Update on World Health Organization HIV drug resistance prevention and assessment strategy: 2004-2011.

The HIV drug resistance (HIVDR) prevention and assessment strategy, developed by the World Health Organization (WHO) in partnership with HIVResNet, includes monitoring of HIVDR early warning indicators, surveys to assess acquired and transmitted HIVDR, and development of an accredited HIVDR genotyping laboratory network to support survey implementation in resource-limited settings. As of June 2011, 52 countries had implemented at least 1 element of the strategy, and 27 laboratories had been accredited. As access to antiretrovirals expands under the WHO/Joint United Nations Programme on HIV/AIDS Treatment 2.0 initiative, it is essential to strengthen HIVDR surveillance efforts in the face of increasing concern about HIVDR emergence and transmission.

Intramedullary spinal epidermoid cyst of the upper thoracic region.

We report a 40-year-old male who presented with a two year history of thoracic cord compression. MRI of the thoracic spine demonstrated a diffuse, non-gadolinium enhancing intramedullary spinal cord tumour, extending from the C7 to T2 vertebral body levels. The lesion was surgically resected and the pathology revealed an epidermoid cyst. Epidermoid cysts are rare slow-growing lesions apparently resulting from inclusion of ectodermal tissue during the closure of the neural tube. The average age of presentation is about 35 years and the history of the symptoms is usually long. The treatment is surgical, and complete removal is the goal, if possible.

The surgical management of contralateral anterior circulation intracranial aneurysms.

This study reviews the surgical management of contralateral anterior circulation aneurysms in patients with bilateral intracranial aneurysms repaired following a unilateral craniotomy. Between 1993 and 1999, 27 patients had 88 intracranial aneurysms repaired. Eleven patients presented following subarachnoid haemorrhage. Excluding midline aneurysms, 31 anterior circulation aneurysms were contralateral to the craniotomy and all were repaired at the same time that ipsilateral or midline aneurysms were repaired. Morbidity included one death and one case of loss of unilateral vision directly attributable to surgery and two cases of cerebral infarction due to vasospasm. No new neurological deficit or mortality could be directly attributed to the repair of a contralateral aneurysm. The repair of all accessible aneurysms, including those contralateral to the craniotomy, during one session avoids the risk of haemorrhage from incidental or unrecognised ruptured aneurysms (particularly during the aggressive treatment of vasospasm), avoids a second craniotomy, decreases overall hospitalisation and can improve visualisation of carotid-ophthalmic aneurysms.

Predicting healing of lower limb ulcers.

Management of ischaemic ulcers in patients with compromised peripheral arterial circulations relies on the physical examination and the simple, non-invasive assessment of arterial supply. This study aims to determine if transcutaneous oxygen pressure (tcPO2) measurement can improve management decisions based on ankle or toe systolic blood pressure measurement. Twenty-two consecutive patients with ischaemic ulcers had tcPO2 measured and the ankle/brachial (ABI) and toe/brachial (TBI) indices calculated. Two months after surgery 12 of 22 (55%) ulcers were healing and 10 (45%) were indolent. Postoperative tcPO2 values were predictive of wound outcome (P < 0.001). A tcPO2 > 31 mmHg was invariably associated with healing whilst a tcPO2 < 28 mmHg was associated with indolence. Ankle/brachial indices and TBI were unable to be calculated in all patients due to falsely elevated pressures and hallux amputations, respectively, and neither was predictive of outcome (ABI P = 0.152, TBI P = 0.069). The response to revascularization was less in diabetic patients with a mean tcPO2 increase of 18 mmHg compared to non-diabetic patients with a mean tcPO2 increase of 37 mmHg. TcPO2 measurement appears to be a reliable technique that can influence ischaemic ulcer management.