Eosinophilic leukemoid reaction associated with carbamazepine hypersensitivity.

Carbamazepine is widely used in the treatment of epilepsy, neuralgic pain, and bipolar affective disorders. Several adverse drug reactions have been described during the course of carbamazepine administration, including exanthemata and hematological reactions. Carbamazepine is one of the common drugs that have been implicated in the etiology of drug hypersensitivity syndrome. A 50-year-old male presented with generalized erythroderma following 10 weeks of ingestion of carbamazepine 200 mg daily for idiopathic epilepsy. His systemic examination was within normal limits. Blood counts revealed marked eosinophilia of 52% (absolute eosinophil count of 10,400 per mm3). Bone marrow aspiration revealed a moderate increase in the eosinophilic series with cells showing normal morphology. The eosinophil counts returned to normal after 2 weeks of oral prednisolone therapy. This case is reported because of its rarity in the Indian medical literature.

Pyoderma gangrenosum treated with sulfasalazine and dapsone.

A case of pyoderma gangrenosum treated initially with sulfasalazine and later with dapsone and being kept in remission with dapsone alone is being reported.

Effect of trolox C on cardiac contratucture induced by hydrogen peroxide

Hydrogen peroxide (H2O2) perfused into the aorta of the isolated rat heart induces a positive inotropic effect, with cardiac arrhythmia such as extrasystolic potentiation or cardiac contractures, depending on the dose. The last effect is similar to the "stone heart" observed in reperfusion injury and may be ascribed to lipoperoxidation (LPO) of the membrane lipids, to protein damage, to reduction of the ATP level, to enzymatic alterations and to cardioactive compounds liberated by LPO. These effects may result in calcium overload of the cardiac fibers and contracture ("stone heart"). Hearts from male Wistar rats (300-350g) were perfused at 31°C with Tyrode, 0.2 mM trolox C, 256 mM H2O2 or trolox C + H2O2. Cardiac contractures (baseline elevation of the myograms obtained) were observed when hearts were perfused with H2O2 (Tyrode: 5.9 + 3.2; H2O2: 60.5 + 13.9 percent of the initial value); perfusion with H2O2 increased the LPO of rat heart homogenates measured by chemiluminescence (Tyrode: 3,199 + 259; H2O2: 5,304 + 133 cps mg protein(-1) 60 min(-1), oxygen uptake (Tyrode: 0.44 + 0.1; H2O2: 3.2 + 0.8 nmol min(-1) mg protein(-1) and malonaldehyde (TBARS) foramtion (Tyrode: 0.12 + 0; H2O2: 0.37 + 0.1 nmol/ml). Previous perfusion with 0.2 mM trolox C reduced the LPO (Chemiluminescence: 4,098 + 531), oxygen uptake (0.51 + 0) and TBARS (0.13 + 0) bud did not prevent the H2O2-induced contractures (33.3 + 16 percent). ATP (Tyrode: 2.84 + 0; H2O2: 0.57 + 0) and glycogen levels (Tyrode: 0.46 + 0; H2O22: 0.26 + 0) were reduced by H2O2. Trolox did not prevent these effects (ATP: 0.84 + 0 and glycogen: 0.27 + 0). Trolox C is known to be more effective than alpha-tocopherol or gamma-tocopherol in reducing LPO though it lacks the phytol portion of vitamin E to be fixed to the cell membranes. Trolox C, unlike vitamin A, did not prevent the glycogen reduction induced by H2O2. Trolox C induced a positive chronotropic effect that resulted in higher energy consumption. The reduction of energy level seemed to be more important than LPO in the mechanism of H2O2-induced contracture.

Emprego de corticoide topico, oclusivo, em aplicacao unica, diaria, em dermatoses eczematosas. / Use of topical and occlusive corticoid in a single dose in eczematous dermatosis

Dezessete pacientes portadores de dermatoses eczematosas foram submetidos a terapeutica topica com creme de halcinonida a 0,1%, sob forma oclusiva, em aplicacao unica diaria, durante duas horas, por periodo de 10 dias. A avaliacao de eficacia da droga foi baseada em criterios objetivos e subjetivos, tendo havido, de modo geral, concordancia entre ambos. Os resultados foram excelentes em 11 casos, bons em cinco e regulares em um caso. No decurso do ensaio nao foram observadas evidencias de efeitos colaterais

Sarcoidose em placas. / Plaque form sarcoidosis

E apresentado um caso de sarcoidose em placas em paciente do sexo feminino, procedente do nordeste brasileiro, tambem portadora de esquistossomose mansonica. Sao revistos alguns criterios basicos para diagnostico e aspectos imunologicos e histopatologicos da sarcoidose, destacada a resposta negativa ao teste intradermico de Mitsuda no presente caso e discutido o seu diagnostico diferencial com reacao sarcoidal sistemica