Heterotopic ossification: treatment of established bone with radiation therapy.

Ectopic bone formation or heterotopic ossification (HO) is frequently seen on rehabilitation units after total hip arthroplasties, burns, and neurological injuries. Currently the major role for treatment is in prophylaxis and the major methods include anti-inflammatory medications, irradiation, and diphosphanate administration. These prophylactic measures are generally considered to be ineffective for the treatment of ectopic bone once it has already formed.

Microvascular function and rheologic changes in hyperdynamic sepsis.

Objective: To investigate the rheologic changes and circulatory abnormalities at the microvascular level during severe sepsis.

Design: Prospective, controlled trial.

Setting: Medical and surgical intensive care units of a university-affiliated hospital.

Diffuse Tl-201 uptake in the lungs. Etiologic classification and pattern recognition.

Diffuse Tl-201 uptake in the lungs could be because of cardiac, neoplastic, inflammatory, or interstitial lung disease. Examples from the different categories, differential diagnosis, and different patterns are presented. The authors discuss the different mechanisms of increased Tl-201 uptake in the lungs which vary according to the underlying pathology.

Clinical characteristics of adult asthmatics requiring intubation.

Fifty eight admissions for 52 adult asthmatics who required intubation were reviewed for the years of 1988-1995 to examine factors related to specific clinical patterns and profile the course of these patients. Of the 56 admissions where patients were intubated for respiratory failure and/or cyanosis, 5 were associated with significant complications of mechanical ventilation/intubation (pneumothorax, subcutaneous emphysema, aspiration pneumonia, and laryngeal edema) and there were no fatalities. Patients > or = 35 years of age had significantly more profound respiratory acidosis in initial arterial blood gases (pH = 7.

Pretreatment of normal humans with monophosphoryl lipid A induces tolerance to endotoxin: a prospective, double-blind, randomized, controlled trial.

Objectives: Endotoxin is one of the principal mediators of Gram-negative septic shock. Pretreatment with monophosphoryl lipid A, a hydrolyzed derivative of endotoxin from Salmonella minnesota R595, induces endotoxin tolerance and nonspecific resistance to infection in experimental animals. The present clinical trial was undertaken to test the response to monophosphoryl lipid A in humans and the ability of monophosphoryl lipid A to attenuate the response of normal human volunteers to U.

A phase III randomized, double-blind multiinstitutional trial of vaccinia melanoma oncolysate-active specific immunotherapy for patients with stage II melanoma.

Background: In a Phase II trial, surgical adjuvant active specific immunotherapy using a live vaccinia virus-augmented allogeneic polyvalent melanoma cell lysate, vaccinia melanoma oncolysate (VMO), produced a significant disease free interval (DFI) in patients with International Union Against Cancer Stage II melanoma with positive lymph nodes. Therefore, a Phase III randomized prospective, double-blind, multiinstitutional, surgical adjuvant VMO trial was performed to determine the efficacy of VMO to increase the DFI and the overall survival in this group of patients with Stage II disease.

Methods: Two hundred and fifty patients with Stage II melanoma were divided into two postsurgical groups.

A comparison of zidovudine, didanosine, zalcitabine and no antiretroviral therapy in patients with advanced HIV disease.

Three nucleoside analogues, zidovudine (AZT), didanosine (ddI), and zalcitabine (ddC), are approved for use in the treatment of patients with HIV infection. This retrospective study compares the 3 drugs and examines the overall utility of antiretroviral therapy by way of comparisons to a no treatment (No Rx) group in patients with advanced HIV disease. Patients with advanced HIV disease were enrolled in didanosine (August 1989-December 1990) or zalcitabine (October 1990-February 1992) expanded access programmes; continued on zidovudine treatment despite fulfilling criteria for zidovudine failure or intolerance; or maintained on no antiretroviral treatment.

Antagonism of mivacurium-induced neuromuscular blockade in humans. Edrophonium dose requirements at threshold train-of-four count of 4.

Background: Mivacurium's rapid rate of recovery has led to the suggestion that routine reversal of its residual effects may be unnecessary once signs of spontaneous recovery are evident. When antagonism is attempted at 90% twitch depression, the time saved to return to train-of-four (TOF) ratios > 0.70 compared to control has been reported to average < or = 8 min.

Total knee arthroplasty in Parkinson's disease.

Total knee arthroplasty in Parkinson's disease (PD) has been reported only twice in the literature. Parkinson's disease is considered a contra-indication for total knee replacement by some authors. We report on a 77-year-old man with PD who underwent total knee arthroplasty for severe degenerative joint disease.

Immunotherapy of a vaccinia colon oncolysate prepared with interleukin-2 gene-encoded vaccinia virus and interferon-alpha increases the survival of mice bearing syngeneic colon adenocarcinoma.

Therapeutic effect of a vaccinia colon oncolysate prepared with interleukin-2 (IL-2) gene-encoded vaccinia virus (IL-2VCO) in combination with recombinant interferon-alpha (IFN-alpha) was studied in a syngeneic murine CC-36 colon hepatic metastasis model. Treatment with this IL-2VCO+IFN-alpha produced a higher survival rate (90% on day 60 after tumor transplantation) in mice having CC-36 hepatic metastases when compared to treatment with IFN-alpha (0%), VCO+IFN-alpha (0%), or IL-2VCO (11%). The only treatment that produced a survival rate similar to the survival rate of IL-2VCO+IFN-alpha was VCO+IL-2 + IFN-alpha (survival rate was 67%).

Early single-photon emission computed tomography in mild head trauma. A controlled study.

Although computed tomography (CT) and magnetic resonance imaging scans often appear normal after mild head trauma, many patients experience attentional or other cognitive disturbances that are difficult to quantify by neuropsychological testing in the absence of a premorbid profile. Within 2 days of mild head trauma, 14 patients with normal-appearing brain CTs were studied with single-photon emission computed tomography (SPECT). They were compared to 15 normal control subjects and to 12 patients with mild human immunodeficiency virus (HIV) encephalopathy.

Relationships between plasma cytokine concentrations and leukocyte functional antigen expression in patients with sepsis.

Objective: To determine the relationships between cytokine concentrations and alterations in leukocyte functional antigen expression in sepsis.

Design: Prospective, cross-sectional study.

Setting: Respiratory, coronary, and medical intensive care units in a university hospital.

Monophosphoryl lipid A protects against gram-positive sepsis and tumor necrosis factor.

Monophosphoryl lipid A (MPL) is a less toxic derivative of lipid A that enhances survival from endotoxemia. This study examined whether MPL induced resistance to Gram-positive sepsis and cytokines. Mice were administered MPL or saline (phosphate-buffered saline) and challenged 24 h later with live Staphylococcus aureus (SA), staphylococcus enterotoxin B (SEB), toxic shock syndrome toxin (TSST-1), and tumor necrosis factor (TNF).

Gastric emptying patterns in Kaposi's sarcoma and gastroenteritis secondary to human immunodeficiency virus infection.

The study included 11 patients with AIDS who underwent gastric emptying studies for solid food, endoscopy (esophagogastroduodenoscopy), and gastric biopsy whenever gastritis was diagnosed on endoscopy. All studies were performed within 1 week. The studies were retrospectively reviewed to analyze the changes in gastric emptying secondary to Kaposi's sarcoma (KS) with or without opportunistic infections.

Influence of the acquired immunodeficiency syndrome on resource availability in critical care medicine in the coming decade.

Information presented regards the consumption of resources in the management of critically ill patients with the acquired immunodeficiency syndrome (AIDS). Predictions are made about future increases in critical care services for patients with this condition. While increased need will primarily be related to an increased number of patients with AIDS, an expanded need for critical care services is also likely to result from changes in the populations at risk and in the presentation of the syndrome.

Transverse rectus abdominis musculocutaneous flaps after liposuction of the abdomen.

We describe a patient for whom bilateral transverse rectus abdominis musculocutaneous flap breast reconstruction was successfully accomplished several years after liposuction of the lower abdominal tissues making up the flaps. A history of liposuction within the area of a proposed musculocutaneous flap does not preclude use of that flap. Issues related to flap elevation in sites of previous liposuction are discussed.

Codetype agreement between MMPI-2 and estimated MMPI profiles in chemically dependent inpatients.

The extent of codetype agreement between the revised version of the Minnesota Multiphasic Personality Inventory (MMPI-2) and estimated MMPI profiles was examined in a sample of 121 inpatients being treated for chemical dependence, primarily alcoholism. Rates of codetype agreement among the entire sample and various subsamples are comparable to those reported elsewhere derived for different samples and using different methods. Implications for MMPI-2 codetype interpretation are discussed.

Astasia and gait failure with damage of the pontomesencephalic locomotor region.

Although there is evidence in experimental animals of the importance of the pedunculopontine area in locomotion, clinical lesion reports are lacking. An 83-year-old woman became unable to stand and to generate stepping movements after a hemorrhage at the pontomesencephalic junction involving the right pedunculopontine area. Her deficit resembled the gait failure present in some elderly individuals.

The effect of chemical dependency on pain perception in persons with AIDS.

A sample of persons with AIDS (N = 71) was drawn from two tertiary care centers and one group residence. Chemical dependence was measured by the Michigan Alcoholism Screening Test (MAST) and the Drug and Alcohol Screening Test (DAST), and the perception of pain was then measured with the Wisconsin Brief Pain Inventory. The hypothesis that the groups would demonstrate a significantly different perception of pain was not supported.

Therapeutic effect of a vaccinia colon oncolysate prepared with interleukin-2-gene encoded vaccinia virus studied in a syngeneic CC-36 murine colon hepatic metastasis model.

Vaccinia CC-36 murine colon oncolysate (VCO) prepared with interleukin-2-gene encoded recombinant vaccinia virus (IL-2VCO) was used in the treatment of a syngeneic murine colon adenocarcinoma (CC-36) hepatic metastasis to test the beneficial effect of the interleukin-2-gene encoded vaccinia virus over a control recombinant vaccinia virus in producing a vaccinia oncolysate tumor cell vaccine. Results suggest that the IL-2VCO treatment significantly reduced the hepatic tumor burden in comparison with the controls that received either IL-2-gene-encoded recombinant vaccinia virus or a plain recombinant vaccinia virus or vaccinia oncolysate prepared with the plain recombinant virus. The survival of mice treated with IL-2VCO was also improved in comparison with mice treated with other preparations.

Intra-arterial chemotherapy for palliation of fungating breast cancer. A case report and review of the literature.

The infusion of chemotherapy into arteries that feed locally advanced tumors has theoretical appeal, since the tumor mass may be exposed to high drug concentrations with administration of reduced or conventional doses of chemotherapy. Experience in applying this technique to patients with breast cancer in the United States is limited. Locally advanced, fungating breast cancers pose particularly difficult management problems for which intra-arterial drug delivery may be appropriate in carefully, selected cases.

Response to inhibition of angiotensin-converting enzyme in human immunodeficiency virus-associated nephropathy: a case report.

The most common chronic nephropathy seen with human immunodeficiency virus (HIV) infection is characterized by heavy proteinuria and rapid deterioration of renal function. We here report the findings in an HIV-seropositive patient with nephrotic-range proteinuria and biopsy-proven HIV-associated nephropathy treated with the angiotensin-converting enzyme (ACE) inhibitor, fosinopril. During treatment periods, the patient demonstrated a significant decrement in 24-hour urinary protein excretion without change in renal function.