Antimalarial agents and lupus

Antimalarials are under-utilized, disease-modifying agents that are useful in the management of lupus erythematosus. Antimalarials can promote a remission in non-organ-threatening lupus and decrease its risk of dissemination. They are especially useful for cutaneous and inflammatory joint disease and have modest actions in improving serositis, fatigue, and cognitive dysfunction. As agents that do not depress the bone marrow or promote opportunistic infections, antimalarials have potential applications in combination with other antilupus medications and with each other.     

Drugs recently associated with lupus syndromes

To assess the long-term outcome in patients with acute cholecystitis treated initially by percutaneous cholecystostomy, the authors reviewed the medical and radiology records of all such patients treated at their hospital from January 1990 to September 1993. Of the 50 patients, 29 had calculous and 21 had acalculous cholecystitis. In the group with calculous cholecystitis, 1 of the patients required no further treatment, 3 subsequently underwent percutaneous stone removal, 14 underwent elective cholecystectomy, 6 underwent emergency cholecystectomy and 5 died of the underlying condition shortly after cholecystostomy. In the group with acalculous cholecystitis, 12 of the patients needed no further treatment after a mean follow-up period of 12 months; 8 of these underwent follow-up ultrasound examination, which revealed gallbladder calculi in only 1 patient. Four patients underwent elective cholecystectomy, 1 underwent emergency cholecystectomy, and 4 died of the underlying condition shortly after cholecystostomy. Over the long term, 23 (79%) of the 29 patients with calculous cholecystitis underwent surgery or removal of calculi. In the other group surgery was required in only 5 (24%) of the 21 patients. The authors conclude that percutaneous cholecystostomy is a useful temporizing measure, which allows patients with calculous cholecystitis to undergo elective cholecystectomy. In most cases of acalculous cholecystitis the procedure is curative, obviating the need for cholecystectomy.     

Acute sympathetic hyperfunction in overlapping syndromes of systemic lupus erythematosus and polymyositis

A 20-year-old woman with arthralgia, serositis, thrombocytopenia, proteinuria, muscle weakness, elevated creatinine kinase, and positive anti-Sm antibody was diagnosed as having polymyositis and systemic lupus erythematosus (SLE). She had persistent high temperature, sinus tachycardia, hyperhidrosis, mydriasis, visual disturbance, hallucination, and loss of consciousness. Levels of plasma adrenaline, noradrenaline, and dopamine and cerebrospinal fluid interleukin (IL)-6 and IL-8 were all high. A diagnosis of sympathetic hyperfunction accompanied by central nervous system (CNS) involvement in SLE was made parenteral. Pulse administration of high dose corticosteroid therapy was effective. This is the first reported case of a connective tissue disease with CNS involvement manifesting as sympathetic hyperfunction with high plasma catecholamine levels.     

Allergic reactions to drugs and biologic agents

Drug allergies are adverse reactions resulting from immunologic responses to drugs or their metabolites. These reactions result in predictable patterns of organ-specific or systemic hypersensitivity that usually recur on subsequent exposure to the same drug. Although diagnostic testing for drug allergy is available for only a few drugs, protocols have been developed to assist in management of allergic reactions to many drugs and biologic agents. Other protocols assist in the management of patients who develop drug reactions while undergoing multiple drug therapy or those with a history of adverse drug reactions who again require treatment for the same condition.     

Role of vigabatrin and lamotrigine in treatment of childhood epileptic syndromes

PURPOSE: Vigabatrin (VGB) and lamotrigine (LTG) are two new antiepileptic drugs (AEDs) with different mechanisms of action for treatment of refractory epilepsies. Previous reports have indicated efficacy of both drugs in a number of epileptic syndromes. METHODS: We compared these new AEDs drugs to determine their respective efficacy against different types of epileptic syndrome and to develop a rational approach to their use. We reviewed the charts of 105 children, with partial and generalized epilepsies. RESULTS: VGB was to be significantly more effective in children with partial epilepsies, and LTG was more effective in those with generalized epilepsies. CONCLUSIONS: VGB and LTG have different therapeutic profiles. Combination treatment with the two drugs may represent rational polytherapy for patients with epilepsy resistant to treatment with either drug alone or as add-on to other AED treatment.     

Acute coronary syndromes: 2. Antiplatelet agents

Therapies with novel antiplatelet agents and anticoagulants are the focus of current research. When used separately or in combination, these agents prevent generation of thrombin by activated platelets. The new therapies, in conjunction with judicious use of fibrinolytic drugs and mechanical interventions, are revolutionizing the management of patients with acute coronary syndromes.     

Role strain and psychological well-being in women with systemic lupus erythematosus.

The following is an abstract of the winning paper submitted for the 1993 Student Research Award Competition in association with the 101st Annual Convention of the American Psychological Association. Karasz's paper was presented as a poster at the convention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hepatotoxicity of anticholesterol, cardiovascular, and endocrine drugs and hormonal agents

Drugs in these categories may have effects on several organs in addition to the liver. For example, amiodarone may produce thyroid and corneal injury apart from or in addition to the phospholipidosis seen in the liver. Oral contraceptive steroids remain a rare but important concern for developing hepatic adenomas and possibly hepatocellular carcinoma, as well as a risk factor for developing Budd-Chiari syndrome in long-term users. Among the antihyperlipidemic agents, nicotinic acid, especially the sustained release formulations, may produce severe of even fatal hepatic injury. Increasing numbers of reports of hepatotoxicity from newer beta blockers and angiotensin-converting enzyme inhibitors require ongoing vigilance in patients receiving these medications.     

Role of viral agents in the pathogenesis of Kaposi''s sarcoma

Several viruses have been detected, at various frequencies, in Kaposi's sarcoma (KS) tissues. The detection of human herpesvirus 8 (HHV-8) in all the epidemiological and histological forms of KS makes it the most attractive candidate causative agent to date. In this report, we discuss the possible explanations for the detection of genomic sequences of various viral agents in KS and the putative role of those viruses in the pathogenesis of the disease.     

Environmental-medical diagnosis and therapy. Hasty diagnosis of unspecified environmental syndromes should be avoided

In the past ten years environmental medicine has virtually exploded. Major instruments for the interdisciplinary environmental-medical diagnosis are history, on-site inspection, biomonitoring and ambient monitoring. Since the definitive diagnosis of an environment-related disease usually requires a joint evaluation of toxicological, somatic and psychosomatic findings, it is recommended that cooperation with an experienced center for environment medicine should be established early on. By doing so, an inappropriate diagnosis of unspecific environment-medical symptom complexes such as, e.g., multiple chemical sensitivity may be avoided. Such "diagnoses" may result in drastic, and for the patient and his family, often stressful, consequences.     

Role of apoptotic response in cellular resistance to cytotoxic agents

To elucidate compositional changes of the pubic symphysis (PS) by aging, elements of pubic symphysis (PSs) removed from 26 cadavers were determined by inductively coupled plasma atomic-emission spectrometry. It was found that the relative contents (RCs) of calcium and phosphorus in women's PSs were about three- and five-fold amounts as compared with those in men's PSs, respectively. In contrast, the RCs of sulfur, magnesium, sodium, and iron in women's PSs were somewhat lower than those in men's PSs. The accumulations of calcium (Ca) and phosphorus (P) in women's PSs occurred mainly beyond the age of 70-yr-old, but did not occur in men's PSs.     

Multi-drug resistance and myelodysplastic syndromes: a possible role for remission inducing agents?

Expression of P-glycoprotein (PGP), the product of the multidrug resistance gene (mdr1), is common in myelodysplastic syndromes (MDSs) and explains in part the low rate of complete remissions (CRs) obtained after aggressive chemotherapy. Reversion of the mdr phenotype to restore chemosensitivity has been the focus of many studies over the last ten years. Two phase III studies evaluated quinine for obtaining reversion of mdr gene expression in MDSs treated by aggressive chemotherapy. Results suggested better response rates and longer survival times in quinine-treated MDR-positive patients. However, the toxicity of quinine warrants further work aimed at developing other mdr phenotype reversion-inducing agents. Some such agents have proved superior over quinine in in vitro studies. Reversion of other mechanisms underlying chemoresistance in MDSs is a promising avenue of research.     

The effects of drugs and anaesthetic agents on the urinary bladder and sphincters

The influence of sedative, anaesthetic and neuromuscular blocking drugs on diagnostic urethral pressure profiles and cystometrograms has been investigated. These agents have marked effects on the results obtained; in particular, the urethral pressure profile was raised by opiates and lowered by anaesthetic induction agents. Bladder capacity as measured by the cystometrogram was greatly increased by halothane. These findings indicate that urodynamic studies should be performed only on conscious unsedated patients.     

Helicobacter pylori and non-steroidal anti-inflammatory drugs: lone agents or partners in crime?

A variety of mechanisms are responsible for the gastric and duodenal mucosal injury known to result from the consumption of non-steroidal anti-inflammatory drugs (NSAIDs). Many of these mechanisms may be influenced by coexistent infection with Helicobacter pylori. However, evidence of increased risk from NSAIDs in patients with this bacterium is contradictory. While some authors have reported that symptoms, severity and prevalence of mucosal damage are higher in H. pylori-positive individuals taking NSAIDs than in those who are H. pylori negative, others have noted no significant difference. Reasons for this conflict may include the age of the subjects studied, duration of treatment, toxicity of the NSAID employed and pathogenicity factors related to different strains of H. pylori.