The impact of AIDS on state and local health departments: issues and a few answers.

Owing to large differences in the incidence of AIDS (acquired immunodeficiency syndrome) and in public health resources and priorities, the impact of AIDS on state and local health departments has been variable. Nonetheless, health departments everywhere are being held responsible for surveillance and control of the HIV (human immunodeficiency virus) epidemic which we believe requires, at minimum, convenient, free HIV testing and counseling; expanded HIV services in sexually transmitted diseases clinics and substance treatment centers; locally oriented AIDS information/education; notification of persons unknowingly exposed to HIV; restrictive measures for HIV-infected persons who, after counseling, persist in exposing others; regulation or closure of public establishments in which HIV transmission is likely to result; and confidential reporting of all HIV test results to public health departments. In Colorado new legislation was passed to require reporting of HIV test results, to provide the reports with near absolute protections against unauthorized disclosure, and to modify quarantine statues to incorporate rights to due process, appeals, and confidentially. States in which there is a legal basis for discrimination against gay men will need to rectify this problem first. There is no evidence that reporting of HIV infections in Colorado has adversely affected the rate at which persons with HIV risk behaviors volunteer to be tested. For Denver and Colorado Departments of Health, more than 70 per cent of the estimated $2,796,000 expended in AIDS activities during 1987 was federal.     

Age-dependent Responses to Thermal Hyperalgesia and Mechanical Allodynia in a Rat Model of Acute Postoperative Pain

Background: Developmental differences in short- and long-term responses to pain, especially surgical pain, have received minimal attention. The purpose of the present study was to examine postoperative responses in rats of developmental ages paralleling the infant to young adult human.

Methods: The withdrawal threshold to von Frey filament testing and withdrawal latency to hind-paw radiant heating were determined before and for various times after hind-paw incision in rats 2, 4, and 16 weeks of age. Control rats of these ages were observed serially without surgery.

Results: In control animals, younger rats were more sensitive to mechanical stimulation and less sensitive to thermal stimulation. Paw incision resulted in similar changes to both types of stimulation in all age groups, peaking 4 h after surgery. However, the return to normal sensitivity to mechanical stimulation, as measured by return of threshold to 80% of normal, occurred more quickly in 2-week-old than in 4- and 16-week-old animals. In contrast, there was no age difference for time to return to normal sensitivity to thermal stimulation after surgery.     

Membrane structure, toxins and phospholipase A2 activity.

The phospholipid-hydrolyzing enzyme phospholipase A2 (PLA2) (EC 3.1.1.4) exists in several forms which can be located in the cytosol or on cellular membranes. We review briefly cellular regulatory mechanisms involving covalent modification by protein kinase C and the action of Ca2+, cytokines, G proteins and other cellular proteins. The major focus is the role of phospholipid structure on PLA2 activity, including (1) the mechanism of PLA2 action on synthetic phospholipid bilayers, (2) perturbation of synthetic and cellular membranes with lipophilic agents and membrane-interactive peptides and (3) the ability of these agents to activate endogenous PLA2 activity, with emphasis on the venom and plant toxins melittin, cardiotoxin and Pyrularia thionein.     

Change management in a group dental practice. A consideration of management issues that may arise in a larger dental practice.

The drive for quality assurance in general dental practice has arisen as a response to changing standards and demands. Dentists need to develop skills in change management in this new culture of change. Groups of practitioners often encounter difficulties when managing change, yet it is essential that they lead the process. Such problems are common among groups of professionals. A wide range of topics is presented that may, from one point of view, represent challenging or problem areas (obstacles) for a group practice but may also, from a different point of view, provide a framework of opportunities for improvement, and facilitate the management processes within the practice and the management of change in particular (tools). The range of skills required to assist a professional group is such that individual dentists or advisers may not be able to achieve much on their own. The best way forward may be to interpret the problems as a professional training need and to organise training as a group. These issues will be considered under the following headings: partners and teams; introduction: the need for change management; the challenge for group practices; obstacles and tools; conclusion: the way forward--a case for training.     

Primate endocrine function after pancreatico-duodenal-splenic allotransplantation

In this study the endocrine function following intraperitoneal hetero- and orthotopic pancreatico-duodenal-splenic allotransplantation (PDS) in hemipancreatectomized, non-immune-suppressed chacma baboons was assessed. Significantly reduced K-values and insulin release together with glucose intolerance during IVGTT were observed in hemipancreatectomized recipients (HPS) without grafts. Orthotopic and heterotopic PDS transplantation improved the glucose intolerance of HPS recipients; orthotopically sited grafts rendering the best curves. Normal glucose tolerance was not achieved. Both orthotopic and heterotopic PDS transplantation rendered suboptimal insulin release during IVGTT; heterotopically draining grafts released significantly more insulin than orthotopic grafts. Hyperglucagonaemia during IVGTT was a constant feature in both groups, heterotopic grafts releasing the most glucagon during stimulation. C-peptide release was significantly lower in orthotopic grafts compared to normal animals or heterotopically drained insulin. It is concluded that glucose tolerance was not directly related to insulin or glucagon release in this study as orthotopic grafts rendered near-normal IVGTT curves in the presence of hypoinsulinaemia, hyperglucagonaemia, and reduced C-peptide values. The hormonal response after PDS transplantation was variable and the advantages of portal vs systemic insulin drainage remain to be defined.     

A REPRODUCIBLE MODEL OF CHRONIC REJECTION IN RAT RENAL ALLOGRAFTS

A reproducible animal model is essential for the study of the pathogenesis of chronic rejection. This study investigates: (i) the optimal pre-transplant blood transfusion conditions to induce tolerance in a strongly rejecting rat kidney allograft model (Dark Agouti to Albino-Surgery) and avoiding post-transplant immunosuppression; (ii) the functional and histological changes that occur in long-term surviving kidneys and their similarity to chronic rejection; and (iii) the maintenance of tolerance. Prolonged survival occurred after administration of at least two donor blood transfusions with concomitant cyclosporin A (5 mg/kg per day). The time-span between transfusions appeared to be critical: 4 days was more effective than 2 or 7 days. Ineffective treatment led to death within the first 2 weeks post-transplant with histological evidence of acute graft rejection. Seventy-five per cent of long-term survivors experienced impaired renal function in the first week which improved spontaneously and remained stable in 93% of the surviving animals after 100 days and in 668 after 200 days. The morphology of long-term allografts was extremely variable from minor to extensive tubular atrophy, interstitial fibrosis, glomerular hypertrophy, focal and segmental glomerulosclerosis and vascular changes. Glomerular hypertrophy occurred in uninephrectomized controls and probably denoted a response to uninephrectomy. Glomerulosclerosis increased with time and was absent in controls. Although chronic damage was evident, the rats remained tolerant to fresh donor skin. Replacement of the original kidney allograft with a fresh donor kidney resulted in 70% survival. These second grafts showed less severe renal dysfunction and morphological damage than the original allografts in the long-term follow up.