A phase I study of the safety of honeybee venom extract as a possible treatment for patients with progressive forms of multiple sclerosis.

Although several reports suggest that bee venom may be an effective treatment for patients with multiple sclerosis (MS), patients may be subjected to real risks of serious allergic reactions as well as emotional and economic costs. This study was conducted to evaluate the safety of bee venom extract as a possible treatment for patients with progressive forms of MS. A total of nine bee venom nonallergic patients with progressive forms of MS, who were 21-55 years of age with no other illnesses, were entered into four groups (A, B, C, and D) on a structured 1-year immunization schedule. Hyperreactivity to bee venom was evaluated by questionnaire, physical examination, and a battery of hematologic, metabolic, and immunologic tests. Responses to therapy were evaluated by questionnaire, functional neurological tests, and changes in measurement of somatosensory-evoked potentials. Although no serious adverse allergic reactions were observed in any of the nine subjects, four experienced worsening of neurological symptoms, requiring termination in the study; this could not be ascribed to side effects of the therapy. Of the remaining five subjects, three felt that the therapy had subjective amelioration of symptoms and two showed objective improvement. Although this preliminary study suggests safety, because of the small numbers studied, there were no definite conclusions regarding efficacy and therefore there was little evidence to support the use of honeybee venom in the treatment of MS. Larger and more carefully conducted multicenter studies will be required to establish efficacy.

Multidetector-row computed tomography angiography for planning intra-arterial chemotherapy pump placement in patients with colorectal metastases to the liver.

PURPOSE: The purpose of this study was to evaluate the use of multidetector computed tomography (MDCT) in the preoperative arterial evaluation of patients scheduled to undergo intra-arterial chemotherapy pump placement. METHODS: Computed tomography scans of 30 patients with hepatic malignancies who were imaged with multiphase MDCT angiography for intra-arterial chemotherapy pump placement were retrospectively analyzed. Dual-phase helical CT was performed, and the arterial phase images were processed to depict the arterial anatomy and to identify pertinent anomalies. All findings were compared and correlated with surgical findings or catheter angiography if surgery was contraindicated. RESULTS: Arterial anomalies identified on CT angiography in 20 of 30 patients included a replaced right hepatic artery (RHA; n = 6) or left hepatic artery (LHA; n = 8), a replaced common hepatic artery (n = 1), an accessory RHA (n = 2) or LHA (n = 6), a replaced gastroduodenal artery (GDA; n = 2), an extrahepatic connection between the accessory RHA and the replaced RHA (n = 1), and a common origin composed of the GDA and RHA and LHA (n = 2). There were no additional arteries or anomalies identified by catheter angiography, when available, or during surgery. Only 1 variant, an accessory hepatic artery, was not located during surgery. In 2 patients, the surgical team decided that pump placement was not feasible because of overly complex anatomy as determined by CT angiography. Computed tomography angiography showed an overall sensitivity of 100% and specificity of 97%. CONCLUSIONS: Multidetector computed tomography angiography is accurate for the preoperative evaluation of normal and aberrant hepatic vasculature in patients under consideration for intra-arterial chemotherapy pump placement. Axial images alone permit recognition of vascular anomalies, including complex anatomy. Nevertheless, 3-dimensional rendering is useful to evaluate complex vascular anatomy and does not require catheter angiographic confirmation. In addition to aiding in selecting patients ideal for pump placement, MDCT permits noninvasive planning of their surgical approach.

Effectiveness of immunotherapy for recurring sinusitis associated with allergic rhinitis as assessed by the Sinusitis Outcomes Questionnaire.

BACKGROUND: Outcomes measurement is a proficient method for determining the effectiveness of medical therapy. Currently, there are no easy-to-use and inexpensive questionnaires available to evaluate the impact of immunotherapy in the treatment of sinusitis by allergists, given the research constraints of a private practice setting. OBJECTIVE: To measure the effectiveness of immunotherapy in the overall treatment of atopic patients with associated sinusitis in a private practice setting. METHODS: A total of 114 patients with a history of rhinitis and sinusitis and positive radiographic evidence of sinus disease were consecutively chosen from 3 private practices nationwide and surveyed for global symptoms and specific symptoms related to the nose, sinuses, eyes, and chest with the Sinusitis Outcomes Questionnaire (SOQ). Their medical history, including prior treatment, was evaluated. This questionnaire was administered twice in one sitting, with the first a recall of symptoms before starting immunotherapy and the second an evaluation of current symptoms. RESULTS: The data revealed that 99% believed immunotherapy worked, with 1% unsure. Patients experienced a 72% decrease in days lost from work or school and a 26% reduction in the use of medications per year. There was a mean reduction of 51% in the overall symptom score of the patients after receiving immunotherapy. CONCLUSIONS: This study demonstrates that the user-friendly SOQ can be effectively and inexpensively used in a private practice setting and suggests that immunotherapy is an effective treatment for patients with sinus disease and allergic rhinitis.

EUS-guided portal vein catheterization and pressure measurement in an animal model: a pilot study of feasibility.

BACKGROUND: The extrahepatic portal vein is inaccessible to direct catheterization. METHODS: Because EUS can readily image the portal vein, the feasibility of EUS-guided portal vein catheterization by using a 22-gauge needle was studied in 7 normal pigs and 14 pigs in which portal hypertension was induced (7/14 anticoagulated). RESULTS: Catheterization was not possible by EUS or transhepatic methods in, respectively, 3 and 5 animals. One anticoagulated animal had a small amount of periduodenal bleeding as a result of EUS catheterization. The mean normal portal vein pressure (1 standard deviation) as determined by EUS and transhepatic methods was, respectively, 20.3 (4) mm Hg and 20.4 (2) mm Hg. Injection of polyvinyl alcohol particles increased the portal vein pressure by 10.2 (11.59) mm Hg. There was a close correlation under all conditions between the mean portal vein pressures obtained by EUS and transhepatic catheterization (r=0.91). CONCLUSIONS: EUS-guided portal vein catheterization appears to be feasible in an animal model and provides accurate pressure measurements.

Renal perfusion defects after endovascular repair of abdominal aortic aneurysms.

PURPOSE: To determine the prevalence of new renal perfusion defects and the association of these events with aneurysm neck atheroma during endovascular stent-graft repair of abdominal aortic aneurysm (AAA). MATERIALS AND METHODS: A retrospective review was performed of 50 patients who underwent AAA repair with bifurcated endovascular stent-grafts without suprarenal components between June 1998 and May 1999. Pre- and postprocedural computed tomographic (CT) angiograms were reviewed to determine the prevalence of new renal perfusion defects. The percent volume of atheroma of the aneurysm neck was determined by three-dimensional volumetric reformation and correlated with prevalence of new postprocedural renal perfusion defects. Follow-up CT angiography was performed between 6 months and 2 years after the procedure and used to evaluate the presence of residual defects and interval changes. RESULTS: Of 50 subjects, 18% (n = 9) had new perfusion defects presumed to be embolic in origin. Follow-up was available for four patients: scarring and cortical thinning consistent with infarction developed in two, whereas the defects resolved in the other two. Analysis of aneurysm neck revealed an average percentage of atheroma of 32% and a range of 0%-73%. In subjects with >/=40% neck atheroma, the prevalence of new renal perfusion defects was 45.4% (five of 11), compared to 10.3% (four of 39) in subjects with <40% neck atheroma. This difference was significant (P =.0170). CONCLUSIONS: In this series, the frequency of renal embolic events associated with AAA endovascular repair was 18%. Prevalence of renal embolic perfusion defects was shown to correlate with volume of aneurysm neck atheroma.

Indoor mold spore exposure: a possible factor in the etiology of multifocal choroiditis.

PURPOSE: To report on the correlation between indoor mold exposure and a case of multifocal choroiditis (MFC). DESIGN: Observational case report. METHODS: A 37-year-old woman diagnosed with MFC who had had extensive mold exposure underwent an allergic evaluation, including a comprehensive environmental history, physical examination, radioallergosorbent test, and skin testing. RESULTS: The patient's vision deteriorated after numerous recurrences of MFC triggered by exposure to extremely high mold environments (mold counts recorded between 3,000 and 13,000 mold spores/m(3)). CONCLUSIONS: Exposure to high indoor mold count environments may be a factor in the etiology of MFC. Further studies are indicated.

Fungal contamination of elementary schools: a new environmental hazard.

BACKGROUND: Sensitivity to fungi is a significant cause of allergic diseases, and prolonged indoor exposure to fungi is a growing health concern. OBJECTIVE: This study evaluates the health effects of mold-contaminated schools on students and teachers. A discussion of the effectiveness of current methods for evaluating these schools, with a focus on the importance of using total mold spore counts, is also provided. METHODS: Two Connecticut public schools were tested using multiple air quality testing methods, with the standard for a healthy indoor environment being total mold spore counts lower than 1,000 spores/m3. The health impact of the mold exposure at each school was evaluated using the validated Rhinitis Outcomes Questionnaire. RESULTS: The testing of the first school found indoor mold counts ranging from 6,000 to 50,000 spores/m3. Eighty-five of the students and teachers reported significant allergic symptoms to the school nurse. This school is currently being demolished. More than 2 years after the exposure ended, a number of occupants of the school continue to have elevated symptoms compared with before their exposure to the school. The testing of the second school revealed total mold spore counts ranging between 2,000 and 9,000 spores/m3, qualifying it an unhealthy environment in need of immediate remediation. Students reported significant allergic symptoms from exposure to certain rooms that are currently being remediated. CONCLUSIONS: Because of the negative impact on health that indoor mold exposure has, particularly in atopic patients, schools should be routinely tested for fungal contamination. Total mold spore counts should be performed using volumetric air sampling such as the Allergenco MK-3 (Allergenco, San Antonio, TX) because testing air quality via semiquantitative culture sampling alone does not give a true reflection of the extent of fungal contamination. Finally, the standard for a healthy indoor environment should be defined as having <1,000 spores/m3.

Fibrin sheaths and central venous catheter occlusions: diagnosis and management.

Central venous catheter malfunction diagnosis and treatment is a growing component of the field of interventional radiology. A thorough understanding of the causes of catheter malfunction and the technical skills needed to treat these problems are necessities to appropriate management. In long-standing central venous catheters, the formation of a fibrin sheath can and often does contribute to catheter malfunction. Differentiating a sheath from thrombus is imperative to appropriate therapy. The purpose of this article is to provide an understanding of the causes of fibrin sheaths and how to treat them.

Health effects of mold exposure in public schools.

This paper profiles the impact of mold exposure on the health of students, teachers, and staff in two public elementary schools in Connecticut, and explains how the air quality in each school was tested, and how the health of teachers and students was assessed. It also proposes standards for testing indoor air quality and evaluating the health impact of indoor mold exposure on students, teachers, and staff members.