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Excerpt Over two years have elapsed since Astwood1first reported his observations on the use of thiouracil in a patient with thyrotoxicosis. It is now well known that the drug has a remarkable effe...

In 1995, the U.S. Public Health Service (USPHS) and the Infectious Diseases Society of America (IDSA) developed guidelines for preventing opportunistic infections (OIs) among persons infected with human immunodeficiency virus (HIV); these guidelines were updated in 1997 and 1999. This fourth edition of the guidelines, made available on the Internet in 2001, is intended for clinicians and other health-care providers who care for HIV-infected persons. The goal of these guidelines is to provide evidence-based guidelines for preventing OIs among HIV-infected adults and adolescents, including pregnant women, and HIV-exposed or infected children. Nineteen OIs, or groups of OIs, are addressed, and recommendations are included for preventing exposure to opportunistic pathogens, preventing first episodes of disease by chemoprophylaxis or vaccination (primary prophylaxis), and preventing disease recurrence (secondary prophylaxis). Major changes since the last edition of the guidelines include 1) updated recommendations for discontinuing primary and secondary OI prophylaxis among persons whose CD4+ T lymphocyte counts have increased in response to antiretroviral therapy; 2) emphasis on screening all HIV-infected persons for infection with hepatitis C virus; 3) new information regarding transmission of human herpesvirus 8 infection; 4) new information regarding drug interactions, chiefly related to rifamycins and antiretroviral drugs; and 5) revised recommendations for immunizing HIV-infected adults and adolescents and HIV-exposed or infected children.

SUMMARY The availability of an increasing number of antiretroviral agents and the rapid evolution of new information has introduced extraordinary complexity into the treatment of HIV-infected persons. In 1996, the Department of Health and Human Services and the Henry J. Kaiser Family Foundation convened the Panel on Clinical Practices for the Treatment of HIV to develop guidelines for the clinical management of HIV-infected adults and adolescents. This report recommends that care should be supervised by an expert, and makes recommendations for laboratory monitoring including plasma HIV RNA, CD4 cell counts and HIV drug resistance testing. The report also provides guidelines for antiretroviral therapy, including when to start treatment, what drugs to initiate, when to change therapy, and therapeutic options when changing therapy. Special considerations are provided for adolescents and pregnant women. As with treatment of other chronic conditions, therapeutic decisions require a mutual understanding between the patient and the health care provider regarding the benefits and risks of treatment. Antiretroviral regimens are complex, have major side effects, pose difficulty with adherence, and carry serious potential consequences from the development of viral resistance due to non-adherence to the drug regimen or suboptimal levels of antiretroviral agents. Patient education and involvement in therapeutic

Excerpt The term, cryoglobulinemia, was proposed by Lerner and Watson28in 1947 in describing a patient whose serum contained a cold precipitable protein and whose presenting symptom was an extensiv...

Excerpt Gargoylism is a heritable and congenital condition, attributable at least in part to defects in cartilaginous development which lead to dwarfism and to numerous characteristic deformities o...

Excerpt FELLOWS OF THE AMERICAN COLLEGE OF PHYSICIANS: By custom I am permitted as your President to address you on this occasion of the Annual Convocation, and in the few moments at my disposal sh...

Excerpt The profound influence of the parathyroid glands on calcium metabolism is apparent from both experimental and clinical studies. Removal of these glands results in a marked decrease in serum...

Excerpt The following case report illustrates difficulties that may be encountered when a large amount of cold precipitable globulin circulates in the blood of a patient with the malady which has b...

Excerpt During the summer and autumn of 1933, 1097 cases of epidemic encephalitis were reported in St. Louis and in St. Louis County.1Study of the disease has revealed that it differs in many impor...

Excerpt Since 18841there have been in the literature scattered references to the occurrence of glycosuria in meningitis. Some have been in the form of case reports, and in several emphasis has been...