Use of liposome preparation to treat mycobacterial infections.

Infections caused by organisms of the genus mycobacteria, such as tuberculosis M. avium disseminated infection in AIDS patients and leprosy, are extremely common around the world. Mycobacteria are intracellular organisms that invade and multiply chiefly within phagocytic cells.

Interleukin-6 antagonizes tumor necrosis factor-mediated mycobacteriostatic and mycobactericidal activities in macrophages.

Interleukin-6 (IL-6) is a cytokine produced by a number of cells, including macrophages, and is directly involved in the inflammatory response. The production of IL-6 can be stimulated by monokines such as IL-1 and tumor necrosis factor (TNF). Mycobacterium avium complex organisms frequently cause disseminated disease in patients with AIDS.

Impact of a shielded safety syringe on needlestick injuries among healthcare workers.

Objectives: Evaluate the impact of a shielded 3 cc safety syringe on needlestick injuries among healthcare workers.

Design: Surveillance study.

Setting: Three medical centers.

The efficacy of inpatient education after myocardial infarction.

Nearly half a million Americans will survive an acute myocardial infarction (MI) this year. Nurses often question whether patients who have had an MI are able to absorb, retain, and use information given in the hospital. This review examines the research literature on inpatient education after MI published between 1975 and 1989 to determine (a) what information patients identify as most important, (b) whether inpatient education increases patients' knowledge, (c) whether anxiety prevents or diminishes learning in this setting, (d) whether inpatient education is able to produce lifestyle changes after discharge, and (e) which teaching methods are most effective.

Vaccination of mice with a soluble protein fraction of Mycobacterium leprae provides consistent and long-term protection against M. leprae infection.

Groups of BALB/c mice were vaccinated intradermally with either Freund's incomplete adjuvant (FIA) alone, 10(7) heat-killed Mycobacterium leprae organisms in FIA, or a number of fractions of M. leprae containing soluble and/or cell wall components. At 1, 3, 6, 9, and 12 months later, vaccinated mice were challenged in the right hind footpad with 5,000 live M.

Development of a hospital ethics committee: lessons from five years of case consultations.

The development and consultation experience of an ethics committee in an urban community hospital has been presented, and various approaches to case consultation have been considered. Our committee has concentrated on the clinical evaluation model. As expected, most consultations have centered on issues of withdrawing or limiting medical care.

Eales' disease with central nervous system infarction.

Eales' disease is a noninflammatory occlusive disorder of the retinal vasculature that causes recurrent hemorrhages into the retina and vitreous and ischemic changes in the eye. Extraocular manifestations of Eales' disease are rare and limited to the central nervous system. We report the case of a patient with Eales' disease and ischemic stroke, and we review the neurologic manifestations of this primarily ophthalmologic vasculopathy.

Infection of "nonprofessional phagocytes" with Mycobacterium avium complex.

Organisms belonging to the Mycobacterium avium complex are the most common bacteria isolated from patients with AIDS. In these patients, M. avium is associated with disseminated disease, and bacteria are found within macrophages in the liver and spleen.

Synergism between diabetic and radiation retinopathy: case report and review.

It is suspected that radiation retinopathy is more likely to develop in an eye with preexisting diabetic retinopathy than in a normal eye. However, there is only one report of this occurring, at a radiation dose of 4500 rads. We present a woman with minimal diabetic retinopathy who had breast carcinoma which was treated with chemotherapy but metastasised to the choroid.

Effects of acute right ventricular ischemia on ventricular interactions during prosthetic left ventricular support.

Systolic ventricular interactions may be partially responsible for right ventricular failure that sometimes occurs during clinical use of prosthetic left ventricular assist devices. In this hypothesis, it is proposed that the left ventricular assist device reduces left ventricular pressure and its contribution to right ventricular performance, thus impairing right ventricular output. On the other hand, these effects may be small compared with other causes of right ventricular failure such as ischemia.

Ethanol affects release of TNF and GM-CSF and membrane expression of TNF receptors by human macrophages.

Ethanol intoxication has been associated with bacterial pneumonia and tuberculosis. More recently, ethanol was shown to impair the capacity of pulmonary macrophages to produce superoxide anion and tumor necrosis factor (TNF). Furthermore, exposure to ethanol compromises macrophage's ability to respond to stimulation with TNF and granulocyte-macrophage colony-stimulating factor (GM-CSF), and kill an intracellular pathogen, Mycobacterium avium.

Disc edema, transient obscurations of vision, and a temporal fossa mass.

A 56-year-old woman presented with a four-month history of transient obscurations of vision that progressed to constant visual loss. She had a nodular, lumpy-bumpy, cauliflower-like asymmetric edema of the nerve head, which suggested direct optic nerve head invasion with foreign tissue. Imaging of her intracranial contents revealed a well circumscribed gadolinium enhancing mass in the middle fossa.

AAEM minimonograph #14: The influence of temperature in clinical neurophysiology.

AAEM MINIMONOGRAPH # 14 Temperature affects biologic and neurophysiologic processes and is, therefore, always well controlled in in vitro experiments. Its role is equally important in the clinical laboratory but has often been neglected. Lower temperature cause slower nerve conduction velocities (NCVs), and increased amplitudes of muscle and nerve potentials.

Complications of rigid gas permeable lenses for extended wear.

A retrospective study of 174 patients wearing rigid gas permeable lenses for a period of 2 years was carried out to determine the success rate and types of complications which typically occur. The results indicate that these types of lenses are a viable modality for extended wear, as the majority of signs which may lead to serious complications can be detected relatively early. When these signs were detected the patients were switched to daily wear and most were able to wear these lenses uneventfully.

A multicenter study of Pneumocystis choroidopathy.

We studied 21 patients with the acquired immunodeficiency syndrome and presumed Pneumocystic carinii choroidopathy. The lesions were characteristically yellow to pale yellow in color, appeared at the level of the choroid, and were found in the posterior pole. They varied in size from 300 to 3,000 microns, initially increasing in number before treatment and eventually resolving after systemic antimicrobial therapy.

Split bipedicle transverse rectus abdominis flaps: expanding their uses in breast reconstruction.

A total of 34 breasts were reconstructed in 21 women, with the bipedicle transverse rectus abdominis island flap technique. Thirteen women had bilateral breast reconstructions and 8 had unilateral reconstructions. The indications for using this technique are (1) bilateral breast defects, (2) a radical mastectomy defect, (3) limited donor tissue or tissue compromised by prior abdominal surgery, and (4) a large, remaining breast that requires matching.

Alternative liability insurance: a physician-owned captive insurance company.

The physician-owned captive insurance company is a lesser known but dynamic alternative to commercial insurance. The Physicians Reimbursement Fund, Ltd., was founded in 1975 in response to the malpractice crisis of that year.

Modified skin incisions for mastectomy: the need for plastic surgical input in preoperative planning.

Skin-sparing mastectomy by definition describes the procedure of mastectomy, either simple or modified radical, with a minimum amount of skin excision. The surgical skin excision must: (1) include the nipple-areola complex, (2) include the biopsy site, and (3) allow for access to the axilla for possible dissection. In 27 mastectomies, the senior author has had direct input in the preoperative skin planning.

Reactive astrogliosis is widespread in the subcortical white matter of amyotrophic lateral sclerosis brain.

Widespread astrogliosis exists in the subcortical white matter in amyotrophic lateral sclerosis (ALS). As revealed by glial fibrillary acidic protein (GFAP) immunostaining, the gliosis has the morphological properties of an active process. It is present in the midfrontal, inferior parietal, temporal, cingulate, and occipital cortices, as well as in the motor cortex.

Interaction of Mycobacterium avium complex with human macrophages: roles of membrane receptors and serum proteins.

Invasive, disease-associated members of the Mycobacterium avium complex are facultative intracellular pathogens of mammalian macrophages. The mechanism(s) by which M. avium is ingested by mononuclear phagocytes is unknown.

Loss of heterozygosity on the short arm of chromosome 17 is associated with high proliferative capacity and DNA aneuploidy in primary human breast cancer.

Loss of heterozygosity (LOH) on the short arm of chromosome 17 (17p) was found in 27 of 52 (52%) previously untreated primary breast cancers. There was a significant correlation between this 17p allelic loss and two parameters associated with aggressive tumor behavior: high cellular proliferative fraction and DNA aneuploidy. These correlations with high cellular proliferative fraction and DNA aneuploidy were not found in tumors with LOH at nine other chromosome locations.

Antitrust and peer review.

An antitrust action against a physician is unlikely if the following guidelines are followed: Do not agree with competing independent doctors on any terms of price, quantity, or quality, or the patients one is willing to serve, the location from which one is permitted to draw patients, or where one will locate offices. Also, do not agree to refuse to offer services to alternate delivery systems. Generally, those who serve on peer review committees are protected if decisions are reached after effort has been made to obtain the facts of the case, after adequate notice and fair hearing procedures are afforded to the physician involved, and when the action has been warranted by the facts and is in the furtherance of health care.

Assessment of the late proliferative phase endometrium by ultrasonography in patients undergoing in-vitro fertilization and embryo transfer (IVF/ET).

This study reports on 330 women aged 29 to 45 years, who underwent 411 cycles of in-vitro fertilization and embryo transfer (IVF/ET). Vaginal sonograms were performed during the late proliferative phase of natural cycles and cycles of controlled ovarian hyperstimulation (COH) with gonadotrophins, to evaluate both the thickness and echogenicity of the endometrium. Findings classified as Grade I; characterized by homogeneous echogenicity of the endometrium, and Grade II; characterized by an outer peripheral layer of dense echogenicity surrounding a central sonolucent area (i.