[Clinical and imaging course of posterior reversible encephalopathy syndrome in a patient with endocarditis and arterial hypertension]. / Klinischer und bildmorphologischer Verlauf eines posterioren reversiblen Enzephalopathiesyndroms bei Endokarditis und arterieller Hypertonie.

Posterior reversible encephalopathy (PRES) is a clinical syndrome characterized by headaches, seizures, cortical blindness, and altered mental status up to coma and by a radiological syndrome defined by edematous alteration on Magnetic Resonance Imaging (MRI)-Scans of the white matter. In the following, we present the case of a 73 years old post-operative patient with PRES in the context of hypertension and endocarditis with E. coli. The initial presentation included a series of seizures, sopor, and cortical blindness. In MRI-Scans a marked cerebral edema could be identified. After successful treatment of underlying conditions, the patient has made a good recovery. However, homonymous hemianopsia towards right due to laminar necrosis in the left occipital lobe remained as a residuum.

[Cerebral amyloid angiopathy associated with inflammation]. / Zerebrale Amyloidangiopathie assoziiert mit Inflammation.

Cerebral amyloid angiopathy (CAA) associated with inflammation is a rare form of a potentially reversible encephalopathy in a subgroup of patients with CAA. The cerebral amyloid deposition can in isolated cases induce an inflammation predominantly of the cerebral blood vessels and a multifocal edema of the cerebral white matter. The courses can occur as monophasic, relapsing remitting and primarily progressive forms. We present seven cases with different courses of the disease and give an overview of the pathophysiology, clinical aspects and treatment of the disease with reference to the current literature. The cases presented show a very different and often difficult differential diagnostic clinical picture and all showed a significant improvement under steroid medication without signs of recurrence of the disease during the course. The recognition and early consistent treatment of inflammatory forms of CAA with and without direct inflammatory involvement of vessels can be decisive for successful treatment.

Ultrasonographic, CTI and MRI of Aberrant Internal Carotid Artery: Infrequent but Important to Know.

This article describes the aberrant course of the internal carotid artery (ICA) through the middle ear as an extremely rare vascular anomaly. On the basis of a case report, the findings of magnetic resonance imaging, computed tomography imaging, and especially color-coded duplex sonography are presented. The diagnosis of an aberrant ICA is important to avoid severe surgical complications of a retrotympanic mass as well as unnecessary diagnostic or therapeutic approaches in expectation of a stroke.

Carotidynia: magnetic resonance imaging and ultrasonographic imaging of a self-limiting disease.

This article describes the characteristic symptoms of carotidynia and the diagnostic options for this rare and not yet officially recognized disease entity. Based on a case report the findings of magnetic resonance imaging (MRI) and ultrasound scanning are presented.

Gene therapy--phase I trial for primary untreated head and neck squamous cell cancer (HNSCC) UICC stage II-IV with a single intratumoral injection of hIL-2 plasmids formulated in DOTMA/Chol.

Recombinant IL-2 protein has shown many immunostimulatory effects in a variety of human tumors. However, the clinical use of rIL-2 is limited by common and serious side effects after systemic administration. IL-2 expression plasmids may circumvent these drawbacks, producing high local IL-2 concentrations that cause limited or no systemic side effects. Due to the superficial growth of squamous cell carcinoma of the head and neck (HNSCC) are readily accessible for direct intratumoral injection and therefore an optimal target for such a gene therapy approach. There has been evidence for local and systemic activation of immune cells by peritumoral injections of IL-2 in patients with advanced HNSCC (Whiteside et al. 1993; Cortesina et al. 1994; De Stefani et al. 1996). We now perform a placebo-controlled, dose-rising study of the safety and tolerability of a single intratumoral injection of hIL-2 plasmid at four dose levels formulated in DOTMA/Chol in patients with primary untreated head and neck squamous cell cancer (HNSCC) TNM stage II-IV. The patients will be monitored for the occurrence of any adverse reactions to the given medication. In addition, we will determine whether the intratumoral administration of the plasmid induces and or enhances tumor-specific host responses at the immunological and or clinical level.

Efficacy of inhaled fluticasone propionate in asthma results from topical and not from systemic activity.

The objective of this study was to determine whether the therapeutic benefits of inhaled fluticasone propionate are mediated through topical or systemic effects. Two hundred seventy-four patients with asthma receiving beclomethasone dipropionate or triamcinolone acetonide during a 2-wk, single-blind, run-in period were randomized to inhaled fluticasone propionate powder 100 or 500 micrograms twice daily, oral fluticasone propionate 20 mg once daily, or placebo during a 6-wk treatment period. Patients receiving inhaled fluticasone propionate had a significantly greater probability of remaining in the study over time compared with patients receiving oral fluticasone propionate or placebo (p = 0.001). FEV1 and PEF rates at end point were significantly higher with inhaled fluticasone propionate treatment regimens than with oral fluticasone propionate (with the exception of PEF rates for inhaled fluticasone propionate 100 micrograms) or placebo treatments (p < or = 0.004). Systemic exposure to fluticasone propionate as assessed by trough plasma concentrations and/or 12-hr plasma concentration area under the curve analyses (AUC12) was higher with the oral fluticasone propionate than with the two inhaled fluticasone propionate treatment groups. The results of this study suggest that the therapeutic benefits of inhaled fluticasone propionate are mediated through topical effects in the lungs and not through systemic effects.

Plant antitumor agents, 19. Novel triterpenes from Maprounea africana.

Four new pentacyclic triterpenes have been isolated from Maprounea africana. These triterpenes are members of the previously unknown urs-12-en-29-oic acid series. The structures of these compounds were deduced from spectral and chemical evidence. The parent compound, maprounic acid, was identified as 3B-hydroxyurs-12-en-29-oic acid. The remaining three triterpenes were identified as maprounic acid 3-p-hydroxybenzoate, 7 beta-hydroxymaprounic acid 3-p-hydroxybenzoate, and 2 alpha-hydroxymaprounic acid 2,3-bis-p-hydroxybenzoate. Of the four triterpenes, only the 7 beta-hydroxy derivative exhibited in vivo P-388 activity.

The pharmacist's role as a member of the institutional review board.

Since World War II, concern about the protection of human subjects in biomedical research has increased considerably. The Nuremberg Code and the Helsinki Declaration have been published. The United States Department of Health, Education, and Welfare (DHEW) has developed and published regulations that specify a review process which research institutions must follow in order to receive DHEW funds for research involving human subjects. Part of this process includes a review of research projects by an Institutional Review Board (IRB). Membership on the IRB must be varied and should include allied scientists. Because many of the projects include investigational drugs, the inclusion of a pharmacist as a member is logical. The pharmacist, if properly selected and prepared, can play a vital role in the review of research projects by assisting in the evaluation of the scientific merit of the plan, the appropriateness of the volunteer agreement, and the regulatory compliance of the project. The selected pharmacist should view the duty as another opportunity to practice clinical pharmacy.

Isolation and structural studies of coprine, the disulfiram-like constituent of Coprinus atramentarius.

Coprine, the constituent of the mushroom Coprinus atramentarius Fr. responsible for its disulfiram-like activity, was isolated. Chemical and spectral data indicate that the compound is N5-(1-hydroxycyclopropyl)glutamine. Although coprine was shown to produce hyperaldehydemia in mice following ethanol ingestion, the compound was not found to be an inhibitor of mouse liver aldehyde dehydrogenase in vitro.