Faculty Bibliography

In a sharp turnaround driven by the need to stop the AIDS epidemic, the World Health Organization is moving ahead with plans for the first large trials of the two most widely tested experimental AIDS vaccines. The United States rejected plans for testing the vaccines in this country in June. The trials now being planned could involve several thousand volunteers. The experiments are aimed at determining whether the vaccines can prevent infection with HIV, not whether they can prevent AIDS in people already infected with HIV. Developing an AIDS vaccine has been a top priority for public health officials around the world since shortly after AIDS was first recognized in 1981. But the goal has become more urgent as the number of people infected with HIV has surged. The World Health Organization now estimates that 17 million people have been infected and that 4 million have AIDS. Even a vaccine with a low degree of protection would be valuable

Both vaccines have gone through the first two stages of a three-stage testing system, evaluating safety and immunologic responses. The third phase tests the vaccines' ability to protect against the disease, and the trials now being planned could involve several thousand volunteers. The experiments are aimed at determining whether the vaccines can prevent infection with H.I.V., not whether they can prevent AIDS in people already infected with H.I.V. If enough volunteers relaxed their guard against H.I.V., the incidence of H.I.V. could rise in the community. Although the concern is theoretical, Dr. [Peter Piot] said, 'we are taking it seriously,' The World Health Organization will take steps to augment community efforts for H.I.V. prevention through education and counseling and to measure the impact of a vaccine trial on a community. 'We want to make sure that we are not exposing more people to H.I.V. than before the vaccine trial,' Dr. Piot said

Developing an AIDS vaccine has been a top priority for public-health officials around the world since shortly after acquired immune deficiency syndrome was first recognized in 1981. But the goal has become more urgent as the number of people infected with HIV has surged. The WHO now estimates that 17 million people have been infected and that four million have AIDS. Even a vaccine with a low degree of protection would be valuable

In a sharp turnaround driven by a desperate need to stop the AIDS epidemic, the World Health Organization is moving ahead with plans for the first large trials of the two most widely tested experimental AIDS vaccines. The United States rejected plans for testing the vaccines in this country in June. Both vaccines have gone through the first two stages of a three-stage testing system, evaluating safety and immunologic responses. The third phase tests the vaccines' ability to protect against the disease, and the trials now being planned could involve several thousand volunteers. The experiments are aimed at determining whether the vaccines can prevent infection with HIV, not whether they can prevent AIDS in people already infected with HIV. Developing an AIDS vaccine has been a top priority for public health officials around the world since shortly after AIDS was first recognized, in 1981. But the goal has become more urgent as the number of people infected with HIV has surged. WHO now estimates that 17 million people have been infected and that 4 million have AIDS. Even a vaccine with a low degree of protection would be valuable

Both vaccines have gone through the first two stages of a three-stage testing system, evaluating safety and immunologic responses. The third phase tests the vaccines' ability to protect against the disease, and the trials being planned could involve several thousand volunteers. The experiments are aimed at determining whether the vaccines can prevent infection with HIV, not whether they can prevent AIDS in people already infected with HIV. Developing an AIDS vaccine has been a top priority for public health officials around the world since 1981, shortly after AIDS was first recognized. But the goal has become more urgent as the number of people infected with HIV has surged. WHO estimates that 17 million people have been infected and 4 million have AIDS. Even a vaccine with a low degree of protection would be valuable

Now, despite reports that a World Health Organization team has found that plague did strike in two cities, Indian experts in infectious diseases maintain that the epidemic was not plague, but was due to some other as yet unidentified agent. Their contention is based largely on two points: that the plague bacterium, Yersinia pestis, was never isolated from any case and that the types of laboratory tests used in India are not definitive. Failure to isolate Y. pestis from any case has been one of the major puzzles of the Indian epidemic. But the lack of evidence does not exclude plague because the ability to culture the organism depends on doing the requisite bacteriological tests. But lack of an isolate does eliminate the ability to determine whether the Indian plague epidemic was due to a new strain of Y. pestis as some experts have suggested. India had not reported plague for about 30 years, leading to the mistaken belief that Y. pestis had disappeared from the country. But apparently the only thing that had disappeared was the expertise to diagnose and deal with plague. In the early days of this year's epidemic, doctors and health officials in India were scurrying to get information on plague, but officials at first refused to ask for outside help or even to accept it when offered

At the same time, however, anyone from the area with any fever resembling plague was labelled as a suspected plague case. Most of the more than 6,000 suspected plague cases reported were due to other diseases, Dr. [David Dennis] said. The measures overwhelmed the laboratories and the health system's ability to investigate the epidemic

Chemosensitivity of B lymphocytes, obtained from 65 patients with B-cell chronic lymphocytic leukemia (B-CLL), Rai stages 0 through IV, was determined using the MTT assay. The results were expressed by the drug concentration required for 50% inhibition of cell viability (IC50). The cytotoxicity of chlorambucil (CLB) was compared with that of fludarabine and the DNA topoisomerase I inhibitors, camptothecin, 9-aminocamptothecin, 10,11-methylenedioxy-20(S)-camptothecin (10,11-MDC) and 9-amino-10,11-methylenedioxy-20(S)-campthothecin (9-A-10,11-MDC), and topotecan. Considerable heterogeneity in sensitivity to CLB was observed, with a median IC50 of 40.5 mumol/L in untreated patients. B-CLL cells from patients treated with CLB had a significantly higher median IC50 of 86.0 mumol/L (P < .01). Untreated as well as CLB-treated patients were divided into two subsets. For the purpose of this study, B-CLL lymphocytes with an IC50 CLB of less than 61.0 mumol/L were designated as 'sensitive' and those with an IC50 CLB of > or = 61.0 mumol/L were designated as 'resistant.' After baseline assays, 15 untreated patients received CLB; after treatment, the IC50 increased in B-CLL lymphocytes from 13 of 15 patients. The response to CLB treatment, determined by its effect on the absolute lymphocyte count and by the Eastern Cooperative Oncology Group clinical criteria, was significantly better in patients whose lymphocytes had an IC50 CLB of less than 61.0 mumol/L before therapy (P < .01). B-CLL lymphocytes also had a variable degree of sensitivity in vitro to each of the other drugs. There was significant cross-resistance between CLB and fludarabine (P < 0.01). Whereas only 29% of CLB-resistant B-lymphocyte specimens obtained from individual patients were sensitive to fludarabine in vitro, 52% and 67% of CLB-resistant lymphocyte samples were sensitive to 10,11-MDC and 9-A-10,11-MDC, respectively. We have previously reported that p53 gene mutations were associated with aggressive B-CLL and a poor prognosis. B lymphocytes from seven patients with these mutations were resistant to CLB, and five of six were resistant to fludarabine. Lymphocytes from four of seven were resistant to 10,11-MDC, and three of four were resistant to 9-A-10,11-MDC. This study implies that the MTT assay may be useful in identifying subsets of CLL patients resistant to conventional chemotherapy. However, definitive conclusions can not be drawn in view of the small number of patients studied prospectively. In addition, these results suggest the potential of camptothecin-based therapy for patients unresponsive to standard treatment

BACKGROUND: Costochondritis (CC) is a common, but poorly understood condition among patients with chest wall pain. We have prospectively analyzed distinctive features of patients presenting to the emergency department with chest pain and CC. METHODS: Patients with a chief complaint of chest pain, not due to trauma, fever, or malignancy, were prospectively evaluated for the presence of CC and compared with another chest pain group without CC. RESULTS: Of 122 consecutive patients studied, 36 had CC (30%) and in 17 the pain induced reproduced the original one (15%). Women made up 69% of the patients with CC (vs 31% of control subjects) and Hispanics 47% (vs 24% of control subjects). Only three patients (8%) with CC met the American College of Rheumatology criteria for fibromyalgia, while none of the control subjects did. Widespread pain was more common in the CC group (42% vs 5%). The mean sedimentation rate in the CC group was 44 +/- 31 mm/h vs 41 +/- 31 mm/h in the control group. The acute myocardial infarction rate was 6% in the CC group vs 28% in the control group. Rheumatoid arthritis and osteoarthritis were diagnosed in three and two patients, respectively, of 32 patients with CC cases. One year later, 11 (55%) of 21 patients with CC were still suffering from chest pain, but only one third still had definite CC. CONCLUSIONS: Costochondritis is common among patients with chest pain in an emergency department setting, with a higher frequency among women and Hispanics. It is associated with fibromyalgia in only a minority of cases. Patients with CC appear to have a lower frequency of acute myocardial infarction. Spontaneous resolution is seen in most cases at 1 year

Letters of support from well-wishers poured into Mr. [Ronald Reagan]'s home in California. But there was little comfort in reports that the 83-year-old Mr. Reagan, whose talent as a storyteller was legendary, now forgets the punch lines to some of his favorite jokes