Clinical efficacy of bromocriptine and the influence of serum prolactin levels on disease severity in patients with chronic plaque-type psoriasis

Psoriasis is a T-cell mediated hyperproliferative cutaneous disease of multifactorial etiology. Prolactin [PRL] has been implicated in the pathogenesis of psoriasis and several studies have pointed to a potential therapeutic role of bromocriptine in psoriasis. To assess the clinical efficacy of bromocriptine and the influence of serum prolactin levels on disease severity in patients with chronic plaque-type psoriasis. Forty-five patients with chronic plaque-type psoriasis and 45 healthy control subjects were included in the study. The patients were divided into three equal groups; a group treated with narrow-band ultraviolet B [NB-UVB], a group treated with bromocriptine, and a group treated with both NB-UVB and bromocriptine. Serum PRL levels and psoriasis area severity index [PASI] scores were measured before and after a 12-week treatment period. There was no significant difference in the serum PRL levels between the patients prior to treatment and the controls. Correlations between PASI scores and serum PRL levels before and after treatment were insignificant. Post-treatment PASI scores were significantly lower than pretreatment values in each of the treated groups. Post-treatment serum PRL levels were significantly lower in both groups receiving bromocriptine than the group receiving NB-UVB alone, they were also significantly lower in the group treated with NB-UVB and bromocriptine than the group treated with bromocriptine alone. Bromocriptine may be of value in the treatment of chronic plaque-type psoriasis in the absence of hyperprolactinemia. NB-UVB may have an additive effect to bromocriptine on serum PRL levels

Osteoporosis of the Hip in pregnancy and lactation

Osteoporosis of pregnancy and lactation has been described as an uncommon transient and self-limited condition of uncertain aetiology and prognosis. The duration of the signs and symptoms was described to be one to 45 months.mostly 3-12 months. All signs and symptoms are non -specific and non pathognomonic. Diagnosis necessitates awareness for detection and the exclusion of many clinical conditions both intra- and extra-articular. Similar changes were described in males, children and pregnant females in different joints, bones and the spine; this fact adds to the difficulty in diagnosis and understanding of the underlying mechanisms. Many methods of treatment were described and many authors believe that none of the treatment regimens seem to alter the course of the disease. In the present report, thirteen pregnant and/or lactating women were diagnosed, treated and followed -up for 6-7 years after the last delivery. Eight women were treated with Salmon Calcitonin. The results were significantly better than those treated by bed rest and analgesics only. Recurrences were encountered in 15.4% of the patients. High index of suspicion is needed for diagnosis of this condition and calcition may be of some help in its treatment

Management of giant cell tumour of the distal end of the radius by en-block excision and reconstruction by free-autogenous graft using the upper end of the fibula

This study included 17 patients [6 women and 11 men with a mean age 36.5 years] with giant cell tumor [GCT] of the distal end of the radius treated by en-block resection and reconstruction by autogenous massive graft using the upper end of the fibula. The main presentation was pain; 13 patients complained of swelling as well 3 had undisplaced pathological fractures. In all patients, en-block excision of the lower end of the radius with a safety margin and removing the tumor with its pseudo capsule was carried out. The excised segment was replaced by a massive autograft from the upper end of the fibula. The graft was fixed to the remaining radius by a plate and screws and temporarily to the carpus or distal end of ulna by K wire or screw. The results showed that three patients developed a local recurrence, two had distant metastases and one patient was lost for follow up. Recurrent cases turned malignant. A functional study was done for the remaining 11 patients, which showed a good hand function and a slight limitation of wrist movement and almost normal pronation/supination. There was a widening of the wrist and no recurrence for an average of 18.1 years was detected