Efficacy of botulinum toxin in chronic anal fissure

Background Chronic anal fissures (CAF) are caused by anal sphincter hypertonia leading to an ischaemic ulcer. By inducing temporary sphincter relaxation, botulinum toxin (Botox) injection has been shown to heal CAF in approximately 73–96% of cases in clinical trials. Aim This study looks at the efficacy of Botox clinical practice. Methods The medical charts were reviewed of all patients with CAF treated with Botox (30iu injected into the sphincter complex in three 10iu aliquots) in the Ulster Hospital, Dundonald, Northern Ireland between March 1999 and November 2001. Results Fifty-one charts were identified. Four patients failed to attend for review and were excluded from the study. Of the remaining 47 patients, 37 (78.7%) were healed following Botox injection. 10 out of 37 (27.0%) developed a recurrent CAF after a median time of 16.0 months (IQR 3.8–20 months). Eight of these patients opted for repeat Botox injection, which was successful in 7 (87.5%) cases. No adverse effects were reported. Conclusion Botox injection for the treatment of CAF is as effective in clinical practice as reported in clinical trials from specialist centres.     

Sertraline treatment of posttraumatic stress disorder: results of 24 weeks of open-label continuation treatment

BACKGROUND: Posttraumatic stress disorder (PTSD) is typically associated with a high degree of chronicity, comorbidity, and psychosocial disability. The efficacy of sertraline in the acute treatment of PTSD has been confirmed based on the results of 2 large, placebo-controlled studies, but almost no prospective long-term treatment studies have been reported. METHOD: One hundred twenty-eight patients who completed 12 weeks of double-blind, placebo-controlled, acute-phase treatment for DSM-III-R-defined PTSD with sertraline were continued into a 24-week open-label continuation phase. Efficacy was evaluated using the endpoint change in the 17-item Clinician Administered PTSD Scale Part 2 (CAPS-2) severity score, the 15-item patient-rated Impact of Event Scale, and the Clinical Global Impressions-Improvement and -Severity of Illness scales as primary outcome measures. Treatment response was defined as > or =30% decrease in the CAPS-2 total severity score (compared with acute-phase baseline score) and a Clinical Global Impressions-Improvement score of 1 or 2. RESULTS: Ninety-two percent of acute-phase responders maintained their response during the full 6 months of continuation treatment. In addition, 54% of acute-phase nonresponders converted to responder status during continuation therapy. Over the 36-week course of acute and continuation therapy, 20% to 25% of the improvement in the CAPS-2 severity score occurred during the continuation phase. Sertraline was well tolerated, with 8.6% of patients discontinuing due to adverse events. A high pretreatment CAPS-2 score (> 75) predicted a longer time to response and a greater likelihood that response occurred after 12 weeks of acute treatment. CONCLUSION: The acute efficacy of sertraline is sustained in the vast majority of patients, and at least half of nonresponders to acute treatment will eventually respond to continued treatment.     

Stapes prosthesis: evaluation with CT

We used computed tomography (CT) to evaluate 44 patients who had undergone stapedectomy with insertion of a prosthesis. Several patients had poor surgical results, including recurrent conductive hearing loss, vertigo, and sensorineural hearing loss. Conductive hearing loss occurring immediately after the procedure was most often caused by anatomic limitations or surgical technique. Causes of delayed or recurrent conductive hearing loss included reparative granuloma formation, incus necrosis (at the attachment of the wire), prosthesis subluxation (most often posterior), and regrowth of otosclerosis, which occasionally is further complicated by incus dislocation. We found that CT is often diagnostic when these complications occur. Immediate sensorineural hearing loss or vertigo can be self-limited if caused by serous labyrinthitis. When delayed, these symptoms may be due to perilymph fistula. If caused by the latter, CT may not yield abnormal findings unless subluxation of the prosthesis into the vestibule has occurred.     

Acute pancreatitis associated with end-stage renal disease

Various reports in the literature have suggested an association between end-stage renal disease (ESRD) and acute pancreatitis. Little information concerning this association has been discussed in the radiological literature. In this report, the authors review their experience with 54 episodes of acute pancreatitis in 34 patients, including 26 treated with maintenance dialysis, six who underwent renal transplantation, and two managed conservatively before definitive therapy. Ten (29%) of these patients died. Thirty-one computed tomographic (CT) and 49 ultrasound (US) studies of 30 patients were reviewed and demonstrated findings ranging from normal anatomy to fulminant necrotizing pancreatitis. Fifteen US examinations were technically inadequate for evaluation of the pancreas. None of the CT scans were technically inadequate. The authors emphasize the need for increased awareness of ESRD as a possible risk factor for the development of acute pancreatitis.     

MR-guided aspiration biopsy: needle design and clinical trials

Nonferrous needles of pure brass, titanium, or copper, and ferrous needles of different alloys of stainless steel were analyzed for the size, area, and distribution of the image artifact created when the needles were placed in a 0.6-T magnet. Results demonstrated that a stainless steel prototype needle (type 316) would be visible on magnetic resonance images and would provide an artifact similar to that seen in computed tomographic-guided biopsies. Further testing of this prototype included assessment of the effect on the artifact when changes were made in annealing properties, gauge, length, needle-tip geometry, pulse sequence, and orientation relative to the magnetic field. To date, three human liver biopsies have been successfully and safely performed using a stainless steel type 316 needle.     

Significance of multiparameter flow cytometric analysis of ovarian cancer

A prospective flow cytometric examination of ovarian epithelial tumors was undertaken to further characterize aneuploid (including triploid and tetraploid) tumor cell populations according to expression of ovarian tumor antigen CA125 and to expression of class I (normally present in ovarian epithelium) and class II (normally absent in ovarian epithelium) major histocompatibility complex antigens. Samples from thirty-two of 42 patients (76%) exhibited at least one aneuploid population of tumor cells. Separate analysis of the aneuploid and diploid components of samples with aneuploid populations revealed between-tumor variation: seven of 23 aneuploid populations (30%) were positive for CA125; eight of 22 aneuploid populations (40%) exhibited substantial decreases in major histocompatibility complex class I expression, compared with corresponding diploid components of the same samples; and eight of 22 aneuploid populations (36%) exhibited substantial expression of major histocompatibility complex class II antigens. The frequencies of aneuploid populations and of the foregoing antigen expression categories were independent of tumor cell type, stage, and grade. The significance of these results for prognosis remains to be determined.