Comparison of efavirenz and nevirapine in HIV-infected patients (NEEF Cohort).

The non-nucleoside reverse transcriptase inhibitors (NNRTIs) efavirenz (EFV) and nevirapine (NVP) taken in combination with nucleoside reverse transcriptase inhibitors (NRTIs) have both shown to be just as highly effective as protease inhibitors (PIs) in reducing viral load in patients infected with HIV. Our study compares the performance of these two NNRTIs with each other. This was a non-randomized, prospective, two-arm, multi-centre trial. We evaluated all patients with an EFV- or NVP-containing antiretroviral regimen. The primary endpoint was the difference in success rates defined as a viral load of

Methicillin-resistant Staphylococcus aureus colonization in inflammatory versus non-inflammatory skin diseases: who should be screened?

The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) was prospectively investigated in a dermatology outpatient setting. Swabs were taken from anterior nares, perineum and lesional skin in 229 patients with erosive inflammatory skin diseases (n=88), venous leg ulcers (n=58) or basal cell carcinoma (n=83) and processed by standard methods. The isolated MRSA strains were characterized by pulsed-field gel electrophoresis after digestion with the restriction enzyme SmaI. MRSA carriage was detected in 10/88 patients with inflammatory skin diseases, 5/58 with venous leg ulcers and 0/83 with basal cell carcinoma. Most of the MRSA isolates could be identified as either the Rhine-Hessen epidemic strain or local epidemic strains. None of the isolated strains was resistant to vancomycin, gentamicin or mupirocin. MRSA is uncommon in outpatients in our dermatology clinic; however, the presence of chronic ulcers and erosions was significantly associated with MRSA positivity. Therefore, patients with chronic ulcers and erosions should be screened for MRSA colonization to implement infection control measures.

Quantitative venous severity scoring using the venous arterial flow index by duplex sonography.

BACKGROUND: Volume flow, as the product of the mean blood flow velocity by the cross sectional area, means an interesting hemodynamic pattern that can be calculated by duplex. OBJECTIVE: To quantify the severity of venous insufficiency using the correlation between the volume flow in the common femoral vein (VFV) and artery (VFA), called the venous arterial flow index (VAFI). METHODS: A total of 163 consecutive patients were included: 46 patients with postthrombotic syndrome (PTS, group 1), 38 patients with complete varicosity of the greater saphenous vein (group 2), 40 patients with only segmental or truncal varicosity (group 3), and 39 patients with competent veins (group 4). Under standardized conditions, duplex sonography was performed to calculate volume flow in the common femoral vein and artery as a product of mean blood flow velocity (vm) and precise diameter (d = 2pir) of the vessel due to the formula VF = vmxpir2 (L/min). Division of the venous and arterial volume flow data calculated the VAFI. RESULTS: Significant differentiation of VFV (P <.001) and VAFI (P <.0001) between varicose veins and healthy limbs were found. In PTS the mean VFV was 0.50 L/min and the mean VAFI was 1.465. In the complete varicosity group, mean VFV was 0.46 L/min and mean VAFI was 1.48. In group 3, the mean VFV was 0.41 L/min and the mean VAFI was 1.31. In healthy persons, mean VFV was 0.36 L/min and mean VAFI was 0.87. CONCLUSION: The VAFI can be used to quantify the hemodynamic severity in venous insufficiency.

Lymphangioma circumscriptum of the vulva following surgical and radiological therapy of cervical cancer.

BACKGROUND: Lymphangioma circumscriptum of the vulva rarely develops after postoperative pelvic irradiation. GOAL: The goal was to describe two cases of lymphangioma circumscriptum and their treatment and present a brief review of the literature. STUDY: Two female patients, aged 75 years and 46 years, presented with persistent edema, papules, and vesicles of the labia majora, which had developed 15 and 9 years after hysterectomy, lymph node dissection, and subsequent irradiation of cervical cancer. The external diagnosis was genital warts. RESULTS: In both cases histology revealed lymphangioma circumscriptum of the vulva. Whereas the older woman's condition responded well to laser treatment, keloids developed in the second patient at the site of carbon dioxide laser vaporization. CONCLUSION: CO2 laser treatment recently has been recommended for vulvar lymphangioma circumscriptum and is effective in vaporizing the communicating vessels to deeper cisterns. To our knowledge this is the first description of keloid development after laser therapy for vulvar lymphangioma circumscriptum, and such an effect should be considered before CO2 laser surgery is applied for this particular entity.

Are zinc levels in seminal plasma associated with seminal leukocytes and other determinants of semen quality?

OBJECTIVE: To evaluate a potential association of zinc levels with seminal leukocytes, the outcome of semen cultures; and semen quality and sperm fertilizing capacity. DESIGN: Prospective study. SETTING: Outpatient infertility clinic of a university hospital. PATIENT(S): Two hundred fifty-six randomly chosen asymptomatic males from subfertile couples. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Determination of zinc in seminal plasma by flame atomic absorption spectroscopy. In aliquots of the same ejaculates the following tests were performed: immunocytochemical round cell differentiation to determine leukocyte counts and ratios, microbial screening, and comprehensive evaluation of semen quality (sperm analysis, biochemical parameters, antisperm antibody testing, and in vitro examination of sperm ability to penetrate cervical mucus). The patients underwent medical history, clinical examination, and postcoital testing. Subsequent fertility was determined (controlled for female infertility factors). RESULT(S): The concentration of zinc in seminal plasma did not correlate in a statistically significant way with leukocytes in semen, nor was it associated with bacterial colonization. There was no statistically significant relationship of zinc in seminal plasma or serum with semen quality parameters nor with local antisperm antibody testing of the IgG or IgA class. Zinc levels did not influence sperm capacity to penetrate cervical mucus in vitro or in vivo, and did not affect subsequent fertility. CONCLUSION(S): The zinc level in seminal fluid and serum is not associated with silent male genital tract infection (indicated by seminal leukocytes); nor is it related to semen cultures in asymptomatic individuals. The lack of association with other semen quality parameters indicates that the routine determination of zinc levels during infertility investigation is not recommended.