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Mitral leaflet prolapse MLP ; is a common valvular anomaly with a reported adult prevalence of up to 5% most series. A small subgroup of individuals with MLP, particularly those with thickened and redundant valve leaflets, are at risk of developing significant mitral regurgitation MR ; . Degenerative valve disease of this type is now the commonest cause of progressive MR in the Western world and has the potential to terminate a flying career. Treatment with mitral valve replacement in these cases is disqualifying for all classes of flying because of the additional risks associated with oral anticoagulation. However, a favourable prognosis following surgical repair to the valve in a subset of individuals may allow a safe return to restricted flying duties in the multicrew environment. The cases of two military aviators treated with mitral valve repair for progressive MR are described and the evidence upon which the subsequent aeromedical risk assessments were based is reviewed. It is concluded that patients with good left ventricular function, near normal left heart dimensions and a good functional result six months following mitral valve repair, may be considered for recertification restricted to the multicrew environment. Such individuals would need to be in sinus rhythm, to show no propensity to atrial fibrillation on ambulatory ECG monitoring, and to have a normal exercise tolerance without induced arrhythmias. Furthermore, they would require regular follow up at intervals not exceeding one year.
24 On motion and upon such terms as are just, the court may relieve a party or his legal representative from a final judgment, order or proceeding for the following reasons: 1 ; mistake, inadvertence, surprise or excusable neglect; 2 ; newly discovered evidence which by due diligence could not have been discovered in time to move for a new trial under Civ.R. 59 B 3 ; fraud whether heretofore denominated intrinsic or extrinsic ; , misrepresentation or other misconduct of an adverse party; 4 ; the judgment has been satisfied, released or discharged, or a prior judgment upon which it is based has been reversed or otherwise vacated, or it is no longer equitable that the judgment should have prospective application; or 5 ; any other reason justifying relief from the judgment. The motion shall be made within a reasonable time and for reasons 1 ; , 2 ; and 3 ; not more than one year after the judgment, order or proceeding was entered or taken. To prevail on a Civ.R. 60 B ; motion, a party must meet three requirements: 1 ; the party has a meritorious defense or claim to present if relief is granted; 2 ; the party is entitled to relief under one of the grounds stated in Civ.R. 60 B ; 1 ; through 5 and 3 ; the motion is made within a reasonable time, and where the grounds of relief are Civ.R. 60 B ; 1 ; , not more than one year after the judgment, order or proceeding was entered or taken. GTE Automatic Elec., Inc. v. ARC Industries, Inc. 1976 ; , 47 Ohio St.2d 146, paragraph two of the syllabus. All three requirements must be met for the motion to be granted. Rose Chevrolet, Inc. v. Adams 1988 ; , 36 Ohio St.3d 17, 20. Appellant argues that the probate court abused its discretion in overruling Magistrate Poulos's findings that appellant was entitled to reopen the judgment of April 22, 1988. He claims it was error because he has met all the requirements of Civ.R. 60 B ; 5 and hydrocodone and flonase, because flonase inhaler.
The discovery of multiple subtypes of human immunodeficiency virus type 1 HIV-1 ; worldwide has created new challenges for the development of both therapeutic and preventive AIDS vaccines. We examined T-helper proliferative responses to HIV-1 clade A, B, C, G, and E whole-killed virus and to HIV-1 clade G and B core p24 ; antigens in HIV-1-infected subjects taking potent antiviral drugs who received HIV immunogen Remune ; therapeutic vaccination. Subjects who were immunized mounted strong proliferative responses to both whole virus and core antigens of the different clades. These results suggest that a whole-killed immunogen may have broad applications as a therapeutic as well as a preventive vaccine in the current multiclade HIV-1 pandemic. The development of variations of envelope with the resulting subtypes of human immunodeficiency virus type 1 HIV-1 ; has created new challenges for the development of both therapeutic and preventive AIDS vaccines worldwide 27 ; . For example, HIV-1 clade C, which is endemic in Africa and parts of Asia, may now account for one-half of the infections with HIV-1 worldwide 6, 12, 19, ; . Subtype-specific HIV preventive vaccines are being tested, but an alternative, more global, approach might utilize a whole-killed vaccine, which might be capable of inducing cross-clade CD4 and CD8 antiviral immune responses. The lack of CD4 T-helper cell activity in response to HIV-1 antigens is characteristic of very early HIV infection and is a defect not restored in chronic HIV infection with antiviral drug treatment 1, 2, 8, ; . The rare exceptions to this are individuals with nonprogressive HIV-1 disease, and they may represent the best model of control of HIV-1 by the immune system. HIV-1-seropositive individuals with nonprogressive disease typically have low but measurable HIV-1 viral loads but do not progress clinically or develop profound CD4 depletion for at least 10 years 20, 28 ; . One explanation of such sustained control of viral replication is that cell-mediated immunity is able to suppress viral replication below a threshold that results in clinical disease. A low level of viral replication may be an important source of antigenic stimulation necessary for the immune system to maintain host immunosurveillance. We hypothesized that an inactivated, gp120-depleted HIV immunogen clade A G ; Remune ; might be capable of inducing T-helper immune responses to multiple HIV-1 clades. Previously we had characterized and quantitated viral antigens within this immunogen 22, 23 ; . We therefore examined the lymphocyte proliferative response to different HIV-1 wholekilled virus preparations as well as p24 protein antigens of different clades in 11 subjects with chronic HIV-1 infection. The subjects were treated with a gp120-depleted, whole-killed.
From the Section of Infectious Diseases, Department of Medicine, St, Luke's Medical Center, Quezon City, Philippines; * Fellow and * Consultant, Section of Infectious Diseases, Department of Medicine, SLMC ; ABSTRACT Nocardiosis is an important opportunistic disease that can manifest as a localized or disseminated infection. Although said to occur more commonly among the immunocompromised individuals and those with predisposing factors, there have been a considerable number of reports of nocardiosis among the immunocompetent individuals. Local journal literature has documented only 4 cases of nocardiosis. This opportunistic disease, manifesting as pneumonia, brain abscess and prosthetic valve endocarditis encountered in St. Luke's Medical Center is presented in three 3 ; separate cases. Clinical manifestations and severity of infection caused by Nocardia are extremely variable and its diagnosis is limited by the difficulty in its isolation and the need for invasive diagnostic procedures in order to obtain culture specimen. N. asteroides is the most common offending species and the pulmonary system being the most commonly involved organ system. Sulfonamides, with or without trimethoprim, have been regarded as the drug of choice for the treatment of nocardiosis. However, other antimicrobial agents can be used as alternative in cases of allergy or lack of response to sulfa drugs. It is given for a minimum of 6-12 months for nonimmunocompromised patients with pulmonary or systemic nocardiosis excluding CNS ; and those with CNS should be treated for a period of 12 months. All immunosuppressed patients, whatever syndrome, should receive a minimum of 12 months therapy. Cure rates of almost 100 percent are found in patients with skin and soft tissue involvement as compared with 90 percent in pleuropulmonary, 63 percent in disseminated and 50 percent in brain abscess. Mortality rates remain high, reaching 55% among immunocompromised patients. Early diagnosis and therapy are crucial in the successful management of nocardiosis. Phil J Microbiol Infect Dis 2001; 30 2 56-61 ; Key words: Nocardiosis, N. asteroides, pneumonia, brain abscess, prosthetic valve endocarditis, sulfonamides and hyzaar.
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This work was supported by grant CA45762 from the National Cancer Institute. Additional support was provided by grant FD-U-00082 from the Food and Drug Administration. Dr. Brian Strom has been a consultant for most of the manufacturers of nonsteroidal antiinflammatory drugs and has received funding from many for research, though not on this topic.
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