a Medical Food-Supplemented Detoxification Program in the Management of Chronic Health Problems

Objective * To evaluate the effectiveness of a medical food-supplemented detoxification program versus a hypoallergenic, calorie-controlled diet alone in the management of symptoms in chronically ill patients. Design * Outcome-focused study of patient response to dietary interventions. Setting * Clinical outpatient research facility. Patients * 106 chronically ill patients. Intervention * A medical food supplement designed to provide nutritional support for gastrointestinal healing and hepatic detoxification in addition to an oligoantigenic, calorie-controlled diet, versus an oligoantigenic, calorie-controlled diet alone. Results * The 84 patients in the experimental group, who consumed the medical food supplement, had a 52% reduction in symptoms over 10 weeks as measured by the Metabolic Screening Questionnaire. In comparison, the 22 patients on the control diet had only a 22% reduction of symptoms. Symptom reduction in the intervention group occurred concomitantly with the normalization of hepatic phase I cytochrome P450 activity in relation to phase II glycine conjugation detoxification function measured before and after intervention. The intervention group also had a statistically significant increase in urinary sulfate-to-creatinine ratio after treatment, suggesting improved reserves of sulfur-conjugating nutrients and glutathione status. Enhanced nutrient absorption after intervention was implied by the increased absorption and urinary excretion of mannitol after the 10 weeks of therapy, although the results were only marginally significant. Conclusions * These results suggest that this supplemental medical food program may provide an important adjunctive therapy for the management of many complex symptoms associated with the chroni     

Adherence to guidelines for the prevention of HIV-related respiratory diseases

In this study we characterized the pattern of use of preventive therapies for specific respiratory diseases within a cohort of homosexual men and assessed the impact of targeted feedback on the level of compliance with guidelines for these diseases. All human immunodeficiency virus seronegative (HIV-) (n=169) and acquired immune deficiency syndrome (AIDS)-free human immunodeficiency virus seropositive (HIV+) (n=154) participants in our cohort, who completed four annual visits between October 1989 and December 1993, were identified. Information about the use of purified protein derivative (PPD) (tuberculin) testing, history of pneumococcal vaccinations, influenza vaccinations, use of Pneumocystis carinii pneumonia (PCP) prophylaxis, symptoms and CD4 counts was obtained yearly for each subject. In 1992, participating physicians were provided with feedback regarding the overall levels of compliance with contemporary guidelines for the prevention of respiratory disease. As part of this exercise, the guidelines were distributed and discussed. The percentage of HIV+ patients who underwent PPD testing increased from 43 to 65% during the study (p=0.001). Significantly more HIV+ than HIV- patients underwent PPD testing (p<0.001). A total of 144 (94%) HIV+ men received at least one influenza vaccination compared to 60 (35%) HIV- men (p<0.001). Utilization of influenza vaccination in the HIV+ group significantly increased from 78% in 1992 to 92% in 1993 (p<0.001). A total of 104 (68%) HIV+ men received pneumococcal vaccination compared to 2 (1%) HIV- men (p<0.001). Among HIV+ individuals whose absolute CD4+ count was less than 200 cells x mm(-3), the percentage of men who received primary PCP prophylaxis was 0, 86, 72 and 88 for the years 1990-1993, respectively. Among HIV+ patients whose only eligibility criterion for PCP prophylaxis was a CD4+ percentage <20%, compliance was 55, 30, 37 and 50% for the years 1990-1993, respectively. Among HIV+ subjects, increases in the compliance level were noted for all preventive therapies after targeted feedback was provided during the last quarter of 1992. However, only utilization of influenza vaccine exceeded a 90% compliance in 1993. These data demonstrate that a suboptimal level of compliance with current guidelines for the prevention of respiratory disease among human immunodeficiency virus-infected individuals can be significantly improved using targeted feedback. Although it is likely that similar effects could be achieved in other populations or the community at large, this remains to be demonstrated.     

Early postoperative gadolinium-DTPA-enhanced MR imaging after successful lumbar discectomy

Cytotoxic T lymphocytes (CTLs) recognise antigenic peptides in the context of major histocompatibility complex (MHC) class I molecules on virus-infected cells. The formation and transportation of antigenic peptides to class I MHC in the cells are multi-step reactions known as antigen processing. In order to design a good DNA vaccine, it is important to dissect the specificity of antigen processing. Here we describe the construction of an epitope-based plasmid vector as a device to investigate antigen processing in transfected cells. The epitope-based plasmid vector was constructed by insertion of an epitope-encoding minigene into the lacZ gene. We used a CTL epitope on influenza A virus nucleoprotein (NP366-374 epitope) as a model. Upon transfection, the epitope-based plasmid vector induced the expression of NP epitope antigenically as well as immunogenically. Immunization of mice with plasmid-transfected cells was able to induce NP epitope-specific CTLs in vivo. Moreover, the plasmid vector functioned as a gene vaccine; NP epitope-specific CTLs were primed in vivo upon transfection of the vector into dermis by electroporation. The results suggest that this epitope-based DNA delivery system may provide a new strategy for in vivo induction of epitope-specific CTLs to investigate antigen processing and presentation.     

Impaired processing of proopiomelanocortin in corticotroph macroadenomas

The p53 mutations in the reported 243 lung cancers and our 59 cases were analyzed. The common base substitutions found in the lung cancer were G to T transversion (35%), C:G to T:A (26%) and A:T to G:C transitions (11%). Four types of the hot spot, 1) G to T transversion, 2) A to G transition in ApT site, 3) C to T transition in CpG site and 4) mix of the transversion and transition were identified. It is suggested that A to G transition at ApT site in the non-transcribed strand may be a new hot spot in the p53 gene in lung carcinoma. We also show that microscopic selection of cancer cells will facilitate the detection of p53 mutations in adenocarcinomas.     

Totally implantable venous access devices in adult patients with cystic fibrosis

Between September 1987 and April 1995, 33 totally implantable venous access devices (TIVADs) were implanted at the Cardiff Adult Cystic Fibrosis Centre, U.K., for the purpose of intermittent antibiotic therapy, including 22 PORT-A-CATH (Simcare Ltd.) devices (PCs) to 18 patients, and 11 P.A.S.PORT (Simcare Ltd.) devices (PPs) to nine patients. There were 50 complications during 25 824 days of catheter function which were severe enough to lead to removal of the devices in eight patients (six PCs and four PPs). Overall, patients' acceptance of these devices was excellent. Despite a shorter functional time and a higher rate of complications in PPs compared with PCs, PPs were preferred by many patients for cosmetic reasons. Totally implantable venous access devices provide safe, effective and convenient means of venous access in cystic fibrosis patients requiring intermittent antibiotic therapy.