Paying injection drug users to educate and recruit their peers: why participant-driven interventions are an ethical public health model.

The criminalization of drug use has made it difficult to reach injection drug users (IDUs) with public health interventions. The "peer-driven intervention" (PDI) makes use of the existing social network of IDUs to educate and recruit participants in the intervention. Participant IDUs are given nominal financial rewards for being interviewed, for recruiting IDUs to the program, and for educating their recruits. Using peers as educators, PDIs build a discourse of prevention in the community and contextualize those messages in daily interactions of IDUs. Some critics of the PDI model, however, have balked at the idea of providing active injectors with financial rewards that can be used to purchase drugs. This essay, which describes some of the ways that the Eastern Connecticut Outreach Project worked to avoid potential pitfalls of the reward program, defends the PDI as an ethically superior model for public health intervention.

Coxsackie virus infections in rheumatic fever.

The close relationship between Group A beta Hemolytic Streptococci (GABS) and rheumatic fever is a well established one. However, the concept of the streptococcus as the sole etiologic agent of the rheumatic heart disease (RHD) has been challenged over the past years. Since coxsackievirus group B (CVB) has long been proposed as a cause of acquired valvular disease simulating rheumatic fever, we attempted in this study to document infections with this group of viruses in patients with rheumatic fever. We obtained blood samples from 106 patients with old (quiescent) rheumatic fever/rheumatic heart disease [group I], 94 patients with acute rheumatic fever (ARF) [group II], and 74 normal matched controls. We tested for the presence of neutralizing antibodies to the 6 serotypes of CVB by a micro neutralization test. We have found that infection with CVB, especially types B2 and B4, was common in the studied population. Forty-two percent of normal individuals had evidence of infection with any of the 6 serotypes of CVB. Patients of group I had significantly more frequent infections with CVB 2. Patients in group II had significantly more frequent infections with CVB 2 and CVB 6. There was no clear correlation between such infections and the clinical course of rheumatic fever. There was no difference in the incidence of CVB infections between patients with definite ARF, and patients with suspected ARF. We set a low order association between rheumatic fever and infection with CVB types B2 and B6. We emphasize the importance of pursuing the investigation of the role of CVB in relation to RHD.

Comparison of L-hyoscyamine, glucagon, and placebo for air-contrast upper gastrointestinal series.

Previous studies have compared the use of anticholinergic drugs and glucagon for upper gastrointestinal (UGI) radiography. Many radiologists prefer glucagon because these comparisons showed it to have a shorter duration of action with fewer side effects. L-Hyoscyamine is the levo-rotatory form of atropine with minor adverse side effects. This study compared the effects of glucagon (N = 48), L-hyoscyamine (N = 43), and placebo (N = 45) on gastric and duodenal distension, mucosal coating, and patient tolerance. L-Hyoscyamine provided gastric and duodenal images equal in quality to glucagon. Except for the more frequent reporting of dry mouth with L-hyoscyamine, side effects were not different among the groups. L-Hyoscyamine is an economical alternative to glucagon for hypotonic gastrointestinal radiography.

Gallium-67 and pulmonary complications of amiodarone.

A 66-year-old white man with amiodarone pneumonitis is presented. The diagnosis was made with the aid of Ga-67 imaging, which is a sensitive method of detecting amiodarone pulmonary toxicity in patients with symptomatic pulmonary infiltrates on chest radiographs. Ga-67 imaging is especially useful in distinguishing amiodarone pneumonitis from congestive heart failure.

Computed tomography of renal sarcoidosis.

Radiographic evidence of renal involvement by sarcoidosis is usually demonstrated as nephrocalcinosis or nephrolithiasis. We present a case of renal sarcoidosis manifested as noncalcified masses on contrast enhanced CT.

Bullet injury to the esophagus detected by intestinal migration.

Esophageal injury resulting from a gunshot wound of the chest is unusual. Even more rare is intraluminal movement of the bullet through the gut, which we found described only twice previously. The perforation was demonstrated by esophagram and confirmed by thoracotomy.

CT demonstration of gastropancreatic fistula due to penetrating gastric ulcer.

We report a patient with gas in the pancreatic duct due to a gastropancreatic fistula resulting from gastric ulcer. No mass or pseudocyst was demonstrated. This entity should be considered when patients with gas in the pancreas are encountered.

Computed tomography of duodenal hematoma.

As the initial study in cases of abdominal trauma, computed tomography may demonstrate intramural duodenal hematoma as an inhomogeneous, high-attenuation mass associated with obstructive changes. Representative cases show the manifestations of this injury as presented by this technique.

Intraventricular calcitonin gene-related peptide inhibits gastric acid secretion.

Calcitonin gene-related peptide (CGRP) is a 37 amino acid peptide recently demonstrated to be a peptide expressed by the calcitonin gene in the rat central nervous system. Intracerebroventricular administration of CGRP in pylorus ligated rats resulted in a dose dependent suppression of gastric acid secretion. This effect was also present in acutely vagotomized rats. In addition, CGRP inhibited the stimulation of gastric acid secretion by thyrotropin releasing hormone. CGRP was considerably less potent in its effect on gastric acid than calcitonin, a well known central inhibitor of gastric acid secretion in the rat. This study suggests that CGRP may be a factor in the central regulation of gastric acid secretion in the rat.

Branching pattern in CT scans of mucin producing carcinoma metastases to the liver.

Intrahepatic calcification occurring in a branching pattern with a periportal distribution has not previously been described in hepatic metastases. We report a patient with a unique branching pattern of calcified hepatic metastases. There were no low density masses associated with the calcifications as is usually seen in calcified metastases to the liver demonstrated by computed tomography.

Abrupt termination of the common bile duct: a sign of malignancy identified by high-resolution real-time sonography.

Although contrast cholangiography has a greater accuracy than sonography in determining the precise nature of extrahepatic biliary obstruction, it is not without risk. High-resolution real-time sonography is frequently adequate to evaluate the extrahepatic biliary system in multiple planes without known risk to the patient. In a one-year period the authors prospectively observed eight instances of distal biliary obstruction with abrupt termination of the common bile duct, and all were associated with malignant obstruction. There was no instance of abrupt ductal termination secondary to benign disease in this series. Malignancy should be suspected when careful sonograms along the longitudinal axis of an obstructed distal common bile duct reveal an abrupt termination.

Method for continuous purification of biological material using immunosorbent.

A mechanical device for the continuous purification of biological material using immunosorbent was developed. The system consists of heat-sealed nylon pouches containing agarose-bound antibody, attached to an endless 35 mm wide Mylar belt that passes through four chambers sequentially. The biological material is bound and dissociated, and the immobilized antibody is regenerated for repeated isolation and purification of antigen. The belt design incorporates features to minimize carry-over between chambers and prevent damage to the agarose-bound antibody in repeated passes through the system. An existing batch method for the purification of human placental alkaline phosphatase using immobilized rabbit antisera was adapted to continuous purification in the device. The belt contained a low affinity immunosorbent and made five complete passes through the system. A decrease in antigen binding capacity between free immunosorbent suspensions and belt immunosorbent in pouches was observed. This was shown to be the result of the diffusion resistance offered by the pouch and the short exposure times of each pouch in the chambers. A decrease in antigen binding capacity between successive belt passes was also observed, and resulted from the inability of the agarose in the pouches to resuspend completely after each pass. The low efficiency of the agitation method and the roller device used to squeeze the pouches were the reasons for this deficiency.