The Effect of Renal Replacement Therapy in a Patient with Mercaptopurine Toxicity: Time to Revise Guidelines.

INTRODUCTION: Mercaptopurine, a thiopurine, is used in various disorders of immune regulation, such as autoimmune hepatitis. Thiopurine metabolism is complex with risk for overdosing, especially when metabolism is impaired by liver dysfunction. Hepatotoxicity may be due to mercaptopurine overdose and is often reversible after prompt cessation of the drug. CASE PRESENTATION: Treatment of thiopurine toxicity is mainly supportive and literature on enhanced elimination by renal replacement therapy is ambiguous. CONCLUSION: In this case of thiopurine toxicity, a patient with autoimmune hepatitis presents with abdominal pain, nausea, vomiting, and diarrhea. We show in this case report that renal replacement therapy had no effect on total body clearance of mercaptopurine.

Alzheimer patients report less pain intensity and pain affect than non-demented elderly.

Pain assessment for patients with Alzheimer's disease (AD) is generally aimed at quantifying pain, i.e., the intensity and locations of pain. Based on the extensive neuropathology in limbic brain areas with this disorder, we hypothesized that, compared to control patients, AD patients would report an additional loss of qualitative aspects of pain, i.e., pain affect. This hypothesis was tested by administering specific parts of three pain questionnaires and comparing the use of analgesics in 19 AD patients with that of 18 elderly patients without dementia who were matched for the presence of painful conditions. Results reveal that AD patients, compared to controls, experience less intense pain and less pain affect. In contrast, the number of AD patients using analgesics did not differ from the number of controls. These findings suggest that pain assessment for patients with AD should be focused on both quantitative and qualitative aspects of pain.

A comparison of the effects of measured, predicted, estimated and constant residual volumes on the body density of male athletes.

The aim of this study was to use the measured residual volume (RV) of male athletes (n = 207) as a criterion and assess the error in their RV, body density (BD) and relative body fat (%BF) associated with using RVs predicted from regression equations, RVs estimated from vital capacity (VC) and an assumed constant RV of 1300 ml. The ventilated residual volume (RV) was determined both before and after the underwater weighing by helium dilution with the subject immersed to neck level. The mean of the absolute differences Idl and SEE between the 2 RV trials were 66 and 89 ml, respectively. These increased to values ranging 195-747 and 259-308 ml, respectively, when the means of the 2 RV trials for each subject were compared with the RVs predicted via regression equations, estimated from the VC and assumed to be a constant of 1300 ml. A similar trend emerged with variation of only the RV in the BD formula for each subject. The 2 RV trials resulted in a Idl and SEE of .00109 (.5% BF) and .00145 g.cm-3 (.6% BF), respectively, but these increased to values ranging .00306 (1.3% BF)-.01207 (5.1% BF) and .00394 (1.7% BF)-.00441 g.cm-3 (1.9% BF), respectively, for predicted, estimated and assumed constant RVs. In all cases the lowest Idl and SEE were associated with the RVs predicted by a multiple regression equation (R = .616; SEE = 259 ml) which was generated on our sample.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of ulcerative reflux oesophagitis with colloidal bismuth subcitrate in combination with cimetidine.

Twenty patients took part in a controlled double blind study comparing the efficacy of colloidal bismuth and cimetidine (800 mg at night) with cimetidine alone in the treatment of ulcerative reflux oesophagitis. Colloidal bismuth 120 mg was administered through an intraoesophageal tube four times a day. Cimetidine with colloidal bismuth gives significantly (p less than 0.001) better results than cimetidine alone. Of 10 patients treated with cimetidine and bismuth, seven had no endoscopic signs of oesophagitis after three weeks and three had grade I oesophagitis. Of 10 patients treated with cimetidine alone, one had grade I oesophagitis and three grade II oesophagitis after three weeks. The remaining six still had grade III oesophagitis. This study also shows that in nine of 10 patients reflux oesophagitis was accompanied by infection with campylobacter like organisms (CLO). After treatment the bacteria disappeared promptly in five patients receiving combination therapy and in two of four treated with cimetidine alone. The possible role of CLO in reflux oesophagitis is uncertain.

The effects of acute cerebrovascular disease on serum and cerebrospinal fluid parameters.

In order to evaluate the effects due to acute cerebrovascular disease on serum and cerebrospinal fluid (CSF) parameters, biochemical data from 312 patients were studied. In serum, CK, LD and alpha 1 protein fraction showed a moderately close relationship to the severity of stroke. In CSF there could not be observed any relation between enzymatic activities (LD, ASAT, CK) and the severity of the disease. The same result was found for CSF protein and the ratio CSF albumin/serum albumin, parameters which are indicative for Blood Brain Barrier (BBB) disturbances. Substances from the intermediate metabolism in the Central Nervous System (CNS) (lactate and pyruvate) were evidently raised in CSF and there was a clear relation between the CSF concentration and the severity of stroke. No indication for IgG immunoglobulin abnormalities in CSF was found. The concentration of neurotransmitter metabolite 5HIAA in CSF was significantly higher in (in)completed stroke than in Transient Ischaemic Attack.