A very particular case of long-term non-progressor: nineteen consecutive years of follow-up in the absence of any detectable HIV-1 viraemia.

A case of extremely prolonged non-progression of HIV-1 infection, characterized by 19 consecutive years of persistently undetectable viraemia (or no laboratory markers of HIV replication) is presented and discussed based on recent literature issues regarding virological and immunological outcome of the natural history of HIV-1 infection.

"Side" effects of HAART: decreasing and changing occupational exposure to HIV-infected patients.

To investigate percutaneous exposures to HIV in the highly active antiretroviral therapy (HAART) era, we performed an analysis of all percutaneous exposures reported from January 1994 to December 1998 in 18 Italian acute-care hospitals. Frequency and rate per 100 prevalent AIDS cases of HIV exposures decreased by 40% (from 4.3% to 2.6%, and from 1.0% to 0.6%, respectively; p<0.001), which were mainly those related to the insertion/manipulation of peripheral vascular access devices (from 7.2% to 4.8%; p=0.05). We conclude that the benefits of HAART have changed the complexity of care required and therefore, the number and type of procedures performed on HIV patients that place the HCW at risk of injury.

Cervicofacial and pulmonary actinomycosis associated with non-Hodgkin's lymphoma.

A case of cervicofacial and pulmonary actinomycosis associated with non-Hodgkin's lymphoma (NHL) is reported. The patient underwent antimicrobial treatment and surgical debridement of a palatine lesion. Complete clinical recovery was achieved. The presence of actinomycosis may obscure and delay the diagnosis of NHL.

Effect of retinoic acid and valproate on sea urchin development.

The effect of valproate and retinoic acid on Paracentrotus lividus development and fertilization is reported. Retinoic acid at concentrations between 5 microM and 7 microM causes severe disturbance of development and at 10 microM complete embryo degeneration if added in the period from fertilization on. Concentrations up to 7 microM are uneffective if retinoic acid addition is started 16 h after fertilization. Valproate at concentrations between 1 mM and 5 mM causes severe disturbances of development if added from 5 min after fertilization on. Concentrations of 20 mM are lethal to all embryos. If the drug is added 16 h after fertilization no effect is observed up to the concentration of 10 mM. The effect of valproate is specific, because its isomere 2-en at 10 mM has very little effect on development. Both drugs affect fertilization only at higher concentrations: more than 1 microM for retinoic acid and more than 10 mM for valproate.

Effect of doxorubicin and phenytoin on sea urchin development.

The effect of doxorubicin and phenytoin on Paracentrotus lividus development and fertilization is reported. Doxorubicin at concentrations between 1.4 and 1.8 microM causes severe disturbances of development and at 2.0 microM, complete embryonic degeneration, if added in the period from fertilization on. Concentrations up to 20 microM are ineffective on development if the treatment is started at 12 h after fertilization. Phenytoin at concentrations between 4.0 and 7.0 microM causes severe disturbances of development, if added from 5 min after fertilization on. Concentrations of 10 microM are lethal to all embryos. Again, if the drug is added at 12 h after fertilization, no effect is observed up to the concentration of 20 microM. Both drugs are ineffective on the fertilization process up to the concentration of 20 microM for doxorubicin and of 200 microM for phenytoin.

Arthroscopic treatment of ankle injuries.

Arthroscopic examination of the ankle joint permits complete examination of the intra-articular structures. With recent advances in equipment and additional experience, numerous ankle problems can be handled arthroscopically. These problems include treatment of soft-tissue and bony impingement, osteochondral lesions of the talus, removal of loose bodies, treatment of acute and chronic fractures, lateral ankle stabilization, and arthroscopic fusion procedures.

Shoulder arthroscopy: surgical technique.

Arthroscopic techniques for shoulder arthroscopy have evolved and been refined constantly over the last decade. Significant advances have been made, compared to the first arthroscopic intraarticular examinations on cadavers by Takagi in 1918. Advances in fiberoptics, computer technology, and surgical instrumentation, coupled with innovative ideas and improved operative skills, have opened a new era in the orthopedic evaluation of intraarticular structures and treatment of pathology by the orthopedic surgeon. Arthroscopic examination of the glen humeral joint and sub acromial bursa permits the surgeon to visually assess, document, and treat shoulder pathology in an injury specific manner. Critical to effective use of this technology and skill is a comprehensive and reproducible system for thorough examination and documentation, so that no abnormality is inadvertently overlooked and treatments are effectively performed. In this fashion, standardization is developed for evaluating surgical treatments and providing a common base for professional communication and continued education within the orthopedic community. At the Southern California Orthopedic Institute, a comprehensive 15-point glenohumeral and 8-point subacromial examination from both posterior and anterior portals has been developed and is widely accepted in most arthroscopic forums. The operating room set-up, instrumentation, patient positioning, and the authors' preference for systematic glenohumeral arthroscopy and bursoscopy will be described. Specific methods for-arthroscopic subacromial decompression, distal clavicle resection, and evaluation of the rotator cuff will be outlined. It is imperative that the surgeon have a complete knowledge of normal shoulder anatomy and common variants.

Clinical experience with vena caval filters in high-risk cancer patients.

Our experience with the placement of intracaval filter devices in patients with malignancies, is reviewed. Seventy patients had either a Mobin Uddin or Greenfield Umbrella Filter placed since 1971. The indications for caval interruption in our series included contraindications to anticoagulant therapy, bleeding with anticoagulant therapy, and recurrent pulmonary embolism with anticoagulant therapy. Of the 70 patients, 47 had a diagnosis of deep vein thrombosis, 15 had the diagnosis of pulmonary embolus, and eight had the diagnosis of both deep vein thrombosis and pulmonary embolus. The types of malignancies that were present in our patients included breast carcinoma, gynecologic tumors, colon tumors, pancreatic carcinoma, and hematologic malignancies. We report no operative mortality and a low operative morbidity of 7% utilizing this method of caval interruption. The late morbidity of stasis sequelae following caval interruption was present in 14% of the patients. Based on a favorable experience with this method of vena cava interruption in high-risk patients with advanced malignancies, the authors suggest a more liberal indication for caval interruption in this group of patients.