The major vault protein (MVP), a new multidrug resistance associated protein, is frequently expressed in multiple myeloma.

The major vault protein (MVP), a ribonucleoprotein complex which mediates the transport of xenobiotic toxins, has been implicated in multidrug resistance (MDR) not mediated by p-glycoprotein (P-gp) or multidrug resistance related protein (MRP). We evaluated, via immunohistochemistry, the presence of MVP in plasma cells of myeloma patients. Among 73 patients registered with the Southwest Oncology Group (SWOG), 52 patients (74%) were positive for MVP. The presence of MVP and P-gp were significantly associated (p < 0.01). A univariate analysis of response versus MVP positivity showed borderline statistical significance (p = 0.043) with no association with OS or PFS. In particular, MVP positivity at first biopsy was associated with non-responsiveness to therapy (7/7 patients, 100%). MRP was not present in any of 23 samples tested. An increased proliferative rate (Ki-67 > 5%) was significantly associated with shorter OS (log rank p-value = 0.0002). The collective work indicates that MVP protein is common and abundant in myeloma with potential relevance to therapeutic response.

Program used by a national home infusion therapy provider to prepare for Joint Commission site surveys.

A process developed by a national provider of home infusion therapy to prepare branch pharmacy centers for site surveys by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is described. Each of the 20 branches to be surveyed by JCAHO was visited three times by a corporate quality assurance team, which consisted of a pharmacy quality assurance manager and a nursing quality assurance manager. During the initial visit, the team performed a baseline quality assurance audit based on pre-established audit criteria. During the second visit, the team conducted a mock survey that replicated the official JCAHO survey. The final visit was scheduled to coincide with the JCAHO survey; its purpose was to provide support to the branch. Results from each of the visits were documented and reviewed with branch and corporate management. As of January 1990, 19 branches and the corporate service had been surveyed. Sixteen branches received a three-year JCAHO accreditation; the JCAHO accreditation status of the remaining three branches is pending. The JCAHO surveyor made only minor recommendations during the oral summary of the survey results. A program for preparing the staff at branch facilities of a major home infusion therapy provider for JCAHO surveys was successful.

Experience with home aerosolized pentamidine treatment in patients with AIDS.

Pneumocystis carinii pneumonia (PCP is the most frequent opportunistic infection in patients with AIDS and is the most common cause of death in these patients. Conventional parenteral trimethoprim/sulfamethoxazole or parenteral pentamidine treatment is often not completed because of frequent incidence of adverse reactions. Aerosolized pentamidine appears to be better tolerated and is considered an alternative treatment for PCP in both hospital and community settings. This report describes our experience with 34 patients with AIDS who received aerosolized pentamidine at home. All patients were over 18 years old and had received either parenteral or aerosolized pentamidine within a medically supervised setting before home treatment was initiated. The Respigard II nebulizer system powered by an oxygen source was used as the delivery system. All patients took two puffs of metaproterenol sulfate 10 minutes prior to two 15-minute sessions of pentamidine inhalation. No relapse or adverse reactions were observed in patients. Large randomized clinical trials currently are underway to compare the value of aerosolized pentamidine with other forms of treatment for PCP.

[Characteristic parameters of the population of circulating DNA in cases of disseminated lupus erythematosus ]. / Paramètres caractéristiques de la population d'ADN circulant dans les cas de lupus erythémateux disséminé.

Important quantities of circulating DNA (up to congruent to 50 micrograms/ml) have been shown to be present in the sera of patients with serious systemic lupus erythematosus. This DNA is double-stranded, as demonstrated by colorimetric, enzymatic and biophysic tests. The circulating DNA population is made up of a main fraction at 250 base pairs and a heterogeneous tail up to 300 bases pairs, as demonstrated by electrophoretic measures on polyacrylamide gel. After hydrolysis in limited conditions with DNAse I and 32P labelling, the repartition of autoradiographed material confirms the reality of a main peak and of a more dispersed tail.

Monitoring the hospital activities of medical service representatives.

A comprehensive program to monitor and regulate the activities of medical service representatives (MSRs) in a large teaching hospital is described. The MSR program consists of written policies and procedures for regulating the activities of MSRs within the hospital, an orientation program for MSRs, and quarterly MSR committee meetings. In addition, MSRs are involved in planning and implementing an annual drug fair for all hospital personnel and biannual continuing-education sessions for physicians. Compliance with policies and procedures is monitored using a MSR visitation roster in the pharmacy department. This organized program has resulted in an optimum exchange of information between the hospital and the pharmaceutical industry.