Qualitative MRI findings in patients with schizophrenia: a controlled study

A variety of brain structural abnormalities, which can be identified only by qualitative methods, have been shown to correlate with clinical presentation and course of schizophrenia. In the present study, MRI scans of 122 patients with DSM-IV schizophrenia and 81 non-psychiatric controls were evaluated. Among males, the frequency of CNS developmental abnormalities (CDAs) was higher in patients than in controls. Lateral ventricular enlargement (LVE) was more frequent in patients than in controls; when subjects were grouped in three age classes, LVE was more frequent in patients than in controls in the youngest and the oldest age group. Patients with LVE or third VE were older than those without these abnormalities. Schizophrenic patients with LVE or cortical atrophy (CA) had a longer duration of illness than those without these abnormalities. Both patients with LVE and those with third VE had a poorer outcome than those without these abnormalities. CDA findings add to the evidence of a higher frequency of neurodevelopmental abnormalities in male schizophrenic patients. Results concerning LVE suggest that both developmental and degenerative processes underlie this abnormality. The association of LVE and third VE with a poor outcome indicates that qualitative MRI evaluation might be of clinical relevance.     

Gemcitabine and vinorelbine in pretreated advanced breast cancer: A pilot study

Purpose:Gemcitabine (GEM) and vinorelbine (VNR) are both activeagainst advanced breast cancer (ABC), being able to induce a median ORR of25% and 40%, respectively. Because of their different mechanismof action and good tolerability, the combination of GEM and VNR has beentested in ABC. Patients and methods:Twenty-nine ABC patients pretreated withanthracycline-taxane were treated with GEM 1000 mg/m² on day 1, 8,15, and VNR 25 mg/m² on day 1 and 8 every twenty-eight days.Analysis of toxicity pattern, response rate, TTP and OS were carried out. Results:Twenty-nine patients were enrolled into the trial. TheORR was 48% (95% CI: 29–67): a CR was observed in threepatients (10%; 95% CI: 2–27), while eleven patients(38%; 95 CI: 21–58) achieved PR, eight (28%) had a SD, andseven (24%) progressed. Toxicity was mainly hematological and included:grade 3 leukopenia in 48% of cases without episodes of neutropenicfever, grade 3–4 thrombocytopenia in 10%, and grade 2 anemia in7%. Non-hematological toxicities were mild and rather infrequent. Conclusions:The GEM–VNR combination seems to be active inpretreated ABC with an acceptable toxicity pattern, and may well reppresentan interesting therapeutic choice after anthracycline/taxane regimens.     

Influence of sulpiride on gastrointestinal motility: experimental radiological study in the dog.

A radiological study has been carried out in the dog to control the influence of N-ethyl-2(2-methoxy-5-sulfamido-benzamidomethyl)-pyrrolidine (sulpiride) on the motility of the gastrointestinal tract. The drug was administered orally and parenterally at different doses for each pharmaceutical form and for such route of doses for each pharmaceutical form and for each route of administration. In doses which were considered optimal, the results have demonstrated that sulpiride exerts hypertonic and hyperphasic effects on the smooth musculature of the gastrointestinal tract. Consequently, there is a reduction of the transit time and of the emptying of the opaque meal in the various sectors of the gastrointestinal tract, which is in the order of about 50% with respect to normal. Using doses which are inferior to those considered optimal, no significant results were obtained, while following higher doses the action of sulpiride is manifested by an inhibitory effect on gastrointestinal motility.     

Emerging drugs for ocular allergy

Ocular allergy is a common condition that usually affects the conjunctiva of the eye and is, therefore, often referred to as allergic conjunctivitis. The severity of the disease can range from mild itching and redness, as seen in seasonal allergic conjunctivitis, to the more severe, sight-threatening forms such as vernal and atopic keratoconjunctivitis. The central mechanism in the pathogenesis of these diseases is IgE-mediated mast cell degranulation and activation of T lymphocytes, eosinophils and conjunctival structural cells. The pharmacotherapy of allergic conjunctivitis consists of several classes of drugs: antihistamines, mast cell stabilisers, dual-acting agents and corticosteroids. None of the available drugs completely abolishes the development of ocular allergy. For this reason, new topical antiallergic/anti-inflammatory agents are currently and continually under clinical trials. This review provides a background to ocular allergic diseases, the medical need for therapy and current and potential new treatments.     

Perinatal management of gastroschisis: analysis of a newly established clinical pathway

Purpose

The authors developed a clinical pathway for optimal management after antenatal diagnosis of gastroschisis. This is the outcomes analysis of our first 30 consecutive patients.

Method

Antenatal counseling was provided for all families with in-utero diagnosis of gastroschisis. Bowel dilatation, thickness, motility, amniotic fluid volume, and fetal development were followed by ultrasonography every 4 weeks. Babies were delivered by cesarean section between 36 and 38 weeks gestation if the lungs were mature or earlier for bowel complications. Gastroschisis repair was scheduled 90 minutes after birth. Primary repair was attempted in all through the abdominal wall defect without an additional incision, resulting in an umbilicus with no abdominal scar.

Results

Primary repair was achieved in 83%. Babies needed assisted ventilation for 3 days, reached full feeds by 19 days, and were discharged by 24 days (all medians). There were 3 (10%) deaths, all after staged repair.

Conclusions

Our new protocol of both scheduled elective cesarean section and early gastroschisis repair resulted in a higher proportion of primary repair, shorter duration of mechanical ventilation, earlier full feeds, and shorter length of stay. There was no increase in mortality or morbidity. The primary-repair babies had no mortality and had excellent cosmesis.     

Preferential allocation of marginal kidney allografts to elderly recipients combined with modified immunosuppression gives good results

BACKGROUND: There is an increasing tendency to allocate kidneys from marginal donors in older recipients. This combination optimizes the uses of an expanded donor pool but demands attention for the higher nephrotoxic sensitivity of the kidney and the increased immunosuppression vulnerability of the elderly recipients. We aimed to reduce these hazards by means of a calcineurin-free induction therapy followed by a maintenance regimen targeted to minimize/withdraw steroid. METHODS: Eighty-eight single (43%) or double (57%) transplant recipients (58.4+/-5.7 years) from 88 marginal donors (67+/-8.3 years) received monoclonal anti-IL-2 receptor antibodies, mycophenolate mofetil (MMF), and steroid. When serum creatinine was less than 2.6 mg/dL, tacrolimus was started and MMF was withdrawn when the tacrolimus trough level was above 15 ng/ml. Steroid was tapered to 5 mg at day 45 and then progressively reduced. RESULTS: Overall patient and graft survival at the first and fourth year were respectively 100 and 96%, and 98 and 79%. Acute rejection rate was 13.6% (12/88), creatinine clearance remained stable (48.2 ml/min at the sixth month, 50.9 ml/min at 48th month). At the first, second, third, and fourth years, 23, 69, 80, and 100% of recipients were off steroids. For those on steroids, mean dose was respectively 2.6 mg/day from month 12. No recipient re-assumed steroids CONCLUSIONS: In the "old-for-old" allocation, the calcineurin-inhibitor avoidance at induction and the steroid withdrawal/minimization during the tacrolimus-based maintenance regimen allow a low acute rejection rate, a stable renal function, and favorable recipient and graft outcomes.     

Renal transplantation in patients over 65 years of age: no more a contraindication but a growing indication

INTRODUCTION: Worldwide organ shortage and the increasing age of end-stage renal disease patients demanding a graft have prompted extensive use of marginal donors. The "old-for-old" allocation has been proposed for the elderly. The aim of this study was to evaluate the results of a policy of free acceptance into the waiting list of recipients older than 65 years. METHODS: From 1987 to 2004 70 patients whose mean age was 67.4 +/- 2.8 years, underwent an extensive pretransplant evaluation including cardiac studies. Immunosuppression was based upon low-dose steroids, and cyclosporine (50%) or tacrolimus (44%). RESULTS: Patient and graft survival at 1, 3, 5, and 10 years were 85%, 78.5%, 75%, 50%, and 80%, 74%, 70%, 36%, respectively. Death occurred in 17/70 (24%), 14 of whom had a functioning graft. The causes of death were 30% cancer, 23% cardiovascular, 23% sepsis, 12% cerebrovascular hemorrhage, 12% meningitis. The acute rejection (AR) rate was 18.6%. The causes of graft loss were: 71% patient death, 4% irreversible AR, 4% vascular thrombosis, and 21% chronic allograft dysfunction. The main complications were: 52% prostatic hypertrophy, 40% urinary tract infections, 8.6% diabetes, 11% pneumonia, 10% cardiovascular diseases, 7% urological complications, 8% abdominal pathology, 6% acute pyelonephritis, 8% non-skin cancer. CONCLUSIONS: Despite the increased vulnerability of the elderly, they should not be excluded a priori from renal transplantation. Extensive pretransplant screening, mainly cardiovascular, and a tailored immunosuppression are two crucial issues. The moderate rate of AR suggests that these patients do not have an impaired immunocompetence as far as acute rejection is concerned.     

Evaluation of the ultrasound influence in the cutaneous penetration of d-panthenol: test in vitro

Background d‐panthenol is a popular additive in cosmetic and pharmaceutical preparations. However, in order for this vitamin to provide skin benefits, it must penetrate the stratum corneum. Objective To verify the penetrability of d‐panthenol in the skin and evaluate the effect of ultrasound on the cutaneous penetration of this vitamin. Methods The diffusion cell technique with pig skin as the membrane, distilled water as the receptor solution, and a hydrophilic d‐panthenol gel were used for the research. The experimental groups were gel + d‐panthenol (10%) and gel + d‐panthenol (10%) + ultrasound. The receptor solution was collected at predetermined times and the amount of d‐panthenol was determined by using a spectrophotometer at 406 nm. Results Ultrasound resulted in a statistically significant increase (P < 0.05) in the penetration of d‐panthenol at 2, 60, and 240 min. Conclusion d‐panthenol penetration through the pig's skin is enhanced through the use of ultrasound.     

Cyclosporin is safe and effective in severe atopic dermatitis of childhood. Report of three cases

Severe atopic dermatitis causes major impairment in the life of both children and their parents. Generally, symptoms can be controlled with emollients, topical steroids, antibiotics, antihistaminic but some patients remain intensely ill and may require treatment with systemic steroids and so on. Cyclosporin has been found to be effective in a variety of inflammatory skin disorders since it reduces the number of activated T-cells expressing interleukin 2 (IL-2) receptors. In order to monitor the safety and clinical efficacy of therapy and days of remission we performed Cyclosporin on 3 children with severe atopic dermatitis, refractory to all traditional therapies. Cyclosporin suspension at dosage of 5 mg/kg daily, in 2 doses for 8 weeks has been used. Cyclosporin blood levels, liver and kidney function, blood pressure and some immunological parameters (eosinophils, IgE, IL-2 receptors) were monitored. All patients showed a marked clinical improvement with reduction of pruritus, erythema, papules, vesciculation, excoriation, scaly crusts and lichenification. No clinical or haematological side effects were demonstrated. The soluble IL-2 receptor concentration decreased even after 8 weeks of treatment in all 3 patients, regardless of IgE levels (case 1: low IgE level; case 2: very high IgE level) as in several others T-cell mediated non IgE-related skin disease. The authors suggest that courses of 8 weeks seem effective and safe as well as longer time in producing early remission with the advantage of a low cumulative exposure to the drug. The main question is whether a prolonged remission will permain as well as continuous therapy. This study underscores the potential value of systemic administration of this powerful immuno-suppressive agent in the treatment of many cases of severe atopic dermatitis working regardless of the IgE values. Although 3 cases report does not justify any definitive conclusion however it does a contribute to understand the heterogeneity of atopic dermatitis and it adds information to its current treatment guidelines.