Montelukast treatment of urticaria

OBJECTIVE: To review clinical trial data to determine the benefits of using montelukast alone or as combination therapy in the treatment of urticaria. DATA SOURCES: MEDLINE (1966-March 2006) and International Pharmaceutical Abstracts (1970-October 2005) were searched to find clinical trial publications that addressed the use of montelukast in urticaria. DATA SYNTHESIS: Six clinical trials were identified. Montelukast was compared alone and as combination therapy with nonsedating histamine1-receptor antagonists to determine efficacy and safety. Patients had chronic or physical urticaria. The results were mixed. Some studies demonstrated that montelukast can decrease urticarial symptoms with minimal adverse effects, while others found no differences. CONCLUSION: Large-scale, controlled trials are needed to determine which patients would likely benefit from treatment with montelukast.     

Protective effects of N-acetylcysteine and rutin on the lipid peroxidation of the lung epithelium during the adult respiratory distress syndrome

This study investigates the effects of N-acetylcysteine (NAC) and rutin on the lung oxidative burden of patients with early adult respiratory distress syndrome (ARDS). The protection was evaluated by measuring expired ethane and malondialdehyde (MDA), and oxidized (GSSG) and reduced glutathione (GSH) in the epithelial lining fluid of 36 patients who developed ARDS less than 24 hours before enrollment in the study. The patients were randomly assigned to 3 groups, receiving 250 mL 5% dextrose in water (group 1), NAC 50 mg/kg body weight in 5% dextrose (group 2), and NAC 50 mg/kg + rutin 5 mg/kg in 5% dextrose (group 3). Ethane and MDA concentrations were significantly reduced in the treatment groups after day 6. GSH was 30% increased in the treatment groups. No significant variations were observed in the control group until day 9. The trial confirms that NAC and rutin are efficient in protecting the lungs of patients with ARDS.     

Simultaneous detection in the bone marrow of mammary cancer metastatic cells and of their labelling index as respective markers of the residual minimum submacroscopic disease and its proliferative condition (preliminary results)

A study of 200 patients with breast cancer carcinoma at different stages of the disease, was carried out for detecting in their bone marrow, mammary cells and their proliferative condition using a double labelling method with two types of monoclonal antibodies. The mammary cells were visualised with monoclonal antibodies raised against human breast epithelium and/or carcinoma. DNA synthetising cells (in S phase) were detected on the same slide, using a monoclonal antibody directed against an antigen associated with bromodeoxyuridine (BrdU) after cell incubation with BrdU. Mammary cells could be detected in the bone marrow of 13 out of 20 cases presenting macroscopically visible metastasis, 12 out of 20 patients at diagnosis of their disease, 90 out of 160 patients in apparent disease free condition. The labelling index was 6/13, 6/12 and 45/90 in those respective three groups of patients. The similarity of these three groups for both parameters suggests that the fate of breast carcinoma patients and their prognosis in three types (++, +-, --) is carried from the beginning of the disease. We have, with Eriguchi shown that the mammary (and other) cancer patients survival exponential curves do not express homogeneous populations but are in fact composed of three segments, the first with a rapid slope represents the acute type patients, at high risk of early relapse, the second, with a slow slope, represents the chronic type patients at risk of late relapse and the third, the slope of which is parallel to the general population life expectancy, represents the so called "cured patient".(ABSTRACT TRUNCATED AT 250 WORDS)     

Comparison of the roll-plate and sonication techniques in the diagnosis of microbial ureteral stent colonisation: results of the first prospective randomised study

Background

Microbial ureteral stent colonisation (MUSC) is one leading risk factor for complications associated with ureteral stent placement. As MUSC remains frequently undetected by standard urine cultures, its definitive diagnosis depends on microbiological investigation of the stent. However, a standard reference laboratory technique for studying MUSC is still lacking.

Materials and methods

A total of 271 ureteral stents removed from 199 consecutive patients were investigated. Urine samples were obtained prior to device removal. Stents were divided into four parts. Each part was separately processed by the microbiology laboratory within 6 h. Ureteral stents were randomly allocated to roll-plate or sonication, respectively, and analysed using standard microbiological techniques. Demographic and clinical data were prospectively collected using a standard case-report form.

Results

Overall, roll-plate showed a higher detection rate of MUSC compared with sonication (35 vs. 28 %, p < 0.05) and urine culture (35 vs. 8 %, p < 0.05). No inferiority of Maki’s technique was observed even when stents were stratified according to indwelling time below or above 30 days. Compared with roll-plate, sonication commonly failed to detect Enterococcus spp., coagulase-negative staphylococci (CoNS) and Enterobacteriaceae. In addition, sonication required more hands-on time, more equipment and higher training than roll-plate in the laboratory.

Conclusions

This prospective randomised study demonstrates the superiority of Maki’s roll-plate technique over sonication in the diagnosis of MUSC and that urine culture is less sensitive than both methods. The higher detection rate, simplicity and cost-effectiveness render roll-plate the methodology of choice for routine clinical investigation as well as basic laboratory research.     

Improvement in the detection rate of PJI in total hip arthroplasty through multiple sonicate fluid cultures

The microbiological culture of sonicate fluid (SFC) of explanted endoprosthetic components has increased the rate of bacterial isolation in comparison to conventional microbiological methods. However, this creates the problem of interpreting cases of singular bacterial isolation through SFC, while all other microbiological samples remain negative. The aim of this study was to reference these singular positive SFC against, the histological classification of the periprosthetic membrane (PM), and the utilization of multiple SFC (separate sonication of individual endoprosthetic components). In this prospective study we compared the effect of multiple SFC for detection of periprosthetic joint infection (PJI) in patients with total hip revision surgery. All microbiological results were referenced against PM. Of the 102 cases there were 37 cases of PJI. Single SFC achieved the highest sensitivity of all individual parameters with 89% and a specificity of 72%. When multiple SFC were employed the sensitivity and specificity increased to 100%. There was a concordance of 86% between the PM and SFC. SFC achieved the highest sensitivity and it was possible to further improve the sensitivity and specificity when using multiple cultures. Multiple SFC and PM are beneficial to help reference singular bacterial isolations and achieve the diagnosis of PJI. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31:2021–2024, 2013     

Temporal and geographical trends in indications for implantation of cardiac defibrillators in Europe 1993-1998. Medtronic ICD System Investigators

Despite the demonstrated efficacy of implantable cardioverter defibrillators (ICDs) in reducing sudden and total mortality in selected populations, their implantation rates vary greatly between countries. The aim of our study was to analyze temporal and geographical trends in ICD implantations in countries with similar health related expenditure in Western Europe. A total of 2,257 patients from ten European evaluation studies of Medtronic defibrillators and defibrillation electrodes, conducted between 1993 and 1998, representing 12 countries, was included in this analysis. Rates of implantation and clinical characteristics were compared between countries and years of implantation. Rates of implantation differed greatly between Western European countries and did not correlate with indices of health related expenditure (i.e., number of patients per physician and number of patients per hospital bed). However, there was a strong and statistically significant negative correlation between the use of amiodarone and the rates of implantation (r = -0.66, P = 0.02). Temporal trends showed a significant increase in the age of the patients receiving an ICD between 1993 and 1998 (57 +/- 14 vs 61 +/- 12 years, mean +/- SD, P < 0.001). There was also a temporal trend towards an increased incidence of coronary artery disease and a significant decrease in the incidence of cardiomyopathy. There was a temporal increase in implantations in patients with a history of ventricular tachycardia. Despite a general scientific agreement that ICDs are a first line treatment for patients at high risk of sudden cardiac death, their acceptance remains low in several developed countries. This low acceptance may not be entirely related to budget constraint but may also be related to their perceived efficacy by physicians and health authorities.     

Effects of amiloride on pH regulation in canine cardiac Purkinje fibers

Myocardial cells utilize membrane transport systems for proton extrusion as well as internal buffers to preserve pH homeostasis. Our laboratory had shown previously that amiloride (0.01-1.0 mM) causes a time- and dose-dependent increase in action potential duration, early after depolarizations and enhanced automaticity. Ion-selective microelectrode technique was used to evaluate whether the observed electrophysiologic effects of amiloride are linked to inhibition of Na/H exchange and subsequent inability of the myocardial cell to maintain steady-state intracellular pH (pHi), either under normal physiological conditions or in the presence of an imposed acid load. We analyzed different components of intracellular pH transients that occur in response to NH4Cl exposure and washout, which allowed us to quantitatively describe the effects of Na/H exchange inhibition in a multicellular preparation. Amiloride (0.01-1.0 mM) did not change the steady-state pHi, but did cause a dose-dependent increase in both the time for the pHi to reach a minimum value (time-to-peak) during washout of NH4Cl as well as in the absolute minimum value of pHi (peak acid). The effects of amiloride on pHi transients are rapidly reversible and antagonized by physiologic values of extracellular sodium activity. We conclude that Na/H exchange inhibition by amiloride does not cause intracellular acidosis under normal physiologic conditions, despite the dramatic changes in action potential characteristics. However, amiloride affected the time-to-peak and the peak acid value of the pHi transient during NH4Cl washout at concentrations that had no discernible effect on the overall time course of pHi recovery.     

The Effects of Psychosocial Services in Substance Abuse Treatment

Objective. To examine whether the addition of counseling, medical care, and psychosocial services improves the efficacy of methadone hydrochloride therapy in the rehabilitation of opiate-dependent patients.

Design. Random assignment to one of three treatment groups for a 6-month clinical trial: (1) minimum methadone services (MMS)—methadone alone (a minimum of 60 mg/d) with no other services; (2) standard methadone services (SMS)—same dose of methadone plus counseling; or (3) enhanced methadone services (EMS)—same dose of methadone plus counseling and on-site medical/psychiatric, employment, and family therapy.

Setting. The methadone maintenance program of the Philadelphia (Pa) Veterans Affairs Medical Center.

Subjects. Ninety-two male intravenous opiate users in methadone maintenance treatment.

Results. While methadone treatment alone (MMS) was associated with reductions in opiate use, 69% of these subjects had to be “protectively transferred” from the trial because of unremitting use of opiates or cocaine, or medical/psychiatric emergencies. This was significantly different from the 41% of SMS subjects and 19% of EMS subjects who met the criteria. End-of-treatment data (at 24 weeks) showed minimal improvements among the 10 MMS patients who completed the trial. The SMS group showed significantly more and larger improvements than did the MMS group; and the EMS group showed significantly better outcomes than did the SMS group. Minimum methadone services subjects who had been “protectively transferred” to standard care showed significant reductions in opiate and cocaine use within 4 weeks.

Conclusions. Methadone alone (even in substantial doses) may only be effective for a minority of eligible patients. The addition of basic counseling was associated with major increases in efficacy; and the addition of on-site professional services was even more effective.