Urinary tricyclic antidepressant screening: comparison of results obtained with Abbott FPIA reagents and Syva EIA reagents

Human urine was tested for tricyclic antidepressants with fluorescence polarization immunoassay (FPIA) reagents on Abbott's ADx system and with EIA reagents on Syva's ETS system. A 75-ng/mL imipramine calibrator cutoff was used with the ADx system and a 300-ng/mL nortriptyline calibrator cutoff with the ETS system. The ETS system was adapted to analyze tricyclic antidepressant (TCA) samples using the Syva Emittox serum TCA assay. Negative urine was spiked with various tricyclic and tetracyclic antidepressants, phenothiazines, and other medications with potential to interfere with the assays. Verification of samples was performed by thin-layer chromatography and gas chromatography/mass spectrometry. The different compounds were added to urine at concentrations of 200, 400 and 1,000 ng/mL. At 1,000 ng/mL all TCA compounds tested gave positive results with the ADx and ETS systems. However, some non-TCA medications spiked at 1,000 ng/mL gave false positive results with both systems. The tetracyclic antidepressants did not cross-react and gave negative results. Clomipramine-spiked urine at 400 ng/mL yielded a false negative result on the ETS system.     

The stability of health status in rheumatoid arthritis: a five-year study of patients with established disease.

We employed a health status measure to describe the outcomes of rheumatoid arthritis patients over five years. Of the 410 rheumatoid arthritis patients who were originally administered the Arthritis Impact Measurement Scales (AIMS), 299 completed a follow-up five years later. Data were analyzed using nine health status scales, three components of health status, and an overall arthritis impact item. Results for survivors indicated that there were no clinically important deteriorations in any of these measures. In fact, small improvements on most measures were found. The health status changes were similar for patients originally in a clinical trial and for those receiving routine specialty care. Age was found to positively relate to improvements in psychological status and overall arthritis impact, but we were unable to demonstrate any consistent effects of sex, marital status, education, or disease duration. Our results contrast with other studies that have noted major declines over time in the health status of patients with rheumatoid arthritis. Furthermore, level of education was not a major determinant of morbidity in this group. These results suggest that health status in certain patients with rheumatoid arthritis is more stable than previously thought. This has implications for both clinical practice and clinical research in rheumatology.     

Hodgkin disease: contributions of chest CT in the initial staging evaluation

Chest radiographs and chest computed tomography (CT) scans were compared in 203 patients with newly diagnosed Hodgkin disease. The incidence of positive findings was tabulated from six intrathoracic lymph node groups, lung parenchyma, pericardium, pleura, and chest wall. The discordant cases were assessed to determine impact on clinical management. The CT scans provided additional evidence of disease involvement, ranging from 0% to 15% at each of the designated anatomic sites. Treatment was altered in 9.4% of all patients (19 of 203), including 13.8% (nine of 65) of those undergoing radiation therapy alone and 8.2% (ten of 122) of those undergoing combined-modality treatment. We conclude that routine chest CT examinations are valuable in the clinical management of those patients for whom radiation therapy is planned.