Treatment of falciparum malaria with quinine-erythromycin.

A total of 47 complicated cases of falciparum malaria were treated eight-hourly with quinine dihydrochloride 10 mg/kg in a 5 percent dextrose intravenous drip two to four hours. If parasitemia was more than 5 percent and severe complications were observed, a first dose of quinine dihydrochloride 20 mg/dl was given. Oral quinine sulphate, 10 grains every eight hours replaced the treatment when patients were able to take treatment by mouth without vomiting and diarrhea for a duration of seven days. This was followed with erythromycin 250 mg four times daily for seven days. In cases of children (<12 years), quinine and erythromycin dosages were calculated from an adult weight of 60 kg adjusted to the body surface area. After follow-up for four weeks, the cure rate was 84 percent (21/25 cases), while recrudescence of 16 percent (4/21 cases) was observed. Very mild side effects such as tinnitus from the quinine and nausea and vomiting from the erythromycin, but all patients showed good tolerance of the treatment.

A study of pheochromocytoma 34 cases.

A twenty years (1976-1995) retrospective study was undertaken of 8,768 cases hypertensive patients who were admitted to Siriraj Hospital, with pheochromocytoma in 34 cases (0.39%). The latter group comprised of nine males (26.5%) and 25 females (73.53%), giving a male:female ratio of 1:2.8 their aged range were 7-59 years (mean 34.12 years). Most of the patients presented with cardinal symptoms:headache, diaphoresis and palpitation plus other minor symptoms. Wit the exception of one patient whose blood pressure was high (mean arterial pressure = 148+ 18 mm. Hg) and unstable from 110/70 to 270/170 mm. Hg during the 24 hours recorded. The investigations for the etiology were divided into two periods The first period was from 1976 to 1982. A phentolamine test was performed in 11 cases, with positive results. The investigations then continued with perirenal air insufflations and adrenal angiography, which gave results of tumour masses in the adrenal glands. The investigations during the second period from 1982-1995 were comprised of the measurements of plasma catecholamine in 12 cases, and 24 hours urine cetechalamine, and vanillyl mandelic acid (VMA) in 18 and 17 cases respectively. The means levels of plasma catecholamine, urine catecholamine4 and urine VMA were 7.5+ 8 μg/L (normal < 1.5 μg/L), 255.8+ 181.4 μg (normal < 15 μg) and 51.2+ 27.7 μg (normal = 1.5-10 μg) respectively. These values were higher than normal especially for urine catecholamine but these values significantly returned to normal after operation in the cases of benign pheochromocytoma. CT scan and metaiodobenzylguanidine (MIBG) were ten performed in 21 and 2 cases respectively with the demonstration of sites and sied of tumour masses in the adrenal glands in 19 cases and extraadrenal in 2 cases, of the latter, one patient had a tumour mass which was seated in front and had invaded the inferior vena cava, while the second patient was found to have a tumour mass on the Zackerkandl gland. Another two cases of Zuckerkandl were detected by surgery. These four extra adrenal tumours were observed. The α adrenergic blocking drug of choice for control blood pressure before surgery in the first period was phenoxybenzamine (20-80 mg/day) while the second period the drug of choice was a post synapic α1 adrenergic blocking drug (prazosin) which was used until blood pressure was well controlled. The started dose was 2 mg of prazosin and increasing to not more than 20 mg/day. Aβ adrenergic blocking drug (propranolol) was administered orally for control of the pulse rate when it increasing duringα adrenergic drug was given. When both blood pressure and pulse rate of the patients treated during the two period was controlled, surgery was performed with the results of 30 benign tumours (88.24%) size 1 x 1.2 – 16 x 15 x 8.5 cm )mean 5.54 x 4.83 x 4 cm) and 4 malignants (11.76%). One patient died (2.94%) during the operation as a result of massive haemorrhage following the surgery, benign pheochromocytoma patients showed a cure rate of 100 percent without requiring any antihypertensive drugs. The four cases of malignant tumour had to be treated with high dose of prazosin, with two cases also received palliative e radiotherapy treatment resulting a temporary reduction the size of the tumour was achieved. One patient who was a regular attendance at the hypertension clinic survived for 12 years.

Malaria and ciprofloxacin.

Ten case of uncomplicated P. failciparum were treated with ciprofloxacin 500 mg orally twice a day for 3 days. Mean parasitemia declined from 117.2 per 200 wbc before treatment to 60, 39.4, 17.3, and 2.6 per 200 wbc at 24, 48, 72, and 92 hours after the first dose of ciprofloxcin. Two cases were malaria free after 1 month follow up. No malaria complications developed during the trail. The drug was safe and well-tolerated.

Doxazosin in the treatment of hypertension.

Eifhteen mild to moderate hypertensive patients were treated with doxazosin once a day. Dosage was adjusted every two weeks to obtain diastolic blood pressure < 90 mmHg. After ten weeks of treatment mean blood pressure was reduced from 171/107 mmHg to 166/100 mmHg, HDL-cholesterol was increased from 40 mg/dL to 45 mg/dL (P<0.05) with the mean daily dose of doxazosin of 6.1 mg. Cardiovascular disease risk was reduced 19.1% from the baseline. Doxazosin used once a day is well tolerated and suitable for mild hypertension.

Felodipine ER in the treatment of hypertension.

Twenty-two patients with mild to moderate hypertension were treated with felodipine ER 5 mg once daily for the three weeks of treatment at the out patient department. At the end of the three-week period, if diastolic blood pressure still exceeded 90 mmHg, then dose of felodipine ER would be increased to 10 mg/day until the end of the trail (6 weeks). After three and six weeks of treatment, systolic blood pressure was significantly reduced from 164.6+14.6 to 149.4+17.3 and 140.4+14.5 mmHg, diastolic blood pressure also was significantly reduced from 102.8+7.8 to 94.7+7.6 and 91.9+8.4 mmHg, repectively. The responder rate (diastolic blood pressure < 90 mmHg) was 64 percent at the end of the trial. No changes of blood sugar, serum lipid and renal function were observed, but the Na+ level was decreased, and SGOT and SGPT were increased significantly from the pre-treatment level; however, they remained within the normal range. Therefore, felodipine ER is one of the calcium antagonists which is suitable for treatment of mild to moderate hypertension.