Open trial of carbamazepine in the prevention of recurrence of bipolar disorder in adolescents

While the existence of bipolar disorder in children and adolescents is now recognized, the prevalence of the disorder is still unknown, although it is clear that its' incidence increases markedly at puberty. The risks inherent in the course of the disorder, including recurrence and suicidal gestures, highlight the importance of its early recognition; however, diagnosis and identification of predictive factors in childhood bipolar disorder is problematic. Given the development of new mood-regulating psychopharmacological treatments for adults, early diagnosis in children is even more important. For children and adolescents, previous studies have shown the efficacy of lithium in the prevention of recurrence of bipolar disorder, but only over short periods of time. There are very few published studies on the use of carbamazepine in bipolar disorder; those that exist are most often single case studies. The authors present the results of an uncontrolled study of 11 patients, aged 10 to 17 years, diagnosed with bipolar according to DSM III-R criteria. These patients were treated with carbamazepine for a period of over 1 year. Two cases, especially noteworthy for their improvement, are presented in greater detail. A positive response was considered to have been obtained if a period greater than 1 year of normal affect was obtained. According to this criterion, seven patients were positive responders, two were moderate responders and two did not respond to treatment. Tolerance to the medication was good; in no cases it was necessary to interrupt treatment. Principle adverse side effects were biological, involving an increase in a single liver enzyme. Comparison among positive, moderate and non responders did not reveal any criteria predictive of therapeutic effectiveness. Despite methodological difficulties, these data point the importance of developing controlled studies with carbamazepine in the prevention of recurrence of bipolar disorder.     

Epidemiology of cholangiocarcinoma: An update focusing on risk factors

(Cancer Sci 2010; 101: 579–585) Cholangiocarcinoma is relatively rare, but high incidence rates have been reported in Eastern Asia, especially in Thailand. The etiology of this cancer of the bile ducts appears to be mostly due to specific infectious agents. In 2009, infections with the liver flukes, Clonorchis sinensis or Opistorchis viverrini, were both classified as carcinogenic to humans by the International Agency for Research on Cancer for cholangiocarcinoma. In addition, a possible association between chronic infection with hepatitis B and C viruses and cholangiocarcinoma was also noted. The meta‐analysis of published literature revealed the summary relative risks of infection with liver fluke (both Opistorchis viverrini and Clonorchis sinensis), hepatitis B virus, and hepatitis C virus to be 4.8 (95% confidence interval [95% CI]: 2.8–8.4), 2.6 (95% CI: 1.5–4.6), and 1.8 (95% CI: 1.4–2.4), respectively – liver fluke infection being the strongest risk factor for cholangiocarcinoma. Countries where human liver fluke infection is endemic include China, Korea, Vietnam, Laos, and Cambodia. The number of infected persons with Clonorchis sinensis in China has been estimated at 12.5 million with considerable variations among different regions. A significant regional variation in Opistorchis viverrini prevalence was also noted in Thailand (average 9.6% or 6 million people). The implementation of a more intensive preventive and therapeutic program for liver fluke infection may reduce incidence rates of cholangiocarcinoma in endemic areas. Recently, advances have been made in the diagnosis and management of cholangiocarcinoma. Although progress on cholangiocarcinoma prevention and treatment has been steady, more studies related to classification and risk factors will be helpful to develop an advanced strategy to cure and prevent cholangiocarcinoma.     

Expressions rhumatologiques paranéoplasiques

Paraneoplastic syndromes are characterized by different signs and symptoms related to an occult or already identified tumour, without any anatomical relationship between the paraneoplastic manifestations and the tumour. The nature of the tumour is usually malignant but it may happen to be benign. If the tumoural treatment is efficient, resulting in true recovery, the paraneoplastic manifestations disappear and do not relapse, except in case of tumour relapse. A rheumatic paraneoplastic syndrome is different from a pre-neoplastic situation. Many rheumatic conditions may be discussed, in addition to other neurologic and dermatologic paraneoplastic syndromes. Main rheumatic paraneoplastic entities are discussed in the present paper: palmar fasciitis syndrome with polyarthritis, paraneoplastic osteomalacia, secondary hypertrophic osteoarthropathy, paraneoplastic hypercalcemia, paraneoplastic inflammatory rheumatisms, muscular paraneoplastic syndromes and paraneoplastic vasculitides.     

Monoclonal gammopathy of undetermined significance,multiple myeloma,and osteoporosis

The finding of monoclonal gammopathy of undetermined significance (MGUS) is not infrequent during an evaluation for osteoporosis or a fracture. In most cases, the diagnosis is MGUS, whose prevalence increases with age. Although the impact of MGUS on bone mineral density, bone remodeling, and the fracture risk remains unclear, this asymptomatic hematological disorder may constitute a risk factor for osteoporosis. Furthermore, each year, 1% of patients with MGUS progress to multiple myeloma, a disease whose pathophysiology and association with bone loss and pathological fractures are increasingly well understood. Osteoporotic fractures, although probably common in myeloma patients, are less likely to be recognized. Here, we discuss the pathophysiology of myeloma and MGUS and their impact in terms of bone mineral density, osteoporotic fractures, and bone turnover markers.     

Taxonicity of anxiety sensitivity: a multi-national analysis

Taxometric coherent cut kinetic analyses were used to test the latent structure of anxiety sensitivity in samples from North America (Canada and United States of America), France, Mexico, Spain, and The Netherlands (total n = 2741). Anxiety sensitivity was indexed by the 36-item Anxiety Sensitivity Index--Revised (ASI-R; [J. Anxiety Disord. 12(5) (1998) 463]). Four manifest indicators of anxiety sensitivity were constructed using the ASI-R: fear of cardiovascular symptoms, fear of respiratory symptoms, fear of publicly observable anxiety reactions, and fear of mental incapacitation. Results from MAXCOV-HITMAX, internal consistency tests, analyses of simulated Monte Carlo data, and a MAMBAC external consistency test indicated that the latent structure of anxiety sensitivity was taxonic in each of the samples. The estimated base rate of the anxiety sensitivity taxon differed slightly between nations, ranging from 11.5 to 21.5%. In general, the four ASI-R based manifest indicators showed high levels of validity. Results are discussed in relation to the conceptual understanding of anxiety sensitivity, with specific emphasis on theoretical refinement of the construct.