Identifying and improving non-adherence in bipolar disorders

Objectives:  To review the definition of non-adherence, its clinical and economic impact and identify its role and impact in clinical practice.
Methods:  A selective review of the literature as conducted of articles and literature known to the authors.
Results:  There is a paucity of studies examining specifically treatment non-adherence and its consequences in bipolar disorder. Few studies have systematically examined ways in which treatment adherence can impact treatment and improve outcome.
Conclusion:  Non-adherence is common in the management of bipolar disorder. Clinicians and Researchers alike need to remain alert and be aware of issues related to non-adherence – in particular suicide. Like other course-modifiers non-adherence has to be considered, sought and addressed, and this is perhaps best done by including psychoeducation in routine clinical care.     

Amino acid profile in Down's syndrome

Fasting plasma and urinary amino acid concentrations were studied under carefully controlled conditions in 22 children with Down's syndrome and in age matched controls. The only significant difference between the groups was a higher mean plasma lysine concentration in Down's syndrome patients compared to controls.     

Establishment and control of the L5178Y-cell tumor dormant state in DBA/2 mice

Summary The L5178Y-cell tumor dormant state in DBA/2 mice is an excellent model for assessing immunologically mediated tumor-growth restraint mechanisms associated with establishment and control of a tumor dormant state. It has enabled us to relate components of the host's tumor suppressive immune system to the stage of tumor dormancy and the magnitude of the tumor burden. A strong CTL response has been associated with establishment of the tumor dormant state and can be reelicited in vivo or in vitro, after its initial decline, by reexposure to tumor antigen. This reelicitation is mediated via immunologic stimulation of memory CTL. Combined cultures of NAD T-lineage lymphocytes and macrophages from tumor dormant mice produce considerable cytolytic activity where little or no activity can be detected in the individual populations. Based on the similar pattern of tumor target cell specificity of the two responses, it is likely that memory CTL contribute to this synergistic cytolytic activity. The synergistic cytolytic response persists after CTL activity has waned to undetectable levels and is probably the predominant cytolytic activity associated with maintenance of the tumor dormant state. However, this activity may be obscured by proliferation of endogenous tumor cells, which in turn triggers direct macrophage-mediated cytolytic activity. The target cell specificity of this direct macrophage-mediated cytolytic response is also similar to the CTL response suggesting T cell (or memory CTL) involvement in its generation. The L5178Y-cell tumor dormant model is well suited for attempts at cure with immunotherapy. Active specific and nonspecific immunotherapy are each capable of eliminating all tumor cells from approximately 50% of tumor dormant mice. The L5178Y-cell tumor dormant state is one of several animal models of tumor dormancy. The great variety of growth restraint mechanisms that control tumor dormant states in animal systems is strong evidence that tumor dormant states exist in cancer in human beings.     

Inflammatory aortic aneurysm (periaortic fibrosis): radiologic imaging

Inflammatory aneurysms represent a distinct surgical entity with a reported incidence varying from 5% to 23% of all abdominal aortic aneurysms. Surgical repair of inflammatory aneurysms is associated with a higher morbidity and mortality than is repair of simple aortic aneurysms. Complicated cases require suprarenal aortic control, and the surgeon must be forewarned to maximize the chance for successful aneurysm repair. Preoperative diagnosis of this entity by cross-sectional imaging facilitates improved planning of the operative approach and permits the institution of preoperative steroid treatment to reduce the volume of the periaortic fibrotic mass. Ultrasound demonstrates the inflammatory process as a hypoechoic mass surrounding the intensely echogenic, thickened aortic wall. Computed tomography reveals a thickened, often calcified aortic wall and a mass of periaortic inflammatory tissue. Dynamic scanning reveals rapid intraluminal enhancement, slightly delayed enhancement of the inflammatory mass, and nonenhancement of the thick fibrous adventitia.     

Percutaneous cecostomy for decompression of the massively distended cecum

Massive dilatation of the cecum developed in an elderly man following admission for an acute episode of upper gastrointestinal hemorrhage complicated by myocardial infarction, ventricular fibrillation, and pulmonary edema. A diagnosis of pseudo-obstruction was made. After an unsuccessful attempt at colonoscopy, percutaneous cecostomy was performed under computed tomographic guidance, using trocar technique. The cecal distention resolved and did not recur. Percutaneous cecostomy is an alternative to colonoscopy and to surgical cecostomy in the treatment of massive cecal distention.