Hand osteoarthritis patients characteristics according to the existence of a hormone replacement therapy.

BACKGROUND: Hand osteoarthritis (hand OA) mostly occurs in women around the time of menopause, but its relationship with sexual hormones remains a controversial issue. The eventual influence of hormone replacement therapy (HRT) on the incidence and progression of hand OA is still debated. OBJECTIVE: To assess whether HRT influences the occurrence and disease activity of hand OA. METHODS/PATIENTS: Epidemiological prospective cross-sectional study. PATIENTS: Menopausal women, aged 50-75, consulting for painful hand OA, for another rheumatic condition with hand OA or controls (no disease of the upper limbs). ELIGIBILITY CRITERIA: hand OA [American College Rheumatology (ACR) criteria] with X-ray evidence. PATIENTS with 'painful' hand OA defined by a Dreiser's functional index score > or = 6 and pain on VAS > or = 35 mm. Study parameters: Demographics, personal histories and gynaecologic data for patients and controls including the administration of HRT (+) or not (-). For patients, description and symptom activity of hand OA. STATISTICS: Descriptive analysis in the studied population and in subsets taking into account treatment and disease activity factors. RESULTS: 711 women were studied: 238 with 'painful' hand OA, 240 with 'quiescent' and 233 controls. Baseline characteristics were similar for patients and controls except for age (patients were older). HRT+ patients were younger (-5 years) (P < 0.0001), slightly taller (P < 0.0045) and more often cigarettes smokers (P < 0.012) than HRT- patients. They did not differ in gynecologic characteristics with the exception that the women in the HRT+ group had been menopausal for a shorter period of time, probably because of their younger age. There were no differences between HRT+ and HRT- patients, whatever the symptom activity, on the characteristics of hand OA: Dreiser's index scores were, respectively, 11.3 +/- 3.8 vs 12.3 +/- 4.5 in 'painful' patients, 3.6 +/- 2.5 vs 3.7 +/- 2.7 in 'quiescent' patients. Pain on VAS showed no difference between the two groups. CONCLUSION: Few differences were found between hand OA patients receiving HRT or not. HRT did not seem to influence the severity or the symptom activity of hand OA. Further prospective studies are required in order to evaluate the exact effect of HRT on hand OA.

No effect of long-term vigabatrin treatment on central nervous system conduction in patients with refractory epilepsy: results of a multicenter study of somatosensory and visual evoked potentials. PMS Study Multicenter Group.

PURPOSE: In dogs, vigabatrin (VGB) has been associated with intramyelinic edema producing delayed central conduction in somatosensory and visual evoked potentials (SEP, VEP). No such effects have been reported in humans. We assessed whether abnormalities of central conduction could be detected prospectively in patients with epilepsy treated with VGB as long-term add-on medication. METHODS: Two hundred one patients with refractory partial epilepsy were enrolled and monitored for as long as 2 years. VGB was added to the treatment at an average dose of 2-3g/day. Conduction in somatosensory and visual pathways was assessed by median nerve SEP and pattern VEP recordings performed at inclusion and once every 6 months. The upper limit and test-retest variability of EP latencies were evaluated at time of enrollment in the patient group. Prolonged N13-N20 or P14-N20 SEP intervals and P100 VEP latency >2.5 SD above the baseline mean, observed on repeated runs in the same session and exceeding the test-retest variability at enrollment were considered to indicate central conduction slowing. RESULTS: One hundred nine patients completed the 2-year study period, and 92 discontinued VGB, of whom 37 were monitored with regard to EP until the end of the study. No consistent change in SEP or VEP was observed in the entire group during VGB treatment. The number of occasional EP values outside the baseline range in patients treated with VGB similar to that in patients whose VGB treatment had been discontinued. CONCLUSIONS: We detected no evidence of changes in SEP and VEP attributable to altered neuronal conduction in the CNS during long-term VGB treatment.

Treatment of negative symptoms in schizophrenia with amisulpride.

BACKGROUND: The efficacy of low doses of certain neuroleptics in improving negative symptoms is still controversial. This study assessed the efficacy of amisulpride, a benzamide which increases dopaminergic transmission at low doses via presynaptic dopamine receptor blockade, on negative symptoms of schizophrenia. METHOD: The study was designed as a parallel-group, double-blind, placebo-controlled trial. Patients had to fulfil DSM-III criteria for schizophrenia, Andreasen's criteria for negative schizophrenia, and to have a total score of at least 75 on the SANS; those treated with neuroleptics or antidepressants underwent a six-week placebo wash-out. One hundred and four in-patients were randomly assigned to amisulpride 100 mg/d, amisulpride 300 mg/d, or placebo for six weeks; 85 patients completed the study. RESULTS: Both amisulpride doses were significantly more effective than placebo on the primary evaluation criterion (SANS total score, MANOVA P < 0.02). No significant changes were found in positive symptoms or in extrapyramidal symptoms. CONCLUSIONS: Negative symptoms can be improved by low doses of amisulpride, favouring the hypothesis of dopaminergic hypofunction as one of the causes of negative symptoms.

[Comparative study of the effects of metoclopramide and metopimazine on the duodenojejunal motility during the interdigestive period: a manometric study in healthy subjects]. / Etude comparative du métoclopramide et de la métopimazine sur la motricité duodéno-jéjunale en période interdigestive, étude manométrique chez l'homme normal.

The objective of this paper was to compare the effects of metoclopramide (MTC) and of metopimazine (MTP) on intestinal motility in normal subjects in the period between digestion by injecting these two agents at a well-defined time of the migrating motor complex (MMC). Duodenojejunal motility was recorded by manometry (four microperfused catheters; study segment: 30 cm) during the period between phases of digestion (fasting greater than 12 hrs), for 4.6 hrs on average (3, 4, 6 hrs). 14 normal volunteer subjects (6 males, and 8 females 19 to 49 years of age) were randomly assigned to 2 study groups and were given MTC (10 mg) or MTP (10 mg) in slow IV injection (5 mins.) at a controlled rate, performed 25 mins after onset of a phase 3 (P3) in the study segment. As a reference, results obtained in a control group of seven subjects recorded under the same conditions are reported, in addition. Changes in MMC were evaluated in each group by the mean number of P3 hourly and the percent of subjects presenting a P3 within the two hours following injection of the test drug. Variations in phase 2 type motility (P2) were measured using motility indices (MI): the sum of the amplitudes, number of waves, per 5 minute interval. The number of hourly P3 was 0.40 for MTC vs 0.28 for MTP (control 0.47); 90 minutes after an injection, the first P3 appeared in 71% of patients in the MTC groups vs. 14% in the MTP group (control 57%). P3 recorded following injection were not different from the preceding in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Prevention of HLA immunization with leukocyte-poor packed red cells and platelet concentrates obtained by filtration.

HLA immunization is a common complication of transfusion therapy in 30% to 60% of oncohematologic patients. Evidence shows that leukocytes present in cellular blood products are the main component involved in the occurrence of HLA immunization, and several studies showed that leukocyte-poor blood products are less able to induce it. However, leukocyte-poor platelet concentrates obtained by conventional techniques, ie, centrifugation, frequently have a high level of remaining leukocytes. Cotton wool filter Imugard IG 500 can be used to obtain leukocyte-poor cellular blood products. The technique is easy to perform, even in an emergency, and can be used with either packed RBCs or platelet concentrates. Means of 97%, 92%, and 76% elimination of leukocytes are obtained for packed RBCs, pooled standard platelet concentrates, and single-donor platelet concentrates, respectively. Patients were randomized to receive either standard (control group) or filtered (leukocyte-poor group) blood products. Of 112 randomized patients, 69 were evaluable, 35 in the control group and 34 in the leukocyte-poor group. Both groups are comparable according to age, diagnosis, sex ratio, previous transfusions, and pregnancies. There is a significant difference in regard to the HLA immunization rate (31.4% in the control v 11.7% in the leukocyte-poor group, P less than .05) and frequency of refractoriness to platelet transfusions (46.6% v 11.7%, P less than .05). We conclude that this filtration technique can be an efficient means to reduce the HLA immunization rate in polytransfused oncohematologic patients.

Combination cyclophosphamide, adriamycin, and cis-platinum in recurrent and metastatic cervical carcinoma.

Thirty evaluable patients with recurrent and/or metastatic cervical cancer were treated with a combination of cyclophosphamide, adriamycin, and cis-platinum. We observed no complete response and three partial responses (10%). One year survival rate was 45%. CAP combination did not prove to be more effective than single agent cis-platinum.