Topiramate for cocaine dependence: a systematic review and meta-analysis of randomized controlled trials.

AIMS: To assess the efficacy of topiramate in treating cocaine use disorder (i.e. retention, efficacy, safety and craving reduction) through a systematic review and meta-analysis. METHODS: We searched six scientific databases from inception to 23 December 2014 with no date limits. Data were reviewed, extracted and analysed systematically. Studies were included if they were peer-reviewed randomized control trials with participants meeting diagnostic criteria for cocaine dependence or cocaine use disorder, with the treatment arm involving topiramate with or without psychosocial intervention, and the control arm involving no intervention or psychosocial intervention with or without placebo. A random-effects meta-analytical model was computed. RESULTS: Five studies met inclusion criteria (n = 518). Topiramate was compared with placebo (four studies) and no medication (one study). In a meta-analysis, we observed no significant differences between topiramate and placebo in improving treatment retention risk ratio (RR) = 0.85; 95% confidence interval (CI) = 0.60-1.22, P = 0.38. However, compared with a placebo, use of topiramate was associated with increased continuous abstinence in two of five studies (RR = 2.43; 95% CI = 1.31-4.53, P = 0.005). No differences were observed in frequency of adverse effects reported between topiramate and placebo (RR = 1.06; 95% CI = 0.91-1.23, P = 0.48). Topiramate was associated significantly (P < 0.05) with a reduction in craving in only one of five studies. CONCLUSIONS: Evidence does not currently support the use of topiramate to improve treatment retention for cocaine use disorder, although it may extend cocaine abstinence with a similar risk of adverse events compared with placebo.

Prevalence of risk factors for contrast-induced nephrotoxicity in outpatients undergoing intravenous contrast-enhanced computed tomography studies.

OBJECTIVE: To document the prevalence and pattern of risk factors for contrast-induced nephrotoxicity (CIN) in an outpatient population referred for contrast-enhanced computed tomography (CT) (CECT) studies. METHODS: Over a 4-month period, 3261 patients presenting for CT studies were asked to consent to a survey of CIN risk factors. Among these patients, 957 were outpatients who received contrast material before the CT study. Demographic information and available serum creatinine (SCr) data for these patients were extracted from medical records and then analysed. A telephone questionnaire to document risk factors was administered to 200 of these patients, who were outpatients not referred from the emergency department or on dialysis. RESULTS: Among the 200 surveyed patients, 69% reported risk factors for CIN or for kidney function impairment (low estimated glomerular filtration rate [eGFR]) at baseline. Among these patients, 43% reported multiple (2 or more) risk factors. Patients older than the mean age of 53 years had a higher incidence of having multiple risk factors when compared with those younger than this age. Patients with kidney function impairment at baseline had a higher incidence of having multiple risk factors when compared with those with normal kidney function. Among the patients with no SCr investigation in the 3 months preceding a CECT, 64% had multiple risk factors. In the study population of 957 outpatients undergoing CECT, 52% had SCr measurements within 3 months before the study. An eGFR of less than 60 mL/min/1.73 m(2) was found in 17% of the study population, and, in 0.6%, the eGFR was less than 30 mL/min/1.73 m(2). CONCLUSION: In an ambulatory outpatient population, many patients presenting for outpatient CECT studies will have risk factors for CIN or for kidney function impairment (low eGFR) at baseline. Kidney function assessment, therefore, is indicated in this patient population before CECT.

Low-dose MDCT findings of blunt hepatobiliary trauma.

This pictorial essay shows low-dose multi-detector computed tomography (MDCT) findings of blunt hepatobiliary trauma, and describes the indications and protocol for MDCT. Given the universal usage of MDCT in assessing the liver in blunt abdominal trauma, reduction of patient dose is essential. The new l0se MDCT protocol presented here can achieve up to 50% dose reduction while maintaining diagnostic image quality and thus facilitate dose sensitive patient management. Our institution's blunt hepatobiliary MDCT imaging algorithm can help determine which patients require operative therapy. Injury to the liver is graded on various schemes, one being the Organ Injury Scale devised by the American Association for the Surgery of Trauma classification based on the extension of the lesion and bleeding.

Calcified cavitating mesenteric lymph node syndrome: case presentation and literature review.

Cavitating mesenteric lymph node syndrome (CMLNS) is a rare complication of celiac disease. Globally, only 36 cases of CMLNS have been reported to date. The present article reports an incidence of its unique pathology and possible complications of celiac disease, followed by a review of the syndrome. A case involving a 51-year-old man with celiac disease who was referred to hospital because of a nontender abdominal mass is described. Plain film x-ray of the abdomen revealed fine curvilinear calcifications in the left lower quadrant. A complex, cystic-appearing, lobulated mass with somewhat echogenic walls most consistent with calcifications was revealed on subsequent ultrasound (US) imaging. Colour Doppler imaging showed no evidence of vascularity within the lesion. Computed tomography (CT) imaging showed a thin rim of calcification in the walls of multiple cystic components. Enhanced magnetic resonance (MR) imaging revealed a mixed solid and cystic multiloculated mass, with fat-fluid layers originating from the root of the small bowel mesentery. A CT-guided biopsy was performed. The fine-needle aspirate revealed calcified matter with no associated cellular material. No malignant cells were seen; CMLNS was established as the diagnosis. To the authors' knowledge, there are no previous reports in the literature describing the finding of rim calcification on US or MR imaging in the setting of CMLNS. CMLNS is an important diagnosis to consider, particularly in patients with a history of celiac disease. The finding of rim calcification on US in the setting of cavitating mesenteric adenopathy should prompt further diagnostic imaging studies such as CT or MR imaging. These may lead to additional pathology studies such as a CT-guided biopsy to further characterize the lesion at the cellular level, to investigate potential malignancy and to further guide follow-up and patient management.