Faculty Bibliography

WHEN men are infected with H.I.V. and another sexually transmitted disease, like gonorrhea, their semen contains about eight times as much AIDS virus as is found in semen of men who who do not have dual infections, a new study has found. The findings indicate that control measures used in some countries to battle AIDS are worthwhile and suggest that widespread detection and treatment programs for sexually transmitted diseases could help prevent many new H.I.V. infections, said the study's authors, from the University of North Carolina School of Medicine in Chapel Hill. The findings are relevant for the United States and other developed countries, said Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, which is one of a number of Federal agencies that paid for the study along with the World Health Organization. Family Health International conducted the study along with the University of North Carolina researchers

The sonographic finding of hyperechoic or dilated fetal bowel raises suspicion of a number of prenatal disorders including meconium ileus (MI), meconium peritonitis, congenital infection, neoplasm, or chromosomal trisomy. These findings may also represent transient normal variants. The following case report details the evaluation of one pregnancy with abnormal intestinal echogenic findings on serial sonograms (US), to demonstrate inherent diagnostic difficulties in such a case. A diagnostic algorithm is presented to aid in the proper use of US and DNA mutation analysis for cystic fibrosis (CF), so that the cause of an abnormal abdominal US can be established earlier and more accurately than suggested by previous management schemes. Earlier fetal diagnosis may help to anticipate postnatal problems associated with CF/MI, and therefore provide more optimal clinical management of the affected fetus.

OBJECTIVES: To describe the changes in psychoactive drug use in nursing homes after implementation of physical restraint reduction interventions and mandates of the Omnibus Budget Reconciliation Act of 1987 (OBRA '87). METHODS: A secondary analysis was conducted using data from a controlled clinical trial that took place in three nursing homes: a control home, one that received an educational intervention, and one that received an educational/consultation intervention. All three homes were influenced by the OBRA mandates. Complete pre- and 6 months' post-intervention data on use of psychoactive drugs and physical restraints were available for 446 resident subjects. Changes were first analyzed with the resident subjects as the unit of analysis and then using the nursing home ward (n = 16) as the unit of analysis. RESULTS: While physical restraint use declined in the home that received the educational/consultation intervention, neither neuroleptic nor benzodiazepine use increased in any of the homes after the interventions. The percentage of residents taking neuroleptics declined in the control home (18.6% to 11.3%, P = .014). Benzodiazepine use, which was more prevalent than described previously in the literature, declined in all three homes (P < .001). Of those residents whose physical restraints were discontinued, only 2% were started on neuroleptics. When the effect of OBRA mandates on appropriateness of neuroleptic use was examined, the percentage of residents on neuroleptics who lacked an OBRA-approved indication declined from 21.3% to 14.6% in the total sample, and from 39.9% to 8% in the control home. CONCLUSIONS: Interventions to reduce physical restraint did not lead to an increase in psychoactive drug use; further, reduction in both can occur simultaneously. OBRA mandates regarding psychoactive drug use were not uniformly effective, but appear, at minimum, to have increased awareness of the indications for neuroleptics.

Lawrence K. Altman reviews the book 'Naked to the Bone: Medical Imaging in the Twentieth Century' by Bettyann Holtzmann Kevles

Dr. [Richard Doll] said he believed that an important factor in the gap was that the male body was bigger and had more cells, providing a greater chance for something in a cell to go wrong. 'Lung cancer mortality in nonsmokers, for example, is about 20 percent higher in males than females, and one can easily account for that by the greater number of cells' in the airways, Dr. Doll said. The data analyzed by Dr. [Eileen Crimmins] are not nearly as bleak as is commonly believed. 'The difference in death rates makes women look less healthy in old age,' Dr. Crimmins said. 'The males have died off before they become disabled.' 'It is not that women have a greater tendency to get health problems,' Dr. Crimmins said, 'but that they live long enough' to fall into the most vulnerable period of life for disabling illness. And, she said, 'they live longer once they have them.'

In a surprising finding that is likely to intensify the hunt for viruses as causes of cancer, scientists have linked an AIDS-associated virus with a common blood cancer. The virus, Kaposi's sarcoma herpes virus, was discovered in 1994 among individuals who had AIDS and Kaposi's, a cancer that affects the skin and internal organs. In the new study, the virus was linked to multiple myeloma, the second most common blood cancer in this country, after non-Hodgkins lymphoma. The Kaposi's virus was found in all 15 myeloma patients tested but not in 16 patients with other cancers and 10 healthy volunteers, the authors said in a report being published today in the journal Science. The virus was also detected in patients with two related, but less common blood disorders, Waldenstrom's and amyloidosis, Dr. James R. Berenson, a co-author, said in an interview. To their surprise, the scientists found the Kaposi virus only in noncancerous cells and not in the malignant myeloma ones. The Los Angeles team suspects that the Kaposi's sarcoma virus may cause myeloma indirectly by the infected cells chemically stimulating other cells to become malignant