Long-term efficacy of sertraline in the prevention of alcoholic relapses in alcohol-dependent patients: A single-center, double-blind, randomized, placebo-controlled, parallel-group study

WOS: 000180013400004Background: Alcoholism may be related to dysfunction of the serotonergic system in some patients. Therapy with a selective serotonin reuptake inhibitor (SSRI) may help to reduce alcohol consumption in these patients. Objective: The aim of this study was to examine the long-term efficacy of the SSRI sertraline in preventing alcoholic relapse and in increasing the number of abstinent days after alcohol withdrawal in alcohol-dependent patients. Methods: Male patients who met the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R) diagnostic criteria for alcohol dependence with no concurrent disorders on Axis 1 participated in this single-center, double-blind, randomized, placebo-controlled, parallel-group study. All of the patients had been withdrawn from alcohol for 7 to 21 days when included in the study during their inpatient treatment and were followed up for 6 months with monthly assessments. Patients were given either two 50-mg capsules of sertraline hydrochloride daily (100 mg/d) or 2 placebo capsules daily. Results: A total of 59 patients (mean [SD] age, 43.8 [8.5] years) were enrolled (30 in the sertraline group and 29 in the placebo group). The 2 groups differed significantly in terms of the mean (SD) number of abstinent days (sertraline, 125.5 [60.6] days; placebo, 91.9 [66.4] days; P = 0.047). Although the percentage of relapse was lower in the sertraline group in all monthly assessments, the difference in percentage of relapse between the 2 groups reached statistical significance only at month 4 (P = 0.027). Conclusions: Sertraline seems to increase the number of abstinent days and thus has a preventive effect on alcoholic relapse. However, this finding needs to be supported by further controlled studies

The effect of allopurinol pretreatment on intestinal hypoperfusion encountered after correction of intestinal volvulus

After reversal of blood flow following a prolonged period of ischemia, blood flow returns for a few seconds and is reduced afterward. This is called ''no-reflow phenomenon.'' Antioxidants such as allopurinol have been shown to prevent the occurrence of this phenomenon in organs other than the intestine. An experimental study was conducted to investigate the effect of allopurinol pretreatment on intestinal blood flow after correction of intestinal volvulus in rabbits. In group 1, baseline intestinal blood flow (IBF) was evaluated using radiolabeled red blood cells. In group 2, 720 degrees intestinal volvulus was created and IBF was evaluated 6 hours later. In group 3, intestinal volvulus was created and devolvulus was performed 6 hours later. Intraperitoneal isotonic saline was injected 60 minutes before correction of the volvulus. IBF was evaluated after correction of the volvulus. Group 4 had the same procedures as group 3, but allopurinol (200 mg/kg) was injected in place of the isotonic saline. IBF stopped 6 hours after volvulus. Compared with the baseline group, IBF was significantly lower in the group with volvulus + devolvulus (P < .01). The IBF of the allopurinol-treated group was significantly higher than that of the isotonic saline group (P < .01) and it did not differ significantly from that of the baseline group. Histopathological examination showed that intestinal volvulus leads to histological injury. The histological injury was more pronounced in the devolvulus group and was less severe in the allopurinol group in comparison to the isotonic saline pretreatment group (P < .01). It is concluded that allopurinol pretreatment prevents the intestinal hypoperfusion (no-reflow phenomenon) and histological injury encountered after correction of intestinal volvulus of 6 hours' duration. Copyright (C) 1996 by W.B. Saunders Compan

The WHO/ISUP grading system for renal carcinoma

Histological tumor grading is an accepted prognostic parameter of renal cell carcinoma (RCC). In 2012, the International Society of Urologic Pathologists (ISUP) proposed a novel grading system for RCC, mainly based on the evaluation of nucleoli: grade 1 tumors have nucleoli that are inconspicuous and basophilic at ×400 magnification; grade 2 tumors have nucleoli that are clearly visible at ×400 magnification and eosinophilic; grade 3 tumors have clearly visible nucleoli at ×100 magnification; and grade 4 tumors have extreme pleomorphism or rhabdoid and/or sarcomatoid morphology. This grading system was validated for clear cell renal cell carcinoma and papillary renal cell carcinoma. At the same time, the ISUP proposed not grading chromophobe renal cell carcinomas according to this system. At a consensus conference in Zurich the World Health Organization (WHO) recommended the ISUP grading system; thus, the WHO/ISUP grading system is now going to be implemented internationally. The ISUP/WHO grading system has not been validated as a prognostic parameter for other tumor subtypes, but can be used for descriptive purposes