Treatment with daily consensus interferon (CIFN) plus ribavirin in non-responder patients with chronic hepatitis C: a randomized open-label pilot study

BACKGROUND/AIMS: Therapeutic options for hepatitis C non-responder patients are limited. METHODS: We initiated an open-label pilot study to investigate the efficacy of CIFN plus ribavirin on viral kinetics, sustained virological response (SVR), and histological response in hepatitis C non-responder patients. Seventy-seven patients were enrolled to receive CIFN given daily in combination with 1000/1200 mg ribavirin. An 8-week induction-dosing regimen of 18 microg CIFN, followed by 9 microg for 40 weeks was compared to 9 microg CIFN for 48 weeks. 90% of patients were infected with HCV-genotype 1. RESULTS: Overall, 82% of the patients demonstrated an early virological response, 65% had an end-of-treatment response, and the SVR was 30%. Interferon/ribavirin non-responders demonstrated a SVR of 22%. Induction-dosing resulted in a greater first-phase HCV-RNA decay that, however, did not translate to better SVRs, presumably due to more dose modifications. High ALT, younger age, and second-phase viral kinetics were associated with SVR. Only sustained responders and relapse patients showed an improved liver histology. CONCLUSIONS: Daily dosing of CIFN plus ribavirin may be a promising concept for selected non-responder patients before considering therapies which are anti-viral but not curative. However, motivation and compliance are requisites and a CIFN induction is not required.     

Der petromastoidale Kanal

Background

The petromastoid canal was first described in 1904 by Mouret and Rouviere. Since then, there have been very few publications about this canal. Modern high-resolution computed tomography (CT) enables a slice thickness of 1 mm and less, so the course of the petromastoid canal is visible. In this study the petromastoid canal is introduced and its dimensions measured.

Materials and methods

This study involved 316 CT scans of normal temporal bones of subjects age 19.6–84.2: 156 temporal bones of women and 160 temporal bones of men. The slice thickness of the CT scan was 0.5 mm, and 16-slice or 64-slice CT was used. The middle diameter, length, and angle of the petromastoid canal were measured.

Results

The middle diameter of the petromastoid canal was 1.16±0.4 mm (0.25–2.5 mm), the length was 10.7±0.9 mm (4.25–16.1 mm), and the angle was 134.5±17.3° (124–157°).

Conclusion

The study shows for the first time the length and angle of the petromastoid canal. A slice thickness of at least 1 mm guarantees 100% imaging of the petromastoid canal. The petromastoid canal is an important anatomical landmark and is of clinical relevance.     

小儿骶管阻滞麻醉40例

1 临床资料骶管阻滞麻醉手术患儿40(男26,女14)例,年龄3 d～5岁,体质量2～17 kg.十二肠闭锁胃空肠吻合术4例;肠套叠切开复位术4例,坏死性肠炎肠切除肠吻合腹腔引流术3例;腹股沟斜疝疝囊高位结扎5例(包括1例莰顿性斜疝);无肛、直肠阴道瘘直肠修补腹骶会阴肛门形成术12例;隐匿性阴茎矫正术5例;产伤性左股骨骨折切开复位内外固定术2例;左右下肢骨折胫前移置术2例;马蹄足松解术 3例.手术时间25～160 min.术前20 min im咪唑安定0.2 mg/kg,阿托品0.02 mg/kg,5 kg以下0.1 mg,氯胺酮7 mg/kg.用生命监护仪测P,R,BP,SpO2,患儿意识消失,静脉开放一条,患儿取左侧卧位,常规消毒、铺敷,采取短针改良法,以6～7号注射针自骶裂孔处穿刺垂直刺入达骨膜后,针干渐向尾椎斜倒与皮肤呈40°角方向前进,穿过骶尾韧带有突破减压感,再推进0.5 cm,进针不宜过深,一般以3～4 cm为度,新生儿、婴儿更浅些,避免过深刺破蛛网膜下腔,注气无阻力也无皮下气肿可确定针已进入骶管,抽吸无脑脊液或血液后一次注入局麻.视体质量及预计手术时间长短,手术大小及部位不同,注入5～11.5 g/L利多卡因8～10 mg/kg和0.5～2.5 g/L布比卡因2 mg/kg(表1).     

Quality of life,work productivity impairment and healthcare resources in inflammatory bowel diseases in Brazil

BACKGROUND Inflammatory bowel diseases(IBD) have been associated with a low quality of life(QoL) and a negative impact on work productivity compared to the general population.Information about disease control,patient-reported outcomes(PROs),treatment patterns and use of healthcare resources is relevant to optimizing IBD management.AIM To describe QoL and work productivity and activity impairment(WPAI),treatment patterns and use of healthcare resources among IBD patients in Brazil.METHODS A multicenter cross-sectional study included adult outpatients who were previously diagnosed with moderate to severe Crohn's disease(CD) or ulcerative colitis(UC).At enrolment,active CD and UC were defined as having a Harvey Bradshaw Index≥8 or a CD Activity Index≥220 or calprotectin 200 μg/g or previous colonoscopy results suggestive of inadequate control(per investigator criteria) and a 9-point partial Mayo score≥5,respectively.The PRO assessment included the QoL questionnaires SF-36 and EQ-5 D-5 L,the Inflammatory Bowel Disease Questionnaire(IBDQ),and the WPAI questionnaire.Information about healthcare resources and treatment during the previous 3 years was collected from medical records.Chi-square,Fisher's exact and Student's t-/Mann-Whitney U tests were used to compare PROs,treatment patterns and the use of healthcare resources by disease activity(a=0.05).RESULTS Of the 407 patients in this study(CD/UC:64.9%/35.1%,mean age 42.9/45.9 years,54.2%/56.6% female,38.3%/37.1% employed),44.7%/25.2% presented moderate-to-severe CD/UC activity,respectively,at baseline.Expressed in median values for CD/UC,respectively,the SF-36 physical component was 46.6/44.7 and the mental component was 45.2/44.2,the EQ-visual analog scale score was 80.0/70.0,and the IBDQ overall score was 164.0/165.0.Moderate to severe activity,female gender,being unemployed,a lower educational level and lower income were associated with lower QoL(P 0.05).Median work productivity impairment was 20% and 5% for CD and UC patients,respectively,and activity impairment was 30 %,the latter being higher among patients with moderate to severe disease activity compared to patients with mild or no disease activity(75.0% vs 10.0%,P 0.001).For CD/UC patients,respectively,25.4%/2.8% had at least one surgery,38.3%/19.6% were hospitalized,and 70.7%/77.6% changed IBD treatment at least once during the last 3 years.The most common treatments at baseline were biologics(75.3%)and immunosuppressants(70.9%) for CD patients and 5-AS A compounds(77.5%) for UC patients.CONCLUSION Moderate to severe IBD activity,especially among CD patients,is associated with a substantial impact on QoL,work productivity impairment and an increased number of IBD surgeries and hospitalizations in Brazil.     

Prevalence and distribution of calcified nodules in carotid arteries in correlation with clinical symptoms

Purpose

Calcified nodules (“CN”) are responsible for up to 5% of coronary-infarcts and, therefore, classified as minor criteria of “vulnerable” atherosclerotic plaque. We sought to evaluate prevalence and distribution of CN in carotid arteries in correlation with clinical symptoms.

Methods

178 consecutive patients with unilateral ischemic stroke and carotid plaques ≥2 mm by duplex ultrasound underwent a carotid-black-blood-3T-MRI with fat-saturated pre- and post-contrast T1w-, PDw-, T2w- and TOF images using dedicated surface-coils. CN were defined as distinct calcification with an irregular, protruding, and convex luminal surface. Prevalence of CN was determined in common carotid artery (“CCA”) and internal carotid artery (“ICA”) in consensus by two reviewers blinded to clinical information.

Results

Thirty seven CN in 28 arteries of 26 patients were identified. Prevalence of CN in CCA compared to ICA was slightly higher (59 vs. 41%), but nearly similar in 66 arteries with ≥30% compared to 290 arteries with <30% stenosis (9.1 vs. 7.6%) and in the artery ipsilateral versus contralateral to stroke (7.9 vs. 7.9%; P values n.s.). Prevalence of CN was significantly higher in 40 symptomatic arteries with ≥30% stenosis compared to asymptomatic 26 arteries (15.6 vs. 0%; P = 0.04). There was a significantly higher prevalence of hypercholesterolemia and hypertension in patients with CN (57.7 vs. 36.0 and 88.5 vs. 66.7%; P values <0.05).

Conclusion

CN were found in 7.9% of arteries with carotid-plaques ≥2 mm by duplex-ultrasound; prevalence was significantly higher in symptomatic arteries with ≥30% stenosis compared to asymptomatic with <30% stenosis, suggesting that CN play a role in pathogenesis of ischemic stroke in a small subset of patients.

     

MRA of abdominal vessels: technical advances

Magnetic resonance angiography (MRA) in general and MRA of the abdominal vessels in particular have undergone substantial improvements in the past 5 years triggered by the introduction and application of parallel imaging (PI), new sequence techniques such as centric k-space trajectories and undersampling, dedicated contrast agents and clinical high-field scanners. All of these techniques have the potential to improve image quality and resolution or decrease the image acquisition time. However, each of them has its own specific advantages and drawbacks. This review describes the main technical innovations and focuses on the impact these developments may have on abdominal MRA. Special consideration is given to the interaction of these various technical advances. The clinical value of advanced MRA techniques is discussed and illustrated by characteristic cases.An erratum to this article can be found at     

Whole-body MRI and PET-CT in the management of cancer patients

Mortality rate, prognosis, and treatment outcome of cancer patients depend strongly on the detection of malignancy at an early stage and efficient monitoring of the disease. Multimodality diagnostic approaches are now widely applied for tumor detection, staging, and follow-up. However, the introduction of whole-body imaging modalities into clinical practice has substantially expanded diagnostic options. PET-CT has increased diagnostic accuracy by providing “anatometabolic” information by fusing tumor glucose-uptake measures from the PET examination and accurate delineation of anatomical structures given by spiral CT. Since PET-CT is associated with high doses of ionizing radiation, it is used in mainly tumor staging and screening within the scope of tertiary prevention. Here promising results have been reported for various tumor entities. MRI provides excellent tissue contrast, detailed morphological information and lack of ionizing radiation. MRI has been employed for the assessment of focal pathologies in specific anatomical regions. Whole-body MRI scanners using multiple receiver channels with parallel acquisition techniques now allow tumor screening from head to toe within substantially shorter examination times and without compromises in image resolution. We report our experience with these two novel techniques and discuss their benefits and drawbacks in terms of systemic tumor screening.