A comparison of a 3 day course with a 2 week course of oral prednisolone in patients with chronic asthma

This study was carried out as an attempt to evaluate the relationship between the results of nasal patency examinations and selected anthropometric measurements of nasal cavities in children with complete primary and secondary cleft palate. The examined group consisted of 130 children with cleft palate treated by means of surgery in early childhood owing to their clefts. Concerning the diagnostic methods the study group was divided into two subgroups. Group I consisted of 75 children in whom face photographs in frontal and axial projections towards the external nasal aperture were analysed. Group II consisted of 55 children in whom by means of P-A teleradiography projection the total area, the maximum height and width of nasal cavity were measured separately for the side with cleft and without cleft. The assessment of nasal patency tests using the objective method--active anterior rhinomanometry was carried out.     

Therapy for neurocysticercosis: a reappraisal

Accepted approaches to therapy for the different forms of neurocysticercosis are reviewed. Therapy must be individualized according to the level of disease activity and the location of the parasite. Patients with inactive disease should receive only symptomatic treatment. In contrast, patients with parenchymal brain cysts must receive a course of anticysticercal drugs. Both albendazole and praziquantel are useful; however, recent evidence favors the former as the drug of choice for this form of the disease. Albendazole (but not praziquantel) is also effective in the treatment of giant subarachnoid cysts; such medical treatment obviates surgery in some cases. Patients with ventricular cysts may also benefit from medical therapy; however, surgery is the current approach to this type of lesion, as it is to spinal cysticercosis. Although intraocular cysts have classically been resected by surgery, a recent study indicates that albendazole is equally effective. For patients with mixed forms of neurocysticercosis, therapeutic measures related to--but not directly targeting--the disease (i.e., steroid administration for brain edema or shunt placement for hydrocephalus) should be contemplated before therapy with anticysticercal drugs is instituted.     

Diary of a week in practice

Spontaneous cavernositis is a distinctly uncommon entity. Corporeal infection and abscess formation have been described in association with priapism, cavernosography, intracavernous injection therapy, trauma and penile prostheses. We report a case of acute necrotizing cavernositis in a diabetic patient, which presumably originated with hematogenous seeding from a periodontal abscess. Isolation of typical oral pathogens from corporeal cultures provides bacteriological evidence of a dental source for the corporeal infection.     

Treatment of canine pyoderma with co-amoxyclav: a comparison of two dose rates

The efficacy of oral co-amoxyclav, administered twice daily for up to 12 weeks either at the manufacturer's dose rate of 12.5 mg/kg or at 25.0 mg/kg, in curing the lesions of canine folliculitis, furunculosis and cellulitis was compared in a blind study. A total of 97 dogs entered the trial and 67 completed it. There was no significant difference in the rate of cure or the duration of therapy. The lesions of folliculitis were cured in 91.5 per cent of cases, in a mean period of 25.3 days. Furunculosis and cellulitis were cured respectively in 87.5 per cent and 60.0 per cent of the dogs, in mean periods of 37.6 and 44.7 days. The standard dose rate was very effective in folliculitis and furunculosis and there was no benefit in doubling the dose. Too few cases of cellulitis were treated to provide a reliable dose comparison.     

Combined albendazole and praziquantel versus albendazole alone in the treatment of hydatid disease

BACKGROUND/AIMS: This study was conducted to evaluate the effect of different regimens of medical treatment in hydatid disease at the Armed Forces Hospital, Riyadh. METHODOLOGY: Between April 1985 and August 1990 albendazole was used alone in the treatment of 22 patients with hydatid disease, mainly of the liver. Since September 1990, we have used a combination treatment of albendazole and praziquantel in 19 patients. RESULTS: For those patients treated only with albendazole, 8 patients (36.4%) showed a complete disappearance of the cyst, in 4 of which the treatment period ranged between 6 months to 2 years. The other 4 patients had ruptured liver cyst into biliary tree and had endoscopic treatment with complete recovery over a short period. For those patients treated with albendazole and praziquantel the following results were found. During a follow-up period of 2 months to 3 years and a treatment period of only 2-6 months there was complete disappearance of the hydatid cyst in 9 patients (47.4%) and over 50% reduction of the hydatid cyst in 5 patients (36.84%). CONCLUSION: Combination treatment with albendazole and praziquantel for hydatid disease is more effective than albendazole alone.     

Ocular and sinus microsporidial infection cured with systemic albendazole

PURPOSE: To report treatment of a patient with acquired immunodeficiency syndrome (AIDS) and ocular and paranasal sinus microsporidial infection. METHOD: Case report. RESULTS: A patient with AIDS and ocular microsporidial infection experienced resolution of ocular symptoms with topical fumagillin, but symptoms recurred upon cessation of therapy. Paranasal sinus microsporidial infection was diagnosed. The patient received sequential systemic treatment with itraconazole followed by albendazole. Sinus symptoms resolved with albendazole. He remained symptom-free with a normal examination 17 months after concluding therapy. CONCLUSIONS: Although fumagillin and itraconazole may have played a role, systemic albendazole appears to be responsible for clinical resolution of microsporidial infection.     

Pneumococcal pneumonia with a sever course

The authors present a case of a 70-years old patients with bilateral pneumonia of pneumococcal etiology. During the treatment, after the initial improvement respiratory failure was observed and mechanical ventilations was applied. Following this procedure appeared such complications as left pneumothorax and pleural empyema. After drainage and evacuation of purulent fluid from pleural cavity the clinical improvement was observed. The case shows how pneumonia is still dangerous, especially for patients with chronic obstructive pulmonary disease.     

Pharmacokinetic optimisation of the treatment of neurocysticercosis

Neurocysticercosis is the most important parasitic infection of the nervous system. It is common in communities living in conditions with poor hygiene. Until the last 2 decades, there was no specific pharmacological treatment: surgery and corticosteroids were the only medical alternatives. The recent introduction of anticysticercal drugs, an isoquinoline (praziquantel) and a benzimidazole (albendazole), has dramatically changed the medical management of neurocysticercosis. Praziquantel is taken orally and undergoes extensive first pass hepatic biotransformation. Peak concentration in serum is reached after 1 to 2 hours and the elimination half-life is between 1 and 3 hours. Praziquantel permeates the blood-brain barrier, thus explaining its effectiveness on parenchymal brain cysticercosis. Plasma concentrations of the drug are increased when a high carbohydrate diet is administered. Cimetidine also increases the plasma concentration of praziquantel by inhibition of cytochrome P450. Bioavailability of the drug is markedly reduced when given jointly with antiepileptics or corticosteroids, specially carbamazepine, phenytoin or dexamethasone. The current schedule for neurocysticercosis treatment lasts 2 weeks at daily doses of 50 mg/kg. Recently, a new therapeutic scheme has been proposed that considers the pharmacokinetics of the drug. This regime lasts only 1 day and includes 3 dosages of 25 mg/kg at 2-hour intervals. This increases the time that the parasite is exposed to high drug concentrations. This therapeutic scheme has produced similar results to longer schemes, with the additional advantages of cost, length of usual treatments and reduction in total dose received (being one-tenth of the total dosage). Albendazole is considered by many as the drug of choice for treatment of neurocysticercosis. It is given orally and is rapidly and extensively metabolised to albendazole sulfoxide (ALBSO), which is considered to be the metabolite directly or indirectly responsible for both toxicity and efficacy outside the gastrointestinal tract. Concentrations of ALBSO are highly variable between individuals and it has a half-life of between 6 and 15 hours. It also crosses the blood-brain barrier. In patients with extrahepatic obstruction, the elimination process is prolonged and plasma concentration is increased. Fatty meals improve absorption. Concomitant administration of albendazole with dexamethasone or with praziquantel increases plasma concentration of ALBSO. Albendazole is administered in an 8 day course of 15 mg/kg per day in 2 divided doses 12 hours apart. This scheme, based on drug pharmacokinetics, has proven to be highly effective. Inflammation is a common accompaniment of neurocysticercosis; in many cases it is the aetiopathogen responsible for histological damage. Corticosteroid therapy is useful for preventing further tissue injury. Long term corticosteroid therapy can be accomplished with 50 mg of oral prednisone 3 times a week. Acute corticosteroid therapy includes brief courses with high dosages of intramuscular dexamethasone or intravenous methylprednisolone. Clinical decisions on cysticidal and anti-inflammatory treatments must be made with the information gathered by neuroimaging studies, either computed tomography or magnetic resonance, and by the analysis of cerebrospinal fluid.     

Subarachnoid neurocysticercosis with occlusion of the major intracranial arteries: case report

Cysticercosis is the most common parasitic disease affecting the central nervous system. Stroke is a recognized complication of neurocysticercosis, occurring in 2 to 12% of cases, mostly in the form of small lacunar infarcts. We report a case of hemiparesis and aphasia in a 51-year-old Hispanic woman, which was secondary to complete occlusion of the left internal carotid and bilateral anterior cerebral arteries. Magnetic resonance imaging demonstrated the presence of enhancing subarachnoid material surrounding these occluded cerebral arteries, providing antemortem, noninvasive documentation of the inflammatory meningeal cysticercotic reaction that was presumably responsible for the occlusive arteritis causing the cerebral infarction. This represents the third reported case of internal carotid artery occlusion and the first reported case of anterior cerebral artery occlusion secondary to neurocysticercosis.     

Treatment of hypertension during the course of kidney diseases

The aim of this paper was to discuss: pathomechanism of arterial hypertension in patients with renal diseases and the choice of antihypertensive therapy and optimal target blood pressure in these patients.     

Severe massive pseudomembranous colitis with a fulminant course

Psoriasis vulgaris has HLA associations. We have previously defined HLA-Cw6,DR7,DQA1*0201 as the central element of the risk haplotypes for psoriasis. On the other hand, Cw6 as a single gene has the strongest association with psoriasis. The aim of this study was to determine whether the risk haplotype and Cw6 correlate with the clinical parameters of the disease. The series consisted of 64 patients and the clinical parameters were age at onset, family history of psoriasis, arthritis and the frequency of inpatient treatment. The HLA risk haplotype Cw6,DR7,DQA1*0201 had previously been found in 30% and Cw6 alone in 54% of the patients. The presence of Cw6 correlated with early age at onset (Pc = 0.01). The presence of the risk haplotype correlated with a positive family history of psoriasis among the first-degree relatives (Pc = 0.02) and an overall positive family history (Pc = 0.04), but Cw6 had a stronger correlation with an overall positive family history (Pc = 0.01). There were no positive correlations with arthritis or the number of inpatient treatment periods. Only type I psoriasis was associated with Cw6 (Pc = 0.0006). In conclusion, Cw6 and the haplotype Cw6,DR7,DQA1*0201 are important in the heredity of psoriasis vulgaris, but the presence of Cw6 alone is sufficient to indicate a clinically significant risk for psoriasis.     

The course of preexistent immune abnormalities in HIV negative haemophiliacs treated for two years with a monoclonal purified factor VIII concentrate

The administration of factor VIII concentrates has been associated with immune abnormalities in patients with severe haemophilia A, even in the absence of HIV infection. The effects of a monoclonal purified factor VIII concentrate, Hemofil M (Baxter), on preexistent immune abnormalities were assessed over a 2 year period in 22 HIV negative haemophiliacs. They were treated previously with other concentrates, and received Hemofil T from 1983 to 1988. No HIV infection was demonstrated. No serologic evidence for other viral (re)-infections was seen. A decrease of HLA-DR expression on non-B lymphocytes in the first year (P = 0.026), and a decrease of T4-T8 ratio over the 2 years were found (P = 0.0016). Skin tests were non-contributive. The decrease in HLA-DR expression is suggestive for an improved immune function, possibly due to a reduced content of protein or virus in this concentrate.     

Prevalence of neurocysticercosis in individuals affected by epilepsy

INTRODUCTION: In this investigations, was carried out a neurocysticercosis (NC) prevalence study during seven months in the Instituto Neurológico de Antioquia with the purpose of known neurocysticercosis frequency as cause of epilepsy in patients older than ten years that we attended in our institute. MATERIAL AND METHODS: Computerized tomographies (CT) were made to 503 patients, with epilepsy, 24.7% of them were CT positive for NC. Cysticercosis enzyme linked immunoelectrotransfer blot (EITB) and enzyme linked immunoabsorbent assay (ELISA) test were made to 178 patients, 19.6% were EITB positive for NC and 5% ELISA positive for NC. Results. From this result it is possible to infer that about 8% of the 503 patients with epilepsy had cysticercosis, according to EITB that is the golden assay for NC. The CT and ELISA test had 94.3% and 27.7% sensitivity, respectively, according to EITB. The specificity of the CT for NC was 49.2% and specificity for ELISA test was 100% as compared to EITB. The multivariate analysis with logistic regression allowed to establish association of positive EITB with factors such as male sex, eating pork, headaches and multiple lesions in CT. CONCLUSIONS: Prevention and education actions are necessary for the interruption of the neurocysticercosis transmission chain in order to diminish the high prevalence of epilepsy in the country and its complication and consequences.     

Different course of reactive arthritis in two HLA-B27 positive brothers with fatal outcome in one

During an outbreak of Yersinia pseudotuberculosis III, one of two HLA-B27 positive brothers developed reactive arthritis (ReA), mild at first, but later severely destructive and ultimately fatal. The reactivation of ReA was possibly triggered by an oral polio vaccine. The cause of death was severe secondary amyloidosis. The other brother was exposed to the same Y. pseudotuberculosis strain but did not develop any disease during or after the outbreak. However, he later developed ReA due to a Salmonella infection, with a benign course.