Restorative proctocolectomy with ileal reservoir

International Journal of Colorectal Disease -     

The effect of glucosamine and/or chondroitin sulfate on the progression of knee osteoarthritis: a report from the glucosamine/chondroitin arthritis intervention trial

OBJECTIVE: Osteoarthritis (OA) of the knee causes significant morbidity and current medical treatment is limited to symptom relief, while therapies able to slow structural damage remain elusive. This study was undertaken to evaluate the effect of glucosamine and chondroitin sulfate (CS), alone or in combination, as well as celecoxib and placebo on progressive loss of joint space width (JSW) in patients with knee OA. METHODS: A 24-month, double-blind, placebo-controlled study, conducted at 9 sites in the United States as part of the Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT), enrolled 572 patients with knee OA who satisfied radiographic criteria (Kellgren/Lawrence [K/L] grade 2 or grade 3 changes and JSW of at least 2 mm at baseline). Patients with primarily lateral compartment narrowing at any time point were excluded. Patients who had been randomized to 1 of the 5 groups in the GAIT continued to receive glucosamine 500 mg 3 times daily, CS 400 mg 3 times daily, the combination of glucosamine and CS, celecoxib 200 mg daily, or placebo over 24 months. The minimum medial tibiofemoral JSW was measured at baseline, 12 months, and 24 months. The primary outcome measure was the mean change in JSW from baseline. RESULTS: The mean JSW loss at 2 years in knees with OA in the placebo group, adjusted for design and clinical factors, was 0.166 mm. No statistically significant difference in mean JSW loss was observed in any treatment group compared with the placebo group. Treatment effects on K/L grade 2 knees, but not on K/L grade 3 knees, showed a trend toward improvement relative to the placebo group. The power of the study was diminished by the limited sample size, variance of JSW measurement, and a smaller than expected loss in JSW. CONCLUSION: At 2 years, no treatment achieved a predefined threshold of clinically important difference in JSW loss as compared with placebo. However, knees with K/L grade 2 radiographic OA appeared to have the greatest potential for modification by these treatments.     

Alcohol in a social context: findings from event-contingent recording studies of everyday social interactions

Background:  Data concerning the effects of alcohol on social interaction in everyday life are limited.
Methods:  Healthy volunteers in 4 studies of social behaviors and mood were instructed to complete record forms immediately after a social interaction had occurred, a method known as event-contingent recording. Record forms asked questions about quarrelsome, agreeable, dominant, and submissive behaviors; about aspects of mood; and, in 3 studies, about perceptions of others. Each form also contained a question about alcohol consumption prior to a social interaction. For the present report, only social interactions taking place in the evening and outside the work setting were included. Only individuals who consumed alcohol at least once in these circumstances were included ( n  = 171).
Results:  Social interactions involving alcohol were primarily characterized by higher levels of agreeable behaviors, by perceptions of greater agreeableness in others, and by more positive mood. Alcohol consumption was not associated with higher levels of quarrelsomeness.
Conclusions:  Alcohol consumption in a social context may have predominantly positive effects, an observation which is at odds with most alcohol-induced aggression experiments performed in laboratory settings. Drinking in everyday life may be less likely to result in aggression because, unlike in most laboratory experiments, individuals can choose among a variety of behaviors in response to social cues and the alcohol dose consumed is usually lower. Event-contingent recording provides a new approach for the study of alcohol's effects in everyday life and the conditions in which alcohol might result in interpersonal aggression.     

Spontaneous termination of prolonged ventricular fibrillation after acute myocardial infarction

We describe a case of ventricular fibrillation occurring during acute myocardial infarction converting to sinus rhythm without specific additional drug therapy or direct current cardioversion. Ventricular fibrillation occurred during therapy with a temporary transvenous bipolar pacemaker and prophylactic intravenous lidocaine. Reversion of ventricular fibrillation without direct current cardioversion is unusual. Direct current shock remains the first form of treatment for witnessed ventricular fibrillation.     

Caspase activation and neuroprotection in caspase-3- deficient mice after in vivo cerebral ischemia and in vitro oxygen glucose deprivation

Caspase-3 is a major cell death effector protease in the adult and neonatal nervous system. We found a greater number and higher density of cells in the cortex of caspase-3(-/-) adult mice, consistent with a defect in developmental cell death. Caspase-3(-/-) mice were also more resistant to ischemic stress both in vivo and in vitro. After 2 h of ischemia and 48 h of reperfusion, cortical infarct volume was reduced by 55%, and the density of terminal deoxynucleotidyltransferase-mediated dUTP nick end labeling-positive cells was decreased by 36% compared with wild type. When subjected to oxygen-glucose deprivation (2 h), cortical neurons cultured from mice deficient in caspase-3 expression were also more resistant to cell death by 59%. Mutant brains showed caspase-specific poly(ADP-ribose) polymerase cleavage product (85-kDa fragment) in vivo and in vitro, suggesting redundant mechanisms and persistence of caspase-mediated cell death. In the present study, we found that caspase-8 mediated poly(ADP-ribose) polymerase cleavage in caspase-3(-/-) neurons in vivo and in vitro. In addition, mutant neurons showed no evidence of compensatory activation by caspase-6 or caspase-7 after ischemia. Taken together, these data extend the pharmacological evidence supporting an important role for caspase-3 and caspase-8 as cell death mediators in mammalian cortex and indicate the potential advantages of targeting more than a single caspase family member to treat ischemic cell injury.     

The use of follow-up chest roentgenograms among hospitalized patients

Follow-up chest roentgenograms are a commonly performed test. We prospectively evaluated their diagnostic and therapeutic influence at a tertiary care teaching hospital. When a follow-up chest roentgenogram was ordered, physicians indicated their reason for ordering the test, the likelihood that the roentgenogram would show changes, and expected alterations in therapy. After the roentgenogram was obtained, physicians described the help provided by the roentgenogram and what changes in therapy were performed. Using receiver operating characteristic curves, we have shown that physicians have difficulty in predicting which roentgenograms will show important changes. Unexpected findings are frequent (25.4%) and highly valued by the physician. Fifty-seven percent of these roentgenograms had a definite or possible influence on patient treatment. Further studies are indicated to define when follow-up chest roentgenograms are likely to be of benefit.     

The neurotoxic effect of gold sodium thiomalate on the peripheral nerves of the rat. Insights into the antiinflammatory actions of gold therapy

Although gold is one of the few therapeutic agents that has been proven effective in producing remission in patients with rheumatoid arthritis, its mechanism of action is unknown. Since nociceptive afferent and sympathetic efferent fibers of the peripheral nervous system contribute to the pathophysiology of inflammation, and since a known side effect of gold therapy is a polyneuropathy, we tested the hypothesis that gold is toxic to small-diameter peripheral nerve fibers in the rat. We found that prolonged treatment with gold, at the same dosage reported to be effective against adjuvant-induced arthritis in the rat, produced a significant decrease in the numbers of unmyelinated, but not of myelinated, axons. Gold treatment also elevated nociceptive thresholds in both articular and nonarticular structures. These results suggest that gold produces an antiinflammatory effect on arthritis by a neurotoxic effect on the peripheral nerves involved in neurogenic inflammation.     

Utility of echocardiography in patients with suspected mitral valve prolapse

PURPOSE: Echocardiography has become a widely utilized test since its introduction into clinical medicine in the early 1970s. Although it has frequently been performed in patients suspected of having mitral valve prolapse (MVP), its usefulness in this setting has not been systematically studied. To investigate the use and value of echocardiography in patients suspected of having MVP, we conducted a prospective study in which physicians were interviewed before and after ordering echocardiographic testing for patients in whom there was a suspicion of MVP. PATIENTS AND METHODS: The study population included consecutive patients referred to the echocardiography laboratory at Boston University Medical Center because of suspected MVP between January 1 and December 31, 1987. Two standardized telephone interviews were conducted with the physician most responsible for ordering the echocardiogram. The following information was obtained during the first interview, which was always conducted before the echocardiogram was performed: patient demographic and clinical data; the reason for ordering the echocardiogram; the physician's most likely clinical diagnosis; the physician's estimate of the likelihood that the patient had MVP; and the physician's proposed management plans. After the referring physician received the echocardiographic results, a second interview was conducted to determine changes in the most likely clinical diagnosis and management plans. The impact of the echocardiogram on diagnosis and management was evaluated by comparing physician responses before and after reception of echocardiographic results. Receiver operating characteristic (ROC) curves were constructed to assess the physician's skills at distinguishing patients with echocardiographic-documented MVP from those without MVP. RESULTS: A total of 106 echocardiograms were ordered by 45 different physicians. More than 80% of all echocardiograms were ordered to address diagnostic or therapeutic concerns. On echocardiography, 47 (44%) patients were found to have MVP, six (6%) had mitral regurgitation without prolapse, and 53 (50%) had normal results. On the basis of the ROC curve analysis, the physician's ability to discriminate between patients with and without echocardiographic MVP varied significantly by physician specialty and practice setting. The echocardiographic results led to a change in diagnosis in 59 (56%) patients. A change in management occurred in 29 (27%) patients, with 25 of these 29 changes (86%) related to the initiation or discontinuation of antibiotics. CONCLUSIONS: Echocardiography frequently alters diagnostic assessments and leads to therapeutic changes in some patients suspected of having MVP. However, the benefits of such changes have not yet been demonstrated.     

Detection of bulimia in a primary care setting

Objective: To develop a screening tool for the identification of bulimia in ambulatory practice. Design: Administration of a 112-item questionnaire about eating and weight-control practices to women with known bulimia and to healthy control patients. Questions were compared with DSM-III-R criteria of bulimia as a “gold standard.” Setting: Self-help group for eating disorders and hospital-based primary care practice. Subjects: Thirty of 42 women with known bulimia met DSM-III-R criteria for current bulimia, and 124 of 130 control patients met the criterion of no history of an eating disorder. Main results: Thirteen individual questions discriminated between bulimic subjects and control subjects with a sensitivity and specificity of >75%. When these questions were entered into a stepwise logistic model, two questions were independently significant. A “no” response to the question “Are you satisfied with your eating patterns?” or a “yes” response to “Do you ever eat in secret?” had a sensitivity of 1.00 and a specificity of 0.90 for bulimia. The positive predictive value, based on a 5% prevalence, was 0.36. Conclusions: A set of two questions may be as effective as a more extensive questionnaire in identifying women with eating disorders, and could be easily incorporated into the routine medical history obtained from all women.