Occupational transmission of HIV in health care workers: A review

Health care workers have a small but real risk of acquiringHIV infection as a result of occupational exposure. In thispaper, we review all reports in the scientific literature from1984 through to December 1993 of confirmed and probable casesof HIV seroconversion after a specific occupational exposure.A total of 64 confirmed cases have been reported, 24 in Europe,36 in the USA and 4 in other countries. Most seroconversionshave resulted from percutaneous exposure (91%) to AIDS patients(62%), usually caused by hollow bore needlestick injuries inflictedduring blood drawing procedures. Almost all seroconversionshave been detected within 6 months of exposure (94%) and haveusually been preceded by an episode of acute illness (73%).Ten seroconversions have occurred in spite of partial or completecourses of zidovudine prophylaxis. An additional 113 probablecases have been reported, 75 in the USA, 35 in Europe and 3in other countries. Aggregating the results of the prospectivestudies carried out, it is calculated that the risk of seroconversionfollowing percutaneous exposure is 0.33% or 3 in 1000 exposures(95% Cl: 0.21–0.52%), while the risk following mucocutaneousexposure is much lower (0.04%, 95% Cl: 0.006–0.31%). Thedocumented failure of zidovudine prophylaxis following occupationalexposure in a number of instances indicate its effect is, atbest, only partial; furthermore, exposure to source patientswho have been receiving the drug may lead to transmission ofzidovudine-resistant strains of HIV. Risk factors for occupationalexposure to HIV and for transmission, given that an exposurehas occurred, are discussed.     

Abnormal Automaticity as Mechanism of Atrial Tachycardia in the Human Heart—Electrophysiologic and Histologic Correlation:

Abnormal Automaticity in Human Atrium, introduction: A 32-year-old woman was operated upon because of drug refractory atrial tachycardia.
Methods and Results: Electrophysiologic study was performed prior to operation. During surgery, epicardial mapping of the electrical activity of the left atrium was performed. The left atrial appendage was resected and studied in a tissue bath. Thereafter, histologic examination was performed. Polarity of the P wave in the surface ECG suggested that the tachycardia originated high in the left atrium. Epicardial mapping disclosed earliest activation in the apex of the left atrial appendage. Intracellular recordings from surgical specimen made at the site of origin, which was marked during surgery, revealed cells with phase 4 depolarization at cycle lengths ranging from 360 to 540 msec. Exit block prevented spread of activation from the spontaneously firing cells to surrounding tissue. Histology showed that spontaneous activity arose in an area with abnormal cells-characterized by an amorphous, pale eosinophilic staining cytoplasm and absence of nuclei-surrounded by normal myocytes.
Conclusion: The observations indicate that the mechanism of the atrial tachycardia was based on abnormal automaticity in an area consisting of a conglomeration of normal and abnormal myocytes.     

In Vivo Ventricular Lesion Growth in Radiofrequency Catheter Ablation

While radiofrequency catheter ablation has proved highly effective in the treafment of various supravenfricular tQchyarrhythmias, resulls in the trentment of ventricular tachycardia invite improvement. Knowledge of lesion growth in vivo might improve understanding of this discrepancy. So far only information from in vitro and in vivo studies using a small 2 mm tip eiectrode is available. Growlh of ventricular radiofrequency lesions created with a 4 mm ahlalion electrode was studied in 11 closed-chest dogs. Endocardia] ablations were performed at 31 left and 35 right ventricuiar sites at a power setting of 25 Watts and 5, 10, 20, 30 or 60 seconds pulse duration. Macroscopic and histopathologic lesion examination were performed after one week survival. Mean lesion volume increased from 52 mm³ after 5 seconds pulse duration to a maximum 388 mm³ and approximately 7 mm depth after 30 seconds. Lesions were prolate spheroid in form, with a sparing of subendocardial myocardium and maximum lesion diameter at some millimeters depth. Results indicate that catheter positioning at no more tlian 7 mm from the target is required for successful ablation. Due to lesion geometry, subendocardial targets demand even more exact catheter positioning, while subepicardial substrates may not be ammenable to ablation if ventricular wall thickness exceeds 7 mm at the ablation site. Repeated pulses at adjacent sites may be required for ablation of extended arrhytbmogenic areas. Volume at 5 seconds was only approximately 15% of mature lesions. Therefore, the use of a short'test pulse after careful mapping may be useful to pinpoint the most appropriate site for ablation in discrete pathways.     

Successful use of infliximab in a patient with neuro‐Behçet’s disease

Behçet′s disease (BD) is a systemic vasculitic disorder of unknown aetiology characterised by recurrent oral and often genital ulcers, which may be associated with ocular, cutaneous, articular, neurological or vascular involvement. We report a 52‐year‐old woman diagnosed of neuro‐BD who was treated with infliximab with a dramatic response to this treatment.     

The −589C>T polymorphism in the interleukin‐4 gene (IL‐4) is associated with a reduced risk of myocardial infarction in young individuals

Summary. Background: Inflammatory reactions contribute to the development of arterial disease. We investigated the role of interleukin‐4 (IL‐4) in the development of myocardial infarction (MI) by genotyping patients with MI and control subjects for the ?589C>T (rs2243250) single nucleotide polymorphism (SNP), which tags a functional haplotype of IL‐4. Methods and results: Study of Myocardial Infarctions Leiden (SMILE) included 560 men with a first MI and 646 control subjects. The Valencia study included 305 patients with MI at ≤52 years (men and women) and 310 control subjects. In SMILE no clear overall association with the ?589C>T genotype was found [odds ratio (OR) 0.84; 95% CI 0.37–1.95 for ?589TT and 0.82; 95% CI 0.62–1.07 for ?589CT compared with ?589CC]. In patients younger than 50 years, carriership of one or two ?589T alleles was associated with a reduced risk of MI (OR 0.57: 95% CI 0.34–0.95). This result was replicated in the Valencia study, where carriers of one or two ?589T alleles had a reduced risk of MI (OR 0.67: 95% CI 0.47–0.95), with a strong protective effect of the ?598T allele in homozygous ?589T (OR 0.33: 95% CI 0.10–1.05). In the control subjects of the Valencia study, the ?589T allele was associated with reduced levels of F1+2. Conclusion: Our data indicate that the IL‐4 haplotype tagged by the ?589T allele reduces the risk of MI in young individuals.     

Circulating activated protein C is reduced in young survivors of myocardial infarction and inversely correlates with the severity of coronary lesions.

BACKGROUND: Cardiovascular risk factors for myocardial infarction (MI) are less frequent in younger than in older MI survivors. Therefore, the thrombotic component of MI may play a more important role at a young age. As activated protein C (APC) provides systemic anticoagulant and anti-inflammatory protection, a low plasma APC level may be an arterial thrombotic risk factor. AIM: To determine whether there is an association between reduced APC levels and early MI and severe coronary lesions. METHODS: APC was measured in 231 young MI survivors and 231 controls. RESULTS: Low APC levels were significantly associated with MI. Compared with the fourth quartile, the odds ratio (OR) for APC values in the first quartile was 3.7 [95% confidence interval (CI) = 2.1-6.4], and 3.2 (1.5-7.0) after adjustment for cardiovascular risk factors. Moreover, each decrease of 0.43 ng mL(-1) (1 SD) in APC increased the OR 1.7 times (1.4-2.2), and 1.5 times (1.2-1.9) after adjustment for cardiovascular risk factors. Low APC levels were also associated with the number of coronary arteries affected and with the severity of coronary lesions (P < 0.001). CONCLUSIONS: There is a significant association between low circulating APC levels and both early MI and the extent and severity of coronary atherosclerosis, which might be related to the anticoagulant and anti-inflammatory properties of APC.     

Clinico-Pathological Investigation on Patients With "Early Gastric Cancer" and "Intermediate Gastric Cancer" in Chile

We reported the final results obtained in a group of 30 patientswith gastric cancer confined to the mucosa or submucosa (earlygastric cancer) and in 29 cases with cancer infiltration upto the muscularis propria (intermediate gastric cancer). The clinical findings and postoperative course were presented.The five-year survival rate was 84% in early gastric cancercases and 44% in intermediate gastric cancer patients.     

Gastric Cancer in Chile: A Cooperative Interhospital Study III. Five-Year Survival Rate

This report showed the survival figures for gastric cancer inChile. For the whole group, a survival rate of 6.6% was obtained.This figure can be divided into 19% for the resected cases and0% for the non-resected patients. In the resected group, the mean survival rate was 75.7% forearly gastric cancer cases; 48.4% for patients with cancer infiltrationsup to the muscularis propria and 21.4% for those with serosalinvasions. A mean survival rate of 25.4% was obtained with subtotal distalgastrectomy performed for patients with cancer located in themiddle or lower third of the stomach. When cancer was locatedin the upper third of the stomach, the 5-year survival ratein total gastrectomy cases was 19% and proximal gastrectomycases was 8.7% in Chile.