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 7,148 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Multidrug-resistant falciparum malaria is a major health problem along the Thai-Burmese border. From July 1985 until December 1986 a total of 5192 patients with falciparum malaria (1734 males, 3458 females) from this area were given supervised treatment with the combination mefloquine-sulfadoxine-pyrimethamine (MSP). The radical cure rate, assessed 21 days after drug administration, was 98.4% for the first 1975 patients, and 98.8% when assessed at 28 days for the remaining 3217 patients. In 3.8% of cases, parasites were still detected in peripheral blood smears on day 7 after treatment but this had fallen to 0.27% by day 9. Adverse reactions among the first 1975 patients were: vertigo (7.5% of patients), vomiting (5.8%), epigastric pain (0.6%), and transient confusional state (one case). MSP is an effective and well-tolerated drug for the treatment of drug-resistant falciparum malaria; however, delayed parasite clearance may give a false impression of RII resistance.
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PMID:Malaria on the Thai-Burmese border: treatment of 5192 patients with mefloquine-sulfadoxine-pyrimethamine. 332 87

Group respiratory intoxication with balagrin (a pesticide from the nitroanilide group) in 3 agricultural female workers is described. Such group intoxication has not been described up to 1984. The clinical course is manifested by two syndromes: cerebrotoxic--which is the leading syndrome and includes headache, vertigo, adynamia, weakness, EEG changes; upper dyspeptic--which is a secondary syndrome and includes epigastric pain, nauseous, vomiting, anorexia. By X-ray examination a third syndrome--pulmonotoxic--has been registered without any other respiratory manifestations. It is probably due to venous stasis and peribronchial interstitial changes. The treatment with glucose infusions, vit. B6, vit C and cerucal could not fully abolish the cerebral manifestations. This led to, a prolonged treatment with cerebroprotective drugs (Pyramem, vitamin B complex). The 8-month observation showed a slow reverse evolution of the subjective complaints and the objective findings. It is concluded that the pesticide balagrin exerts marked toxic action under certain conditions.
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PMID:[Clinical picture and treatment of acute respiratory poisoning by balagrin]. 343 46

41 patients (20 females and 21 males aged from 8 to 68 years) were prescribed 2-cyclohexylcarbonyl-1,2,3,6,7,11b-hexahydro-4H-pyrazino[2,1-a]isoquinolin-4-one(praziquantel, EMBAY 8440, Biltricide) at a dose of 25 mg/kg body weight given three times on a single day at intervals of 4 h, for the treatment of opisthorchiasis. Clinical as well as biological tolerance was followed up very closely, first during a hospitalization period of 6 days, then on day 20, 40, 90 or more after treatment. None of the biological controls consisting of a total of 47 parameters (haematological, biochemical, urinary) showed any variation from before to after treatment. Clinical examinations, recorded in very carefully prepared case report sheets, served for systematically screening general signs and symptoms (fever, headache, etc.), digestive manifestations or neurological signs. Tolerability was absolutely perfect in 10 patients. In the remaining 31 cases the following signs were observed: lassitude or vertigo (15 times), headache (14 times), drowsiness and nausea (5 times), epigastric pain (9 times), arthralgia-myalgia (3 times), sweating (1 time). All these signs lasted one or two days only and were of weak or moderate intensity, thus allowing the conclusion that even at higher dosages tolerability to praziquantel is excellent.
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PMID:[Study on the tolerability of high doses of praziquantel in Laotians with parasitic liver infections (author's transl)]. 719 55

Bleeding pseudocysts respectively pseudoaneurysms represents a seldom complication of chronic pancreatitis in owing to erosion of pancreatic or peripancreatic arteries. The potential rupture into neighbouring organs or in the peritoneal cavity is accompanied with paramount life-threatening risks. During the last years we observed 3 patients with acute intestinal bleeding caused by pseudocysts converted to pseudoaneurysms. The goal of our report is to analyze the diagnostic tools and the management of patients with bleeding pancreatic pseudocysts, also well establish the clinical constellation, which is typical for this complication, the best diagnostic tool and the modalities to immediate control of the acute bleeding situation. All three patients suffered from chronic pancreatitis and alcohol abuse. The first patient had a known pancreatic pseudocyst, which penetrated through the gastric wall and caused a life-threatening bleeding. The second patient was admitted in owing to melena. The examinations yielded a pancreatic pseudocyst with hematosuccus pancreatis. The third patient suffered from abdominal pain and vertigo caused by anemia. With endoscopy, Cat and celiacography a pancreatic pseudocyst with cysto-colic fistula has been identified. The color-doppler ultrasound revealed a pseudoaneurysm supplied from a splenic artery branch. With management of these patients with hemorrhagic complications of pancreatic pseudocysts we acquired the following findings: 1. Patients with known chronic pancreatitis and abdominal tumor, especially when accompanied by epigastric pain and anemia, are highly suspicious for pancreatic pseudoaneurysms. 2. The color-doppler ultrasound is the best diagnostic tool, since this investigation can establish the pseudoaneurysm and identify the source.
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PMID:[Hemorrhage from pseudocysts caused by pseudoaneurysms in chronic pancreatitis. Diagnosis and management]. 837 41

The resistance of Plasmodium falciparum to the chloroquine-proguanil association (C/P) as antimalarial chemoprophylaxis is becoming increasingly common in Africa. Daily oral doxycycline hyclate 100 mg is effective as malaria prophylaxis. But the hyclate salt's adverse effects combined with the capsule's galenic form are incompatible with good chemoprophylaxis compliance. We conducted a randomized group study of 522 French soldiers deployed in Gabon and Chad for 4 months to determine the tolerability of short-term malaria chemoprophylaxis with a 100-mg daily tablet of a monohydrate doxycycline salt compared with a daily C/P capsule. At days 7 and 120, compliance was better in the doxycycline group [respectively 98.5%vs. 73.9% (P < 0.001) and 90.5%vs. 74% (P < 0.001)]. No major event (evacuation, hospitalization) was related to the medications. Epigastralgia, diarrhoea, urticaria, mouth ulcers, sun sensitization and desquamation were significantly more frequent in the C/P group (P < 0.05). There was no statistical difference for malaria incidence, vertigo, nausea and hair loss. These results suggest that doxycycline monohydrate may be safely used in short-term malaria chemoprophylaxis. With the same efficacy as a hyclate doxycycline, doxycycline monohydrate could be a good chemoprophylaxis for short-term travellers at particular risk of C/P resistant P. falciparum malaria.
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PMID:Tolerability of doxycycline monohydrate salt vs. chloroquine-proguanil in malaria chemoprophylaxis. 1239 May 96

Old generation H1-type antihistamines are the standard therapeutic option for acquired cold urticaria (ACU), but adverse effects are common. New antihistamines are well tolerated but efficacy is often poor. The present study aims to evaluate efficacy and safety of cinnarizine in the treatment of ACU patients intolerant to old antihistamines and resistant to new drugs. We studied 14 patients (4 males and 10 females). Mean duration of the disease was 48.9 (range 7-102) months. Cold cube test was positive in 78.6 % of patients. Cold urticaria was idiopathic in 10 (71.4 %) patients. Cryoglobulins were detected in the serum of 4 cases (28.6 %). Cinnarizine (25 mg t.i.d.) was administered for 3 months, and then it was gently tapered off and stopped within 2 months. A complete or good response was obtained in 8 (57.1 %) and 2 (14.3 %) patients, respectively. Only two patients were unresponsive (21.4 %). Tapering off or stopping cinnarizine was followed by the relapse of cold urticaria in 7 cases (50.0 %). These patients were amenable to a second treatment cycle. Six patients (42.9 %) had a persistent remission. A patient interrupted the therapy because of severe vertigo. Three patients reported mild and transitory adverse effects including epigastralgia, weight gain and drowsiness. In conclusion, cinnarizine at high doses may be considered as an effective and well-tolerated treatment for ACU.
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PMID:Cinnarizine is a useful and well-tolerated drug in the treatment of acquired cold urticaria (ACU). 1260 83

Gastric rupture is extremely rare in childhood beyond the neonatal period. We describe a previously healthy 6-year-old girl with a large laceration along the greater curvature on the posterior wall of the stomach. The patient was admitted to a neighboring hospital because of vertigo with 1-day history of intractable vomiting and epigastric pain. Although abdominal distension was noticed during the physical examination, muscular rigidity was not detected on palpation. Laboratory data showed severe hypotonic dehydration and moderate metabolic acidosis with hyperkalemia. She suddenly developed cardiac arrest within an hour after admission. After resuscitation, surgical consultation was obtained. Abdominal X-ray and ultrasound revealed abdominal free air and massive cloudy ascites. At laparotomy, there was a large laceration on the greater curvature of the stomach. Pathology of the gastric wall showed mucosal necrosis while the musculature remained intact consistent with an acute gastric ulcer. Since clinical condition of gastric rupture deteriorates rapidly, early diagnosis and appropriate treatment is essential for good prognosis. One should consider that ulcer formation might cause gastric rupture in childhood.
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PMID:Lethal gastric rupture caused by acute gastric ulcer in a 6-year-old girl. 1615 19

In May 2004, a 48-year-old male surgeon, resident in Bucaramanga, Colombia, suffered a superficial cut with a scalpel to the lateral aspect of the mid-phalanx of the second finger of the left hand while performing a pulmonary decortication surgical procedure for tuberculous empyema with pulmonary entrapment. The injury healed normally but, approximately 2 weeks after the event, an erythematous, nonpainful papule of approximately 3 mm in diameter developed, and increased progressively to 7 mm 3 days after its initial appearance. At this time, the papule showed spontaneous secretion of a clear liquid and superficial ulceration (Fig. 1). Approximately 3 weeks after the injury, a Gram stain of the liquid was performed; it showed no bacteria but a moderate leukocyte reaction. Because of the high suspicion of possible tuberculous infection, bacilloscopy of the liquid was performed, and was positive (++) for acid-fast bacteria (Fig. 2). The liquid was cultured and grew Mycobacterium tuberculosis. The culture was sent to the Laboratory of Mycobacteria at the National Institute of Health, Bogota, Colombia for drug resistance testing. Susceptibility was demonstrated against streptomycin, isoniazid, rifampicin, and ethambutol. During this time, the patient presented an ipsilateral painful axillary adenopathy of about 2.5 cm in diameter. The patient consulted with an infectologist, who initiated a Directly Observed Therapy Short Course (DOTS) regimen [first phase (8 weeks): daily, except Sundays, streptomycin 1 g intramuscularly, pyrazinamide 1500 mg orally, isoniazid 300 mg, and rifampicin 600 mg; second phase (18 weeks): twice weekly rifampicin 600 mg and isoniazid 500 mg], accompanied by daily pyridoxine to prevent secondary effects from isoniazid. After 3 weeks of treatment, the finger lesion had disappeared. Treatment was undertaken as described above, with the patient reporting symptoms of vertigo, nausea, epigastralgia, and mild myalgia as the adverse effects of medication. A chest x-ray was taken and reported to be normal. The axillary adenopathy disappeared approximately 6 months after the injury. Nearly 3.5 years after the incident, the patient has not presented any type of symptomatology.
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PMID:Primary cutaneous inoculation tuberculosis in a healthcare worker as a result of a surgical accident. 1871 65

Disulfiram treatment for alcohol dependence is used with acceptable outcomes. By inhibiting the aldehyde dehydrogenase enzyme, this treatment increases acetaldehyde concentration after the ingestion of alcohol causing an unpleasant disulfiram-alcohol reaction. Typical symptoms include flushing, headache, nausea, vomiting, sweating, vertigo, and lightheadedness. However, there have also been descriptions of more serious reactions including severe hypotension, arrhythmias, myocardial infarction, and cardiovascular collapse. We report a patient with a severe disulfiram-alcohol reaction marked by flushing, confusion, generalized malaise, epigastric pain, and hypotension. Cardiac biomarker and electrocardiographic changes were suggestive of non-ST-elevation myocardial infarction (NSTEMI). Left heart catheterization showed no angiographic evidence of coronary artery disease. Because of the frequency of alcohol dependence and its treatment with disulfiram, it is critical for physicians to be aware of these types of life-threatening complications.
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PMID:Disulfiram--alcohol reaction mimicking an acute coronary syndrome. 2474 56

Awareness of the spectrum of clinical manifestations of syphilis, especially uncommon changes, is essential for diagnosis and effective management of patients. A 48-year-old Han businessman presented to the ear, nose and throat surgeons with an eight-week history of epigastric pain, a four-week history of a widespread non-itchy rash including the scrotal skin and a one-week history of tinnitus and dizziness. On examination, he was afebrile with widespread lymphadenopathy and a maculopapular rash affecting his trunk and scrotum. His abdomen was soft but tender in the epigastrium. The Treponema pallidum particle agglutination assay result was positive, and the rapid plasma reagin was 1:2. Gastroscopy showed ulcers in the gastric antrum and pylorus. Histopathological examination of gastric mucosa lesions showed a large amount of lymphoplasmacytic infiltrate detected in the lamina propria of the gastric mucosa. The T. pallidum Liferiver real time polymerase chain reaction kit assay performed on specimens from skin lesions and gastric mucosal tissue were positive. The patient was treated with intravenous sodium penicillin followed by intramuscular benzathine penicillin. On the fourth day of the treatment, the rash, epigastric pain and lymphadenopathy subsided. Two weeks after treatment, the tinnitus alleviated and vertigo disappeared.
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PMID:Syphilis gastritis: a case report. 2858 Aug 32


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