Faculty Bibliography

Malignant tumors, particularly Kaposi's sarcoma and certain cancers of the lymph system, have been common among AIDS patients since the disease was first recognized in 1981. But now the array of cancers is broadening in mysterious ways. Once rare cancers are appearing more often. Some kinds of cancer that were expected to increase in frequency have not. And strange geographical patterns of certain cancers are emerging. It is a baffling situation, yet scientists see hope in it. Researchers are looking at the puzzling trends with the aim of identifying and using biological clues to unlock the secrets of the myriad cancers that afflict people who are not infected with H.I.V, the virus that causes AIDS, and to devise new ways to treat them. An emerging theory is that most AIDS-related cancers are somehow linked to viral infections. But doctors do not know if H.I.V. enhances the ability of other viruses to produce certain cancers, scientists said here last week, at the first international meeting devoted to AIDS and cancer. The meeting was sponsored by the National Cancer Institute

OBJECTIVE: To determine whether patient preferences for the use of coronary revascularization procedures differ between white and black Americans. DESIGN: Cross-sectional survey. SETTING: Tertiary care Department of Veterans Affairs hospital. PATIENTS: Outpatients with and without known coronary artery disease were interviewed while awaiting appointments (n = 272). Inpatients awaiting catheterization were approached the day before the scheduled procedure (n = 80). Overall, 118 blacks and 234 whites were included in the study. MEASUREMENTS AND MAIN RESULTS: Patient responses to questions regarding (1) willingness to undergo angioplasty or coronary artery bypass surgery if recommended by their physician and (2) whether they would elect bypass surgery if they were in either of two hypothetical scenarios, one in which bypass surgery would improve symptoms but not survival and one in which it would improve both symptoms and survival. Blacks were less likely to say they would undergo revascularization procedures than whites. However, questions dealing with familiarity with the procedure were much stronger predictors of a positive attitude toward the procedure use. Patients who were not working or over 65 years of age were also less interested in procedure use. In multivariable analysis race was not a significant predictor of attitudes toward revascularization except for angioplasty recommended by their physician. CONCLUSIONS: Racial differences in revascularization rates may be due in part to differences in patient preferences. However, preferences were more closely related to questions assessing various aspects of familiarity with the procedure. Patients of all races may benefit from improved communication regarding proposed revascularization. Further research should address this issue in patients contemplating actual revascularization.

Plasma homocyst(e)ine [H(e)] levels correlate with the prevalence of arterial occlusive diseases. Recently, transesophageal echocardiography (TEE) has been used to evaluate patients with atherosclerotic plaques in the thoracic aorta. The purpose of this study was to determine whether H(e) levels correlate with the degree of atherosclerotic plaque in the thoracic aorta (ATH) as seen on TEE. Maximum plaque areas for three locations in the thoracic aorta (arch, proximal descending, and distal descending) were measured with TEE in 156 patients. Maximum plaque areas for these locations were added to yield an estimate of ATH. ATH and H(e) levels, and levels of folic acid, vitamin B12, and pyridoxal 5'-phosphate were measured in a double-blind manner. Univariate analysis demonstrated a significant correlation of H(e) with ATH (r = 0.3, p< 0.001). On multivariate analysis, H(e) was independently predictive of ATH (r for the model including H(e) was 0.63, p < 0.0001). Plasma H(e) levels are therefore significantly and independently correlated with the degree of atherosclerosis in the thoracic aorta

A novel vaccine has protected two chimpanzees that were deliberately injected with the AIDS virus, scientists said today. The experiments involved a vaccine made by incorporating weakened genes from H.I.V., the virus that causes AIDS. The experimental vaccine, which is based on DNA, is also being tested on humans, but it is too early for any meaningful results, said Dr. Anthony S. Fauci, the head of the National Institute of Allergy and Infectious Diseases. The authors of the chimp study injected large amounts of H.I.V. into the animals. Tests showed that the virus could be detected only once and in very small amounts during a 48-week monitoring period. In comparison, large amounts of H.I.V. were continually detected in another chimpanzee that received a different, weaker vaccine, the team of authors, led by Dr. David B. Weiner of the University of Pennsylvania, report in the journal Nature Medicine

A novel vaccine has protected two chimpanzees that were deliberately injected with the AIDS virus, scientists said yesterday. The experiments involved a vaccine made by incorporating weakened genes from HIV, the virus that causes AIDS. The experimental vaccine, which is based on DNA, is being tested on humans, but it is too early for any meaningful results, said Dr. Anthony S. Fauci, the head of the National Institute of Allergy and Infectious Diseases