ABSTRACT
OBJECTIVES: A randomized clinical trial of low dosage combination of pentamidine and allopurinol was carried out with objectives to assess the efficacy and toxicity as compared to full dosage of pentamidine in antimony unresponsive visceral leishmaniasis (VL) patients. METHODS: Using a randomized control clinical trial, a total of 158 antimony unresponsive patients of VL were randomly allocated into two treatment groups. Patients in one group (n=80) received half the dosage of pentamidine i.e. 2 mg/kg body weight by IM route on alternate day and allopurinol in dose of 15 mg/kg body weight in three divided dosages for 30 days; patients in the second group (n=78) received pentamidine in dose of 4 mg/kg body weight by IM route on alternate day for 15 injections in 30 days. The efficacy and safety of the two regimens were compared. RESULTS: Apparent cure i.e. clinical and pathological cure at the end of therapy, in 78 (97.5%) and 67 (86%), and ultimate cure i.e. clinical and parasitological cure at the end of follow-up of six months, in 73 (91.25%) and 58 (74.35%) patients was observed in the combination regimen and single regimen group respectively. The difference of the ultimate cure between two groups of the patients was statistically significant (p < 0.01). In single regimen group, 11 (14%) patients showed primary unresponsiveness (with no response during treatment) and nine (13%) relapse (after six months of follow-up) respectively, where as in combination regimen group, two (2.5%) patients showed primary unresponsiveness and five (6.4%) relapse respectively. By the end of the treatment, the incidence of injection-related toxicity, such as rigor and fever, was same in both groups. No hyperglycemia was observed in combination therapy probably due to reduced dose of pentamidine and three patients in single regimen developed hyperglycemia and one of them developed irreversible hyperglycemia. CONCLUSIONS: The study showed that the combination of pentamidine (half dose) and allopurinol is more effective in achieving ultimate cure with an added advantage of reduced toxicity in unresponsive cases as compared to full pentamidine dose.
Subject(s)
Allopurinol/administration & dosage , Antiprotozoal Agents/administration & dosage , Leishmaniasis, Visceral/drug therapy , Pentamidine/administration & dosage , Adolescent , Chi-Square Distribution , Child , Drug Therapy, Combination , Enzyme Inhibitors/administration & dosage , Female , Humans , Male , Middle AgedABSTRACT
Primary adenosquamous carcinoma of the colon is an aggressive entity. We report a 41-year-old man with a combination of adenocarcinoma and squamous cell carcinoma of the cecum, treated by right hemicolectomy and ileo-transverse anastomosis. Postoperatively he received adjuvant chemotherapy. However, the tumor recurred at the original site within two months and thereafter the patient was lost to follow up.
Subject(s)
Carcinoma, Adenosquamous/pathology , Cecal Neoplasms/pathology , Neoplasm Recurrence, Local/pathology , Adult , Anastomosis, Surgical , Biopsy, Needle , Carcinoma, Adenosquamous/surgery , Cecal Neoplasms/surgery , Colectomy/methods , Follow-Up Studies , Humans , MaleABSTRACT
The natural biology of spilled intraperitoneal gallstones is not known. We report a patient with subphrenic abscess following spilled gallstones at laparoscopic cholecystectomy.
Subject(s)
Cholelithiasis/surgery , Postoperative Complications/etiology , Subphrenic Abscess/etiology , Cholecystectomy, Laparoscopic , Cholelithiasis/complications , Female , Humans , Middle Aged , Postoperative Complications/diagnostic imaging , Postoperative Complications/drug therapy , Subphrenic Abscess/diagnostic imaging , Subphrenic Abscess/drug therapy , UltrasonographyABSTRACT
Fibromatosis covers a broad group of benign fibrous tissue proliferations of varied microscopic appearances that are intermediate in their biological behaviour between bengin fibrous tumour and fibrosarcoma, Extra abdominal fibromatosis in the neck occassionally cause serious sequellae when aggressive invasion of vital structure occurs. However, the principle of wide excision is difficult to apply in some patients because of the important organs surrounding the tumour. We describe a primary spindle cell tumour of thyroid that raised initial diagnostic problems and was eventually diagnosed as fibromatosis of thyroid gland.
ABSTRACT
We report a patient with hydatid cyst in the head of the pancreas who presented with obstructive jaundice. At operation, the cyst was compressing the common bile duct and pancreatic duct. Excision of the cyst with choledochoduodenostomy was performed.
Subject(s)
Cholestasis/etiology , Echinococcosis/complications , Pancreatic Cyst/diagnosis , Adult , Choledochostomy , Cholestasis/diagnostic imaging , Cholestasis/surgery , Diagnosis, Differential , Echinococcosis/diagnostic imaging , Echinococcosis/surgery , Female , Humans , Pancreas/diagnostic imaging , Pancreas/pathology , Pancreatic Cyst/etiology , Radiography , UltrasonographyABSTRACT
Ability of peripheral blood monocytes in association with HLA-DR molecules to support T-cell activation in response to soluble Leishmania donovani antigen was investigated. Adherent cells were stained with monoclonal antibodies. The increased number of cells with DR expression was more efficient in presenting L. donovani antigen to sensitized T-cells. The results suggest that quantitative variation in monocytes with expression of DR molecules, correlates with their ability to support T-cell response to L. donovani antigen, in vitro, as assessed by migration inhibition factor (MIF). However, it is not clear whether this is due to only HLA-DR antigen on the surface or whether other factors are involved.
