Pruritus can be a debilitating symptom in patients with chronic cholestasis. Based on previous reports of its efficacy, we evaluated the impact of rifampin on the pruritus associated with primary biliary cirrhosis. Fourteen patients were included in a randomized, crossover study. After a 15-day washout period, subjects were followed for three weeks. During the first and third week, patients received 600 mg of rifampin or placebo; no treatment was administered during the second week. Pruritus was subjectively scored on a scale from 0 to 100. With rifampin, pruritus disappeared in 11 patients and partially improved in three; with placebo, only two had a partial response (P less than 0.001). Six patients with a prior poor or no response to cholestyramine improved with rifampin. No changes in biochemical tests or side effects were observed during this period. We conclude that short-term administration of rifampin relieves pruritus in primary biliary cirrhosis. When administered over a period of eight months in an open study, the relief of pruritus was maintained, while one individual developed an allergic reaction. Rifampin appears to be a safe drug in the management of the pruritus of primary biliary cirrhosis.

Five cases of small cell carcinoma (SCC) of the bladder are reported with pathologic and immunohistochemical findings and clinical follow-up. Sixteen additional cases reported in the literature are studied and staged according to depth of tumor infiltration of the bladder wall. In our series of five cases and those reviewed from the literature, survival appeared to be dependent on stage of the tumor, analogous to the more common transitional cell carcinoma (TCC). We report two of five patients with the longest recorded follow-up times in the literature who are alive with no evidence of disease at 4 and 6 years. Contrary to the belief that SCC of the bladder is an aggressive, rapidly disseminating tumor similar to SCC of the lung, our findings support the notion that this is a potentially curable neoplasm with a prognosis that appears to be dependent on stage and surgical resectability.

Background-Less than 15% of patients with chronic hepatitis C show a sustained virological response to interferon treatment. Aim-To evaluate the eYcacy and safety of diVerent doses of ketoprofen combined with interferon-2b in the treatment of chronic hepatitis C. Patients/Methods-Seventy compensated patients with chronic hepatitis C received interferon-2b 3 million units three times a week for six months. They were randomly assigned to: group 1 (n = 23), interferon2b alone; group 2 (n = 23), interferon-2b plus 200 mg ketoprofen three times a week; group 3 (n = 24), interferon-2b plus 200 mg ketoprofen twice a day. Complete and sustained responses were defined as normal serum alanine aminotransferase levels and negative serum hepatitis C virus RNA at six and 12 months respectively. Results-Complete and sustained responses were similar in groups 1 and 2: 10% v 5% and 5% v 0% respectively. In group 3, complete response was 29% (p = 0.13 v group 1 and p = 0.04 v group 2) and sustained response was 26% (p = 0.07 v group 1 and p = 0.01 v group 2). Overall, adverse events were similar in the three groups. However, 'flu-like syndrome was less common in group 2 (30%) and group 3 (37%) than in group 1 (77%) (p = 0.01). Conclusions-Twice daily ketoprofen administration combined with interferon2b produced an increase in complete and sustained responses. Although the combination of interferon-2b with ketoprofen was well tolerated and decreased the incidence of 'flu-like syndrome, it is advisable to monitor possible non-steroid antiinflammatory drug hepatotoxicity.

Calciphylaxis, or calcific uremic arteriolopathy, commonly affects people with end-stage renal disease and carries with it a high rate of morbidity and mortality. Here, we present the unusual case of a 56-year-old woman, with extensive medical problems, who developed calciphylaxis in the presence of primary hyperparathyroidism. Our patient initially presented with bilateral, exquisitely tender thigh lesions. The diagnosis of calciphylaxis was rendered histologically by extensive calcification of the subcutaneous blood vessels. Subsequent parathyroidectomy identified the presence of a hyperactive mediastinal parathyroid adenoma, weighing 0.62 grams. Postoperatively, the patient had normalization of hypercalcemia and parathyroid hormone levels, with subsequent healing of her thigh wounds. Currently, there have been sixteen cases described in the English literature, with only nine being offered a potentially therapeutic parathyroidectomy. It is contingent upon the vigilant physician to diagnose and properly manage this difficult yet treatable condition.

A scoring system was used to classify 310 patients with breast carcinoma. Tumors were divided and scored according to their architectural patterns and histological features of known prognostic significance such as tumor volume, nuclear grade, mitosis, etc. According to the scoring value, tumors were classified as aggressive (A), moderately aggressive (M), and low aggressive (L). Results showed a higher rate of metastasis in patients with A tumors (72%) and M tumors (63%) when compared with L tumors (22%). There were 175 patients with axillary lymph node metastasis. Of these, 101 had A tumors, 91 had recurrences (90%), and 81 died (80%); of the 56 patients with M tumors, 26 had recurrences (46%) and 9 died (16%) (P less than 0.001). None of the 18 cases classified as L recurred (P less than 0.001). There were 135 patients with no nodal metastasis: 39 had A tumors (21 recurrences [54%] and 19 deaths [49%] and 96 had M and L tumors (1 recurrence [1%] and no deaths) (P less than 0.001).