Community treatment programs take up buprenorphine.

Clinicians have been working out ways to incorporate buprenorphine into their treatment models. Representatives of three addiction treatment programs - a Veterans Affairs methadone clinic, a group of outpatient mental health centers, and a nationwide organization of therapeutic communities - talk about their plans and experiences.

Vitamin E treatment for tardive dyskinesia. Veterans Affairs Cooperative Study #394 Study Group.

Background: Several short-term, controlled trials have documented the efficacy of vitamin E in treating tardive dyskinesia. However, the persistent nature of the disease prompted us to perform a multicenter, longer-term trial of vitamin E.

Methods: The study was a prospective, randomized, 9-site trial of up to 2 years of treatment with d-vitamin E (1600 IU/d) vs matching placebo.

Amyloid and nonfibrillar deposits in mice transgenic for wild-type human transthyretin: a possible model for senile systemic amyloidosis.

The human serum protein transthyretin (TTR) is highly fibrillogenic in vitro and is the fibril precursor in both autosomal dominant (familial amyloidotic polyneuropathy [FAP] and familial amyloidotic cardiomyopathy [FAC]) and sporadic (senile systemic amyloidosis [SSA]) forms of human cardiac amyloidosis. We have produced mouse strains transgenic for either wild-type or mutant (TTRLeu55Pro) human TTR genes. Eighty-four percent of C57BI/6xDBA/2 mice older than 18 months, transgenic for the wild-type human TTR gene, develop TTR deposits that occur primarily in heart and kidney.

Risk of transmission of Creutzfeldt-Jakob disease by transfusion of blood, plasma, and plasma derivatives.

Studies in experimental animals and case-reports of transmission of Creutzfeldt-Jakob Disease (CJD) by blood transfusion or by albumin products have raised the possibility that CJD may be transmitted by transfusion. The risk of transmission of CJD by transfusion remains theoretical, since no confirmed case of CJD has ever been causally attributed to the receipt of a blood transfusion, no confirmed case of CJD has developed in recipients of clotting factor concentrates, and no cluster of CJD cases has been reported following the administration of a pooled plasma derivative to which a donor who subsequently developed CJD had contributed. However, based on a review of the hitherto available data, it is impossible to conclude at this time that CJD is not transmitted by blood or plasma transfusion or by the administration of pooled plasma derivatives.

Prevention of recurrent nephrolithiasis.

The first episode of nephrolithiasis provides an opportunity to advise patients about measures for preventing future stones. Low fluid intake and excessive intake of protein, salt and oxalate are important modifiable risk factors for kidney stones. Calcium restriction is not useful and may potentiate osteoporosis.

Relationship between plain radiographic patterns and three- dimensional trabecular architecture in the human calcaneus.

The purpose of this study was to determine the relationship between three-dimensional (3D) trabecular structure and two-dimensional plain radiographic patterns. An in vitro cylinder of human calcaneal trabecular bone was three-dimensionally imaged by micro-CT using synchrotron radiation, at 33.4 micrometer resolution.

Computational methods for ultrasonic bone assessment.

Ultrasound has been proposed as a means to noninvasively assess bone and, particularly, bone strength and fracture risk. Although there has been some success in this application, there is still much that is unknown regarding the propagation of ultrasound through bone. Because strength and fracture risk are a function of both bone mineral density and architectural structure, this study was carried out to examine how architecture and density interact in ultrasound propagation.

Long-term treatment effects of vitamin E for tardive dyskinesia.

Background: Several studies have found that alpha-tocopherol (vitamin E) can effectively treat tardive dyskinesia (TD). A limitation of these trials is their short treatment durations (maximum of 12 weeks), which do not allow us to address the effects of long-term treatment.

Methods: To participate, patients had to have TD and be on stable oral medications.

Racial differences in performance of invasive cardiac procedures in a Department of Veterans Affairs Medical Center.

Racial differences have recently been described in hospital practice, most notably with regard to cardiac procedure utilization. To evaluate the possible reasons behind these differences, we analyzed statistics generated from a surgical referral conference at a large, tertiary care Veterans Affairs hospital between the years 1988 and 1996. In this setting, there is no financial incentive for physicians to recommend or perform invasive procedures, as all physicians are salaried employees of the Veterans Administration.

Bacterial infections.

Non-opportunistic bacterial infections are an important cause of morbidity and mortality for HIV-infected adults and children. Factors associated with increased risk of these include altered B- and T-cell function; altered phagocytic cell function; skin and mucous membrane defects; and use of indwelling vascular catheters, antibiotics, or cytotoxic agents. The pathogens encountered most frequently are S.

The hematological complications of alcoholism.

Alcohol has numerous adverse effects on the various types of blood cells and their functions. For example, heavy alcohol consumption can cause generalized suppression of blood cell production and the production of structurally abnormal blood cell precursors that cannot mature into functional cells. Alcoholics frequently have defective red blood cells that are destroyed prematurely, possibly resulting in anemia.

Time course of lysophosphatidylcholine release from ischemic human myocardium parallels the time course of early ischemic ventricular arrhythmia.

Background: We determined the kinetics of the release of lysophosphatidylcholine (LPC) into the coronary sinus of patients undergoing stress tests after coronary artery bypass grafting. The kinetics were consistent with a role for this amphiphile in the pathogenesis of ischemic ventricular arrhythmia, a major cause of sudden death.

Methods: Stress testing was initiated in the operating suite by pacing at a rate of 160 beats/min for 2 min.

Antioxidant treatment of tardive dyskinesia.

Tardive dyskinesia (TD) is a frequently occurring side effect of treatment with neuroleptic antipsychotic drugs. TD is a persistent and often irreversible syndrome characterized by abnormal movements, including lingual and orofacial dyskinesia, grimacing, tics, choreic movements of the limbs and trunk, and athetosis and dystonia. In some patients the muscles of respiration and speech may also be involved.

Prevention of community-acquired and nosocomial pneumonia.

Pneumonia is an important cause of morbidity and mortality in the United States. The provision of effective prophylaxis for pneumonia has become a major goal for both public health officials and individual physicians. Prophylaxis for community-acquired pneumonia is pathogen-specific and is directed toward the most common microorganisms that cause it.

Alterations of the retinoblastoma gene in clinically localized, stage B prostate adenocarcinomas.

Alterations of the retinoblastoma (Rb) tumor suppressor gene and its encoded protein have been detected in a variety of malignant neoplasms. The authors have evaluated a series of 26 clinically localized stage B prostate adenocarcinomas for loss of heterozygosity (LOH) at 13q14 (including the Rb locus), rearrangements or partial deletions of the Rb gene, and alterations of Rb protein level by quantitative immunohistochemistry. LOH at the Rb locus occurred in 35% of the informative specimens.

Chronic actinic dermatitis. An immunohistochemical study of its T-cell antigenic profile, with comparison to cutaneous T-cell lymphoma.

Chronic actinic dermatitis (CAD) describes a persistent photosensitivity disorder in the absence of continued exposure to photosensitizers; it is characterized by a T-cell infiltrate within the epidermis and dermis. The purpose of this study was to characterize the T-cell infiltrate better immunohistochemically. Serial cryostat sections of fresh-frozen punch biopsy specimens of skin were analyzed in 11 patients with CAD and 3 patients with erythrodermic cutaneous T-cell lymphoma (CTCL).

Factors affecting the yield of acid-fast sputum smears in patients with HIV and tuberculosis.

Objective: To evaluate the sensitivity of acid-fast sputum smears in the diagnosis of pulmonary Mycobacterium tuberculosis (MTB).

Design: Retrospective chart and radiographic film review.

Setting: Department of Veterans Affairs Medical Center in New York City.

Alterations in the p53 and MDM-2 genes are infrequent in clinically localized, stage B prostate adenocarcinomas.

Alterations in the p53 gene have been described in a variety of human malignant neoplasms. We have examined 29 stage B prostate carcinomas for alterations in the p53 gene and for amplification of the MDM-2 gene. No evidence of mutations in the conserved exons 5 to 8 was found by polymerase chain reaction single-stranded conformation polymorphism analysis and no accumulation of p53 protein was found by immunohistochemistry.

Trazodone for antidepressant-associated insomnia.

Objective: The authors investigated trazodone as a hypnotic for depressed patients who had persistent, exacerbated, or new insomnia while taking either fluoxetine or bupropion.

Method: Seventeen depressed patients who had insomnia while taking fluoxetine or bupropion were given either trazodone or placebo in a double-blind crossover trial. Sleep was assessed by self-report with the Pittsburgh Sleep Quality Index and the sleep items of the Yale-New Haven Hospital Depressive Symptom Inventory.

Cell cycle control of the BN51 cell cycle gene which encodes a subunit of RNA polymerase III.

The BN51 cell cycle gene complements a temperature-sensitive cell cycle mutation of BHK-21 cells which leads to arrest in G1 at the nonpermissive temperature. Recent evidence indicates it encodes an essential subunit of RNA polymerase III. The BN51 gene is induced 4-fold 4-h after stimulation of quiescent, serum-starved fibroblasts with serum.

The nuances of lymphocytopenia.

We have discussed the causes of lymphocytopenia and attempted to categorize them according to pathogenesis. This effort may be tenuous at best, because so much is still unknown about lymphocyte function and kinetics. In describing pathogenesis we have reported what has been published and not speculated on mechanisms when they were not stated.

Pneumococcal vaccine in the prevention of community-acquired pneumonia: a skeptical view of cost-effectiveness.

Streptococcus pneumoniae (pneumococcus) is an important pathogen that causes pneumonia, bacteremia, and meningitis in adults. In recent years, pneumococcal isolates resistant to penicillin have become increasingly prevalent in the U.S.