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Florence Lot, MD; Jean-Christophe Séguier, MD; Sophie Fégueux, MD; Pascal Astagneau, MD, PhD; Philippe Simon, MD; Michèle Aggoune; Patrice van Amerongen, MD; Martine Ruch, MD; Mireille Cheron, MD; Gilles Brücker, MD; Jean-Claude Desenclos, MD; and Jacques Drucker, MD, MSc

In October 1995, the French Ministry of Health offered HIV testing to patients who had been operated on by an orthopedic surgeon in whom AIDS was recently diagnosed. The one HIV-positive patient identified was HIV-negative before surgery and had viral sequences closely related to those obtained from the surgeon. This finding suggests that the surgeon may have transmitted HIV to this patient during surgery.

Topics: hiv, hiv seropositivity, hiv transmission, health personnel, acquired immunodeficiency syndrome, hiv screen, ...
  

Chelation therapy appears to slow the progression of renal insufficiency in patients with mildly elevated body lead burden. This implies that long-term exposure to low levels of environmental lead may be associated with impaired renal function in patients with chronic renal disease.

Topics: kidney failure, chelation therapy
  
George W. Petty, MD; Robert D. Brown Jr., MD; Jack P. Whisnant, MD; JoRean D. Sicks, MS; W. Michael O'Fallon, PhD; and David O. Wiebers, MD

In this study, complication rates for warfarin and intravenous heparin given for secondary stroke prevention were lower than rates reported from earlier trials and observational studies. For warfarin, however, these rates were higher than those found in more recent randomized trials. Rates were higher for heparin than for aspirin and warfarin. These rates can be used to judge the applicability of complication rates derived from ongoing clinical trials.

Topics: aspirin, warfarin, ischemic stroke, intravenous heparin, stroke prevention, frequency, transient ischemic attack, ...
  
Antonio Pelliccia, MD; Franco Culasso, PhD; Fernando M. Di Paolo, MD; and Barry J. Maron, MD

In a sample of highly trained athletes, left ventricular cavity dimension varied widely but was strikingly increased to a degree compatible with primary dilated cardiomyopathy in almost 15% of patients. When systolic dysfunction is absent, this dilatation is probably an extreme physiologic adaptation to intensive athletic conditioning.

Topics: dilatation, pathologic, cavity of left ventricle, athlete, sports, diastole
  
Franc Strle, MD; Robert B. Nadelman, MD; Joze Cimperman, MD; John Nowakowski, MD; Roger N. Picken, PhD; Ira Schwartz, PhD; Vera Maraspin, MD; Maria E. Aguero-Rosenfeld, MD; Shobha Varde, MS; Stanka Lotric-Furlan, MD; and Gary P. Wormser, MD

Erythema migrans caused by Borrelia afzelii in Slovenia and erythema migrans caused by B. burgdorferi in New York have distinct clinical presentations. Caution should be used when clinical and laboratory experience from one side of the Atlantic is applied to patients on the other side.

Topics: borrelia, borrelia burgdorferi, glossitis, benign migratory, slovenia
  
Josiah D. Rich, MD, MPH; Nathan A. Merriman, ScB; Eleftherios Mylonakis, MD; Thomas C. Greenough, MD; Timothy P. Flanigan, MD; Brian J. Mady, MD; and Charles C.J. Carpenter, MD

The availability of sensitive assays for plasma HIV viral load and the trend toward earlier and more aggressive treatment of HIV infection have led to the inappropriate use of these assays as primary tools for the diagnosis of acute HIV infection. Physicians should be cautious when using these assays to detect primary HIV infection, especially when the pretest probability of infection is low.

Topics: hiv-1, plasma, viral load result, hiv infection, misdiagnosis
  
Akihiro Matsumoto, MD; Shin-ichi Momomura, MD; Seiryo Sugiura, MD; Hideo Fujita, MD; Teruhiko Aoyagi, MD; Masataka Sata, MD; Masao Omata, MD; and Yasunobu Hirata, MD

In this study, nitric oxide inhalation improved gas exchange in patients with congestive heart failure. This treatment may be useful as supportive therapy when other conventional vasodilators worsen gas exchange.

Topics: nitric oxide, congestive heart failure, pulmonary gas exchange, isosorbide dinitrate
  
Eugene R. Schiff, MD

Among the many topics related to hepatology that gained attention in 1997, this Update focuses on viral hepatitis, other types of liver disease, complications of cirrhosis, and liver transplantation.

Topics: acetaminophen overdose, liver cirrhosis, interferons, lamivudine, liver transplantation, infection, gb virus c, ...
  
Emilie H.S. Osborn, MD, MPH; Maxine A. Papadakis, MD; and Julie Louise Gerberding, MD, MPH

Medical students may be at high risk for occupational exposures to blood. This study found that instruction in universal precautions is not sufficient to prevent exposures to blood during medical training. Medical schools must assume greater responsibility for ensuring that students are proficient in the safe conduct of clinical procedures and must develop systems so that students can report and learn from their mistakes.

Topics: body fluid, exposure, occupational exposure, students, medical, needlestick injuries, needle device, infection ...
  

In 1899, Karel F. Wenckebach unraveled the complicated arrhythmia that bears his name. He is remembered for his insight into atrioventricular circulation, which is as valid today as it was a century ago.

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In this issue, Lot and colleagues report what they believe to be the first case of HIV transmission from an infected surgeon to a patient during a surgical procedure. It is reassuring that this is only the second reported instance of an infected health care provider transmitting HIV to a patient. Rational prevention policies will further reduce this very small risk.

Topics: hiv transmission, infection, hiv
  

Medical students participate actively in patient care and thus incur some of the risks of experienced physicians, especially the risk for exposure to bloodborne viruses. As a result, schools must train their students in safe procedures and establish response capacities for any break in technique that leads to a possible exposure to bloodborne pathogens. In this issue, Osborn and colleagues describe an outstanding approach to this problem.

Topics: hepatitis, schools, medical, students, medical, tuberculosis, infection, acquired immunodeficiency syndrome, intern, exposure, ...
  

Our understanding of the molecular biology of adenocarcinoma of the esophagus and gastric cardia and of Barrett esophagus is increasing. However, the cause of the increasing incidence of adenocarcinoma is not yet known, and this limits our ability to intervene to reduce the incidence.

Topics: barrett's esophagus, cancer, adenocarcinoma, esophageal adenocarcinoma, cardia
  
Faith T. Fitzgerald, MD

What is the relation between “humaneness” and curiosity? How is curiosity suppressed in medical students and physicians?

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Keith Luther, MD

After hospitalization for pancreatitis, Henry returns to the hotel where he lives and faces the challenge not to drink.

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Myron M. LaBan, MD; and Ronald S. Taylor, MD
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Paul G. Shekelle, MD, PhD; Ian A. Coulter, PhD; and Robert H. Brook, MD, ScD
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R. Sean Morrison, MD; Mark R. Chassin, MD; MPP, MPH; and Albert L. Siu, MD, MSPH
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Michael Scott Mahoney, MD; and Marc Kahn, MD
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Maria M.W. Koopman, MD; and Harry R. Büller, MD
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Emile L.E. de Bruijne, MD; Gonneke H.J.C. Keulen-de Vos, MD; and Rob J.Th. Ouwendijk, MD, PhD
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Emmanuel J. Diamantopoulos, MD; Georgia Yfanti, MD; and Emmanual Andreadis, MD
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Robert K. Bolan, MD
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Mary Bessesen, MD; Marianne McCollum, RPh; and BCBS
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Richard Frothingham, MD
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David Casarett, MD, MA; and John Lantos, MD
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Lawrence Corey, MD; and Timothy Schacker, MD
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Chi-yuan Hsu, MD
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Andrew Naidech, MD
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Faith T. Fitzgerald, MD
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Annette T. Carron, DO; Joanne Lynn, MD; and Patrick Keaney, BS

Improvement in end-of-life care has become a demand of the public and a priority for health care professionals. Medical textbooks could support this improvement by functioning as educational resources and reference material. This paper evaluates four widely used general internal medicine textbooks for their coverage of the clinical management of patients in advanced stages of fatal illnesses.

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Monty M. Bodenheimer, MD
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