A SERVICE
OF 
Journal Briefs:
Methadone in Liver Patients; Expectations of Stem Cell Transplant Patients; A
Genetic Mutation in Interstitial Lung Disease
March 1, 2001· by TNN Medical Reporter Virginia
Baskerville
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Journal articles in late February focused on methadone use in liver
transplant candidates, discrepancies between doctors and patients in their
expectations of stem cell transplants, and a genetic link to interstitial lung
disease.
- Recovering drug addicts seeking liver transplantation face a
conundrum: about a third of liver transplant programs require transplant
candidates to stop using methadone. However, discontinuation of methadone as a
medically supervised opiate replacement therapy can result in relapse to
illicit opiate use in about 82% of patients, and relapse may disqualify
patients for surgery, Monika Koch, MD, and Peter Banys, MD, of Veterans Affairs
Medical Center in San Francisco, reported on February 28 in JAMA
(2001;285:1056-1058). The authors concluded that there is no evidence "to
support the practice of discontinuing methadone maintenance as a precondition
for liver transplantation." See
http://jama.ama-assn.org/issues/current/abs/jbr10014.html.
- Before stem cell transplantation, patients with advanced disease
tend to be more optimistic about the outcome than their doctors, Stephanie J.
Lee, MD, MPH, and colleagues at Dana-Farber Cancer Institute in Boston said in
the same issue of JAMA (2001;285:1034-1038). However, the patients
and the doctors who were surveyed by the researchers were fairly accurate in
estimating treatment-related mortality when mortality was below 30%. The
authors suggested that doctors should try to determine their patients'
expectations early in the process of deciding whether to have a transplant. See
http://jama.ama-assn.org/issues/current/abs/joc01946.html.
- A mutation in the surfactant protein C gene (SP-C gene) has been
associated with familial interstitial lung disease, researchers led by Lawrence
M. Nogee, MD, of Johns Hopkins University School of Medicine said on February
22 in The New England Journal of Medicine (2001;344:573-579). The
authors found the mutation in a mother and her newborn daughter; neither had
respiratory symptoms at birth but both developed interstitial lung disease in
infancy. Investigators hope that identification of SP-C gene mutations as a
possible cause of interstitial lung disease may provide for more accurate
classification of the many conditions categorized as interstitial lung disease.
Newborns who lack another component of surfactant, SP-B, can survive with the
help of a lung transplant. See
www.nejm.org/content/2001/0344/0008/0573.asp.
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