PubMed · 10701554
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Y Kanpolat, Y S Cağlar. 2000. Third ventriculostomy.. https://doi.org/10.3171/jns.2000.92.3.0511
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BACKGROUND: Findings of a needlestick survey at our institution yielded an estimate that 1 case of occupationally acquired human immunodeficiency virus (HIV) among the approximately 1100 residents and third- and fourth-year medical students would potentially occur every 2 to 3 years, and also revealed types of exposures, circumstances, rates of reporting, and reasons for not reporting. OBJECTIVE: The present study is a 5-year follow-up study to investigate changes in these parameters. METHODS: A self-administered, anonymous 2-page questionnaire covering occupational exposures and other risk factors was distributed to medical students in classes, and to residents in grand rounds and required conferences. The response rate was 71%. RESULTS: The incidence of needlestick accidents dropped dramatically over 5 years (1994-1995 vs 1989-1990), especially for surgical residents. Because the proportion of known sources positive for HIV increased over the same period, estimates of occupational HIV risk remain essentially the same, with a projection that 1 student or resident would be expected to experience an occupationally acquired HIV infection approximately every 2 years. The nonoccupational risk for this population, in contrast, seems to be lower than in their age group as a whole. CONCLUSIONS: While the decrease in overall occupational exposures (especially for surgical residents) coupled with slight increases in rates of exposure documentation and use of universal precautions constitute positive findings, the increased proportion of exposure sources who are HIV positive leads to an unchanged estimate of occupational HIV risk for residents and students. Study findings therefore support the continued need for educational efforts aimed at prevention, along with timely dissemination of advances in approaches to postexposure prophylaxis.
OBJECTIVES: Elevation of serum prostate-specific antigen (PSA) after radical prostatectomy for prostate cancer is considered a surrogate marker of therapeutic failure. The most likely explanation for early PSA failure is considered to be due to local recurrent disease, provided the patient had a nondetectable PSA level after radical prostatectomy. Others have recently suggested that benign prostatic glands located on the surgical margins may often lead to detectable PSA levels. We examined the frequency of benign prostatic glands at the surgical margins of radical prostatectomy specimens and the factors associated with this finding. METHODS: One hundred nineteen consecutive radical prostatectomies were performed by two experienced oncologic surgeons. Whole-mount sectioning of the prostatectomy specimens was performed at 3-mm intervals. Bivariate and multivariate analyses were used to determine which clinical and pathologic factors were associated with benign glands on inked surgical margins. RESULTS: Of the 119 cases, 13 (11%) had benign glands on the inked surgical margins. Four of these 13 had tumor on the inked margins. The remaining 9 cases (8%) were organ confined (pT2), with negative surgical margins. Benign glands were most often seen to involve the apex focally (7 of 9 cases). On bivariate and multivariate analyses, a high Gleason score and prostate gland volume were significantly associated with finding benign glands on the surgical margins. Only 2 of 86 patients with follow-up had PSA recurrence at 59 and 67 days and neither had benign glands on the inked surgical margins. CONCLUSIONS: The presence of benign prostatic glands identified on inked surgical margins was an infrequent occurrence in this consecutive series of 119 whole-mount prostatectomy specimens. When benign glands were identified, they most often consisted of 1 to 3 glands at the apex margin. These findings suggest that benign glands on surgical margins are an unusual cause of postoperative detectable PSA.
OBJECTIVE: To determine the sensitivity of 33 currently available and seven earlier tests for the detection of HIV or HIV antibody in primary HIV-1 infection, to estimate the duration of the 'window period' and the influence of early initiated antiretroviral treatment (ART). DESIGN: A prospective cohort study of 38 patients with primary HIV-1 infection. ART was initiated at a median time of 13 (range 0-23) days after the onset of symptoms in 10 patients. MAIN OUTCOME MEASURES: The time from infection to onset of symptoms and from onset of symptoms to the appearance of HIV antibody as measured by 36 different tests, and the start and duration of viraemia, as detected by four different tests. RESULTS: The illness appeared 13-15 days after infection in 12 of 15 determinable cases, and seroconversion was detected within 1-2 weeks after the onset of illness by 27 of 30 currently available tests for HIV antibody, in contrast to the 2-7 weeks or more needed by the old tests. HIV RNA appeared during the week preceding the onset of illness and was detected in all subsequent samples, except when ART had been initiated, which also induced a delay of the antibody response. CONCLUSION: Many tests for HIV or HIV antibody can now be employed for an early confirmation of primary HIV infection (PHI). Currently available screening tests proved much more sensitive than older tests, and seroconversion was usually detected within one month after infection. Consequently, in Sweden we now recommend only 3 months of follow-up after most cases of HIV exposure.