Assuming that 35% of exposures were to HIV-positive sources, the zidovudine regimen prevented 53 HIV seroconversions per 100,000 exposures, at a societal cost of $2.0 million per case of HIV prevented. The cost per quality-adjusted life year saved was $175,222. A three-drug chemoprophylactic therapy program (postulating 100% effectiveness and 35% source HIV positivity), prevented 66 seroconversions per 100,000 exposures, at a cost of $2.1 million per case of HIV prevented and $190,392 per quality-adjusted life year saved. Treating sources known to be HIV-positive and treating severe exposures were the most cost-effective strategies.     

Endovascular grafts

The clinical application of endovascular grafts began with the work of Parodi in 1990, which fused intravascular stent and prosthetic graft technologies. These less invasive devices have been applied to the treatment of arterial aneurysm, long segment occlusive disease, and traumatic vascular injuries. A host of different systems have been developed that exploit the unique properties of balloon, superelastic metal, and vascular graft devices.     

An unusual cause of spinal cord injury: case report and discussion

Traumatic spinal cord injury is a devastating condition that alters every aspect of the victim's life. Motor vehicle accidents cause about half of the cases, whereas others are the result of falls, recreational and sporting accidents, or acts of violence. We report a case of a C3 spinal fracture with a resultant Brown Sequard syndrome, which occurred in a unique manner and could have easily been prevented. There is a need for the medical community to play a more active role in educating the public to prevent accidents that lead to these catastrophic injuries.     

Ajoene in the topical short-term treatment of tinea cruris and tinea corporis in humans. Randomized comparative study with terbinafine.

Ajoene (CAS 92284-99-6), an organic trisulphur originally isolated from garlic, has an antimycotic activity which has been widely demonstrated both in vitro and in vivo. The objective of this work was to compare the safety and effectiveness of ajoene (0.6%, gel) with terbinafine (CAS 91161-71-6) (1%, cream) for the treatment of tinea corporis and tinea cruris. The patients selected were 60 soldiers with clinical and mycological diagnosis of either dermatophytosis. They were distributed at random in two treatment groups, one treated with ajoene at 0.6% and the other with terbinafine at 1%. All patients were evaluated clinically and mycologically 30 and 60 days after completion of the treatment, which was considered effective when clinical signs and symptoms had disappeared and the mycological cultures were negative. Thirty days after treatment, the percent healing rate was 77 and 75 for the groups treated with ajoene and terbinafine, respectively. Sixty days after treatment, the healing rate 73% and 71% for the groups treated with ajoene and terbinafine, respectively. These results and those obtained in previous studies confirm that ajoene is a new agent for the topic treatment of superficial mycoses, and for the first time show the therapeutic usefulness of an inhibitor of phospholipids biosynthesis in eukaryotes.