Follow-up survey of inpatients with AIDS and HIV infection: economic impact on hospitals in North Carolina.

This study is a 2-year follow-up to a 1987-1988 survey of North Carolina hospitals regarding hospital utilization by patients with acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) infection. Almost 99% of the state's hospitals participated in the re-survey for the fiscal year 1989-1990. The number of general hospitals treating these patients grew by 57%; HIV/AIDS inpatients increased by 189% from 540 to 1,561. Total general hospital charges for HIV/AIDS inpatients increased from $7,685,000 to $26,957,000, an increase of 251%. Of these charges the amount that was uncompensated by insurance increased by 293% to $7,733,000. Fifteen large tertiary general hospitals treated 80% of the HIV/AIDS inpatients and accounted for $6,093,000 (79%) of the uncompensated charges related to these patients.

Designing clinical protocols for optimal use: measuring attributes of treatment and cancer control trials.

The design of clinical protocols is an important factor in assuring patient accrual and compliance. This paper describes the methods used to assess the attributes of treatment and cancer control research protocols. Measures are presented for assessing three attributes considered important: relative advantage, complexity, and compatibility.

Inpatients with AIDS and AIDS-related complex: economic inpact on hospitals in North Carolina.

To determine the economic impact of acquired immunodeficiency syndrome (AIDS) or AIDS-related complex (ARC) cases on North Carolina hospitals, we collected inpatient data from all North Carolina hospitals on charges and number of patients discharged with these diagnoses. More than 97% of the state's hospitals responded to the survey for the study year (1987-1988). There were 540 AIDS/ARC discharges from 58 North Carolina general hospitals and 125 AIDS/ARC discharges from 13 other types of hospitals, for a statewide total of 665 patients. The total general hospital charges for AIDS/ARC inpatients in North Carolina were approximately $7.7 million per year, and almost $2 million of these charges were uncompensated by any insurance. The greatest burden of cost for this care was borne disproportionately by 15 of the 58 general hospitals, accounting for 82% of the discharges.

Esophageal biopsy findings in the acquired immunodeficiency syndrome (AIDS): clinicopathologic correlation in 20 patients.

We reviewed 20 esophageal biopsy specimens from 180 adult patients with the acquired immunodeficiency syndrome (AIDS). Ten (50%) showed superficial Candida infection, and four revealed esophagitis due to cytomegalovirus. Candida was never invasive, even though it was associated with significant ulceration. Esophageal candidiasis did not necessarily imply the presence of oral candidiasis, and conversely, oral candidiasis did not imply esophageal candidiasis. Odynophagia was associated with significant histologic ulcerations in eight of ten patients. In the patients who had odynophagia, biopsy was almost equally likely to show Candida or viral cytopathic effect. We discuss the clinicopathologic implications of these findings.

Dermatopathologic findings in patients with acquired immunodeficiency syndrome.

We recently undertook a survey of all patients with acquired immunodeficiency syndrome (AIDS) seen at the University of Miami/Jackson Memorial Medical Center (UM/JMMC) and reviewed all skin biopsies received from these patients. Skin was the second most common organ biopsied; 36% of all patients (78/217) with AIDS had at least one skin biopsy. Kaposi's sarcoma (KS), the most frequent diagnosis, was seen in 47% of the biopsy specimens. Cutaneous infection, most commonly herpes simplex infection, was present in 19%. Atypical presentations of common dermatologic infections were also seen. Among the patients with neither KS nor infection, 16 had a vacuolar type of interface dermatitis.

Interface dermatitis in patients with the acquired immunodeficiency syndrome.

We report twenty-five patients with the acquired immunodeficiency syndrome (AIDS) and interface dermatitis. Patients with AIDS and interface dermatitis had numerous opportunistic and herpetic infections. Nearly all patients were receiving at least one medication prior to the development of their rash and many were clinically thought to have a drug eruption. When compared to skin biopsy specimens from non-AIDS patients with drug eruptions, specimens from patients with AIDS and interface dermatitis demonstrated a greater degree of vacuolar change, the frequent occurrence of necrotic keratinocytes, often in clumps, and the absence of eosinophils and polymorphonuclear leukocytes in the dermal infiltrates. Histologic and clinical features of our patients with AIDS and interface dermatitis are presented and contrasted with other interface dermatitides. Systemic and cutaneous immune abnormalities in patients with AIDS may be relevant to the pathogenesis of this interface process.

Nonmedical drug use patterns among medical students.

Interrelationships in the use of nonmedical drug use and tobacco use are explored based on self-reports by 165 medical students at an average-sized southeastern medical school. Lifetime and current use of drugs among these students appears consistent with earlier studies. Several background and demographic characteristics are correlated with drug use; higher rates of use are found among males, older students, and students who frequently miss classes. No correlation is observed between drug use and class standing, sibling position, social relationships, or family drug use patterns. Tobacco use was found to be low among these medical students but was highly correlated with nonmedical drug use. Drug use patterns appear to have developed in high school and college, and to persist, albeit at a diminished rate, during medical school. The findings provide little support for the belief that marijuana or cocaine use substitutes for alcohol use; higher consumption of virtually any recreational drug is predictive of higher use of other recreational drugs.

Single coronary artery originating from the right pulmonary artery.

An infant with a single coronary artery originating from the right pulmonary artery branch is the subject of this report. He survived to the age of one month possibly because of the association of two ventricular septal defects. While the pulmonary vascular resistance remained high, perfusion of the heart muscle was accomplished due to the pulmonary hypertension. The electrocardiogram did not show typical signs of infarction, but poor left ventricular contractility was observed by echocardiogram. The diagnosis was made postmortem. This specific coronary malformation has not been previously described and needs to be included in the classification of congenital coronary arteries anomalies.

Drug abuse by anesthesia personnel.

Anesthesia personnel of 15 southeastern academic departments reported significantly less use of marijuana and cocaine among their staffs than did a class of medical students describing their own use. The chairmen reported that between 1% and 2% of anesthesia personnel came to their attention because of drug or alcohol abuse. Of 44 persons known to abuse drugs or alcohol, seven were reported to have died secondary to abuse.