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Gravel Fill Under Ground Supported Concrete Slabs: Gravel base course and cushion course with impervious sheeting in between. Extend from bottom of concrete slab down to original firm soil or to top of engineered fill. Compact to prevent subsequent settlement. Impervious sheeting not required under exterior slabs. 1. Base course shall be at least 4" thick and extend up to within 2" of concrete slab supported thereon. Level base course, compact, and cover with impervious sheeting, lapping side and end joints at least 6". Cover impervious sheeting with gravel cushion course at least 2" thick. Bring to level smooth surface or sloped grade as indicated. Miglitol is an oral anti-diabetic drug that is classified as a alpha-glucosidase inhibito acarbose is a drug used to treat type 2 diabetes mellitu incretin mimetic exenatide also exendin-4, marketed as byetta ; is the first of a new class of medications approved for the treatment of type 2 diabetes. Two studies are currently enrolling to examine the safety and efficacy of GW-873140, a new orally available CCR5 coreceptor blocker being developed by GlaxoSmithKline. So far the agent has demonstrated activity against HIV in laboratory studies and no major safety concerns have arisen in early clinical trials. I ; In the first open-label Phase II dose-ranging study, treatment-naive participants will receive GW-873140 in combination with lopinavir. Treatment will last 96 weeks. Eligible subjects must be at least 18 years of age, must have HIV viral loads of at least 50, 000 copies mL, and must be starting HAART for the first time no more than two weeks' prior use of antiretroviral drugs ; . They must have either R5- or R5 X4-tropic HIV, and may not have X4-tropic virus which can enter cells using the CXCR4. Since preparation of this manuscript, Sjoerdsma and associates Lancet 2: 1092-1094, 1965 ; have reported on the effects of a-methyltyrosine in man. Decreases in blood pressure were equivocal or absent in patients with essential hypertension.

CLINICAL IMPLICATIONS: Tuberculosis is the commonly occurring pulmonary infection in HIV positive patients. DISCLOSURE: S. Sinha, None. BRONCHOSCOPY IN THE HIV-INFECTED PATIENT IN THE ERA OF ANTIRETROVIRAL THERAPY: ROLE OF BRONCHOALVEOLAR LAVAGE AND TRANSBRONCHIAL LUNG BIOPSY Steve H. Salzman, MD; Adam J. Posner, MD * ; Rana Adawi, MD; Beth Israel Medical Center, Albert Einstein College of Medicine, New York, NY PURPOSE: Antiretroviral therapy has reduced the incidence of pulmonary complications of HIV. The use of high-volume, multilobe bronchoalveolar lavage BAL ; has improved the yield for Pneumocystis jiroveci pneumonia PCP ; . This study evaluates the role of bronchoscopy in 2000-2002 in comparison to our same-institution data from 1992 Salzman et al, JBronchology1996; 3: 88-95 ; . METHODS: All HIV-infected inpatients who underwent bronchoscopy from 7 00-9 02 were enrolled. Data collected included results of sputum examination, BAL and trans-bronchial biopsy TBB ; . Charts were reviewed to determine final diagnoses. RESULTS: In the 2000-2002 period 147 bronchoscopic procedures were performed in HIV-infected patients, including 27 in mechanically-ventilated patients. Bronchoscopy was diagnostic in 84 147 57% ; cases; BAL in 69 147 47% ; and TBB in 58 99 59% ; . TBB was the exclusive source of diagnostic material in 11 99 11% ; . In 1992, bronchoscopy was more frequently diagnostic, with 162 181 90% ; positive p 0.001 ; . In 2000-2002 PCP was diagnosed in 60 41% ; procedures; BAL was positive in 58 60 97% ; and TBB was positive in in 45 94% ; . Only 2 48 5% ; had PCP established only by TBB. In 1992, TBB was the exclusive positive specimen for PCP in 8 95 8% ; For diagnoses other than PCP, in 2000-2002 TBB provided exclusive diagnosis in 9 24 38% ; . In 1992, TBB provided exclusive diagnosis in 34 55 62% ; of non-PCP cases p 0.05 ; . In 2000-2002, there were 5 3.4% ; complications pneumothorax 2 ; , massive hemoptysis requiring intubation 1 ; , post-procedure intubation 2 . TBB was performed in 6 mechanically-ventilated patients without complication. Pneumothorax postbronchoscopy occurred only in PCP cases, 2 53 3.7% ; . CONCLUSION: In comparison with 1992, bronchoscopy in HIVinfected patients was perfomed less frequently in 2000-2002 and was less likely to be diagnostic. This is likely due to the lower incidence of opportunistic pulmonary complications due to antiretroviral therapy. The use of large-volume bilobar BAL as standard technique in HIV-infected patients may account for the significanly lower additional yield of TBB in 2000-2002. CLINICAL IMPLICATIONS: Although the complication rate of bronchoscopy was relatively low 3.4% ; in HIV-infected patients, some will choose to use BAL alone. TBB should also be done when non-PCP diagnoses are likely or when BAL is negative on an initial procedure. DISCLOSURE: A.J. Posner, None. ROLE OF TRANSBRONCHIAL LUNG BIOPSY IN HIV PATIENTS SUSPECTED TO HAVE PNEUMOCYSTIS CARINII PNEUMONIA Rakesh Patel, MD; Gilda Diaz-Fuentes, MD; Ernesto Sy, MD; Varadarajalu Lakshmi, MD * ; Latha Menon, MD; Bronx Lebanon Hospital, Bronx, NY PURPOSE: Despite previous reports on the results of fiberoptic bronchoscopy FOB ; in patients suspected to have Pneumocystis carinii pneumonia PCP ; , controversy still exists regarding the role of transbronchial biopsy TBbx ; in addition to bronchoalveolar lavage BAL ; in these patients.The goal of the study was to evaluate the role of TBbx in addition to BAL in the evaluation of patients suspected to have PCP. METHODS: A retrospective chart review of all the HIV positive patients, who were sputum negative for PCP, and who underwent FOB in 2002 and 2003 for suspicion of PCP. Results of TBbx and BAL and adequacy of specimen were reviewed. RESULTS: 164 patients underwent FOB. 125 had TBbx and BAL done; six of these patients were excluded from analysis due to poor specimens. In the 119 patients analyzed, 39 were PCP positive Analysis in table 1 in the remaining 80 patients who underwent TBbx and BAL, the TBbx supported an alternative diagnosis in 47 59% ; patients; tuberculosis 4 ; , malignancy 1 ; , sarcoidosis 1 ; , Cytomegalovirus 2 ; and inflammatory changes consistent with pneumonia 39 ; was found with the TBbx. BAL alone was done in 39 patients; PCP was identified in 8 of them. Only one patient who underwent biopsy had a complication namely bleeding, which was easily controlled. CONCLUSION: TBbx increases the diagnostic yield, in patients suspected to have PCP. BAL alone had a yield of 74% 29 39 ; , whereas the yield from TBbx and BAL was 95% 37 39 ; . In 26% ; of patients, the diagnosis of PCP was obtained only by TBbx. TBbx also provided alternative diagnosis such as tuberculosis and malignancy. CLINICAL IMPLICATIONS: We recommend that where possible, both BAL and TBbx be done in patients suspected to have PCP, as it improves the diagnostic yield and provides incremental diagnosis without significantly increasing the complications. Performing BAL alone carries the risk of missing the diagnosis in a significant number of patients.

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