The effect of an abuse-deterrent opioid formulation (OxyContin) on opioid abuse-related outcomes in the postmarketing setting.

An extended-release opioid analgesic (OxyContin, OC) was reformulated with abuse-deterrent properties to deter abuse. This report examines changes in abuse through oral and nonoral routes, doctor-shopping, and fatalities in 10 studies 3.5 years after reformulation. Changes in OC abuse from 1 year before to 3 years after OC reformulation were calculated, adjusted for prescription changes. Abuse of OC decreased 48% in national poison center surveillance systems, decreased 32% in a national drug treatment system, and decreased 27% among individuals prescribed OC in claims databases. Doctor-shopping for OC decreased 50%. Overdose fatalities reported to the manufacturer decreased 65%. Abuse of other opioids without abuse-deterrent properties decreased 2 years later than OC and with less magnitude, suggesting OC decreases were not due to broader opioid interventions. Consistent with the formulation, decreases were larger for nonoral than oral abuse. Abuse-deterrent opioids may mitigate abuse and overdose risks among chronic pain patients.

Screening for thyroid dysfunction and diabetes in patients with carpal tunnel syndrome.

BACKGROUND: Current literature demonstrates that patients with carpal tunnel syndrome (CTS) have a higher prevalence of hypothyroidism and diabetes. The British Society for Surgery of the Hand (BSSH) advises screening CTS patients for thyroid and glucose dysfunction before surgery. This study aimed to analyze the current departmental practice for patients listed for carpal tunnel decompression (CTD) with respect to preoperative assessment of diabetic and thyroid status. METHOD: A retrospective review of all patients who underwent surgery for CTS under one team over a 3 year period (2009-2011) in a UK teaching hospital was performed. Patients' medical records and pathology results were reviewed. RESULTS: A total of 103 procedures were performed in 100 patients. Preoperative thyroid function was checked in 63/100 patients with an abnormal result in 3/63 patients. Two of these patients were subsequently diagnosed with hypothyroidism. Similarly blood glucose was checked in 67/100 patients. This resulted in the new diagnosis of three patients with diabetes. CONCLUSION: The results are consistent with the view that CTS is associated with thyroid dysfunction and diabetes and screening helps in diagnosing new cases of these conditions in this select group. The cost of diagnosing new cases of hypothyroidism and diabetes can be considered as money well spent.

Immunolocalization of IL-1beta and IL-6 in optic nerves of patients with AIDS.

PURPOSE: Immunohistochemical procedures were employed to test the hypothesis that cytokines such as interleukin-1beta (IL-1beta) and interleukin-6 (IL-6) are involved in AIDS-related optic neuropathy and to determine the primary cell types involved. METHODS: Fixed sections of six human HIV-1 infected optic nerves were immunostained for the presence of IL-1beta and IL-6, using horseradish peroxidase and diaminobenzidine as markers. RESULTS: IL-1beta and IL-6 were found in astrocytes, macrophages, microglia, and endothelial cells. The great majority of astrocytes demonstrated strong immunoreactivity. CONCLUSION: Our findings support the premise that IL-1beta and IL-6 are significant pro-inflammatory mediators in AIDS-related optic neuropathy. This finding supports the theory that HIV infection stimulates the release of IL-1beta and IL-6 in astrocytes, macrophages, and endothelial cells in the optic nerve which ultimately leads to demyelination, astrogliosis, and neuronal destruction.

Prevalence of proximal colonic polyps in average-risk asymptomatic patients with negative fecal occult blood tests and flexible sigmoidoscopy.

BACKGROUND: Proximal colonic adenomas were found in 13% to 37% of patients without distal adenomas who underwent colonoscopy. Fiberoptic flexible sigmoidoscopy (FFS) was not performed prior to colonoscopy in all studies except one. The proximal colon at colonoscopy was defined as that portion of the colon proximal to either the descending-sigmoid junction or 60 cm from the anus while withdrawing the colonoscope. These estimates may not reflect exact colonic location when a 60 cm length sigmoidoscope is fully inserted. Therefore, the aim of our study was to determine the prevalence of proximal colonic neoplasms in asymptomatic patients with average risk for colon cancer, aged 50 years and over, with negative fecal occult blood tests and without adenomas at FFS. METHODS: Colonoscopy was performed in 80 patients without and 95 patients with adenomas at FFS. Polypectomy was done using hot biopsy forceps or snare cautery. RESULTS: Twenty-four proximal colonic adenomas (19 < 1 cm and 5 > or = 1 cm) were found in 18 of 80 patients (23%) with normal FFS compared with 39 proximal colonic adenomas (32 < 1 cm and 7 > or = 1 cm), in 28 of 95 patients (29%) with adenomas at FFS (p = 0.31). In patients with normal FFS, there were 20 tubular, 2 tubulovillous, and 2 villous (1 with severe dysplasia) adenomas. In patients with adenomas at FFS, there were 31 tubular, 5 tubulovillous, and 3 villous (1 with severe dysplasia) adenomas. CONCLUSIONS: Proximal colonic adenomas are found in up to one fourth of asymptomatic average-risk patients with negative fecal occult blood test and both with and without adenomas at FFS. The adenomas in both groups have similar size, histology, and location. Severe dysplasia is rarely present.

Serum electrolyte, mineral, and blood pH changes after phosphate enema, water enema, and electrolyte lavage solution enema for flexible sigmoidoscopy.

Hypertonic sodium phosphate (Fleet) enema is a commonly used preparation for fiberoptic flexible sigmoidoscopy. Unfortunately, Fleet has been associated with complications in children and adults. The purpose of this study was to compare the serum electrolytes, mineral, and blood pH changes before and after the administration of Fleet with water and polyethylene glycol electrolyte lavage solution (Golytely) as enemas in an adult population undergoing flexible sigmoidoscopy. Sixty-six patients were randomized in a double-blind fashion to receive two enemas of either Fleet (N = 22), water (N = 20), or Golytely (N = 24). The cleansing ability was graded from 1 to 4 (1 = poor, 4 = excellent). The Fleet had significantly better optimal cleansing efficacy compared with water (p < 0.05) but not to Golytely (p > 0.05). There was a significant increase in the serum phosphorus in the Fleet group compared with water (p < 0.001) or Golytely (p < 0.001). However, absolute serum phosphorus values after Fleet enema always remained within normal range in all but one patient. The changes in other electrolytes, minerals, and venous pH were insignificant.

Endoscopic removal of colonic leiomyoma.

Most gastrointestinal leiomyomas are found in the stomach, only 3% of them arising in the colon. Surgical resection of the leiomyoma is usually necessary owing to its submucosal location. We describe a patient with a 1.5 cm pedunculated leiomyoma of the colon successfully removed by colonoscopic snare electrocauterization. We believe this to be the first report of a colonic leiomyoma of this size removed endoscopically without complication. We review the literature regarding gastrointestinal leiomyomas with special attention to pedunculated leiomyomas and their endoscopic management.

Gastrointestinal Kaposi's sarcoma as the first manifestation of acquired immunodeficiency syndrome.

Gastrointestinal Kaposi's sarcoma can occur in HIV-infected patients without previously diagnosed AIDS. Gastrointestinal symptoms in such patients should be thoroughly investigated because of the possibility of gastrointestinal Kaposi's sarcoma, despite the absence of the cutaneous form. The discovery of gastrointestinal Kaposi's sarcoma establishes the diagnosis of AIDS, as it did in our two patients.