Prevention of venous thrombosis and thrombophlebitis in long-haul flights with pycnogenol.

The aim of this study was to evaluate the occurrence of deep venous thrombosis (DVT) and superficial vein thrombosis (SVT) and its prophylaxis with an oral anti-edema and antithrombotic agent (Pycnogenol, Horphag, Research Management SA, Geneva, Switzerland) in long-haul flights, in subjects at moderate to high-risk of DVT and SVT. The study pre-included 244 pre-selected subjects; 211 were included (33 were excluded for several reasons due to logistic problems) and 198 completed the study; 13 subjects were lost for follow-up at the end of the flight, all for non-medical problems (i.e., for difficult connections). All subjects were scanned within 90 minutes before the flight and within 2 hours after disembarking. Subjects were supplemented with 100 mg Pycnogenol per capsule. Treatment subjects received two capsules between 2 and 3 hours before flights with 250 mL of water; two capsules were taken 6 hours later with 250 mL of water and one capsule the next day. The control group received comparable placebo at the same intervals. The flight duration was on average 8 hours and 15 minutes (SD 55 min) (range, 7.45-12.33). In the control group there were five thrombotic events (one DVT and four superficial thromboses) while only nonthrombotic, localized phlebitis was observed in the Pycnogenol group (5.15% vs. no events; p<0.025). The ITT (intention to treat) analysis detects 13 failures in the control group (eight lost to follow up + five thrombotic events) of 105 subjects (12.4%) vs. five failures (4.7%; all lost, no thrombotic events) in the treatment group (p<0.025). No unwanted effects were observed. In conclusion, this study indicates that Pycnogenol treatment was effective in decreasing the number of thrombotic events (DVT and SVT) in moderate-to-high risk subjects, during long-haul flights.     

Comparison of LCx with other current viral load assays for detecting and quantifying human immunodeficiency virus type 1 RNA in patients infected with the circulating recombinant form A/G (CRF02)

LCx was compared to other assays in measuring human immunodeficiency virus type 1 (HIV-1) CRF02 viremia. LCx showed significant but low correlation with the other methods. Values of <2.60 log(10) cp/ml were observed in 29.6% of specimens with LCx and in only 14.8% with bDNA and PCR, suggesting suboptimal performance of LCx with CRF02.     

Changes in neurocognitive performance in a cohort of patients treated with HAART for 3 years

OBJECTIVES: To describe changes in HIV-associated neurocognitive impairment in patients treated with highly active antiretroviral therapy (HAART) for at least 3 years. METHODS: Prospective, observational study of comprehensive neuropsychologic (NP) testing, neurologic examination, and laboratory measures before HAART and after 6, 15 and 45 months of HAART, on 28 consecutive patients seen in our department since April 1996. RESULTS: At baseline, 16 patients were neurocognitively impaired and 12 were not. Among the 16 impaired patients, 5 patients failed to meet the criteria for impairment after 6 months and 9 patients after both 15 and 45 months of HAART, respectively. Statistically significant improvements ( p < or =.01) were seen in two of six measures exploring the concentration and speed of mental processing, two of three measures exploring mental flexibility, in one of five measures exploring memory, and in two of two measures exploring fine motor functions. Unimpaired study subjects performed better than impaired ones in 10 of 17 measures at baseline, in eight of 17 after 6 months, in six of 17 after 15 months, and in seven of 17 after 45 months of HAART. CONCLUSIONS: During the course of HAART, patients experienced a positive and sustained improvement in their neurocognitive performance. However, the presence of 7 of 16 (43.7%) patients with neurocognitive impairment, and the persistence of statistically significant differences in the neurocognitive performance between impaired and unimpaired patients after more than 3 years of HAART, suggests that ongoing HIV-related neurologic damage can occur even during potent antiretroviral treatment.     

Increasing proportion of late diagnosis of HIV infection among patients with AIDS in Italy following introduction of combination antiretroviral therapy

We analyzed trends over time and determinants of late diagnosis of HIV infection among people diagnosed with AIDS in 1986 to 1998 in a tertiary care center in Rome, Italy. Information on the date of a first HIV test was collected prospectively, in addition to data routinely collected for AIDS reporting. Patients with AIDS were defined as "late testers" if the time interval between first positive HIV test result and AIDS diagnosis was < or = 3 months. Overall, 503 people with AIDS of 1977 included in the analysis (25.4%) were late testers. the proportion of late testers decreased from 62.5% in 1986 to 16% in 1995. Thereafter, this proportion increased to 20.5% in 1996, 33.7% in 1997, and 36.6% in 1998. In multivariate analysis, the following variables were significantly associated with late testing: AIDS diagnosis in years 1986 to 1993 or 1997 to 1998 compared with 1995, male gender, age > or = 45 years, men who have sex with men, heterosexual contacts, or having unknown transmission mode compared with intravenous drug users, and being born outside Italy. Since 1996, the overall number of AIDS cases diagnosed at our center began to decrease whereas the number of late-testing AIDS patients did not decrease, resulting in an increasing proportion of late testers during the last 3 years of the study. This findings may reflect the effect of combination antiretroviral therapy in slowing progression to AIDS of HIV-infected persons aware of their status. A relevant number of people still discover their HIV infection late and may therefore miss treatment opportunities. New testing strategies are needed to reach more people who engage in high-risk behaviors, especially those at risk for sexual transmission, and those born outside Italy.     

Unicameral bone cysts —Comparison between surgical and steroid injection treatment

Summary Two series of 20 patients each with unicameral bone cysts were compared, one treated before 1975 by curettage and bone grafting and the other treated after 1975 with methylprednisolone acetate (MPA) injections. At follow-up, the majority of patients were at the end of skeletal growth. In the MPA-treated series, the average age of the patients at diagnosis was 9.1 years, whereas the average age at follow-up was 16.7 years. The average follow-up interval was 7 years. The steroid-treated series had better radiographic final results than the surgically treated series, with a lower recurrence rate. The number of MPA injections required to heal the lesion ranged from one to six, with 70% of the patients requiring a maximum of three injections. Steroid injection treatment should be preferred to surgical treatment for the better final results, for the virtual absence of complications, and for the greater simplicity of execution and postoperative care.

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Zusammenfassung Von zwei Gruppen von je 20 Patienten, die an prematuren Knochenzysten litten, wurde die eine vor 1975 durch Curettage und Auffüllung mit Knochenspänen behandelt, die andere Gruppe nach 1975 durch intea-zystische Infiltrationen mit Methylprednisolone (MPA) behandelt. Sie wurden lange nach Beendigung der Therapie miteinander verglichen. Das durchschnittliche Alter bei der Diagnose der mit MPA behandelten Patienten war 9,1 Jahre und bei der Kontrolle 16,5 Jahre. Die durchschnittlich verstrichene Zeitspanne vom Ende der Behandlung bis zur darauffolgenden Kontrolle betrug 7,3 Jahre. Die Patienten, die mit MPA behandelt wurden, erzielten bessere Endergebnisse, und es gab weniger Rückfälle bei ihnen als bei der Gruppe, die durch Knochenersatz behandelt wurden. Die Anzahl der durchgeführten Infiltrationen variierte zwischen eins und sechs, bei 70% der Patienten waren drei Infiltrationen ausreichend. Anhand der erzielten Ergebnisse stellen wir fest, daß die Behandlung mit MPA, der besseren Endergebnisse wegen, der chirurgischen Behandlung vozuziehen ist, weil außerdem kaum Komplikationen auftreten und weil die Behandlung selbst sowie die postoperative Therapie sich als einfacher erweist.

     

Anti-HIV I antibodies prevalence in parturients through newborn testing: Results of the Italian anonymous serosurvey

A prevalence assessment of HIV infection among parturients was performed in order to estimate the future incidence of pediatric AIDS cases and obtain data on the trend of the infection in Italy.Consecutive whole blood samples from newborns collected on filter paper from all regions of Italy (October-December 1990) for routine metabolic screenings, were anonymously examined for HIV-1 antibodies by an ELISA technique. Positive results were confirmed by Western blot.Among 97,658 blood samples tested, 121 (0.124%, 95% confidence interval Poisson distribution 0.103–0.148) were positive. A high prevalence of HIV infection (> 0.2%) was observed in four regions from North and Central Italy while, in some regions in the South, the seroprevalence was ten times lower. In the Lazio Region, namely in Rome, 5 inner-city hospitals with a particularly high prevalence of HIV infection were identified.Assuming that the prevalence of HIV infection observed in the population in this study may reflect the infection rate in the total population of childbearing women, we estimate that approximately 700 newborn babies were delivered from HIV-positive mothers in Italy during 1990. The identification of high prevalence areas could allow for the development of targeted testing programs to plan and provide adequate counselling and care of HIV-infected women and their infants.U. Angeloni (Roma), I. Antonozzi (Roma), R. Beghini (Verona), S. Carta (Roma), R. Ciannainea (Lecce), L. Chiovato (Tirrenia), V.D. Dainato (Foggia), G.C. Fiorucci (Torino), R. attei (Siena), A. Bracco (Napoli), A. Misserini (Taranto), E. Pasquini (Firenze), S. Piazzi (Bologna), L. Piceni-Sereni (Milano), A. Pignero (Napoli), C. Pintor (Cagliari), G. Pugliese (Potenza), C. Romano (Genova), V. Rossolini (Fano).     

Correction measured by attenuation in tomographic heart studies with single photon emission with thallium 201. Comparison with positron- emission tomographic studies with ammonium marked with nitrogen

PURPOSE: We investigated 201Tl myocardial uptake with(out) nonuniform attenuation compensation in ischemic myocardiopathy patients. The segmental patterns of the two types of SPECT images were compared with PET [13N]NH3 studies performed in the same patient. PET images were taken as reference and the diagnostic accuracy of SPECT with(out) attenuation correction was evaluated. MATERIAL AND METHODS: During the SPECT study transmission and emission data were simultaneously recorded by a triple head gamma camera equipped with fan beam collimators and a 99mTc transmission line source (740MBq). SPECT and PET images, the former reconstructed with(out) attenuation correction, were corecorded and reoriented along the short axis. The left ventricular wall was divided into 11 segments and segmental activity normalized to maximum in each study. RESULTS: Statistically significant differences were found between PET/(un)corrected SPECT ratios in posterior and septal segments. In these myocardial regions, attenuation correction compensates for attenuation artifacts, by correcting the underestimation of radioactivity concentration caused by radiation absorption. A statistically significant difference was also found in midventricular anterior and apical segments (p < .05). However, in these regions attenuation correction results in a decrease in corrected relative to uncorrected SPECT activity. The agreement rate with PET data is higher for corrected SPECT (mean differences were 3.12 +/- 11.51 and 2.19 +/- 8.63 for uncorrected versus corrected SPET). We had 50% positive and 77% negative predictive value without attenuation correction, versus up to 69% and 90%, respectively, with attenuation correction. CONCLUSIONS: The attenuation correction procedure with simultaneous transmission-emission effectively reduces attenuation artifacts in SPECT myocardial imaging. While diagnostic accuracy increases in posterior and septal myocardial regions, anterior and apical data need careful interpretation because a relative decrease in radioactivity concentration can be observed after attenuation correction.     

B cells mediate chronic allograft rejection independently of antibody production

Chronic rejection is the primary cause of long-term failure of transplanted organs and is often viewed as an antibody-dependent process. Chronic rejection, however, is also observed in mice and humans with no detectable circulating alloantibodies, suggesting that antibody-independent pathways may also contribute to pathogenesis of transplant rejection. Here, we have provided direct evidence that chronic rejection of vascularized heart allografts occurs in the complete absence of antibodies, but requires the presence of B cells. Mice that were deficient for antibodies but not B cells experienced the same chronic allograft vasculopathy (CAV), which is a pathognomonic feature of chronic rejection, as WT mice; however, mice that were deficient for both B cells and antibodies were protected from CAV. B cells contributed to CAV by supporting splenic lymphoid architecture, T cell cytokine production, and infiltration of T cells into graft vessels. In chimeric mice, in which B cells were present but could not present antigen, both T cell responses and CAV were markedly reduced. These findings establish that chronic rejection can occur in the complete absence of antibodies and that B cells contribute to this process by supporting T cell responses through antigen presentation and maintenance of lymphoid architecture.