Psychiatric morbidity in people born in Ireland

Background: Irish immigrants are reported to be over-represented in psychiatric admission statistics for England when compared to native whites. This study examines whether this finding is sustained for users of psychiatric services as a whole and explicates the reasons for any differential uptake of mental health care by comparison with community morbidity rates in the same population. Methods: Demographic and clinical data were collected from staff concerning all adults living in a multi-ethnic inner-city health district and using mental health services during a 6-month period. A separate interview-based survey of private household residents in the same area was undertaken to ascertain the prevalence of psychiatric disorder in the community. Results: Psychiatric service use was found to be greater for Irish-born people compared to the remainder of the white population. However, this finding only persisted for alcohol use disorders, the rates for schizophrenic and affective disorders being comparable in the two groups. Access to psychiatric care was also similar both with respect to overall morbidity as well as for affective and alcohol use disorders, levels of service use being attributable to patterns of morbidity in the population rather than nosocomial factors. Conclusions: The excess morbidity for alcohol use disorders reported in people born in Ireland is affirmed and the need for longitudinal and ethnographic research into this important public health issue emphasised. Accepted: 30 July 1999     

Tuberculous anal ulcer

Two patients with anorectal tuberculosis, without prior or concurrent knowledge of active pulmonary infection with mycobacteria, are described. Anal fissure in an unusual location which is slow to heal should have a biopsy performed, with appropriate stains and cultures carried out, to rule out tuberculous disease. Chemotherapy is then highly effective for ulcerative perianal tuberculosis     

Salvage therapy with nelarabine,etoposide, and cyclophosphamide in relapsed/refractory paediatric T‐cell lymphoblastic leukaemia and lymphoma

A combination of 5 d of nelarabine (AraG) with 5 d of etoposide (VP) and cyclophosphamide (CPM) and prophylactic intrathecal chemotherapy was used as salvage therapy in seven children with refractory or relapsed T‐cell leukaemia or lymphoma. The most common side effects attributable to the AraG included Grade 2 and 3 sensory and motor neuropathy and musculoskeletal pain. Haematological toxicity was greater for the combination than AraG alone, although median time to neutrophil and platelet recovery was consistent with other salvage therapies. All patients had some response to the combined therapy and five of the seven went into complete remission after one or two courses of AraG/VP/CPM. Our experience supports the safety of giving AraG as salvage therapy in synchrony with etoposide and cyclophosphamide, although neurological toxicity must be closely monitored.     

A long‐term experience with expansion of Milan criteria for liver transplant recipients

The Milan criteria (MC) have historically determined eligibility for transplantation for hepatocellular carcinoma (HCC). The United Network for Organ Sharing (UNOS) Region 4 expanded the criteria for transplantation in HCC to include a single tumor ≤6 cm or up to 3 tumors with the largest diameter ≤5 cm and total additive diameter ≤9 cm (R4C). The aim of this study was to report the 10‐year outcomes of this expanded criteria compared to MC. Transplants performed for HCC in Region 4 between October 2007 and December 2016 were reviewed using the UNOS database. Recipients were categorized based on imaging findings at initial evaluation. A total of 2068 patients were included in the study. There was no significant difference in 10‐year patient survival between the groups (53% MC vs 48% R4C, P = .23). There was also no significant difference in recurrence‐free survival (54% MC vs 47% R4C, P = .15) or allograft survival (53% MC vs 48% R4C, P = .16). Finally, there was no significant difference in outcomes between the MC and R4C groups when stratifying patients by locoregional therapy. This study demonstrates promising data that the criteria for liver transplantation in HCC can be safely expanded to the R4C without compromising outcomes.     

Characteristics of patients and patterns of psychiatric service use in ethnic minorities

BACKGROUND: The differential uptake of psychiatric services by ethnic minorities has been widely reported. Less attention has been given to comparisons of these patients and variations in the types of interventions they receive. AIMS: To assess whether for people accessing psychiatric services in the UK, differences exist across ethnic groups both in their sociodemographic characteristics and patterns of mental health care utilisation. METHODS: All adults resident in an inner city health district and using psychiatric services during a six-month period were identified. Demographic, clinical and service use data were collected from staff and records. These were compared across black Caribbean, Indian, Pakistani, Irish and white ethnic groups for two broad diagnostic categories: psychotic/bipolar and depressive/neurotic disorders. RESULTS: There were significant differences between ethnic groups on most demographic variables in each of the diagnostic categories. There were variations in the level of contact with different mental health professionals. The only significant difference in the use of specific services was for those with psychotic/bipolar disorders, black Caribbean patients being more likely to be detained in hospital compulsorily. CONCLUSIONS: Ethnic diversity both in the characteristics of patients and their patterns of psychiatric care should be addressed when planning and developing services.