Phase-1 studies of malariotherapy for HIV infecton.

OBJECTIVE: To determine whether malariotherapy (an old therapy for treatment of neurosyphilis) improves some clinical and laboratory parameters of HIV-positive patients without iatrogenic complications. METHODS: Total 8 asymptomatic HIV-1 positive subjects whose CD4 cell counts were over 250 x 10(6) cells/L were selected for the phase-1 studies of malariotherapy and were intravenously injected Plasmodia vivax to induce artificial malaria. Malaria was terminated with chloroquine after 10 to approximately 20 malarial fever episodes. Cell-bound CD4 levels were measured by APAAP (a solid-phase enzyme essay) and levels of neopterin (NPT), beta-2-microglobulin (B2M), soluble tumor necrosis factor receptor-2 (sTNF-RII), interleukin-2 (IL-2) and HIV P24 antigen were measured by ELISA. Patients were followed up to 24 to approximately 30 months. RESULTS: CD4 levels increased in 5, NPT decreased in 7 of 8 patients; IL-2 increased in 5 of 6 patients after malariotherapy. The total trends of B2M and sTNF-RII basically remained stable. HIV P24 antigen remained undetectable in 6, remained detectably low level in 1 and experienced increase in 1 of 8 patients after malariotherapy. No any severe complications occurred in all 8 patients. CONCLUSIONS: The results indicate that malariotherapy basically is safe for HIV infection and it seems that the therapy improves some immunological parameters of HIV patients.

Malariotherapy for HIV patients.

The objective of this study was to determine whether HIV patients who undergo malariotherapy experience beneficial immunological change without iatrogenic complications. In an approved, prospective study, asymptomatic. HIV-positive patients were inoculated with P. vivax malaria and the malaria infection was allowed to run a predetermined course according to standard malariotherapy protocols and was cured with chloroquine. After termination of the malaria, the patients have been followed for 2 years with clinical and immunological monitoring. In the first two HIV-positive patients, CD4 counts rose significantly from pre-malaria measurements and remain at normal levels 2 years later without further treatment of any kind. During this time, the patients remained clinically well. An additional six HIV-positive patients were treated with malariotherapy and have remained clinically well during the first 6 months after treatment. These initial studies demonstrate malariotherapy results in an increase in CD4 counts of HIV-positive patients. Furthermore, these increases persist beyond the presence of malaria, for at least 2 years.

The Heimlich maneuver. Best technique for saving any choking victim's life.

The American Red Cross (ARC) and the American Heart Association (AHA) advocated backslaps, chest thrusts, and abdominal thrusts for 10 years after the Heimlich maneuver was introduced in 1974. Even after the Surgeon General in 1985 declared these methods to be "hazardous, even lethal," the ARC and the AHA continue to recommend backslaps and chest thrusts for infants under 1 year of age. ARC and AHA instructional materials that advocate use of these methods have not been recalled, and the public has not been warned of the dangers. One cause of the confusion about backslaps is the flawed belief that gas pressure alone removes a foreign body. In addition, there is lack of understanding that, compared with the Heimlich maneuver, the backslap produces an insignificant amount of the energy required to expel an object from the airway. In fact, the energy produced by the backslap drives the foreign object in the wrong direction, toward the lungs, while the energy produced by the Heimlich maneuver drives the object away from the lungs, toward the mouth. Backslaps and chest thrusts should be publicly recalled as a treatment for choking infants before further deaths and injuries occur. The Heimlich maneuver is the best rescue technique for treating choking victims of all ages.

The micro-trach. A seven-year experience with transtracheal oxygen therapy.

Over a six-year period, 200 patients requiring long-term oxygen therapy for hypoxemic lung disease underwent insertion of the micro-trach transtracheal catheter and were evaluated for one to seven years. The catheter requires no removal for cleaning; it is designed to function undisturbed within the trachea for six months between replacements. Transtracheal oxygen delivery and saline instillation were instituted immediately after inserting the device. Oxygen administration at a rate of 0.25 to 3 L/min was equivalent to 1 to 8 L/min delivered nasally. By the end of one year of follow-up, 12.5 percent of patients had dropped out of the study. Most patients comply with prescribed 24-hour-a-day oxygen use; in keeping with the NOTT study, life expectancy of emphysema patients may therefore be increased.

Oxygen delivery for ambulatory patients. How the Micro-Trach increases mobility.

Transtracheal oxygen delivery with the Micro-Trach is state-of-the-art treatment for patients requiring long-term oxygen therapy. The Micro-Trach diminishes dyspnea because it bypasses the anatomic dead space in the respiratory tract. It eliminates the waste of oxygen that escapes from the nose and mouth when a nasal cannula is used. Therefore, a small oxygen container lasts longer, increasing the patient's mobility. The patient's appetite improves because oxygen is not diverted during deglutition, and the senses of smell and taste are restored. Rehabilitation is enhanced through increased mobility and improved nutrition. Transtracheal instillation of saline solution cleanses the respiratory tract and stimulates coughing, opening occluded air passages. There are fewer lung infections and hospitalizations for infective exacerbations of disease. Prescribed saline solution, mucolytics, and antibiotics can also be instilled through the Micro-Trach to treat cystic fibrosis. This use and others are still being explored.

Using the Heimlich maneuver to save near-drowning victims.

Flooding of the lungs occurs routinely in drowning victims. The cause of death in 90% of them is hypoxemia caused by water in the lungs. Mouth-to-mouth ventilation is ineffective until the water is removed. The Heimlich maneuver expels aspirated water, vomitus, debris, and other foreign matter. In treating near-drowning victims, place the victim in the supine position with head turned to the side and perform the Heimlich maneuver to evacuate water from the lungs, unless you know water is not in the respiratory tract. The Heimlich maneuver is a form of artificial respiration. It elevates the diaphragm, increasing intrathoracic pressure and compressing the lungs, and should be performed intermittently until all water is expelled. It is an especially useful technique because fear of contagion sometimes deters rescuers from using mouth-to-mouth ventilation . Further treatment has not been necessary in most instances. If the victim does not recover after water ceases to flow from the mouth, ventilation techniques, cardiopulmonary resuscitation, and other measures as indicated should be used.

Transtracheal catheter technique for pulmonary rehabilitation.

In over 100 chronic obstructive pulmonary disease patients, continuous oxygen therapy has been provided for up to 4 years using Micro-Trach percutaneous transtracheal catheters less than 2.0 mm in diameter. Successful rehabilitation has been achieved. Advances in materials, insertion technique, and protocols have simplified patient management. Complications occasionally encountered are bleeding, infection, subcutaneous emphysema, increased mucus production, and catheter failure or displacement. Long-term delivery of supplemental oxygen directly into the tracheobronchial tree eliminates the oxygen loss through the oral and nasal orifices that occurs when a nasal cannula is used. This closed system permits maintenance of therapeutic arterial blood levels with improved efficiency, greater comfort, and increased activity. The elimination of nasal irritation and cosmetic objections caused by nasal cannulas increases patient compliance, resulting in uninterrupted 24-hour-a-day oxygen use as indicated. The technique of inserting a transtracheal catheter and postinsertion management are discussed in detail.

Rehabilitation of swallowing after stroke.

Seven consecutive patients who had lost the ability to swallow saliva or ingest food following cerebrovascular accidents were subsequently taught to eat again. Five patients were restored to eating a regular diet and two showed improvement limited by their underlying conditions. Prior to swallowing rehabilitation, their nutrition had been maintained by tube feedings for periods of 5 months to 3.9 years. Patients were instructed in sucking, elevation of the larynx, and coordination of those functions. This method has not been reported previously for use in stroke patients. Oral feeding was initiated with ice chips and progressed to a normal diet. Speech also improved after regaining deglutition. The clinical evidence suggests that paralysis initiated the swallowing disability which persisted due to disuse of retrainable pharyngeal muscles. The reflex sequence of deglutition can be retaught if lost due to stroke.

Heimlich valve for chest drainage.

The Heimlich chest drainage valve was developed so that the process of draining the pleural cavity could be accomplished in a safe, relatively simple, and efficient manner. Replacing the cumbersome underwater drainage bottle system, the Heimlich valve connects to chest tubing and allows fluid and air to pass in one direction only. The valve, which functions in any position, need never be clamped, and regulated suction can be attached to it if necessary. The valve drains into a plastic bag that can be held at any level, allowing the patient undergoing chest drainage to be ambulatory simply by carrying the bag. The construction and function of the valve is easily understood by medical and nursing staffs. It is presterilized, stored in a sterile package, and readily utilized on emergency vehicles and in the operating room.

Respiratory rehabilitation with transtracheal oxygen system.

A system of transtracheal oxygen administration has been developed which is more effective for rehabilitating chronic obstructive pulmonary disease (COPD) patients than traditional systems for providing continuous oxygen therapy. The procedure involves administering oxygen continuously through a No. 16 intravenous catheter inserted transtracheally. Therapeutic PaO2 levels are attained with an oxygen flow of 0.25 to 1 liter per minute. Transtracheal oxygen administration has numerous advantages over nasal cannula or Venturi mask devices. With this system, the patient requires 3 to 4 times less oxygen; therefore, a 2.7-kg (6-lb) portable tank will last most of one day. Oxygen-enriched air via transtracheal catheter reaches the lungs directly with less respiratory effort. Delivery of oxygen is not impaired by sinusitis, mouth-breathing, displacement of nasal cannula or loss of oxygen into the room. Patients experience an immediate sensation of being able to breathe more easily, begin ambulating the day of the procedure, have improved nutrition and return to many normal activities.