Malignancies following long-term azathioprine treatment in chronic liver disease

ABSTRACT— One hundred and fifty-four patients with histologically verified nonalcoholic chronic liver disease were randomized to azathioprine or prednisone treatment. After a median of 91 months observation time, the cause of death was assessed retrospectively. Autopsy was performed in 82% of 71 deaths. In the azathioprine group 33% (13/39) died from malignant neoplasia, and in the prednisone group (13%) (4/32) (p = 0.08). Considering a possible fatal outcome as a consequence of treatment, this finding urges caution in the long-term application of azathioprine at the usual dose level.     

Central benzodiazepine receptors in human brain: estimation of regional Bmax and KD values with positron emission tomography.

Studies of central benzodiazepine receptors in the human brain in vivo are now possible using positron emission tomography (PET) and [11C]flumazenil. With the aim of measuring Bmax and Kd in brain regions, we used a two-injection [11C]flumazenil (at high and low specific radioactivity, respectively) pseudo-equilibrium paradigm to evaluate, in seven unmedicated healthy volunteers, the relative merits of three 'reference' structures (pons, hemispheric white matter and corpus callosum) in which the free radioligand concentration in brain tissue was estimated 15-40 min after i.v. injection of the radioligand. By means of high-resolution PET, the Bmax and Kd were calculated for each subject in 18 gray matter structures, based on a two-point Scatchard plot. We found that the use of the corpus callosum as reference often resulted in spurious Bmax and Kd values. The pons was the best reference structure because it provided satisfactory Bmax values (closest to in vitro data) and most consistent Kd values, and was the region easiest to sample on PET images. The pattern of regional Bmax was consistent with that expected from in vitro studies, with values highest in the cerebral cortex, intermediate in the cerebellum, and lowest in the striatum and the thalamus. The Kd values were uniform among regions and were consistent with earlier in vitro and in vivo data. This work documents the feasibility of estimating Bmax and Kd of central benzodiazepine receptors in multiple brain regions for clinical research.     

Symptom occurrence, symptom distress, and quality of life in renal transplant recipients.

The growing number of persons who have successful renal transplants and the challenges they undergo as they adjust to changed lifestyles increases the need for knowledge of the recipient's view of the changes resulting from the transplantation process. One area for exploration is the recipient's perception of the symptoms that occur after transplantation. The purpose of this study was to determine symptom occurrence and symptom distress following renal transplantation and their relationships to quality of life in patients with renal transplants.     

Plasma concentrations of epidural bupivacaine in mother and newborn: 0.125% versus 0.375%

Central venous plasma concentrations of bupivacaine were determined in two groups of 15 parturients each who were given epidural analgesia for labor and vaginal delivery. One group received 10 ml of 0.125% bupivacaine plus epinephrine 1:800,000, the other group received 7 ml of 0.375% bupivacaine plus epinephrine 1:800,000. Plasma concentrations of bupivacaine in the umbilical venous (UV) and the umbilical arterial (UA) blood of their babies were also determined. The mean UA, UV, and maternal central venous (MV) plasma concentrations of bupivacaine differed significantly between the two groups: in patients given 0.375% bupivacaine UA values were 63% higher (P less than 0.01), UV values were 57% higher (P less than 0.01), and the MV values were 34% higher (P less than 0.05) than in patients given 0.125% bupivacaine. The measured plasma concentrations speak in favor of the less concentrated solution of bupivacaine in epidural analgesia for obstetrics. Seven milliliters of bupivacaine 0.375% is suitable for epidural analgesia in obstetrics but a low concentration-low dose technique, using 10 ml of bupivacaine 0.125% plus epinephrine 1:800,000 is safer. It provides good analgesia with minimal or no motor block and is associated with low maternal and neonatal plasma concentrations of bupivacaine, well below toxic levels and, to our knowledge, lower than in any other study.     

Methodology of post-mortem research. Apropos of setting-up a data bank for studying the biology of depression

Investigation of post mortem neurobiochemical changes is an important field in biological psychiatry which allows analyses of the analogies between peripherical markers and the central neurochemical processes they represent. Our study discusses the pathological neuroanatomy (collection and conservation of the anatomical specimens) and clinical criteria (selection of an evaluation and diagnostic scale, analysis of results of retrospective clinical interviews: "the psychological autopsy"). We also discuss the many methodological issues which arise in interpretations of these correlations. We wish to encourage others to apply a standardized methodology to these scientific studies of post mortem neurochemical parameters and retrospective clinical diagnosis.     

Is leg length discrepancy associated with the side of radiating pain in patients with a lumbar herniated disc?

STUDY DESIGN: The association between leg length discrepancy and the side of the radiating pain in lumbar disc herniation was investigated in a case series. OBJECTIVES: To investigate whether pain tends to radiate into the longer or shorter leg in patients with a lumbar herniated disc. SUMMARY OF BACKGROUND DATA: No previous studies have investigated the association between leg length discrepancy and side of radiating pain in patients with a herniated disc. Results of studies of low back pain with radiation and leg length discrepancy are inconsistent concerning this association. METHODS: Of 132 consecutive patients admitted to a district hospital for surgical management of a lumbar herniated disc, leg length discrepancy was assessed using the indirect method as described by Calliet. RESULTS: Seventy-three patients (55%) were men, and 59 (45%) were women. The mean age was 40 years, and 99% of all herniated discs appeared at L4-L5 (n = 60) or L5-S1 (n = 71). In 64 (62%) of the 104 patients with a leg length discrepancy of 1 mm or more, the pain radiated in the shorter leg (P = 0.02). In subgroups of patients with larger leg length discrepancies, similar results were found but because of smaller sample sizes, these findings did not each statistical significance. In 32 of the 57 men (56.1%), the pain radiated to the shorter leg (P = 0.43); this was observed in 33 of the 47 women (70.2%; P = 0.01). CONCLUSION: The results of this study showed a statistically significant association between leg length discrepancy and the side of radiating pain in a case series of patients with lumbar herniated discs. The relation was more pronounced and statistically significant in women only.     

强化阿托伐他汀治疗对急性脑梗死患者血清sdLDL水平影响分析

目的:研究强化阿托伐他汀钙(AC)治疗对急性脑梗死(ACI)临床效果及血清低密度脂蛋白(sdLDL)水平的影响.方法:选取2015年12月～2016年12月我院收治的102例ACI患者作为观察对象.以随机数字表法分为对照组和观察组各51例.两组均采用常规ACI治疗,对照组在常规治疗的同时给予正常剂量的AC(20mg/d)治疗;观察组在接受常规治疗的同时给予强化剂量的AC(40mg/d)治疗.对比治疗前后的疗效及高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)等各项指标变化情况.结果:治疗后,观察组治愈占比45.10％(23/51),总有效率94.12％(48/51),显著高于对照组的23.53％(12/51)、78.43％(40/51);治疗后观察组血脂与炎症因子均显著低于对照组;治疗前两组颈动脉内膜中层厚度(IMT)及斑块面积均无显著差异,治疗后两组IMT及斑块面积均显著下降,观察组下降幅度明显大于对照组;治疗前两组sdLDL水平均无显著差异,治疗后1个月后及6个月观察组与对照组sdLDL水平均显著下降,观察组下降幅度明显大于对照组(P<0.05).结论:强化AC治疗ACI不仅疗效显著,还可以有效降低血脂与炎症因子指标,同时有效改善IMT值及斑块面积,sdLDL水平大幅度下降,值得临床推广.