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BMJ No 7106 Volume 315 Papers - Abstracts Saturday 23 August 1997
Management of chronic hepatitis C: clinical audit of biopsy based
management algorithm
Management of chronic hepatitis C: clinical audit of biopsy based management algorithmG R Foster, R D Goldin, J Main, I Murray-Lyon, S Hargreaves, H C Thomas AbstractObjective: To assess the attendance, outcome, compliance with treatment, and response to interferon alfa in patients with chronic hepatitis C who attended during 1995 and were treated according to a biopsy based algorithm.Design: Retrospective audit of all patients with chronic hepatitis C attending outpatient clinics over one year. Setting: The liver unit at a London teaching hospital. Subjects: 255 patients with chronic hepatitis C. Main outcome measures: Patient survival, attendance, and compliance with diagnostic and therapeutic regimens. Response to interferon alfa treatment, based on loss of viraemia three months after cessation of treatment. Results: A large proportion of patients (39%) with newly diagnosed chronic hepatitis C infection do not want to undergo further investigation. Of those patients who do attend for further treatment, a large proportion with severe hepatic fibrosis (42%) do not want to undergo currently available treatment. The response rate to interferon (21%) in treated patients was similar to that previously reported in a trial setting. There was no significant difference in response rates in patients with or without severe fibrosis not amounting to cirrhosis. In patients with cirrhosis there was a high incidence of hepatocellular carcinoma (18%) over a follow up period of 20 months. Conclusion: Current strategies aimed at investigating and treating patients with chronic hepatitis C are not acceptable to a large proportion of patients. Many patients with cirrhosis related to hepatitis C infection develop hepatic neoplasms, and management strategies to deal with this problem are urgently required. Liver Unit and Department of Histopathology, Chelsea and Westminster Hospital, Kensington and Chelsea and
Westminster Health Authority, Correspondence to: Dr Foster. Withdrawal of long term diuretic medication in elderly patients: a double blind randomised trialEdmond P Walma, Arno W Hoes, Colette van Dooren, Ad Prins, Emiel van der Does AbstractObjectives: About 20% of elderly people use long term diuretic medication, but there is doubt whether prolonged diuretic medication on such a large scale is necessary. We performed a study to assess what proportion may successfully be withdrawn from diuretic therapy.Setting: General practice. Subjects: 202 patients taking long term diuretics without manifest heart failure or hypertension. Interventions: Patients were allocated to either placebo (withdrawal group, n=102) or continuation of diuretic treatment (control group, n=100). Main outcome measure: Occurrence of clinical conditions requiring diuretic therapy based on fixed criteria. Results: During follow up diuretic therapy was required in 50 patients in the withdrawal group and 13 in the control group (risk difference 36%; 95% confidence interval 22% to 50%). Heart failure was the most frequent cause of prescribing diuretic therapy (n=25). Cessation of diuretic therapy caused a mean increase in systolic blood pressure of 13.5 (9.2 to 17.8) mm Hg and in diastolic pressure of 4.6 (1.9 to 7.3) mm Hg. Conclusion: Withdrawal of long term diuretic treatment in elderly patients leads to symptoms of heart failure or increase in blood pressure to hypertensive values in most cases. Any attempt to withdraw diuretic therapy requires careful monitoring conditions, notably during the initial four weeks. Department of General Practice, Department of Epidemiology and
Biostatistics, Correspondence to: Dr Walma. Home | Current contents | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline
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