Johns Hopkins Gazette: June 24, 1996

In Brief

Testosterone level may predict weight loss in HIV men

Declining testosterone in HIV-positive men may be an early signal for the dangerous weight loss that occurs when AIDS develops. Adrian S. Dobs, an associate professor of medicine and lead author of the study, told the annual meeting of the International Congress of Endocrinology that "helping them prevent or slow weight loss may become an important new treatment for AIDS."

In a related study, Hopkins researchers recently found that HIV-positive men who lose too much weight before developing AIDS are at risk for earlier death than those who maintain their weight.

Two other ongoing Hopkins studies are investigating whether testosterone injections and testosterone skin patches help HIV-positive men regain lean body weight, possibly increasing life span and improving their quality of life. If the studies show the hormone is effective, researchers plan to test whether testosterone should be given before weight loss prevents wasting.

Laser treatment for knees may cause lasting damage

A surgical laser commonly used to repair knee joints may repair the knee in the short term but cause hidden damage to surrounding cells, worsening the injury in the long term.

"Our findings suggest that even when there's no visual evidence of damage, significant cell death in the articular cartilage may occur following exposure to the laser's energy," Hopkins assistant professor of orthopedic surgery Leigh Ann Curl told the annual meeting of the American Orthopedic Society for Sports Medicine.

"This laser may generate lethal heat to cartilage cells that hasn't been previously recognized," said the animal study's lead author.

Surgeons use the arthroscopic laser, called pulsed holmium: YAG, for a variety of knee-joint repairs because it effectively cuts tissue, causes simultaneous blood clotting and was believed to cause little or no harm to surrounding cells. An arthroscope is a thin, flexible tube for viewing and treating the inside of joints.

Schizophrenia genes sought among Ashkenazim

A new Hopkins medical study may help locate genes that contribute to the development of schizophrenia among Ashkenazi Jews. Although there is no indication yet that schizophrenia occurs more frequently in this or any other ethnic, racial or religious population, this population is ideal for the study because they tend to marry within their faith, said Ann Pulver, an associate professor of psychiatry and the study's director. "Culturally self-contained populations like this give you a greater chance of finding genes, because there are clearer lines of inheritance that you can trace back many generations," she said.

Schizophrenia affects approximately 1 percent of the population. Symptoms include hallucinations, emotional impairment, paranoia, lack of motivation and inability to experience pleasure.

If you or someone you know has symptoms of schizophrenia, and you would like to participate in this study, please call Pulver toll-free at 1-888-289-4095. Baltimore residents call 955-0455.

Babies who inhale topsoil dust could become 'floppy'

Physicians at the Johns Hopkins Children's Center recently treated a 4-month-old baby who developed botulism after inhaling topsoil dust. Infant botulism is a rare, but treatable, neurological disorder caused by bacteria found in many soils and households. It results from ingestion of Clostridium botulinum spores that germinate and produce toxin in the infant's intestines and attack nerve fibers connected to muscle causing temporary paralysis.

Previously healthy infants ages 2 to 4 months are at greatest risk; however, cases have been recorded with infants up to 11 months. Symptoms of infant botulism, which generally evolve over several days, include constipation, lethargy, poor feeding (by bottle or breast), weak cry, diminished gag reflex and general weakness often called "floppy infant."

Left untreated, the child could die of respiratory failure.

There is no cure for infant botulism, which occurs 75 to 100 times each year nationally (with clusters of incidents in California, Utah and southeastern Pennsylvania.) Most patients must be placed on a ventilator for weeks or even months to allow the toxin to leave the immune system. During this time, patients are nourished by nasogastric tube feedings and as the paralysis lessens, physical therapy can help the child regain muscle usage.

Most cases of infant botulism have unknown causes, said Tom Crawford, director of the pediatric neuromuscular clinic at the Children's Center. "Honey and corn syrup may be a source and are not recommended for infants under a year," he says. "As for aerosolized topsoil, I don't want parents to be so concerned that they're afraid to take their babies outdoors. I suggest keeping them away from blowing topsoil and look for symptoms," he said.

Race plus roaches: A breathtaking link

African Americans are far more likely than Caucasians to develop asthma linked to cockroach sensitivity, according to research from the Johns Hopkins Children's Center.

Researchers found that among the 80 Baltimore youth sampled, the African American child was 16.4 times more likely than a Caucasian child to be sensitive to allergens left behind by cockroach droppings and saliva. And poor children or those from out of cities were 11.9 times more likely to be affected by roach infestation than those from middle or high income families.

The study, reported in the June issue of The Journal of Allergy and Clinical Immunology, is also the first to report that children in the most infested homes are the most sensitive to the allergens, a clear indication of dose responsiveness, the researchers said.

"We honestly don't know why race plays a role independent of poverty," said Peyton Eggleston, professor of pediatrics and co- author of the study. Eggleston speculated that racially based genetic differences, important in the regulation of immune responses, hold a clue. Eggleston said the researchers hope to use this information to perform further studies that better their understanding of the root causes of cockroach allergen.

British, U.S. medical giants celebrate 50-year alliance

Two giants of medicine--Johns Hopkins and London's Guy's Hospital--celebrated this past weekend in London the 50th anniversary of an unusual trans-Atlantic partnership that began during World War II. While the official topic of the conference was "Molecular Medicine: The Dream, the Promise, the Reality," more than 30 leading scientists, clinicians and health care administrators from each institution gathered at Guy's Hospital to reminisce about their ongoing relationship.

After Allied medical units from Johns Hopkins and Guy's worked together in North Africa, Guy's dean suggested that an exchange program would "maintain the friendship, cooperation and exchange of ideas which has been one of the better things which have come out of this War."

Since 1946, two physicians a year from each institution have traveled to their sister institution for a month, and hundreds of medical students have spent elective study periods overseas. The first Hopkins surgeon on the exchange program, Alfred Blalock, introduced heart surgery to England, while immunologists from Hopkins and Guy's collaborated for years on an insect allergy project that advanced understanding of the field. And despite the differences in the British and U.S. health systems, administrative teams also have participated in the exchange, resulting in the introduction of decentralized management at Guy's, for instance.

Originally established as an exchange scheme between Guy's Hospital and The Johns Hopkins University School of Medicine, it has evolved into a program involving the United Medical and Dental School (UMDS) of Guy's and St. Thomas's and the NHS Trust, together with The Johns Hopkins Hospital and University. Over the years, the program has brought the staffs of both institutions closer together, and academic and clinical collaborations have developed as a result.

This year, for the first time, Hopkins' nursing leaders--the dean of The Johns Hopkins University School of Nursing and the vice president for nursing of The Johns Hopkins Hospital--also participated in the celebration. Their counterparts at Guy's & St. Thomas's Hospitals and the Royal College of Nursing invited them to establish linkages with nursing in England that parallel the physicians' relationship.

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