LONG-TERM TREATMENT OF HYPERPROLACTINAEMIA WITH BROMOCRIPTINE: EFFECT OF DRUG WITHDRAWAL

Fifty-one patients with hyperprolactinaemia (23 with macroadenoma, 23 with microadenoma, and five with idiopathic hyperprolactinaemia) were treated with bromocriptine for 2-12 years (4.9 +/- 2.9 years, mean +/- SD). During therapy, the serum PRL levels were suppressed into the normal range in all but five patients. In these five patients, despite the high circulating PRL, gonadal function returned to normal in three, while in the other two gonadotrophin reserve was impaired even before therapy. Gel chromatography showed that one of these patients had a high proportion of a large molecular weight form of PRL. Twenty-four patients received bromocriptine as the sole method of treatment for over 2 years (3.4 +/- 2.3 years). In five out of the 24 subjects (21%), serum PRL remained normal with no clinical symptoms after prolonged drug withdrawal (1-4 years). Twenty-one patients received radiotherapy in conjunction with bromocriptine therapy. Of these 11 had prior surgery. After a follow-up of 6.0 +/- 3.0 years after radiotherapy, serum PRL remained within the normal range in 6 out of 21 subjects (29%), 1-4 years after bromocriptine withdrawal. One of the patients had impaired GH response to insulin hypoglycaemia developing after radiotherapy. We conclude that prolonged bromocriptine treatment is an effective treatment for prolactinomas.     

ARTHROPATHY IN ACROMEGALIC PATIENTS BEFORE AND AFTER TREATMENT: A LONG-TERM FOLLOW-UP STUDY

The medical records of 90 patients with acromegaly were reviewed. Arthralgias were noted in 76% of the patients with 17% having the onset of joint pain concomitant with the clinical onset of acromegaly. Of 47 patients followed prospectively for 5 or more years after pituitary irradiation, six (12.8%) were unaffected by arthralgias. A statistically higher mean baseline growth hormone level was found for the 19 (40.4%) radiotherapy patients who had severe and disabling arthropathy. Mean intervals between clinical onset of acromegaly and the development of arthropathic symptoms were shorter (4.1 years) for patients over 40 years of age and longer (9.7 years) for those under 31 years of age. Severely affected patients tended to have increased joint spaces in both weight-bearing and non-weight-bearing joints followed by a progressive decrease in joint spaces. Arthropathy is a common complication of acromegaly and may progress independently of a fall in growth hormone, induced by any form of treatment, once significant cartilage overgrowth develops. Cartilage overgrowth is a predisposing factor in the development of an arthropathy associated with the wide range of growth hormone levels characteristic of acromegaly.     

PYROPHOSPHATE ARTHROPATHY: A PROSPECTIVE STUDY

One hundred and four consecutive patients with pyrophosphatearthropathy were followed prospectively and re-studied at amean of 4.6 years. Sixty-four patients (43F, 21M; mean age atreview 71.2 years) completed the study (24 died of unrelateddisease, 16 were unavailable for review). The knee had beenthe major presenting joint in 91%. Symptoms were improved in41%, unchanged in 33% and had worsened in only 27%: 27% developedsymptoms in new joints. Radiographic changes of arthropathywere unaltered in 50%: although ‘worsening’ of previouslyinvolved joints was seen in 16%, the most common change wasincrease in osteophyte with bone remodelling (31%). Despitedynamic changes in chondrocalcinosis in most patients (77%)there was no correlation between extent of calcification andprogression of arthropathy. It is concluded that the outcomeof pyrophosphate arthropathy is not necessarily progressive,patients presenting with acute attacks alone do particularlywell. KEY WORDS: Calcium pyrophosphate, Osteoarthritis, Crystals     

血浆置换治疗弥漫性硬皮病的前瞻性研究

报告血浆置换（ＰＥ）合用青霉时治疗１３例弥漫性硬皮病患者（Ⅰ组）的疗效，并与青霉胺治疗的１６例患者（Ⅱ组）进行比较。Ⅰ组于ＰＥ结束时皮肤积分、齿距、指距、关节压痛指数、握力、血沉、ＩｇＧ、血浆肾素、血管紧张素Ⅱ与治疗前相比有显著改善（Ｐ＜０．０５～ｐ＜０．０１），医生和患者评价有效率分别为６１．１％和６９．２％。观察至治疗后１８个月，病情继续改善，疗效与Ⅱ组相比差异有显著性（Ｐ＜０．０５）。７８次ＰＥ中发生低血压４次，经处理后恢复正常。     

MULTICENTRE COLLABORATIVE PROSPECTIVE STUDY OF ENDOSCOPIC TREATMENT OF EARLY GASTRIC CANCER

Aims: The present study was conducted with the aims of elucidating the present state of endoscopic treatment, in particular endoscopic mucosal resection (EMR) of early gastric cancer, as well as any associated problems, and the prospects for further broadening of the indications for EMR. Subjects and methods: This study was begun in 1994 and completed in 2002. Lesions were classi?ed into Group I, with macroscopic appearance of 0–I, IIa, IIb or IIc·U1(–), well‐ to moderately differentiated intramucosal carcinoma ≤ 20 mm in diameter, and Group II, with the same macroscopic appearance as Group I, intramucosal carcinoma either the same histological type with diameter 21–40 mm, or undifferentiated carcinoma ≤ 40 mm in diameter. Of the 412 subjects registered (Group I, 305 subjects; Group II, 107 subjects, including seven undifferentiated carcinoma cases), 258 were evaluated (Group I, 199 subjects; Group II, 59 subjects including seven undifferentiated carcinoma). Results: The overall complete excision rate for Group I was 71.9%, and was 82.4% for ≤ 10 mm, 67.2% for 11–15 mm, and 45.5% for 16–20 mm, thus declining with increasing lesion size. The long‐term results, including cases of additional treatment for residual cancer following the original EMR, showed that recurrence occurred in eight out of 199 cases (4.0%), in ?ve of whom local cure was achieved with endoscopic treatment, giving a ?nal local cure in 196 cases (98.5%). The overall complete excision rate for Group II differentiated carcinoma was 46.2%. With the inclusion of additional treatment, local cure was achieved with endoscopic treatment in 57 out of 59 cases (96.6%). The remaining two cases of recurrence underwent open surgery. Conclusion: Regardless of Group I or II classi?cation, if the diagnosis of intramucosal cancer from the specimen resected at the initial EMR is histologically correct, then local cure can be achieved with endoscopic treatment, including cases of recurrence, with appropriate follow up and use of concomitant techniques such as piecemeal resection and coagulation therapy. The indications for endoscopic treatment can now reasonably be widened to include Group II lesions.     

LONG-TERM SURVIVAL IN SMALL CELL LUNG CARCINOMA

We assessed outcome in 208 patients with small cell lung carcinoma two to seven years after treatment with combination chemotherapy, with or without chest and cranial radiotherapy. Fourteen patients (6.7%) survived cancer free for 30 months or longer. Nine of these (64%) had limited disease at diagnosis and four others had extensive disease with only one metastatic site. Two patients remain alive and disease free more than five years after diagnosis but median survival is still only 3.2 years. One patient died from intercurrent causes at 5.4 years but was free from small cell lung carcinoma at autopsy. Six patients are alive and disease free at intervals greater than 30 months but less than five years from diagnosis. All surviving patients are fully active with lifestyles similar to that prior to diagnosis. Five patients died from small cell lung carcinoma which relapsed more than 30 months after diagnosis. A few patients with small cell lung carcinoma are cured but 30-month survival is insufficient to show cure as late relapses do occur. Late toxicity from aggressive therapy does not appear to outweigh the benefits of long-term survival and potential cure in small cell lung carcinoma.     

FACTORS PREDICTING DEATH, SURVIVAL AND FUNCTIONAL OUTCOME IN A PROSPECTIVE STUDY OF EARLY RHEUMATOID DISEASE OVER FIFTEEN YEARS

Sixty-four survivors from a prospective study of early rheumatoiddisease were assessed again at a mean of 15.2 years from presentationand their status compared with 29 patients who had died. Elevenof the dead and only two of the survivors had been treated withsteroids. There was a small increase in mortality due to thedisease itself but only one death was directly caused by it. As might be expected, those who died were older. In the firstyear of disease, they had lower haemoglobin levels, a lowerbody mass, higher sedimentation rates and higher levels of bloodurea. One-fifth at entry to the study and two-fifths by thetime of death, had poor functional capacity. Of 64 survivors, six had poor functional capacity at entry andnine after 15 years. Discriminant analysis was performed toidentify the most powerful combination of early features predictinga poor functional outcome. A combmation including early erosivechange, seropositivity, poor grip strength and cervical subluxationpredicted the outcome correctly in 73% of survivors. Almost 60% of survivors remained with or improved to normalfunction at 15 years suggesting that morbidity is not as badas has been suggested in the past. KEY WORDS: Early rheumatoid arthritis, Prospective study, Functional outcome     

SERUM AMYLOID A PROTEIN DURING THE TREATMENT OF RHEUMATOID ARTHRITIS WITH SECOND-LINE DRUGS

Serum amyloid A protein (SAA), serum C-reactive protein (CRP)and the ESR were measured in 19 patients with rheumatoid arthritisbefore treatment and during therapy with gold, penicillamineor sulphasalazine for a mean period of 148 months (range 6—23months). All three measurements decreased significantly; however,only 7% of SAA values fell to within the normal range (18—44mg/l). compared to 38% measurements of serum CRP (>10 mg/l)and 32% of the ESR (>25 mm/h). In 8 (42%) of the 19 patients,SAA remained high (>400 mg/l) for 3 months or more whilstserum CRP was depressed below 20 mg/l; this discrepancy wasnot related to particular drugs We conclude that during treatment of rheumatoid arthritis withgold, penicillamine or sulphasalazine. SAA concentrations canbe high when serum CRP and ESR are suppressed SAA may be a moresensitive index of disease activity KEY WORDS: Rheumatoid arthritis, Serum amyloid A protein, C–reactive protein, Erythrocyte sedimentation rate     

A PROSPECTIVE STUDY OF LOW BACK PAIN

Consecutive patients attending hospital for the first time withbackache were entered into a prospective study, provided thatcertain defined causes (infective, neoplastic, metabolic andinflammatory etc.) were not apparent at the first visit. Amongst188 available for analysis, 65% were discharged and 28% defaulted,together making a total of 93% who ‘recovered uneventfully’(in the sense that they were no longer attending hospital) onaverage in about three months, 4% came to ‘myelography’(radiculography using Dimer-X or Amipaque) including 2% to discectomy,1.5% proved to have treatable underlying diseases accountingfor their backache while 1.5% became ‘qchronic attenders’.Information available at the first visit (patient characteristics,history, examination, radiographs and psychological questionnaire)provided few pointers to what the outcome would be or how longthe patient would attend hospital. In particular, routine X-rayexamination did not provide clues to any important conditionsnot already suspected by the clinicians. A case is made forreserving routine radiography for patients who have not recoveredwithin about three months.     

THE FIRST WEEK AFTER DRUG TREATMENT: THE INFLUENCE OF TREATMENT ON DRUG USE AMONG WOMEN OFFENDERS

Over the last decade, there has been a dramatic rise in the number of women arrested for drug offenses, and many have serious drug abuse problems. Increasingly, these women have been mandated to drug treatment, often in community-based settings. This article examines the impact of the treatment programs on the short-term posttreatment drug use of women offenders (N = 165) leaving two community-based treatment programs in Portland, Oregon. Our analyses indicate that women who abstained from drug use during the first week after treatment were more likely than those who used drugs during this time to have remained in treatment longer, received a plan to make a successful transition out of treatment, avoided associations with other drug users after leaving treatment, and obtained encouragement from individuals and groups in support of abstinence.