ABSTRACT
BACKGROUND: The decision to interrupt a ticlopidine regimen in a patient who develops an adverse effect can be particularly difficult when discontinuing the drug could lead to a high risk situation. CASE REPORT: A 64-year old patient developed a skin rash after taking ticlopidine for coronary artery stenting. Stopping ticlopidine could have led to stent occlusion and no alternative therapy seemed to be suitable. We therefore decided to carry on the treatment under close clinical surveillance. The skin signs rapidly resolved. DISCUSSION: This cases shows that ticlopidine may be continued in patients who develop an adverse skin reaction. The rapid involution of the cutaneous signs in our patient demonstrated that the risk of discontinuing treatment can be greater than that of continuing.
Subject(s)
Angioplasty, Balloon, Coronary , Coronary Disease/therapy , Coronary Thrombosis/therapy , Drug Eruptions/etiology , Fibrinolytic Agents/adverse effects , Stents , Ticlopidine/adverse effects , Dose-Response Relationship, Drug , Drug Administration Schedule , Fibrinolytic Agents/administration & dosage , Humans , Male , Middle Aged , Risk Factors , Ticlopidine/administration & dosageABSTRACT
OBJECTIVE: Endoscopic postoperative recurrences occur early after 'curative' surgery for Crohn's disease. Pentasa has been shown to be effective in the maintenance treatment of quiescent Crohn's disease. The aim of this study was to test the efficacy of a 12-week oral intake of Claversal in the prevention of endoscopic recurrences after 'curative' resection for ileal, colonic or ileocolonic Crohn's disease. We conducted a multicentre double-blind controlled trial comparing Claversal (1g tid) with placebo, starting within 15 days after surgery. The macroscopic normality of the two anastomotic segments was assessed at surgery. Patients were clinically and biologically evaluated twice (6-week interval), and colonoscopy was performed at 12 weeks. Endoscopic relapse was defined by any anastomotic ulcerations or stenosis and staged according to a four-grade score. RESULTS: Between May 1989 and May 1991 12 centres included 126 patients, 70 women and 56 men, aged 33 +/- 12 years (range 16-70) in the study. Disease locations were ileal, colonic and ileocolonic in 45, 6 and 49%, respectively. Claversal and placebo groups were similar at inclusion, except for ESR (37 +/- 26 vs. 27 +/- 23 mm/h in the Claversal and placebo groups, respectively; P < 0.05). Nine patients were withdrawn from the study. Adverse reactions occurred only in six patients. Five patients were excluded for protocol violation. Finally, 106 patients could be evaluated at 12 weeks (55 Claversal and 51 placebo). An endoscopic relapse was observed in 50% and 63% of the Claversal and placebo groups, respectively (P = 0.16), with a similar grade distribution. Claversal was well tolerated. CONCLUSIONS: Our study confirms that a large proportion of endoscopic recurrences occur within 3 months of resection in Crohn's disease. There was a slight trend towards greater efficacy of Claversal; it could be worthwhile trying higher dosages and/or 5-ASA compounds with different intestinal release profiles.
Subject(s)
Aminosalicylic Acids/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Crohn Disease/prevention & control , Administration, Oral , Adolescent , Adult , Aged , Aminosalicylic Acids/administration & dosage , Aminosalicylic Acids/adverse effects , Anastomosis, Surgical , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Chemoprevention , Colonic Diseases/pathology , Colonic Diseases/prevention & control , Colonic Diseases/surgery , Colonoscopy , Constriction, Pathologic/pathology , Crohn Disease/pathology , Crohn Disease/surgery , Double-Blind Method , Drug Tolerance , Female , Humans , Ileal Diseases/pathology , Ileal Diseases/prevention & control , Ileal Diseases/surgery , Male , Mesalamine , Middle Aged , Placebos , Recurrence , Ulcer/pathologyABSTRACT
We report the case of a woman who had been operated upon for a recurrent meningioma of the falx cerebri which, 22 years after it was discovered, produced pulmonary metastases. Metastases from meningiomas are extremely rare; they affect the lungs in 60% of the cases or, less frequently, the liver or lymph nodes. The factors predictive of secondary dissemination are the site of the tumour, the quality of excision, the histological type (haemangiopericytic meningioma) and the presence of cell necrosis, hypercellularity and strong mitotic activity.
Subject(s)
Brain Neoplasms/pathology , Lung Neoplasms/secondary , Meningeal Neoplasms/pathology , Meningioma/pathology , Adult , Female , Humans , Neoplasm Recurrence, Local , Neoplasm SeedingABSTRACT
A case of herniation of the cecum through the foramen of Winslow is reported in a 49-year-old man, admitted for acute abdominal pain. Diagnosis, suspected by abdominal plain films, and established by water-soluble enema, was confirmed by emergency surgical management. Herniation through Winslow's foramen represents the least common variety of internal hernias. Only 136 observations were previously reported, the cecum being involved in 25-30% of cases. Radiological diagnosis was made in only one patient out of ten. Although rare in occurrence, it carries a high mortality risk when diagnosis and treatment are delayed. A better appreciation of the classic radiological features will allow for earlier recognition and treatment. Therefore, the authors emphasize the interest of radiologic findings in this condition.
