Faculty Bibliography

A woman apparently acquired the AIDS virus from deep kisses with an infected man, Federal health officials said yesterday. They said the case was the first reported transmission of H.I.V., the AIDS virus, through kissing. Both the man and woman had gum disease, factors that apparently facilitated transmission of H.I.V. Transmission most likely was through the man's blood, not saliva, the Centers for Disease Control and Prevention in Atlanta said in its weekly report. In emphasizing the rarity of such transmission, the Federal centers said the case was the only known one involving kissing among the 500,000 AIDS cases that have been reported to it since the epidemic was detected in 1981

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