Effect of experimental diabetes on craniofacial growth in rats

OBJECTIVES: The goal of this study was to assess the effect of type 1 diabetes mellitus (T1DM) on the craniofacial growth and skeletal maturation using the STZ-DM rat model. DESIGN: Experimental T1DM was induced in 3-week-old male Wistar rats by a single dose of 60 mg/kg body weight of streptozotocin (STZ). Lateral and dorsoventral X-rays of the head were taken at the age of 7 weeks. The X-rays were scanned, digitised and selected linear distances were measured and analysed statistically. RESULTS: In STZ-DM statistical analysis of results revealed a reduction in growth of most of the linear measurements in the neurocranium and mandible by X-ray analysis, and all measurements were significantly lower in viscerocranium. CONCLUSIONS: Uncontrolled T1DM reduces craniofacial growth, resulting in retardation of skeletal development.     

Hepatitis C treatment of patients with bipolar disorder: a case series

Background: Hepatitis C virus (HCV) chronic infection affects 10% to 15% of patients with bipolar disorder. Patients with HCV infection and comorbid psychiatric illness pose a tremendous clinical and therapeutic challenge. The cases presented in this report illustrate several critical issues facing clinicians who manage patients with comorbid HCV infection and bipolar disorder. Method: Five cases are described in which patients with DSM-IV bipolar disorder were treated with interferon-alpha-based therapies and ribavirin to induce viral clearance of HCV. In all cases, the patients were treated using an integrated model of care, and the treatment decision was a consensus between the treating hepatologists and psychiatrists. Results: In the first case, the patient had no significant neuropsychiatric adverse effects and had viral clearance. In 2 other cases, viral clearance of HCV was achieved through the delicate management of affective symptoms induced by interferon-alpha and ribavirin. Interferon-alpha and ribavirin treatment was halted due to mania and suicidal ideation in the 2 remaining cases. Conclusion: These cases suggest that patients with hepatitis C and bipolar disorder should be evaluated for HCV antiviral treatments, as these patients can receive and tolerate these treatments if assessed meticulously, observed carefully, and followed extensively during interferon-alpha and ribavirin treatment. This case series will hopefully spark a dialogue about when HCV antiviral treatment should be withheld or delayed in these difficult cases.     

Sensitivity analysis of cost factors for various therapy options in the treatment of follicular lymphoma

BACKGROUND: In Germany, patients with relapsed follicular non-Hodgkin's lymphoma do not all receive the same treatment. In this study, 3 therapy regimens were analyzed which were considered to be similar. With the goal of determining the treatment option with the lowest direct costs whilst maintaining the same degree of effectiveness, a cost analysis model was established and applied by way of example to the existing illness constellation. METHODS: The German doctors' fee scale (Einheitlicher Bewertungsmassstab, EBM) valid until 2005 served as the basis for the calculation of medical services within the scope of the present statutory health insurance guidelines. A virtual standard patient was constructed for the cost model and treated with the different therapy regimens. The incidences of individual adverse events described in literature served as the basis for the characterization of the average toxicity of the respective treatment methods. RESULT: The overall costs result from the sum of the treatment costs and the toxicity-related costs. The effect of additional interventions on the overall cost was also examined. CONCLUSION: Whereas the accompanying documentation of costs in clinical studies is organizationally complex and very tedious, the model applied here offers a reliable method of quantifying the costs of the different therapy regimens. It permits the comparison of different treatment alternatives, and it enables, by means of a cost variance analysis, the identification of cost drivers and less expensive measures within a therapy method.