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Perioperative anticoagulant prophylaxis for postoperative venous thromboembolism (VTE) in neurosurgical patients has not gained wide acceptance due to the fear of intracranial bleeding. Physical methods give a worthwhile reduction of postoperative VTE but there still remains a substantial residual incidence. In other clinical indications, low molecular weight heparins have proven to be effective for prophylaxis of VTE when administered postoperatively, with the advantage of no bleeding enhancement during surgery. Therefore, we performed a multicentre, randomized, double-blind trial in neurosurgical patients to investigate the efficacy and safety of adding a low molecular weight heparin (LMWH), nadroparin, initiated postoperatively, to graduated compression stockings in the prevention of VTE. Deep-vein thrombosis was detected by mandatory venography. Bleeding was determined according to pre-defined objective criteria for major and minor episodes. An adequate bilateral venogram was obtained in 166 of 241 LMWH patients (68.9%) and 179 of 244 control patients (73.4%). A total of 31 of 166 LMWH patients (18.79b) and 47 of 179 control patients (26.3%) had VTE up to Day 10 postoperatively (p = 0.047). The relative risk reduction (RRR) was 28.9%. The rates for proximal deep-vein thrombosis/pulmonary embolism were 6.9% and 11.5% for the two groups, respectively (RRR: 40.2%; p = 0.065). Secondary analyses involved all VTE up to day 56 post-surgery which was detected in 33 patients of 241 in the LMWH group (13.7%) and 51 of 244 control patients (20.9%; RRR 34.5%; p = 0.018). The corresponding percentages for proximal deep-vein thrombosis/pulmonary embolism were 5.8% and 10.2% for the two groups, respectively, giving a RRR of 43.3%; p = 0.036. Major bleeding complications, during the treatment period, occurred in six low molecular weight heparin treated patients (2.5%) and in two control patients (0.8%); p = 0.087. A higher mortality was observed in the low molecular weight heparin group over the 56-day follow-up period (22 versus 10; p = 0.026). However, none of these deaths was judged by a blinded adjudication committee to be related to the study drug. In conclusion, this study demonstrates that the low molecular weight heparin, nadroparin, added to graduated compression stockings results in a clinically significant decrease in VTE without inducing any significant increase of major bleeding.

BACKGROUND AND OBJECTIVES: To assess the potential role of bisexual men in the transmission of HIV to women. STUDY DESIGN: The study population consisted of homosexual men participating in a longitudinal cohort study on HIV and AIDS in Amsterdam, the Netherlands, which started in 1984. Between April and November 1991, an additional questionnaire was administered concerning sexual behavior with both male and female partners in the last 6 months. RESULTS: Of these men, 27% described their sexual preference as bisexual or heterosexual. In the last 6 months, 23 (3%) had heterosexual contacts. Vaginal intercourse was the sexual technique most practiced. Anal intercourse with a female partner was rare. Four heterosexual active HIV positive men always used condoms when having heterosexual contact (1 missing). Of the 18 heterosexually active HIV seronegative men, 12 did not use condoms consistently with their female partner(s). Two of these 12 men also had unprotected insertive anogenital intercourse with male partners, which conveys a small transmission risk in the window period in the case of a seroconversion. CONCLUSION: Widespread transmission of HIV from these homosexual men in this study is not likely. However, the studied men are most probably not representative for homosexual men in Amsterdam, the Netherlands. Further study on the potential role that bisexual men play in the HIV transmission to women is therefore needed.

To assess heterosexual behavior of injecting drug users (IDUs) over time the authors studies 174 IDUs with regard to their steady casual and commercial partners over a 1-year period. Within this period a large national AIDS prevention campaign had been implemented in the Netherlands. In addition condom use was discussed with participants during follow-up visits. The authors found a large turnover in IDUs who reported having steady casual or commercial partners. Limited change in sexual behavior occurred: the frequent use of condoms increased only with casual partners (30-49%) and the proportion of female IDUs working as prostitutes decreased from 56% to 41%. At both measurements IDUs who knew that they were HIV-infected used condoms more frequently with their steady partners and tended to report fewer casual partners than those who knew they were not infected. In addition HIV-infected women tended to be less active in prostitution than noninfected women. The authors conclude that large-scale voluntary testing of IDUs along with repeated discussion of risks of sexual transmission of HIV and condom use as a preventive measure (counseling) may at least among HIV-infected IDUs result in some risk reduction. Health education to increase the use of condoms should also be directed at IDUs who at the present time do not have steady casual or commercial partners. (authors modified)