Care of injection drug users with soft tissue infections in San Francisco, California.

Context: Illicit injection drug use results in serious soft tissue infections that are the number one nonpsychiatric reason for admission to San Francisco General Hospital (SFGH), San Francisco, Calif.

Objective: To establish a specialized clinic to provide accessible, high-quality, and cost-effective medical care to patients with soft tissue infections. DESIGN, SETTING, INTERVENTION, AND OUTCOME MEASURES: The Integrated Soft Tissue Infection Services (ISIS) Clinic was established to provide coordinated surgical intervention, substance abuse counseling, and social services for patients with soft tissue infections treated in a public hospital.

Diagnosis and management of trauma to the kidney.

Because trauma is an unplanned event, guidelines for managing patients sustaining upper urinary tract injury must already exist in the surgeon's mind before laying eyes on the injured patient. In order to simplify and standardize the evaluation and treatment of such patients, urologists have applied a system of staging paradigms and treatment algorithms, analogous to systems successfully used in the less chaotic arena of, for example, urologic oncology. Advancements in imaging modalities, improvements and renovations of surgical technique, and critical review of outcomes data have impacted on the management of genitourinary trauma and will be likely to influence the way we treat trauma patients in the future.

Depression screening in a women's clinic: using automated Spanish- and English-language voice recognition.

Clinical depression is frequently unrecognized, even in health care settings. This study (a) reports high levels of major depressive episodes (MDEs) and depressive symptoms in a public sector women's clinic, (b) compares computerized voice recognition with live interviews, and (c) compares Spanish and English versions of the depression-screening instruments. Patients (N = 104) completed face-to-face interviews and/or computerized voice recognition interviews in counterbalanced order; 38% scored positive for current MDE, and 67% scored positive for lifetime MDE.

Pulmonary cryptococcosis in patients without HIV infection.

Purpose: To further elucidate the diagnostic and therapeutic approaches to patients with pulmonary cryptococcosis who are not HIV-infected.

Subjects: All of the patients without HIV infection who received care at two Midwest hospitals between January 1986 and February 1996 and had a respiratory isolate of Cryptococcus neoformans.

Methods: The medical records of the study patients were reviewed for demographic data, host immune status, respiratory symptoms, diagnostic studies, treatment, and follow-up.

Dissemination of Mycobacterium tuberculosis across the San Francisco Bay Area.

The propensity of Mycobacterium tuberculosis genotypes to spread across geographic boundaries was investigated by comparing the IS6110 and polymorphic GC-rich sequence patterns of M. tuberculosis isolates from San Francisco and the East Bay, two distinct regions separated by San Francisco Bay. Of 724 isolates from incident tuberculosis patients during 1992 and 1993, only 53 (7.

Indium as internal standard in square wave anodic stripping analysis of lead in blood with microelectrode arrays.

The toxic effects of lead on humans, especially children have been well documented. ASV has been an important technique in the analysis of lead in blood of humans. This research has demonstrated that indium(III) can be used as an internal standard in the analysis of lead in blood samples with mercury film microelectrode arrays.

Ontogenic expression of renal and hepatic angiotensin II receptor genes in the rat.

In addition to its well-characterized renal hemodynamic effects, angiotensin II (Ang II) promotes growth of cultured glomerular and tubular cells, suggesting a possible role in renal development. To better define potential developmental effects of Ang II, we examined the expression of Ang II receptors in embryonic (E19) and postnatal (1, 2, 3, 10 days, 6 weeks, 3 and 9 months) rat kidneys, using in situ autoradiography and the nonpeptide antagonists losartan and PD-123177 to identify receptor subtypes. At E19, 125I-[Sar1, Ile8]Ang II binding was equally reduced by losartan and PD-123177, indicating the presence of both AT1 and AT2 receptors.

Institute of Medicine report on prevention of mental disorders. Summary and commentary.

A comprehensive report mandated by the U.S. Congress on the state of the science of prevention recommends a stricter definition of the term prevention; summarizes specific preventive intervention research programs across the life span; and specifies funding, personnel, and coordination priorities to build a national prevention research infrastructure.

Regulation of inducible nitric oxide synthase in hepatic sinusoidal endothelial cells.

Nitric oxide (NO) has many important physiological effects that depend in part on its cellular source(s). In liver, NO is produced by all major cell types, including hepatocytes, Kupffer, stellate, and sinusoidal endothelial cells (SECs). Although endothelial cells have been commonly associated with constitutive NO production, recent evidence suggests that NO is inducible in this cell type.

Zinc levels and infections in hospitalized patients with AIDS.

Impaired cellular and humoral immunity and phagocytic function have been attributed to zinc deficiency. This study examined the association between low serum zinc concentration and opportunistic infections in hospitalized patients with the acquired immune deficiency syndrome (AIDS). We examined the records from all 505 inpatient consultations performed by our Nutrition Service from May 1992 through June 1994.

Asymptomatic chronic gastrointestinal blood loss in patients taking aspirin or warfarin for cardiovascular disease.

Objective: To determine whether low-dose aspirin or warfarin induces fecal occult blood loss.

Patients And Methods: A prospective, cross-over study, of 100 participants over 40 years of age in 1 of 3 groups, taking: (1) no aspirin or warfarin, (2) daily aspirin (either 81 or 325 mg), or (3) warfarin, but no aspirin. Stool samples were collected and analyzed for the presence of occult blood using HemoQuant and Hemoccult II.

Keratin 14 gene mutations in patients with epidermolysis bullosa simplex.

Mutations in genes encoding the keratin intermediate filaments expressed in basal cells have been identified in some families with epidermolysis bullosa simplex as the proximate cause of the fragility. We have systematically scanned genomic sequences of one of these keratins, keratin 14, for mutations in patients from 49 apparently independent kindreds using single-strand conformation polymorphism analysis. The ten mutations identified are clustered at three sites--the ends of the helices and the L12 linker region, mutation sites that have been identified in past, more limited studies.

Involvement of the double-stranded-RNA-dependent kinase PKR in interferon expression and interferon-mediated antiviral activity.

The signaling mechanisms responsible for the induced expression of interferon (IFN) genes by viral infection or double-stranded RNA (dsRNA) are not well understood. Here we investigate the role of the interferon-induced dsRNA-dependent protein kinase PKR in the regulation of IFN induction. Biological activities attributed to PKR include regulating protein synthesis, mediating IFN actions, and functioning as a possible tumor suppressor.

Homozygous achondroplasia: US distinction between homozygous, heterozygous, and unaffected fetuses in the second trimester.

Purpose: To determine if and at what gestational age prenatal ultrasonography (US) enables distinction between homozygous, heterozygous, and unaffected fetuses when both parents have heterozygous achondroplasia.

Materials And Methods: Serial US scans of 15 fetuses at 25% risk of homozygous achondroplasia were reviewed retrospectively. Femoral growth curves were established and compared with published standards to determine the gestational age, calculated according to biparietal diameter (BPD), at which femoral length crossed below the 3rd percentile.

The need for additional options in the treatment of human immunodeficiency virus infection.

Current therapy for human immunodeficiency virus (HIV) infection is inadequate to control the progression of the disease. Although existing nucleoside analogues, such as zidovudine, have clear benefits, they also have drawbacks, including toxicity and the possibility of drug resistance. In addition, the timing of therapy and the use of monotherapy versus combination therapy as initial treatment have not been definitively established.

Rate of glucose entry into hepatic uridine diphosphoglucose by the direct pathway in fasted and fed states in normal humans.

We used the glucuronate (GlcUA) probe technique to measure the rate of glucose entry into hepatic uridine diphosphoglucose (UDP-glc) by the direct pathway, to quantify the rate of appearance (Ra) of hepatic UDP-glc, and to calculate hepatic glucose cycling in vivo in normal humans. The direct pathway contribution to UDP-glc as determined by the ratio of [1-d1]-GlcUA to plasma [LD1]-glucose enrichments was minor (15% to 20%) in normal men after an overnight fast. After 9 hours of refeeding with intravenous (IV) glucose or an oral liquid formula meal each at a rate of 7 mg carbohydrate/kg/min, the direct pathway increased to 66.

Interferon gamma inhibits lipocyte activation and extracellular matrix mRNA expression during experimental liver injury: implications for treatment of hepatic fibrosis.

Background: A central feature of liver injury involves activation of hepatic lipocytes (perisinusoidal cells), a process characterized by their morphologic transformation to myofibroblast-like cells. Important features of this process include new expression of smooth muscle alpha actin and production of increased amounts of extracellular matrix. Interferon gamma is a cytokine with immunomodulatory and antifibrotic properties that has potent effects on lipocytes in a culture model of activation.

Metabolic interactions between surplus dietary energy intake and cigarette smoking or its cessation.

Cigarette smoking (CS) alters lipid metabolism and is associated clinically with an atherogenic lipid profile. We recently showed that, under controlled eucaloric dietary conditions, CS stimulates lipolysis without increasing oxidation of fat and that cessation of CS does not result in a rebound tendency to synthesize or store fat. We asked here whether the ad libitum intake of surplus dietary energy interacts with the metabolic effects of CS or its cessation.

Identification of a common clonal human immunodeficiency virus integration site in human immunodeficiency virus-associated lymphomas.

Infection with human immunodeficiency virus type 1 (HIV-1) is associated with a high incidence of lymphoma. Typically, the lymphomas are B-cell in origin, and although they occur in the setting of HIV-1 infection, historical studies have found no evidence for the presence of HIV-1 within the transformed B-cells. We describe a new class of large cell lymphoma wherein HIV p24 expression within the tumor specimens was found to be extremely high.

Licorice ingestion and blood pressure regulating hormones.

Nearly half a century ago Revers reported that administration of a paste prepared from succus liquiritiae, a dried watery extract of the roots of Glycyrrhiza glabra, resulted in a reduction in abdominal symptoms as well as radiographic evidence of healing in patients suffering from gastric ulcer. Subsequent studies demonstrated that this preparation could prevent the formation of gastric ulcers in experimental animals and confirmed the salutary effects in patients, but found that approximately 20% of patients so treated developed facial and dependent edema, often accompanied by headache, shortness of breath, stiffness, and pain in the upper abdomen. Although these symptoms suggested an allergic reaction, they were not accompanied by eosinophilia or relieved by antihistamines.

Effects of cigarette smoking and its cessation on lipid metabolism and energy expenditure in heavy smokers.

The relationship between thermogenic and potentially atherogenic effects of cigarette smoking (CS) and its cessation was investigated. Heavy smokers (n = 7, serum cotinine > 200 ng/ml, > 20 cigarettes/d) were maintained on isoenergetic, constant diets for 2 wk, 1 wk with and 1 wk without CS. Stable isotope infusions with indirect calorimetry were performed on day 7 of each phase, after an overnight fast.