Kidney allograft biopsy: timing to complications.

BACKGROUND: Clinical Practice guidelines recommend that patients be observed overnight after kidney biopsy based upon data that 1/3 of bleeding complications occur 12 hours post-procedure. Retrospective studies of same day discharge after kidney allograft biopsy suggest this practice may be safe, but no prospective studies to date have examined time to bleeding complications. METHODS: We conducted a single center, prospective, observational study of adult outpatient kidney allograft recipients undergoing elective percutaneous allograft biopsy who were observed for 8 hours post-procedure before discharge home. Bleeding complications were characterized as minor or major and tracked by time post-biopsy. Baseline demographics were assessed for correlation with complications. RESULTS: 8/124 (6.4%) of patients had a bleeding complication and 7/8 (87.5%) of complications occurred within the observation window. 3.2 % were minor and 3.2% were major complications with one major complication occurring after the 8-hour period. Neither the baseline demographics nor drop in serum hemoglobin of > 1 g/dl 6 hours after biopsy predicted a bleeding complication. However, a drop of > 1.5 g/dl correlated with a significant bleeding event (p = 0.006). CONCLUSIONS: An 8-hour observation window captures the majority of bleeding complications after adult kidney transplant biopsy.

Trauma, dissociation, impulsivity, and self-mutilation among substance abuse patients.

Among 85 substance abusing or dependent inpatients, it was found that those with histories of distressing traumatic events reported more self-mutilative acts, higher levels of dissociation, and a greater degree of impulsivity than did patients without such histories. Implications of the findings for research and clinical practice are discussed.

A double-blind, placebo-controlled pilot study of carbamazepine for the treatment of alcohol dependence.

Carbamazepine, chemically related to the tricyclic antidepressants, has multiple clinical actions. It is a potent anticonvulsant, mild sedative, and mood stabilizer. It is nonaddictive and has little toxicity when clinical and laboratory monitoring is performed. It has proven efficacy in the treatment of acute alcohol withdrawal. Kindling and protracted withdrawal are the theoretical rationale for the mechanism of its action in the treatment of alcohol dependence. This 12-month double-blind placebo-controlled pilot study of 29 subjects evaluated the efficacy of carbamazepine for the treatment of alcohol dependence. Subjects were randomly assigned to either placebo or carbamazepine. A baseline assessment and bimonthly follow-up for 12 months assessed demographic variables, mood and functioning, treatment compliance, drinking behaviors, biological markers of drinking, and medication toxicity. Despite the small sample size, compliance difficulties after 4 months and a sizable drop-out rate, there were treatment effects favoring carbamazepine. Univariate analyses showed a decrease in drinks per drinking day and maximum number of heavy drinking days in a row at 2 and 4 months of follow-up. Survival analysis revealed a significant delay in time to first episode of heavy drinking, and close to a trend level of significance for time to first drink. There were significant time, but not time by treatment group, effects on multiple measures of mood. These pilot results are encouraging and support carbamazepine as a possible pharmacologic tool in the treatment of alcohol dependence.

The relationship between sexual abuse and eating pathology.

OBJECTIVE: The present study examined whether patients with histories of sexual abuse reported a higher degree of pathological eating behaviors and attitudes than a nonsexually abused control group. METHOD: Subjects, 134 psychiatric inpatients, completed the Eating Disorder Inventory (EDI) to assess eating pathology, and a questionnaire that gathered information regarding sexual abuse experiences. RESULTS: A logistic regression model found that a complex of EDI subscales was significantly related to a history of childhood abuse. Exploratory analyses found that survivors of sexual abuse obtained higher scores on the EDI subscales scores of Drive for Thinness, Interpersonal Distrust, Perfectionism, and Interoceptive Awareness. Further, the mean score for sexual abuse survivors without an eating disorder on the majority of EDI subscales was above established means for eating-disordered groups. DISCUSSION: These findings suggest that inpatients with a history of sexual abuse are likely to present with eating disorder symptomatology.

PTSD substance abuse comorbidity and treatment utilization.

The present study investigates the prevalence of posttraumatic stress disorder (PTSD) among a sample of treatment-seeking substance abusers and examines the relationship between PTSD comorbidity and rates of inpatient substance abuse treatment. Eighty-four patients (48 male and 36 female) admitted for detoxification at a private hospital were administered self-report measures of lifetime stressor events, PTSD symptomatology, and prior treatment history. Approximately one quarter of the sample was found to present with significant PTSD symptomatology. Women were more likely than men to have been physically and sexually abused, and women reported experiencing a greater number of traumatic events. Consequently, more women than men were classified as having possible PTSD. With respect to inpatient substance abuse treatment admission rates, the PTSD group reported a greater number of hospitalizations than their non-PTSD counterparts. Implications of these findings for routine trauma screening and more effective treatment for substance abusers with concomitant PTSD are highlighted.