Our aim was to investigate the corticospinal tracts (CST) in motor neurone disease, using MRI, and to correlate findings with clinical data. We studied 31 patients with amyotrophic (ALS) and eight with primary lateral sclerosis (PLS). The signal from the CST was classified into four grades on T2-weighted images, and compared to T2-weighted images of 37 age-matched control subjects. No abnormalities were seen in the CST on T1-weighted images and were rarely evident on proton-density weighting. Variable high signal in the CST was found on T2-weighted images in 35 patients, and in 29 control subjects. Our grades 0 and 1 were more frequent in control subjects, grades 2 and 3 more frequent in patients. We found no correlation between the high signal and clinical data, including the duration of the illness. We therefore conclude that this technique is neither sensitive nor specific except in grade 3 which is quite specific for ALS. In half the patients we found atrophy of the superior parietal gyrus, which merits further study.

Our purpose was to compare prospectively the sensitivity of contrast-enhanced magnetisation transfer (MT) MRI and gradient-echo (GE) T1-weighted images in metastatic disease of the brain. We studied 52 patients with brain metastases, using conventional T1-weighted GE and MT spin-echo (SE) images after the same standard dose of gadolinium. Axial 5-mm reconstructions of GE data were compared with 5-mm MT images in the same plane. Metastases were counted independently by two neuroradiologists. In 12 patients (23%) MT imaging showed more metastases than GE images (P = 0.03). We detected 68 more metastases with the former technique.

This study was designed to evaluate drug use and drug costs of treatment of 1112 AIDS patients at the Infectious Diseases Unit at F. Houphouët Boigny Hospital in Marseilles, France, between January 1, 1990 and December 31, 1994. All drug expenditures directly or indirectly related to AIDS treatment were recorded for both inpatients and outpatients. There were 1952 hospital stays. For each stay baseline characteristics including age, sex risk factors, costs, and duration of hospitalization were noted. Patients were mainly young male drug addicts around thirty years of age. Reason for admission was also noted. The overall number of admissions per year has decreased since 1991 probably due to development of outpatient care. The number of stays per patient per year has decreased since 1993 because of the use of more appropriate therapeutic and prophylactic protocols. The number of drugs used was high increasing from 750 in 1990 to 868 in 1994. Cost of treatment doubled between 1990 and 1994 due to the introduction of many expensive new drugs. Closer analysis showed that the greatest increase in expenditure involved 'antibiotic/antiviral', 'psychiatry/neurology' and 'specialized therapy'. Although not frequently prescribed, costly drugs such as immunoglobulins, hematopoietic growth factors, and parenteral nutrition solutions accounted for a high proportion of total costs. Since AZT, ddI and ddC were used mainly for outpatient treatment, their cost was low in inpatients. Cytomegalovirus-related retinitis, tuberculosis, and multiple infections were cost-intensive complications. The increasing number of cytomegalovirus infections underlines the need for cost evaluation and surveillance of this complication. This study demonstrates that cost of treating AIDS patients is rising due to the use of more and costlier drugs. This finding underlines the need to evaluate and compare new therapeutic modalities in terms of cost effectiveness.

Objective: To evaluate the impact of protease inhibitors on drug cost and frequency of admission-defining events for HIV-infected patients in the infectious diseases unit of F Houphouët Boigny Hospital in Marseilles, France, which provides conventional hospitalization and outpatient care.Methods: Data from a prospective eight-year study conducted from January 1,1990, to December 31,1997, were used. Data from nurse records were collected daily by a pharmacy resident. Statistical analyses were performed to compare 1997 data with previous years, since protease inhibitors were not available in France until March 1996.Results: A total of 1,558 inpatients, accounting for 2,717 admissions, participated in the study. From 1995 to 1997, we observed a decrease in the percentage of hospitalized patients compared with the total number of patients (48.8%). We also noticed a reduction in number of stays (52%) and mean duration of stays (from 16.06 ± 1.81 to 11.08 ± 1.80 d). Total drug cost in the inpatient care unit dropped by one-half (based on 100 patients/y). The number of hospital admissions and mean drug cost per stay also decreased for some opportunistic infections described as late complications of AIDS; at the same time, drug costs in the outpatient unit rose sharply. Conclusions:This study confirms recent advances in HIV management. Use of protease inhibitors has reduced the relative risk of opportunistic infections and cost of inpatient treatment. This reduction has been associated with a sharp cost increase for outpatient therapy, resulting from widespread use of protease inhibitors.

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