Pain from herpes zoster and postherpetic neuralgia

Under observation there were 82 patients operated on for ulcer disease of the stomach and duodenum. Dissemination of the mucosa with Helicobacter pylori (HP) was studied by means of using the urease test. Before the operation the positive result of the study was obtained in 73 patients (89%). In 1-6 months after the operation the HP infection was found in 29 patients (39.7%). The HP persistence retained in 39.7% of the patients subjected to resection of the stomach in spite of the preoperative treatment including De-nol and Metronidazole. Post-resectional reflux-gastritis and anastomositis were more pronounced in HP carriers. The antireflux variants of anastomoses (transversal, terminolateral gastroduodenal anastomosis and gastrojejunal anastomosis by Roux) were followed by much less HP persistence and less frequent cases of anastomositis and gastritis of the gastric stump.     

Presumed bilateral herpes zoster ophthalmicus in an AIDS patient: a case report

A 31-year-old man with the acquired immunodeficiency syndrome presented with herpes zoster ophthalmicus on the right. Five days after he began treatment for the zoster pseudodendrites and skin lesions, he developed superficial punctate keratitis, uveitis, and crusting skin lesions in the left eye. After treatment, the ocular lesions resolved in both eyes without incident. The bilateral manifestation of herpes zoster ophthalmicus is a result of the increased severity associated with immunosuppression caused by the human immunodeficiency virus.     

Association of herpes zoster ophthalmicus with acquired immunodeficiency syndrome and acute retinal necrosis

We conducted a review to investigate the prevalence of human immunodeficiency virus (HIV), or acquired immunodeficiency syndrome (AIDS), in patients with herpes zoster ophthalmicus, as well as the incidence of acute retinal necrosis after herpes zoster ophthalmicus. All charts of patients seen at our institution between 1987 and 1992 with a primary diagnosis of herpes zoster ophthalmicus were reviewed. Of 112 patients with herpes zoster ophthalmicus, 29 (26%) had HIV or AIDS. All these patients were younger than 50 years at the time of diagnosis. Five of 29 (17%) immunocompromised patients had acute retinal necrosis after herpes zoster ophthalmicus. No acute retinal necrosis was identified in the nonimmunocompromised patients after herpes zoster ophthalmicus. We recommend that all patients younger than 50 years who have herpes zoster ophthalmicus at initial examination be tested for HIV. Additionally, HIV-infected patients should be monitored closely after herpes zoster ophthalmicus for development of acute retinal necrosis. Long-term oral prophylactic as well as initial high-dose intravenous acyclovir may be appropriate in HIV-infected individuals with herpes zoster.     

The effect of treating herpes zoster with oral acyclovir in preventing postherpetic neuralgia. A meta-analysis

BACKGROUND: Herpes zoster is a common affliction in older patients, with up to 15% experiencing some residual pain in the distribution of the rash several months after healing. Despite numerous randomized clinical trials, the effect of treating herpes zoster with oral acyclovir in preventing postherpetic neuralgia remains uncertain because of conflicting results. METHODS: Meta-analysis of published randomized clinical trials on the use of acyclovir to prevent postherpetic neuralgia using the fixed-effects model of Peto. RESULTS: Thirty clinical trials of treatment with oral acyclovir in immunocompetent adults were identified. After excluding studies with duplicate data, suboptimal and topical dosing, non-placebo-controlled or nonrandomized designs, and those using intravenous acyclovir, 5 trials were found to be homogeneous and were combined for analysis. From these trials, the summary odds ratio for the incidence of "any pain" in the distribution of rash at 6 months in adults treated with acyclovir was 0.54 (95% confidence interval, 0.36-0.81). CONCLUSION: Treatment of herpes zoster with 800 mg/d of oral acyclovir within 72 hours of rash onset may reduce the incidence of residual pain at 6 months by 46% in immunocompetent adults.     

Evaluation of acceleration plethysmograms in dermatology--efficacy of lipo PGE1 preparations against herpes zoster and neuralgia following herpes

Utilisation of outpatient services in government owned district hospitals in Dar es Salaam, declined by more than 50% following the introduction of user charges in these health facilities in mid July 1993. Outpatient attendances in the private health facilities studied remained constant throughout the year although these charged higher fees. Education and employment status were found to be major factors influencing utilisation of public versus private health facilities. Public facility users (62.8%) had five to eight years of formal education. Private facility users with five to eight years of education were 45.5% and those with more than years of education were 47.1%. While 68.6% of public facility users paid for their own healthcare, more than a quarter (27.3%) had their costs met by relatives or friends. The employer paid for 72% of private facility users, 49.2% of whom stated that this was the reason why they used private facilities. Despite introduction of charges in public hospitals, availability of prescribed medication was poor. Drugs were reported to be always available by only 27.3% of public health facility users compared to 80% of private health facility users.     

Immunomodulating and antiviral therapy in herpes zoster

Two groups of patients with herpes zoster were followed up. The first group was subjected, beside a symptomatic therapy, to an immunological and antiviral treatment. The control group was treated only symptomatically. The immunological preparations used were: the immunostimulant SRE (Corynebacterium parvum), which stimulated the lymphocytes and macrophages, Moroxidin (Virustat-Paris) and Antiherpin (interferon inductor), which acted by blocking the virus replication. The preparations were indigenous and atoxic. A significant difference between the courses of disease in the two groups was observed, namely, the severity and duration of subjective and objective symptoms were more than double and followed by persistent neurological sequelae in the control group in comparison with the patients of the experimental group.     

Lactation associated with herpes zoster pectoralis

The phenomenon of lactation associated with herpes zoster is unexpected. To our knowledge such an association has been reported only once. A case is reported in whom spontaneous lactation occurred in the ipsilateral breast following herpes zoster. It is believed to have resulted from stimulation of the intercostal nerve endings supplying the overlying skin of the breast.     

Clinical presentation of herpes zoster in a Singapore hospital

The purpose of the study was to give a histological picture of the different skin regions of the mammary gland in mares. Special emphasis on the dark coating in the sulcus intermammarius was given. As a result, the dark pigmented udder skin can be subdivided into the skin of the Corpus mammae, the sulcus intermammarius and the teat skin. In the sulcus intermammarius the whole epidermis was considerably thicker than usual, especially the stratum corneum (up to 70 layers of cornified layers) and the stratum spinosum. In general, the squamous keratinocytes were unusually large. The histological preparations of the coating revealed a stratum corneum instead of a supposed secretion of the sebaceous glands. The dermal papillae ended immediately below the stratum corneum.     

Horner's syndrome secondary to ophthalmic herpes zoster

INTRODUCTION: Ophthalmoparesias is a frequent complication of ophthalmic herpes zoster. It occurs in 31% of all cases. However, the presence of Horner's syndrome during viral reactivation is a rarity which has only been previously described on two occasions, and never associated with cranial nerve involvement. CLINICAL CASE: We describe a patient with the first case of Horner's syndrome secondary to ophthalmic herpes zoster, with simultaneous, homolateral lesions of the third and sixth cranial nerves. Clinical evaluation, the course of the disorder, negative magnetic resonance studies and tests with cocaine and foledrin eye drops confirmed the presence of a post-ganglionar sympathetic lesion, probably situated in the ipsilateral cavernous sinus. CONCLUSIONS: Ophthalmoparesias as a complication of ophthalmic herpes zoster may have various origins. Diffusion of viral particles from the Gasserian ganglion and branches of the trigeminal nerve to adjacent structures, muscles, nerves and vessels, is the mechanism often mentioned. Presence of a simultaneous sympathetic lesion is very rare and of unknown pathology. However, it is probable that the origin of the lesion of the vegetative fibres is the same as that of the sensory or motor fibres, and adjacent inflammatory process caused by the virus extending. We analyze the factors involved in the low incidence of this association.     

Treatment of herpes simplex & varicella zoster infection

Fourteen patients underwent pancreaticoduodenectomy between January 1991 and February 1995 for periampullary carcinoma. In the first 8 patients pancreaticojejunostomy was performed; two of them developed pancreatic leak and died. In the subsequent 6 patients, pancreaticogastrostomy was performed; in this group there was no pancreatic leak and no perioperative mortality. THere was no difference between the two groups in preoperative bilirubin level, duration of jaundice, diameters of the common bile duct and pancreatic duct at surgery, operative time and blood loss. Postoperatively, the patients undergoing pancreaticogastrostomy fared better; they were started on oral feeds earlier (6.0 +/- 0.6 vs 10.2 +/- 0.8 days, p < 0.001), became ambulatory earlier (7.2 +/- 0.4 vs 12.3 +/- 1.5 days, p < 0.001) and had less loss of body weight at the time of discharge (2.2 +/- 0.2 vs 3.8 +/- 0.4 Kg, p < 0.001).