Generic drug prescriptions following hospital discharge: a prospective study in France.

AIMS: Systematic generic prescription at discharge could reduce confusion on drug-name usage, decrease commercial influence on medicine, and reduce drug-related expenditures. This study aimed to analyze generic drug prescriptions at discharge from hospital and to estimate the potential savings associated with a total substitution policy (substitution of every substitutable drug for its cheapest generic counterpart). METHODS: Drug prescriptions before admission and at discharge of all patients from three medical units of a university hospital were prospectively collected for five weeks without informing prescribers. RESULTS: Prescriptions from 85 patients were analyzed. On admission, 68 patients (80%) received 413 drugs; 141 were substitutable brand-name drugs and 23 (16%), which were directly prescribed as generics. At discharge, 488 drugs were prescribed to the 85 patients; 180 were substitutable drugs but only 5 (2.8%) were written as generics on prescription pads, a decrease of 78% (p<0.0001) compared to admission. In average, generics were 18% less expensive than brand-name drugs. Some common therapeutic classes offered even greater price difference, such as proton-pump inhibitors (42%), statins (32%), or antihypertensive agents (28%). Potential savings from a total substitution policy at discharge were estimated to €1512 per 1000 patients per week; for lifetime drugs, savings amounted to €18,960 per 1000 patients per year. CONCLUSIONS: Very few drugs are written as generics on medical forms at discharge in France. Hospital practitioners should be encouraged to prescribe generics, particularly in chronic diseases. A broad generic prescription policy at hospital discharge would result in substantial savings for health insurance.

Frailty, osteoporosis and hip fracture: causes, consequences and therapeutic perspectives.

OBJECTIVE: The aim of this review of the literature is to report the factors which both contribute to the frailty syndrome and increase hip fracture risk in the elderly. This work is the fruit of common reflection by geriatricians, endocrinologists, gynecologists and rheumatologists, and seeks to stress the importance of detection and management of the various components of frailty in elderly subjects who are followed and treated for osteoporosis. It also sets out to heighten awareness of the need for management of osteoporosis in the frail elderly. DESIGN: The current literature on frailty and its links with hip fracture was reviewed and discussed by the group. RESULTS: The factors and mechanisms which are common to both osteoporosis and frailty (falls, weight loss, sarcopenia, low physical activity, cognitive decline, depression, hormones such as testosterone, estrogens, insulin-like growth factor-I (IGF-I), growth hormone (GH), vitamin D and pro-inflammatory cytokines) were identified. The obstacles to access to diagnosis and treatment of osteoporosis in the frail elderly population and common therapeutic pathways for osteoporosis and frailty were discussed. CONCLUSION: Future research including frail subjects would improve our understanding of how management of frailty can can contribute to lower the incidence of fractures. In parallel, more systematic management of osteoporosis should reduce the risk of becoming frail in the elderly population.

Rapid multifocal chondrolysis after liver transplantation in four patients.

BACKGROUND: Favourable clinical outcomes achieved with liver transplantation may be jeopardised by corticosteroid-induced osteoarticular complications, such as osteoporosis or aseptic osteonecrosis. CASE REPORT: A previously unreported joint complication in liver transplant recipients is described. METHODS: Retrospective study of liver transplant recipients in whom destructive joint disease developed, identified among 330 symptomatic patients out of a total of 1260 managed over a 15 year period (November 1984-January 2000) in a university based liver transplantation centre. RESULTS: In four patients (23-56 years), rapid chondrolysis developed 2-12 years after transplantation in more than three weightbearing or non-weightbearing joints free of radiological features of avascular osteonecrosis, evidence of infection, or defined inflammatory arthritis. Pathological examination of five hip joints and one knee joint found no evidence of infection or inflammation. Six joint replacement procedures were performed successfully in three patients. CONCLUSION: Clinicians managing liver transplant recipients, and perhaps recipients of other organs, should be aware that rapid chondrolysis may develop. The pathogenesis of this rare complication is unclear.

Normocomplementemic urticarial vasculitis inaugurating destructive polyarthritis.

Urticarial vasculitis is an entity characterized by recurrent bouts of urticaria and histological evidence of leukocytoclastic vasculitis. An underlying systemic disease is often present. Joint manifestations occur mainly in cases with hypocomplementemia. We report a case of destructive polyarthritis preceded by urticarial vasculitis without hypocomplementemia.

A comparison of fluconazole oral suspension and amphotericin B oral suspension in older patients with oropharyngeal candidosis. Multicentre Study Group.

BACKGROUND: the optimum treatment for oropharyngeal candidosis, particularly in older patients, has not been established. Local treatment with nystatin and amphotericin B can be problematic. The oral suspension formulation of fluconazole may offer a good alternative to these conventional agents. OBJECTIVE: to compare the safety and efficacy of fluconazole oral suspension with amphotericin B oral suspension in the treatment of older patients with oropharyngeal candidosis. DESIGN: randomized open-label study. PATIENTS: three hundred and five patients, aged 62 or older, with at least one sign or symptom of oropharyngeal candidosis. METHODS: we evaluated patients for the signs and symptoms of candidosis before receiving the study drug and on days 4, 7 and 14. We assessed patients who were cured or improved after 7-14 days of treatment 2 weeks after the end of treatment (follow-up). We obtained specimens from buccal lesions for microscopic examination (baseline only) and culture at baseline and on days 7 and 14. Patients were evaluated for adverse events on days 4, 7 and 14. RESULTS: one hundred and fifty patients received fluconazole and 155 received amphotericin B. There were no statistically significant differences in clinical or mycological response between fluconazole and amphotericin B at the end of treatment or at follow-up. At the end of treatment, 122 (81%) of 150 fluconazole-treated and 135 (87%) of 155 amphotericin B-treated patients were clinically cured or improved. Mycological cure rates were 35% and 46% for fluconazole and amphotericin B, respectively. The symptoms of burning sensation and buccal pain resolved significantly sooner (P < 0.05) in fluconazole-treated patients. The presence of dentures did not affect the response to antifungal therapy. The incidence of adverse events was 46% in the fluconazole group and 50% in the amphotericin B group (not statistically significant). CONCLUSION: fluconazole oral suspension is a good therapeutic alternative to amphotericin B oral suspension in the treatment of older patients with oropharyngeal candidosis.

Hepatic hypertrophic osteoarthropathy: the value of liver transplantation.

We describe 4 cases of hepatic hypertrophic osteoarthropathy treated successfully by liver transplantation. Hepatic hypertrophic osteoarthropathy is a rare and disabling condition associated with severe liver diseases. It responds poorly to conservative management, and liver transplantation is the only radical treatment option.

Aspergillus osteomyelitis after heart-lung transplantation.

Aspergillus osteomyelitis is a severe complication of invasive aspergillosis. Fewer than 15 cases have been observed after solid organ transplantation. We describe a case of Aspergillus osteomyelitis of the ilium after heart-lung transplantation with favorable outcome after medical treatment.

[Giant hemangioma of the liver disclosed by fever and an inflammatory syndrome. Apropos of 3 cases]. / Angiomes géants du foie révélés par de la fiévre et un syndrome inflammatoire. A propos de 3 cas.

Three cases of giant liver haemangioma were revealed by fever and biological inflammatory changes, which disappeared after resection of the haemangioma. These rare symptoms accompanying liver haemangioma may lead to misdiagnosis. Resection whenever possible results in the disappearance of symptoms. Anatomic necrotic changes inside the angioma seem to be the cause of these inflammatory patterns.

Interphase cytogenetic studies of bladder cancer.

Transitional cell carcinomas of human urinary bladder were studied by interphase fluorescence in situ hybridization (FISH). With current hybridization to isolated nuclei, 26 tumors were investigated and nonrandom +7, -9 and -10 were identified. Monosomy 11, tetraploidies and polyploidies were detected in invasive and poor-differentiated tumors. Hybridization on frozen sections offers another means of analysing surgical samples. FISH to vesical washings can be applied to monitor tumor progression. Hybridizations on paraffine sections and on tissues previously stored in liquid nitrogen allow retrospective studies of the archived materials. Our data suggest that the interphase FISH can become a powerful tool for cytogenetic studies of bladder cancer.

Nonrandom changes of chromosome 10 in bladder cancer. Detection by FISH to interphase nuclei.

Fluorescence in situ hybridization (FISH) to interphase nuclei has been a valuable method for examining the chromosome copies in tumor cells in clinical practice. Twelve cases of transitional cell carcinoma (TCC) of the bladder were investigated with a biotin-labeled repetitive DNA probe to detect numerical aberrations of chromosome 10 in interphase nuclei. The cells containing one fluorescent signal were screened in two of seven non-invasive tumors and in four of five invasive tumors. Two patients presented two FISH spots of different sizes. More than two signals were seen in one invasive tumor. The findings suggest that partial or complete loss of a chromosome 10 is a nonrandom aberration in bladder cancer.

[Preoperative localization of parathyroid adenomas. Role of cervical ultrasonography]. / Localisation pré-opératoire des adénomes parathyroidiens. Place de l'échographie cervicale.

OBJECTIVES: We evaluated the sensitivity and specificity of cervical ultrasonography for the detection of primary parathyroid adenomas. METHODS: From January 1990 to May 1992, ultrasonography was performed before exploratory cervicotomy in 30 patients (10 males, 20 females, mean age 56.3 yr) whose diagnosis was primary hyperparathyroidism based on radioimmunoassay of parathyroid hormone. The same trained operator performed all the ultrasonographic examinations. RESULTS: Twenty-six parathyroid tumours were detected in 23 of the 30 patients examined by ultrasonography. The four standard localizations and one ectopic tumour were visualized. At surgery 37 tumours were found in 30 patients. Among the 11 false negatives, the operator had identified an abnormal tumour incorrectly as a cervical lymph node in 2. Most of the false negatives occurred early in the study. The sensitivity of ultrasonography was thus 70 % with a 100% specificity. CONCLUSIONS: Cervical ultrasonography is a reliable, non-invasive and relatively inexpensive examination which should be used as a first-line test for the aetiological assessment of hyperparathyroidism.

Karyotype and FISH analysis of a newly established cell line derived from a human bladder carcinoma.

A new human malignant urologic cell line was established in vitro from a moderately differentiated transitional cell carcinoma of the bladder and cytogenetically characterized. Repeated chromosome analyses of the cell line using conventional RHG and GTG banding and non-radioactive in situ hybridization showed a stable karyotype with a modal number of 48 and chromosomal rearrangements, some of which have not been previously described. Numerical deviation included three trisomies (+7, +8, +9) and one nullisomy (-19, -19). Structural changes involved a balanced translocation (1;5)(q12;q12), an isochromosome 3q, a 14p+, and two markers. Fluorescence in situ hybridization (FISH), using biotin-labeled alpha satellite probes for chromosome 9 or painting for chromosomes 1 and 8, applied to interphase nuclei or metaphases showed similar results to those found by conventional cytogenetic study. This cell line may be an interesting model for fuller characterization by molecular biology studies and for testing anti-cancer drugs in vitro.

[Chromosomal analysis of bladder tumors. Technical aspects, anatomoclinical correlations and perspectives. Report of 18 cases]. / Analyse chromosomique des tumeurs de vessie. Aspects techniques, corrélations anatomocliniques et perspectives. A propos de 18 cas.

The course of bladder tumours is difficult to predict. The most reliable prognostic factor at the present time is histological grade. Cytogenetic subclasses of bladder tumours can be distinguished on the basis of the demonstration of karyotype anomalies in bladder tumour cells. Eighteen patients underwent cytogenetic examination of their bladder tumour and were followed for an average of 35 months. Multivariate analysis of the clinical and laboratory parameters studied revealed the importance of age and the absence of trisomy 7 in the tumour on patient survival. The presence of trisomy 7 in a bladder tumour may therefore constitute a factor of poor prognosis. This hypothesis needs to be confirmed by further studies in larger populations. The search for this anomaly can be performed by fluorescent in situ chromosomal hybridisation, a technique which transforms cytogenetics from an experimental procedure into a routine complementary investigation. These techniques can be performed on urine samples, suggesting the possibility of their application to screening or follow-up of bladder tumours.