Single-dose pharmacokinetics of fluphenazine after fluphenazine decanoate administration

Fluphenazine decanoate is commonly used as part of maintenance treatment of schizophrenia, but its pharmacokinetics are poorly understood. We administered a single intramuscular dose of fluphenazine decanoate to nine patients and found that plasma fluphenazine level did not decline to 50% of the peak level by day 26 in any of the patients. This means that it has a long half-life measurable in months rather than weeks.     

Heterogeneity in intergenic regions of the ribosomal repeat of the pine-blister rustsCronartium flaccidum andPeridermium pini

Mixed aeciospore isolates ofCronartium flaccidum andPeridermium pini were obtained from single-tree infections in Britain, Italy and Greece. The 5.8s ribosomal RNA gene and flanking intergenic transcribed spacer regions ITS 1 and ITS2 were found to be highly similar betweenC. flaccidum andP. pini. Within samples heterogeneity was detected at three nucleotide loci in the ITS1 and at four loci in the ITS2 suggesting that several fungal genotypes may occur at a single infection court. The heterogeneity was confirmed by heteroduplex polymorphism analysis of mixed aeciospore products. RFLP of the ribosomal intergenic spacer region 1 (IGSI) amplified from the same templates indicated limited sequence polymorphism in some copies of this repeated locus. Both the sexual and asexual forms ofC. flaccidum show evidence of sequence polymorphism in two independent, non-coding regions of the ribosomal gene array. Variation appears to be greater in the sexual formC. flaccidum, than in the monoaecious formP. pini.     

Gestosis and the psychosomatic phenomenon--an empirical investigation.

Patients suffering from psychosomatic diseases in the strict sense of the term (asthma, ulcers, colitis etc.) have characteristic object relations which we call the 'relation blanche'. The present investigation aims at finding out whether similar features can be observed in patients suffering from early and late gestosis. The results indicate that there is a definite connection between gestosis and the group of strictly psychosomatic diseases, thus confirming our hypothesis that gestosis does not primarily represent a neurotic conflict situation nor a psychotic breakdown.     

Course of virologic breakthroughs under long-term lamivudine in HBeAg-negative precore mutant HBV liver disease

We studied the course of virologic breakthroughs detected by a quantitative polymerase chain reaction (PCR) assay in 32 of 78 patients with hepatitis B e antigen (HBeAg)-negative precore mutant hepatitis B virus (HBV) chronic liver disease under long-term lamivudine monotherapy. Serum HBV DNA levels were measured every 3 months and on every biochemical breakthrough. YMDD mutants were detected in 30 of the 32 patients with virologic breakthroughs. Among these 32 patients, biochemical remission rate was 44% at 6 months, 21% at 12 months, and 0% at 24 months after the onset of virologic breakthrough. Development of biochemical breakthroughs was associated with a significant increase of serum HBV DNA levels, which exceeded 100,000 copies/mL in 19 of 20 patients (95%) with biochemical breakthroughs and in only 1 of 8 patients (12.5%) remaining in biochemical remission for at least 6 months after the onset of virologic breakthrough (P <.001). Alanine aminotransferase (ALT) level peaked within 0 to 3 months after the onset of biochemical breakthrough and decreased at 6 months but remained abnormal in all but 2 patients. Follow-up liver histologic lesions in patients with biochemical breakthroughs did not differ from baseline findings, although they were significantly improved in patients remaining in virologic and biochemical remission. In conclusion, the frequent emergence of viral resistance under long-term lamivudine monotherapy in HBeAg-negative precore mutant HBV chronic liver disease is followed by increasing viremia levels culminating in the development of biochemical breakthroughs in most cases. ALT activity peaks close to the onset of biochemical breakthrough, decreasing thereafter but remaining persistently abnormal with fluctuating levels.     

Spontaneous bacterial peritonitis (SBP): clinical,laboratory, and prognostic features. A single-center experience

BACKGROUND: The aim of the present study was to assess the clinical and laboratory characteristics, the course, and the factors influencing the hospital mortality and relapse rate of spontaneous bacterial peritonitis (SBP) in cirrhotic patients admitted in a single University Hospital in Greece. METHODS: The study comprises the evaluation of 81 cirrhotic patients who developed SBP during a 30-month period. RESULTS: The occurrence of SBP was independent of the etiology of liver disease and was symptomatic in 66/81 patients (82%). Encephalopathy, as presenting symptom, occurred mainly in Child C patients. Ascitic fluid culture was positive in 20 patients (25%); E. coli (60%) and Enterococcus faecalis (14%) were the most common bacteria isolated. Empirical treatment was effective in 94% of patients. Renal impairment was observed in 21 patients (26%), six of whom developed hepatorenal syndrome. Total mortality was 10% and was related to the existence of symptoms (P<0.01), ascetic fluid polymorphonuclear cell count (P<0.05), bilirubin levels (P<0.01), and kidney function at the beginning of the episode (P<0.01). The relapse rate was 24.6% and was related to the Child stage (P<0.01). CONCLUSIONS: SBP was asymptomatic in a substantial number of patients. Deterioration of renal function was frequently observed and was the main cause of death. The low (10%) in-hospital mortality seems to be related to earlier diagnosis and treatment. Relapse was associated with the severity of liver disease.     

Bleomycin for orbital and peri-orbital veno-lymphatic malformations – A systematic review

BackgroundOrbital and peri-orbital venolymphatic malformations (VLM) are low flow vascular malformations. Intralesional bleomycin is now commonly being used to treat such malformations.ObjectiveThe purpose of this systematic review is to synthesize evidence on the safety and efficacy of bleomycin/pingyangmycin sclerotherapy for the treatment of orbital and peri-orbital VLM.MethodsWe searched Medline, Embase, Scopus and Cochrane database for studies reporting outcomes of bleomycin/pingyangmycin sclerotherapy for orbital and peri-orbital VLM between 1974 to April 5th, 2019. Nine retrospective cohort studies enrolling 132 patients were included. Two reviewers independently screened and extracted data and assessed the risk of bias. Predefined outcome measures were subjective and objective reduction of the lesion and associated complications.ResultsSubjective reduction of the lesions was seen in 96.2% of the studies. Objective reduction of the lesion and symptomatic improvement were reported in 91.6 and 95% of the studies respectively. Non responders were 9.0%. Minor adverse events were reported in 18.1% of the studies. Major complications like pulmonary toxicity or pulmonary fibrosis was not encountered in any of the included studies. Quality of evidence was generally low.ConclusionBleomycin/pingyangmycin sclerotherapy is very effective and relatively safe for the treatment of orbital and periorbital VLM and is not associated with any major side effects including pulmonary fibrosis.Limitations: The systematic review is limited mainly due to low quality of the included studies with retrospective design.     

Dissection During Restenotic Lesion Balloon Angioplasty: Comparison with Initial Angioplasty

The aim of this study was to assess the frequency and severity of dissection during repeat angioplasty for restenosis, to correlate the occurrence of this event with the lesion characteristics and the procedure-related factors and to examine if dissection during initial angioplasty predisposes to dissection during the repeat procedure. Sixty-nine significant lesions in native coronary arteries were treated with balloon angioplasty (A?PTCA) and retreated for restenosis with balloon angioplasty (B?PTCA). Dissection was detected less frequently during B?PTCA (7/69 vs. 18/69, p < 0.05). Anatomic variables did not differ significantly between A? and B?PTCA. Balloon to artery ratio (B/A ratio) was slightly but significantly higher during B?PTCA (1.03 +/- 0.13 vs. 0.97 +/- 0.14, p < 0.05) and duration of inflation was shorter (377 +/- 218 vs. 473 +/- 305 sec, p < 0.05). In 17 out of the 18 lesions which were dissected during A?PTCA, dissection did not occur during B?PTCA, despite the application of a higher B/A ratio (1.05 +/- 0.13 vs. 0.97 +/- 0.17, p < 0.05). Duration of inflation was shorter during B?PTCA (390 +/- 227 vs. 639 +/- 394 sec, p < 0.05). Six out of seven lesions which were dissected during B?PTCA had not been dissected during A?PTCA. In this subgroup, lesion characteristics did not differ between the two interventions and duration of inflation was shorter during B?PTCA (340 +/- 101 vs. 458 +/- 128, p < 0.05). CONCLUSIONS: Dissection occurred less frequently during restenotic lesion PTCA. Dissection during A?PTCA did not predispose to dissection during B?PTCA. These findings may be ascribed to the proliferative nature of the restenotic process.     

Serologic markers of persistent Chlamydia pneumonia infection and long-term prognosis after successful coronary stenting

Background

Previous studies have shown an incremental role of inflammation in late prognosis following coronary stenting (CS). In particular, high preprocedural levels of plasma C-reactive protein (CRP) have been related to increased hazard of late ischemic complications. Persistent Chlamydia pneumoniae (Cp) infection, detected by positive IgA anti-Cp titers, may be associated with this inflammatory process and portend a high risk of late adverse prognosis after CS.

Methods

A total of 483 consecutive patients with either stable or unstable coronary syndromes were followed-up for 1 year after successful CS. The composite of cardiac death, myocardial infarction, rehospitalization for rest-unstable angina, and exertional angina, whichever occurred first, was the clinical end point. Additionally, the rate of in-stent restenosis and progression of coronary artery disease during this period were evaluated. Anti-Cp titers and plasma CRP levels were measured before the procedure.

Results

Positive immunoglobulin A (IgA), but not positive immunoglobulin G (IgG), titers were significantly associated with high plasma CRP levels in patients with unstable coronary syndromes (P = .005), but not in those with stable angina (P = .7). Moreover, positive IgA titers were significantly related to increased risk of both the composite clinical end point (P = .04) and progression of coronary artery disease (P < .001) in patients with unstable coronary syndromes but not in those with stable angina. Neither positive IgA nor positive IgG titers were associated with the rate of in-stent restenosis.

Conclusions

Persistent Cp infection may drive an inflammatory response in the coronary vasculature and portends an adverse late outcome after CS in patients with unstable coronary syndromes.