[Blindness after nitrous oxide anesthesia and internal gas tamponade]

The authors describe the case of a patient with bilateral retinal detachment. Immediately after surgery for the second eye under general anesthesia with nitrous oxide, the patient reported severe visual loss in the first eye successfully treated surgically 2 weeks before, with a residual gas bubble (C3F8) of 50%. In this case, nitrous oxide had rapidly entered the gas bubble and induced a transient expansion of the gas tamponade with a dramatic increase in intraocular pressure. The consequence was a central retinal artery occlusion, which resulted in irreparable ischemic retinal damage and blindness, explaining the severe and sudden visual loss. Nitrous oxide is regularly used but contraindicated if intraocular gas is present, due to its potential threat to visual function. We suggest that patients anesthetized with nitrous oxide carry a card or a bracelet detailing the risks of intraocular gas tamponades combined with nitrous oxide and with travel to high altitudes. This would inform not only patients but also medical personnel caring for these patients.

Characterisation of atovaquone resistance in Leishmania infantum promastigotes

Atovaquone, an antiparasitic agent, could possibly represent an alternative therapy after relapse following classical treatment for visceral leishmaniasis. Atovaquone-resistant strains were selected in vitro by stepwise drug pressure to study the mechanism of resistance in Leishmania. Characteristics of a promastigote strain resistant to 250 microg/ml of atovaquone were compared with those of the wild type (WT) strain. Resistant strains were shown to have a high level of resistance (45 times). They were stable in drug-free medium for 6 months, and showed no cross-resistance with other antileishmanial drugs. Rhodamine uptake and efflux were studied. They were not modified in the resistant strain, indicating the absence of P-glycoprotein overexpession. The effect of atovaquone on membrane lipidic composition was determined in both WT and atovaquone-resistant promastigotes. Analysis of lipid composition of the atovaquone-resistant strain showed that sterol biosynthesis was decreased in atovaquone-resistant parasites. Cholesterol was found to be the major membrane sterol as opposed to the WT strain. Cholesterol, due to its ordering effect, could decrease membrane fluidity and subsequently block the passage of atovaquone through the membrane. Increased membrane cholesterol content and altered drug membrane fluidity resulted from possible decrease of ergosterol biosynthesis by atovaquone, incorporation of cholesterol by promastigotes in the culture medium, solubilisation of atovaquone by cholesterol and co-passage of the two compounds or influence of dimethylsulfoxide. These results indicate that different cellular alterations may participate in the resistant phenotype, by altering drug membrane permeability.

Allogeneic hematopoietic stem cell transplantation in ovarian carcinoma: results of five patients

Allogeneic hematopoietic stem cell transplantation is often used to treat hematologic malignancies. The efficacy of this procedure is due to both myeloablative conditioning and graft-versus-leukemia (GVL). However, the disadvantages of allogeneic transplantation include graft-versus-host disease (GVHD), relapse from the original tumor, and patient susceptibility to opportunistic infections. Lately, allogeneic transplantation has been developed to treat solid tumors, with the expectation that graft-versus-tumor (GVT), like GVL, will have a significant anti-tumor effect. This effect has been demonstrated in renal carcinomas, and with less evidence in breast cancers. Five patients with malignant ovarian tumors resistant to chemotherapy underwent allogeneic transplantation, four from bone marrow, and one from peripheral blood stem cells. All donors were HLA-identical siblings. One patient received a myeloablative conditioning regimen, while the other four received a non-myeloablative regimen. Two patients received donor lymphocyte infusions (DLI). Four of the patients presented with acute or chronic GVHD associated with tumor regression of at least 50%. These tumor regressions were measured by CA-125 levels and CT scans. The fifth patient died of rapid progression just after transplantation. Of the four transplantation survivors, three received a non-myeloablative regimen which did not seem to reduce treatment effectiveness. While it did reduce toxicity, one of these patients died of GVHD after 127 days. DLI was administered to two patients. These infusions seemed to promote GVHD which was able to control disease progression for one patient and had no apparent effect on the other. Allograft of hematopoietic stem cells might be of interest in ovarian cancer. The results in one patient also suggest that DLI may be an effective immunotherapy, although doses and timing need to be determined. The number of cases presented is small, however, and clinical experience on a larger scale will be required to determine the real clinical efficacy of graft versus cancerous ovarian cells.

Assessment of genetic variability of resistance to gastrointestinal nematode parasites in Creole goats in the humid tropics

Goat production is widespread in the tropics. Goats are very susceptible to gastrointestinal nematode infection, but there is less evidence of their genetic resistance. Genetic resistance of Creole goats to gastrointestinal nematodes has been studied at Guadeloupe in the French West Indies since 1995. The objective of this research was to investigate genetic variation for resistance to gastrointestinal nematode infection, in order to introduce this trait into breeding schemes. Genetic variability was assessed within a Creole experimental flock. Forty-nine sire groups were characterized at weaning and 55 during fattening after weaning. Kids were naturally infected, mainly by Haemonchus contortus and Trichostrongylus colubriformis. Fecal egg counts were determined once at weaning and every 6 and 7 wk after drenching during fattening. Blood samples were collected every 7 wk during fattening for determination of packed cell volume. Live weights were recorded at weaning and at the beginning and middle of every infection period during fattening. Genetic parameters were estimated using the REML for multivariate animal models. The heritability estimate for transformed fecal egg count was 0.37+/-0.06 at weaning. During fattening, it increased from 0.14+/-0.05 at 4 mo to 0.33+/-0.06 at 10 mo. Heritabilities of packed cell volume ranged from 0.10 to 0.33. At weaning, maternal heritability of fecal egg count reached 0.26 and direct heritability 0.20. After 6 mo of age, maternal effects were found to be unimportant for fecal egg count and packed cell volume. Live weights presented significant genetic variability. Genetic relationships between fecal egg counts and live weight in infected pastures were never significant. Genetic correlations between packed cell volume and live weight decreased from 0.47 to 0.10 from weaning to 10 mo of age. These results demonstrated the feasibility of breeding for improved resistance to nematodes in Creole kids.

Changes in womens' roles: impact on and social policy implications for the mental health of women and children

In recent years. womens' roles have changed dramatically, prompting researchers to examine the impact of these changes on the development of women and children. In this article, we examine three major changes that women have experienced over the past several decades: increased participation in the paid labor force, changes in domestic labor and child-care patterns, and increased numbers of female-headed single-parent families. For each, we first describe the nature of the changes that have occurred over the last 50 years. We then review research concerning the effects of these changes on the development of women and children. Finally, we discuss the implications for social policy that stem from this research. It is broadly concluded that research informed by a developmental-contextual perspective may contribute importantly to the development of social policies focused on promoting the well-being of women and children.

Prospective study of pulmonary function for cyclomegalovirus infection after renal transplantation

Pulmonary involvement remains the main complication of cytomegalovirus (CMV) infection in renal transplantation (RT). Early diagnosis is required for the best management of patients, and preemptive therapy could be a successful approach. In order to define the predictive value of lung alveolocapillary abnormalities. We prospectively studied 26 renal transplant recipients for their diffusing capacity of carbon monoxide (DLCO) and their pulmonary clearance of a 99mTc-DTPA aerosol. Patients were studied before transplantation and then every 2 weeks up to the end of the 3rd month following RT. Viral blood cultures and serological determinations were performed every week during these first 3 months. Bronchoalveolar lavage (BAL) was done in case of CMV disease. Statistic analysis was done using Student's t-test and Pearson's chi-square test. During the 3-month follow-up, 13 patients remained free of CMV infection. Three non-infected and 8 infected patients showed DTPA clearance abnormalities (P < 0.05). Six non-infected and 7 infected patients showed DLCO disturbance (P > 0.50). DTPA clearance were significantly modified on days 45 and 60 in the infected group. Serial DTPA scanning, in association with viral blood cultures, could be a useful test to avoid unnecessary BAL in a preemptive therapy strategy.

Women's experience following a cardiac event: the role of the self in healing

This study explored the role of the self in the experiences of women living with cardiovascular disease. The study, which used a naturalistic design, involved interviewing 13 women with a diagnosis of coronary heart disease (CHD) and analyzing their reports through constant comparative analysis. For women, living with CHD was characterized by changing images of the self. Women reported engaging in processes involving seeking meaning, creating mastery, and accepting the self. These processes were marked by the overarching theme of connectedness with significant others. The study findings enhance understanding of the role of the self in recovery for women with diagnosed CHD.

Social and contextual etiology of coronary heart disease in women

We explored the social and contextual etiology of coronary heart disease (CHD) prevention and management in women. Social and contextual influences on CHD risk include such factors as socioeconomic status, access to healthcare, cultural mores, working conditions including work overload, multiple role responsibilities, and social isolation. Women, particularly economically disadvantaged women, occupy lower levels on the social status hierarchy and, therefore, experience more stressful life experiences, less favorable living conditions, and less opportunity to affect positive health behavior and outcomes. Women are often discriminated against economically, politically, and socially, and this discrimination may adversely affect their efforts at CHD health promotion and treatment. Multiple role responsibilities within the family and psychosocial factors, including chronic life stress, are critical to an understanding of the health status of women, particularly poor and minority women. Although community-based interventions appear to be ideal for addressing the contextual risks related to CHD in women, a number of issues need to be considered, for example, the limited acknowledgment of secular trends in economic development that influence lifestyle decisions and health promotion efforts. Directions for research and interventions include recognition of the full spectrum of CHD risk in women, recognition of culturally competent interventions, and recognition of the need for empowerment of women.

Barriers to outpatient cardiac rehabilitation participation and adherence

BACKGROUND

A significant proportion of eligible patients do not participate in outpatient cardiac rehabilitation. The purpose of this study was to identify barriers to participation and adherence to outpatient cardiac rehabilitation by querying program staff.

METHODS

In January 1999, a survey was mailed to all North Carolina program directors of outpatient cardiac rehabilitation programs. The response rate was 85% (61/72).

RESULTS

Across programs, the most common barrier to participation in outpatient cardiac rehabilitation was financial. Other barriers identified by program directors included lack of patient motivation, patient work or time conflicts, and lack of physician support or referral. When program directors were asked to cite reasons that referred patients provided for not participating in rehabilitation, the most common answer was financial or lack of motivation or commitment. The most common reason cited for dropping out of the rehabilitation program was work, followed by financial reasons and lack of motivation or commitment.

CONCLUSIONS

The results of this statewide survey of program directors indicated a common set of barriers that many patients currently face to begin and continue participating in outpatient cardiac rehabilitation.

[Acquired ocular toxoplasmosis (panuveitis) after liver transplantation]

We present one case of acquired Toxoplasma gondii retinochoroiditis after livrer transplantation. Three weeks after receiving liver transplant from a seropositive donor for Toxoplasma gondii, the fundus examination showed a vitreal haze and an edematous retinal lesion with retinal hemorrhages. Routine screening tests for uveitis were performed. The serum toxoplasmosis titers revealed a seroconversion for toxoplasmosis (pre-transplantation tests were negative). The PCR assay on aqueous humor resulted in an amplified product identical to toxoplasmosis. This immunocompromised patient likely received an infected hepatic transplant. The patient's ocular inflammation cleared on 1-month pyrimethamine-sulfadiazine medication. Four months later, the patient developed a retinal detachment with massive proliferative vitreoretinopathy.

[Double irradiation for macroscopic radioresistance or recurrence of melanomas of the posterior uvea: clinical, ballistic, therapeutic and prognostic aspects. Series of 19 cases among 462 patients]

We describe two comparative series of patients treated with double-dose betaraysbrachytherapy (106 Ruthenium) between 1983 and 1994, and double-dose proton beam therapy between 1991 and 1996. The indications for double-dose irradiation with the same radio-element corresponded to "macroscopically abnormal" situations: immediate and prolonged radioresistance, recurrence or secondary radioresistance. Thirteen cases are called series 1 (Ruthenium) and 6 cases are called series 2 (protons). The series 1 allows a more reliable study as far as follow-up is higher (5.8 to 7.5 years) than in series 2 where the follow-up is shorter (13.6 to 29 months). Although double-dose irradiation was macroscopically efficient in 11 out of 13 cases in series 1, and in 3 out of 6 cases in series 2 (stabilization or decrease of tumour height measured before the second therapeutic session), 2 patients are deceased and 1 has a metastatic disease in the group "recurrence" of Ruthenium serie. Another one has also a metastatic disease in the group "recurrence" of protons series. Nevertheless double-dose radiotherapy allows a complementary decrease or stabilization of tumour height after a first session. It also decreases the indications for enucleation if there is no severe anatomic complications, when a tumour does not regress or recurs after a first session of radiations.

Noncardiac surgery in individuals with coronary heart disease

Atherosclerosis is a pathological condition of the coronary arteries clinically manifested as cardiovascular disease, the major cause of death in the industrialized world. Coronary heart disease (CHD) and cerebrovascular disease (CVD), both of which are atherosclerotic diseases, cause more death, disability, and economic loss in the United States than any other disease.

Family-centered care after acute myocardial infarction

The experience of a cardiac event is a significant source of stress for both patients and their family members. The acute phase after myocardial infarction reflects a crisis for patients and family members as they attempt to reconcile the affect of the event and adapt to the uncertainties associated with hospitalization and the initial recovery process. This article reviews empirical research available to cardiovascular nurses that may guide family-centered care during the acute phase after myocardial infarction. Directions for practice and research focus on cardiovascular nursing interventions that address family needs after an acute myocardial infarction. The experience of an acute myocardial infarction is a source of stress for both patients and their family members and may be viewed as a crisis that significantly disrupts family functioning and dynamics. The trajectory of cardiovascular disease involves multiple adjustments by patients and family members as they attempt to reconcile the affect of the event and adapt to the uncertainties associated with the acute phase of illness. Efforts by patients and family members to manage the stressors associated with the acute phase of cardiovascular illness are often associated with alterations in physiologic and psychologic functioning.

Predictive ability of social cognitive theory in exercise research: an integrated literature review

The mechanisms that underlie successful initiation and adherence to physical activity regimens are not well understood. Few theoretical models have used consistent explanatory variables that are theory-driven and many findings that use extant models are equivocal. Social Cognitive Theory (SCT) as presented by Bandura (1986, 1997) appears to have strong promise as a guide to understanding physical activity behaviors and developing clinically relevant interventions to promote the initiation and maintenance of physical activity. This critical systematic review of research using SCT was completed to determine the predictive ability of model constructs in explaining physical activity behavior and in identifying key intervention components found to enhance physical activity initiation and maintenance. Following review for quality and adequacy, published research during the years 1990-1998 contained 27 studies that examined the relationship between the construct of SCT, self-efficacy, and physical activity. All of the descriptive studies found a statistically significant relationship between self-efficacy and exercise behavior. Intervention studies demonstrated that participation in an exercise program promoted self-efficacy, and that programs designed to increase outcome expectations and self-efficacy significantly increased exercise behavior. Due to the centrality of self-efficacy in many of the social psychological theories that help explain the attitude-intention-behavior triad, a strong need remains to design interventions to maximize its usefulness. Clear, generalizable, systematic and theoretically comprehensive, randomized, controlled studies are needed to understand the usefulness of the construct.

Comparison of high-dose therapy and autologous stem-cell transplantation with conventional therapy for Hodgkin's disease induction failure: a case-control study. Société Francaise de Greffe de Moelle

PURPOSE

To determine the prognostic factors and outcome of first-line induction failure Hodgkin's disease patients who were treated with a salvage regimen of high-dose chemotherapy and autologous stem-cell transplantation, and to compare them with matched, conventionally treated patients.

PATIENTS AND METHODS

We retrospectively analyzed data relating to 86 Hodgkin's disease patients who underwent autologous stem-cell transplantation after failure of the first chemotherapy regimen, either because they did not enter a complete remission and experienced progression of disease less than 3 months after the end of their first-line treatment or because they showed evidence of disease progression during first-line therapy. Graft patients were matched with 258 conventionally treated patients (three controls per case) for age, sex, clinical stage, B symptoms, and time at risk; patient data were obtained from international databases.

RESULTS

Among the 86 graft patients, the median age at diagnosis was 29 years (range, 14 to 57 years). Thirty-nine percent of patients had stage II disease, 23% had stage III disease, and 38% had stage IV disease. Seventy percent of the patients received chemotherapy and 30% received combined modality therapy; 60% of the patients received a seven- or eight-drug regimen. After this first-line treatment, 91% had disease progression and 9% had a brief partial response. Eighty patients received a second-line treatment; pretransplantation status was as follows: 24% of patients had a complete remission, 38% had a partial remission (PR), 14% had stable disease, and disease progression occurred in 24%. With a median follow-up of 22 months (range, 4 to 105 months) from diagnosis, the 5-year event-free survival and overall survival rates from transplantation were 25% and 35% (95% confidence intervals, 15 to 36 and 23 to 49), respectively. In multivariate analysis, the pretransplantation disease status after salvage therapy was the only significant prognostic factor for survival (PR: relative risk = 2.8, P = .017; progressive disease: relative risk (RR) = 5.26, P < .001). From diagnosis, the 6-year overall survival rates of the graft patients and 258 matched conventionally treated patients were 38% and 29%, respectively (P = .058).

CONCLUSION

Autologous stem-cell transplantation represents the best therapeutic option currently available for patients with primary induction failure and is associated with acceptable toxicity. Response to second-line treatment before high-dose chemotherapy is the only prognostic factor that can be correlated with survival.

The index of self-regulation: development and psychometric analysis

This paper describes the development and initial psychometric evaluation of a measure of individual self-regulation in the maintenance of health behavior change. Items were developed from inductively generated data to index dimensions of self-regulation in behavioral change (Fleury, 1991). Quantification of Index of Self-Regulation (ISR) content validity was supported through the ratings of 10 experts, following criteria established by Imle and Atwood (1988). The instrument was tested in successive steps with 146 individuals who were participating in an outpatient cardiac rehabilitation program for reliability and validity, including internal consistency reliability and three forms of validity assessment (content validity, criterion-related validity, and construct validity). The three subscales of Stimulus Control, Reconditioning, and Behavioral Monitoring demonstrated internal consistency ranging from .73-.76. Total scale alpha was .87. Initial estimates of criterion-related and construct validity were documented with correlations between ISR subscales and theoretically related criterion measures (.20-.47). With refinement the ISR will provide a basis for tailoring and evaluating clinical interventions designed to enhance motivation in the maintenance of health behavior change.

[Postoperative proliferative vitreoretinopathy in rhegmatogenous retinal detachment associated with stage B preoperative proliferative vitreoretinopathy: comparative results of trans-scleral retinopexy with diode laser or trans-pupillary retinopexy with argon laser]

PURPOSE

To compare the rate of severe postoperative PVR in primary rhegmatogenous retinal detachments (RD) associated with preoperative grade B PVR and managed either with transpupillary Argon laser photocoagulation or transscleral Diode laser photocoagulation.

MATERIAL AND METHODS

We evaluated 72 primary rhegmatogenous retinal detachment associated with preoperative grade B PVR (retinal tears with curled posterior edges), referred before any failed attempt to reattach the retina. Eleven RD were due to giant tear. The retinopexy was performed using transpupillary Argon laser. photocoagulation in 46 eyes, and transscleral Diode laser photocoagulation in 26 eyes. Follow up was 6 to 30 months. Statistical analysis used Chi-square test, and variance analysis.

RESULTS

The overall rate of postoperative PVR was 6.9% (5/72 eyes). The rate of postoperative PVR was 6.5% (3/46) in eyes managed with Argon laser photocoagulation and 7.7% (2/26) in eyes managed with Diode laser photocoagulation (p > 0.05). The rate of postoperative PVR in RD due to horseshoe tears was 5.4% (2/37) in eyes managed with Argon laser and 8.3% (2/24) in eyes treated with Diode laser (p > 0.05). The rate of postoperative PVR in giant tear was 11.1% (1/9) in eyes managed with Argon laser photocoagulation and 0% (0/2) in eyes managed with Diode laser photocoagulation (p > 0.05).

CONCLUSION

In the present series the rate of postoperative PVR was not influenced by the method of photocoagulation (transpupillary Argon laser or transscleral Diode laser). Therefore each technique can be used as the retinopexy method in primary rhegmatogenous retinal detachment associated with preoperative grade B PVR.

A phase II study of interleukin-2 in 49 patients with relapsed or refractory acute leukemia

In this report we present the results of a multicenter phase II study of high-dose recombinant Interleukin-2 (rIL-2) in patients with refractory or relapsed acute leukemia. Forty-nine patients with acute myeloid leukemia (AML: 30 patients) or acute lymphoblastic leukemia (ALL: 19 patients) were included. Median age was 30 years (range: 4-71). Four patients were treated for primary refractory disease and 45 for relapsed disease (16 patients > 2nd relapse). Twenty-four patients (49%) had previously received bone marrow transplantation (allogeneic: 5, autologous: 19). Patients were scheduled to receive three 5-day cycles of rIL-2 given every other week. rIL-2 was administered as bolus I.V. infusion of 8 x 10(6) UI/m2 every 8 hours during cycle I and every 12 hours during cycles 2 and 3. Patients received a mean of 76% of rIL-2 planned dose. Main toxicity was hematologic (grade IV thrombopenia: 84%). Hemodynamic and metabolic toxicities lead to treatment discontinuation in 10 patients (20%). Strong immune activation was achieved including a significant increase in activated T-cells and Lymphokine-Activating-Killer cell (LAK) activity. Twenty-seven out of 30 AML patients could be evaluated for response: 2(7%) achieved complete remission (CR) which lasted 3 and 4 months. No response was observed in the 18 assessable ALL patients, most of whom (77 %) presented absolute drug resistance. These results show that this high dose rIL-2 regimen induces significant biological effects and provides some anti-leukemic activity in patients with advanced leukemia. Considering the severe toxicity observed and the limited remission rate achieved here, rIL-2 does not appear to be a valuable therapeutic option for such patients. However, the undoubted anti-leukemic activity of this cytokine invites further investigation especially in the minimal residual disease situation.

Treatment-related deaths and second cancer risk after autologous stem-cell transplantation for Hodgkin's disease

Autologous stem-cell transplantation has become a widely used therapy in Hodgkin's disease (HD). To appreciate the early and late risks associated with this procedure, its lethal toxicity and effects on the incidence of secondary cancers were studied. Data related to 467 French patients grafted from 1982 to 1995 for primary sensitive disease (PSD, 22%), primary refractory disease (PRD, 18%), first relapse (R1, 45%), or subsequent relapses (R2, 15%) were analyzed. Grafted patients (PSD, PRD, and R1; n = 393) were matched (3 controls for 1 case) on age, gender, clinical stage, B symptoms, and time at risk with 1179 conventionally treated patients issued from international databases. The proportional hazards (Cox) model was used to assess relative risks (RR). Among grafted patients, 8% died of toxicity related to the procedure, and 18 secondary cancers occurred leading to a 5-year cumulative incidence rate of 8.9%. In this series, risk factors for second cancer were age >/=40 years (RR = 3.73, P = .007) and the use of peripheral blood stem cells as source of graft (RR = 3.10, P = .03). Among grafted and matched ungrafted patients, risk factors for the development of secondary cancer were age >/=40 years (RR = 2.90, P < .001), relapse versus no relapse (RR = 5.22, P = .006), PRD versus other patients (RR = 3.86, P = .033), and grafted versus ungrafted patients (RR = 2.04, P = . 024). Solid tumors were more frequent in grafted than in ungrafted patients (RR = 5.19, P = .001) although the incidence of myelodysplasia and acute myeloid leukemia was similar in the two groups. We conclude that high-dose chemotherapy administered as first-line treatment or after relapse is associated with an acceptable toxic death rate. The risk of secondary myelodysplasia or acute myeloid leukemia is not significantly increased after autologous stem-cell transplantation for HD, whereas an increased risk of solid tumors exists. The peripheral blood stem-cell-associated risk of secondary cancer among grafted patients needs further investigations.

Primary and secondary prevention strategies among older postmenopausal women

Women may choose to initiate, reinitiate, or discontinue hormone replacement therapy (HRT) at any time beyond the perimenopausal period. HRT, exercise, and nutrition are reviewed in terms of their potential benefits as primary and secondary preventive therapies against coronary heart disease, osteoporosis, breast and genital cancers, and the maintenance of cognitive function among older postmenopausal women. Lifestyle alternatives involving nutrition and exercise that offer many of the same benefits as HRT are discussed. Since both pharmacologic and lifestyle interventions offer significant benefit for primary and secondary prevention of disease and disability, each should be offered to women for consideration as they enter the perimenopausal period. Additionally, each can be recommended for initiation even at much older ages and subsequent to adverse health occurrences, such as the experience of breast or genital cancer or a cardiac event. Each should be sustained over the long term. The decision whether to discontinue these interventions among the most elderly will be influenced by other quality of life considerations.

Early intensive therapy with autologous stem cell transplantation in advanced Hodgkin's disease: retrospective analysis of 158 cases from the French registry

This retrospective study was undertaken to evaluate cure rates, toxicity and late effects of early intensive therapy followed by autologous stem cell transplantation (ASCT) in patients with advanced Hodgkin's disease (HD). One hundred and fifty-eight cases of ASCT registered in the French database (SFGM) were retrospectively analyzed. Disease status at the time of ASCT was first partial response (PR) in 85, first complete remission (CR1) in 45 or primary refractory in 28 cases. The median time interval between diagnosis and ASCT was 7 months (range 4-13). At the time of analysis in December 1995, 121/158 patients (76.6%) were alive, including 111 (70.2%) in continuous CR with a median follow-up for surviving patients of 46 months (range 8-123). Peri-ASCT toxic death rate was 3%, and the actuarial risk of new malignancies was 4.9% at 5 years. The cumulative probability of 5-year overall survival (OS) was 75.2% for the entire group of patients, 80.6% for the chemosensitive ones, and 33.9% for the primary refractory (chemosensitive vs refractory, P < 0.0001). The cumulative probability of 5-year event-free survival (EFS) was 66.1% for the entire group of patients, 73.7% for the chemosensitive ones, and 26.1% for the primary refractory (chemosensitive vs refractory, P < 0.0001). The only significant prognostic factor for both OS and EFS was disease status at the time of ASCT. Early ASCT in advanced HD is feasible, with a low risk of toxicity and without a higher rate of late effects compared with conventional treatment. Results achieved in chemosensitive patients at the time of transplantation lay the basis of future prospective randomized trials comparing ACST as front-line treatment to conventional treatment in high-risk cases.

Carolyn Murdaugh as a transformational leader

This article presents the lessons learned from Dr Carolyn Murdaugh, a transformational leader in the field of cardiovascular nursing as well as the larger community of scientists and scholars. Dr Murdaugh has inspired us and empowered us with the love of learning, science, and caring for others and ourselves. We present aspects of Dr Murdaugh's leadership, including her abilities to create a vision, model professional commitment, the value of hard work, and the creation of balance.

Women's rehabilitation and recovery

It is clear that as a chronic illness, heart disease can create multiple stressors for women, including limitations on the performance of daily activities, difficulties managing symptoms and treatment, changes in role performance, lack of social support, and a reduced quality of life. Although available studies provide valuable information regarding aspects of the recovery process, they represent a fragmented body of knowledge. The acknowledgment of unique aspects of rehabilitation and recovery in women, as perceived by the women being treated, may enable the development of relevant and effective clinical interventions that facilitate physiologic and psychosocial recovery.

Prognostic factors for survival after high-dose therapy and autologous stem cell transplantation for patients with relapsing Hodgkin's disease: analysis of 280 patients from the French registry. Société Française de Greffe de Moëlle

High-dose therapy with autologous stem cell transplantation (ASCT) has been widely proposed for patients with relapsed Hodgkin's disease (HD). From 1982 to 1993, we selected (from the French registry for bone marrow transplantation) 280 patients, who underwent ASCT for relapsed HD after initial treatment including chemotherapy. Patient characteristics at diagnosis were: sex ratio (M/F): 1.5; median age: 30 years (5-59 years), stage I, II: 43%; III, IV: 57%; 32% had chemotherapy, 68% chemo+ radiotherapy. All patients achieved complete remission after first-line therapy and subsequently relapsed. The median interval between diagnosis and high-dose therapy was 34 months. First relapse occurred in 78% of the patients at a median end-of-treatment to relapse time of 18 months. All patients received salvage chemotherapy before high-dose therapy, and the median time between relapse and high-dose therapy was 5 months. After this regimen, 84% of the patients were considered to have chemosensitive relapse. Conditioning regimens were: BEAM: 60%; CBV/BEAC: 26%. Transplant-related mortality was 6%. With a median follow-up of 3 years after high-dose therapy, overall and progression-free survivals at 4 years were 66 and 60%, respectively. Neither the conditioning regimen nor the stem cell source affected survival. Good prognostic factors for survival were: chemosensitivity of relapse (P < 0.01) and first relapse vs further relapse (P < 0.05). For 214 patients in first relapse, other significant factors for survival were: end-of-treatment to relapse interval < 12 months (P < 0.05) and nodal vs extranodal relapse (P < 0.001). These two prognostic factors were used to validate a prognostic model with three significantly different subgroups: 0 (n = 59), 1 (n = 125), or 2 factors (n = 30) with 4-year survival, respectively, at 93, 59 and 43% (P < 0.001). Salvage therapy can be tailored in patients with relapsing HD: conventional treatment in the good prognosis group (0 factor), high-dose therapy after response to second line regimen (1 factor) and more intensive treatments for the bad prognosis group (2 factors).

Promoting wellness in individuals with coronary heart disease

The care of patients with coronary heart disease is focused toward assisting each individual to maximize his or her level of wellness by understanding and adhering to the prescribed medical regimen as a means for reducing or eliminating modifiable cardiovascular risk factors. Despite the role of risk modification in the management of coronary heart disease, lack of adherence to prescribed regimens is a fundamental problem. Behavioral models have examined factors that explain the likelihood of engaging in risk modification efforts and provide a rich theoretical basis for describing and predicting various aspects of behavioral change; however, difficulty in achieving sustained risk modification for individuals with diagnosed coronary heart disease makes it important to examine new directions for study. This article presents a model for wellness motivation related to the prevention of cardiovascular disease and outlines potential intervention strategies to enhance motivation in behavioral change.

High-dose chemotherapy with hematopoietic rescue in patients with stage III to IV ovarian cancer: long-term results

PURPOSE

A series of 53 patients with poor-prognosis epithelial ovarian cancer treated with high-dose chemotherapy (HDC) followed by hematopoietic rescue was retrospectively studied from the day of diagnosis for toxicity and long-term survival analysis.

PATIENTS AND METHODS

Patients were treated with surgery followed by cisplatin combination chemotherapy. After second-look operation (SLO), HDC was administered: 23 patients received melphalan (140 mg/m2 on day 1) and 30 patients received a combination of carboplatin (400 mg/m2 on days 1 to 4) and cyclophosphamide (1.6 g/m2 on days 1 to 4). After HDC, autologous stem-cell transplantation was performed for hematologic support.

RESULTS

One patient died of cardiac failure after HDC, but the acute toxicity was acceptable for the other patients. With a median follow-up of 81.5 months, the 5-year overall survival rate for the 53 patients was 59.9% and the disease-free survival (DFS) rate at 5 years was 23.6%. Twenty-four patients (45.3%) were alive, 12 with no evidence of disease and 12 with recurrent disease. The best results were achieved in 19 patients with pathologic complete response at SLO (74.2% 5-year overall survival; 32.8% 5-year DFS).

CONCLUSION

HDC followed by autologous stem-cell support is a well-tolerated therapeutic approach for patients with poor-prognosis ovarian carcinoma. In this report, the 59.9% survival of 53 patients at 5 years must be compared to the 20% to 30% 5-year survival observed after conventional therapy. These results should be confirmed by an ongoing prospective randomized trial.

rhGM-CSF vs placebo following rhGM-CSF-mobilized PBPC transplantation: a phase III double-blind randomized trial

In this placebo-controlled randomized trial we evaluated the hematological and clinical effects of r-Hu GM-CSF after high-dose chemotherapy (HDC) followed by GM-CSF-mobilized PBPC transplantation. Fifty patients with poor prognosis malignancies were randomized in a double-blind study to receive either GM-CSF or placebo after HDC followed by PBPC rescue. For all patients, PBPCs were recruited using a combination of VP-16 (300 mg/m2 on days 1 and 2), cytoxan (3 g/m2 on days 3 and 4) and GM-CSF (5 micrograms/kg from day 5). No differences were demonstrated between the two groups in median time to neutrophil or platelet recoveries. There was no significant difference between the GM-CSF group and the placebo group in the median duration of post-transplant hospitalization, in the number of days of antibiotic treatment, in the number of infections and in red blood cell or platelet transfusion requirements. There was a significant difference with an advantage for the placebo group in the mean duration of febrile days (P = 0.01). We conclude that the administration of GM-CSF in patients transplanted with GM-CSF-mobilized PBPC is not associated with a clinical benefit in term of tempo of engraftment, numbers of documented infections, transfusion requirements and mucositis grading.

Acute bacterial pneumonia in rats increases alveolar epithelial fluid clearance by a tumor necrosis factor-alpha-dependent mechanism

To study the rate and regulation of alveolar fluid clearance in acute pneumonia, we created a model of Pseudomonas aeruginosa pneumonia in rats. To measure alveolar liquid and protein clearance, we instilled into the airspaces a 5% bovine albumin solution with 1.5 microCi of 125I-human albumin, 24 h after intratracheal instillation of bacteria. The concentration of unlabeled and labeled protein in the distal airspaces over 1 h was used as an index of net alveolar fluid clearance. Since there was histologic evidence of alveolar epithelial injury, several methods were used to measure alveolar fluid clearance, including the use of experiments in rats with blood flow and the use of experiments in rats without blood flow, so that movement across the epithelial barrier would be minimized in the latter group. The results with each method were identical. We found that P. aeruginosa pneumonia increased alveolar liquid clearance over 1 h by 48% in studies with blood flow, and by 43% in rats without blood flow, compared with respective controls (P < 0.05). In both studies, this increase was inhibited with amiloride. However, propranolol had no inhibitory effect, thus ruling out a catecholamine-dependent mechanism to explain the increase in alveolar fluid clearance. An antitumor necrosis factor-alpha neutralizing antibody, instilled into the lung 5 min before bacteria, prevented the increase in alveolar liquid clearance in rats with pneumonia (P < 0.05). Also, TNFalpha (5 microg) instilled in normal rats increased alveolar liquid clearance by 43% over 1 h compared with control rats (P < 0.05). In normal rats instilled with TNFalpha, propranolol had no inhibitory effect. In conclusion, gram-negative pneumonia markedly upregulates net alveolar epithelial fluid clearance, in part by a TNFalpha-dependent mechanism. This finding provides a novel mechanism for the upregulation of alveolar epithelial sodium and fluid transport from the distal airspaces of the lung.

Cryopexy in primary rhegmatogenous retinal detachment: a risk factor for postoperative proliferative vitreoretinopathy?

PURPOSE

To evaluate the role of cryopexy in the stimulation of postoperative proliferative vitreoretinopathy (PVR) in primary rhegmatogenous retinal detachment.

MATERIALS AND METHODS

A series of 595 eyes of 554 patients with primary rhegmatogenous retinal detachment, referred before any failed surgery, were prospectively evaluated. Univariate and multivariate statistical analyses of the data were conducted.

RESULTS

The incidence of postoperative PVR in relation to the methods used for retinopexy was dependent on the types and anatomy of retinal breaks associated with retinal detachment. The incidence of postoperative PVR was nil in retinal detachments due to atrophic holes in lattice, oral dialyses, and macular holes, regardless of the retinopexy methods. Postoperative PVR occurred solely in retinal detachments due to horseshoe tears (incidence 4.42%), paravascular tears of the postequatorial region (18.18%), and giant tears (24.6%) (P < 0.00001). The incidence of postoperative PVR was 0.5% in eyes with horseshoe tears with mobile posterior edges vs 9.72% in eyes with horseshoe tears with curled posterior edges, regardless of the retinopexy methods (P < 0.00001). In retinal detachments due to horseshoe tears with mobile posterior edges the incidence of postoperative PVR (0.5%) was not influenced by the retinopexy methods. In contrast, in retinal detachments due to horseshoe tears with curled posterior edges the incidence of postoperative PVR was higher in eyes managed with cryopexy (14.77%) than in eyes managed with laser retinopexy (1.78%) (P < 0.02). In retinal detachments due to giant tears the incidence of postoperative PVR was not statistically significantly greater in eyes managed with cryopexy (33.3%) than in eyes managed with laser retinopexy (15.6%). In tears 180 degrees and over in size, however, the incidence of postoperative PVR was significantly higher in eyes managed with cryopexy (9/11 eyes) than in eyes managed with laser retinopexy (5/17 eyes) (P = 0.006).

CONCLUSIONS

Cryopexy is not a stimulating factor for postoperative PVR in primary rhegmatogenous retinal detachments due to atrophic holes in lattice, oral dialyses, macular holes, or horseshoe tears with mobile posterior edges. In contrast, cryopexy probably is a stimulating factor for postoperative PVR in retinal detachments due to horseshoe tears with curled posterior edges or to retinal tears 180 degrees and over.

Infections associated with totally implantable venous access devices (TIVAD) in human immunodeficiency virus-infected patients

We report on a retrospective study evaluating infectious morbidity associated with totally implantable venous access devices (TIVAD) (Port-A-Cath) in HIV-infected patients. This study of 84 consecutive HIV-infected patients requiring 89 TIVAD between January 1990 and October 1993 was performed in the Department of Infectious Diseases Hôpital de l'Institut Pasteur, Paris, France. The total number of catheter days was 11,595. Eighteen of 89 patients with TIVAD (20%) were infected, causing 25 infectious events (25/89: 28%) among 17 different patients (17/84: 20%). The infection rate was 0.22 per 100 catheter days. Mean onset of infection was 82 days. Twenty microorganisms were isolated: Staphylococcus aureus in eight cases (40%), coagulase-negative Staphylococcus in six cases (30%), Streptococcus D faecalis in one case; Gram-negative bacilli were found in five cases (25%). All patients received an intravenous antibiotherapy combined with a local lock treatment in eight cases. Nine TIVAD removals were performed. One death was related to the TIVAD infection. No additional predisposing factor for infection was identified other than the implied condition of the HIV infection. The population and material in this study were homogeneous. The TIVAD infection rate was comparable to other published reports. Prospective evaluation comparing tunneled catheter and TIVAD in HIV-infected patients is needed.

Health promotion across the continuum: challenges for the future of cardiovascular nursing

Issues surrounding health care spending, reform, and future directions have generated much concern and debate among health care providers. Increasingly, cardiovascular nurses are challenged to respond to the health care needs of clients in the 21st century. This article discusses trends in the health care system, including the current emphasis on illness and emerging efforts supporting health promotion. The discussion includes an overview of health care restructuring and the use of care management as a comprehensive strategy for cardiovascular nursing practice to support health promotion across a trajectory of illness and wellness.

Wellness motivation theory: an exploration of theoretical relevance

Data were collected from 14 older, rural African American men and women to explore how individual motivation affects the initiation and maintenance of health-related behavior. The research consisted of an inductive exploration designed to examine the validity and cultural relevance of an existing theoretical framework for wellness motivation in health behavior change. Through the technique of constant comparative analysis, the basic social process of empowering potential was substantiated as a process of individual growth and goal-directed behavior that facilitated the initiation and maintenance of positive health patterns. The process of empowering potential consisted of three stages: appraising readiness, changing, and integrating change. Two categories provided a cultural context for the process: health value orientation and network affiliation. The data validated and expanded a developing theoretical framework for wellness motivation in health behavior change.

Genetic variability in resistance of Creole goats to natural infection with trichostrongylids in Guadeloupe

The objective of this study was to show the existence of genetic variability in resistance of Creole goats to natural infection with intestinal nematodes. Four successive cohorts of male and female kids were reared from weaning during 9 months in intensive pangola pastures (stocking rate 1.4 t/ha, regrowth of 21 days, 300 kg N/ ha/year of fertilization). All cohorts considered, 203 offsprings from 13 bucks and 149 goats were used in the experiment. Animals were treated with an oral dose of ivermectin every seven weeks, from 3 to 11 months of age. They were sampled for fecal egg counts (FEC) and packed cell volume (PCV), 6 weeks after drenching, when 6 and 10 months old. Haemonchus contortus and Trichostrongylus colubriformis were the predominant species. Data of one cohort when 6 months of age and another one when 10 months old were not included in calculations because a self-cure occurred during a rainy season. Estimated means of FEC after square-root transformation were 1054 and 711 respectively for 6-month-old and 10-month-old kids. Phenotypic correlations between FEC and PCV were -0.46 (p < 0.001) and -0.29 (p < 0.01) when 6 and 10 months old, respectively. FEC repeatabilities estimated as variance ratio were 0.47 and 0.06 for within-age measures (data recorded at one week interval) and between age measures (6 vs. 10 months) respectively. No sire effect was significant for PCV. Sire effect on FEC was more significant when 6 months old (p < 0.03) than when 10 months old (p < 0.15). Further studies are now being carried out to confirm this genetic determinism of resistance to natural infection with strongyles in Creole goats.

Screening of health risk factors prior to exercise or a fitness evaluation of adults with traumatic brain injury: a consensus by rehabilitation professionals

A modified Delphi technique was used to obtain group consensus among 31 rehabilitation professionals (RPs) from nine rehabilitation centres throughout the province of Québec (Canada) to ascertain their expert opinion on the health risk factors (HRF) to be verified prior to beginning an exercise programme or evaluation for patients with traumatic brain injury (TBI). From the initial survey 87 items were generated, which were later regrouped into 27 HRFs. The relative importance of each HRF in regard to being screened before exercise in a population with TBI was then assessed by each RP using a five-point ordinal scale (1 = not important to 5 = extremely important). HRFs that were considered extremely important by at least 50% of HPs include: angina pectoris, aortic stenosis, exertional syncope, musculoskeletal sequelae which are exacerbated by exercise, outward aggressivity, pulmonary embolism, uncontrolled epilepsy (seizures), and ventricular arrhythmias. Professionals involved in exercising patients with TBI may find these factors useful to the efficient conduct of their rehabilitation programme.

High-dose therapy and autologous bone marrow transplantation in first complete or partial remission for poor prognosis Hodgkin's disease

We report the experience of three French centres which evaluated high-dose therapy (HDT) as consolidation therapy for poor prognosis Hodgkin's disease (HD). From March 1986 to April 1990, 23 consecutive patients with poor prognosis stage IV HD underwent HDT followed by autologous bone marrow transplantation (ABMT) after achieving either complete remission (CR1) or good partial response (GPR1) (reduction mass> 75%). The median age was 31 years (range 18 to 55 years), 14 were male. All patients except one initially had at least 2 poor prognosis factors such as: systemic symptoms (n = 19), bulky tumor (n = 16), more than one extranodal site (n = 9), bone marrow involvement (n = 5), lymphocyte count < or = 1.10(9)/1 (n = 8) and biological stage B (n = 21). All patients had previously been treated with alternating MOPP/ABVD. Ten patients were in GPR1 and 13 in CR1 before transplant. The conditioning regimens were: CBV (n = 17), BEAM (n = 5), BEAC (n = 1) followed by bone marrow rescue. Radiotherapy was introduced just before the conditioning regimen for 6 patients or after ABMT for 5 patients. Nine of 10 patients in GPR1 achieved CR after ABMT but one died early of treatment-related toxicity. Five of 22 patients who were in CR posttransplant, relapsed (3, 4, 4, 18, 36 months). Seventeen patients remain alive in continuous CR with a median follow-up of 60 months (range: 30-100 months). The overall survival (OS) and disease-free survival (DFS) projected at 5 years are 92% and 77% respectively. Consolidation by HDT and ABMT proved to be well tolerated. An international trial is currently underway to attempt to demonstrate a clear benefit on survival for this subset of poor prognosis HD patients.

Recurrent bilateral anterior uveitis with hypopyon and rifabutin therapy

Rifabutin is used in patients with human immunodeficiency virus infection to prevent and treat Mycobacterium avium complex infection. We report a case of recurrent bilateral anterior uveitis with hypopyon in a patient who was taking 600 mg of rifabutin daily. The rate of recurrence with the continuation of rifabutin seems to be high, especially in the opposite eye (alternate uveitis with hypopyon); rifabutin should be discontinued if uveitis recurs.

[Has the incidence of postoperative PVR in rhegmatogenous retinal detachment decreased?]

PURPOSE

To determine whether the incidence of severe postoperative PVR in primary rhegmatogenous retinal detachment has decreased over the last twelve years.

MATERIALS AND METHODS

We prospectively evaluated 595 eyes of 554 consecutive patients with primary rhegmatogenous retinal detachment, referred before any failed attempt to reattach the retina, managed by the same surgeon between March 1983 and December 1994. The eyes were divided into two consecutive series: 275 eyes operated on from March 1983 through February 1988 (series no. 1), and 320 eyes operated on from February 1988 through December 1994 (series no. 2). We conducted univariate and multivariate statistical analyses to compare the incidence of postoperative PVR in the two consecutive series.

RESULTS

The overall incidence of postoperative PVR was 8.72% (24/275 eyes) in series no. 1, versus 2.81% (9/320 eyes) in series no. 2 (p < 0.01). The incidence of postoperative PVR in retinal detachments due to atrophic holes in lattice degeneration, oral dialyses, and macular holes in myopic eyes, was nil in both series. The incidence of postoperative PVR in retinal detachments due to horseshoe tears with mobile posterior edges was 1.16% (1/86 eyes) in series no. 1, and 0% (0/109 eyes) in series no. 2. The incidence of postoperative PVR in retinal detachments associated with horseshoe tears with curled posterior edges was 21.15% (11/52 eyes) in series no. 1 versus 3.2% (3/93 eyes) in series no. 2 (p < 0.001). The incidence of postoperative PVR in giant tears was 35.5% (11/31 eyes) in series no. 1. and 14.7% (5/34 eyes) in series no. 2 (chi square = 3.77; at the limit of significance). The incidence of postoperative PVR in retinal detachments du to paravascular tears of the post-equatorial region in myopic eyes was 25% (1/4 eyes) in series no. 1, and 14% (1/7 eyes) in series no. 2.

CONCLUSION

In our own experience, the incidence of postoperative PVR in primary rhegmatogenous retinal detachment has decreased at a statistically significant level since 1988. We believe that the decreased incidence of postoperative PVR in our most recent series is mainly related to the use of laser photocoagulation retinopexy rather than cryopexy in the management of high risk eyes (retinal detachments associated with horseshoe tears with curled posterior edges, and giant tears).

Contribution of bronchoalveolar lavage to the diagnosis of posttraumatic pulmonary fat embolism

OBJECTIVE

To verify whether the determination of the percentage of cells recovered by bronchoalveolar lavage and containing fat inclusions is a useful diagnostic tool of posttraumatic pulmonary fat embolism.

DESIGN

Prospective study.

SETTING

Surgical Intensive Care Units in two university hospitals.

PATIENTS

56 successive trauma patients needing prolonged postinjury mechanical ventilation, including 4 with clinical definite fat embolism syndrome, 5 in whom the diagnosis had been clinically suspected but was impossible to confirm or exclude before bronchoscopy, and 47 with no clinical evidence of the syndrome. Control groups included 8 patients without previous trauma who developed ARDS and 6 healthy surgical patients.

METHODS

Bronchoalveolar lavage was performed within the first post-traumatic 3 days in trauma patients, at the beginning of the pulmonary disease in non trauma ARDS patients and just after anesthesic induction in healthy ortopedic patients. The magnitude of lipid content in alveolar cells was compared with the clinical pattern of the pulmonary fat embolism syndrome retrospectively evaluated at the seventh day postinjury in trauma patients.

RESULTS

All the patients with definite fat embolism syndrome had more than 70% of lavage cells containing fat droplets. The group of patients in whom the diagnosis of the fat embolism syndrome was suspected had percentages of fat cells above 30% in 4 out of 5 patients. A percentage of fat cells above 30% was only observed in 7 out of the 47 patients without clinical evidence of the syndrome. The percentage varied between 0% to 35% in the group of non trauma ARDS patients and between 0 to 5% in healthy surgical patients.

CONCLUSION

Lipid inclusions in alveolar cells are common during traumatic and non-traumatic respiratory failure. Determination of the percentage of cells recovered by bronchoalveolar lavage and containing fat droplets may contribute to the diagnosis of the fat embolism syndrome in mechanically-ventilated trauma patients with respiratory failure provided that the significant threshold would be 30%.

Life after a cardiac event: women's experience in healing

OBJECTIVE

To describe the experience of women's recovery after an acute cardiac event.

DESIGN

Grounded theory provided the methodologic basis for qualitative data generation and analysis.

SAMPLE

Thirteen women who had experienced an acute cardiac event. The participants' ages ranged from 42 to 78 with a mean age of 58 years. Four participants attended the group sessions after experiencing an acute myocardial infarction; five had undergone coronary artery bypass grafting; and two had undergone percutaneous transluminal coronary angioplasty. Two participants had undergone exercise testing that indicated myocardial ischemia. The time after the cardiac event ranged from 8 weeks to 3 years at the initiation of the study, with a mean time after the cardiac event of 8 months.

RESULTS

Healing, the basic social process identified from the data, explained women's struggle through the uncertainty surrounding the cardiac event as a way of creating new and positive health patterns. The process of healing consisted of three stages: surviving, originating, and patterning balance. These stages of healing illustrated determinants of individual motivation that guided the initiation and maintenance of risk factor modification efforts in women after the cardiac event.

CONCLUSIONS

Results of this study provide a basis for the development and evaluation of comprehensive rehabilitative interventions designed to enhance individual recovery after a cardiac event.

[Infectious complications of implantable catheters in HIV infected patients. Retrospective study of 46 patients]

OBJECTIVES

Investigate the rate of infection in HIV positive patients with an implantable venous access device.

METHODS

Forty-six totally implantable venous access devices (port-a-cath, PAC) were inserted in 46 HIV infected patients between January 1990 and May 1992. We analyzed the rate of infectious complications and tried to find predictive factors.

RESULTS

There were five infectious complications in five patients. The total complication rate was 0.06 per 100 catheter days. Staphylococcus aureus was responsible in two cases, Staphylococcus epidermidis was responsible in one case and Acinetobacter in one case. No predictive factor was recognized.

CONCLUSION

The rate of PAC infection was lower than in other published studies concerning HIV-infected patients. Totally implantable central venous access devices play an increasingly important role in the clinical management of HIV-related diseases. We have shown that the PAC device is safe and convenient in HIV-infected patients.

New method for stem cell quantification: applications to the management of peripheral blood stem cell transplantation

A dramatic increase in peripheral blood stem cells (PBSC) is observed after high-dose chemotherapy followed by haematopoietic growth factors. The degree of mobilisation of PBSC is quantified by the level of clonogenic cells detected by CFU assays (CFU-GM or CFU-GEMM) or CD34+ cell determination. Working under the hypothesis that, in peripheral blood, mononuclear cells in DNA synthesis (MCDS) are proliferating stem cells, we decided to detect these cells by flow cytometric measurement of their DNA content. The relations between the number of MCDS and well-known haematopoietic progenitor indicators such as CFU-GM or CD34+ cells were analysed. We studied the kinetics of recruitment of PBSC in cancer patients, treated with rmeHuG-CSF following VP-16 cytoxan chemotherapy, until the first day of leukapheresis. For the 31 patients studied the individual curves of peripheral MCDS and CFU-GM reconstitutions showed identical profiles and a good correlation was noted between the numbers of peripheral MCDS and CFU-GM (r = 0.73). In the leukapheresis product, the predictive value of MCDS was equivalent to CFU-GM for PBSC quantification (r = 0.70). In conclusion, MCDS analysis by flow cytometry provides reliable results and appears to be an alternative to CFU-GM assay or CD34+ cell determination for PBSC quantification.