Clinical phenotypes and therapeutic responses in cutaneous-predominant sarcoidosis: 6-year experience in a tertiary referral service.

BACKGROUND: There is a limited evidence base for the treatment of cutaneous sarcoidosis. OBJECTIVE: To describe treatment modalities and responses in patients with predominantly cutaneous sarcoidosis, in addition to clinical characteristics and prevalence of systemic disease. METHODS: Data were prospectively collected over a 6-year period. The Cutaneous Sarcoidosis Activity and Morphology Index was used to assess treatment effectiveness. RESULTS: In total, 47 patients with biopsy-confirmed cutaneous sarcoidosis were identified. Morphologically, the most common lesions were papules (49%) and plaques (42.6%). The most commonly affected sites were the head and neck (79%); 89.4% had systemic as well as cutaneous disease; 77% received systemic corticosteroid therapy, while 87% required further steroid-sparing treatment; 40% achieved clinical remission with hydroxychloroquine (HCQ) and 88% achieved clinical remission with methotrexate (MTX). OR of achieving remission on MTX compared with HCQ was 9.8 (95% CI 2.4-40.4, P = 0.001). MTX was superior to both azathioprine (AZA) (OR = 22; 95% CI 1.7-285.9; P = 0.02) and mycophenolate mofetil (MMF) (OR = 22; 95% CI 1.7-285.9; P = 0.02) in achieving remission. CONCLUSION: HCQ is effective and well-tolerated. MTX was associated with significantly increased probability of achieving clinical remission compared with AZA and MMF.

Indice de captación de 99mTc-MIBI en el ventrículo derecho como marcador indirecto de isquemia en los estudios de perfusión miocárdica / Right ventricular uptake index of 99mTc-MIBI in myocardial perfusion studies

Se describe un nuevo método para cuantificar la captación relativa del ventrículo derecho en los estudios de perfusión miocárdica. Se demuestra que el índice de captación propuesto está en relación con el grado de isquemia miocárdica en el ventrículo izquierdo.

A new method for quantification of relative right ventricular uptake in myocardial perfusion Studies is described. A direct relationship between the proposed uptake index and the degree of left ventricular myocardial ischemia is demonstrated.

A protocol for the calibration of gamma cameras to estimate internal contamination in emergency situations.

The concern about accidents involving radioactive materials has led to the search of alternative methods to quickly identify and quantify radionuclides in workers and in the population. One of the options to face up an eventual demand for mass monitoring of internal contamination is the use of a nuclear medicine diagnostic equipment known as gamma camera, a device used to scan patients who have been administered specific amounts of radioactive materials for medical purposes. Although the gamma camera is used for image diagnosis, it can be calibrated with anthropomorphic phantoms or point sources for the quantification of radionuclide activities in the human body. This work presents a protocol for the calibration of gamma cameras for such application. In order to evaluate the suitability of this type of equipment, a gamma camera available in a public hospital located in Rio de Janeiro was calibrated for the in vivo measurement of 131I. The calibration includes the determination of detection efficiencies and minimum detectable activities for each radionuclide. The results show that the gamma camera presents enough sensitivity to detect activity levels corresponding to effective doses below 1 mSv. The protocol is the basis to establish a network of Nuclear Medicine Centres, located in public hospitals in eight countries of Latin America (Argentina, Brazil, Colombia, Cuba, Chile, Mexico, Peru and Uruguay) and in Spain that could be requested to collaborate in remediation actions in the event of an accident involving incorporation of radioactive materials. This protocol is one of the most significant outputs of the IAEA-ARCAL Project (RLA/9/049-LXXVIII) aimed to the Harmonization of Internal Dosimetry Procedures.

Design and evaluation of "3 + 1" mixed ligand oxorhenium and oxotechnetium complexes bearing a nitroaromatic group with potential application in nuclear medicine oncology.

The synthesis and evaluation of a series of oxotechnetium and oxorhenium complexes containing a nitroaromatic moiety as potential radiopharmaceuticals for targeting tumour hypoxia is presented. 99mTc labelling was performed in high yield (>85%) and radiochemical purity (>90%). Their structure was corroborated by means of the rhenium complexes. Reduction potentials were in the range for bioreducible compounds. 99mTc complexes III-VI were selected for "in vivo" experiments in view of the results of cytotoxicity studies. Biodistribution in normal animals was characterized by high initial blood, lung and liver uptake, fast blood and soft tissue depuration and preferential excretion via the hepatobiliary system. Initial tumour uptake was moderate but tumour/muscle ratios for complexes III and IV, were favourable at all time points. Although the results are encouraging further development is still necessary in order to achieve higher tumour uptake and lower gastrointestinal activity.

Quality control of 188W/188re generators

Quality control of 188W/188Re generators from two different manufacturers and two levels of activity each, was carried out.Elution yields, chemical as well as radionuclidic and radiochemical purities, elution profiles along six months, were evaluated.Broad elution profile, high efficiency, with tandem alumina column added, ionic exchange column needed for increase of radionuclidic concentration were characteristics of type I generators.Easy handling with slightly lower yields and high concentrations of activity were observed in type II generators. Similar radionuclidic impurities namely 192Ir, 191Os, 188W, 110mAg, 54Mn, 134Cs and 60Co as well as similar radiochemical yields obtained in the labelling of 188 Re-HEDP were observed with eluates of both generator types.Absorbed doses to radiopharmacy staff were less important in type II generators.

Lymphocyte-proliferative responses to HIV antigens as a potential measure of immunological reconstitution in HIV disease.

Lymphocyte-proliferative responses (LPRs) to HIV antigens are absent or of low magnitude in the majority of HIV-infected individuals, even early in the disease. However, lymphocytes from 2% to 3% of individuals proliferate very strongly to HIV Env or Gag antigens, and these individuals remain well clinically, without antiretroviral therapy. In established HIV infection, suppression of HIV-replication with potent antiretroviral therapy does not result in the development of strong LPRs to HIV antigens. Large LPRs to HIV antigens can be induced by HIV vaccines in patients with established infection, even though they were not formed in response to infection. Studies must be designed to determine whether large LPRs induced by vaccines administered in conjunction with potent antiretroviral therapy are associated with long-term control of HIV infection.

Medical practice and physician executives face the uncertain future. Strategic stakeholder management III.

This article, third in a series addressing stakeholder management, presents preliminary findings of Round Two data from the "Facing the Uncertain Future" study. One purpose of this study is to determine how experts define key stakeholders of medical group practices now and how these stakeholders might change by the year 2000. This analysis highlights a comparison of two expert panels: medical practice executives (MPEs) and physician executives (PEs). The purpose was to ascertain whether or not MPE and PE perspectives for the present and predictions for the future differed on a series of key issues. The key issues discussed are: organizational goals, who will be responsible for managing the organization towards these goals, assessment of the external environment and identification of key stakeholders. MPEs and PEs, with the exception of the physician manager and several current organizational goals, view the present similarly and also showed convergence in their predictions for 2000. Despite different training and career experiences, our analysis found that MPEs and PEs view the present and future in surprisingly similar ways. As a result, MPEs and PEs are encouraged to be less preoccupied with perceived differences in perspective and, instead, focus their energies on developing clear strategies and specific tactics to strengthen their organization's position in this turbulent environment.

Integrated delivery systems/networks in the uncertain future. Strategic stakeholder management, Round One continued.

This article presents an analysis of Round One data with a focus on integrated delivery systems/networks (IDS/Ns). These complex, multifaceted organizations are growing in importance in the turbulent health care industry. The emergence of these multi-organizational forms requires that all health care industry organizations--medical groups, hospitals, payer organizations, suppliers--adapt to the ever-increasing demands placed on them as the industry experiences revolutionary changes. The findings presented in this article were compiled from the responses of 580 health care industry experts about the uncertain future facing health care executives. These respondents represented virtually every health care organizational form, including medical groups, physicians, hospitals, payer organizations, academic researchers, pharmaceutical firms and other health care industry suppliers. Each of these health care respondent panels answered hundreds of questions pertaining to both the present (1994) and the future (1999). These analyses seek to describe the different relationships between medical groups, their stakeholders and IDS/Ns, and how they will change over the years of 1994 to 1999. We also present experts' perceptions and predictions about five other key stakeholders of medical groups--managed care organizations, governments, employers, system hospitals and patients.

Strategic stakeholder management. First round results from 'Facing the Uncertain Future'.

Authors summarize preliminary results from the first round of a two-round modified Delphi study called "Facing the Uncertain Future." Health care experts were asked to comment on the status of the health care industry in 1994 when the study began and their predictions for change by 1999. Major findings based on the 580 responses received include: (1) the continued movement of the U.S. health care industry from a primarily private insurance industry to one in which medical groups and hospitals will be members of integrated delivery systems/networks (IDS/N); (2) the increasing dominance of the components of IDS/Ns in 1999 (components are defined as: medical practices, system hospitals, managed care organizations and IDS/Ns); and (3) the potential effects of IDS/Ns on the health care industry, including: increases in cost effectiveness, quality of administrative management and the quality of physician leadership, as well as decreases in availability of advanced medical technology and the duplication of ancillary services, facilities and equipment. The study is being conducted jointly by the Medical Group Management Association and Texas Tech University with funding from Abbott Laboratories.

Prevalence of HIV infection in New York call girls.

In order to evaluate the frequency of sexual transmission of human immunodeficiency virus (HIV) among promiscuous heterosexuals, we studied the prevalence of HIV infection among a group of predominantly Caucasian call girls and women working for escort services and massage parlors in New York City. In the 78 subjects studied, the mean age was 31.6 years and the mean duration of prostitution was 5.1 years. Study participants each had a median of 200 different sexual partners in the preceding year. Six women had a history of intravenous drug abuse and none had a history of any other recognized risk factor for HIV infection. Ninety percent of the women studied used condoms during intercourse with at least some of their partners. One of the six women with a history of drug abuse and none of the 72 non-drug-abusers were seropositive for HIV. This study indicates that despite their promiscuity, HIV infection is still uncommon in call girls in New York City.

Functional properties of Ly 11.2 lymphocytes: a role for these cells in leukemia?

Functional studies of lymphocyte subpopulations reveal that Ly 11.2, a newly defined T cell surface antigen, is present on prothymocytes and natural killer cells, but not on suppressor T cells for antigen-specific IgE antibody responses, Ly 1+, 2-, 3- helper T cells nor on tumor-specific cytotoxic effector cells. Changes in the expression of Ly 11.2 regularly accompany leukemogenesis and are quite distinct from changes of other cell surface antigens thus far observed. After intrathymic inoculation of radiation leukemia virus (RadLV), many more Ly 11.2-positive cells are found expressing viral antigens than cells expressing other cell surface phenotypes. In addition, after RadLV inoculation, significantly more Ly 11.2-positive cells can be found in the thymus of susceptible mice than in the thymus of resistant mice. The greater availability of permissive (Ly 11.2-positive) cells in susceptible vs resistant hosts at the time when infectious virus is present may account for the shorter latency period and high leukemia incidence of susceptible vs resistant mice.

Definition of a new T lymphocyte cell surface antigen, Ly 11.2.

The present communication defines a new cell surface antigen, Ly 11.2, which appears from its strain and tissue distribution to be distinct from all other previously defined normal or virally coded antigens or traits of the mouse. Lymphocytes of the T cell lineage, but not B cells or nonlymphoid cells, bear this marker. Although the locus coding for this antigen appears to be closely linked to the minor histocompatibility locus H-30 and to the locus coding for Ly 6.2, a chromosome assignment has not yet been made for my of these loci.