Comparison of liver stiffness, fibrotest and liver biopsy for assessment of liver fibrosis in kidney-transplant patients with chronic viral hepatitis

To assess the accuracy of the noninvasive tools, fibrotest (FT) and liver stiffness measurement (LSM) for assessing liver fibrosis in kidney-transplant patients with chronic hepatitis virus B (HBV) or C (HCV) infection. Thirty-eight consecutive kidney-transplant patients with HCV ( n  =   26) or HBV ( n  =   12) underwent liver biopsies followed by a FT and LSM. Liver biopsies gave the following fibrosis-grade distribution using METAVIR scores: F0/F1, n  =   10 (26.9%); F2, n  =   14 (36.8%), F3, n  =   7 (18.42%); F4, n  =   7 (18.4%). The area under the receiver-operating characteristic curve for mild fibrosis stage 相似文献   

Twenty-four hour kinetics of hepatitis C virus and antiviral effect of alpha-interferon

Numerous studies reported that patients infected by the genotype 1 of hepatitis C virus (HCV) and/or with a high baseline viral load responded poorly to antiviral therapy. Study of viral kinetics has provided clues to the understanding of non-response to alpha-interferon (IFN-alpha)-based therapy. The objective of this study was to clarify the influence of viral factors such as the genotype and baseline viral load on HCV resistance to treatment through the study of their impact on the first phase of viral decline. HCV RNA levels were determined frequently following the administration of 3 million units of IFN-alpha in 22 chronic HCV carriers. The evolution of HCV RNA level over 24 hr was different in genotype 1-infected patients, compared to that in patients infected by other genotypes. The viral load decline at 24 hr was lower in patients with genotype 1. Patients with a high baseline viral load exhibited a viral dynamics different from patients with a lower level of viremia; the extent of the first phase was also lower in these patients. Non-responder patients had a slower viral decay on day 1 of therapy than patients who cleared the virus under treatment. In conclusion, 24 hr HCV dynamics is regulated by genotype and baseline viral load. Genotype 1 strains and those that produce high viral loads are the most resistant to the antiviral action of IFN-alpha. Resistant HCV strains could be distinguished from sensitive viruses as early as a few hours after the beginning of the treatment.     

Three-dimensional conformal radiotherapy for localized prostate cancer in kidney transplant recipients

BACKGROUND: This is the first report of graft function and prostate cancer control in renal transplant recipients subjected to modern conformal radiotherapy. METHODS: Eight kidney transplant recipients were treated with three-dimensional conformal radiotherapy. All patients but one were subjected to transitory hormonal deprivation. A three-dimensional radiotherapy-planning system (Pinnacle, Philips Medical System, Bothell, WA) was used to delineate anatomic contours on pretreatment computed tomography and for dose computation. The clinical target volume encompassed the prostate and was expanded with a 10-mm wide margin in all directions to obtain the planning target volume. The irradiation technique consisted of a nine-field arrangement delivering 70 Gy in 2-Gy fractions, with 18-MV photon beams. Biochemical recurrence was defined as two consecutive increases in prostate-specific antigen (>1.5 ng/mL). Graft function was monitored by creatinine clearance. Excretory profiles were assessed by furosemide-stimulated diethylenetriaminepentaacetic acid renography. All patients were subjected to hip magnetic resonance imaging to assess for avascular hip necrosis. RESULTS: After a mean follow-up of 28 months, two patients showed isolated biochemical recurrence and six patients remained free of recurrence. In seven patients with functional allografts, the creatinine clearance was unimpaired by treatment. However, significant obstruction of the terminal ureter was revealed in two patients by furosemide-stimulated diethylenetriaminepentaacetic acid renograms. The doses delivered to the uretero-neocystostomy were calculated to range from less than 20 Gy to more than 45 Gy depending on bladder repletion. CONCLUSIONS: Adequate cancer control was achieved at the expense of infraclinical ureteral obstruction. The doses delivered to the uretero-neocystostomy may be reduced by having a full bladder at the time of irradiation. No avascular hip necrosis was observed.     

Common complementary and alternative therapies for yeast vaginitis and bacterial vaginosis: a systematic review

This article is a systematic review of the literature regarding the most commonly used complementary and alternative medicine (CAM) therapies for yeast vaginitis and bacterial vaginosis. A search was conducted of all published literature on conventional search engines (PubMed, EMBASE, the Cochrane Registry, CINAHL, LILACS) and alternative medicine databases (Natural Medicines Comprehensive Database, Longwood Herbal Taskforce, and Alternative Medicine Alert), for all studies of the five most commonly used CAM treatments of vaginitis. Inconsistencies in definition of vaginitis, type of intervention, control groups, and outcomes prevented performance of a meta-analysis, and paucity of high-quality studies made ranking by evidence-based scales unsuitable. Lactobacillus recolonization (via yogurt or capsules) shows promise for the treatment of both yeast vaginitis and bacterial vaginosis with little potential for harm. Boric acid can be recommended to women with recurrent vulvovaginal Candidal infections who are resistant to conventional therapies, but can occasionally cause vaginal burning. Because of associated risks in the absence of well-documented clinical benefits, douching remains a practice that should not be recommended for the treatment of vaginitis. Finally, tea tree oil and garlic show some in vitro potential for the treatment of vaginitis, but the lack of in vivo studies preclude their recommendation to patients for the time-being. The available evidence for CAM treatments of vaginitis is of poor quality despite the prevalent use of these therapies. Well-designed randomized, controlled trials investigating the efficacy and safety of these therapies for vaginitis are needed before any reliable clinical recommendations can be made. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader will be able to list the most common complementary and alternative medicine therapies for vaginitis, summarize the data surrounding the efficacy of each therapy, describe the adverse affects of each therapy, and outline which therapies are recommended and not recommended for vaginitis.     

An HPLC method for the measurement of 5-fluorouracil in human plasma with a low detection limit and a high extraction yield

High performance liquid chromatographic (HPLC) techniques for the quantification of 5-fluorouracil (5-FU) in human plasma have been reported in the literature, however, a low limit of detection was generally found to result in a comparatively low extraction yield. We have developed a simple, rapid and sensitive HPLC method for the measurement of 5-FU in plasma which provides both a low limit of quantification and a high extraction yield. This method involves the solid phase extraction of 5-FU from a 500 microl plasma sample. The extract is then injected into an HPLC system equipped with a C18 (mu)Bondapak column, and a UV detector set at 260 nm. Ethyl acetate and potassium dihydrogen phosphate are used for the solid phase extraction and the HPLC mobile phase, respectively. This method provides in a good baseline, a sharp and symmetrical peak for 5-FU, and a high resolution between 5-FU and the internal standard. The retention time of 5-FU using this method is 4.7 min with a limit of detection of 5 ng/ml, and an extraction yield of 96.2+/-0.5% (SE). The next injection is possible in 11 min, and the coefficients of variation are 4.2-8.9% for interday precision, and 5.2-10.6% for day-to-day reproducibility. An HPLC method has been developed that has a low limit of detection and a high extraction yield. This technique was successfully applied in a clinical pharmacokinetic study of 5-FU.     

An evaluation of methylated collagen as a substitute for vitreous and aqueous humor

Purpose:To evaluate ocular tolerance of methylated collagen gel injected intravitreally and into the anterior chamber. Methods: Methylated collagen (type I/III) was tested in New Zealand white rabbits. Vitreous cavity: After pars plana vitrectomy, methylated collagen gel was injected intravitreally. The eyes were examined clinically; electroretinogram recordings were made before and after surgery. Vitreous samples were taken for immunological analysis for the presence of the injected collagen. The rabbits were sacrificed 6 months after surgery; the retina was evaluated by light microscopy. Anterior chamber: In another group of rabbits, methylated collagen gel (0.2 ml, 0.1 ml, or 0.05 ml) was injected into the anterior chamber after paracentesis. The eyes were examined with a slit lamp; intraocular pressure was measured postinjection. The rabbits were sacrificed after 4 months; the corneas were evaluated histologically. Results: Vitreous cavity: The fundus view was clear for 6 months after intravitreal injection. Scotopic and photopic electroretinograms were normal in 6/7 eyes; one eye experienced a mild decrease one month postoperatively. No abnormal changes were found in the retinal histology. Anterior chamber: Some corneas were hazy and edematous around the injection site for one week. The injected collagen appeared in bundles, patches, and little pieces in the anterior chamber with precipitates on the corneal endothelium, pupillary margin, and the anterior capsule of the lens. The collagen diminished gradually, without causing permanent opacity. Histologically, the corneal endothelium in the eye which received 0.2 ml collagen showed a mild distention of the mitochondriae and vesicle formation between endothelial cells under transmission electron microscope. Conclusion: Methylated collagen gel was tolerated by the eye after intravitreal injection. Localized temporary clinical and mild ultrastructural corneal changes were observed after anterior chamber injection.