Bone mineral density and lifetime physical activity in South African women

We investigated the relation between lifetime physical activity and bone mineral density (BMD) in South African women using data collected in a case-control study of breast cancer in relation to BMD. Subjects (n = 144) were of black African or mixed ancestral origin, and <60 years of age (mean age 42.6 +/- 8.9 years). Cases had newly diagnosed breast cancer (n = 62) and controls were referred for conditions unrelated to BMD or breast cancer (n = 82). Physical activity data consisting of household, occupational and leisure-time activity, and activity for transport, were collected via questionnaire at 4 life stages (epochs), viz. 14-21, 22-34, 35-50, and 50+ years of age. Total energy (MET hrs) and peak strain scores were calculated. Lumbar spine and total proximal femur BMD were measured using dual-energy x-ray absorptiometry. BMD measures were similar between groups, therefore data were combined. BMD measures were unrelated to total lifetime physical activity. However, the major determinants of total proximal femur BMD included age, transport activity including walking and bicycling between the ages of 14 and 21 years, and current weight (adjusted r2 = 0.33, P < 0.0001). The major determinants of lumbar spine BMD included age, household energy expenditure between the ages of 14 and 21 years, and current weight (adjusted r2 = 0.23, P < 0.0001). Total peak bone strain score for activities between 14-21 years of age was also significantly correlated with lumbar spine BMD ( r = 0.18, P < 0.05). Intraclass correlation coefficients to assess tracking of activity through epochs 1, 2, and 3 were high for total energy expenditure (0.96; 95%CI: 0.94-0.97), household (0.98; 95%CI: 0.97-0.99) and occupational activity (0.78; 95%CI: 0.71-0.84) and activity for transport (0.92; 95%CI: 0.89-0.94). These data suggest that walking or activities resulting in impact loading at a young age are associated with higher BMD in later years. In addition, our findings suggest tracking of physical activity over time.

Informed choice--the timing of postpartum contraceptive initiation

BACKGROUND

In South Africa injectable progestogen-only contraceptives (IPC) are typically administered to women immediately after delivery. Several guidelines advise that breast-feeding women should not commence IPC until 6 weeks postpartum on the basis of theoretical risks to the infant.

OBJECTIVE

We examined women's preferences regarding timing of postpartum IPC initiation, as well as women's contraceptive and breast-feeding behaviours and pregnancy risk in the early postpartum period. DESIGN AND DATA COLLECTION: A cross-sectional study was conducted among 200 antenatal clinic (ANC) attendees and 180 mothers attending a child health clinic (CHC). At the ANC, women were given information on the theoretical risks of IPC and re-interviewed about their postpartum contraceptive intentions.

RESULTS

Most ANC women planned to use IPCs (92%) and to breast-feed (98%) after delivery. Most CHC mothers had used IPCs (91%) and had breast-fed (83%) after delivery. When women at the ANC were provided with appropriate information they made decisions about when to initiate IPC by balancing the theoretical risks of IPC to their infant against their personal risk of pregnancy and ability to return to a clinic in the early postpartum period.

CONCLUSION

It is important to include informed choice in postpartum IPC initiation guidelines.

Cost-effectiveness analysis of recruitment strategies in a community-based intervention study of HIV-infected persons

This paper describes and evaluates recruitment methods used to reach adults with HIV infection and to enroll eligible candidates in a randomized trial of aerobic exercise. Potential participants residing in the metropolitan Washington DC area were recruited from January 1994 to December 1996. The yield and associated cost of clinic centre site-visit (CSV) recruitment are compared to similar outcomes for community-based (CB) recruitment strategies, which consisted of presentations to local groups, mail/phone canvasses of caregivers, neighbourhood network promotion, public site postings and print media notices. Of 833 HIV infected adults ascertained during the recruitment phase as prospective study candidates, 66.7% were initially contacted during CSV recruitment. The remainder, 33.3% were CB recruits. The percentage of screened candidates who were subsequently enrolled in the study was 13.5% for CSV recruitment and 21% for CB recruitment. Ascertainment and screening costs combined were $158 per CB recruit compared to $232 per CSV recruit. Using multiple recruitment approaches we successfully achieved our enrollment goal of at least 100 volunteers from diverse populations by the end of the planned recruitment period.

Limited Pap screening associated with reduced risk of cervical cancer in South Africa

BACKGROUND

We investigated the effect of Pap smear screening on the incidence of invasive cancer of the cervix in the Western Cape, South Africa where screening is limited.

METHODS

Data were derived from a case-control study of the association of hormonal contraceptives and invasive cervical cancer. Incident cases (n = 524) of invasive cervical cancer who presented at two tertiary hospitals and controls (n = 1540) series matched for age, race, and place of residence were interviewed. Information on a wide range of variables was collected including whether the women had previously had a Pap smear taken and the number and timing of smears. Odds ratios (OR) and 95% CI were calculated using multiple logistic regression.

RESULTS

The OR of cervical cancer was reduced among women who had ever had a smear (OR = 0.3, 95% CI: 0.3-0.4). The OR declined with increasing number of smears to 0.2 for >/=>3 smears (trend P = 0.0003). Among women who had a smear <5 years previously the OR was 0.3, but even if the smear was taken >/=15 years previously the women remained at reduced risk (OR = 0.5).

CONCLUSION

The data suggest that even limited Pap smear screening reduces the risk of cervical cancer. Should a screening programme be successfully implemented, the incidence of cervical cancer might be reduced by as much as 70%.

Non-degradable microparticles containing a hydrophilic and/or a lipophilic drug: preparation, characterization and drug release modeling

Non-degradable microparticles based on ammonio methacrylate copolymers (Eudragit RS:RL 4:1 blends) containing the hydrophilic drug propranolol HCl and/or the lipophilic drug nifedipine were prepared with an oil-in-water (O/W) and a water-in-oil-in-water (W/O/W) solvent evaporation technique. Both drugs were successfully incorporated separately as well as simultaneously. In all cases, the resulting release rate(s) of the drug(s) was/were found to be controlled over periods of at least 8 h. To elucidate the underlying mass transport mechanisms, the microparticles were thoroughly characterized by X-ray powder diffractometry, differential scanning calorimetry, particle size analysis, and determination of the actual drug loading(s). Analytical solutions of Fick's second law of diffusion considering non-steady state conditions were used to describe the release of propranolol HCl. Interestingly, the resistance for drug release within the unstirred liquid boundary layers on the surfaces of the microparticles was found to be negligible compared to the diffusional resistance within the polymeric devices. Importantly, the mathematical theories could be used to normalize the experimentally determined in vitro drug release with respect to the microparticle size. Thus, the effect of the type of preparation method (O/W vs. W/O/W) and device composition (polymer blend plus one drug only vs. polymer blend plus drug combination) on the diffusional resistance within the microparticles could be studied. In addition, further insight into the occurring mass transport processes was gained. For example, the time-dependent evolution of the drug concentration profiles within the microparticles upon exposure to the release medium could be calculated. An interesting practical application of the mathematical theories is the possibility to predict the effect of different formulation parameters on the resulting drug release patterns, e.g. the effect of the microparticle size.

Elevated plasma homocysteine leads to alterations in fibrin clot structure and stability: implications for the mechanism of thrombosis in hyperhomocysteinemia

Elevated plasma homocysteine is associated with an increased risk of atherosclerosis and thrombosis. However, the mechanisms by which homocysteine might cause these events are not understood. We hypothesized that hyperhomocysteinemia might lead to modification of fibrinogen in vivo, thereby causing altered fibrin clot structure. New Zealand White rabbits were injected intraperitoneally (i.p.) every 12 h through an indwelling catheter with homocysteine or buffer for 8 weeks. This treatment raised the plasma homocysteine levels to about 30 micro mol L(-1) compared with 13.5 micro mol L(-1) in control rabbits by the end of the treatment period. The fibrinogen levels were 3.2 +/- 0.6 in homocysteine-treated and 2.5 +/- 1.1 mg mL(-1) in control rabbits. The reptilase time was prolonged to 363 +/- 88 for plasma from homocysteine-treated rabbits compared with 194 +/- 48 s for controls (P < 0.01). The thrombin clotting time (TCT) for the homocysteine-treated rabbits was significantly shorter, 7.5 +/- 1.7 compared with 28.6 +/- 18 s for the controls (P < 0.05). The calcium dependence of the thrombin clotting time was also different in homocysteinemic and control plasmas. Clots from plasma or fibrinogen of homocysteinemic rabbits were composed of thinner fibers than control clots. The clots formed from purified fibrinogen from homocysteine-treated rabbits were lyzed more slowly by plasmin than comparable clots from control fibrinogen. Congenital dysfibrinogenemias have been described that are associated with fibrin clots composed of thin, tightly packed fibers that are abnormally resistant to fibrinolysis, and recurrent thrombosis. Our results suggest that elevated plasma homocysteine leads to a similar acquired dysfibrinogenemia. The formation of clots that are abnormally resistant to fibrinolysis could directly contribute to the increased risk of thrombosis in hyperhomocysteinemia.

Microencapsulation of low molecular weight heparin into polymeric particles designed with biodegradable and nonbiodegradable polycationic polymers

Owing to its lack of oral absorption, heparin has to be administered parenterally. However, parental administration has negative aspects such as multiple injections, possible infection, patient inconvenience, and high cost. Now, low molecular weight heparin (LMWH) is taking part in antithrombotic treatment and is proven to confer more advantages than unfractionated heparin. The aim of our present study was to formulate, by the w/o/w emulsification process, LMWH microparticles as potential oral carriers prepared with biodegradable (poly-epsilon-caprolactone and poly-lactic-co-glycolic acid) and nonbiodegradable polycationic polymers (Eudragit RS and RL), used alone or blended. The encapsulation efficiency ranged from 16 to 47% and was highly dependent on the presence of the positively charged polymers. In the same way, a low in vitro LMWH release was observed when Eudragit polymers composed totally or partially the polymeric matrix, compared with biodegradable polymers exhibiting higher LMWH release (40 and 60%). For each formulation, LMWH released from microparticles preserved its biological activity as shown by the antifactor Xa activity. Experiments performed with fluorescein-labeled LMWH showed the drug distribution in microparticles and may give information about the mechanisms controlling LMWH encapsulation and release.

Antibiotic prescription practices, consumption and bacterial resistance in a cross section of Swedish intensive care units

BACKGROUND

The purpose of this work was to study usage of antibiotics, its possible determinants, and patterns of bacterial resistance in Swedish intensive care units (ICUs).

METHODS

Prospectively collected data on species and antibiotic resistance of clinical isolates and antibiotic consumption specific to each ICU in 1999 were analyzed together with answers to a questionnaire. Antibiotic usage was measured as defined daily doses per 1000 occupied bed days (DDD1000).

RESULTS

Data were obtained for 38 ICUs providing services to a population of approximately 6 million. The median antibiotic consumption was 1257 DDD1000 (range 584-2415) and correlated with the length of stay but not with the illness severity score or the ICU category. Antibiotic consumption was higher in the ICUs lacking bedside devices for hand disinfection (2193 vs. 1214 DDD1000, p=0.05). In the ICUs with a specialist in infectious diseases responsible for antibiotic treatment the consumption pattern was different only for use of glycopeptides (58% lower usage than in other ICUs: 26 vs. 11 DDD1000,P=0.02). Only 21% of the ICUs had a written guideline on the use of antibiotics, 57% received information on antibiotic usage at least every 3 months and 22% received aggregated resistance data annually. Clinically significant antimicrobial resistance was found among Enterbacter spp. to cephalosporins and among Enterococcus spp. to ampicillin.

CONCLUSIONS

Availability of hand disinfection equipment at each bed and a specialist in infectious diseases responsible for antibiotic treatment were factors that correlated with lower antibiotic consumption in Swedish ICUs, whereas patient-related factors were not associated with antibiotic usage.

Low molecular weight heparin-loaded polymeric nanoparticles: formulation, characterization, and release characteristics

The aim of the present work was to investigate the preparation of low molecular weight heparin (LMWH) nanoparticles (NP) as potential oral heparin carriers. The NP were formulated using an ultrasound probe by water-in-oil-in-water (w/o/w) emulsification and solvent evaporation with two biodegradable polymers [poly-epsilon-caprolactone, PCL and poly(D,L-lactic-co-glycolic acid) 50/50, PLGA] and two non-biodegradable positively charged polymers (Eudragit RS and RL) used alone or in combination. The mean diameter of LMWH-loaded NP ranged from 240 to 490 nm and was dependent on the reduced viscosity of the polymeric organic solution. The surface potential of LMWH NP prepared with Eudragit polymers used alone or blended with PCL and PLGA was changed dramatically from strong positive values obtained with unloaded NP to negative values. The highest encapsulation efficiencies were observed when Eudragit polymers took part in the composition of the polymeric matrix, compared with PCL and PLGA NP exhibiting low LMWH entrapment. The in vitro LMWH release in phosphate buffer from all formulations ranged from 10 to 25% and was more important (two- to threefold) when esterase was added into the dissolution medium. The in vitro biological activity of released LMWH, determined by the anti-factor Xa activity with a chromogenic substrate, was preserved after the encapsulation process, making these NP good candidates for oral administration.

Preparation and characterization of heparin-loaded polymeric microparticles

Microparticles containing heparin were prepared by a water-in-oil-in-water emulsification and evaporation process with pure or blends of biodegradable (poly-epsilon-caprolactone and poly(D,L-lactic-co-glycolic acid)) and of positively-charged non-biodegradable (Eudragit RS and RL) polymers. The influence of polymers and some excipients (gelatin A and B, NaCl) on the particle size, the morphology, the heparin encapsulation rate as well as the in vitro drug release was investigated. The diameter of the microparticles prepared with the various polymers ranged from 80 to 130 microns and was found to increase significantly with the addition of gelatin A into the internal aqueous phase. Microparticles prepared with Eudragit RS and RL exhibited higher drug entrapment efficiency (49 and 80% respectively) but lower drug release within 24 h (17 and 3.5% respectively) than those prepared with PCL and PLAGA. The use of blends of two polymers in the organic phase was found to modify the drug entrapment as well as the heparin release kinetics compared with microparticles prepared with a single polymer. In addition, microparticles prepared with gelatin A showed higher entrapment efficiency, but a significant initial burst effect was observed during the heparin release. The in vitro biological activity of heparin released from the formulations affording a suitable drug release has been tested by measuring the anti-Xa activity by a colorimetric assay with a chromogenic substrate. The results confirmed that heparin remained unaltered after the entrapment process.

Analyzing fibrin clot structure using a microplate reader

Fibrin clot structure studies are often performed using optical methods. For example, the clot's fiber structure can be assessed by measuring light scattering as a function of wavelength. From these measurements, one can calculate the mass/length ratio (mu), a relative measure of fibrin thickness. Fiber thickness has important functional correlates in terms of clot stability and resistance to fibrinolysis. Typically, measurements to calculate mass/length ratios are carried out on high-end spectrophotometers. However, limitations of this instrument include the large sample volume required and the inability to read multiple samples at one time. To circumvent these limitations, a plate-reading spectrophotometer is more commonly used to monitor clot formation; increases in absorbance indicate clot formation, while decreases indicate clot lysis. However, it is unclear whether plate-reading spectrophotometers can be used to quantitatively evaluate fibrin fiber structure. In the current study, we compared spectrophotometric analysis of fibrin gels on single-sample and plate-reading spectrophotometers. Results show that a plate-reading spectrophotometer does not give accurate measurements of the fiber mass/length ratio. However, the plate-reading spectrophotometer can provide a qualitative measure of fiber structure for both purified fibrinogen and plasma. We suggest that plate-reading spectrophotometers can provide a convenient, rapid, and inexpensive means of analyzing fibrin clot structure.

Anti-heart antibodies in postpericardiotomy syndrome: cause or epiphenomenon? A prospective, longitudinal pilot study

OBJECTIVES

To assess the role of anti-heart antibodies (AHA) in postpericardiotomy syndrome (PPS) and the timing of their appearance in relation to the initial manifestations of PPS.

DESIGN AND SUBJECTS

Twenty patients who were scheduled to undergo elective coronary artery bypass grafting (CABG) were enrolled in a prospective, longitudinal pilot study.

METHODS

Serum was sampled for AHA on the day prior to surgery and at regular intervalsfollowing surgery in all patients. In those who developed PPS, the serum AHA was determined on the day that typical clinical manifestations of PPS appeared and at regular intervals following the onset of PPS.

RESULTS

All patients were negative for AHA on the day precedingsurgery. Three(15%) patients developed PPS. Their sera were negative for AHA on the day they were diagnosed as sufferingfrom PPS and the sera became positive for AHA within 14 days from the time of diagnosis. The intensity of immunofluorescence decreased markedly 30 days afterwards and AHA had disappeared within 90days after diagnosis of PPS. The other 17 (85%) patients were negative for AHA prior to surgery and remained so during the six-month postoperative follow-up period.

CONCLUSION

The findings of this study suggest that serum AHA may not play a causal role inthe pathogenesis of PPS, but may rather be an epiphenomenon, reflecting an immune response to pericardial and/or myocardial injury.

'Men leave me as I cannot have children': women's experiences with involuntary childlessness

BACKGROUND

This study explores the concerns and experiences related to involuntary childlessness of infertile women living in a diverse cultural urban community in South Africa.

METHODS

In-depth interviews were conducted with 30 women seeking treatment for involuntary childlessness. Women were interviewed at the time of their first visit to an infertility clinic in a tertiary referral centre.

RESULTS

All women verbalized intense emotions about their involuntary childlessness. In addition, a large number of women experienced negative social consequences including marital instability, stigmatization and abuse.

CONCLUSIONS

These findings demonstrate that infertility can have a serious effect on both the psychological well-being and the social status of women in the developing world. Furthermore, the study provides insight into the cultural context of involuntary infertility in South Africa. The delivery of good infertility care in a community requires awareness of the implications of infertility and insight into the context in which these occur. Since many of the negative social implications of infertility are probably rooted in low status women in the developing world, effective intervention will ultimately require social, economical and political changes.

Infertility in South Africa: women's reproductive health knowledge and treatment-seeking behaviour for involuntary childlessness

BACKGROUND

Infertility is a major reproductive health problem in Africa. This paper presents the findings of two studies which focus on the knowledge that infertile women have about fertility and the causes of infertility, their treatment-seeking behaviour and their expectations of an infertility clinic.

METHODS

A total of 150 infertile women from a culturally diverse, urban community in South Africa participated in the two studies. Both qualitative and quantitative research methods were applied using in-depth, semi-structured interviews and structured questionnaires.

RESULTS

The women who participated had little knowledge about human reproduction and modern treatment options for infertility. They were highly motivated to find treatment and accessed both traditional and modern health care. Treatment barriers within modern health care were identified.

CONCLUSIONS

The importance of health education and counselling is recognized, and both need to be integrated into infertility management, particularly in the developing world. The introduction of clinical guidelines is recommended in order to overcome treatment barriers and improve the delivery of health services.

Phase II trial of topotecan and cisplatin in persistent or recurrent squamous and nonsquamous carcinomas of the cervix

OBJECTIVE

Cisplatin is a standard treatment in advanced, recurrent cervical cancer. Because topotecan is an established treatment in gynecologic malignancies such as ovarian cancer and exhibits nonoverlapping toxicity with cisplatin, a phase II trial was conducted to evaluate the tolerability and antitumor activity of a cisplatin/topotecan doublet in persistent or recurrent cervical cancer patients.

METHODS

Patients with bidimensionally measurable persistent or recurrent squamous cell and non squamous cell cervical cancer and adequate bone marrow were enrolled. Patients received 50 mg/m(2) of cisplatin intravenously over 1 h on Day 1 and 0.75 mg/m(2) of topotecan intravenously over 30 min on Days 1, 2, and 3 of 21-day cycles for six cycles or until disease progression. Tumor response and regimen toxicity were assessed using established Gynecologic Oncology Group criteria.

RESULTS

Thirty-two of 35 enrolled patients were evaluable for toxicity and tumor response. All but 2 evaluable patients had received previous radiotherapy. No patient received prior chemotherapy. The cisplatin/topotecan doublet was well tolerated, with 77 and 78% of courses given without interruption or delay and at full doses, respectively. As anticipated, the most common toxicity was hematologic, with grade 3/4 neutropenia and thrombocytopenia reported in 30 and 10% of cycles, respectively. The overall response rate was 28% (9/32), with 3 complete and 6 partial responses. The antitumor response in nonirradiated fields (30%) was similar to the response observed in previously irradiated fields (33%), suggesting good drug penetration. Median duration of response was 5 months (range, 2 to 15+ months). An additional 9 (28%) patients achieved stable disease. Median survival was 10 months, with 3 patients in lasting remission.

CONCLUSIONS

These results demonstrate that the cisplatin/topotecan combination is safe, well tolerated, and active in persistent or recurrent cervical cancer patients. A phase III, multicenter trial is under way (cisplatin/topotecan versus cisplatin) based on these favorable results to confirm the safety and efficacy profile in this patient population.

Leaching of diethylhexyl phthalate from polyvinyl chloride bags into intravenous etoposide solution

OBJECTIVE

To compare the release of diethylhexyl phthalate (DEHP) from polyvinyl chloride (PVC) bags from four different manufacturers into intravenous etoposide solutions.

METHOD

Etoposide solutions, 0.4 mg/mL, containing the vehicle polysorbate 80 were prepared in 5% dextrose or 0.9% sodium chloride injection PVC bags and stored at room temperature for 24 h. DEHP content was analysed by high-performance liquid chromatography.

RESULTS

Substantial amounts of DEHP (up to 20 microg/mL at room temperature) leached into the etoposide solutions. However, no significant differences were found in the amounts of DEHP leached into the etoposide infusion solutions prepared using either 5% dextrose or 0.9% sodium chloride injection and stored in the four different containers.

CONCLUSION

To minimize patient exposure o DEHP, etoposide solutions should ideally be stored in a glass or polyolefin container.

The epidemic of obesity in South Africa: a study in a disadvantaged community

OBJECTIVE

The objective of this study was: 1) to determine the anthropometric profile of adults in Mamre, a small town in South Africa, which has a population of mixed ancestry ("colored" people of Afro-Euro-Malay-Khoisan ancestry); and 2) to determine the change in this profile between 1989 and 1996.

DESIGN

Cross-sectional surveys conducted in random samples of adults in 1989 and 1996.

PARTICIPANTS

The subjects were 684 women and 529 men in 1989, and 546 women and 430 men in 1996, aged 15 and older.

MAIN OUTCOME MEASURES

The following measurements were recorded: height, weight, and circumference of waist, hips, and mid-upper arm.

RESULTS

Based on data from the 1996 survey, 32% of women are obese (body mass index [BMI] > or = 30) at ages 25-44 years, rising to 49% at ages 45-64 years. A much lower prevalence of obesity is seen in men: 14% at ages 35-64 years. Obesity levels significantly increased in women between the two surveys (P=.015): up from 44% in 1989 to 49% in 1996 at ages 45-64 years. There was an increase in the prevalence of overweight (BMI 25-29.9) in men, though not in obesity. Mean BMI increased by about 3% in women and 2% in men between 1989 and 1996.

CONCLUSIONS

This study conducted among people of mixed ancestry living in a disadvantaged community in South Africa shows that half of middle-aged women are obese. A rising trend in BMI was seen in adults of both sexes between 1989 and 1996. This trend may be explained by factors associated with rural-urban transition, including electrification, reduced physical activity, and increasing availability of energy-dense food.

Community-based tobacco control program: the Mamre study, a demonstration project

OBJECTIVES

To assess the feasibility of a 5-year community-based tobacco control program in the community of Mamre in South Africa, while measuring the smoking and quitting rates at the beginning and end of this demonstration project.

METHODS

A tobacco intervention program was developed at low cost in collaboration with the community, and involved a wide range of activities targeting people of all ages, especially those at risk for cardiovascular disease. Community members were trained to deliver smoking cessation programs and specific advice to smokers. Cross-sectional surveys were conducted in 1989 in a random sample of 1238 people, aged 15 years and older, prior to the 5-year demonstration project, and again in 1996 among 974 people at the end of the project. Demographic data and smoking and quitting patterns were collected by interviewer-administered questionnaires. Trained field workers used standardized procedures for recording blood pressure, height, and weight.

RESULTS

The community participated with enthusiasm in the activities surrounding smoking cessation and the annual World No Smoking Day. The smoking rate decreased significantly between the two surveys (OR 1996/1989 = 0.82; 95% CI of 0.69-0.99), and the quitting rate increased significantly during the 5-year intervention period compared to the 5 years prior to the baseline survey (OR 1996/1989 = 0.74; 95% CI of 0.57-0.98). Men who participated in the program but continued to use tobacco in 1996 smoked more cigarettes than those who smoked in 1989. People who quit during the intervention period tended to be older, hypertensive, and obese; they consumed no alcohol, and noticed the health warnings posted in the community if they were older and had 10 or more years of education.

CONCLUSIONS

A low-cost community-based tobacco control program was successfully implemented in the Mamre community. The program was received enthusiastically, built tobacco cessation skills, and significantly reduced the community's smoking rate compared to that before the demonstration project.

[Desirudin (Revasc) to prevent thromboembolic complications after hip or knee replacement surgery]

Since March 1999, desirudin (REVASC), a recombinant hirudin, has been used in Nancy to treat patients who undergo total hip or knee replacement with a high risk of thromboembolic complications. We carried out a retrospective study using clinical data on the first 15 consecutive patients treated with desirudin to find out prescription motivations, type of shift (indirect anticoagulants or low-molecular-weight-heparin) and evolution. They all had a high risk of deep vein thrombosis (thrombophily, obesity, history of thromboembolic events). Some of this patients would have been excluded of the studies which permitted desirudin to be approved. In this study, we found no thromboembolic complications. The only striking facts are one bleeding complication (after difficult surgery) and one pulmonary embolism (2 months later).

Generation of species cross-reactive aptamers using "toggle" SELEX

Species cross-reactivity facilitates the preclinical evaluation of potentially therapeutic molecules in animal models. Here we describe an in vitro selection strategy in which RNA ligands (aptamers) that bind both human and porcine thrombin were selected by "toggling" the protein target between human and porcine thrombin during alternating rounds of selection. The "toggle" selection process yielded a family of aptamers, all of which bound both human and porcine thrombin with high affinity. Toggle-25, a characteristic member, inhibited two of thrombin's most important functions: plasma clot formation and platelet activation. If appropriate targets are available, the toggle strategy is a simple measure that promotes cross-reactivity and may be generalizable to related proteins of the same species as well as to other combinatorial library screening strategies. This strategy should facilitate the isolation of ligands with needed properties for gene therapy and other therapeutic and diagnostic applications.

Liposarcoma complicating pregnancy

BACKGROUND

An adnexal mass in pregnancy is a common occurrence. Malignancy is uncommon and only seven cases of liposarcoma have been reported in association with pregnancy.

CASE

We present a case of a pregnant patient who was diagnosed with an adnexal mass detected by ultrasound at 13 weeks gestation. The mass was surgically removed postpartum, when it was found to be a liposarcoma. Postoperatively she received chemotherapy but eventually succumbed to her disease.

CONCLUSIONS

Liposarcoma is rarely found in association with pregnancy and may follow an aggressive course.