Doença de Creutzfeldt-Jakob forma Heidenhain: relato de caso com achados de ressonância magnética e DWI / Creutzfeldt-Jakob disease, Heidenhain variant: case report with MRI (DWI) findings

A doença de Creutzfeldt-Jakob (CJD) é uma forma de demência pré-senil de rápida evolução, geralmente fatal em um ano. Casos autóctones no Brasil têm sido raramente descritos assim como achados de ressonância magnética. Mulher, natural de Ponta Grossa PR, branca , 54 anos , foi admitida no serviço em outubro de 2001 com quadro de amaurose bilateral cortical progressiva desde há 1 mês do internamento. Nunca viajou ao exterior e foi somente submetida a uma cirurgia de redução do estômago, para obesidade. História familial sem relato de casos semelhantes. Logo após o internamento a paciente desenvolveu quadro de disfasia mista, hemiparesia flácida direita, com movimentos coreoatetóticos e crises parciais motoras. Paciente evoluiu com quadro demencial progressivo; atualmente, acamada, torporosa, dependente de alimentação enteral, recebendo mepacrina, fenitoína e clorpromazina , estabilizando o quadro até final de maio de 2002. Exames laboratoriais negativos ou normais. Pesquisa de proteína 14-3-3 no líquor foi positiva; enolase-neurônio-específica no líquor foi normal. Estudo genético do gen PRNP não revelou mutação descrita anteriormente. EEG (23/10/2001) revelou intensa atividade irritativa hemisfério cerebral esquerdo. Estudo de ressonância magnética revelou áreas de hipersinal em T2 e FLAIR em regiões temporal esquerda e bioccipital; gânglios da base normal. Imagens de DWI mostraram hipersinal nas mesmas áreas.Outro EEG (15/03/2002) revelou padrão periódico de ondas trifásicas sugestivos de CJD. A paciente fez uso de mepacrina associado a clorpromazina com aparente estabilização do quadro, até seu óbito por complicações infecciosas pulmonares em abril de 2003.

Mepacrine therapy in niclosamide resistant taeniasis.

OBJECTIVE: To evaluate the efficacy of mepacrine (quinacrine) in patients with niclosamide resistant Taenia saginata infection. METHODS: Eighty six cases with niclosamide resistant Taenia saginata (unresponsive to 2-8 courses of niclosamide) were treated with quinacrine (1 g) administered orally or via a nasogastric tube, and followed at 2, 4, 8 and 12 weeks for recurrence of passage of proglottids and presence of Taenia eggs in the stool examinations. Pre and post-therapy egg counts were obtained and egg viability was tested by staining with methylene blue. RESULTS: Eighty-one (94.2%) patients responded promptly with passage of the worm within 4-72 hours. The egg counts showed a drastic fall in 79 cases and a fall in viability from a median of 100% to 0% was observed. Only one patient demonstrated a relapse at 4 weeks. Gastrointestinal side effects occurred in 9 cases but were controlled easily by symptomatic therapy. CONCLUSION: We conclude that quinacrine is a safe, inexpensive, effective and generally well tolerated drug for the treatment of niclosamide resistant Taenia saginata infestations.

Esterilización femenina con pellets de quinacrina endouterinos / Female sterilization with transcervical quinacrine pellets

Para determinar la seguridad y eficacia de la administración de pellets de quinacrina como método de esterilización femenina voluntaria se ha realizado en Valdivia un estudio prospectivo con seguimiento a largo plazo. Los resultados se presentan en detalle y corresponden a la utilización de pellets endouterinos con un tiempo de disolución de 10 minutos en una cohorte de 151 mujeres fértiles que solicitaron su esterilización. Las quejas y complicaciones atribuibles al método fueron mínimas y de corta duración en tanto que la efectividad del procedimiento ha sido probada por una tasa de embarazos de 5,9 por ciento luego de 165 años de seguimiento. Se concluye en que se trata de un excelente método ambulatorio, de bajo costo, fácil de aprender y de realizar lo que podría permitir su uso en consultorios de nivel primario de nuestro país

Tasas estandarizadas de incidencia y prevalencia de patología cervical preclínica en 1061 mujeres esterilizadas con quinacrina intrauterina / Standards index of incidence and prevalence of preclinic cervical pathology in sterilized women with intrauterine quinacrine

A un grupo de 1061 mujeres en edad fértil que solicitaron esterilización quirúrgica con pellets de quinacrina insertos en la cavidad uterina por 2 ó 3 veces con un intervalo de 30 a 40 días y en las cuales se había efectuado uno o varios exámenes de Papanicolaou, antes o después de la esterilización, obtuvimos algún grado de positividad en 75 mujeres 7,1 por ciento. En 36 de ellas esta positividad fue anterior a la inserción, tasa de prevalencia= 34,05 por ciento. En 39 mujeres aparecieron lesiones después de la inserción, tasa de incidencia= 2,62 por ciento en un total de 3285 años/mujer entre el primero y el último PAP efectuado. Los resúmenes de los análisis estadísticos se adjuntan en varias tablas. La conclusión de este estudio indica que la utilización de quinacrina intrauterina no aumenta las tasas de incidencia de cáncer cérvico uterino en la población esterilizada con respecto a las cifras que espontáneamente se presentan en la población de Santiago

Derrame pleural neoplásico (DPN): normatización para su tratamiento / Neoplasic pleural effusion: treatment guide

El derrame pleural neoplásico es una manifestación de enfermedad avanzada y su tratamiento debe dirigirse a mejorar la calidad de vida con baja morbilidad. Se expone la conducta seguida utilizando un flujograma terapéutico para la indicación del sellamiento pleural con tetraciclinas o pleurectomia. Se trataron 32 pacientes con derrame y sintomatología invalidante, en 29 se realizó pleurodesis con tetraciclina con un 97// de respuestas. La hipertemia (28//) y el dolor (24//) fueron complicaciones más frecuentes. En los 3 restantes se efectuó pleurectomía y no recidivó el derrame, pero dos se complicaron (infección de herida y defecto de reexpansión). La supervivencia media fue de 9,2 meses

Treatment of human taeniasis in the Philippines: a review.

Studies relating to the treatment of human taeniasis in the Philippines using Atabrine, bithionol, and mebendazole are reviewed. Cure rates of 93.7% for Atabrine, 85%-100% for bithionol, and 84.62% for mebendazole are reported. Aside from these studies, recent experience in the treatment of Taenia saginata infections at the Department of Parasitology, College of Public Health, is also reported. Twenty patients referred to the department were treated, 3 with bithionol, 17 with praziquantel. Of the 17 patients treated with praziquantel, the study reported cure rates of 47-88.24%.

Studies on taeniasis in Taiwan. V. Field trial on evaluation of therapeutic efficacy of mebendazole and praziquantel against taeniasis.

Taeniasis is a major public health problem among the aboriginal populations on Taiwan, and is highly prevalent and wide spread in the mountain areas of 10 Counties. Over 27,000 cases of tapeworm infection are estimated influencing the health and economy in the endemic areas. A treatment of taeniasis with mebendazole and praziquantel followed by a re-treatment with atabrine has been done in the field trial, and confirmed that praziquantel is highly effective agent against tapeworm infection, but mebendazole is not. Based upon experiments reported here praziquantel in a single dose of 150 mg, and 450 mg are highly effective against taeniasis and hymenolepiasis respectively.

Treatment of giardiasis in children with quinacrine, metronidazole, tinidazole and ornidazole.

One hundred and twenty four children with symptomatic and parasitologically confirmed giardiasis were treated in a comparative trial. The dosage of antigiardia drug was adjusted to the body surface area of the patients from the adult basic dosage as 100 mg of quinacrine t.i.d. for 5 days, 200 mg of metronidazole t.i.d. for 7 days, 2 gm of metronidazole once, 2 gm of tinidazole once or 2 gm of ornidazole once. They were hospitalized for follow-up for 30 days. The parasitological follow-up consisted of daily examination of stool specimens. Reinfections were unlikely. The rates of success were: a 5-day course of quinacrine, cured all of them, 20 patients; a 7-day course of metronidazole, 12 of 20; metronidazole, single dose, 11 of 21; tinidazole, single dose, 18 of 21; ornidazole, single dose, 21 of 22; placebo, none of 20. After a single dose, 5 patients had transient elevation of transaminases, one patient in each of metronidazole and tinidazole group 3 patients in ornidazole group. A 5-day course of quinacrine gave excellent result but the drug is not widely marketed. Ornidazole or tinidazole were more effective, both of them were recommended as a drug of choice as single dose therapy, however transient increase of transaminases may occur in some cases.