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Terms modified by Median Selected AbstractsSmall and Medium-Sized Congenital Nevi in Children: A Comparison of the Costs of Excision and Long-Term Follow-UpDERMATOLOGIC SURGERY, Issue 12 2009FERNANDO ALFAGEME ROLDÁN MD BACKGROUND Clinical decisions on whether to follow up or remove small and medium congenital melanocytic nevi (SMCMN) in children have cost implications that have not been studied. OBJECTIVES To compare the costs of excision of SMCMN in children with lifelong follow-up in a tertiary center. METHODS AND MATERIALS We elaborated models for the evaluation of the costs of excision and long-term follow-up. We retrospectively collected data on 113 consecutive excised SMCMN (105 single-step interventions and 8 multiple-step interventions) from the medical records of our pediatric dermatology unit from 2001 to 2007 and calculated and compared the costs (direct and indirect) of surgery and follow-up. RESULTS The mean ± standard deviation and total cohort costs for single-step interventions were ,1,504.73 ± 198.33 and 157,996.20, respectively. Median and cohort lifelong follow-up costs were similar if performed every 4 years (1,482.66 ± 34.98 and 156,679.63). For multiple-step interventions (3 or 4 steps), surgery costs were similar to those of annual lifelong follow-up. In the case of two-step surgery, costs were similar to lifelong follow-up every 2 years. CONCLUSIONS An analysis of the costs of surgery and long-term follow-up in children with SMCMN is possible. Although the clinical judgment of the dermatologist and parental opinion are the main determinants in the management of SMCMN, costs should also be taken into account. [source] Age at onset in 3014 Sardinian bipolar and major depressive disorder patientsACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2010L. Tondo Tondo L, Lepri B, Cruz N, Baldessarini RJ. Age at onset in 3014 Sardinian bipolar and major depressive disorder patients. Objective:, To test if onset age in major affective illnesses is younger in bipolar disorder (BPD) than unipolar-major depressive disorder (UP-MDD), and is a useful measure. Method:, We evaluated onset-age for DSM-IV-TR major illnesses in 3014 adults (18.5% BP-I, 12.5% BP-II, 69.0% UP-MDD; 64% women) at a mood-disorders center. Results:, Median and interquartile range (IQR) onset-age ranked: BP-I = 24 (19,32) < BP-II = 29 (20,40) < UP-MDD = 32 (23,47) years (P < 0.0001), and has remained stable since the 1970s. In BP-I patients, onset was latest for hypomania, and depression presented earlier than in BP-II or UP-MDD cases. Factors associated with younger onset included: i) being unmarried, ii) more education, iii) BPD-diagnosis, iv) family-history, v) being employed, vi) ever-suicidal, vii) substance-abuse and viii) ever-hospitalized. Onset-age distinguished BP-I from UP-MDD depressive onsets with weak sensitivity and specificity. Conclusion:, Onset age was younger among BPD than MDD patients, and very early onset may distinguish BPD vs. UP-MDD with depressive-onset. [source] Positive impact of radiation dose on disease free survival and locoregional control in postoperative radiotherapy for squamous cell carcinoma of esophagusDISEASES OF THE ESOPHAGUS, Issue 4 2009S. Moon SUMMARY., The effect of total radiation dose (TRD) on the outcome of patients with postoperative radiotherapy (RT) for squamous cell carcinoma of esophagus was assessed. Sixty-seven patients with esophagectomy, followed by postoperative RT for squamous cell carcinoma of esophagus from June 1984 through February 2001, were retrospectively reviewed. Of these, 13 patients were excluded. No patient had chemotherapy. Patients were classified into two groups based on TRD delivered: TRD of less than 50 Gy (Group A, n = 16) and at least 50 Gy (Group B, n = 38). Follow-up duration of all patients ranged from 4 to 140 months (median, 14). Median TRD of Group A and B were 45 Gy (range, 45,48.6) and 54 Gy (range, 50,59.6), respectively. Median overall survival (OS) and disease-free survival (DFS) of all patients were 15 and 10 months, respectively. Although the TRD of 50 Gy or higher was marginally significant for improved OS (hazard ration [HR] 0.559, P = 0.066), it was statistically significant for improved DFS (HR 0.398, P = 0.011), and locoregional recurrence-free survival (HR 0.165, P = 0.001) with multivariate analysis. Three patients in group A and two in group B experienced a complication of grade 3 or higher. Our study suggests a positive impact of TRD of 50 Gy or higher on DFS and locoregional control, with acceptable morbidity in postoperative RT for patients with squamous cell carcinoma of esophagus. According to the present analysis, TRD should be at least 50 Gy in postoperative RT alone setting. [source] Determinants of successful chronic hepatitis C case finding among patients receiving opioid maintenance treatment in a primary care settingADDICTION, Issue 12 2009Oliver Senn ABSTRACT Aims Injection drug users are at high risk for chronic hepatitis C virus infection (CHC). Opioid maintenance treatment (OMT) offers a unique opportunity to screen for CHC. This study proposed the hypothesis that a general practitioner (GP) with special interest in addiction medicine can achieve CHC screening rates comparable to specialized centres and aimed to investigate determinants for a successful CHC case finding in a primary care setting. Design and participants Retrospective medical record analysis of 387 patients who received opioid maintenance therapy between 1 January 2002 and 31 May 2008 in a general practice in Zurich, Switzerland. Measurements Successful CHC assessment was defined as performance of hepatitis C virus (HCV) serology with consecutive polymerase chain reaction-based RNA and genotype recordings. The association between screening success and patient characteristics was assessed using multiple logistic regression. Findings Median (interquartile range) age and duration of OMT of the 387 (268 males) patients was 38.5 (33.6,44.5) years and 34 (11.3,68.0) months, respectively. Fourteen patients (3.6%) denied HCV testing and informed consent about screening was missing in 13 patients (3.4%). In 327 of 360 patients (90.8%) with informed consent a successful CHC assessment has been performed. Screening for HCV antibodies was positive in 136 cases (41.6%) and in 86 of them (63.2%) a CHC was present. The duration of OMT was an independent determinant of a successful CHC assessment. Conclusions In addicted patients a high CHC assessment rate in a primary care setting in Switzerland is feasible and opioid substitution provides an optimal framework. [source] Does the standard intravenous solution of fentanyl (50 µg/mL) administered intranasally have analgesic efficacy?EMERGENCY MEDICINE AUSTRALASIA, Issue 1 2010Dianne Crellin Abstract Background: Intranasal (IN) fentanyl provides rapid and powerful non-parenteral analgesia in the ED. A concentrated solution of fentanyl (300 µg/mL) has been used in prior trials, yet many ED use the standard solution at a concentration of 50 µg/mL, which is widely available and of low cost. We set out to determine if this lower concentration of fentanyl is also efficacious. Methods: Prospective audit in children aged 5,18 years presenting with upper limb injuries. Patients received IN fentanyl (50 µg/mL) at 1.5 µg/kg. Patient assessed pain scores were collected 5, 10, 20, 30 and 60 min following IN fentanyl administration using a visual analogue scale or Bieri Faces , Revised scale. Parental scores were used if patients were unable to provide a score. Results: Of the 59 eligible patients, 36 were enrolled; median age was 6.8 years (range 5,15 years), and 89% (32/36) ultimately required fracture reduction. Median first dose of IN fentanyl was 1.4 µg/kg. Median pain scores dropped from 7 (interquartile range 5,10) pre-fentanyl to 5 (interquartile range 4,8) at 5 min and 2 (interquartile range 1,4) at 30 and 60 min. A total of 21 (58%) children did not require further analgesia in the ED. There were no adverse events. Conclusions: Standard i.v. concentration IN fentanyl (50 µg/mL) appears to have analgesic efficacy in children with upper limb injuries. [source] Pharmacokinetics of detomidine administered to horses at rest and after maximal exerciseEQUINE VETERINARY JOURNAL, Issue 5 2009J. A. E. HUBBELL Summary Reason for performing study: Increased doses of detomidine are required to produce sedation in horses after maximal exercise compared to calm or resting horses. Objectives: To determine if the pharmacokinetics of detomidine in Thoroughbred horses are different when the drug is given during recuperation from a brief period of maximal exercise compared to administration at rest. Methods: Six Thoroughbred horses were preconditioned by exercising them on a treadmill. Each horse ran a simulated race at a treadmill speed that caused it to exercise at 120% of its maximal oxygen consumption. One minute after the end of exercise, horses were treated with detomidine. Each horse was treated with the same dose of detomidine on a second occasion a minimum of 14 days later while standing in a stocks. Samples of heparinised blood were obtained at various time points on both occasions. Plasma detomidine concentrations were determined by liquid chromatographymass spectrometry. The plasma concentration vs. time data were analysed by nonlinear regression analysis. Results: Median back-extrapolated time zero plasma concentration was significantly lower and median plasma half-life and median mean residence time were significantly longer when detomidine was administered after exercise compared to administration at rest. Median volume of distribution was significantly higher after exercise but median plasma clearance was not different between the 2 administrations. Conclusions and potential relevance: Detomidine i.v. is more widely distributed when administered to horses immediately after exercise compared to administration at rest resulting in lower peak plasma concentrations and a slower rate of elimination. The dose requirement to produce an equivalent effect may be higher in horses after exercise than in resting horses and less frequent subsequent doses may be required to produce a sustained effect. [source] Measurement of the soluble angiopoietin receptor tie-2 in patients with coronary artery disease: development and application of an immunoassayEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 7 2003N. A. Y. Chung Abstract Background The angiopoietin family has emerged as a group of crucial growth factors to normal angiogenesis. They are essential to the development of the mature vessel wall and interact with the endothelium via endothelial cell-specific tyrosine kinase receptors, tie-1 and tie-2. The role of the tie-2 receptor has been extensively examined in neovascularization associated with malignancy, but little is known about the role it may play in atherosclerosis, a condition whose pathophysiology also involves angiogenesis. Soluble tie-2 has been detected in the plasma of healthy controls, but this has yet to be applied to patients in the clinical setting. Materials and methods We developed an ELISA to detect plasma tie-2 levels and applied these to a clinical setting. The intra- and interassay coefficients of variation for the assay were 4·7% and 9·6%, respectively. We then measured levels of tie-2, vascular endothelial growth factor (VEGF), another factor associated with angiogenesis, and the soluble VEGF receptor Flt-1 (sFlt-1) in 75 patients with coronary artery disease [25 with acute myocardial infarction (AMI), 25 with acute coronary syndromes (ACS) and 25 with stable angina] and 25 healthy controls. Results Median [IQR, interquartile range] levels of tie-2 were significantly higher in the coronary artery disease patients (AMI 12 [10,17] ng mL,1, ACS 10 [9,14] ng mL,1, stable angina 9 [3,11] ng mL,1) when compared with the controls (7·5 [7,9] ng mL,1P = 0·004). As expected, levels of VEGF and sFlt were significantly different from those in the healthy controls (P = 0·011 and P < 0·001, respectively). Significant correlations were found between levels of tie-2 and VEGF (Spearman r = 0·59, P < 0·001), tie-2 and sFlt-1 (r = 0·45, P < 0·001) and VEGF and sFlt-1 (r = 0·56, P < 0·001) in the whole study group. Conclusion We suggest that tie-2 may be potentially used as a marker of angiogenesis in atherosclerosis and may help elucidate the role of the angiopoietin/tie-2 system in atherogenesis. [source] Web-based virtual patients in dentistry: factors influencing the use of cases in the Web-SP systemEUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 1 2009N. Zary Abstract We studied the students' acceptance and utilization of virtual patients (VPs) authored by faculty using the Web-SP system over two consecutive years. We also studied factors of importance for the utilization of VPs for self-assessment. Both year-groups studied found the Web-SP system easy to use and their overall opinion of Web-SP was positive (Median: 5, p25-p75: 4-5). They found the VPs engaging, realistic, fun to use, instructive and relevant to their course. Students used, on average, 9.68 VPs per course, which constitutes 43 percent of the available VPs. The number of VPs available seemed to be sufficient for the target course, even if some of the students preferred a higher number of VPs. Of the VPs encountered, 71% (CI: 68-75%) were VPs with feedback, and correspondingly 29% of the VPs chosen were without feedback. The difference in utilization between both types of VPs was significant, at p < 0.001. Thus, the students clearly favoured VPs with feedback compared to VPs without feedback. There were three modes of engagement in which the VP was utilized. Mode 1 was the preferred mode for VPs without feedback, while mode 3 was dominant for VPs with feedback.. Whether or not a VP was selected for review during a teacher led seminar or not, did not affect student behaviour, at least on the surface. Teacher led seminars may still be of importance to provide credibility to the VPs by integrating them into the curriculum. [source] Therapy-related leukemia following chemoradiotherapy for esophageal cancerEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 4 2010Naoya Mimura Abstract Chemoradiotherapy has improved the outcome of patients with esophageal cancer. Although a sufficiently long-time survival has resulted in the increase of several treatment-related late toxicities, little is still known about the incidence of secondary malignancies. In our hospital, 348 patients with esophageal cancer received chemotherapy consisting of nedaplatin and 5-fluorouracil and concurrent irradiation. Median and average follow-up durations were 8 and 21 months (1,92), respectively. Four patients developed leukemia after 19,48 months of follow-up. Two patients were diagnosed with overt leukemia from myelodysplastic syndrome presenting a complex karyotype, including the deletion of chromosome 5 or 7. Notably, one patient showed an additional chromosomal abnormality with t(9;22)(q34;q11). Other patients developed acute myeloid leukemia with t(9;22)(q34;q11) and Burkitt leukemia with t(8;14)(q24;q32). All patients eventually succumbed to leukemia. Platinum and fluorouracil have shown relatively lower risks for secondary malignancies in comparison with alkylating agents and topoisomerase II inhibitors. Especially, nedaplatin has never been described to introduce secondary neoplasms. Our report supports the idea that the concurrent administration of radiotherapy with these agents affects the risk of leukemia. Interestingly, rare balanced chromosomal abnormalities were observed in the present cases, thus providing new insights into the leukemogenesis of therapy-related leukemia. [source] Results of the PETHEMA ALL-96 trial in elderly patients with Philadelphia chromosome-negative acute lymphoblastic leukemiaEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 2 2007Juan-Manuel Sancho Abstract Background and aim:,Only 20,30% of elderly patients with acute lymphoblastic leukemia (ALL) are enrolled in clinical trials because of co-morbid disorders or poor performance status. We present the results of treatment of Philadelphia chromosome-negative (Ph,) ALL patients over 55 yr treated in the PETHEMA ALL-96 trial. Patients and methods:,From 1996 to 2006, 33 patients 55 yr with Ph, ALL were included. Induction therapy was vincristine, daunorubicin, prednisone, asparaginase, and cyclophosphamide over 5 weeks. Central nervous system (CNS) prophylaxis involved triple intrathecal (IT) therapy, 14 doses over the first year. Consolidation-1 included mercaptopurine, methotrexate, teniposide and cytarabine, followed by one consolidation-2 cycle similar to the induction cycle. Maintenance consisted of mercaptopurine and methotrexate up to 2 yr in complete remission (CR) with monthly reinduction cycles (vincristine, prednisone and asparaginase) during the first year. Results:,Median (range) age was 65 yr (56,77). Phenotype (30 patients): early-pre-B 7, common/pre-B 18, T 5. Cytogenetics (28 patients): normal 12, complex 10, t(4;11) 2 and other 4. CR was achieved in 19/33 (57.6%) patients, early death occurred in 12 (36.4%) and 2 (6%) were resistant. Overall survival and disease-free survival probabilities (2 yr, 95% CI) were 39% (21%,57%) and 46% (22%,70%), respectively (median follow up of 24 months). Removal of asparaginase and cyclophosphamide from the induction decreased induction death (OR 0.119, CI 95% 0.022,0.637, P = 0.013) and increased survival (20% vs. 52%, P = 0.05). Conclusions:,The prognosis of elderly Ph, ALL patients is poor. In this study, less intensive induction decreased toxic death, allowing delivery of planned consolidation therapy and increased survival probability. [source] Structure,fungitoxicity relationships of some volatile flavour constituents of the edible mushrooms Agaricus bisporus and Pleurotus floridaFLAVOUR AND FRAGRANCE JOURNAL, Issue 4 2001Eugene Sebastian J. Nidiry Abstract The fungitoxicity of the diethyl ether extracts of two basidiomycete mushrooms, Agaricus bisporus and Pleurotus florida, and 14 flavour constituents present in these mushrooms is being reported. Median effective molar concentrations (EC50) of the compounds for the mycelial growth inhibition of Colletotrichum gloeosporioides on potato,dextrose,agar (PDA) medium were computed and compared. Among the constituents tested for fungitoxicity, 1-octanol exhibited the highest activity. Structure,activity relationship studies of the constituents revealed that high hydrophobicity of the alkyl moiety, the presence of the primary alcoholic group and the absence of branching of the alkyl group are responsible for the high activity of 1-octanol. Copyright © 2001 John Wiley & Sons, Ltd. [source] Changes in treatment strategies for severe haemophilia over the last 3 decades: effects on clotting factor consumption and arthropathyHAEMOPHILIA, Issue 5 2001K. Fischer A cohort study was performed among 214 patients with severe haemophilia, born 1944,1994, to describe changes in treatment over the last 3 decades and its effects on clotting factor consumption and haemophilic arthropathy. Data on treatment strategy, clotting factor consumption, and outcome were collected for 3567 patient years (from 1972 to 1998), and 493 Pettersson scores were analysed. Median follow up was 17 years (range 6,27 years), and median age in 1998 was 27.6 years. Since 1965, replacement therapy, prophylaxis, and home treatment have been used and treatment intensified. Over the last 3 decades, annual clotting factor consumption increased by 260%, for both prophylactic and on-demand treatment. Annual clotting factor consumption kg,1 increased during childhood and appeared to stabilize in early adulthood for patients born 1965,79, who were treated with early replacement therapy or early prophylaxis. In contrast, clotting factor consumption increased continuously for patients born before 1965, who had had no access to replacement therapy during the early years of their life. The annual number of joint bleeds decreased over the years. Arthropathy as measured by the Pettersson score generally became apparent around the age of 15 years and was lowest in patients treated with primary prophylaxis. In conclusion, clotting factor consumption has increased and haemophilic arthropathy has decreased due to the intensification of treatment for severe haemophilia over the last 3 decades. Annual clotting factor consumption stabilizes in adulthood for patients who receive early intensive treatment. [source] Divalproex Sodium Extended-Release for the Prophylaxis of Migraine Headache in Adolescents: Results of a Stand-Alone, Long-Term Open-Label Safety StudyHEADACHE, Issue 1 2009George Apostol MD Objective., The objective of this long-term open-label study in adolescents was to assess the safety and tolerability of divalproex sodium extended-release in the prophylaxis of migraine headaches. Background., Two formulations of divalproex sodium have demonstrated efficacy in the prevention of migraine headaches in adults. However, no medications are currently approved for this indication in adolescents, and long-term safety data on agents for migraine prevention are lacking for this younger population. Therefore, the current study was conducted to assess the long-term safety and tolerability of divalproex extended-release in adolescents with migraine headaches. Methods., This was a 12-month, phase 3, open-label, multicenter study of adolescents aged 12 to 17 years with migraine headaches diagnosed by International Headache Society criteria. Divalproex sodium extended-release was initiated at 500 mg/day for 15 days then increased to 1000 mg daily, with subsequent adjustments permitted within a dosing range of 250-1000 mg daily. Study visits were conducted at days 1 and 15 and months 1, 2, 3, 6, 9, and 12. Safety was evaluated by adverse event collection, laboratory assessments, physical and neurological examinations, vital signs, electrocardiograms, the Udvalg for Kliniske Undersøgelser Side Effect Rating Scale, the Wechsler Abbreviated Scale of Intelligence, and the Behavioral Assessment Scale for Children. Efficacy was evaluated by following the number of migraine headache days reported in subjects' headache diaries over sequential 4-week intervals for the duration of the trial. Results., A total of 241 subjects were enrolled and treated. The most frequently reported adverse events were nausea (19%), vomiting (18%), weight gain (12%), nasopharyngitis (11%), migraine (10%), and upper respiratory tract infection (10%). Ten (4%) subjects experienced serious adverse events, and 40 (17%) subjects discontinued because of an adverse event. Increases in ammonia levels were observed. No other clinically significant changes were observed in laboratory values, vital signs, rating scales, or electrocardiograms. Median 4-week migraine headache days decreased 75% between the first and the fourth months of the study (from 4.0 to 1.0) and remained at or below this level for the remainder of the study. Conclusions., In this long-term open-label study of adolescents with migraine, the safety and tolerability profile of divalproex sodium extended-release was consistent with findings from previous trials in adults, as well as 2 studies recently completed in adolescents. In general, divalproex sodium extended-release was well-tolerated in adolescents with migraine. [source] Median-based aggregation operators for prototype construction in ordinal scalesINTERNATIONAL JOURNAL OF INTELLIGENT SYSTEMS, Issue 6 2003Josep Domingo-Ferrer This article studies aggregation operators in ordinal scales for their application to clustering (more specifically, to microaggregation for statistical disclosure risk). In particular, we consider these operators in the process of prototype construction. This study analyzes main aggregation operators for ordinal scales [plurality rule, medians, Sugeno integrals (SI), and ordinal weighted means (OWM), among others] and shows the difficulties for their application in this particular setting. Then, we propose two approaches to solve the drawbacks and we study their properties. Special emphasis is given to the study of monotonicity because the operator is proven nonsatisfactory for this property. Exhaustive empirical work shows that in most practical situations, this cannot be considered a problem. © 2003 Wiley Periodicals, Inc. [source] Association of circulating tumor cells with tumor-related methylated DNA in patients with hormone-refractory prostate cancerINTERNATIONAL JOURNAL OF UROLOGY, Issue 5 2010Takatsugu Okegawa Objectives: To assess whether circulating tumor cells with tumor-related methylated DNA can be used to predict survival in patients with hormone-refractory prostate cancer. Methods: Blood samples from 76 patients with hormone-refractory prostate cancer were analyzed. Circulating tumor cells were enumerated with the CellSearch System in whole blood. This system was developed using an epithelial cell adhesion molecule antibody-based immunomagnetic capture and automated staining methodology. Hypermethylation at adenomatosis polyposis coli, glutathione-S-transferase-,, prostaglandin-endoperoxide synthase 2, multidrug resistance 1 and Ras association domain family 1 isoform A was analyzed using a sensitive SYBR green methylation-specific polymerase chain reaction. Patient charts were retrospectively examined. Results: Median overall survival time was 19.3 months (range 11,48). Of the 76 patients, 47 (62%) had five or more circulating tumor cells, with a median overall survival of 12.0 months compared with 26.0 months for patients with fewer than five circulating tumor cells (P < 0.001). Circulating tumor cells were detected in 36 of 39 (92%) patients with tumor-related methylated DNA but only 11 of 37 (30%) patients without methylated DNA (P < 0.001). Thirty-nine (51%) patients had one or more methylated marker. Their median overall survival time was 12.0 months compared with 48.0 months or more for patients without methylated DNA (P < 0.001). Prostate-specific antigen-doubling time, circulating tumor cells and methylated DNA were independent predictors of overall survival time. Conclusions: Hormone refractory prostate cancer patients with circulating tumor cells and/or tumor-related methylated DNA show a significantly poorer outcome than those without these blood markers. [source] Length of Stay for Older Adults Residing in Nursing Homes at the End of LifeJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2010Anne Kelly MSW OBJECTIVES: To describe lengths of stay of nursing home decedents. DESIGN: Retrospective cohort study. SETTING: The Health and Retirement Study (HRS), a nationally representative survey of U.S. adults aged 50 and older. PARTICIPANTS: One thousand eight hundred seventeen nursing home residents who died between 1992 and 2006. MEASUREMENTS: The primary outcome was length of stay, defined as the number of months between nursing home admission and date of death. Covariates were demographic, social, and clinical factors drawn from the HRS interview conducted closest to the date of nursing home admission. RESULTS: The mean age of decedents was 83.3±9.0; 59.1% were female, and 81.5% were white. Median and mean length of stay before death were 5 months (interquartile range 1,20) and 13.7±18.4 months, respectively. Fifty-three percent died within 6 months of placement. Large differences in median length of stay were observed according to sex (men, 3 months vs women, 8 months) and net worth (highest quartile, 3 months vs lowest quartile, 9 months) (all P<.001). These differences persisted after adjustment for age, sex, marital status, net worth, geographic region, and diagnosed chronic conditions (cancer, hypertension, diabetes mellitus, lung disease, heart disease, and stroke). CONCLUSION: Nursing home lengths of stay are brief for the majority of decedents. Lengths of stay varied markedly according to factors related to social support. [source] Levels of aspartate aminotransferase (AST) in saliva of patients with different periodontal conditionsJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 8 2003Ricardo de Toledo Cesco Abstract Objectives: The purpose of this study was to evaluate the relationship between aspartate aminotransferase (AST) levels in saliva measured by ReflotronÔ System of Diagnosis and periodontal condition indicated by Community Periodontal Index of Treatment Needs (CPITN). Material and methods: Fifteen patients were assigned to one of four groups C0, C1, C3 and C4, based on their largest CPITN code among the examined sites, totaling 60 participants. About 1.0 ml of non-stimulated saliva was collected from the individuals after a mouth rinse with water. Biochemical analyses of saliva samples were carried out using the proposed system in order to quantify their AST concentration. Results: There were no significant differences between levels (U/ml) of AST (median; interquartile range) from groups C0 (30.9; 14.7,41.7), C1 (30.3; 19.5,39.4) and C3 (35.1; 27.0,63.5). However, group C4 (106.2; 84.4,129.7) differed statistically from the others (p<0.001) and presented AST levels as high as 284.2 U/ml. Gingival bleeding and suppuration were observed in three individuals with concentrations higher than 125.0 U/ml. Conclusion: Levels of AST in saliva from patients presenting CPITN code 4 were higher than from patients coded lower and could be detected by the evaluated diagnostic system. Periodontal destruction such as periodontal pockets, gingival bleeding and suppuration seems to be related to higher AST levels in saliva. Zusammenfassung Ziele: Der Zweck der Studie war die Evaluation der Beziehung zwischen den Levels von Aspartataminotransferase (AST) im Speichel, die mit dem ReflotronÔ System gemessen wurden, und den parodontalen Bedingungen, die mit dem CPITN erfasst wurden. Material und Methoden: 15 Patienten wurden für eine der vier Gruppen C0, C1, C3 und C4 ausgesucht, was aufgrund ihres höchsten CPITN-Wertes unter den überprüften Flächen bei total 60 Teilnehmern geschah. Ungefähr 1.0 ml von nicht stimuliertem Speichel wurde von den Personen nach einer Mundspülung mit Wasser gesammelt. Die biochemischen Analysen der Speichelproben wurden unter Nutzung des vorgeschlagenen Systems durchgeführt, um die AST Konzentration zu bestimmen. Ergebnisse: Es gab keine signifikanten Differenzen zwischen den Levels (U/ml) von AST (Median, Streuung) bei den Gruppen C0 (30.9; 14.7,41.7), C1 (30.3; 19.5,39.4) und C3 (35.1; 27.0,63.5). Jedoch unterschied sich die Gruppe C4 (106.2; 84.4,129.7) signifikant von den anderen (p<0.001) und zeigte AST Level höher als 284.2 U/ml. Gingivale Blutung und Suppuration wurden bei drei Personen beobachtet mit Konzentrationen höher als 125.0 U/ml. Schlussfolgerung: Die Level von AST im Speichel von Patienten mit einem CPITN von 4 waren höher als bei den Patienten, deren CPITN niedriger war. Sie konnten mit dem evaluierten Diagnostiksystem entdeckt werden. Parodontale Destruktion wie parodontale Taschen, gingivale Blutung und Suppuration scheinen zu höheren AST Level im Speichel in Beziehung zu stehen. Résumé Objectifs: Cette étude se propose d'évaluer la relation entre les niveaux d'aspartate aminotransferase (AST) dans la salive, mesuré par le ReflotronÔ System of Diagnosis et la condition parodontale déterminée par le CPITN. Matériel & méthodes: 15 patients (60 au total) furent répartis dans un des 4 groupes C0, C1, C3 et C4, sur la base de leur plus grand code CPITN parmi les sites examinés. Environ 1.0 ml de salive non stimulée fut prélevé après rinçage à l'eau. Des analyses biochimiques des échantillons salivaires furent réalisées avec le système proposé afin de quantifier la concentration en AST. Résultats: Il n'y avait pas de différences significatives entre les niveaux (U/ml) d'AST (median; interquartile range) entre les groupes C0 (30.9; 14.7,41.7), C1 (30.3; 19.5,39.4) et C3 (35.1; 27.0,63.5). Cependant, le groupe C4 (106.2; 84.4,129.7) présentait une différence significative par rapport aux autres (p<0.001) avec des niveaux d'AST allant jusqu'à 284.2 U/ml. Le saignement gingival et la suppuration s'observaient chez trois individus avec des concentrations au dessus de 125.0 U/ml. Conclusion: Les niveaux d'AST dans la salive de patients au CPITN code 4 étaient plus importants que ceux des patients au code CPITN inférieur et pouvaient être détectés par le système de diagnostique évalué. Des destructions parodontales comme des poches parodontales, des saignements gingivaux et des suppurations semblent en relation avec des niveaux plus grands d'AST dans la salive. [source] Local application of n,3 or n,6 polyunsaturated fatty acids in the treatment of human experimental gingivitisJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 4 2002Jörg Eberhard Abstract Background: Polyunsaturated fatty acids have the potential to attenuate inflammation by the synthesis of mediators of the 15-lipoxygenase pathways, which show opposite effects to the pro-inflammatory arachidonic acid metabolites such as leukotriene B4 (LTB4). Aims: The aim of this clinical study was to evaluate the effects of topical application of n,6 or n,6 polyunsaturated fatty acids in patients with experimental gingivitis. Methods: In each subject, similar teeth served as experimental and control over a 21-day non-hygiene phase and a 9-day resolving phase. Efficacy assessment was based on the bleeding on probing frequency (BOP) and the gingivocrevicular fluid volume (GCF). GCF was determined by inserting a filter paper strip for 30 s and measurements were performed on a Periotron 8000. The LTB4 concentration was analyzed by reversed-phase high-pressure liquid chromatography. Results: After 21 days of plaque growth, the BOP, GCF and LTB4 levels were significantly increased in all groups, with no differences between the control and experimental side. Rinsing of an area with established gingivitis for a 9-day period significantly reduced the GCF in the n,6 group (71.9 (18.7) versus 47.4 (11.4) Periotron Units, median (inter quartile range)). Conclusion: The topical application of n,6 or n,6 fatty acids failed to inhibit the development of experimental gingivitis. Rinsing with n,6 fatty acids could reduce the level of GCF in established experimental gingivitis. Zusammenfassung Hintergrund: Vielfach ungesättigte Fettsäuren haben das Potential, die Entzündung durch die Synthese von Mediatoren des 15-Lipoxygenaseweges zu behindern. Dies zeigt Gegeneffekte zu den pro-inflammatorischen Arachnoidonsäuremetaboliten wie Leukotrien B4 (LTB4). Ziele: Das Ziel dieser klinischen Studie war die Überprüfung des Effektes einer topischen Applikation von n,3 oder n,6 vielfach ungesättigten Fettsäuren bie Patienten mit experimenteller Gingivitis. Methoden: Bei jeder Person dienten ähnliche Zähne als Experiment und Kontrollen über eine 21tägige Nichthygiene-Phase und einer 9tägigen Erholungsphase. Wirksamkeitsmessungen basierten auf der Häufigkeit von Provokationsblutung (BOP) und dem Volumen der gingivalen krevikulären Flüssigkeit (GCF). GCF wurde durch Einbringen von Filterpapierstreifen für 30 Sekunden bestimmt. Die Messungen wurden mit einen Periotron 8000 durchgeführt. Die LTB4 Konzentration wurde mit der Umkehrphasen-Hochdruck-Flüssigkeitschromatographie analysiert. Ergebnisse: Nach 21 Tagen des Plaquewachstums waren die Level für BOP, GCF und LTB4 in allen Gruppen signifikant erhöht, ohne Differenzen zwischen den Kontrollen und den experimentellen Flächen. Die Spülung eines Gebietes mit etablierter Gingivitis für eine 9tägige Periode reduzierte die GCF in der n,6 Gruppe signifikant (71.9 (18.7) versus 47.4 (11.4) Peritron-Einheiten, Median (Zwischenquartilstreuung)). Zusammenfassung: Die topische Applikation von n,3 oder n,6 Fettsäuren verhindert die Entwicklung einer experimentellen Gingivitis nicht. Die Spülung mit n,6 Fettsäure konnte den Level der GCF bei einer bestehenden experimentellen Gingivitis reduzieren. Résumé Origine: Les acides gras poly-insaturés ont le potentiel d'atténuer l'inflammation en synthétisant des médiateurs des voies de la lipoxygénase 15 qui montrent des effets opposés aux métabolites de l'acide arachidonique pro-inflammatoire comme la leucotriène B4 (LTB4). But: Le but de cette étude clinique a été d'évaluer les effets de l'application topique d'acide gras poly-insaturés n,3 ou n,6 chez des patients effectuant d'une gingivite expérimentale. Méthodes: Chez chaque sujet, des dents semblables ont servi de sites tests et contrôles durant une phase sans hygiène buccale de 21 jours et une phase de retour à la normale de 9 jours. L'efficacité a été mesurée sur base de la fréquence du saignement au sondage (BOP) et le volume de fluide gingivale (GCF). Le GCF a été déterminé en insérant des papiers filtres pendant 30 s et les mesures ont été lues à l'aide du Périotron 8000. La concentration de LTB4 a été analysée par chromotographie liquide à haute pression à phrase arrière. Résultats: Après 21 jours d'accumulation de plaque dentaire les niveaux de BOP, GCF et LTB4 ont augmenté significativement dans tous les groupes sans aucune différence entre les sites tests et contrôles. Le rinçage d'une zone avec gingivite établie durant une période de 9 journées diminuait les GCF dans le groupe n,6 (unités du Péritron 72 (médian 19) versus 47 (11)). Conclusion: L'application topique d'acide gras n,3 ou n,6 ne permettait pas d'inhiber le développement de la gingivite expérimentale. Le rinçage avec des acides gras n,6 pouvait réduire le niveau de GCF dans la gingivite expérimentale établie. [source] Low-dose intravenous pantoprazole for optimal inhibition of gastric acid in Korean patientsJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 9 2007Jung-Hwan Oh Abstract Background and Aim:, Proton-pump inhibitor (PPI) therapy for bleeding ulcers is more efficacious in Asian patients than in non-Asian patients. The aim of this study was to evaluate the efficacy of various doses of pantoprazole on intragastric acidity in Korean patients. Methods:, A prospective randomized study was conducted in 52 patients either with bleeding peptic ulcers after successful endotherapy or who received endoscopic mucosal resection for gastric neoplasms. Patients were randomized into two doses of intravenous pantoprazole: 40 mg q.d. and 40 mg b.i.d. We compared these results with our preliminary study utilizing high-dose pantoprazole (80 mg + 8 mg/h). The potential contribution of CYP2C19 genetic polymorphisms and the presence of Helicobacter pylori were also assessed. Results:, Pantoprazole 40 mg b.i.d. and high-dose pantoprazole demonstrated better inhibition of intragastric acid than pantoprazole q.d. (P < 0.05). The pantoprazole 40 mg q.d. group exhibited significant variations in acid inhibition correlating with CYP2C19 genotype. Median 24 h pH values did not differ significantly between the pantoprazole b.i.d. and high-dose pantoprazole groups, regardless of H. pylori infection status. A median intragastric pH < 6.0 was observed in only three of 28 patients in the 40 mg b.i.d. group; these three patients were extensive metabolizers. Conclusion:, A 40 mg b.i.d. dose of pantoprazole is sufficient to maintain pH > 6.0 in Korean patients, except for patients with extensive metabolizing CYP2C19 genotypes. [source] Comparison of maximum bite force and dentate status between healthy and frail elderly personsJOURNAL OF ORAL REHABILITATION, Issue 6 2001H. Miura The purpose of the present study was to (1) determine the standard value of maximum bite force and to (2) compare the maximum bite force of the elderly between healthy and frail subjects. Subjects included 349 healthy elderly individuals (149 males, 200 females) and 24 frail elderly individuals (seven males, 17 females) ranging from 65 to 74 years of age. Maximum bite force was evaluated using a Dental Prescale systemÔ. The maximum bite force of the healthy subjects was significantly higher than that of the frail subjects in both males (P=0·020) and females (P=0·015). However, no significant difference was observed in the number of present teeth between the healthy and frail subjects. Median of maximum bite force in healthy males was 408,0 N, and that of the healthy females was 243,5 N. These results suggest that the frail elderly have latent bite force problems. [source] Fluoroscopic guidance of Arndt endobronchial blocker placement for single-lung ventilation in small childrenACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2008B. MARCINIAK Background: Thoracoscopic surgery may require single-lung ventilation (SLV) in infants and small children. A variety of balloon-tipped endobronchial blockers exist but the placement is technically challenging if the size of the tracheal tube does not allow the simultaneous passage of the fibreoptic scope and the endobronchial blocker. This report describes a technique for endobronchial blocker insertion using fluoroscopic guidance in children undergoing SLV. Methods: After approval from the local Medical Ethics Committee and parental consent, 18 patients aged 2 years or younger scheduled for thoracic surgery requiring SLV were prospectively included. Following induction of anesthesia, a 5 Fr endobronchial blocker (Cook® Arndt endobronchial blocker) was inserted first into the trachea under direct laryngoscopy. Correct placement in the main bronchus was assessed by fluoroscopy and tracheal intubation next to the endobronchial blocker. Optimal position and balloon inflation was verified using a fibreoptic scope. The duration and number of insertion attempts as well as age, weight and size of the tracheal tube were recorded. Results: Eighteen patients were studied. Median (range) age and weight were 12 (0.2,24) months and 11.2 (4,15) kg, respectively. SLV was successfully achieved in all patients using a 5 Fr endobronchial blocker outside a 3.5,4.5 mm ID tracheal tube within 11.2 (±2.2) min. No side effects were observed during the procedure. Conclusion: Fluoroscopic-guided insertion of extraluminal endobronchial blocker is an effective and reliable tool to place Arndt endobronchial blockers in small children. [source] Coffee and Cigarette Consumption and Perceived Effects in Recovering Alcoholics Participating in Alcoholics Anonymous in Nashville, TennesseeALCOHOLISM, Issue 10 2008Michael S. Reich Background:, Alcoholics Anonymous (AA) members represent an important and relatively understudied population for improving our understanding of alcohol dependence recovery as over 1 million Americans participate in the program. Further insight into coffee and cigarette use by these individuals is necessary given AA members' apparent widespread consumption and the recognized health consequences and psychopharmacological actions of these substances. Methods:, Volunteers were sought from all open-AA meetings in Nashville, TN during the summer of 2007 to complete a questionnaire (n = 289, completion rate = 94.1%) including timeline followback for coffee, cigarette, and alcohol consumption; the Alcoholics Anonymous Affiliation Scale; coffee consumption and effects questions; the Fagerstrom Test for Nicotine Dependence (FTND); and the Smoking Effects Questionnaire. Results:, Mean (±SD) age of onset of alcohol consumption was 15.4 ± 4.2 years and mean lifetime alcohol consumption was 1026.0 ± 772.8 kg ethanol. Median declared alcohol abstinence was 2.1 years (range: 0 days to 41.1 years) and median lifetime AA attendance was 1000.0 meetings (range: 4 to 44,209 meetings); average AA affiliation score was 7.6 ± 1.5. Most (88.5%) individuals consumed coffee and approximately 33% of coffee consumers drank more than 4 cups per day (M = 3.9 ± 3.9). The most common self-reported reasons for coffee consumption and coffee-associated behavioral changes were related to stimulatory effects. More than half (56.9%) of individuals in AA smoked cigarettes. Of those who smoked, 78.7% consumed at least half a pack of cigarettes per day (M = 21.8 ± 12.3). Smokers' FTND scores were 5.8 ± 2.4; over 60% of smokers were highly or very highly dependent. Reduced negative affect was the most important subjective effect of smoking. Conclusions:, A greater proportion of AA participants drink coffee and smoke cigarettes in larger per capita amounts than observed in general U.S. populations. The effects of these products as described by AA participants suggest significant stimulation and negative affect reduction. Fundamental knowledge of the quantitative and qualitative aspects of coffee and cigarette consumption among AA members will enable future research to discern their impact on alcohol abstinence and recovery. [source] Mortality from peptic ulcer bleeding: the impact of comorbidity and the use of drugs that promote bleedingALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2010K. Åhsberg Summary Background, Use of drugs promoting peptic ulcer bleed has increased several folds. Aim, To make a time-trend analysis of peptic ulcer bleed patients and evaluate the impact of age, gender, comorbidity and use of drugs promoting peptic ulcer bleed on outcome. Methods, Retrospective review of hospitalizations for peptic ulcer bleed at Lund University Hospital during 1984, 1994 and 2004. Univariate analyses between years and multivariable logistic regression for risk factors of fatal outcome. Results, Incidence decreased from 62.0 to 32.1 per 100 000 inhabitants between 1984 and 2004. Mortality rates were stable. Median age (70,77 years; P = 0.001), number of comorbidities (mean ± s.d.: 0.88 ± 0.96 to 1.16 ± 0.77; P = 0.021), use of aspirin (16,57%; P < 0.001) and warfarin (5,17%; P = 0.02) increased. Pharmacological and endoscopic therapy improved. Age above 65 years (OR: 1.11, 95% CI: 1.02,1.23) and number of comorbidities (OR: 6.00, 95% CI: 2.56,17.4) were independent risk factors for in-hospital mortality. Bleeding promoting drugs did not influence outcome negatively. Aspirin decreased the risk of fatal outcome (OR: 0.12, 95% CI: 0.012,0.67). Conclusions, Incidence of peptic ulcer bleed decreased despite higher prescription rates of bleeding promoting drugs. The in-hospital mortality remained unchanged. The effect of improved therapy against peptic ulcer bleed is probably outweighed by older and more comorbid patients. The decreased risk of fatal outcome in aspirin users warrants further investigations. [source] The predictors of complications in patients with drug-induced liver injury caused by antimicrobial agentsALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 11 2010S. TREEPRASERTSUK Aliment Pharmacol Ther,31, 1200,1207 Summary Background, Antimicrobials are the leading cause of idiosyncratic drug-induced liver injury in most series. Aim, To determine the incidence and the predictors of complications in patients with drug-induced liver injury caused by antimicrobial agents requiring hospitalization. Methods, Medical records of patients with drug-induced liver injury caused by antimicrobial agents were identified by ICD-10, for the period between 2002 and 2006. Clinical information and blood tests during hospitalization were recorded. The causality assessment of drug-induced liver injury was determined by the Roussel UCLAF causality assessment method (RUCAM) scale. Results, Of 47 594 in-patient admissions per year, the annual incidence of drug-induced liver injury was 0.03%. Male: female ratio was 7:3 with a median age of 47 years. Eighty reactions of drug-induced liver injury were caused by anti-tuberculosis drugs (85%) and by antibiotics (15%). The median (IQR) of RUCAM scale was 6 (5,8). A total of 36% had HIV infection and 9% of patients had diabetes mellitus. Median (IQR) duration of hospitalization was 9 (5,15) days. Serious complications and death were found in 27.5% and 26%, respectively. By a multivariable logistic analysis, the presence of jaundice was found to be significantly associated with an unfavourable outcome. Conclusion, Although rare, antimicrobial agents-related drug-induced liver injury requiring hospitalization has a high mortality rate. The presence of jaundice predicts poor outcome. [source] Mercaptopurine rescue after azathioprine-induced liver injury in inflammatory bowel diseaseALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 1 2010F. BERMEJO Summary Background, Azathioprine (AZA) liver toxicity arises in approximately 3% of inflammatory bowel disease patients and may result in treatment discontinuation. Aim, To describe the tolerance to mercaptopurine (MP) in patients with previous AZA-related liver injury. Methods, Retrospective description of 31 patients (14 Crohn's, 17 ulcerative colitis), in which AZA therapy was interrupted because of liver injury, with MP started as alternative therapy. Results, Mean AZA dose was 2.2 ± 0.4 mg·kg/day. Median (interquartile range) of AZA exposure when liver injury was detected was 2 months (1,5.2). The type of AZA-related injury was cytolitic in 32%, cholestatic in 39% and mixed in 29%. After a median of 2.5 months (0.7,5.2), the therapy was switched to MP at a mean dose of 1.3 ± 0.2 mg·kg/day. Median of follow-up of MP therapy was 32 months (8,54). In 87.1% of patients (95%CI: 70,96%), MP was tolerated without further liver injury; of these, 77.4% tolerated full MP doses and 9.7% tolerated lower doses. In a further cohort of 12.9% of patients, (95%CI: 3,29%), liver injury reappeared (two cholestasis, two mixed), 1,3 months after the onset of MP exposure. Conclusion, The administration of MP is a good alternative in patients with AZA-related liver injury, before thiopurines are definitely discarded. [source] Efficacy and safety of secondary prophylactic vs. on-demand sucrose-formulated recombinant factor VIII treatment in adults with severe hemophilia A: results from a 13-month crossover studyJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 1 2010P. COLLINS Summary.,Background: Hemarthroses in severe hemophilia precipitate physical, psychosocial and financial difficulties. Objective: To compare the effects of secondary prophylaxis with on-demand sucrose-formulated recombinant factor VIII (rFVIII-FS) therapy in severe hemophilia A. Patients and methods: This open-label study included patients aged 30,45 years with factor VIII (FVIII) coagulant activity < 1 IU dL,1 who were using on-demand FVIII treatment. Patients were treated with rFVIII-FS on demand for 6 months, followed by 7 months prophylaxis (20,40 IU kg,1, three times per week, with the first month considered a run-in). The primary endpoint was the number of hemarthroses. Results: Twenty patients were enrolled (n = 19 completed); the mean age was 36.4 years, and 16 had target joints. The median (25,75%) number of joint bleeds decreased significantly with prophylaxis [0 (0,3)] vs. on-demand [15 (11,26); P < 0.001] therapy. The number of all bleeds was 0 (0,3) vs. 20.5 (14,37; P < 0.001), respectively. Median (range) total Gilbert scores improved after prophylaxis [18 (3,39)] compared with on-demand [25 (4,46)] therapy, predominantly reflecting the improved bleeding score. Median time from last prophylactic infusion to bleed was 2 days; 82.5% of bleeds occurred 2,3 days after the last infusion. Median 48-h and 72-h FVIII trough levels measured during months 10 and 13 were consistently > 6 and > 4 IU dL,1, respectively. Treatment was well tolerated, and no inhibitor formation was observed. Conclusion: Secondary prophylaxis with rFVIII-FS significantly reduced the frequency of hemarthroses compared with on-demand therapy in adult patients with severe hemophilia A. [source] The use of exclusive enteral nutrition for induction of remission in children with Crohn's disease demonstrates that disease phenotype does not influence clinical remissionALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 5 2009E. BUCHANAN Summary Background, Exclusive enteral nutrition (EEN) achieves variable remission rates in patients with Crohn's disease (CD). Aim, To describe our experience of treating CD with an 8-week course of primary EEN and to study factors affecting treatment outcome. Methods, All CD patients treated with EEN in our centre between 2004 and 2007 were included in the study. Remission was determined by a combination of clinical parameters. Disease phenotype was assigned using published classifications. Inflammatory markers and anthropometry (Z -scores) were calculated before and after treatment. Results, A total of 114 children were treated (four were excluded). Median age at diagnosis was 11.6 years. Fifty-seven (51.8%) were fed orally whilst 53 (48.2%) were fed by tube. Eighty-eight (80%) achieved remission with consequent reductions in erythrocyte sedimentation rate and C-reactive protein (P < 0.001). Patients in remission had comparative improvements in weight (,1.04 cf. ,0.40) and BMI Z -scores (,0.98 cf. ,0.03) by the end of treatment (P < 0.001). Individuals with isolated terminal ileal disease (n = 4) had lower remission rates than other locations (P = 0.02). No other significant differences in remission rates for any other disease locations were found. Conclusions, Exclusive enteral nutrition induces clinical remission, normalization of inflammatory markers and improves weight/BMI Z -scores in most patients. This study demonstrates that disease phenotype should not influence clinicians when commencing patients on EEN. [source] Intestinal decontamination improves liver haemodynamics in patients with alcohol-related decompensated cirrhosisALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 9 2009J. VLACHOGIANNAKOS Summary Background, Endotoxaemia is commonly seen in cirrhotic patients with ascites and this may be associated with increased portal pressure. Aim, To investigate the effect of intestinal decontamination on liver haemodynamics in alcohol-related cirrhotic patients with ascites. Methods, We included 30 patients. At day 0, systemic and splanchnic circulation endotoxin levels were determined and HVPG measurement performed. Patients received rifaximin (1200 mg/day) for 28 days. At day 29, systemic and splanchnic circulation endotoxin levels were determined and HVPG measurement performed again. Results, Median (range) plasma endotoxin levels decreased significantly after rifaximin administration both in systemic [1.45(0,3.1) vs. 0.7(0,2.7), P < 0.0001] and splanchnic circulation [1.8(0,3.4) vs. 0.8(0,2.1), P < 0.0001]. Meanwhile, the difference seen in endotoxin levels between the splanchnic and systemic circulation at day 0 (P = 0.001) was not noted at day 29 (P = 0.137). HVPG measurement was possible in 28 patients. Median (range) HVPG values were 18 mmHg (12.7,26.3) on day 0 vs. 14.7 mmHg (7,20) on day 29 (P < 0.0001). HVPG decreased after rifaximin in 23, remained stable in two and increased in three patients. Conclusion, Hepatic venous pressure gradient values decreased significantly after intestinal decontamination with rifaximin in patients with alcohol-related decompensated cirrhosis and this might have been achieved through significant reduction of plasma endotoxin levels. [source] Sequential Plasma Lactate Concentrations as Prognostic Indicators in Adult Equine EmergenciesJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 1 2010B.S. Tennent-Brown Background: Sequential lactate concentration ([LAC]) measurements have prognostic value in that hospitalized humans and neonatal foals that have a delayed return to normolactatemia have greater morbidity and case fatality rate. Hypothesis: Prognosis for survival is decreased in horses with a delayed return to normal [LAC]. Animals: Two hundred and fifty adult horses presented for emergency evaluation excepting horses evaluated because of only ophthalmologic conditions, superficial wounds, and septic synovitis without systemic involvement. Methods: Prospective observational study. [LAC] was measured at admission and then at 6, 12, 24, 48, and 72 hours after admission. The change in [LAC] over time ([LAC],T) was calculated from changes in [LAC] between sampling points. Results: Median [LAC] was significantly (P < .001) higher at admission in nonsurvivors (4.10 mmol/L [range, 0.60,18.20 mmol/L]) when compared with survivors (1.30 mmol/L [range, 0.30,13.90 mmol/L]) and this difference remained at all subsequent time points. The odds ratio for nonsurvival increased from 1.29 (95% confidence interval 1.17,1.43) at admission to 49.90 (6.47,384) at 72 hours after admission for every 1 mmol/L increase in [LAC]. [LAC],T was initially positive in all horses but became negative and significantly lower in nonsurvivors for the time periods between 24,72 hours (, 0.47, P= .001) and 48,72 hours (, 0.07, P= .032) when compared with survivors (0.00 at both time periods) consistent with lactate accumulation in nonsurvivors. Conclusions and Clinical Importance: These results indicate that lactate metabolism is impaired in critically ill horses and [LAC],T can be a useful prognostic indicator in horses. [source] The safety profile of anti-tumour necrosis factor therapy in inflammatory bowel disease in clinical practice: analysis of 620 patient-years follow-upALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2009C. W. LEES Summary Background, Anti-TNF agents are now widely used in Crohn's disease (CD), and in ulcerative colitis (UC). Aim, To review the safety profile of anti-TNF agents in all patients treated with infliximab in Edinburgh from 1999 to 2007. Methods, Complete data were available on 202/207 patients comprising 157 CD, 42 UC and three coeliac disease. Median follow-up was 2.4 years (1.0,4.9) with a total of 620 patient-years follow-up. About 19.1% of CD patients were subsequently treated with adalimumab. Results, Seven deaths (3.3%) occurred in follow-up; only one death was <1 year post-infliximab (at day 72, from lung cancer). A total of six malignancies (three haematological, three bronchogenic) and six cases of suspected demyelination (three with confirmed neurological disease) were reported. In the 90 days following infliximab, 95 adverse events (36 serious) occurred in 58/202 (28.7%) patients. In all, 42/202 (20.8%) had an infectious event (22 serious) and 27/202 (13.4%) of patients had an infusion reaction: 19 acute (four serious) and eight delayed (three serious). Conclusions, Serious infections, malignancies and neurological disease complicate anti-TNF use in clinical practice. Although evidence for causality is unclear, potential mechanisms and predisposing factors need to be explored. In individual patients, the risk/benefit analysis needs to be carefully assessed and discussed prior to commencement of therapy. [source] | |||||||||||||||||||||||||||||||||||||||||||