Placebo effect in burning mouth syndrome: a systematic review

Placebo controls play a critical role in the evaluation of any pharmacotherapy. This review surveys the placebo arm in 12 randomized controlled trials (RCTs) investigating burning mouth syndrome (BMS) and documents a positive placebo response in 6 of them. On average, treatment with placebos produced a response that was 72% as large as the response to active drugs. The lack of homogeneity in the use of placebos adds to the difficulty in comparing results and aggregating data. Future RCTs investigating BMS would benefit from larger sample sizes, adequate follow‐up periods, and use of a standard placebo.     

Laparoscopic scar: A mimicker of Sister Mary Joseph’s nodule on positron emission tomography/CT

Positron emission tomography/CT is an established imaging method in the diagnosis and staging of cancers. ¹⁸F‐fluoro‐2‐deoxy‐d ‐glucose (FDG) is the most commonly used radiotracer in positron emission tomography/CT. It is a tumour viability agent and usually its uptake within a lesion reflects the presence of a viable tumour tissue. However, false‐positive FDG uptake is known to occur in benign processes of either inflammatory or infectious aetiology. We describe FDG uptake at the site of laparoscopic scar that mimicked Sister Mary Joseph’s nodule in a patient with gastric adenocarcinoma. Here, the knowledge of the patient’s history and subtle imaging findings helped in accurate staging of the patient. In this case report, we emphasize the value of the knowledge of the patient history and awareness of different pitfalls of FDG to achieve a correct diagnosis on positron emission tomography/CT.     

Interventional radiologic procedures in the renal transplant

Percutaneous interventional procedures can be valuable in the evaluation and treatment of urologic complications of renal transplantation. Thirty-three patients underwent percutaneous procedures, including relief of obstruction by catheter nephrostomy, diagnostic antegrade pyelography with Whitaker testing, aspiration of various fluid collections (lymphocele, hematoma, urinoma, and abscess), and renal artery angioplasty, during a three year period at three institutions, to provide temporizing treatment and anatomic data. Surgical intervention was sometimes avoided, but more often it could be deferred to allow the patient to stabilize prior to surgery. Complications that required surgery occurred in two patients.     

Non-pharmacologic approaches to graft-versus-host prevention

Allogeneic transplant offers a curative option for selected hematological malignancies and improved disease free survival in those where cure is not possible. For patients in these categories, Graft-versus-host disease (GVHD) occurs often and is a significant cause of morbidity and mortality following transplantation. Pharmacological immunosuppression has considerable toxicity and controls GVHD in about 75% of transplant recipients when used in combination and continually. Thus, there is the need for viable and non-toxic alternatives for GVHD prevention and this is the impetus for seeking novel non-pharmacological strategies. Most techniques directed to this end are based on various permutations of T-cell depletion. Total T-cell depletion was the first graft engineering strategy employed but while beneficial, it was associated with delay in engraftment and early relapses. Modern depletion and adoptive immunotherapy techniques are directed toward specific subsets of T-cells which include alloreactive, naive, NK cells, T-helper and cytotoxic T-cells. While large bodies of preclinical evidence attest to the efficacy of currently available non-pharmacological prevention techniques, such is not the case with vigorous clinical trials. Where available, the proven non-pharmacological prevention techniques are yet to be fully interwoven into the patient care arena. Integration of available strategies and continuing research are therefore acutely needed to improve the chronic morbidity and mortality seen with both allogeneic transplant-associated GVHD and the use of pharmaceutical immunosuppressants.     

Chromium as adjunctive treatment for type 2 diabetes

OBJECTIVE: To review the chemistry, pharmacology, efficacy, and safety of trivalent chromium in the treatment of type 2 diabetes and hyperlipidemia. DATA SOURCES: The English literature was searched from 1966 through May 2002 using MEDLINE, International Pharmaceutical Abstracts, and EMBASE. The key words included chromium, glucose, lipids, and diabetes. Pertinent references from review articles and studies were used as additional sources. DATA SYNTHESIS: Trivalent chromium is an essential nutrient and has a key role in lipid and glucose metabolism. Supplementation with chromium does not appear to reduce glucose levels in euglycemia. It may, however, have some efficacy in reducing glucose levels in hyperglycemia. The effects of chromium on lipid levels are variable. Chromium in doses <1000 microg/d appears to be safe for short-term administration. Kidney function and dermatologic changes need to be monitored. CONCLUSIONS: Chromium appears to be a safe supplement and may have a role as adjunctive therapy for treatment of type 2 diabetes. Additional large-scale, long-term, randomized, double-blind studies examining the effect of various doses and forms of chromium are needed.     

The muscle fiber in central core disease

Summary From correlated histochemical and electron microscope investigations, of a biopsy specimen of central core disease, several pathological characteristics are recognized in the muscle cell. The central core area consists of amassed myofilaments without distinct separation into fibrils. This region contains a pathological, filament-like opaque substance which is thought to be derived from the Z band. The interfibrillar spaces in the core region are greatly reduced or absent. Concomitantly, neither mitochondria nor an elaborate reticulum is present: this is reflected histochemically in the absence of lipoid and basophilic elements. The periphery of the muscle fiber outside the core appears normal.

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Zusammenfassung Histochemische und elektronenmikroskopische Untersuchungen an Biopsiematerial eines Falles von Zentralfibrillenerkrankung der Muskelfasern (central core disease) führen zur Feststellung verschiedener pathologischer Merkmale. So besteht die Zone der zentralen Fibrillen aus einer Anhäufung von Myofilamenten ohne Unterteilung in Fibrillen. Außerdem enthalten sie eine krankhafte, opake Formation in filamentartiger Anordnung, die vermutlich mit dem Z-Streifen in Zusammenhang steht. Der interfibrilläre Zellraum in der Zentralregion ist entweder nicht oder nur in geringstem Ausmaße vorhanden. Gleichzeitig fehlen an dieser Stelle sowohl Mitochondrien als auch ein voll ausgebildetes sarkoplasmisches Reticulum, ein Befund, dem auch die histochemisch erhobene Abwesenheit von lipoiden und basophilen Gewebselementen entspricht. Der periphere Anteil der Muskelfaser entspricht der Norm.

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With 13 Figures in the Text (1 in Color)