Warren Grant Magnuson Clinical Center Research Articles

President Biden Chooses Monica M. Bertagnolli, MD, to Lead the NIH

President Biden Chooses Monica M. Bertagnolli, MD, to Lead the NIH

Von Willebrand factor content in Alphanate® (Laurence J. Logan) – reply

HaemophiliaVolume 15, Issue 1 p. 370-371 von Willebrand factor content in Alphanate® (Laurence J. Logan) – reply W. L. NICHOLS, W. L. NICHOLS Special Coagulation Laboratory, Division of Hematopathology, Department of Laboratory Medicine and Pathology, and Coagulation Clinic and Comprehensive Hemophilia Center, Division of Hematology and Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MNSearch for more papers by this authorM. B. HULTLN, M. B. HULTLN Department of Medicine, Stony Brook University, Stony Brook, NYSearch for more papers by this authorA. H. JAMES, A. H. JAMES Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NCSearch for more papers by this authorM. J. MANCO-JOHNSON, M. J. MANCO-JOHNSON Department of Pediatrics, University of Colorado Denver, Aurora, CO and Center for Cancer and Blood Disorders, Children’s Hospital of Denver, Denver, COSearch for more papers by this authorR. R. MONTGOMERY, R. R. MONTGOMERY Blood Research Institute, BloodCenter of Wisconsin, and Section of Pediatric Hematology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WISearch for more papers by this authorT. L. ORTEL, T. L. ORTEL Division of Hematology, Department of Medicine, and Clinical Coagulation Laboratory, Department of Pathology, Duke University Medical Center, Durham, NCSearch for more papers by this authorM. E. RICK, M. E. RICK Hematology Service, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MDSearch for more papers by this authorJ. E. SADLER, J. E. SADLER Department of Medicine, Washington University, St Louis, MOSearch for more papers by this authorM. WEINSTEIN, M. WEINSTEIN Office of Blood Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Rockville, MDSearch for more papers by this authorB. P. YAWN, B. P. YAWN Department of Research, Olmsted Medical Center, Rochester, MN, and Department of Family and Community Medicine, University of Minnesota, Minneapolis, MN, USASearch for more papers by this author W. L. NICHOLS, W. L. NICHOLS Special Coagulation Laboratory, Division of Hematopathology, Department of Laboratory Medicine and Pathology, and Coagulation Clinic and Comprehensive Hemophilia Center, Division of Hematology and Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MNSearch for more papers by this authorM. B. HULTLN, M. B. HULTLN Department of Medicine, Stony Brook University, Stony Brook, NYSearch for more papers by this authorA. H. JAMES, A. H. JAMES Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NCSearch for more papers by this authorM. J. MANCO-JOHNSON, M. J. MANCO-JOHNSON Department of Pediatrics, University of Colorado Denver, Aurora, CO and Center for Cancer and Blood Disorders, Children’s Hospital of Denver, Denver, COSearch for more papers by this authorR. R. MONTGOMERY, R. R. MONTGOMERY Blood Research Institute, BloodCenter of Wisconsin, and Section of Pediatric Hematology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WISearch for more papers by this authorT. L. ORTEL, T. L. ORTEL Division of Hematology, Department of Medicine, and Clinical Coagulation Laboratory, Department of Pathology, Duke University Medical Center, Durham, NCSearch for more papers by this authorM. E. RICK, M. E. RICK Hematology Service, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MDSearch for more papers by this authorJ. E. SADLER, J. E. SADLER Department of Medicine, Washington University, St Louis, MOSearch for more papers by this authorM. WEINSTEIN, M. WEINSTEIN Office of Blood Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Rockville, MDSearch for more papers by this authorB. P. YAWN, B. P. YAWN Department of Research, Olmsted Medical Center, Rochester, MN, and Department of Family and Community Medicine, University of Minnesota, Minneapolis, MN, USASearch for more papers by this author First published: 15 January 2009 https://doi.org/10.1111/j.1365-2516.2008.01903.x William L. Nichols, MD, Special Coagulation Laboratory and Comprehensive Hemophilia Center, Hilton 200, Mayo Clinic, Rochester, MN 55905, USA.Tel.: 507 284 5978; fax: 507 284 8286;e-mail: [email protected] Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume15, Issue1January 2009Pages 370-371 RelatedInformation

Treatment of Severe Aplastic Anemia with Combined Immunosuppression: Antithymocyte Globulin (ATG), Cyclosporine A (CSA), and Mycophenolate Mofetil (MMF).

Severe aplastic anemia can be successfully treated with immunosuppressive therapies (IST) or hematopoietic stem cell transplantation (HSCT). Response rates with horse anti-thymocyte globulin (ATG) plus cyclosporine (CsA) are about 60–70%, and robust responders have excellent long term survival (Rosenfeld, Follmann et al. 2003). Relapse require reinstitution of IST and does not negatively affect survival. We introduced a third immunosuppressive agent to standard horse ATG/CsA, mycophenolate mofetil, in an attempt to improve response rate, survival and to decrease the relapse rate and clonal evolutions to myelodysplasia or leukemia. MMF blocks the proliferation of active lymphocytes by the inhibition of the enzyme inosine monophosphate dehydrogenase, an important step in purine and therefore DNA synthesis. MMF immunosuppression is due to direct inhibition of T cell proliferation and therefore, would be anticipated to favor the induction of tolerance by selective depletion of active lymphocytes. MMF has been employed as a “kidney-sparing” adjunct to CSA in renal and other solid organ transplantations, post-HSCT, and in certain autoimmune diseases with a favorable toxicity profile. A total of 104 consecutive patients with SAA were treated with horse ATG/CsA/MMF from May 1999 to June 2003 at the Warren Grant Magnuson Clinical Center at the National Institutes of Health in Bethesda, MD. Response was defined by blood counts no longer satisfying criteria for severe AA. The overall response rate at 6 months was 62%, with 24 (37% of responders) patients relapsing at a median of 389 days from ATG. Fifteen relapses occurred after CsA was discontinued at 6 months but before 18 months, while patients were still on MMF. Nine patients showed evidence of clonal evolution following ATG, five responders and 4 nonresponders. The median survival among responders was not reached and among nonresponders was 1,759 days. There was no difference in overall survival among patients who relapsed and those who did not relapse. Over half of the relapses occurred during MMF administration (15 of 24), suggesting that this drug is not active in preventing relapses among responders. Evolution to clonal disorders did not change with the intensification of immunosuppression with MMF. Despite a strong theoretical rationale for its use, MMF did not result in improvement in response or relapse rates, and it cannot be routinely recommended as a CsA-sparing agent in responders with poor tolerability to CsA.

A randomized, phase II trial of ketoconazole plus alendronate versus ketoconazole alone in patients with androgen independent prostate cancer and bone metastases: Figg WD, Liu Y, Arlen P, Gulley J, Steinberg SM, Liewehr DJ, Cox MC, Zhai S, Cremers S, Parr A, Yang X, Chen CC, Jones E, Dahut WL, Center for Cancer Research, National Cancer Institute, Warren Grant Magnuson

Alendronate (AL), a potent oral bisphosphonate, blocks the secretion of matrix metalloproteinase-2 and the establishment of bone metastases in animal models. Ketoconazole (KT) has demonstrated activity in androgen independent prostate cancer (AIPC). In this study we determined whether KT plus AL produced acceptable disease responses compared with KT alone. As the experimental design, 72 patients with progressive AIPC metastatic to bone were randomized to receive KT (1,200 mg daily) plus hydrocortisone (H) (30 mg daily) with or without AL (40 mg daily). Prostate specific antigen (PSA) consensus criteria and radiographic scans were used to determine the proportion of patients with a PSA decrease, time to progression and response duration. The pharmacokinetics of KT and AL were characterized and changes in circulating angiogenic factors were assessed. At a median potential followup of 23.9 months the proportion of patients with a greater than 50% decrease in PSA was similar in the KT/H/AL and KT/H, groups (50% and 47%, respectively). The median duration of response was 8.9 and 6.3 months in the KT/H/AL and KT/H groups, respectively (p = 0.125). Median progression-free survival was not significantly prolonged in the KT/H/AL group (4.6 vs 3.8 months, p = 0.27). There was no significant difference in overall survival between the 2 treatment arms but there was a trend toward improved survival in the KT/H arm (p = 0.074). Toxicity in the 2 groups was mild and there were no clear associations between changes in circulating angiogenic factor levels and clinical outcomes in either treatment arm. There were no statistically significant differences in response rate, progression-free survival or overall survival between KT/H alone and KT/H plus AL treatment in patients with AIPC. The addition of AL to KT/H may increase the response duration with an acceptable safety profile compared with treatment with KT/H alone. However, the addition of AL offers no survival benefit in patients with AIPC.

A New Concept of Unopposed β-Adrenergic Overstimulation in a Patient with Pheochromocytoma

Letters21 June 2005A New Concept of Unopposed β-Adrenergic Overstimulation in a Patient with PheochromocytomaVitaly Kantorovich, MD and Karel Pacak, MD, PhD, DScVitaly Kantorovich, MDFrom the National Institutes of Health, Bethesda, MD 20892.Search for more papers by this author and Karel Pacak, MD, PhD, DScFrom the National Institutes of Health, Bethesda, MD 20892.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-142-12_Part_1-200506210-00023 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Background: The concept of unopposed β-adrenergic overstimulation during selective α-adrenergic blockade in patients with pheochromocytoma is well recognized (1-4). We present a case that suggests the existence of an opposite phenomenon: a syndrome of unopposed β-adrenergic overstimulation.Case Report: A 46-year-old woman with multiple endocrine neoplasia type 2A was admitted to the endocrine ward of the National Institutes of Health Warren Grant Magnuson Clinical Center. On a previous admission, she had reported progressive spells of headaches, paleness, and palpitations and was found to have bilateral adrenal pheochromocytomas (right side, 4.7 × 3.1 cm; left side, 2.0 × ...

New Home for Nation’s Research Hospital

BETHESDA, MD—The Mark O. Hatfield Clinical Research Center at the National Institutes of Health (NIH), which opened to patients in April, is a technological marvel with a human heart. The Hatfield Center adjoins the Warren Grant Magnuson Clinical Center, which opened in 1953. These two buildings, plus an ambulatory care research facility, constitute the NIH Clinical Center. Among federal buildings, the Clinical Center is second in size only to the Pentagon. The $596 million Hatfield Center is named for the Republican senator from Oregon, a longtime champion of government support for biomedical research. Before retiring in 1997, Hatfield helped break ground for the building’s construction. Four patient care wings house 242 inpatient beds and 90 day-hospital stations. Paired around two landscaped courtyards, the wings flank a 7-story glass-enclosed atrium, whose ground floor includes admitting and discharge areas and public services. Two of the patient wings stretch out into laboratory wings that command about one third of the center’s total space. Patient care units and laboratories occupy levels 1, 3, 5, and 7. Levels 2, 4, and 6 and a penthouse above level 7 house mechanical systems, offering workers walk-around room and full access to the floor below for maintenance and remodeling. Hatfield is the first NIH building to incorporate dedicated infrastructure levels. “It is designed to adapt to changes in medicine that have not yet been imagined,” says chief architect Robert Frasca. Two pedestrian bridges connect Hatfield to Magnuson. After the Hatfield building opens, about one third to half of Magnuson will be outfitted with new research laboratories and offices. Some services will remain in Magnuson; other areas will be mothballed pending future remodeling. A new entrance to the NIH campus will speed access to the hospital.

National Institutes of Health's Clinical Center Sets New Policy on Use of Herbal and Other Alternative Supplements by Patients Enrolled in Clinical Trials

The nationwide concern over the escalating use of herbal and other alternative dietary supplements is prompting a call for action in health care organizations. Not only is there mounting evidence to support a strong concern for patient safety, but the use of these products by people participating in biomedical research protocols has an added impact on the integrity of the research design and data gathering. These issues are of increasing concern to the National Institutes of Health's hospital for biomedical research, the Warren Grant Magnuson Clinical Center. Surveys completed in 2000 showed that 25–45% of Clinical Center patients reported taking herbal and other alternative dietary supplements. In 2001, the Clinical Center moved forward to develop and implement a policy to guide hospital staff in the management of patient use of herbal and alternative supplements. The policy established the requirement for all patients to be screened for supplement use upon admission or outpatient visit. Continued use of supplement products during hospitalization and/or outpatient enrollment on protocol require a physician's authorizing order. The implementation of this policy has increased awareness and provided an important step forward in protecting patient safety and preserving the scientific integrity of the research at the NIH's Clinical Center.

Research Training in Imaging at the NIH

Establishment of the National Institute of Biomedical Imaging and Bioengineering (NIBIB) at the National Institutes of Health (NIH) represented a milestone for radiology, biomedical engineering, and the imaging sciences. In the coming years, research supported by NIBIB will advance both clinical care and biomedical research. As a result, radiologists will possess an array of new tools that will enable them to detect and diagnose disease earlier and treat patients less invasively and more effectively. Similarly, investigators in the biological sciences and biomedical engineering will benefit from imaging techniques that permit observation at the cellular and molecular levels. Despite this bright outlook, the creation of NIBIB also presents radiology with major challenges. The number of top-quality imaging proposals each year will be a major determinant in both the growth of the NIBIB budget and the allocation of resources within the new institute. An increasing number of such proposals will be needed each year to sustain the growth of funding for imaging research in NIBIB. Radiology is not, at present, prepared to meet this challenge. Too few radiologists are being trained to be competitive investigators, and too much of the research in radiology fails to meet the high standards that exist in other fields supported by NIH funds. Much of the solution will lie in the expansion and improvement of extramural research training programs in the academic radiology departments that are training the next generation of radiologists. The Academy of Radiology Research Committee on Research and Research Training, under the leadership of Co-Chairs N. Reed Dunnick, MD, and Ronald L. Arenson, MD, will be working with academic leaders to develop strategies to increase the amount and quality of research training in radiology residency programs. In that regard, the recent announcement that the NIBIB is offering Individual Postdoctoral Fellowships (F32 grants) and Institutional Training Grants (T32 grants) in biomedical imaging, bioengineering, and multidisciplinary biomedical research represents an important new opportunity for radiology and imaging science. Such grants can be part of the solution to training the numbers of investigators that will be needed. Training at the NIH itself is another important part of the answer. Numerous research training opportunities exist within the intramural program at the NIH. Historically, young investigators in radiology have not had adequate opportunities for training at the NIH. Intramural training experiences constitute an important component of the research culture in other disciplines, however. According to the NIH Office of Intramural Research, more than 3,000 postdoctoral fellows train at the NIH annually in approximately 1,200 intramural laboratories (1). Over time, this produces a large group of NIHtrained investigators who have the benefit of personal contacts at the NIH and who are well versed in the NIH system and culture and well prepared to compete for extramural research grant support after they return to their home institutions. Because of the relatively small number of programs that have focused primarily on imaging, radiology has not participated to a great extent in NIH intramural training. This must change if radiology is to become a scientific discipline that can compete on an equal basis for NIH funding. Fortunately, both the availability and quality of intramural research training opportunities in imaging at the NIH are improving dramatically, primarily because of the development of the Imaging Sciences Program (ISP) at the Warren Grant Magnuson Clinical Center. The ISP was organized by R. Nick Bryan, MD, PhD, who served as director of diagnostic radiology at the Clinical Center in the late 1990s. Dr Acad Radiol 2002; 9:750–752

Auditory dysfunction in Stickler syndrome.

To characterize the natural history and possible mechanisms of hearing loss in Stickler syndrome (OMIM 108300; or hereditary progressive arthro-ophthalmopathy) and to determine if the auditory phenotype is a useful discriminating feature for the differential diagnosis of this group of disorders. Multifamily study. Outpatient audiology and otolaryngology clinics at the Warren Grant Magnuson Clinical Center of the National Institutes of Health, Rockville, Md. Forty-six affected individuals from 29 different families segregating Stickler syndrome. Clinical audiologic and otolaryngological examinations were performed on all individuals, including pure-tone audiometry, speech audiometry, and middle ear immittance testing. Otoacoustic emissions, auditory brainstem response, infrared video electronystagmography, and temporal bone computed tomography were performed on a subset of participants. The hearing loss was most often sensorineural in adults, and approximately 28 (60%) of the 46 adult patients had 2 or more thresholds greater than the corresponding 95th percentile values for an age-matched, otologically normal population. The hearing loss most often affected high frequencies (4000-8000 Hz) and was generally no more progressive than that due to age-related hearing loss. Type A(D) tympanograms (classification using the Jerger model), indicating hypermobile middle ear systems, were observed in 21 (46%) of the 46 affected individuals. Computed tomography of the temporal bones revealed no inner ear malformations in 19 affected individuals. The hypermobile middle ear systems observed in ears with normal-appearing tympanic membranes represent a novel finding for Stickler syndrome and are likely to be a useful diagnostic feature for this disorder. The overall sensorineural hearing loss in type I Stickler syndrome is typically mild and not significantly progressive. It is less severe than that reported for types II and III Stickler syndrome linked to COL11A2 (OMIM 120290) and COL11A1 (OMIM 120280) mutations, respectively, or the closely related Marshall syndrome. This difference will be a useful discriminatory feature in the differential diagnosis of this group of disorders.

Phagocyte Function and Dysfunction: From Descriptive Biology to Molecular Defects and Cytokine Therapy

Dr. Gallin, a graduate of Amherst College, earned his medical degree at Cornell University Medical College. He completed his internship and residency in internal medicine at New York University–Bellevue Hospital Medical Center in 1971 and received training in infectious diseases at the National Institutes of Health (NIH) from 1971 to 1974. In 1974, he served as senior chief medical resident at the New York University–Bellevue Hospital Medical Center. Subsequently, he returned to the NIH, where he has been an active clinician, researcher, and administrator since 1975. Dr. Gallin served as head of the Bacterial Diseases Section at the National Institute of Allergy and Infectious Diseases Laboratory of Clinical Investigation (NIAID) from 1978 to 1986 and then as scientific director at NIAID from 1985 to 1994. As scientific director, Dr. Gallin oversaw all intramural activities for NIAID, which included doubling of the research budget in response to the AIDS epidemic, introduction of a modern informatics program to NIAID, and revitalization of NIAID’s Rocky Mountain Laboratories in Hamilton, Montana. Since 1991, Dr. Gallin has been chief of the Laboratory of Host Defenses at NIAID. His primary research interests focus on the role of phagocytes in host defense. His laboratory has described the genetic basis for several forms of chronic granulomatous disease (CGD) as well as the use of interferon-γ to reduce life-threatening infections in CGD. In 1994, Dr. Gallin was appointed to his current position as director of the Warren Grant Magnuson Clinical Center, with a dual appointment as the associate director for Clinical Research at the NIH. The Warren Grant Magnuson Clinical Center serves the clinical research needs of 17 NIH institutes and is the largest clinical research hospital in the world. In his current position, Dr. Gallin has led the revitalization of clinical research at NIH, which has included establishment of a curriculum in clinical research and utilization of telemedicine in clinical research. Recently, Dr. Gallin has written about managing the interface among medical schools, hospitals, and clinical research and the need for clinical research education in the medical school curriculum. Among Dr. Gallin’s awards are the USPHS Distinguished Service Award, the Young Investigator Award of the American Federation for Clinical Research, and the Squibb Award of the Infectious Diseases Society of America. In 1988, he received an honorary Doctor of Science degree from Amherst College. In 1991, he received the USPHS Award for Orphan Product Development for his groundbreaking studies leading to the licensing of interferon-γ to reduce infections in CGD. In 2001, he received the US PHS Physician Executive of the Year Award. Dr. Gallin is a member of the American Society for Clinical Investigation, the Association of American Physicians, and the Institute of Medicine of the National Academy of Sciences.

Managing the Interface Between Medical Schools, Hospitals, and Clinical Research

Warren Grant Magnuson Clinical Center, National Institutes of Health, and the Health Care Financing Administration, United States Department of Health and Human Services, Bethesda, Maryland

Navigational aids for real-time virtual bronchoscopy

Diagnostic Radiology Department, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD, U.S.A.

Epstein-Barr Virus and the Immune System

CASE PRESENTATION A 35-YEAR-OLD an was admitted to the Warren Grant Magnuson Clinical Center at the National Institutes of Health, Bethesda, MD, with Burkittlymphoma. The patient had been in good health until 2 months before admission, when he developed back pain. One month before admission, he noted left supraclavicular adenopathy followed by numbness in the left flank, clonus of the left leg, and a rapidly increasing mass in the left paraspinal area. He was admitted to a local hospital, where a biopsy specimen of the supraclavicular node showed lymphoma. A computed tomographic scan showed periaortic and retroperitoneal lymphadenopathy, and a magnetic resonance image showed extradural compression of the spinal cord. The patient received oral dexamethasone and radiotherapy to the area of cord compression; the back pain resolved and the paraspinal mass diminished in size. On examination at the Clinical Center, there was no apparent lymphadenopathy or hepatosplenomegaly, and

Managing the Interface Between Medical Schools, Hospitals, and Clinical Research

To review how academic health centers are coping with the changing environment of health care delivery with special emphasis on the impact of the changing health care system on clinical research. In response to Health and Human Services Secretary Donna Shalala's 1995 mandated review of the National Institutes of Health (NIH) Warren Grant Magnuson Clinical Center, an NIH review team visited 30 health facilities and government-owned organizations throughout the country. The review team determined what strategies are used by academic health centers to survive and thrive in the changing health care marketplace. The findings have implications for the NIH Clinical Center as well as academic health centers. Management strategies in successful academic health centers include streamlined governance structures whereby small groups of highly empowered group leaders allow institutions to move quickly and decisively; an active strategic planning process; close integration of hospital and medical school management; heavy investment in information systems; and new structures for patient care delivery. Successful centers are initiating discussions with third-party payers and are implementing new initiatives, such as establishing their own managed care organizations, purchasing physician practices, or owning hospitals. Other approaches include establishing revenue-generating centers for clinical research and new relations with industry. Attention to the infrastructure required to support the training and conduct of clinical research is essential for the future vitality of medical schools.

Successful treatment of hepatosplenic candidiasis through repeated cycles of chemotherapy and neutropenia.

Hepatosplenic candidiasis (HSC) or chronic disseminated candidiasis is an increasingly recognized problem in patients with cancer. Whether patients with HSC should continue to receive antineoplastic therapy, which may cause neutropenia with the risk for progressive HSC or breakthrough fungemia, can be a major dilemma. Patients with HSC at the National Cancer Institute continue antineoplastic therapy, when possible during antifungal therapy for HSC, despite repeated bouts of neutropenia. Therefore, whether this strategy resulted in breakthrough fungemia or progression of HSC was investigated. All patients consecutively treated at the National Cancer Institute at the Warren-Grant Magnuson Clinical Center from 1982-1992 for HSC were prospectively studied for therapeutic and outcome variables of antifungal and antineoplastic management. Each case was summarized on a time-event line to quantify the duration of simultaneous periods of antineoplastic therapy and antifungal therapy (AFT). Sixteen patients (median age, 22 years) with HSC were studied. Eleven patients had relapsed tumor and 5 had newly diagnosed tumor. During antifungal therapy for HSC, 12 of 16 patients were neutropenic for a median of 10 days (range, 6-91 days) and 11 were profoundly neutropenic for a median of 13 days (range, 1-55 days). Hepatosplenic candidiasis was successfully treated with complete antifungal response in 12 patients and a partial response in 2; 2 patients continued to receive AFT. No patient had breakthrough fungemia and two patients had progression of HSC, only one episode of which occurred during neutropenia. Hepatosplenic candidiasis in patients with cancer may be treated successfully under careful observation through repeated courses of chemotherapy-induced neutropenia without progression of hepatosplenic candidiasis or breakthrough fungemia.

Intraluminal Clots in Groshong Catheters

The Groshong™ catheter (Bard Access Systems, Salt Lake City), which has a unique three-way slit valve, requires less care than other, non-valved, catheters, because the valve is designed to prevent blood reflux into the catheter tubing. However, patients and nursing staff at our institution, the Warren Grant Magnuson Clinical Center, have frequently observed blood in these catheters even when they are not in use. To document this paradox more carefully, we examined 28 Groshong catheters immediately after they had been explanted. All 28 had clot in one or both lumens, usually adherent to the wall. Only 8 of the 28 catheters had documented malfunction prior to removal. There was no association between the size of the catheter lumen and clot appearance.

Neurologic complications of petrosal sinus sampling.

HomeRadiologyVol. 183, No. 3 PreviousNext LettersNeurologic Complications of Petrosal Sinus SamplingDonald L. MillerDonald L. MillerAuthor AffiliationsDiagnostic Radiology Department, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20892; Department of Radiology, Georgetown University School of Medicine, Washington, DCDonald L. MillerPublished Online:Jun 1 1992https://doi.org/10.1148/radiology.183.3.878-bMoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Article HistoryPublished in print: June 1992 FiguresReferencesRelatedDetailsCited By, Vol. 21, Vol. 118Rivista di Neuroradiologia, Vol. 7, No. 1Radiologic Clinics of North America, Vol. 31, No. 5Seminars in Ultrasound, CT and MRI, Vol. 14, No. 3Recommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 183, No. 3 Metrics Altmetric Score PDF download

Prophylactic zidovudine after occupational exposure to the human immunodeficiency virus: an interim analysis.

Note from Dr. Merle A. Sande--Health care workers are at risk of acquiring human immunodeficiency virus (HIV) infection subsequent to accidental sticks with needles contaminated with blood from infected patients. The risk is small but real. Postexposure management is critically important, but few solid data are available. Can zidovudine (AZT, azidothymidine) prevent infection? How soon after exposure must the drug be given? At what dosage? For how long? Two leading authorities were asked to discuss this problem and to offer recommendations. Both have developed programs in their institutions, Dr. David K. Henderson at the Warren Grant Magnuson Clinical Center at the National Institutes of Health and Dr. Julie L. Gerberding at the University of California, San Francisco.