ABSTRACT
The aim of the study was to determine for the first time the response of systemic sclerosis (SSc) patients to treatment with intravenous immunoglobulin (IVIg). Three patients with progressive and rapidly deteriorating disease (mainly affecting the skin) were planned to receive six monthly courses of high-dose IVIg (2 g/kg). All had a thorough physical examination, clinical evaluation by the modified Rodnan total skin thickness score, and measurement of the titres of PM-Scl antibodies before and after the treatment, and before and after each treatment course. Two of the three patients received six IVIg courses as planned and no adverse effects or disease progression occurred during the therapy. The third patient received three courses, after which he developed renal failure and later died of sepsis. All three patients had a large decrease in their skin score after the treatment compared to that before the treatment. No modification of PM-Scl antibody titres was noted in any patient. Intravenous immunoglobulin (IVIg) may have a role in the treatment of SSc patients with rapidly deteriorating skin disease. The specific indications, as well as the safety of this treatment, should be further researched.
Subject(s)
Immunoglobulins, Intravenous/therapeutic use , Scleroderma, Systemic/drug therapy , Scleroderma, Systemic/pathology , Skin/pathology , Adult , Female , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
Churg-Strauss vasculitis (CSV) is a systemic vasculitis usually treated with steroids and cytotoxic drugs. Herein, we describe the beneficial effect of intravenous immune globulin (IVIG) in a 50-year-old man with CSV. The IVIG therapy brought a marked clinical improvement, with impressive decline in the titers of antineutrophil cytoplasmic autoantibody.
Subject(s)
Churg-Strauss Syndrome/drug therapy , Immunoglobulins, Intravenous/therapeutic use , Antibodies, Antineutrophil Cytoplasmic/blood , Antibodies, Antineutrophil Cytoplasmic/drug effects , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
Community-acquired pneumonia is one of the most common infectious conditions that require hospitalization. When intravenous treatment is indicated, cefonicid is usually the drug of choice. The aim of this study was to find out if chloramphenicol, which is superior to the standard drugs from a financial point of view, could serve as an equally efficient treatment, especially in the elderly. The outcomes of 3 pneumonia patient groups who were either treated with cefonicid, chloramphenicol or penicillin-G (n = 59, 17, 24, respectively) were retrospectively compared. Data about demographic characteristics of the patients, clinical outcomes, rehospitalization rates, duration of improvement/treatment/ hospitalization and clinical laboratory tests were obtained from each patient's medical records. Only minor differences (even though occasionally significant) were found with respect to rehospitalization and improvement rates, duration of hospitalization, treatment and improvement, death rates and clinical laboratory tests. However, chloramphenicol patients were found to be significantly older than cefonicid patients. Moreover, no bone-marrow suppression was associated with chloramphenicol treatment. All 3 drugs tested seem to have the same efficacy. We conclude that since chloramphenicol is as safe as, and much cheaper than cefonicid, this antibiotic agent is not inferior to the others, its usage in older patients with pneumonia should be considered.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Cefonicid/therapeutic use , Chloramphenicol/therapeutic use , Penicillin G/therapeutic use , Pneumonia, Bacterial/drug therapy , Anti-Bacterial Agents/adverse effects , Blood Cell Count , Cefonicid/adverse effects , Chloramphenicol/adverse effects , Community-Acquired Infections/drug therapy , Community-Acquired Infections/mortality , Humans , Middle Aged , Penicillin G/adverse effects , Pneumonia, Bacterial/mortality , Retrospective Studies , Survival RateABSTRACT
A 27-year-old woman developed Wernicke's encephalopathy in the 18th week of her pregnancy after 11 weeks of vomiting accompanied by weight loss of 21 kg and moderately abnormal liver function tests. The patient recovered after thiamine therapy but the fetus was lost. Review of the literature published during the last 25 years revealed an additional 14 cases of Wernicke's encephalopathy complicating hyperemesis gravidarum. All patients vomited for at least 4 weeks. Six of the 15 patients (40%) had aspartate aminotransferase values > 100 U/l, much higher than the rate reported in previous series of patients with hyperemesis gravidarum (7%). This suggests the need for parenteral thiamine supplementation in patients with severe hyperemesis gravidarum lasting more than 3 weeks, especially those with abnormal liver function, and supports the hypothesis that the hepatic abnormality plays a pathogenetic role in the development of Wernicke's encephalopathy in hyperemesis gravidarum.
Subject(s)
Hyperemesis Gravidarum/complications , Wernicke Encephalopathy/etiology , Adult , Aspartate Aminotransferases/metabolism , Female , Humans , Liver Function Tests , Pregnancy , Thiamine/therapeutic use , Wernicke Encephalopathy/diagnosis , Wernicke Encephalopathy/drug therapy , Wernicke Encephalopathy/metabolismABSTRACT
Sixty obese outpatients participated in a double-blind comparison of diethylpropion hydrochloride and placebo in conjunction with a behavior modification program for weight reduction. Assessments of efficacy and program acceptance included total weight loss, percent of initial (baseline) weight loss, percent excess weight lost, effectiveness of overall program, and helpfulness of medication. Diethylpropion was significantly better than placebo in all five assessments. An added behavioral technique, a substantial refundable deposit of money, reduced the attrition rate of all study entrants from 50% to 10%; thus patient compliance was greatly enhanced.
