Faculty Bibliography

OBJECTIVES: Although human immunodeficiency virus (HIV)-infected patients are now living longer, there are no published data on colorectal cancer (CRC) screening in this population. We hypothesized that HIV-infected patients were less likely to be screened for CRC compared to patients without HIV. METHODS: Consecutive HIV-infected patients > or =50 yr old seen in our outpatient clinic from 1/1/01 to 6/30/02 were identified. For each HIV-infected patient, we selected one age- and gender-matched control subject without HIV infection who was seen during the same time period. The electronic medical records were reviewed to determine the proportion of patients that had a fecal occult blood test (FOBT), flexible sigmoidoscopy, air-contrast barium enema (ACBE), or colonoscopy. RESULTS: During the 18-month study period, 538 HIV-infected outpatients were seen and 302 (56.1%) were > or =50 yr old. Despite significantly more visits with their primary care provider, HIV-infected patients were less likely to have ever had at least one CRC screening test (55.6%vs 77.8%, p < 0.001). The proportion of HIV-infected patients who ever had a FOBT (43.0%vs 66.6%, p < 0.001), flexible sigmoidoscopy (5.3%vs 17.5%, p < 0.001), ACBE (2.6%vs 7.9%, p= 0.004), or colonoscopy (17.2%vs 27.5%, p= 0.002) was significantly lower than in control subjects. In addition, HIV-infected patients were significantly less likely to be up-to-date with at least one CRC screening test according to current guidelines (49.3%vs 65.6%, p < 0.001). CONCLUSIONS: A substantial number of HIV-infected patients are > or =50 yr of age and CRC screening is underutilized in this population. Public health strategies to improve CRC screening in HIV-infected patients are needed.

In a series of human corticotroph adenomas, we recently found predominant mRNA expression of somatostatin (SS) receptor subtype 5 (sst5). After 72 h, the multiligand SS analog SOM230, which has a very high sst5 binding affinity, but not Octreotide (OCT), significantly inhibited basal ACTH release. To further explore the role of sst5 in the regulation of ACTH release, we conducted additional studies with mouse AtT-20 cells. SOM230 showed a 7-fold higher ligand binding affinity and a 19-fold higher potency in stimulating guanosine 5'-O-(3-thiotriphosphate) binding in AtT-20 cell membranes compared with OCT. SOM230 potently suppressed CRH-induced ACTH release, which was not affected by 48-h dexamethasone (DEX) pretreatment. However, DEX attenuated the inhibitory effects of OCT on ACTH release, whereas it increased the inhibitory potency of BIM-23268, an sst5-specific analog, on ACTH release. Quantitative PCR analysis showed that DEX lowered sst(2A+2B) mRNA expression significantly after 24 and 48 h, whereas sst5 mRNA levels were not significantly affected by DEX treatment. Moreover, Scatchard analyses showed that DEX suppressed maximum binding capacity (B(max)) by 72% when 125I-Tyr3-labeled OCT was used as radioligand, whereas B(max) declined only by 17% when AtT-20 cells were treated with [125I-Tyr11]SS-14. These data suggest that the sst5 protein, compared with sst2, is more resistant to glucocorticoids. Finally, after SS analog preincubation, compared with OCT both SOM230 and BIM-23268 showed a significantly higher inhibitory effect on CRH-induced ACTH release. In conclusion, our data support the concept that the sst5 receptor might be a target for new therapeutic agents to treat Cushing's disease.

[Bush], 59, remains in the 'superior' fitness category for a man his age, the doctors said. They also said Bush, who exercises six times a week, was 'fit for duty' and expected to remain so for the rest of his term. His resting heart rate is 47 beats a minute, normal for a well- trained athlete, and his blood pressure is normal, 110 over 64. When Bush ran for 26 minutes and 20 seconds, his heart rate reached 183 beats a minute, showing no abnormalities. Tests showed a low to very low risk of coronary artery disease

Mr. [Bush], 59, remains in the ''superior'' fitness category for a man his age, the doctors said. They also said Mr. Bush, who exercises six times a week, was ''fit for duty'' and expected to remain so for the rest of his term. Mr. Bush's parents, former President George H.W. Bush, and his wife, Barbara, suffered from overactivity of the thyroid gland, a condition that can cause unintended weight loss. Their son's thyroid function tests were reported as normal yesterday. Mr. Bush, who stopped running because of knee problems, bicycles 15 to 20 miles at 15 to 18 miles per hour and has suffered scrapes and bruises in falls from his bike. Mr. Bush's workouts also include exercising on a treadmill and an elliptical trainer, free-weight resistance training and stretching, the doctors said

[Bush], 59, remains in the 'superior' fitness category for a man his age, the doctors said. They also said Bush, who exercises six times a week, was 'fit for duty' and expected to remain so for the rest of his term. Bush's parents, former President George H.W. Bush, and his wife, Barbara, suffered from overactivity of the thyroid gland, a condition that can cause unintended weight loss. Their son's thyroid function tests were reported as normal yesterday. Bush, who stopped running because of knee problems, bicycles 15 to 20 miles at 15 to 18 miles per hour and has suffered scrapes and bruises in falls from his bike. Bush's workouts also include exercising on a treadmill and an elliptical trainer, free-weight resistance training and stretching, the doctors said

PHOTO; VISITING A VETERAN: President [Bush] hugs Molly Sloan, mother of Marine Capt. Stephen 'Kyle' Sloan, on Saturday at the National Naval Medical Center in Bethesda, Md. Sloan was injured in Iraq. Bush awarded seven Purple Hearts at the hospital. Getty Images photo/ Eric Draper, The White House

About 1947, the Medical Research Council, the British equivalent of the National Institutes of Health, asked Sir Austin, a professor of medical statistics at the London School of Hygiene, to investigate the causes of lung cancer. Sir [Austin Bradford Hill], who was not a medical doctor. asked Sir Richard to join him. Initially, Sir Richard said that he and most other physicians did not see a link between cigarettes and lung cancer. In fact, Sir Richard said in an interview with this reporter that at first he suspected that the tar used to pave the growing number of roads, or possibly automobile exhaust, were at the root of the lung cancer epidemic. Sir [Harold Himsworth], a physician, was also concerned because the findings were so critically important and unexpected. He demanded that Sir Austin and Sir Richard confirm them in studies elsewhere in England. They did

BACKGROUND:Women have been underrepresented in statin trials, and few data exist on the effectiveness and safety of statins in this gender. We used sequential electron-beam tomography (EBT) scanning to quantify changes in coronary artery calcium (CAC) as a measure of atherosclerosis burden in patients treated with statins. METHODS AND RESULTS/RESULTS:In a double-blind, multicenter trial, we randomized 615 hyperlipidemic, postmenopausal women to intensive (atorvastatin 80 mg/d) and moderate (pravastatin 40 mg/d) lipid-lowering therapy. Patients also submitted to 2 EBT scans at a 12-month interval (mean interval 344+/-55 days) to measure percent change in total and single-artery calcium volume score (CVS) from baseline. Of the 615 randomized women, 475 completed the study. Mean+/-SD percent LDL reductions were 46.6%+/-19.9% and 24.5%+/-18.5 in the intensive and moderate treatment arms, respectively (P<0.0001), and National Cholesterol Education Program Adult Treatment Panel III LDL goal was reached in 85.3% and 58.8% of women, respectively (P<0.0001). The total CVS% change was similar in the 2 treatment groups (median 15.1% and 14.3%, respectively; P=NS), and single-artery CVS% changes and absolute changes were also similar (P=NS). In both arms, there was a trend toward a greater CVS progression in patients with prior cardiovascular disease, diabetes mellitus, and hypertension, whereas hormone replacement therapy had no effect on progression. CONCLUSIONS:In postmenopausal women, intensive statin therapy for 1 year caused a greater LDL reduction than moderate therapy but did not result in less progression of coronary calcification. The limitations of this study (too short a follow-up period and the absence of a placebo group) precluded determination of whether progression of CVS was slowed in both arms or neither arm compared with the natural history of the disease.

On April 5, 1951, at the University of Minnesota in Minneapolis, Dennis performed the world's first open-heart operation to be done with a heart-lung bypass machine. The apparatus worked well, but the patient, a six-year-old girl, died because her heart defect, far more complicated than the surgical team had realized, was beyond any repair then possible. In 1945, when Dennis began his research into such an apparatus, surgeons' ability to repair a damaged heart was very limited. Given its dangers, the leading surgeons of the late 19th century had virtually banned efforts at heart surgery. Yet along the way, a few defiant leaders repaired certain types of heart defects in procedures that, Dennis said, 'fired the imaginations of surgeons.'