Garlic extract therapy in children with hypercholesterolemia.

OBJECTIVE: To determine whether garlic extract therapy is efficacious and safe in children with hypercholesterolemia. DESIGN: Randomized, double-blind, placebo-controlled clinical trial. SETTING: Specialized pediatric lipid disorders ambulatory clinic. PARTICIPANTS: Thirty pediatric patients, aged 8 to 18 years, who had familial hyperlipidemia and a minimum fasting total cholesterol level greater than 4.8 mmol/L (> 185 mg/dL). INTERVENTION: An 8-week course of a commercially available garlic extract (Kwai [Lichtwer Pharma, Berlin, Germany], 300 mg, 3 times a day) or an identical placebo. MAIN OUTCOME MEASURES: Absolute and relative changes in fasting lipid profile parameters. RESULTS: The groups were equivalent at baseline and compliance was similar in the 2 groups (P = .45). There was no significant relative attributable effect of garlic extract on fasting total cholesterol (+0.6% [95% confidence interval, -5.8% to +6.9%1) or low-density lipoprotein cholesterol (-0.5% [95% confidence interval, -8.7% to +7.6%]). The lower limits of the confidence intervals did not include -10%, the minimum relative attributable effect believed to be clinically important. Likewise, no significant effect was seen on the levels of high-density lipoprotein, triglycerides, apolipoprotein B-100, lipoprotein (a), fibrinogen, homocysteine, or blood pressure. There was a small effect on apolipoprotein A-I (+10.0% [95% confidence interval, +1.2% to +16.5%] P=.03). There were no differences in adverse effects between groups. CONCLUSION: Garlic extract therapy has no significant effect on cardiovascular risk factors in pediatric patients with familial hyperlipidemia.

Reliable salbutamol administration in 6- to 36-month-old children by means of a metered dose inhaler and Aerochamber with mask.

A double-blind study was performed to demonstrate that bronchodilator can be administered reliably to infants and children under 3 years of age from a metered-dose inhaler (MDI) by means of an economical valved aerosol-holding chamber device (Aerochamber) fitted with a mask. Symptoms of cough and breathlessness were compared for two 1-week crossover periods with the child either taking active drug or placebo. The MDI and Aerochamber with mask is an effective delivery system for respiratory therapy in these young children.

Amyloidosis presenting as priapism.

A sixty-five-year-old white man presented with sudden onset of painful, priapism. Review of pathologic specimens at the time of surgical decompression revealed massive amyloid infiltration. Purpura, organ enlargement, gastrointestinal bleeding, and congestive heart failure developed subsequently. Postmortem examination revealed widespread amyloidosis. To our knowledge this is the first report of amyloidosis presenting with priapism.

Demonstration by radionuclide imaging of possible vascular steal from a renal transplant.

Radionuclide studies in a renal-transplant patient with congestive heart failure suggested vascular steal from the renal allograft by a contralateral femoral arteriovenous fistula. These reliable, noninvasive diagnostic procedures have potential use in similar settings to evaluate allograft perfusion and function. Correction by removal of the fistula was demonstrated.

Genitourinary aspects of disseminated coccidioidomycosis.

Genitourinary involvement is common in disseminated coccidioidomycosis. Urologic evaluation should include careful examination, cultures and radiograms. The radiographic features of renal coccidioidomycosis parallel those of renal tuberculosis, with feathery, moth-eaten calices, infundibular constriction and caliceal ballooning, and eventual calcification of granulomas. Coccidioidal epididymitis may be chronic, with long asymptomatic intervals. A patient with a 15-year interval between episodes of right and left coccidioidal epipidymitis is described. Complement fixation titers should be used to determine the activity of genitourinary coccidioidomycosis. In 3 of 12 patients dissemination of coccidioidomycosis occurred during treatment with immunosuppressive medications. Renal transplant patients should be evaluated for active coccidioidomycosis prior to transplantation.