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Biomedical subjects

A Wald

Publications and source records attributed to A Wald.

At least 55 records · Page 3Linked to original sources
PubMed1999

Association of major histocompatibility complex determinants with the development of symptomatic and asymptomatic genital herpes simplex virus type 2 infections.

The clinical spectrum of herpes simplex virus (HSV) infections, ranging from asymptomatic to frequently distressing outbreaks, suggests that there may be immunologic determinants of disease severity that are associated with human leukocyte antigen (HLA) expression. A controlled, prospective study identified several major histocompatibility complex (MHC) class I and II antigens whose frequencies are associated with HSV-2 infection or with frequent symptomatic genital recurrences. Previous studies were hampered by the inability to serologically identify patients with asymptomatic HSV-2 infection. Clinical evaluation and Western blot assay were used to identify 3 subject cohorts: 1 with no prior HSV infections, 1 with HSV-2 antibodies but no recognized symptoms, and 1 with HSV-2 antibodies and frequent genital recurrences. Statistical comparisons of HLA frequencies among these cohorts showed associations of HLA-B27 and -Cw2 with symptomatic disease. Also, HLA-Cw4 was significantly associated with HSV-2 infection. These associations indicate that immunologic factors linked to the MHC influence the risk of HSV-2 infection and disease expression.

Adult↗
PubMed1999

New therapies and prevention strategies for genital herpes.

Genital herpes is among the most prevalent sexually transmitted diseases. Optimal management of genital herpes includes accurate diagnosis, antiviral therapy, and counseling of patients about complications and transmission of herpes simplex virus (HSV). Antiviral therapy offers significant palliation, and the option of episodic or suppressive treatment should be offered to all patients with genital herpes. Valacyclovir and famciclovir are two newer antiviral agents that are effective and safe for the treatment of genital herpes. Prevention strategies for sexual and perinatal transmission of HSV have not been well defined. Availability of type-specific serological tests for HSV antibodies may assist in identifying persons at risk for acquiring or transmitting HSV infection. Further research is needed to define strategies to prevent the spread of this epidemic infection.

AIDS-Related Opportunistic Infections↗
PubMed1999

Nocturnal oxygenation during patient-controlled analgesia.

UNLABELLED: Patient-controlled analgesia (PCA) has become a standard modality for the management of postoperative pain, although anecdotal reports of excessive sedation and respiratory depression impugn its safety. To study the prevalence and severity of nocturnal hypoxemia, we measured arterial oxygen saturation (SpO2) continuously overnight in 32 postoperative patients who were receiving morphine via PCA. To evaluate the potential benefit of providing concurrent supplemental oxygen, the patients breathed oxygen-enriched air the night of surgery and room air the next night. Patients experienced more pain and consumed twice as much morphine the first night. However, breathing supplemental oxygen that night, the nocturnal mean SpO2 was 99%+/-1%, 94%+/-4% (P<0.001), and only four patients had periods of hemoglobin desaturation <90%. In contrast, breathing room air the subsequent night, the mean SpO2 was lower (94%+/-4%; P<0.001), and hypoxemia occurred more frequently and was more severe: 18 patients experienced episodes of SpO2 <90%, 7 patients experienced episodes of SpO2 <80%, and 3 patients experienced episodes of SpO2 <70%. One patient required resuscitation for profound bradypnea and cyanosis, but none suffered permanent sequelae. We conclude that when postoperative patients use PCA at night, hypoxemia can be substantial and oxygenation can be improved by providing supplemental oxygen. IMPLICATIONS: Oxygen saturation was measured postoperatively in patients using morphine patient-controlled analgesia. Substantial nocturnal hypoxemia occurred in half of the patients while they breathed room air. The severity of the hypoxemia was reduced when patients received supplemental oxygen.

Aged↗
PubMed1999

Detection of herpes simplex virus DNA in semen of men with genital HSV-2 infection.

BACKGROUND AND OBJECTIVES: Previous studies, using viral culture, have suggested that herpes simplex virus (HSV) isolation from semen is rare. This study attempts to investigate further the role of semen in sexual transmission of HSV. GOALS OF THIS STUDY: To evaluate semen samples for HSV DNA with a sensitive polymerase chain reaction (PCR) test. STUDY DESIGN: Laboratory examination of 255 stored semen samples collected from 15 healthy men with genital HSV-2 infection during a prospective clinical trial. RESULTS: Herpes simplex virus DNA was detected in 8 (3.1%) semen samples, 6 of which were collected during a herpes recurrence. Herpes simplex virus DNA was not detected in any of the 18 samples collected during acyclovir therapy. CONCLUSION: Herpes simplex DNA can be detected in semen, although it appears closely associated with clinical HSV reactivation. More detailed studies will be needed to assess the role HSV-2 in semen plays in transmission of infection.

Acyclovir↗
PubMed1999

An interactive, computer-based program to educate patients about genital herpes.

BACKGROUND AND OBJECTIVES: Education and counseling constitute a substantial portion of management of patients with genital herpes. Innovative methods for education about genital herpes are needed. GOAL: To test the ability of an interactive, computer-based program to educate patients about genital herpes. STUDY DESIGN: Persons seeking care at five urban offices were asked to participate. A knowledge test about genital herpes was administered before and after participation. Participants' satisfaction was assessed with a questionnaire. RESULTS: Four hundred thirty-five participants enrolled, and 428 completed the herpes knowledge test. Of six questions evaluated, a statistically significant increase in the proportion of correct answers was noted on five of six questions. Fifty-one percent of participants answered all the questions correctly after the program, compared with 39% before the program. Satisfaction with the program was very high. CONCLUSIONS: Innovative, computer-based programs can provide education and assist in the management of chronic sexually transmitted infections.

Adolescent↗
PubMed1999

Genital herpes: review of the epidemic and potential use of type-specific serology.

Prevention of genital herpes simplex virus (HSV) infections is desirable from both a public health standpoint and the patient's perspective. A key factor in the spread of genital herpes infections is the high proportion of undiagnosed infections. Persons with subclinical or unrecognized infections are best diagnosed by accurate, type-specific antibody tests. Unfortunately, these tests are only now becoming widely available. The use of current, conventional (non-type-specific) serologic tests for diagnosis of herpes infections has resulted in confusion and misdiagnosis of patients. This review provides recent information on the epidemiology of genital herpes infections, describes the importance of subclinical herpes infection and shedding, summarizes the status of HSV type-specific serologic assays being developed, and provides indications for using such assays.

Animals↗
PubMed1999

Development of a high-throughput quantitative assay for detecting herpes simplex virus DNA in clinical samples.

We have developed a high-throughput, semiautomated, quantitative fluorescence-based PCR assay to detect and type herpes simplex virus (HSV) DNA in clinical samples. The detection assay, which uses primers to the type-common region of HSV glycoprotein B (gB), was linear from <10 to 10(8) copies of HSV DNA/20 microl of sample. Among duplicate samples in reproducibility runs, the assay showed less than 5% variability. We compared the fluorescence-based PCR assay with culture and gel-based liquid hybridization system with 335 genital tract specimens from HSV type 2 (HSV-2)-seropositive persons attending a research clinic and 380 consecutive cerebrospinal fluid (CSF) samples submitted to a diagnostic virology laboratory. Among the 162 culture-positive genital tract specimens, TaqMan PCR was positive for 157 (97%) specimens, whereas the quantitative-competitive PCR was positive for 144 (89%) specimens. Comparisons of the mean titer of HSV DNA detected by the two assays revealed that the mean titer detected by the gel-based system was slightly higher (median, 1 log). These differences in titers were in part related to the fivefold difference in the amount of HSV DNA used in the amplicon standards with the two assays. Among the 380 CSF samples, 42 were positive by both assays, 13 were positive only by the assay with the agarose gel, and 3 were positive only by the assay with the fluorescent probe. To define the subtype of HSV DNA detected in the screening assay, we also designed one set of primers which amplifies the gG regions of both types of HSV and probes which are specific to either HSV-1 (gG1) or HSV-2 (gG2). These probes were labeled with different fluorescent dyes (6-carboxyfluorescein for gG2 and 6-hexachlorofluorescein for gG1) to enable detection in a single PCR. In mixing experiments the probes discriminated the correct subtype in mixtures with up to a 7-log-higher concentration of the opposite subtype. The PCR typing results showed 100% concordance with the results obtained by assays with monoclonal antibodies against HSV-1 or HSV-2. Thus, while the real-time PCR is slightly less sensitive than the gel-based liquid hybridization system, the high throughput, the lack of contamination during processing, the better reproducibility, and the better ability to type the isolates rapidly make the real-time PCR a valuable tool for clinical investigation and diagnosis of HSV infection.

DNA, Viral↗
PubMed1999

Functional disorders of the anus and rectum.

In this report the functional anorectal disorders, the etiology of which is currently unknown or related to the abnormal functioning of normally innervated and structurally intact muscles, are discussed. These disorders include functional fecal incontinence, functional anorectal pain, including levator ani syndrome and proctalgia fugax, and pelvic floor dyssynergia. The epidemiology of each disorder is defined and discussed, their pathophysiology is summarized and diagnostic approaches and treatment are suggested. Some suggestions for the direction of future research on these disorders are also given.

Anus Diseases↗
PubMed1998

Can a multimedia educational computer-based program on genital herpes teach patients about their disease?

Objective: Education of patients with genital herpes about their disease is time consuming. To evaluate the effectiveness of an educational computer program, we developed a multimedia interactive presentation to teach patients about genital herpes. Such programs can supplement clinician visits for patients with genital herpes, or those at risk for HSV acquisition.Methods: Patients seeking care for genital herpes, or those at risk for HSV acquisition, were asked to participate in the program during routine clinic visits at 5 physician's offices nationwide. A self-administered 7 item herpes knowledge questionnaire was given before and after participation. An additional questionnaire evaluating the satisfaction with the program was also self-administered at completion.Results: 428 patients were enrolled and completed the pre- and post-knowledge questionnaire and 332 patients completed the satisfaction survey. On the pre-test, 20.1% of patients answered all questions correctly, 65.4% answered correctly 4 to 6 questions, and 14.5% 3 or less. On the post-test, 32.9% of patients answered all questions correctly, 61.5% answered correctly 4 to 6 questions, and 5.6% 3 or less (P <.001 for pre- and post-test comparison). A positive change in knowledge between pre- and post-test was seen on 6 of 7 items (P <.001 for all 6). The overall satisfaction with the program was high: the mean rating was 6.2 on a scale 1 (poor) to 7 (excellent).Conclusion: Computer-based education programs about genital herpes may provide a useful adjunct to teaching in physician offices and result in knowledge gain about the disease, at least short-term. Such programs may assist in management of chronic sexually transmitted infections.

Journal Article↗
PubMed1998

Herpes. Transmission and viral shedding.

Herpes simplex virus infections are transmitted through contact with infected oral or genital secretions. The virus can be present on mucosa during a symptomatic recurrence or asymptomatically. Most transmissions to neonates and sexual partners occur during asymptomatic viral shedding. The frequency of viral isolation in the absence of lesions ranges from 2% to 6% of days; however, studies using more sensitive tests, such as polymerase chain reaction, show that viral shedding can occur on the average 28% of days.

Female↗
PubMed1998

Herpes simplex virus-2 infection. An emerging disease?

Genital herpes infections continue to increase in the world. As outlined previously, several factors play a role in the continued transmission of genital herpes worldwide. Reducing the medical consequences of HSV-2 infection will not be easy. It is also sobering to realize that widespread penetration of HSV-2 into the population had preceded the spread of sexually acquired HIV in most countries. The biological rationale for a connection between HIV and HSV continues to be strengthened. Currently, a specific program to decrease the transmission of genital herpes does not exist. Recent studies with antiviral agents indicate the potential of these compounds to reduce shedding in HIV-negative and in HIV-positive persons and potentially may be useful in preventing some aspects of HSV transmission. Advances in laboratory techniques to assist in the diagnosis of genital herpes infections have added to our knowledge of the natural history and epidemiology of infection. Because of imperfect laboratory tests, negative results do not always indicate lack of infection; this has important public health implications. Large numbers of unrecognized symptomatic cases and frequent asymptomatic shedding are the likely source of continued genital HSV-2 transmission. Solutions for reducing the transmission of genital herpes range from simple, such as counseling patients regarding symptoms and signs of genital herpes and the frequency of subclinical shedding, to complex and expensive, such as screening high risk populations (e.g., STD clinic attendees) for HSV-2 infection. Chronic antiviral therapy may be indicated in HSV-2 seropositive persons without monogamous relationships as they are at risk to transmit HSV to multiple persons. The authors' aim in this review is to provoke discussion of such a control program and to raise the consciousness of the feasibility of instituting control measures for selected populations. We hope to elicit pilot programs designed to reduce the morbidity of this old but re-emerging infectious disease.

AIDS-Related Opportunistic Infections↗
PubMed1998

Aortoesophageal fistula: case report and review of the literature.

Aortoesophageal fistula is a rare but fatal cause of upper gastrointestinal bleeding. The classic clinical triad consists of midthoracic pain or dysphagia, a sentinel episode of hematemesis, followed by fatal exsanguination. In a patient with hemodynamically significant upper gastrointestinal bleeding of unknown etiology, who has evidence of a tortuous aorta or aneurysm by chest x-ray or who exhibits Chiari's triad, the presence of AEF should be entertained. A prompt and definitive diagnosis at the time of the initial hemorrhage is necessary for a successful surgical outcome. Cautious endoscopy to exclude other causes of bleeding followed by either thoracic CT scan or thoracic aortography are indicated based on circumstances. We report a case of a 76-year-old man who presented with two discrete episodes of hemodynamically significant upper gastrointestinal bleeding. Although there was no radiological evidence of an aneurysm on chest x-ray and no endoscopic evidence of an aortoesophageal fistula, a saccular descending thoracic aorta aneurysm was found by thoracic aortogram. The patient underwent immediate surgical repair of the aorta by graft and esophagectomy, followed by a staged gastric pull-up. Left thoracotomy with fistula repair is the only definitive treatment for AEF. Use of a Sengstaken-Blakemore tube or embolization of the fistula prior to surgery should be considered only if the patient is exsanguinating. Although surgical repairs have high morbidity and mortality, surgery should be undertaken, as untreated cases of AEF are uniformly fatal.

Aged↗
PubMed1998

Evidence of latency and reactivation of both herpes simplex virus (HSV)-1 and HSV-2 in the genital region.

While superinfection with different herpes simplex virus (HSV) types has been demonstrated in animals, the ability of the two HSV types to colonize and reactivate in the same anatomic region in humans has not been well demonstrated. In 6 patients, both HSV-1 and HSV-2 was recovered from genital lesions. In 4 of them, who initially acquired genital HSV-1 infection, subsequent HSV-2 infection presented as a prolonged episode of genital lesions and a marked increase in the frequency of genital recurrences. While most of the subsequent clinical reactivations were HSV-2, in 2 patients the recurrence rate of genital HSV-1 increased after the acquisition of HSV-2. These data demonstrate the ability of a second HSV type to infect the same anatomic region and illustrate the difference in reactivation frequency of the two types in the same person. Typing of HSV isolates may be useful in persons with recent alteration in recurrence rates of genital HSV.

Adult↗
PubMed1998

Herpes simplex virus shedding among human immunodeficiency virus-negative men who have sex with men: site and frequency of shedding.

The frequency and anatomic location of subclinical and symptomatic herpes simplex virus (HSV) shedding were evaluated among human immunodeficiency virus (HIV)-negative HSV-2-seropositive men who have sex with men (MSM). Eight men attended a research clinic daily for 30 days for a detailed genital examination and anoscopy with colposcopy to detect herpes lesions. HSV cultures were obtained daily from four sites (perianal, urethral, penile shaft, and oral) at home and the research clinic. Signs and symptoms of genital herpes were recorded by the participants and clinician. Three (37.5%) of the men shed HSV. Overall, the 8 men shed HSV on 5.5% of days cultures were obtained and shed subclinically on 2.7% of days. All HSV shedding was perianal or rectal; only 1 symptomatic recurrence, concurrent with an external perianal lesion, was detected by anoscopy. Subclinical HSV shedding was frequent among HIV-negative MSM, and anoscopy with colposcopy did not increase the detection rate of rectal HSV lesions or shedding.

Adult↗
PubMed1998

Anorectal manometric characteristics in men and women with idiopathic fecal incontinence.

To characterize and compare the anorectal manometric findings of men and women with idiopathic fecal incontinence referred to a tertiary care center for pelvic floor disorders, we reviewed 86 consecutive patients who underwent anorectal manometry during a 13-month period. We determined the etiologies of all patients and analyzed men and women with no obvious cause (idiopathic). The manometric parameters included resting and squeeze anal canal pressures, duration of squeeze pressures, threshold of external anal sphincter contraction, threshold of rectal sensation, and rectal compliance. Thirty-one of 86 patients were classified as having idiopathic fecal incontinence. The mean age of the 7 male patients with idiopathic fecal incontinence was 65 years, (range, 45-78 years) and 63 years (range, 38-83 years) in the 24 women. Compared with male patients, female patients had lower sphincteric pressures and shorter squeeze durations. Both men and women frequently exhibited poor phasic response of the external anal sphincter to rectal distention. We conclude that, compared with men, women with idiopathic fecal incontinence more often exhibit abnormalities of anal sphincteric motor function. The sex-related differences in muscle mass and past traumatic events related to childbirth may partly account for these findings.

Adult↗
PubMed1998

Interobserver agreement in defecography--an international study.

BACKGROUND: Defecography is considered to be an essential investigation in the evaluation of functional anorectal disorders, but the agreement between observers from different clinical centers has never been evaluated. METHODS: 14 defecographic studies were selected aimed to cover the most relevant defecographic findings responsible for disordered defecation. Eight studies were considered unequivocal, but six were thought to be controversial. All were sent to the ten participants in Europe and the US (five proctosurgeons, three radiologists, two gastroenterologists). They evaluated the studies using a previously agreed upon questionnaire. Interobserver agreement was quantified by kappa statistics and by the proportions of positive and negative agreement as compared to chance agreement, respectively. RESULTS: Overall, only the completeness of rectal emptying and the presence of a rectocele achieved acceptable kappa values above 0.4. When restricting the evaluation to the studies considered to be unequivocal, agreement improved considerably and was moderate to good for all items describing the images (kappa 0.43-0.63). However, whether proctosurgery should be performed and whether defecography contributed to the management of the particular patient remained controversial with very low kappa. CONCLUSIONS: It is doubtful whether defecography contributes substantially to the management of patients with disordered defecation.

Anus Diseases↗