AIDS vaccine development.
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Biomedical subjects
Publications and source records attributed to C Benson.
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To determine the short-term effectiveness and outcome of office-based laser-assisted uvulopalatoplasty, a prospective statistically controlled study was done at the Department of Otolaryngology, Cleveland Clinic Florida. Thirty-eight consecutive snoring patients underwent a total of 98 laser-assisted uvulopalatoplasties, and data were gathered through examination, interview, and analog scales of snoring, pain, and other morbidity. In addition, a failure analysis was performed. Data were analyzed by descriptive statistics, confidence intervals, and adjusted analysis of variance (p < 0.008). Our results suggest that snoring decreased significantly around each laser-assisted uvulopalatoplasty treatment performed (4 to 8 weeks apart). Postoperative pain diminished after the first two laser-assisted uvulopalatoplasty treatments. The only morbidity in the series was the result of significant pain, causing 77% of laser-assisted uvulopalatoplasty failures.
OBJECTIVE AND DESIGN: To determine whether the female genital tract contains factors that affect HIV-1 replication. Cervicovaginal lavage (CVL) samples were collected from HIV-1-seropositive and seronegative women and added to cell cultures. METHODS: HIV p24 production was used to measure the effects of CVL on replication of HIVMN in a T-cell line, of a primary isolate in peripheral blood mononuclear cells, or on HIV expression by the latently-infected monocytic U1 cell line. The effects of CVL on the HIV long terminal repeat (LTR) were determined in 1G5 T cells by measuring luciferase activity. RESULTS: Increased replication of HIVMN and a primary isolate were observed in T cells cultured with CVL samples from three out of 38 HIV-infected women, one out of four uninfected high-risk women, and none of 12 low-risk women. The CVL factor increased replication by enhancing virus expression via activation of the HIV LTR. The HIV-inducing activity was highly stable to heat but was sensitive to proteases, indicating that the activity was distinct from heat-labile cytokines including tumour necrosis factor-alpha. CONCLUSIONS: This is the first study to show that a factor which can stimulate HIV-1 replication is present at biologically active levels in the reproductive tract of women. This factor could potentially affect sexual or vertical transmission of HIV-1 by altering genital tract virus load or virus expression.
Human immunodeficiency virus (HIV)-infected patients are at increased risk for serious and recurrent bacterial infections. We hypothesized that the degree of immunosuppression may play an important role in outcomes for HIV-seropositive patients with infective endocarditis (IE). To test our hypothesis, we retrospectively reviewed 144 cases of IE in injection drug users. One hundred two patients with documented HIV status (45 HIV-seropositive patients and 57 HIV-seronegative patients) were included in the analysis. Eleven patients (6 HIV-seropositive patients and 5 HIV-seronegative patients) died in the hospital. Staphylococcus aureus, the most common etiologic pathogen causing IE in our series, was isolated from 32 HIV-seropositive patients (71.1%) and 32 HIV-seronegative patients (56.1%). A clear inverse correlation between mortality rate and CD4 cell count was demonstrated (r = -.625; P < .001). Both univariate and multivariate analyses supported the finding of significantly higher mortality rates among patients with CD4 cell counts of < 200/mm3 than among patients with CD4 cell counts of > 500/mm3 (OR, 14.7; 95% CI, 2.64-81.9).
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Neurological illness often impairs a patient's mental status, sensory /perceptual and motor functions, creating significant disability. These deficits have been identified as factors that increase the fall risk in these patients. A review of the literature reveals three common manifestations of neurologic disease are related to inpatient falls. These antecedents are altered mental status, sensory/perceptual alteration and impaired physical mobility. These antecedents are found to influence a patient's risk to fall to some extent; however, further research is recommended to further quantify the risk.
Disseminated Mycobacterium avium complex (MAC) infection is a common complication of advanced HIV disease that is associated with significant morbidity. After diagnosis of MAC by recovery of organisms from blood or other normally sterile sites, specific treatment with multiple-drug regimens is appropriate and may reduce morbidity. Multiple-drug regimens with agents active against MAC should be employed to reduce the development of drug resistance. Unfortunately, as most clinical trials of anti-MAC agents have lasted 12 weeks or less and have not compared specific agents, the most effective multiple-drug regimen has not been established. The U.S. Public Health Service Task Force on Prophylaxis and Therapy of MAC recommends treatment of disseminated disease with at least two antimycobacterial agents, one of which should be clarithromycin or possibly azithromycin. Ethambutol, which may have an additive or synergistic effect in combination with other anti-MAC agents, is a reasonable second drug. Other agents with activity include rifampin or rifabutin, clofazimine, ciprofloxacin, or parenteral amikacin. A microbiological response may require up to 2 to 8 weeks. The clinical response generally parallels the microbiological response. Rifabutin, which is licensed for prophylaxis of MAC, reduces the incidence of and delays the time to MAC bacteremia. Individuals at highest risk of MAC bacteremia (i.e., CD4+ cell counts of < 75-100 cells/microliters) had the most benefit from rifabutin prophylaxis. Tuberculosis must be ruled out before rifabutin prophylaxis is initiated. Careful observation without prophylaxis is an acceptable alternative for those who are not able to take rifabutin or alternative agents.
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Persons with AIDS who have CD4+ counts < or = 100 and transplant patients, especially bone marrow allograft recipients, may experience clinically significant infections with acyclovir-resistant herpes simplex virus (HSV) or varicella-zoster virus (VZV). Patients who have received prior repeated acyclovir treatment appear to be at the highest risk of harboring acyclovir-resistant strains. Algorithms for the management of these infections were developed at a recent roundtable symposium. The consensus of the panelists was that treatment with foscarnet should be initiated within 7-10 days in patients suspected to have acyclovir-resistant HSV or VZV infections. Foscarnet therapy should be continued for at least 10 days or until lesions are completely healed.
BACKGROUND: Neovaginal reconstruction after pelvic exenteration has several advantages. Besides the obvious psychosocial benefit to the patient and her partner, the incorporation of viable tissue into the pelvic cavity decreases the incidence of infection and small-bowel complications. Several surgical techniques are available to the gynecologic oncologist for construction of a functional vagina. Recently, myocutaneous flaps incorporating the rectus abdominis and gracilis muscles have been used. Disadvantages of the gracilis myocutaneous flap are the 10-20% incidence of flap loss due to vascular compromise and the potential for prolapse. The rectus abdominis myocutaneous flap is a large flap with a reliable blood supply that allows mobilization without tension on the vascular pedicle, resulting in a much lower incidence of vascular compromise. CASE: We present two case reports, a review of the gynecologic and surgical literature, and the techniques for vaginal reconstruction using the rectus muscle as a myocutaneous flap. CONCLUSIONS: The outcome for both patients was a satisfactory functional vagina that was technically easy to construct. The rectus abdominis myocutaneous flap can provide an adequate neovagina with minimal morbidity.
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The Southwest Oncology Group (SWOG) is a multicentre co-operative group that performs prospective clinical trials in cancer. The SWOG Statistical Center is responsible for preparing a report of studies for the semiannual meetings. The report includes a summary of study design and eligibility criteria, current accrual, baseline patient characteristics, toxicity, and, for studies closed to accrual and with sufficiently mature outcome data, tumour response or patient survival. A software program, Statisticians' Report Worksheet (SRW), has been developed by the programming staff at the SWOG Statistical Center. This program enables each disease specific chapter to be created independently, but ensures that tables and graphs for all chapters are of uniform style. We describe here the coordination of the report, and the use of the SRW program. This reporting system can serve as a model for other groups.
Based on previous studies it was predicted that amino acids 4 or 25 of the DR4 beta 1 and DR7 beta 1 chains are involved in polymorphic antibody binding epitopes on DR4 or DR7 molecules. These predictions were tested by analyzing monoclonal antibody (mAb) binding to transfectants expressing mutant DR4 beta 1 or DR7 beta 1 chains with single amino acid substitutions at positions 4 or 25. Antibody binding to transfectants expressing additional DR4/7 beta 1 hybrids was also analyzed to assess further the contributions of four segments of the DR4 beta 1 or DR7 beta 1 chains: amino acids 1-20, 21-40, 41-97, and the beta 2 domain. Single amino acid substitutions at positions 4 and 25 of the DR4 beta 1 chain or DR7 beta 1 chain eliminate binding of several mAb to DR4 or DR7 molecules, documenting that these residues are involved in antibody epitopes. However, the data with the hybrid DR4/7 beta 1 chains indicate that some of these epitopes require contributions from both segments 1-20 and 21-40 of these DR beta chains, whereas other epitopes can be generated by placing the appropriate segment in the context of the other DR beta chain. In addition, the data with other mAb indicate that their epitopes are determined primarily by sequences within the 41-97 segment or in the beta 2 domain.
In an attempt to define the hemodynamic and radiographic parameters of normal erectile function 6 patients 20 to 41 years old (mean age 30.3 years) with erectile dysfunction that spontaneously resolved after a comprehensive evaluation were reviewed. The results included normal hormonal assays, normal penile biothesiometry and normal penile brachial index. The sleep tumescence and rigidity tracings were abnormal according to the criteria that sleep erections occur every 90 minutes, are associated with penile rigidity of greater than 550 gm. plus an increase in penile circumference of greater than 1.5 cm. and last longer than 15 minutes. High resolution ultrasonography, pulse wave Doppler ultrasound, dynamic pharmacocavernosometry and dynamic cavernosography were performed. After testing the patients were informed that no organic abnormalities had been detected. No medical or surgical treatment was given. The hemodynamic values are presented as suggested normal parameters: maintenance rate (mean 11 +/- 3 cc per minute), initial decompression rate (mean 59 +/- 17 mm. Hg/30 seconds) and radiographic findings (visualization of the cavernous, external pudendal and deep dorsal veins during pharmacocavernosography, performed at intracorporeal pressures of 100 mm. Hg). All 6 patients had maintenance rates of greater than 5 cc per minute. Of these 6 patients 5 had initial decompression rates of greater than 48 mm. Hg/30 seconds and 4 had 5-minute, post-infusion steady state values of less than 50 mm. Hg, criteria that have been used to define corporovenous dysfunction.
The records of children enrolled in the National Wilms' Tumor Study-3 who had Wilms' tumor and thrombosis into the renal vein were reviewed. There were 164 patients with gross involvement of the extrarenal vein and 47 patients with microscopic involvement, an incidence of 11.3% (211 of 1,865 evaluable patients). Two-year survival rates were 90, 79 and 72% for stages II, III and IV, respectively. The most important predictors of survival were histologic pattern and stage. Complete en bloc excision of the tumor and thrombus continues to be the most effective initial management.
A Thoroughbred stallion suspected of having venereal disease was found to have an infection of the accessory sex glands. Purulent debris, blood, and Pseudomonas aeruginosa were recovered from all ejaculates. Treatment with gentamicin sulfate, tobramycin, and amikacin sulfate was unsuccessful in eliminating the infection. The stallion's seminal plasma, collected during treatment with gentamicin sulfate, did not contain any appreciable antibacterial activity. Apparently, negligible amounts of gentamicin diffused across the mucosal cell borders of the accessory sex glands into the seminal plasma. Bilateral seminal vesiculitis and ampullitis were evident on examination of the reproductive tract when the stallion was euthanatized.
A highly sensitive biochemical microassay has been developed for adenosine deaminase (ADA; EC 3.5.4.4), the enzyme deficient in approximately 20% of cases of severe combined immuno-deficiency disease (SCID). The microassay is capable of detecting femtomolar amounts of reaction product in a single blastomere from a mouse 8-cell embryo and thus is sensitive enough to be considered for the possible preimplantation diagnosis of SCID in human embryos.
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