New York University School of Medicine Drug Development Educational Program: 2-Year Benchmark.

Drug development (DD) is a multidisciplinary process that spans the translational continuum, yet remains an understudied entity in medical schools and biomedical science institutes. In response to a growing interest and unmet need, we implemented a DD course series that details identification of viable molecular targets, clinical trial design, intellectual property, and marketing. Enrollment is open to faculty, postdoctoral trainees, and MD, PhD, and MS students. After 2 years, 37 students and 23 students completed the fall and spring courses, respectively. Pre/post-surveys demonstrated gained knowledge across course topics, with mean survey scores increased by 66% (p < 0.001) after each course. Lectures for each course were consistently rated highly, with a mean course rating of 4.1/5. Through this program, trainees will have a more innovative approach toward identification of therapeutic targets and modalities. Furthermore, they will learn to integrate technology and biomedical informatics to find creative solutions in the DD process.

High dose urokinase for restoration of patency of occluded permanent central venous catheters in hemodialysis patients.

BACKGROUND: Catheter thrombosis is common and results in inadequate dialysis treatment and, frequently, in catheter loss. Since dialysis treatment runs on a strict schedule, occluded catheters need to be restored in a timely and cost effective manner. We present a new shortened protocol of urokinase infusion that allows hemodialysis to be performed within 90 minutes. METHODS: To chronic hemodialysis patients, who developed complete catheter occlusion, urokinase was infused simultaneously through both lumens of the catheter (125,000 units to each lumen) over 90 minutes. Technical success was defined as restoring blood pump speed to at least 250 ml/min. We determined the average time from catheter placement to first clot event (primary patency PP), recurrent clot event after urokinase treatment (secondary patency SP), catheter salvage rate and cause for removal. RESULTS: 37 catheters developed total thrombosis and urokinase was used to restore patency one or more times (total 47 treatments). Catheter salvage rate was 97 %. The average time of PP was 152 ± 56 days (7 - 784 days). Nine patients (30%) developed recurrent occlusion and the average time of SP was 64 ± 34 days (2 - 364 days). One catheter was removed because of dysfunction due to thrombosis. Other catheters were removed due to infection, fistula maturation or fell out spontaneously. Hemodialysis was performed immediately after treatment with blood speed of 250 ml/min in all patients. CONCLUSION: Our protocol is highly effective, short, and allows to restore patency of totally occluded central venous catheters with minimal disruption of the dialysis session.

Treatment of end-stage renal failure due to diabetes mellitus with peritoneal dialysis--treatment of choice?

End-stage renal failure (ESRF) is a common complication of diabetes mellitus, especially the insulin-dependent form. Treatment of these patients with dialysis and/or transplantation has become widespread and it has been suggested that peritoneal dialysis has several advantages when compared to hemodialysis. This report describes the results of therapy using peritoneal dialysis in seven ESRF patients. These patients did not do well and only two were alive at the end of the follow-up period. Diabetic retinopathy did not progress during treatment and peritonitis was not more common in diabetics than nondiabetics. Renal transplantation is the preferred mode of treatment in diabetic ESRF patients. In our experience there is no difference between hemodialysis and peritoneal dialysis.

A carcinoid-like syndrome caused by a prostaglandin-secreting renal cell carcinoma.

We report a case of carcinoid-like syndrome in a patient with metastatic renal cell carcinoma. Peripheral venous plasma levels of prostaglandin (PG) E and of a derivative of PGF2 alpha were raised during the attacks. The urinary excretion of 5-hydroxyindoleacetic acid was repeatedly normal. The flushing attacks were not prevented by therapy with antihistamines, phenothiazines, antiserotonin agents, or glucocorticoids. Treatment with aspirin completely prevented the attacks, and its withdrawal led invariably to their recurrence.