Hereditary angioedema: case report and review of management

For treatment of malaria, the World Health Organization recommends 10 mg of quinine per kg body-weight 3 times a day for at least 7 d. In Guinea-Bissau, as in several other African countries, a 3 d treatment regimen (10 mg/kg twice daily) is currently used. We therefore compared the 3 d treatment period with periods of 5 and 7 d. A total of 145 children with clinical malaria due to monoinfection with Plasmodium falciparum, with > or = 20 parasites per 200 leucocytes, were treated with intramuscular Quinimax 10 mg per kg body-weight twice daily for 3, 5 or 7 d. The children were then examined once weekly for 4 weeks. Following the 3 d treatment regimen, 34 of 43 children (79%) had parasitaemia on day 28 or before; following the 5 d treatment regimen, 36 of 40 children (90%) did so; and following the 7 d treatment regimen, 7 of 62 children (11%) were parasitaemic at that time. This study thus suggests that the currently recommended 3 d Quinimax treatment regimen in Guinea-Bissau for moderate and severe malaria is not effective.     

Combination chemotherapy with 5-FU and CDDP or CDDP analog for head and neck cancer

Combination chemotherapy with CDDP and 5-FU is one of the effective regimens for head and neck cancer. We studied the difference in the effects and adverse effects between two kinds of schedules of CDDP administration for CDDP-5-FU combination chemotherapy. For 13 patients, CDDP was administered on 5 consecutive days from day 1 to day 5 at a daily dose of 16 mg/m2 (Regimen A). For 14 patients CDDP was administered 80 mg on day 1 (Regimen B). 5-FU was administered 700 mg/m2/ day as a continuous drip infusion for 120 hours from day 1 to day 5. For regimen A, the response rate was 77%; for regimen B, it was 64%. The pattern of adverse effects showed a difference. Regimen B was more toxic for renal function than regimen A. But regimen A showed toxicity for bone marrow function. Acute phase nausea and vomit appeared more frequently in regimen B. The difference in the adverse effect pattern, which depends on the schedule of CDDP administration, seems important in order to apply this regimen for head and neck cancer patients safely. The schedule of CDDP administration should be changes depending on the renal and bone marrow function of patients. In order to evaluate the efficacy of UFT as adjuvant chemotherapy, UFT was administered p.o. to patients with maxillary sinus carcinoma for more than one year after definitive treatment with surgery or radiotherapy. Fifteen patients with UFT adjuvant chemotherapy showed significantly better survival rates than patients without adjuvant chemotherapy. We also studied adjuvant chemotherapy with CBDCA and FT for patients with advanced head and neck cancer. Administration with UFT (600 mg/day) from day 1 to day 14 with CBDCA 350 mg/m2 at day 7 was repeated more than twice. This regimen showed low toxicity and better survival for nasopharyngeal cancer patients. More clinical trials with this regimen for adjuvant chemotherapy are needed.     

Treatement of excessive weight gain in patients taking lithium

Six female primary affective disorder patients who had gained an average of 9.5 kg while taking lithium lost an average of 2.9 kg on a 10-day 900 calorie a day hospital diet containing 100 mEq of sodium per day. No evidence of lithium toxicity was observed on this regimen. There was no evidence that fluid retention played a major role in the weight gain.     

The treatment of peptic ulcer patients during exacerbation at the day hospital of an industrial enterprise polyclinic

Results are submitted of treatment of 659 patients with exacerbated peptic ulcer at an in-plant day in-patient facility. The basic therapy was hyperbaric oxygenation and ultraviolet irradiation of blood. The relapse rate over the year was 16%. A surgical operation was performed in 1.5% of those cases having completed the course treatment at the day in-patient facility, with 33.3% of patients having been operated on urgently, and 11.28% at a twenty-four-hour department; of these, in 85.62% cases operations were performed in situations of emergency needing prompt action. Duration of temporary disability in patients cared for at the day hospital was 21.3 days, while in those treated at a twenty-four-hour facility-27.8 days. Indications for hospitalization were of social character. Comparison of results of treatment, relapse rates and complications of ulcer disease in hospitalized patients versus those having been treated at a day-care facility gave arguments in favour of reorientation of treatment of major part of those patients experiencing exacerbation of ulcer disease at well equipped day-care in-patient facilities.     

Clinical findings of cefoxitin in the treatment of serious infections and the prevention of postoperative infections (author''s transl)

This clinical trial was designed to evaluate the efficacy, safety and patient tolerance of cefoxitin in 23 patients who were admitted to the hospital from March 1980 to November 1980. The daily dose of cefoxitin for 21 adult patients (ages ranged from 26 to 74 years old) were 6 g for the treatment of infections, and 2 to 6 g for the prevention of infections by either direct or intermittent intravenous infusions. Two children were given 100 mg/kg of cefoxitin either by direct or intermittent intravenous infusions 2 to 3 times a day in divided doses. Summary of findings: I. Treatment of intracranial infections 1. A 60-year-old man with a brain abscess was admitted to the hospital after the unsuccessful treatment with a cephalothin for 9 days. After, the initiation of therapy with cefoxitin, given 6 g a day for 3 days, the abscess was surgically removed. On the second day of treatment with cefoxitin following the operation, his highest temperature was 37.0 degrees C and was normal on the third day of treatment. He was discharged after 12 days after the surgical procedure. 2. A 56-year-old woman with cerebrospinal rhinorrhea and meningitis after the transsphenoidal removal of pituitary microadenoma responded satisfactorily to therapy with cefoxitin, given 6 g a day for 14 days after the unsuccessful treatment with a cephalothin. II. The prevention of infections following surgical operation of the central nervous system 1. Seventeen patients undergoing surgical procedures were treated with cefoxitin for the prevention of postoperative infections. None of the 17 patients developed postoperative infections. 2. A 53-year-old man undergoing repair of cerebrospinal rhinorrhea in the possibly contaminated area was successfully treated with cefoxitin, given intravenous 2 g every 8 hours for 10 days without meningitis having developed. III. The treatment and prevention of complications 1. A 74-year-old comatose male with a brain stem concussion, who was expectorating insufficiently and had difficulty swallowing and developed into pneumonia as a complication. He was successfully treated with cefoxitin, given intravenous 6 g a day for 2 weeks. 2. A 26-year-old male with a brain stem concussion complicated by pneumonia and a urinary tract infection was successfully treated with the same dose regimen of cefoxitin as the previous patient. 3. The prevention of complications A 58-year-old male with pontine glioma undergoing a tracheotomy was administered cefoxitin for the prevention of pulmonary complication. He died of pontine glioma after the three-month treatment. IV. Side effects Results of skin sensitivity tests given prior to the administration of cefoxitin were negative in all of the 23 patients. Neither anaphylaxis nor other allergic reactions or thrombophlebitis occurred with the intravenous administration of cefoxitin. No abnormalities in blood, hepatic function or renal function were observed. Anorexia occurred in 1 patient who was given cefoxitin, 6 g a day.     

Stromal keratitis induced by a unique clinical isolate of herpes simplex virus type 1

The antibody responses of 65 volunteers receiving an i.d. regimen (0.1 ml given at two sites on days 0, 3, 7 and 0.1 ml given at one site on days 30 and 90) were compared with the control group of 35 volunteers receiving the standard i.m. regimen. By day 14, seroconversion was observed in all vaccinees in both groups. Geometric Mean Titers remained higher than 0.5 IU/ml throughout the study period. At the end of the observation period on day 365, antibodies persisted in all subjects. The multisite i.d. PCEC regimen has been proved as immunogenic as the standard i.m. regimen. Both regimens were well tolerated. Thus, it would be the effective and cheapest available rabies post-exposure treatment using tissue culture vaccine.     

Ophthalmologic management of diabetic retinopathy

Changes in lung mechanics were measured in asthmatic adults before and after a 10-day course of daily and a three-week course of alternate day adrenocortical steroid therapy. All patients improved after the 10 days of therapy. This response continued during the a.m. measurements on the alternate day regimen with further improvement through the afternoon of the treatment day. In the afternoon of the day off corticosteroid therapy there was a deterioration in flow rates.     

吉西他滨联合卡铂作为诱导方案治疗老年不可手术的非小细胞肺癌

Objective:The purpose of this study was to evaluate the efficacy and safety of gemcitabine (GEM) and carboplatin (CBP) used as induction regimen in the treatment of elderly patients with locally advanced unresectable non-small cell lung cancer (NSCLC). Methods: Seventy-eight cases of elderly patients have been cytologically and pathologically confirmed with locally advanced unresectable NSCLC, the age of the patients ranged from 65 to 75 years. The patients were treated with the combined regimen of gemcitabine and cisplatin. GEM 1000 mg/m2 intravenously injected by drip on the 1st, 8th day and the dosage of CBP was AUC 4 that was used on the 1st day, 21 days apart to each cycle, most patients received 2 cycles. Treatment response was evaluated according to the criteria of RECIST (Response Evaluation Criteria in Solid Tumor), the side effect of the regimen was judged based on WHO criteria. Results: Seventy-eight patients were evaluated and received a total of 156 cycles chemotherapy. There were no complete regression that could be observed, but 32 cases had partial regression (PR), 37 cases with no change (NC) and 9 cases with progression disease (PD). The overall response rate was 41.0%. The main side effects were hematological toxicity. Conclusion: The GC regimen could be used as induction treatment for elderly patients with locally advanced unresectable NSCLC, and the regimen could be well tolerated and is safe in terms of side effects.     

New protocols for myeloma chemotherapy plus IFN alpha

In two consecutive studies of a pilot study and a multicenter trial 16 patients and 61 patients, respectively, with multiple myeloma were treated with the combination chemotherapy (CMVM regimen; the same intermittent high dose dexamethasone as in VAD regimen, MCNU bolus injection of 1.2mg/m2 on day 1, melphalan 12mg/day on days 1-6) plus IFN alpha (HLBI 300MU every day or two) to assess the efficacy and the toxicity of this protocol. Both studies were achieved in the same regimen except for initial 12 days administration of IFN alpha in the multicenter trial. The treatment was repeated 3 times every 6-8 weeks. Complete remission (CR) in which serum and urine M protein disappeared and myeloma cells in bone marrow were eradicated was obtained in 6 in 16 patients (37.5%) in the pilot study and 16 in 61 patients (26.2%) in the multicenter trial. CR plus PR was 68.8% and 68.9% in two studies. The achievement of CR in such high proportion of patients may exhibit a significant advance in the myeloma therapy.     

Effect of nilvadipine on high-voltage activated Ca2+ channels in rat CNS neurons

Acute rejection following orthotopic liver transplantation is a common problem despite current immunosuppressive regimens. Ursodeoxycholic acid (UDCA) has been shown in small, open-labeled studies to prevent rejection episodes, although its effects on complications such as infections, length of hospital stay, and survival have not been evaluated. We conducted a randomized, placebo-controlled, double-blind trial to determine if UDCA (10-15 mg/kg/d) added to a cyclosporine-based immunosuppressive regimen was associated with a decrease in the incidence of at least one episode of acute cellular rejection. Secondary end-points included determining differences in the total number of rejection episodes, the use of muromonab-CD3, the incidence of infections, length of hospital stay, and survival at 90 days and 1 year. Fifty-two patients were randomized, 28 to the treatment group and 24 to the placebo group. During the 3 months of the trial, there was no difference between the placebo and UDCA groups in the number of patients who were rejection-free; however, there were significantly fewer patients in the treatment group who had multiple episodes of acute rejection (0 vs. 6; P = .007). Patients in the treatment group experienced a significantly lower incidence of bacterial infections (4% vs. 29%; P = .02), shorter hospital stay (25 days vs. 34 days; P = .03), and better 90-day survival (100% vs. 83%; P = .04) and 1-year survival (93% vs. 79%). The addition of UDCA to a cyclosporine-based immunosuppressive regimen results in significantly fewer patients experiencing multiple episodes of rejection and improved survival at 90 days and at 1 year. The use of UDCA as adjuvant therapy for patients undergoing liver transplantation who are treated with a cyclosporine-based immunosuppressive regimen should be considered.     

Gene therapy

Analyzing the duration and efficiency of treatment of 95 inpatients with first detected pulmonary tuberculosis indicated that the mean hospital stay of patients without and with decay was 205 and 291 days, respectively. Medical and social aspects should be considered while defining indications and hospital stay periods in patients with tuberculosis. Long-term hospitalization of the patients is justifiable only in complicated tuberculosis and special circumstances which require direct continuous follow-up.     

Aortic dissection and Turner''s syndrome: case report and review of the literature

Combination chemotherapy with 5-FU and CDDP was given to two patients with obstructive jaundice due to intra-abdominal lymph-node metastases of advanced and recurrent gastric cancer. One patient was a primary case associated with lymph-node metastases of portal fissure and periaorta, and the other was a recurrent case associated with lymph-node metastases of hepatoduodenal ligament and periaorta. The regimen consisted of 5-FU 1,000 mg/ m2 (day 1-5, continuous infusion) and CDDP 100 mg/m2 (day 3, 1 hr drip infusion). The interval was from the 6th to 21st day. The response to chemotherapy showed shrinking of intra-abdominal lymph-nodes and reopening of the biliary tract. The patients could be discharged from the hospital without PTBD tube and enjoyed a better quality of life (QOL). This therapy is thought to be effective against obstructive jaundice due to intra-abdominal lymph-node metastases of advanced and recurrent gastric cancer.     

Isofenphos poisoning: prolonged intoxication after intramuscular injection

We report a unique case of attempted suicide by intramuscular injection of the organophosphate isofenphos which resulted in a muscarinic and nicotinic syndrome lasting 15 days and requiring prolonged mechanical ventilation and hospitalization. The patient, who demonstrated no signs of delayed polyneuropathy on hospital day 25, subsequently died of pneumonia. Toxicological investigations showed isofenphos plasma decay and confirmed the intramuscular route of poisoning. We believe continuous isofenphos absorption resulted in the prolonged intoxication observed in this patient.     

Effects of random versus nonrandom assignment in a comparison of inpatient and day hospital rehabilitation for male alcoholics.

Alcoholic patients randomly assigned to day hospital or inpatient rehabilitation were compared with patients who self-selected these treatment settings to examine differences in substance use and psychosocial outcomes under experimental and nonexperimental designs. Patients who self-selected treatment did not have better outcomes than those who were randomly assigned, and there were no significant differences between day hospital patients and inpatients on any of the 11 outcome measures. Significant interactions between treatment setting and assignment were found with only 2 outcome measures. Therefore, the comparisons between day hospital and inpatient treatment yielded similar outcomes under both "scientific" conditions and the conditions that more closely approximate the experiences of most patients. Implications for the use of nonrandomized participants in alcoholism treatment research and limitations of the study were also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intensive regimen of cytokines with interleukin-2 and interferon alfa-2b in selected patients with metastatic renal carcinoma

We conducted a Phase II trial using an intensive regimen combining interleukin-2 (IL2), interferon-alfa-2b (IFN), and lymphokine-activated killer (LAK) cells. The aim of this study was to evaluate the toxicity and the efficacy of this combination in selected patients with metastatic renal cell carcinoma. Thirty-one assessable patients were treated with at least one cycle of a regimen consisting of 20 x 10(6) IU/day s.c. IFN for 5 days, followed 2 days later by i.v. injections of 24 x 10(6) IU/m2/day IL2 every 8 h together with i.v. bolus of 5 x 10(6) IU/m2/day IFN every 8 h during 5 days. After a 6-day break, during which four leukophereses were performed, this i.v. combination was administered along with the LAK cell reinjections for a maximum of 5 days. Twenty-seven patients underwent the two parts of the first course of treatment; respectively, 42% and 46% of the planned dose of IL2 and IFN were administered. Several severe toxicities were observed including two treatment-related deaths. Significant tumor responses were observed in seven patients, including two complete remissions. Two of these patients remain alive without evidence of disease 36 and 40 months after treatment, respectively. This intensive regimen of IL2 together with IFN and LAK cells cannot be recommended even in selected patients with metastatic renal cell carcinoma. In addition, our results argue against the concept of a dose-response relationship in this setting.     

Clean up of Petroleum-Hydrocarbon Contaminated Soils Using Enhanced Bioremediation System: Laboratory Feasibility Study

The objective of this study was to assess the potential of applying enhanced bioremediation on the treatment of petroleum-hydrocarbon contaminated soils. Microcosm experiments were conducted to determine the optimal biodegradation conditions. The control factors included oxygen content, nutrient addition, addition of commercially available mixed microbial inocula, addition of wood chip and rice husk mixtures (volume ratio = 1:1) as bulking agents, and addition of organic amendments (chicken manures). Results indicate that the supplement of microbial inocula or chicken manures could significantly increase the microbial populations in soils, and thus enhance the efficiency of total petroleum hydrocarbon (TPH) removal (initial TPH = 5,500?mg/kg). The highest first-order TPH decay rate and removal ratio were approximately 0.015?day?1 and 85%, respectively, observed in microcosms containing microbial inocula (mass ratio of soil to inocula = 50:1), nutrient, and bulking agent (volume ratio of soil to bulking agent = 10 to 1) during 155 days of incubation. Results indicate that the first-order TPH decay rates of 0.015 and 0.0142?day?1 can be obtained with the addition of microbial inocula and chicken manures, respectively, compared with the decay rate of 0.0069?day?1 under intrinsic conditions. Thus, chicken manures have the potential to be used as substitutes of commercial microbial inocula. The decay rate and removal ratio can be further enhanced to 0.0196?day?1 and 87%, respectively, with frequent soil shaking and air replacement. Results will be useful in designing an ex situ soil bioremediation systems (e.g., biopile and land farming) for practical application.     

Influence of thyroxine on different ion-dependent ATPase activities in fat body of tasar silkworm, Antheraea mylitta D

OBJECTIVES: To identify characteristics associated with methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection, and to evaluate the efficacy of systemic and topical antimicrobials in the eradication of MRSA carriage among hospitalized patients. DESIGN: A case-control study was done to identify associations. Odds ratios were estimated by unconditional multiple logistic regression. Cohort study was done to evaluate MRSA decolonization efficacy by an oral regimen. Patients infected or colonized with MRSA received a 5-day course of oral (160 mg/800 mg) trimethoprim-sulfametroxazole twice daily and 600 mg of rifampin once daily as decolonization treatment. The proportion of MRSA-free patients after decolonization treatment was determined. Persistence of clearing was estimated by the Kaplan-Meier method. SETTING: Ramón y Cajal Hospital, a 1,249-bed, tertiary-care teaching hospital in Madrid, Spain. PATIENTS: One hundred ninety-two patients with hospital-acquired MRSA infection/colonization and 195 MRSA-free random controls. RESULTS: Six factors were associated independently with MRSA infection/colonization: age (every 10 years of age, odds ratio [OR] = 1.3); ward (surgical, OR = 1; medical, OR = 3.1; intensive care unit, OR = 60); previous hospitalization (OR = 6.9); coma (OR = 25.3); invasive procedures (each, OR = 1.7); 3 or more weeks of hospitalization (OR = 3.8). We failed to show antibiotic therapy to be an independent risk factor for MRSA hospital infection/colonization. Overall, MRSA eradication was 64.2% by day 2 to 9 after completion of treatment. Kaplan-Meier product limit survival analysis showed that the probability of remaining MRSA-free was 65.3% (SE = 0.09) at 32 days after completion of treatment. CONCLUSIONS: The results offer a rationale for reduction of MRSA infection/colonization in the hospital by interventions aimed at early identification of patients at higher risk, at prompt discharge of patients, and at preventing dissemination while performing invasive procedures. They also provide estimates of antibiotic treatment efficacy to reduce the reservoir of MRSA in the hospital.     

Psychotherapy in the day clinic

Recently, the importance of psychiatric day hospital treatment is increasing in German psychiatry, as the regionalization and community-orientation of care advance and catchment areas become smaller. When a psychiatric department of a local general hospital is within easy reach of the patient's residence, the means for intensive treatment, as is available in a hospital, can be utilized during the day, while the patient spends a considerable amount of time (in fact, two thirds) in the familiar surroundings of his/her own home. This is applicable for many psychiatric conditions, including neuroses, personality disorders and psychosomatic diseases. As compared to conventional individual outpatient psychotherapy on the one hand and a distinct limited stay in a psychosomatic sanatorium far from home on the other hand, psychotherapy in a day hospital offers a promising additional way to provide effective and lasting professional help early and with a low threshold. The article summarizes the experience gained in a newly founded department of psychiatry and psychotherapy at a general hospital in one district of eastern Germany, where the staff is struggling to meet the needs of the catchment area in spite of a too small number of hospital beds.     

Paclitaxel with mitoxantrone, fluorouracil, and high-dose leucovorin in the treatment of metastatic breast cancer: a phase II trial

PURPOSE: Paclitaxel is a highly active single agent in the treatment of breast cancer. However, its optimal incorporation into combination regimens awaits definition. In this phase II study, we added paclitaxel, administered by 1-hour infusion, to a previously described combination regimen that included mitoxantrone, fluorouracil (5-FU), and high-dose leucovorin (NFL). PATIENTS AND METHODS: Forty-six patients with metastatic breast cancer received the following regimen as first- or second-line treatment: paclitaxel 135 mg/m2 by 1-hour intravenous (i.v.) infusion on day 1, mitoxantrone 10 mg/m2 by i.v. bolus on day 1, 5-FU 350 mg2/m by i.v. bolus on days 1, 2, and 3, and leucovorin 300 mg i.v. over 30 to 60 minutes immediately preceding 5-FU on days 1, 2, and 3. Courses were administered at 3-week intervals for a total of eight courses in responding patients. RESULTS: Twenty-three of 45 assessable patients (51%) had major responses. Previous chemotherapy, and in particular previous treatment with doxorubicin, did not affect response rate. The median response duration was 7.5 months. Myelosuppression was moderately severe, with 76% of courses resulting in grade 3 or 4 leukopenia. Hospitalization for treatment of fever during neutropenia was required in 13% of courses, and two patients died as a result of sepsis. Two patients developed severe congestive heart failure after a large cumulative anthracycline dose. CONCLUSION: This combination regimen was active as first- or second-line therapy for metastatic breast cancer, although its activity compared with other combination regimens or with paclitaxel alone is unclear. Myelosuppression was more severe than anticipated based on previous results with the NFL regimen or with paclitaxel administered at this dose and schedule as a single agent. The infrequent development of cardiotoxicity in these patients suggests that the paclitaxel/mitoxantrone combination may not share the problems previously reported with the paclitaxel/doxorubicin combination.     

Cocaine withdrawal symptoms and initial urine toxicology results predict treatment attrition in outpatient cocaine dependence treatment.

This study evaluated the ability of cocaine withdrawal symptoms, measured by the Cocaine Selective Severity Assessment (CSSA) and initial urine toxicology results, to predict treatment attrition among 128 cocaine dependent veterans participating in a 4-week day hospital treatment program. The CSSA was administered and a urine toxicology screen was obtained at intake and at the start of the day hospital (about 1 week later). The combination of a positive urine toxicology screen and a high CSSA score at intake predicted failure to complete treatment. Urine toxicology results at the start of the day hospital, but not at intake, predicted failure to complete treatment. Among participants without other psychiatric illness, high CSSA scores at intake predicted failure to complete treatment. The presence of cocaine withdrawal symptoms and a positive urine toxicology screen are clinically useful predictors of treatment attrition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)