A novel treatment for chronic pancreatitis

Background Hereditary pancreatitis is an important cause of chronic pancreatitis, which may result in endocrine and exocrine failure. This may necessitate simultaneous pancreas and kidney transplant (SPK). Bladder drainage of the exocrine secretions may cause problems. Aim To report one such case and its surgical correction. Methods A 20-year-old male with insulin-dependent diabetes mellitus secondary to idiopathic chronic pancreatitis had a SPK with bladder drainage. Urological and metabolic complications secondary to the drainage of pancreatic secretions, rich in proteolytic enzymes required convertion from bladder to enteric drainage. Results He was able to discontinue his pancreatic enzyme supplements, ceased to have steatorrhoea and gained weight. He was referred to the €pean Registry of Hereditary Pancreatitis and Familial Pancreatic Cancer (€PAC), hereditary pancreatitis was confirmed by genetic analysis. Conclusion Enteric-drained pancreas transplantation is a successful treatment for exocrine as well as endocrine pancreatic failure and should be considered as a treatment option in patients with chronic pancreatitis.     

Experiences of the Haight-Ashbury Free Medical Clinic's Community Based Drug Rehabilitation Program

Abstract

The current study examined the relationship between need for cognition (i.e., cognitive motivation or “will”) and educational experience (i.e., cognitive ability or “skill”) to perceived improvements during treatment of probationers receiving residential treatment within the criminal justice system. Probationers were randomly assigned to either receive motivational activities developed by the authors (the “enhanced” condition), or treatment as usual (but with access to general reading materials in lieu of the motivational activities). Need for cognition and educational experience were assessed and used as blocking variables, and ratings of progress were assessed midway and toward the end of treatment. The results indicate that both need for cognition and educational experience are important predictors of improvement during treatment, and that the motivational activities developed by the authors were particularly valuable for clients with lower levels of need for cognition.     

Occupational bladder cancer mortality among racial and ethnic minorities in 21 states

BACKGROUND: Occupational bladder cancer mortality among minority racial/ethnic groups is not well described compared to occupational bladder cancer mortality among non-minority males in the United States. METHODS: Race/ethnicity- and sex-specific bladder cancer mortality (1985-1992) of workers employed in 21 states was examined using a proportionate mortality study design. Mortality of specific racial/ethnic/occupational groups was compared separately with workers in the specific occupation and with members of the specific racial/ethnic group. RESULTS: This study identified elevated bladder cancer mortality among African American males and females and Latino males in several occupational groups with exposure to suspected bladder carcinogens as well as among Asian males in sales (PMR = 2. 13) and Asian females in the personal services industry (PMR = 5.25; CI: 1.64-16.75). CONCLUSIONS: Surveillance of occupational cancer risks among racial/ethnic minorities using regularly available death certificate data is facilitated when states code both usual occupation/industry and race/ethnicity.     

Effects of positive and negative pressure ventilation on cerebral blood volume of newborn infants

The effects of intermittent positive airway and continuous negative extrathoracic pressure ventilation on cerebral blood volume in preterm infants were studied using near infrared spectroscopy. In 12 infants continuous negative extrathoracic pressure caused a median decrease in cerebral blood volume of 0.14ml/100ml brain (95% confidence intervals (CI) 0.035–0.280) compared with no respiratory support. Oxygenated and deoxygenated haemoglobin also decreased, implying increased venous drainage as the main effect. In 17 infants intermittent positive pressure ventilation also caused a median reduction in cerebral blood volume of 0.06 ml/100 ml brain (95% CI 0.010–0.115) compared with endotracheal positive airway pressure. Deoxygenated haemoglobin increased by 0.07 ml/100 ml brain (95% CI 0.010–0.100) while oxygenated haemoglobin decreased by O.lOml/lOOml brain (95% CI 0.005–0.175). The increase in deoxygenated haemoglobin implies decreased venous drainage and the decrease in oxygenated haemoglobin implies that other factors may also be significant. Heart rate, blood pressure and oxygen saturation were monitored continuously and remained stable.     

Non-Hodgkin's lymphomas and organic solvents

Organic solvents have been suggested as a possible risk factor for non-Hodgkin's lymphomas (NHL). We studied 109 NHL incident cases and 276 controls with other cancers (1990/1996) in the city of Salvador, Brazil. Occupational exposure to organic solvents was evaluated through standardized questionnaires and defined by industrial hygienists, taking into account individuals' lifetime history. An association between occupational exposure to organic solvents and NHL was observed, OR = 1.67 (95% CI, 0.97 to 2.87), especially among individuals less than 64 years, OR = 1.91 (95% CI, 0.99 to 3.67), and among those who used domestic insecticides, OR = 2.24 (95% CI, 1.01 to 3.97). Odds ratios were similar for nodal and diffuse NHL. These results suggest that organic solvents may contribute to the causation of NHL, especially among young individuals, and that synergism may play a role in the process of lymphomagenesis.     

Arterial remodelling in Fabry disease

Aim : The enzymatic defect in Fabry disease results in the slow systemic deposition of uncleaved glycosphingolipids in the lysosomes of vascular endothelium and smooth muscle cells, leading to ischaemic strokes, cardiomyopathy and renal failure. Whereas it is known that Fabry disease affects small blood vessels, little is known about its effects on peripheral large arteries. We therefore set out to compare parameters of arterial wall structure and function in a cohort of patients with Fabry disease and an age-matched control group. Methods : Large artery phenotype was non-invasively investigated in 21 hemizygous patients with Fabry disease and 24 age-matched male controls. Common carotid and radial artery diameter, intima-media thickness (IMT) and distensibility were determined with high-definition echotracking systems and aplanation tonometry. Results : Patients with Fabry disease had a significant twofold increase in radial artery IMT and distensibility, independent of body surface area, age and mean blood pressure. In both groups, older age at the time of examination was significantly associated with larger radial artery IMT. The relationship between age and radial IMT was 2.3-fold higher in patients with Fabry disease than in controls ( p > 0.01). Carotid IMT was mildly but significantly increased in patients with Fabry disease (+18%), whereas distensibility was unchanged.
Conclusion : This study presents evidence of a major increase in arterial wall thickness and distensibility, measurable at the site of a medium-sized artery, in a cohort of patients with classic Fabry disease.