Voiding dysfunction in human immunodeficiency virus infections

PURPOSE: We prospectively evaluated the current spectrum of urodynamic pathology in patients infected with human immunodeficiency virus (HIV) who presented with voiding dysfunction. MATERIALS AND METHODS: We obtained a directed genitourinary and neurological history, and performed a physical examination and urodynamic testing in 18 patients. A 4-channel membrane urethral catheter was used to record intravesical and intraurethral pressures simultaneously. RESULTS: Detrusor hyperreflexia was present in 28% of our patients and detrusor-sphincter dyssynergia in 28%. Detrusor areflexia, previously described as the most frequent abnormality, was uncommon in our series (6% of patients). CONCLUSIONS: This changing proportion of urodynamic diagnoses may reflect a changing pattern of neurological manifestations of HIV infection due to more aggressive management. Urodynamic evaluation remains critical for precise diagnosis and treatment in patients with HIV who present with urinary symptoms.     

Numerical aspects of pontine, lateral reticular, and inferior olivary projections to two paravermal cortical zones of the cat cerebellum

Two different olivo-cortico-nuclear zones in the cat cerebellum have been compared quantitatively as regards the numbers of cells projecting to them from within several sources of mossy fibres (MFs), namely the basal pontine nuclei (BPN), nucleus reticularis tegmenti pontis (NRTP), and the ipsilateral lateral reticular nucleus (LRN). The zones chosen were the C3 zone in lobule V of the anterior lobe and the C1 zone in pars copularis of the paramedian lobule (PMLpc), localised by recording climbing fibre-mediated potentials evoked on their surface as a result of volleys set up in their spino-olivocerebellar paths. The zones were injected with fluorescent-labelled latex microspheres and cell bodies, retrogradely labelled in the MF source nuclei and in the contralateral inferior olive, were counted and mapped. Evidence was obtained that tracer efficiency was very high in both the MF projections and the olivo-cerebellar projection and that each olivocerebellar axon may provide only one climbing fibre to the upper part of a lobule V folium but an average of nearly two to the same part of a PML folium. When the numbers of labelled cells in each MF source nucleus were expressed as a percentage of the total number of labelled pontine cells, the biggest source for lobule V was the contralateral BPN, followed by LRN, contralateral NRTP, ipsilateral BPN, and ipsilateral NRTP. For PMLpc, the order was similar except that ipsilateral BPNs exceeded contralateral NRTPs, but the dominance of contralateral BPN as a source was much greater. Cell totals were converted into projection densities (i.e., numbers of cells labelled per square millimetre of cortical sheet involved in the injection site); densities for PMLpc were found to be almost three times greater than those for lobule V for contralateral BPN but the two densities were not significantly different for ipsilateral BPN. The three other MF sources projected at higher densities to lobule V than to PML. These findings indicate that two cortical zones, both of which receive climbing fibres from the rostral part of the dorsal accessory olive and project to nucleus interpositus anterior, nevertheless differ markedly in regard to both the relative and the absolute sizes of the projections they receive from several of their most important sources of MFs.     

Analysis of data from group-randomized trials with repeat observations on the same groups

This study used Monte Carlo simulations to evaluate the performance of alternative models for the analysis of group-randomized trials having more than two time intervals for data collection. The major distinction among the models tested was the sampling variance of the intervention effect. In the mixed-model ANOVA, the sampling variance of the intervention effect is based on the variance among group x time-interval means. In the random coefficients model, the sampling variance of the intervention effect is based on the variance among the group-specific slopes. These models are equivalent when the design includes only two time intervals, but not when there are more than two time intervals. The results indicate that the mixed-model ANOVA yields unbiased estimates of sampling variation and nominal type I error rates when the group-specific time trends are homogenous. However, when the group-specific time trends are heterogeneous, the mixed-model ANOVA yields downwardly biased estimates of sampling variance and inflated type I error rates. In contrast, the random coefficients model yields unbiased estimates of sampling variance and the nominal type I error rate regardless of the pattern among the groups. We discuss implications for the analysis of group-randomized trials with more than two time intervals.     

Reduction of renal uptake of monoclonal antibody fragments by amino acid infusion

The renal uptake of radiolabeled antibody fragments and peptides presents a problem in radioimmunodetection and therapy, compromising lesion sensitivity, especially with intracellularly-retained isotopes. Previously, we showed that cationic amino acids and their derivatives are capable of significantly reducing kidney uptake in animals. We report our initial clinical results of successful renal uptake reduction in five patients who underwent cancer radioimmunodetection with 99mTc-anti-CEA Fab' fragments. METHODS: The patients were infused with two liters of a commercially-available nutritive amino acid solution (containing approximately 2.25 g/liter lysine-glutamate and 2.50 g/liter arginine), whereas 75 control patients received the same volume of saline (quantification of organ and tumor kinetics from conjugate whole-body views by ROI technique). RESULTS: The renal uptake in the amino acid group was significantly lower (p<0.05) than in the control group (11.1 +/- 2.0% injected dose versus 17.7 +/- 7.0% injected dose at 24 hr postinjection), whereas the uptake of all other organs remained unaffected. Gel filtration chromatography of the urine taken from amino-acid-treated patients showed that a significantly higher amount of excreted activity was bound to intact Fab' (53% of excreted activity) in contrast to only less than 10% in the control group. CONCLUSION: The renal uptake of monoclonal antibody fragments in patients can be reduced significantly by amino acid infusion, even at considerably lower doses than those that were safe and effective in animals. As was found in animals, the mechanism seems to rely on an inhibition of the re-absorption of tubularly-filtered proteins by the proximal tubule cells. These results encourage further clinical trials to lower the renal uptake experienced in radioimmunodetection, as well as in therapeutic trials with antibody fragments and peptides.     

Treatment outcome with radiation therapy after breast augmentation or reconstruction in patients with primary breast carcinoma

BACKGROUND: Analyses were performed to determine local control and cosmetic outcome of breast carcinoma patients with prosthetically augmented or reconstructed breasts who had received radiation therapy (RT). METHODS: Twenty-one newly diagnosed breast carcinoma patients with prosthetically augmented or reconstructed breasts were treated with external beam RT. All patients received whole breast RT (median dose, 50.4 gray [Gy]) and 19 were boosted to a median dose of 60.4 Gy. A median dose of 50.4 Gy was delivered to the regional lymph nodes in 12 patients. Tissue equivalent bolus material was used in six patients. Seventeen patients received adjuvant systemic therapy. Cosmetic results were evaluated at 3-6-month intervals. RESULTS: With a median follow-up of 32 months, good/excellent cosmetic results were observed in 71% of patients (100% in those with augmented breasts and 54% in those with reconstructed breasts). Four patients (19%) with fair/poor cosmetic outcomes required implant removal and/or revision. Multiple clinical and treatment-related factors were analyzed for their impact on cosmetic outcome. A worsened cosmetic result was observed with increasing stage (P = 0.076), breast reconstruction (vs. augmentation) (P = 0.030), and bolus application (P = 0.016). All patients with fair/poor cosmetic outcomes had time intervals from implant insertion to RT ranging from 53-213 days. Two patients developed an isolated local recurrence within the augmented breast. CONCLUSIONS: Patients with prosthetically augmented breasts can undergo RT and expect good/excellent cosmetic results. Patients with reconstructed breasts are at a significantly greater risk for cosmetic failure. This risk may be related to the higher percentage of patients with advanced disease, those who received bolus application, and those who received earlier delivery of RT (after the cosmetic procedure) in reconstructed breasts.     

Bioavailability of two clodronate formulations

Sodium clodronate is effective in the management of osteolytic lesions, hypercalcaemia and bone pain associated with skeletal metastasis. Clinical and biochemical data underpin a licensed total daily dose of 1600-3200 mg.     

Human immunodeficiency virus-associated neoplasms: epidemiology, pathogenesis, and review of current therapy

The development of cancer in the setting of human immunodeficiency virus (HIV) infection is a devastating event and highlights the role of impaired immunity in the generation of various neoplasms. Improved strategies to suppress viral replication and prevent opportunistic infections generally have enabled patients with HIV to live longer and more productively. Unfortunately, acquired immune deficiency syndrome (AIDS)-associated neoplasia is increasing. Kaposi's sarcoma (KS), primary central nervous system lymphoma, intermediate- and high-grade B-cell lymphoma, and invasive cervical carcinoma are AIDS-defining conditions and the most commonly encountered malignancies. Recent information suggests an indirect role for HIV in the pathogenesis of these tumors. Effective treatment involves addressing complex variables encountered specifically in patients with AIDS. This review focuses on the epidemiology, pathogenesis, and treatment of KS and non-Hodgkin's lymphoma.