Intravenous iron for CAPD populations: proactive or reactive strategies?

BACKGROUND: The European best practice guideline [Nephrol Dial Transplant 1999; 14 (Suppl 5)] (5A) for the management of anaemia suggests that > 85% of the CAPD population should have a haemoglobin level of > 11.0 g/dl. METHODS: We developed and implemented an outpatient-based protocol for intravenous iron sucrose (IV Fe) and erythropoietin (Epo) in CAPD patients showing iron deficiency despite oral iron therapy. We managed a total of 103 patients over 13 months of study. All CAPD patients were included, regardless of co-morbidity. Treatment developed in two phases: in phase 1 (reactive) (months 1-8), patients with markers of iron deficiency (ferritin < 100 ng/ml or ferritin 100-500 and percentage hypochromic red cells (%HRC) > or =5) were converted from oral iron to IV Fe (300 mg) and reviewed after 4-8 weeks according to haemoglobin (Hb). In phase 2 (proactive) (months 9-13), the criteria for iron therapy were extended: ferritin < 150 ng/ml or ferritin 150-500 and %HRC > or = 2. Patients then received IV Fe (200 mg) and were reviewed after 4 weeks according to Hb. RESULTS: The median haemoglobin increased from 11.0 (Inter quartile range, IQR, 10.1-12.6) g/dl to 11.7 (11.0-12.7) g/dl (P = 0.06). The proportion of patients with absolute iron deficiency (ferritin < 100 ng/ml) decreased from 24 to 2%. The percentage of hypochromic red cells (%HRC) decreased from 4 (2-7) to 1 (1-4) (P < 0.01). CONCLUSIONS: An integrated Epo and IV Fe policy increased the number of patients reaching the European guideline from 50 to 75% with no increase in the population median Epo requirements (42 (IQR, 25-95) IU/kg/week vs 45 (27-101) (P = NS)). This study demonstrates the benefit of early (proactive) intervention in achieving population compliance within current guidelines for renal anaemia.

[Evaluation of two methods to avoid the nephropathy associated with radiologic contrast]. / Estudio de dos métodos para evitar la nefropatía asociada a contraste radiológico.

UNLABELLED: Our objective was to establish the efficacy of two methods to avoid contrast associated nephropathy (C.A.N). We studied in prospective and randomized form a sample of 75 patients of whom 25 were assigned to the CONTROL GROUP: without interventions; 25 to the Saline group: 0.45% saline solution I.V., 1.5 cc/kg/min, 6 hours before and after the angiographic study and 25 to the Dopa group: equal procedure plus the aggregate of dopamine 2 micrograms/kg/min, 30 minutes before the study until the termination. The evaluation effected at patient's entry was considered T0, T1, 24 hs after the T2, 48 hs after. In T0 was registered: age, sex, pathological antecedents, drugs and plasmatic creatinine, and in T2 creatinine. An increase of 25% of the plasmatic creatinine in T2 was considered as C.A.N. The latter was present in 13/25 (OR: 1) CONTROL GROUP patients, 7/25 (OR 0.36), Salina group patients and in 5/25 (OR 0.23) Dopa group patients (p = 0.01). No significant difference was registered in the urinary output nor in the plasmatic creatinine levels. It is concluded that hydration during six hours before and after the study with 0.45% saline solution and the same plan with the aggregate of dopamine are effective to prevent a C.A.N.

Estudio de dos métodos para evitar la nefropatía asociada a contraste radiológico. / [Evaluation of two methods to avoid the nephropathy associated with radiologic contrast]

Our objective was to establish the efficacy of two methods to avoid contrast associated nephropathy (C.A.N). We studied in prospective and randomized form a sample of 75 patients of whom 25 were assigned to the Control group: without interventions; 25 to the Saline group: 0.45

saline solution I.V., 1.5 cc/kg/min, 6 hours before and after the angiographic study and 25 to the Dopa group: equal procedure plus the aggregate of dopamine 2 micrograms/kg/min, 30 minutes before the study until the termination. The evaluation effected at patients entry was considered T0, T1, 24 hs after the T2, 48 hs after. In T0 was registered: age, sex, pathological antecedents, drugs and plasmatic creatinine, and in T2 creatinine. An increase of 25

of the plasmatic creatinine in T2 was considered as C.A.N. The latter was present in 13/25 (OR: 1) Control group patients, 7/25 (OR 0.36), Salina group patients and in 5/25 (OR 0.23) Dopa group patients (p = 0.01). No significant difference was registered in the urinary output nor in the plasmatic creatinine levels. It is concluded that hydration during six hours before and after the study with 0.45

saline solution and the same plan with the aggregate of dopamine are effective to prevent a C.A.N.

Meigs' syndrome in association with a locally invasive adenocarcinoma of the fallopian tube.

A patient with recurrent pleural effusions posed a diagnostic challenge. The pleural aspirate CA-125 assay was markedly elevated which indicated a primary ovarian pathologic process. However, in this case a rare fallopian tube adenocarcinoma was the underlying problem. Meigs' syndrome can resemble a metastatic pelvic carcinoma in its presentation, but the prognosis is much more favourable when the syndrome is associated with a benign ovarian tumour.

Treatment of tinea cruris with topical terbinafine.

Twenty-three patients were enrolled in a randomized, double-blind trial of terbinafine 1% cream versus its vehicle (placebo) in the treatment of tinea cruris. One patient had a negative initial culture and was excluded, and two patients were dropouts, one because of poor study compliance (terbinafine) and one because of an adverse event (placebo). Twenty patients were examined for efficacy of treatment (9 terbinafine-treated, 11 placebo-treated). Both groups were similar in age, sex, duration of disease, prior therapy, size and location of lesion, infecting organism, and predisposing factors. Terbinafine 1% cream was more effective than vehicle cream in the reduction of the signs and symptoms of tinea cruris. In addition, there was a higher conversion rate to negative culture and normal microscopy findings in the terbinafine-treated group. Clinical results combined with evaluation of mycologic tests at end of therapy showed terbinafine to be a rapid and significantly more effective treatment for tinea cruris than placebo (78% vs 18% cure rate, respectively). Follow-up cure rates confirmed these findings (89% and 18%, respectively). No significant adverse events occurred during terbinafine treatment.

Comparing research activities of women and men faculty in departments of internal medicine.

The findings from a questionnaire prepared by the Association of Professors of Medicine and the Association of American Medical Colleges were published in two reports in 1986 and 1987. These reports assessed the research activities of full-time members of departments of internal medicine in 1982 and 1983. The purpose of the present study was to analyze the data of the earlier reports in order to compare the research activities of women and men who were full-time faculty in departments of medicine during the time period originally surveyed. More than half of the faculty women who responded (52%) were less than 40 years old, compared with 23% of the faculty men. Sixty-seven percent of the women held the rank of instructor or assistant professor, in contrast to 40% of the men holding these ranks. Although the faculty of both genders reported generally the same proportions of time devoted to research, the women researchers with M.D. degrees had significantly less National Institutes of Health (NIH) grant support than did their counterparts who were men. Since this difference may have been a function of age, the authors compared NIH grant support of the faculty men and women with M.D. degrees who were 40-59 years old. Even in this older group, significantly fewer of the faculty women had NIH grant support than did the men (16% versus 30%). Furthermore, the percentage of designated laboratory space was significantly lower among the faculty women, regardless of degree (M.D., M.D./Ph.D., or Ph.D.). Further investigation is warranted to monitor the progress of women attempting to develop their research careers and to assess their overall clinical teaching and administrative roles in departments of medicine.

Immunoenzyme techniques in dermatopathology.

The advantages and disadvantages of the immunofluorescence and immunoperoxidase techniques and an introductory description of the major variations of the basic immunoperoxidase method are discussed. The ability to identify intermediate filaments, T and B lymphocyte cell markers, S-100 proteins, myelin basic protein, and carcinoembryonic antigen in tissue sections can assist the dermatopathologist in classifying undifferentiated or histologically similar-appearing tumors. A systematic approach to the diagnosis of a majority of these tumors with the use of immunoenzyme staining is provided.

Comparative trial of a two-dosage schedule of ketoconazole 2% cream for the treatment of tinea pedis.

Sixty-two patients with mycologically confirmed tinea pedis received two different treatment regimens of ketoconazole 2% cream on a randomized double-blind basis for 1 month with weekly evaluations. A 4-week posttreatment follow-up permitted an assessment of recurrence or improvement. After 1 month of treatment, 90% of the patients treated once daily responded clinically, in comparison with 83% of those treated twice daily. The cure rate was 63% for the once-daily and 60% for the twice-daily group. This rate substantially improved at follow-up (77% and 73%, respectively). One patient from each group discontinued therapy for an adverse reaction. On the basis of both clinical and mycologic assessments, topical treatment with ketoconazole 2% cream was effective as a once-daily therapy.

Helping parents achieve optimal development for their children.

Parenting has first to be learnt and then worked throughout the child's development. The cost of optimal development is the parent's continued loving awareness of all his needs. Parents today are avid for information which will help them to bring up their children so that each child will be given every opportunity to develop his full potential. Consequently, it is the responsibility of all those involved in helping parents care for their children to increase their understanding of child development.

Microsurgical repair of the fallopian tubes.

The microsurgical techniques used and the results achieved in a series of 27 patients submitted for fallopian tube repair are presented, the majority following elective sterilization.

PIP: A series of 23 patients undergoing laparotomy for fallopian tube repair between October 1975-December 1981 was reviewed. The patients ranged in age from 22-41, with a mean of 29. 16 of the patients underwent bilateral repair and 7 unilateral. Preoperative assessment of the physical and psychological status of the patient should consider such factors as age, marital status, and previous obstetrical history, as well as fertility of the male partner and the circumstances prompting request for tubal repair. In this series, 14 of 23 patients sought sterilization reversal because of remarriage and desire for more children, 5 had a change of mind and wanted more children in the same marriage and 4 were infertile following previous pelvic inflammation. The status of the fallopian tubes must then be assessed: if the sterilization procedure was via laparotomy and mid-tubal Pomeroy procedure or placement of rings or clips, the prospects for reconstruction are probably good, but the outlook is less favorable if the procedure was by laparoscopy and diathermy. A history of pelvic inflammation or previous tubal surgery reduces the chances for success. Although laparoscopy and hysterosalpingography are often performed preoperatively and can be helpful, laparotomy is the only reliable means of assessing the exact state of the tubes. Microsurgical techniques for tubal assessment and repair are described. The mean operation to conception time was 8 months among those progressing to a successful delivery and about 12 months among those aborting or having an ectopic pregnancy. Postoperative hysterosalpingograms on 11 patients not becoming pregnant within 6 months indicated that 12 tubes remained patent and 8 had again become obstructed. Of the 23 patients undergoing tubal repair, 3 patients were lost to follow-up and 3 had undergone procedures within only 1-4 months, too soon for evaluation. 10 of the remaining 17 had become pregnant, yielding a pregnancy rate of 59% at a mean follow-up time of 27 months. The full-term rate is 41% because of spontaneous abortions and ectopic pregancies. There have been successes following repair both at the mid-tubal level and at the cornual level.

A multicenter double-blind evaluation of ketoconazole in the treatment of dermatomycoses.

A multicenter double-blind study was conducted on the use of ketoconazole and griseofulvin for the treatment of dermatomycoses. Of one hundred thirty cases (one hundred twenty-seven patients) for which efficacy data were available, sixty-six were treated with a single daily dose of 200 mg ketoconazole, and sixty-four were treated with a single daily dose of 250 mg griseofulvin for periods of two to sixteen weeks. The proportion of remissions observed with ketoconazole (61 percent) was significantly greater (p = 0.02) than that observed with griseofulvin (39 percent). The proportion of relapses within two months was significantly less (p less than 0.01) in the ketoconazole group (9 percent) than in the griseofulvin group (43 percent). The frequency and severity of side effects were comparable in the two groups.