A review of GP records relating to methadone-associated deaths in the Lothian region of Scotland 1997-9

Aims : To ascertain the characteristics of patients whose death was associated with methadone intoxication during the period 1997-9 in the Lothian region of Scotland. Design : Patients were identified from death certificates. General practitioner records relating to methadone-associated deaths were reviewed in association with autopsy, toxicology and police reports. Deprivation categories (DepCat) were derived from the postal code of residence and the Carstairs index. Findings : There were 77 methadone-associated deaths in the Lothian Health Board area. GP records were obtained for 60 patients registered with a general practitioner. The majority of methadone-associated deaths (73%) occurred in persons who were not prescribed methadone at the time of their death. Thirty-eight persons were prescribed medication other than methadone or dihydrocodeine at the time of death. Thirty (79%) of those being prescribed for were receiving benzodiazepines. Forty-seven per cent had a history of excessive alcohol consumption. Fifty per cent had a reported psychiatric history. Sixty per cent had previously attended Accident and Emergency through deliberate self-harm or accidental overdose. Low socioeconomic status was found to be associated with the highest rate of methadone-related deaths. Conclusions : Given the variety of characteristics outlined it is likely that reducing drug-related deaths is a longer term aim, not amenable to one particular solution.     

Radiation dose reduction during hysterosalpingography: an application of scanning-beam digital radiography

Hysterosalpingography was performed in 31 patients by means of a low-dose scanning-beam digital radiographic system. The technique permits adequate evaluation of gynecologic abnormalities while allowing significant reduction in radiation: 2.4-mR (6.1 X 10(-7) C/kg) exposure to the skin and 0.7-mrad (7 X 10(-6) Gy) mean dose to the ovaries per image obtained. Sixteen patients demonstrated readily recognizable and documented abnormalities, corroborated by laparoscopy, laparotomy, or other supportive evidence.     

High-dose etoposide and cyclophosphamide without bone marrow transplantation for resistant hematologic malignancy

Seventy-five patients with resistant acute leukemia or lymphoma received high-dose cyclophosphamide and etoposide to explore the activity of this combination in resistant hematologic malignancies, and to determine the maximum doses of these drugs that can be combined without bone marrow transplantation. Etoposide was administered over 29 to 69 hours by continuous infusion corresponding to total doses of 1.8 g/m2 to 4.8 g/m2. Cyclophosphamide, 50 mg/kg/d, was administered on 3 or 4 consecutive days total 150 to 200 mg/kg ideal body weight). At all dose levels myelosuppression was severe but reversible. Mucosal toxicity was dose-limiting with the maximum tolerated dose level combining etoposide 4.2 g/m2 with cyclophosphamide 200 mg/kg. Continuous etoposide infusion produced stable plasma levels that were lower than would be achieved after administration by short intravenous infusion, and this could explain our ability to escalate etoposide above the previously reported maximum tolerated dose. There were 28 complete (35%) and 12 partial (16%) responses. Median duration of complete response (CR) was 3.5 months (range 1.1 to 20+). Seventeen of 40 patients (42%) with acute myelogenous leukemia (AML) achieved CR, including 6 of 20 (30%) with high-dose cytosine arabinoside resistance. We conclude that bone marrow transplantation is not required after maximum tolerated doses of etoposide and cyclophosphamide. This regimen is active in resistant hematologic neoplasms, and the occurrence of CR in patients with high-dose cytosine arabinoside-resistant AML indicates a lack of complete cross-resistance between these regimens.     

Nucleotide Sequences from Tryptophan Messenger RNA of Escherichia coli: The Sequence Corresponding to the Amino-Terminal Region of the First Polypeptide Specified by the Operon

Mutants with internal deletions that terminate near the operator end of the tryptophan operon of E. coli were used in studies on the nucleotide sequence at the 5' end of the messenger RNA transcribed on this operon. The findings obtained permitted identification of a sequence of 43 nucleotides corresponding to the aminoterminal 11 amino acids of anthranilate synthetase component I, the polypeptide specified by the operator-proximal structural gene of the operon. It was also shown that the translation initiation codon for this polypeptide is preceded on the messenger by a "leader" sequence of unknown function, at least 150 nucleotides in length.     

TGFβ modulates cell-to-cell communication in early epithelial-to-mesenchymal transition

Aims/hypothesis  

A key pathology in diabetic nephropathy is tubulointerstitial fibrosis. The condition is characterised by increased deposition of the extracellular matrix, fibrotic scar formation and declining renal function, with the prosclerotic cytokine TGF-β1 mediating many of these catastrophic changes. Here we investigated whether TGF-β1-induced epithelial-to-mesenchymal transition (EMT) plays a role in alterations in cell adhesion, cell coupling and cell communication in the human renal proximal tubule.     

Test of the child/adolescent Rome III criteria: agreement with physician diagnosis and daily symptoms

Background Establishment of the Rome criteria advanced diagnosis of children with Functional Gastrointestinal Disorders. The criteria were overhauled in 2006, but these revisions were never systematically tested. The aim of the current study was to assess psychometric properties of the childhood Rome III criteria and determine how well they agree with physician diagnoses and daily symptoms. Methods A total of N = 135 families from two pediatric gastroenterology clinics completed the Questionnaire on Pediatric Gastrointestinal Symptoms (QPGS‐ RIII). Half of the families completed the QPGS‐RIII again in 2 weeks, the other half completed 2‐week daily diaries. Children above the age of 10 also provided data (N = 64). Physician diagnoses were obtained from the medical records. Key Results Diagnoses: The most common diagnoses per child/parent report were Irritable Bowel Syndrome (IBS; 43–47%) and Abdominal Migraine (26–36%). The most frequent physician diagnoses were Functional Constipation (FC; 53%) and Functional Abdominal Pain (FAP; 29%). Reliability: Moderate to substantial agreement was found between baseline and 2‐week follow‐up for most diagnoses (kappa = .19–.78) and between parent and child reports (kappa = ?.04–.64). Validity: There was low agreement between QPGS‐RIII and physician diagnosis (kappa =?.02–.34) as well as diaries (kappa = .06–30). Conclusions & Inferences The Rome criteria have reasonable test–retest reliability and seem to be inclusive, as the majority of children obtain a diagnosis. However, validity is still an issue: The Rome criteria do not overlap well with physician diagnosis or daily symptoms. These issues will need to be addressed in future revisions of the Rome criteria.     

Scoring the wechsler memory scale: Some issues examined in a New Zealand normative study

Abstract

Wechsler Memory Scale (WMS) protocols from 251 inpatient normals were used to evaluate and compare changes to WMS scoring. Minor changes (e.g., Power, Logue, McCarty, Rosenstiel, & Ziesat, 1979) to Wechsler's (1945) scoring criteria for the Logical Memory (LM) subtest were evaluated, as were minor changes to the scoring of the Visual Reproduction (VR) subtest. Wechsler's scoring criteria for LM proved robust and those of Power et al. reduced absolute scores on LM.     

Readmission Following Gastric Cancer Resection: Risk Factors and Survival

Background

This study utilized a multi-institutional database to evaluate risk factors for readmission in patients undergoing curative gastrectomy for gastric adenocarcinoma with the intent of describing both perioperative risk factors and the relationship of readmission to survival.

Methods

Patients who underwent curative resection of gastric adenocarcinoma from 2000 to 2012 from seven academic institutions of the US Gastric Cancer Collaborative were analyzed. In-hospital deaths and palliative surgeries were excluded, and readmission was defined as within 30 days of discharge. Univariate and multivariable logistic regression analyses were employed and survival analysis conducted.

Results

Of the 855 patients, 121 patients (14.2 %) were readmitted. Univariate analysis identified advanced age (p?<?0.0128), American Society of Anesthesiology status ≥3 (p?=?0.0045), preexisting cardiac disease (p?<?0.0001), hypertension (p?=?0.0142), history of smoking (p?=?0.0254), increased preoperative blood urea nitrogen (BUN; p?=?0.0426), concomitant pancreatectomy (p?=?0.0056), increased operation time (p?=?0.0384), estimated blood loss (p?=?0.0196), 25th percentile length of stay (<7 days, p?=?0.0166), 75th percentile length of stay (>12 days, p?=?0.0256), postoperative complication (p?<?0.0001), and total gastrectomy (p?=?0.0167) as risk factors for readmission. Multivariable analysis identified cardiac disease (odds ratio (OR) 2.4, 95 % confidence interval (CI) 1.6–3.3, p?<?0.0001), postoperative complication (OR 2.3, 95 % CI 1.6–5.4, p?<?0.0001), and pancreatectomy (OR 2.2, 95 % CI 1.1–4.1, p?=?0.0202) as independent risk factors for readmission. There was an association of decreased overall median survival in readmitted patients (39 months for readmitted vs. 103 months for non-readmitted). This was due to decreased survival in readmitted stage 1 (p?=?0.0039), while there was no difference in survival for other stages. Stage I readmitted patients had a higher incidence of cardiac disease than stage I non-readmitted patients (58 vs. 24 %, respectively, p?=?0.0002).

Conclusions

Within this multi-institutional study investigating readmission in patients undergoing curative resection for gastric cancer, cardiac disease, postoperative complication, and concomitant pancreatectomy were identified as significant risk factors for readmission. Readmission was associated with decreased overall median survival, but on further analysis, this was driven by differences in survival for stage I disease only.