Streptococcal toxic shock syndrome after breast reconstruction.

Streptococcal toxic shock syndrome (STSS) is an increasingly common disease entity but has rarely been described in the plastic surgery literature. We present the first known case of STSS associated with a reconstructive procedure. Two weeks postoperatively from a transverse rectus abdominis musculocutaneous flap for breast reconstruction, our patient presented with flulike symptoms and progressed rapidly to multiorgan failure.

The effect of baseline CD4 cell count and HIV-1 viral load on the efficacy and safety of nevirapine or efavirenz-based first-line HAART.

Background: A substantial number of patients start their first-line antiretroviral therapy at an advanced stage of an HIV-1 infection. Potential differences between specific drug regimens in antiviral efficacy and safety in these patients are of major importance.

Methods: A post-hoc analysis within the randomized controlled 2NN trial comparing efficacy between regimes containing nevirapine (NVP), efavirenz (EFV), or both, in addition to stavudine and lamivudine.

Pharmacokinetics of Telzir (fosamprenavir).

Fosamprenavir is a recently licensed protease inhibitor (PI) for the treatment of patients with HIV. It has potent antiviral activity when boosted by ritonavir and produces durable virological suppression when combined with other antiretroviral drugs. In addition, it is well tolerated with a good safety profile, and can be taken once or twice daily with no food restrictions.

Lipodystrophy in patients with HIV-1 infection: effect of stopping protease inhibitors on TNF-alpha and TNF-receptor levels, and on metabolic parameters.

Objective: To evaluate the effects of stopping treatment with protease inhibitors (PIs) on tumour necrosis factor (TNF)-alpha and TNF-receptor levels, and on the metabolic and morphological abnormalities seen in patients with lipodystrophy.

Design: Longitudinal study.

Methods: Ten HIV-positive patients with lipodystrophy (LD) were studied whilst on PIs (LD1) and 3 months after stopping PIs (LD2) together with 10 HIV-positive subjects on PIs without LD (controls).

The impact of Pfannenstiel scars on TRAM flap complications.

For the past two decades, the transverse rectus abdominis musculocutaneous (TRAM) flap has been a mainstay of postmastectomy breast reconstruction. Because the flap depends on musculocutaneous perforating vessels from the rectus muscle for survival, some authors have raised concerns about increased risks of TRAM flap loss in patients with scars from previous abdominal surgeries, particularly those with Pfannenstiel scars. To assess the effects of Pfannenstiel scars on complication rates, we retrospectively evaluated the inpatient and outpatient records of 241 patients undergoing TRAM reconstruction in a single institution over an 11-year period.

Dosage analysis of cancer predisposition genes by multiplex ligation-dependent probe amplification.

Multiplex ligation-dependent probe amplification (MLPA) is a recently described method for detecting gross deletions or duplications of DNA sequences, aberrations which are commonly overlooked by standard diagnostic analysis. To determine the incidence of copy number variants in cancer predisposition genes from families in the Wessex region, we have analysed the hMLH1 and hMSH2 genes in patients with hereditary nonpolyposis colorectal cancer (HNPCC), BRCA1 and BRCA2 in families with hereditary breast/ovarian cancer (BRCA) and APC in patients with familial adenomatous polyposis coli (FAP). Hereditary nonpolyposis colorectal cancer (n=162) and FAP (n=74) probands were fully screened for small mutations, and cases for which no causative abnormality were found (HNPCC, n=122; FAP, n=24) were screened by MLPA.

The treatment of oropharyngeal candidiasis in HIV-infected patients with oral amphotericin B suspension.

Oropharyngeal candidiasis (OPC) is the most frequent opportunistic infection associated with HIV infection. Therapies such as topical clotrimazole and nystatin, as well as oral azoles, which had previously been effective prior to the advent of HIV, are increasingly only partially effective in OPC in HIV infection. The effectiveness of oral amphotericin B suspension for OPC is described in 17 HIV-infected patients whose response to other therapies had been unsatisfactory.

Patient-physician concordance: preferences, perceptions, and factors influencing the breast cancer surgical decision.

Purpose: This study explored patient preferences for involvement in the breast cancer treatment decision and concordance between patients' and physicians' views on decisional role. The impact of demographic and psychosocial characteristics on patients' decisional role was also examined.

Patients And Methods: Women with stage I or II breast cancer who were candidates for either mastectomy or lumpectomy were recruited from a university breast cancer treatment center.

Mastectomy and concomitant sentinel lymph node biopsy for invasive breast cancer.

Background: Although sentinel lymph node biopsy (SNLB) has become a standard ancillary to breast conservation, there remains a hesitancy to perform SLNB concomitant with mastectomy primarily because of concerns regarding reoperation for a positive SLN.

Methods: A retrospective review of 51 patients who underwent SLN biopsy concomitantly with mastectomy for invasive breast cancer was performed. In addition, a survey was sent to surgical oncologists who routinely perform SLNB in conjunction with mastectomy.

Severe acute respiratory syndrome (SARS): a review.

Severe acute respiratory syndrome (SARS) is a newly emerged disease that rapidly spread around the world. The disease originated in southern China and a novel coronavirus (SARS CoV) has been implicated as the causative organism. The path this virus took to set up human infection remains a mystery, though preliminary data point to origins in an animal reservoir.

Breast reconstruction practices in north america: current trends and future priorities.

The Women's Health and Cancer Rights Act (WHCRA) became federal law on January 1, 1999, mandating health care payer coverage for postmastectomy breast reconstruction. Despite passage of this legislation, breast reconstruction rates in the United States remain low. The Surveillance, Epidemiology and End Results (SEER) database for mastectomy patients in 11 regions across the United States show overall rates for immediate and early delayed reconstruction (performed within 4 months of mastectomy) of 15.

Lesson of the week: a new cause of treatable dementia.

Case Report: A 69-year-old married British man presented with 4 months of falls and confusion. HIV antibody test, performed after exclusion of other diagnoses, was positive. Institution of triple antiretroviral therapy resulted in an almost complete recovery.

Patient attitudes toward a Web-based system for monitoring chronic wounds.

This study evaluated patient attitudes toward a store-and-forward telemedicine system for monitoring chronic wounds treated topically, as well as chronic wounds that have been excised and surgically closed. The system involved collection and transmission via the Internet of digital photos and other patient and wound data by a nurse, and assessment by the telemedicine physician via the Web at a later time. For each patient, wound status was assessed in-person by a physician, as well as by the telemedicine system.

Economic and Practical Factors in Diagnosing HNPCC Using Clinical Criteria, Immunohistochemistry and Microsatellite Instability Analysis.

Aim: To determine a cost-efficient strategy for HNPCC molecular diagnostic testing.

Methods: 138 families referred to a Regional Genetics Service had hMLH1 and hMSH2 mutation analysis. The sensitivity and specificity of clinical selection criteria with or without immunohistochemistry (IHC) and microsatellite instability (MSI) analysis to further refine case selection and the effect of these approaches on the cost of mutation analysis were examined.

Novel tastes elevate c-fos expression in the central amygdala and insular cortex: implication for taste aversion learning.

Taste novelty strongly modulates the speed and strength of taste aversion conditioning. To identify molecular signals responsive to novel tastes, immunostaining for c-fos protein (Fos-like immunoreactivity [FLI]) was used to mark neurons that responded differentially to taste novelty. Novel saccharin induced larger increases in FLI than familiar saccharin.

Enhanced retention in the passive-avoidance task by 5-HT(1A) receptor blockade is not associated with increased activity of the central nucleus of the amygdala.

The effect of blockade of 5-HT1A receptors was investigated on (1). retention in a mildly aversive passive-avoidance task, and (2). spontaneous single-unit activity of central nucleus of the amygdala (CeA) neurons, a brain site implicated in modulation of retention.

Drug resistance genotypes predict response to amprenavir-containing regimens in highly drug-experienced HIV-1-infected patients.

We have undertaken a study of virological responses to amprenavir-containing antiretroviral regimens, during the expanded access programme within the UK. Ninety-five HIV-1-infected patients were included for which virological and immunological follow-up was available for 75, and baseline drug resistance data available for 51. These were highly drug-experienced patients, having previously received a median of nine antiviral drugs, within all available classes.

Accuracy of a web-based system for monitoring chronic wounds.

This study evaluated the accuracy of a store-and-forward telemedicine system for assessing the status of chronic wounds, including those surgically repaired. Digital photos and other patient and wound data were collected by a nurse using a laptop and transmitted via the Internet to a database, which organized and posted the data onto a web page for access by the telemedicine physician. Two Veterans' Affairs (VA) medical centers and two specialties (plastic surgery, physical medicine and rehabilitation) participated in the study.

Nevirapine use in HIV-1-infected children.

Objectives: To evaluate the safety, efficacy, and clinical, virological, and immunological responses in HIV-1-infected children receiving nevirapine as part of combination antiretroviral therapy (ART).

Methods: A review of case notes of all HIV-1-infected children 96 weeks after starting nevirapine, under a national compassionate access scheme between August 1997 and March 1999 in the UK. Nevirapine was dosed according to the manufacturer's guidelines.

Evidence-based prevention, management, and monitoring of dental caries.

Dental caries, not unlike periodontal diseases, is now recognized as an infectious, transmissible, multifactorial disease of bacterial origin. Current evidence-based emphasis is on the need to recognize a carious lesion in its earliest stage before demineralization has produced a cavitated lesion that requires restoration by a dentist. As a result of current understanding of caries control, the dental hygienist's role as a prevention specialist is to determine the dental caries risk factors for patients of all ages and to introduce remineralization strategies into the patient's dental hygiene care plan.

Slow acetylator phenotype and genotype in HIV-positive patients with sulphamethoxazole hypersensitivity.

Aims: To test the role of acetylator status, and to investigate the reported discrepancy between acetylator phenotype and genotype in HIV-positive patients with sulphamethoxazole (SMX) hypersensitivity.

Methods: Forty HIV-positive patients (32 of whom were SMX-hypersensitive), and 26 healthy volunteers, were genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis, and phenotyped using dapsone (50 mg) as a probe, for acetylator status. Sequencing of the NAT2 exon was performed where discrepancy between phenotyping and genotyping was detected.

The national utilization of immediate and early delayed breast reconstruction and the effect of sociodemographic factors.

The purpose of this study was to identify important sociodemographic factors affecting the utilization of immediate and early delayed postmastectomy breast reconstruction in the United States. Using the Surveillance, Epidemiology, and End Results (SEER) program, all cases of mastectomy-treated breast cancer that were reported to a SEER registry in 1998 were identified. Data were limited to reconstructions within the first 4 months postmastectomy, and logistic regression was used to analyze the effects of sociodemographic variables on reconstruction rates.

TNF-alpha promoter region gene polymorphisms in HIV-positive patients with lipodystrophy.

Objective: The pathogenic mechanisms underlying lipodystrophy in HIV-positive patients are largely unknown. TNF-alpha has many actions that are consistent with the features of lipodystrophy; therefore, an analysis was carried out to determine whether functionally active polymorphisms in the promoter region of the TNF-alpha gene are associated with the development of lipodystrophy.

Design: Genetic case-control association study.