Colonic spread and serum pharmacokinetics of budesonide foam in patients with mildly to moderately active ulcerative colitis

BACKGROUND

Local treatment with foams in patients suffering from ulcerative proctitis or proctosigmoiditis is considered a rational treatment option.

AIMS

To investigate colonic spread, safety, tolerability and acceptance of a newly developed budesonide foam formulation.

METHODS

Twelve patients (four females, eight males) with acute proctosigmoiditis or left-sided ulcerative colitis were rectally administered a single dose of [99Tcm]-labelled budesonide foam (Budenofalk; Dr Falk Pharma GmbH, Freiburg, Germany) containing 2 mg budesonide in 20 mL foam after diagnostic colonoscopy. Thereafter, the colonic spread was assessed by means of gamma-scintigraphy for 6 h. Serum samples were taken simultaneously.

RESULTS

Budesonide foam spread with a maximum between 11 and 40 cm, thus reaching the sigmoid colon in all patients. In some patients, the foam even extended into the distal third and the middle of the descending colon with maximum radioactivity at 4 h. Systemic budesonide absorption was rapid and pharmacokinetic data were comparable with published data on marketed budesonide enemas, with mean serum C(max) and AUC(0-8 h) values of 0.8 +/- 0.5 ng/mL and 3.7 +/- 1.9 ng h/mL, respectively. The new formulation was well accepted by all patients, who could retain the foam for at least 4 h.

CONCLUSIONS

In the majority of patients, budesonide foam effectively spread up to the left-sided colon and thus qualifies for the local treatment of proctosigmoiditis.

Comprehensive MR angiography of the lower limbs: a hybrid dual-bolus approach including the pedal arteries

The purpose of this study was to include the pedal vasculature into the coverage of peripheral multistation magnetic resonance angiography (3DceMRA). A total of 216 patients suffering from peripheral vascular disease were examined with a modified hybrid dual-bolus technique. The cruropedal arteries were acquired first with two sagittal slabs and time-resolved 3D sequences. Then the aortofemoral vessels were visualized using the bolus-chase technique and a second contrast injection. Interventional procedures were performed in 104 patients, and in 69 of those, the cruropedal vessels were also examined with digital subtraction angiography (iaDSA). Using 3DceMRA, the cruropedal arteries were displayed with both excellent and good quality in 95% (205/216 cases), and without any venous overlay in 94% (203/216 cases). The aortofemoral vessels were not jeopardized by the first contrast injection. With iaDSA as the standard of reference, observed sensitivity of 3DceMRA was found in ranges from 80% (29%, 99%) to 100% (86%, 100%) for assessing significant stenoses, and observed specificity ranged between 93% [80%, 98%] and 100% (82%, 100%). In conclusion, hybrid dual-bolus 3DceMRA significantly reduces the limitations of standard single-bolus 3DceMRA in anatomic coverage and temporal resolution of the cruropedal arteries, thus providing high-quality images of the entire peripheral vasculature.

Zur Differenzialdiagnostik des „signalkompromittierten” Os lunatum in der MR-Tomographie

PURPOSE

To define both the underlying pathology and diagnostic criteria in lunates presenting with conspicuous signal pattern in MRI.

MATERIALS AND METHODS

The retrospective evaluation of 2940 MRI examinations revealed 203 patients with signal alterations of the lunate. All MRI examinations were performed on 1.5-Tesla platforms using dedicated surface coils and an intravenous contrast agent. To establish a definitive diagnosis, a total of 252 MRI examinations (49 follow-ups), 22 CT examinations and 4 arthroscopic studies were obtained in addition to the obligatory conventional radiographs.

RESULTS

Incorporating all clinical data, radiographs and MRI examinations succeeded in assigning a diagnosis in 136 signal-compromised lunates (67.0 %), whereas additional diagnostic procedures or follow-up examinations were required for the definitive diagnosis in 57 cases (33.0 %). The most frequent entities were 51 cases of Kienbock's disease (25.1 %), 47 cases of ulnolunate-(triquetral) impaction syndromes (23.2 %) and 44 cases of intra-osseous ganglion cysts (21.7 %). Other pathologies included 23 degenerative, 19 traumatic and 10 inflammatory changes as well as 9 congenital conditions. For MRI assessment of the altered lunate, the most important parameters were location and morphology as well as involvement of the articular and osseous structures of the carpus.

CONCLUSION

The lunate may be affected by different pathological states of the wrist. In total, only one quarter of the signal-compromised lunate represented Kienboeck's disease.

[The importance of a careful examination of all persons in close contact with newly diagnosed infectious tuberculosis]

The diagnosis of infectious pulmonary tuberculosis was made in a 53-year-old Macedonian man. A careful examination of all persons in close contact with him according to the guidelines of the Swiss respiratory society was performed. Pulmonary tuberculosis was diagnosed in his 22-year-old son, in his 20-year-old daughter and in his 3-year-old granddaughter. Seven persons had isoniazid preventive treatment for latent tuberculosis. These data shows very clearly that a careful examination of all persons in close contact with contagious tuberculosis is very important.

[Diagnostic angiography using multi-slice spiral CT in acute obstruction of the basilar artery]

OBJECTIVE

To evaluate the diagnostic efficiency of CT angiography in case of clinical signs of acute brainstem infarction for the therapeutic management of catheter-based local thrombolysis.

MATERIAL AND METHODS

3 patients (2 males, 1 female) suffering from an acute onset of brainstem symptoms and being suspicious of an occluded basilar artery were included into this report. 1 patient underwent selective vertebral arteriography. 2 patients were initially examined with CT angiography using a 4-row scanner and 100 ml intravenous contrast agent.

RESULTS

In one patient, an occlusion of the basilar artery was excluded with catheter-based angiography. Subsequently, the patient was treated with systemic thrombolysis using r-tPA because of a thalamus infarction seen in MRI. 2 patients who have been initially examined with CT angiography presented with complete occlusions of the basilar arteries. These patients underwent r-tPA thrombolysis by means of superselective micro-catheter approaches of the vertebrobasilar vessels. CT angiography was very useful for determinating the occlusion length of the basilar artery pre-therapeutically, and in 1 case for ruling out an occluded vertrebral artery for catheterization. All patients recovered well under thrombolytic therapy applied systemically or selectively.

CONCLUSION

Cerebral multi-slice CT angiography is a fast and save technique for detecting or ruling out an acute basilar artery occlusion. Thus, in cases of equivocal clinical signs CT angiography is recommended before the decision of thrombolytic therapy is made.

Capgras syndrome--out of sight, out of mind?

OBJECTIVE

Recent theoretical approaches emphasize a disorder of face processing in the pathogenesis of the Capgras syndrome. We report a patient with the Capgras syndrome developing in the physical absence of the person who is believed to be replaced and thus a limited role for a disorder of face processing.

METHOD

The clinical phenomenology of a case of the Capgras syndrome is explored.

RESULTS

A disorder of face processing might not be a sufficient explanation of the course of the disorder in this patient.

CONCLUSION

Face processing accounts, of the Capgras delusion, have to be supplemented by additional assumptions.

Spectral composition of NREM sleep in healthy subjects with moderately increased daytime sleepiness

OBJECTIVE

This study addressed the relationship between daytime sleepiness and spectral composition of the preceding NREM sleep.

METHODS

Nineteen healthy volunteers (mean age: 36.5 years; SD: 10.1) underwent polysomnography during two consecutive nights and the multiple sleep latency test (MSLT) on the following day. Daytime sleepiness was also assessed by the Epworth sleepiness scale (ESS). The sleep recordings were visually scored according to standard criteria. The quantitative sleep EEG analysis was performed using a fast Fourier transform routine. The sleep parameters were compared between subjects with short and long MSLT sleep latencies (cut-off=10 min) and between subjects with low and high ESS scores (cut-off=6 points).

RESULTS

Subjects with short MSLT sleep latencies showed a reduced theta EEG activity. There was no evidence of reduced synchronization of sleep EEG in subjects with high ESS scores.

CONCLUSIONS

Moderately increased daytime sleepiness as indicated by MSLT sleep latency less than 10 min is accompanied by decreased power of theta activity during NREM sleep indicating a deficit of sleep EEG synchronization.

Identification of cell surface determinants in Candida albicans reveals Tsa1p, a protein differentially localized in the cell

To identify cell surface proteins of Candida albicans, the predominant fungal pathogen in humans, we have established an approach using a membrane impermeable biotin derivative in combination with affinity purification. We were able to identify 29 different proteins under two distinct conditions. Among mannoproteins, heat shock proteins and glycolytic enzymes we found thiol-specific antioxidant-like protein 1 (Tsa1p) to be differentially localized depending on the conditions applied. Only in hyphally grown cells Tsa1p was localized to the cell surface whereas in blastospores no surface but mainly nuclear localization was found. This indicates that cell surface expression of at least some proteins is mediated by differential translocation.

Child-Pugh versus MELD score in predicting survival in patients undergoing transjugular intrahepatic portosystemic shunt

BACKGROUND

In patients undergoing transjugular intrahepatic portosystemic shunt (TIPS), prognostic scores may identify those with a poor prognosis or even those with a clear survival benefit. The Child-Pugh score (CPS) is well established but several drawbacks have led to development of the model of end stage liver disease (MELD).

AIM

The aim of the study was to compare the predictive power of CPS and MELD, to validate the original MELD formula, and to assess the predictive value of the determinants used in the two prognostic scores outside of a study setting.

PATIENTS

A total of 501 patients underwent elective TIPS placement and 475 patients fulfilled the inclusion criteria.

METHODS

Data of all patients undergoing elective TIPS in one university hospital and four community hospitals in Vienna, Austria, between 1991 and 2001, were analysed retrospectively. The main statistical tests were Cox proportional hazards regression model, the log rank test, Kaplan-Meier analysis, and concordance c statistics.

RESULTS

Median follow up was 5.2 years and median survival was 4.6 years. During follow up, 230 patients died, 75 within three months after TIPS placement. In stepwise proportional hazards analyses, independent predictors of death were creatinine level, bilirubin level, age, and refractory ascites. MELD was better in predicting survival in a stepwise Cox model but both scores were equally predictive in c statistics for one month, three month, and one year survival. Renal function was the strongest independent predictor of survival.

CONCLUSIONS

Although MELD was the primary predictor of overall survival in multivariate analysis, c statistics showed that both scores can be used for patients undergoing TIPS with equal accuracy. For assessing prognosis in patients undergoing TIPS implantation, there seems little reason to replace the well established Child-Pugh score.