Nonpigmented fixed drug eruption from pseudoephedrine

The biotransformation of oxazepam by Bifidobacterium bifidum was studied. The major metabolite was purified by chromatographic methods and found to be desmethyldiazepam using NMR, IR and other physicochemical data.     

Fixed drug eruption due to allylisopropylacetylurea

We report a case of fixed drug eruption due to allylisopropylacetylurea. A 21-year-old female developed purplish-red round eruptions on her neck and left thigh after taking an analgesic containing isopropylantipyrine, allylisopropylacetylurea, phenacetin and anhydrous caffeine. Patch testing with the analgesic and its ingredients on the eruptive area showed positive reactions to the analgesic and allylisopropylacetylurea, while patch testing on the non-eruptive area showed negative reactions. We diagnosed her condition as a fixed drug eruption due to allylisopropylacetylurea in an analgesic.     

Azoospermia due to aperistalsis of the vas deferens: successful treatment with pseudoephedrine

Three patients presenting with infertility were found to have low volume azoospermia. All 3 were taking sympatholytic medications; 2 were taking antipsychotics and 1 was taking an alpha-blocker. Low volume azoospermia may result from the use of sympatholytic medications, which cause aperistalsis of the adrenergically innervated vas deferens and seminal vesicles. Two patients had normal spermatogenesis on biopsy and were unobstructed on vasography. In 1 patient, biopsy and vasography were avoided. Pseudoephedrine, a sympathomimetic agent, was given to all 3 patients, resulting in marked improvement in semen analysis parameters. A trial of pseudoephedrine can obviate the need for biopsy and vasography in such patients.     

Fixed drug eruption from amoxycillin

We present a case of fixed drug eruption on the genital mucosa induced by amoxycillin. Topical provocation was carried out, applying amoxycilin (10% pet) on the glans penis. No reaction was observed. Oral challenge with amoxycillin was followed by pruritic erythema on the glans penis 6 hours after the intake of 125 mg. The study of cross-reactivity to other betalactams showed good tolerance of phenoxymethyl-penicillin, which shares an identical nuclear structure with amoxycillin. The patient also tolerated cephadroxil, a cephalosporin with a side chain identical to that of amoxycillin. On reviewing the literature we have only found three reports of fixed drug eruption fue to amoxycillin.     

Determination of pseudoephedrine hydrochloride and carbinoxamine maleate in combination drug formulation by liquid chromatography

The permeability to several chemical compounds and the histology of vaginal and buccal mucosa are very similar. Because vaginal mucosa is more abundant, it may be used as a model for the latter. To further develop the vaginal/buccal mucosa model, the objective of the present study was to evaluate the passage of a small polypeptide, vasopressin, across fresh and frozen specimens of these two mucosae. Specimens of fresh buccal and vaginal mucosa were taken from excised tissue obtained following vaginal hysterectomies and various oral surgical procedures. Pieces of buccal and vaginal tissue specimens obtained were used fresh or were snap-frozen and stored at -85 degrees C for periods of up to 10 months. Biopsies from fresh and thawed specimens were mounted in flow-through diffusion cells and their permeability to tritiated vasopressin was determined using a continuous flow-through perfusion system. Specimens were examined histologically before and after freezing as well as before and after permeability experiments and similarities between vaginal and buccal tissues verified. No statistically significant differences between flux values for fresh and frozen vaginal and buccal mucosa, respectively, were found. These results demonstrate that the permeation of vasopressin across fresh and frozen human vaginal and buccal mucosa is for practical purposes similar. These results further support the human vaginal/buccal mucosa model for in vitro permeability studies on therapeutically active compounds.     

Hyperthyroidism due to contamination of the alternative drug Ader-Rein (Vascu-Vitaal)

A 52-year-old woman developed hyperthyroidism due to the alternative Vascu-Vitaal pills. She was suffering from nephrotic syndrome due to membranoproliferative glomerulonephritis and subclinical hypothyroidism, possibly due to renal loss of thyroid hormone. For peripheral vascular disease she took the non-registered Vascu-Vitaal pills on her own initiative. According to the product information, these pills contain multiple vitamins, minerals, amino acids and tissue extracts of bovine adrenals, hypophysis and thymus. The patient developed hyperthyroidism after starting on a new batch of the preparation; it subsided after stopping the treatment. A technetium thyroid scan showed decreased uptake and subsequently the Vascu-Vitaal pills were found to contain both thyroxine and triiodothyronine. The thyroid hormone contamination was probably caused by bovine thyroid tissue. It is suggested to require a health warning statement on the package of alternative therapeutics stating that production and contents are not subject to governmental supervision.     

Negative myoclonic status due to antiepileptic drug tapering: report of three cases

PURPOSE: Epileptic negative myoclonus (ENM) has been increasingly recognized in different epilepsies, but the reasons for its appearance and prognosis remain uncertain. We report 3 patients who developed de novo, almost continuous ENM, triggered by antiepileptic drug (AED) tapering, that resolved with treatment. METHODS: Three patients aged 16, 19, and 65 years with a 13- to 36-year history of partial epilepsy were receiving a therapeutic dosage of carbamazepine or phenobarbital plus either clobazam (CLB) or valproate (VPA). None had previously had ENM. Forty-eight to 72 h after CLB or VPA withdrawal, the habitual seizures recurred. The patient also began to report repetitive postural lapses of one or more limbs that interfered with eating or writing. At this time, each patient underwent polygraphy with simultaneous surface electromyography (EMG) of deltoid, biceps, and triceps muscles and of the wrist extensor and flexor bilaterally. RESULTS: In all patients, EEGs demonstrated almost continuous epileptiform discharges whose spatial distribution was similar to that observed before ENM appearance. Polygraphic recordings showed repetitive loss of postural EMG activity in one or more limbs, 100-400 ms in duration, which occurred in conjunction with the spike-waves. One milligram of clonazepam intravenously always terminated ENM status, which has not recurred in the ensuing 9-36 months. CONCLUSIONS: ENM may emerge as a new type of seizure due to tapering of AED therapy. This effect is possibly related to the great activation of epileptiform activity with consequent interference with cortical activity.     

Does chronic psychosis due to amphetamines abuse exist? Study of 25 drug addicts

The development of a psychotic process was noted in seven amphetamine addicts who had been seen over a period of several years before onset of the psychosis and who had no psychotic tendencies before the addiction. This group was compared with two from the standpoint of the symptomatology of acute psychosis; i.e. acute psychotic episodes under the effects of amphetamines in individuals who were not psychotic before addiction and who were cured at present, and acute psychotic episodes under the effects of amphetamines in individuals who were psychotic at the time of becoming amphetamine addicts. This comparative study attempts to define the signs which precede the development of a chronic psychosis and includes a discussion concerning the clinical picture and its correlation with the pre-existent personality.     

Immunoblastic lymphoid hyperplasia resembling a tumour, due to drug hypersensitivity (author''s transl)]

An evaluation of dorsal longitudinal myelotomy in the management of spasticity of the lower limbs has been done in 17 patients. The follow-up has varied from 1 month to over 2 years. Most patients achieved satisfactory relief from spasticity. Eight patients have died after the operation in chronic care hospitals. In all except one, the spasticity had been relieved. Eight out of the nine living patients have benefited from myelotomy. Recurrence of spasticity following the first operation occurred in four patients, two of whom improved after a repeat myelotomy. In the presence of fixed contractures of the hip and knee joints, a satisfactory clinical result may not be obtained after the myelotomy.     

Visceral fungal infections due to Petriellidium boydii (allescheria boydii). In vitro drug sensitivity studies

Four patients with visceral infections due to the fungus Petriellidium boydii, who were recently hospitalized in our institutions, are described. Three of the patients were compromised hosts; in the fourth patient, infection occurred after trauma. All had received prior steroid and antibiotic therapy. Studies of patients with mycetoma or secondary infection of a pulmonary cavity due to this organism and of patients with visceral infections are reviewed. Because of histologic similarities to Aspergillus species, infections due to P. boydii may have been misdiagnosed in the past if the infecting fungus was not isolated in culture. The fungus has been shown to be resistant in vitro to currently available antifungal agents. Resistance to amphotericin and 5-fluorocytosine is demonstrated in our studies. There are few reports of successful chemotherapy of any manifestation of this infection, and no such reports of visceral disease. We demonstrate in vitro sensitivity of isolates in our cases and in others to micronazole, a new antimicrobial agent; this drug may be indicated for treatment of disease due to P. boydii.     

Mortality due to acute adverse drug reactions: opiates and cocaine in Barcelona, 1989-93

Drug-related deaths have become a major source of premature mortality. This paper presents an analysis of deaths due to acute adverse drug reactions caused by opiates or cocaine in the city of Barcelona over a 5-year period during which figures were stable. Annual mortality rates due to adverse drug reactions of city residents for the 1989-93 period were estimated to be 15.3 per 100,000 people in the 15-49-year age group. Mortality rates for men (25.0) are consistently higher than mortality rates for women (5.8). Mortality rates by age group show different patterns by gender. Males in the 25-29-year group have the highest mortality rate (62.8), almost doubling the rates for the 20-24 (36.1) and 30-34 (33.3)-year groups. The highest differential in age-specific mortality by gender is seen in the 35-39-year age group, where mortality rates for men (21.5) are eight times higher than for women (2.6 per 100,000). The distribution by place of residence, stratifying data across city neighbourhoods and municipal districts displays wide differences between districts in the mean annual rates, ranking between 77.3 and 8.3 per 100,000, a nine-fold magnitude. Differences are even steeper when we break down data by neighbourhood. Although all areas with high adverse drug reactions mortality are areas of low socio-economic level, a more complex association between deprivation and drug use must exist, as other areas with similarly low socio-economic indicators do not suffer from such high mortality. A cross-tabulation of place of residence and district of death shows that for most adverse drug reaction deaths, death takes place in the district of residence but patterns related to districts who attract drug-related deaths and districts who export them may be observed. These results provide new insights into the epidemiology of substance abuse in Barcelona, where it follows patterns that may be similar to those of other major urban areas in Spain, but also in other Southern European countries.     

Autoimmune bullous eruption localized to a breast reconstruction site: response to niacinamide

A case of bullous pemphigoid responding to niacinamide as monotherapy is reported. Clinically, the patient presented with bullous lesions localized to the left breast. She had a history of a left breast mastectomy for breast cancer. This was followed by radiation therapy to the left chest wall and delayed left breast reconstruction achieved with a transposition flap of the latissimus dorsi muscle. There have been reports of bullous pemphigoid treated with a combination of tetracycline and niacinamide. This is the first report, to our knowledge, of a case of bullous pemphigoid responding to niacinamide alone.