Economic impact and clinical benefits of pharmacist involvement on surgical wards

A one-year pilot project was performed to assess the economic and clinical benefit of pharmacist involvement on the surgical wards of a 600-bed tertiary care, teaching hospital. A total of 405 recommendations were collected with a physician acceptance rate of 90%. From these recommendations, 1416 patient follow-ups were performed to document outcome. The total documented cost avoidance of the pharmacists' activities was $33,265.58. The total annual drug expenditure for the department of surgery declined by $59,662 representing a 9% decrease over the previous year with the greatest decline involving antimicrobials which decreased by $52,587 compared with the previous year. Most of the cost-avoidance in this area was attributable to antimicrobial selection and dosing adjustment in renal impairment. Pharmacist-directed pharmacokinetic monitoring of aminoglycosides resulted in a clinical success rate of 93.8% for treatment regimens and a 6.2% incidence of nephrotoxicity. Housestaff education aimed at improving prescribing practices were identified and provided for select agents including midazolam, ketorolac, vancomycin and aminoglycosides. As well, select recommendations were documented which illustrated the benefit to patient care of pharmacist involvement. Pharmacist involvement on the surgery services produced both financial and clinical benefits.

Pain and quality of life in patients with acute duodenal ulcer treated with ranitidine

BACKGROUND

The various components of pain and quality of life in duodenal ulcer patients receiving antisecretory drugs have not been studied to date.

METHODS

Ninety-five patients with epigastric pain and duodenal ulcer at endoscopy completed this prospective, multicenter, open-study. All were treated with effervescent ranitidine 300 mg daily for 4 weeks. The following parameters were assessed: (a) disappearance of duodenal ulcer pain by self-evaluation and on a weekly visual analogue scale (VAS) from 0 to 100; (b) evolution of sensory and affective components of ulcer pain by the Validated French Version of the McGill Pain Questionnaire (Questionnaire Douleur de Saint-Antoine, QDSA); (c) quality of life by the Nottingham Health Profile (NHP) which includes six criteria: pain, mobility, energy, emotions, sleep and social isolation.

RESULTS

Forty-nine, 66 and 87% of the patients were pain-free during the day-time after 7, 14 and 28 days, respectively. Corresponding figures for the night-time were 80%, 88% and 97% respectively. Median time to disappearance of ulcer pain was 8 days. VAS self-assessment showed a significant decrease each week throughout the treatment period (P = 0.001). Sensory and affective QDSA scores were significantly improved after the second day and at each assessment during the 28 days of treatment (P = 0.001). Physical as well as affective aspects of quality of life were significantly improved after 28 days for each of the six criteria explored (P = 0.001). The duodenal ulcer healing rate was 86% after 4 weeks of treatment.

CONCLUSIONS

Using complementary scales measuring different aspects of ulcer pain, sensory and affective components improved significantly from the second day of treatment with ranitidine 300 mg. A significant improvement in quality of life is observed after a 4-week treatment. QDSA and NHP appear to be useful evaluation tools of duodenal ulcer pain and quality of life.

Prevalence of sporadic medullary thyroid carcinoma: the importance of routine measurement of serum calcitonin in the diagnostic evaluation of thyroid nodules

OBJECTIVE

The prevalence of sporadic forms of medullary thyroid carcinoma (MTC) has been studied in patients living in an area of moderate iodine deficiency. Such forms of MTC are usually diagnosed after surgery and have little chance of definitive cure. Using the measurement of basal serum calcitonin (CT) levels in a large series of patients with both thyroid disease and normal 24-hour urinary iodine excretion, we assessed the prevalence of MTC and, in patients affected with the disease, we also evaluated the stage of the disease according to surgical findings and post surgical plasma CT levels.

PATIENTS

A prospective study of 657 patients with thyroid disease (469 with nodular and 188 with non-nodular thyroid disease). As controls, 40 normal subjects were also studied.

MEASUREMENTS

In all patients: (1) measurement of basal serum CT, free T4, total T3, TSH levels and serum TSH-receptor, peroxidase and thyroglobulin (Tg) antibody concentrations, (2) thyroid ultrasonography, (3) fine needle aspiration cytology (FNAC). In patients with increased basal CT levels: (1) measurement of serum CT levels during pentagastrin test prior to surgery, (2) histological examination and immunostaining with both anti-CT and anti-Tg antibodies of all the nodular thyroid tissue surgically removed, (3) measurement of basal and pentagastrin stimulated serum CT values after surgery.

RESULTS

All the patients with non-nodular thyroid disease had normal basal CT levels. Four patients (0.84%) with nodular thyroid disease (2 with uninodular and 2 with multinodular goitre) had both elevated basal and pentagastrin stimulated CT levels. In the two patients with uninodular goitre, FNAC was suggestive of MTC in 1 (nodular diameter 8.0 cm) and of follicular carcinoma in 1 (nodular diameter 2.5 cm). Histological examination of the nodules confirmed these histotypes. Immunostaining with anti-CT antibodies was positive in the former patient but also in the latter. FNAC was suggestive of benign adenomatous tissues in the two patients with multinodular goitre. Histological examination of all the thyroid nodules confirmed the cytological findings. However, serial sections through the gland in each of these two patients showed an occult follicular carcinoma which had, however, positive staining with anti-CT antibodies. Furthermore, immunostaining with anti-Tg antibodies was negative in the patient with MTC but positive in the 3 patients with follicular carcinoma. Finally, both basal and pentagastrin stimulated CT levels remained elevated after total thyroidectomy only in the patient with FNAC suggesting MTC.

CONCLUSIONS

This study demonstrates a surprisingly high prevalence of sporadic forms of medullary thyroid carcinoma in patients with nodular thyroid disease. Such forms of medullary thyroid carcinoma seem to be unrelated to iodine intake and may be pure or mixed with a follicular carcinoma. In these mixed thyroid carcinomas, only the neoplastic follicular pattern was seen on both cytological and histological examination. Routine measurements of serum calcitonin levels should therefore be considered an integral part of the diagnostic evaluation of thyroid nodules. Indeed, increasing the accuracy of diagnosis of medullary thyroid carcinoma encourages the surgeon to perform more radical treatment, thus achieving more frequent normalization of post-operative serum calcitonin levels.

Is prevention of preterm births in twin pregnancies possible? Analysis of the results of a prevention program in France (1989-1991)

OBJECTIVES

A policy aimed at the prevention of early preterm births in twin pregnancies has been evaluated. The prevention program included: early diagnosis of twinning, information of the mothers about the risk of prematurity, attempts to restrain physical activity and early work leave prescription when indicated.

STUDY DESIGN

Cohort study of all twin births in a given geographical area (Hauts-de-Seine district); 546 mothers with pregnancy duration of > or = 26 weeks were included; 1088 newborns were followed up to the 28th day of life.

RESULTS

The recommended prevention program is largely used (88% of early diagnosis of twinning, 62% of the women informed and 73% of prescription for reduced physical activity). The very preterm (26-28 weeks) and early preterm (< or = 32 weeks) birth rates are low: 1.5 and 8.5%, respectively. The stillbirth rate is 11 per thousand and the neonatal mortality rate (0-27 days) is 10 per thousand live births, with a persistent difference between the first and the second twin.

CONCLUSION

The present study demonstrates the open access and acceptability of the prevention policy; in addition, the perinatal outcomes are better than those of comparable published cohorts.

Comparison of four fixatives for routine splenic histology and immunohistochemical staining for group II avian adenovirus

Four different fixatives, A, B, C, and D, were compared for use in routine histology of splenic tissue and for immunohistochemical staining to detect group II avian adenoviral antigen. Sixteen pheasants were experimentally infected with type II adenovirus; spleens from each bird were harvested, divided, and treated with each of the four fixatives. All four fixatives were adequate for routine histology. Fixative B was significantly more sensitive for immunohistochemistry than the three other fixatives, and it also detected the viral antigens at the highest dilutions of the primary antibody.

Effects of selenium on UVA-induced lipid peroxidation in cultured human skin fibroblasts

The effect of selenium on the lethal action of ultraviolet radiations and on the lipid peroxidation induced by exposures to ultraviolet A (320-400 nm; 360 kJ.m-2) and ultraviolet B (290-320 nm; 2 kJ.m-2) have been measured in cultured human skin fibroblasts. The experiments have been performed with either pure selenium or a spring water containing selenium and other trace elements (zinc and strontium). For cells cultured in a standard medium containing 10% fetal calf serum, no effect of selenium or spring water addition to the culture medium was observed on the lethality or on the peroxidative process induced by ultraviolet A and B radiations. Concurrently, there was no detectable increase of the seleno-dependent glutathione peroxidase activity. For cells previously depleted in selenium by a culture in a medium containing only 2% serum, a protective effect of selenium can be detected. Depending on the fibroblast donor, we observed (1) a protective effect on lethality of dividing fibroblasts induced by ultraviolet A radiations, (2) a protective effect on lipid peroxidation induced by ultraviolet A radiations on dividing or quiescent fibroblasts and (3) an increase in glutathione peroxidase activity in fibroblasts.

Effects of thyroid status on thyroid autoimmunity expression in surgically induced hypothyroid patients with Graves' disease

We investigated, in 20 patients with Graves' disease and presenting with both a surgically induced hypothyroid state and increased serum antibodies (Ab) to the TSH receptor (R) levels, the relationships between thyroid status and the serum TSH-R or peroxidase (TPO) Ab levels under L-T4 treatment and after L-T4 cessation. The prevalence of positive TSH-R Ab (100%) and the log mean TSH-R Ab level (1.41 +/- 0.04%) observed during the surgically induced hypothyroid state decreased (p < 0.001, p < 0.01, respectively) under L-T4 therapy (prevalence of positive TSH-R Ab = 50%, log mean TSH-R Ab level 1.21 +/- 0.05%) and increased again (p < 0.001) after L-T4 cessation (prevalence of positive TSH-R Ab = 85%, log mean TSH-R Ab level = 1.45 +/- 0.06%) to reach levels lower (< 0.01) than that observed during the hypothyroid state for prevalence of positive TSH-R Ab but similar to that obtained during such a state for log mean TSH-R Ab value. The log mean TPO Ab level obtained during the surgically induced hypothyroid state (3.2 +/- 0.5 titer) decreased (p < 0.02) under L-T4 therapy (1.8 +/- 0.2 titer) and increased again (p < 0.02) after L-T4 cessation (3.0 +/- 0.5 titer) to reach a similar level to that obtained during the surgically induced hypothyroid state. There were positive correlations between log TSH levels and log TSH-R Ab values (r = 0.40, p < 0.001) or log TPO Ab levels (r = 0.33, p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Evidence for the effect of antibodies to TSH receptors on the thyroid ultrasonographic volume in patients with Graves' disease

OBJECTIVE

It has been demonstrated that antibodies (Ab) to thyroid-stimulating hormone receptors (R), which stimulate the thyroid gland, induce hyperthyroidism in patients with Graves' disease. Furthermore, it has been shown in thyroid cells in culture that thyroid-stimulating hormone receptor Ab acts through the adenosine 3', 5'-monophosphate pathway which stimulates both thyroid hormonogenesis and growth. We investigated the relations between thyroid autoimmunity expression and thyroid ultrasonographic parameters or thyroid hormonal status in patients with Graves' disease.

PATIENTS

A prospective study of 53 consecutive patients referred with untreated Graves' disease.

MEASUREMENTS

Measurements were made of serum TSH-R, peroxidase (TPO) and thyroglobulin (Tg) Ab and basal plasma free T4 (FT4), free T3 (FT3) and TSH. Thyroid morphological characteristics (number and total volume of nodule(s), total volume of lobes and total thyroid volume) were determined by ultrasonography.

RESULTS

There were significant correlations (P < 0.001) between TSH-RAb levels and FT4 values (r = 0.48) or FT3 levels (r = 0.46). Likewise, significant correlations were found between TSH-RAb levels and total lobe volume values (r = 0.56, P < 0.001), total nodular volume values (r = 0.59, P < 0.01) or total thyroid volume values (r = 0.63, P < 0.001). By contrast, no correlation was found between TSH-RAb levels and the number of nodules or between any of the ultrasonographic parameters and TPOAb levels or TgAB values.

CONCLUSIONS

This study demonstrates, in vivo, that TSH receptor antibodies modulate the thyroid ultrasonographic extranodular and nodular volumes in patients with Graves' disease.

Single infusion of intravenous cibenzoline in the treatment of supraventricular tachyarrhythmias following heart surgery. A double-blind placebo-controlled parallel study

The efficacy and safety of a single infusion of cibenzoline, a class I antiarrhythmic drug, were assessed in 86 patients presenting with a supraventricular tachyarrhythmia following heart surgery in a placebo-controlled double-blind parallel study. Cibenzoline was effective in 13 patients (30%) vs three patients (6.9%) with placebo (P < 0.05). In the non-converted patients, ventricular rate was significantly slowed by cibenzoline (P < 0.05), which also significantly increased the duration of QRS and QT intervals. Transient adverse events were seen in nine patients receiving cibenzoline: moderate hypotension, sweating, right bundle branch block. One patient with decreased left ventricular function had an increased ventricular rate and QRS duration associated with hypotension. There were no severe adverse events. These results suggest that cibenzoline is effective for the treatment of postoperative supraventricular tachyarrhythmias in patients without impairment of ventricular function.

[Pseudomembranous colitis caused by antibiotic therapy. Results of a survey of the patient material from the praxis of 900 gastroenterologists]

A retrospective study conducted by interviewing French gastroenterologists was performed with the objective of evaluating the incidence and etiology of pseudomembranous colitis in cases where the diagnosis has been confirmed by coloscopy. This study allowed to collect data on 878 pseudomembranous colitis observed by 438 gastroenterologists within 6 months. It shows evidence of the importance of various antibiotics in the etiology of pseudomembranous colitis (89% of the identified cases). The following is the list of antibiotics or antibiotic classes, in increasing order of their association with the development of pseudomembranous colitis: macrolides which are very rarely associated, a group represented by cefaclor, cefuroxime axetil and cyclins, which are rarely associated, a third group constituted by amoxicillin, ofloxacin and trimethoprim-sulfamethoxazole which appears to be 2 to 3 times more frequently associated than the previous group, and a fourth group of antibiotics, represented by cefixime and the association amoxicillin-clavulanic acid, which is 7 times more frequently associated than antibiotics of the second group.

Occupational paternal exposure to benzene and risk of spontaneous abortion

OBJECTIVE

The purpose of this study was to evaluate the risk of spontaneous abortion among the wives of male workers occupationally exposed to benzene.

METHODS

The wives of 823 men working in two chemical plants at the time of the study were asked to complete a questionnaire describing their pregnancies. The analysis of the 1739 pregnancies that ended in a spontaneous abortion or a birth is presented. The firms' payroll records provided all workers' employment history, including dates. Benzene exposure, graded at two levels (< 5, > or = 5 ppm), was determined for every job, so that benzene exposure for each worker's entire professional life (at these companies) could be assessed. This information was linked to the dates of the pregnancies reported in the questionnaires to enable the exposure status of each pregnancy to be defined (1270 non-exposed and 274 exposed). The frequency of spontaneous abortion, defined as the number of spontaneous abortions divided by the total of spontaneous abortions and births was evaluated.

RESULTS

When adjusted for tobacco consumption, mother's age and pregnancy order, the odds ratio of the association between paternal exposure to approximately 5 ppm of benzene and the risk of spontaneous abortion was close to and statistically not different from unity (OR = 1.1; 95% CI (0.7-1.8).

CONCLUSION

In this study paternal exposure to benzene did not increase the risk of spontaneous abortion.

[Current status of surgical transduodenal papillotomy]

The treatment of biliary lithiasis has changed during the past 20 years. Cholecystectomy remains the gold standard for cholelithiasis, but many options are available for calculi of the common bile duct. Among them are surgical open or laparoscopic choledochotomy, biliary-enteric anastomosis, transduodenal sphincterotomy (TDS), endoscopic sphincterotomy. With the aim to describe the current place of TDS, we reviewed the patients operated on in our department between 1976 and 1992. We found 78 patients with a mean age of 58 years (26-89 years). 34 (43%) of them had acute cholecystitis, with 26 being operated on urgently. 47 (60%) were jaundiced, 15 (19%) had pancreatitis and 12 (15%) had cholangitis before operation. Indications for TDS have been impacted stone or absence of progression of the contrast medium on intraoperative cholangiography in 71 patients (91%). 3 patients died (1 pulmonary embolism, 1 sepsis of pulmonary origin, 1 MOF syndrome complicating preoperative necrotizing pancreatitis). 30 patients (38%) had complications, of which 20 were directly related to TDS. Hemorrhage occurred in 4 cases, and resolved spontaneously without transfusion. Hyperamylasemia occurred in 17 instances, but clinical pancreatitis developed in only 1 case, with complete resolution. 1 duodenal fistula healed after conservative therapy. No death is attributable directly to TDS. Today, the importance of endoscopic sphincterotomy is increasing. This retrospective study shows that TDS, if performed with caution, does not increase the operative risks even in emergent operations. During surgical exploration of the common bile duct, TDS is indicated to remove an impacted stone, or as a bilio-enteric anastomosis if multiple stones are present with a thin common duct.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of thyroid status on thyroid autoimmunity expression in euthyroid and hypothyroid patients with Hashimoto's thyroiditis

OBJECTIVE

In patients with hypothyroid goitrous Hashimoto's thyroiditis, the recovery from hypothyroidism seems to be due to a spontaneous decrease of antibodies (Ab) to the TSH-receptor (R). In contrast, in patients with Graves' disease made euthyroid by antithyroid drug therapy, the suppression of TSH secretion by thyroid hormone during antithyroid drug treatment decreases the production of Ab to TSH-R. We investigated in patients with initially euthyroid or hypothyroid goitrous Hashimoto's thyroiditis the relationships between thyroid status and the serum TSH-R, peroxidase (TPO) and thyroglobulin (Tg) Ab concentrations in untreated or L-thyroxine (T4) treated patients.

PATIENTS

A prospective study of 174 consecutive patients, referred with goitrous Hashimoto's disease in an initially euthyroid (group I, n = 78) or hypothyroid (group II, n = 96) state. The patients with positive (> or = 7%) TSH-RAb (group I, n = 18; group II, n = 22) were reinvestigated 12 months after the initiation of L-T4 therapy. After which, (1) L-T4 was continued and an evaluation performed 2 months later (i.e. 14 months after L-T4 initiation) in 9 patients of group I and in 11 patients of group II or (2) L-T4 was withdrawn and an evaluation performed 2 months later in 9 patients of group I and in 11 patients of group II.

MEASUREMENTS

Measurements of basal plasma TSH, free T4 (FT4) and total T3 and serum TSH-R, TPO and TgAb.

RESULTS

The prevalence of positive TSH-RAb levels did not differ between group I (23.1%) and group II (22.9%). However, the mean TSH-RAb level in group I (9.4 +/- 0.4%) was lower (P < 0.01) than in group II (11.6 +/- 0.5%). In the patients with positive TSH-R Ab, (1) the prevalences of positive TSH-RAb decreased (P < 0.001) under L-T4 therapy (group I = 22.2%, group II = 21.2%) and increased again (P < 0.01) 2 months after L-T4 cessation (group I = 77.7%, group II = 63.6%) to reach lower levels (group I, P < 0.05; group II, P < 0.01) than those obtained prior to L-T4 treatment. Statistical analysis of TSH levels through the course of the study confirmed these results. (2) In contrast to the variations of the mean TgAb values, the variations of the mean TPOAb levels in each group were in good agreement with those of TSH-RAb through the course of the study. (3) There were significant correlations between some parameters of thyroid status and both TSH-RAb (TSH, r = 0.43, P < 0.001; FT4, r = -0.35, P < 0.01) and TPOAb (TSH, r = 0.42, P < 0.001; FT4, r = -0.31; P < 0.01) levels. In contrast, no correlations were found between thyroid status and TgAb values.

CONCLUSIONS

This study demonstrates that thyroid status can modulate thyroid autoimmunity expression, such as TSH-RAb and TPOAb, in patients with euthyroid or hypothyroid goitrous Hashimoto's thyroiditis. Similar results have been reported in patients with Graves' disease made euthyroid by the administration of thyroid hormone during antithyroid drug treatment.

[Leishmaniasis in Ecuador. 1. Incidence of cutaneous leishmaniasis on the Pacific coast]

A clinico-epidemiologic survey on cutaneous leishmaniasis, due to Leishmania panamensis, was carried out on 961 persons in two study areas of the Pacific coast of Ecuador, to estimate the prevalence and the incidence of the disease. In the preandean hills, at Paraiso Escondido, the prevalence of active lesions was 4.8%; in the hills of the coastal cordillera, at La Tablada, it was 3.6%. The incidence of new cases in 1991 was high: 147% in the first village, and 106% in the second. These data are far higher than the Health Ministry statistics. The cumulated prevalence, obtained by addition of the scars and active lesions of leishmaniasis, was as high as 66% at Paraiso Escondido, and 47% at La Tablada. Most of the patients (62%) had only one ulcer or scar. Most of the people are contaminated during the first five years they live in these endemic areas. Nevertheless, the incidence remains high in all the age groups, because large numbers of migrants coming from non endemic regions are continuously settling in these colonization areas. Interviews have shown that the contaminations had occurred in the dry season, between July and December. These findings were confirmed by passive case detection at the Hospital A. Egas of Santo Domingo which covered the region. Contamination of young children and position of the lesions on the face suggested a domiciliary transmission, like in Panama and on the Pacific coast of Colombia.

Quality of life in asthma. I. Internal consistency and validity of the SF-36 questionnaire

Asthma is a chronic disease in which social life is altered. The importance of restrictions on social life may be greater in severe asthma or when symptoms are not adequately controlled. General scales of quality-of-life (QOL) may be used to detect the importance of social life impairment, but it is not yet known whether the scores of such QOL measures are reliable and valid in asthmatic patients. A study was carried out in 252 patients with asthma of variable severity (FEV1 ranging from 25 to 131% of predicted) to assess the validity of a general QOL scale, the first French version of the SF-36 health status questionnaire (SF-36). This is based on 36 items selected to represent nine health concepts (physical, social, and role functioning; mental health; health perceptions; energy or fatigue; pain; and general health). All nine SF-36 category scores were highly significantly correlated with the severity of asthma assessed by the clinical score of Aas (p < 0.0007 to p < 0.0001). Eight SF-36 category scores were highly significantly correlated with FEV1 (p < 0.003 to p < 0.0001). A high internal reliability of SF-36 was found using the alpha coefficient of Cronbach (0.91 for the whole questionnaire). The SF-36 questionnaire is valid and reliable in asthma and can therefore be used to examine QOL in asthmatic and nonasthmatic patients and to determine to what extent asthma impairs social life.

A three-state Markov model of Plasmodium falciparum parasitemia

A three-state Markov model taking into account clinical signs of malaria infections by P. falciparum is described. The three states considered are the noninfected (state 0), the infected exhibiting no clinical signs (state 1), and the infected with clinical signs (state 2). Methods for estimating the transition rates from longitudinal data are indicated. This model was used to assess the effect on children of an intervention trial on the use of mosquito nets impregnated with insecticide. The trial was conducted in West Africa (Burkina Faso) between 1985 and 1987. The analysis showed that the intervention was most effective on transition rates between state 1 and state 2.

Efficacy of subcutaneous sumatriptan in the acute treatment of early-morning migraine: a placebo-controlled trial. Early-Morning Migraine Sumatriptan Study Group

OBJECTIVES

To evaluate the efficacy of self-administered subcutaneous sumatriptan in the acute treatment of early-morning migraine attacks.

DESIGN

A double-blind, randomized, placebo-controlled, cross-over study.

SETTING

Thirteen neurology centres in France.

SUBJECTS

Patients of either sex, 18-65 years old, with two to six attacks of migraine (according to the International Headache Society (IHS) criteria, with or without aura) per month, of which at least two had to be early-morning migraine attacks. One-hundred-and-one patients were included, 96 being evaluable for the first attack and 81 for the cross-over design.

INTERVENTIONS

Two migraine attacks (grade 2/3) were treated with sumatriptan (6 mg) or placebo, with an optional second injection 1-24 h later. Main outcome measures. The primary end-point was headache relief: reduction in headache severity from grade 2/3 (moderate/severe) to grade 1/0 (mild/none) 2 h after treatment.

RESULTS

Sumatriptan was superior to placebo for headache relief (32 [78%] vs. 11 [28%] at the first attack; 29 [73%] vs. 8 [20%] at the second; P < 0.001). Because of a significant carry-over effect for some of the secondary end-points, a parallel-group analysis of the first attack was performed, which confirmed a significantly higher efficacy of sumatriptan for all end-points: pain-free rate (22 [46%] vs. 7 [15%]; P = 0.001) and use of a second injection (26 [53%] vs. 38 [81%]; P = 0.004). Sumatriptan was preferred by 74% of patients vs. 17% for placebo, and 9% expressed no preference (P < 0.0001). After complete relief, headache reappeared in 8/23 (35%) patients with sumatriptan and 3/7 (43%) with placebo. Adverse events were significantly more frequent with sumatriptan but they were minor and transient.

CONCLUSION

Subcutaneous sumatriptan auto-injection is an effective and well-tolerated acute treatment of early-morning migraine attacks allowing earlier return to normal activity.

[Antiemetic effect of ondansetron in recurrent chemotherapy with cisplatin]

Six hundred and twenty-eight courses of cisplatin containing chemotherapy were recorded in patients receiving up to three courses of cytotoxic drugs with ondansetron (OND) given as an antiemetic agent (32 mg as a single iv dose or as a continuous infusion). The sample size of patients decreases from one course to another due to phenomena which may or may not be related to the chemotherapy and the anti-emetic treatment or to the evolution of the cancer disease. For patients with incomplete response to ondansetron, withdrawals could be related to an insufficient antiemetic effect as is known with other antiemetic drugs. Conversely, it is not the case for patients who had a complete response. Therefore, to avoid any bias due to patient selection, the analysis is based on the probability of changes from complete to incomplete response or from complete to complete response between two subsequent courses (i and i + 1). The response to OND treatment for the course i + 1 depends not only on the efficacy during this course (i + 1) but also on the response during the prior course (i). A discrete time-dependent statistical model (Markov chain) was used to test the evolution of the probability of remaining in complete response. This probability was equal to 66% between the first and the second course, and to 88% between the second and the third one. The probability of remaining in complete response significantly increased during repeated courses (P = 0.001). These results show that in patients for whom OND treatment allows a complete antiemetic control during the first course of chemotherapy, the probability of remaining with no emetic episodes at all increases during the two subsequent courses.

[Quality of life and migraine. Validation of the QVM questionnaire in hospital consultation and in general medicine]

The feasibility, the validity and reliability of the questionnaire "Qualité de Vie et Migraine" (QVM) were assessed during a study performed on 107 patients recruited either in neurological departments in hospitals (N = 58) or by G.P. (N = 49). The study was designed as a Test-Retest, the self-questionnaire being filled twice at an interval of one week. The filling-in time was an average 7 min in hospital and 11 min for G.P.'s patients. The missing values were quite rare, between 1% and 2%. The items were assessed "very interesting" or "interesting" by 94% of the patients, and "easy" or "fairly easy to understand" by 96%. The principal component analysis performed on the whole sample allowed the extraction of 4 meaningful factors which were in agreement with the pre-defined structure of the questionnaire QVM. The 1st axis was a factor of psychological repercussion, the 2nd axis was a factor of functional and somatic repercussion, the 3rd axis was a factor of social repercussion and the 4th one was a factor of disturbance generated by the treatment. The QVM questionnaire allowed the calculation of a global index of quality of life and indexes according to the multifactorial structure. The global index was significantly higher for the most severe patients recruited in hospital, which means that the repercussion of migraine on quality of life was greater than for G.P.'s patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Saponin treatment for in situ hybridization maintains good morphological preservation

The commonly used procedures for in situ hybridization require treatment of the tissue with non-ionic detergents and proteolytic enzymes, resulting in considerable loss of morphological detail. In this study proteinase pre-treatment of the tissue was replaced by saponin, a highly surface-active plant glycoside. This saponin treatment allowed good preservation of tissue morphology, as determined by differential interference and contrast enhanced video microscopy. Saponin pre-treatment resulted in an equal or even better hybridization sensitivity with probes recognizing viral (canine distemper virus) and cellular (myelin) nucleic acid sequences in tissue cultures as well as in paraffin sections. Probable mechanisms of how saponin allows probe penetration while maintaining the morphological details are discussed.