The effects of fluoxetine on the polysomnogram of depressed outpatients: a pilot study.

The effects of fluoxetine (FLU) and its active metabolite, norfluoxetine (NFLU), on the polysomnogram (PSG) of nine depressed outpatients (eight with major depression; one with bipolar II, depressed phase disorder) were investigated by contrasting PSG values prior to treatment and during administration of FLU. The PSG changes were correlated with daily dose, cumulative dosage, single serum concentrations, and the total area under the serum concentration curve (AUC) of both FLU and NFLU. Fluoxetine clearly increased both stage 1 sleep time and rapid-eye-movement (REM) latency and decreased both percent REM and REM density. With a few exceptions, the cumulative dosage of FLU and the AUC of FLU and NFLU were better predictors of the changes in awake and movement time in the PSG than single-sample concentrations of FLU and NFLU taken at the time of PSG assessment.

Five vs. ten days of therapy for acute otitis media.

In a double blind study 175 patients with acute otitis media were randomized into 2 treatment groups: 10 days of therapy with cefaclor or 5 days of therapy followed by 5 days of placebo. The dosage of cefaclor was 40 mg/kg/day administered orally in equally divided doses at 12-hour intervals. Tympanocentesis before treatment yielded specimens that contained Streptococcus pneumoniae or Haemophilus influenzae or both in 55% of specimens. Branhamella catarrhalis was isolated from 21% of specimens. Culture of material from the ear canal of patients with spontaneous perforation of the tympanic membrane of less than 24 hours duration yielded pneumococci or H. influenzae or both in 38% of specimens and staphylococci in 31%. Patients were scheduled for follow-up examinations at 5 or 6, 10, 30, 60 and 90 days. Of the 175 children 151 were evaluable at 10 days. There were 123 patients with both tympanic membranes intact at the time of diagnosis. There were 6 (10%) treatment failures of therapy in the 59 patients assigned to 5 days of therapy and 4 (6%) failures and 1 (2%) early relapse in the 64 assigned to 10 days of therapy (difference not significant). There were 28 evaluable patients with spontaneous perforation. There were 8 (53%) failures in the 15 children assigned to 5 days of therapy and only 1 (8%) failure in the 13 children assigned to receive 10 days of therapy (P = 0.016, Fisher exact test). Rates of reinfection and persistent middle ear effusion at 10, 30, 60 and 90 days follow-up were not significant different in patients assigned to 5 to 10 days of therapy. In patients with acute otitis media with intact tympanic membranes we have not been able to show any advantage of the standard duration of 10 days of therapy over a shortened course of 5 days. A 5-day course of antibiotic therapy does not appear to be sufficient for children with acute otitis media and spontaneous purulent drainage.

Tuberculous meningitis: role of CT in management and prognosis.

Serial computed tomographic scans were performed during the course of tuberculous meningitis in 25 patients aged 1-70 years. Hydrocephalus rarely occurred without other abnormalities. Marked ventricular enlargement was associated with extensive basal enhancement. Basal meningeal enhancement was not a good indicator of the clinical state although marked enhancement was a risk factor for the development of basal ganglia infarction. Infarcts were much more common in children than in adults and were sometimes asymptomatic. Radiological abnormalities sometimes developed during treatment and often did not resolve completely. Many patients had severe residual neurological problems.

Juvenile laryngeal papillomatosis.

From the records of 23 patients with juvenile laryngeal papillomatosis, various aspects of the aetiology, natural history and treatment of the condition have been presented. The lesions are thought to be viral in origin, they are notoriously unpredictable in their behaviour, and treatment can often be prolonged and frustrating. Tracheostomy should be avoided, if possible, owing to the risk of further dissemination down the trachea and bronchi. The CO2 laser now seems to be the surgical treatment of choice, and early reports of adjuvant interferon therapy are encouraging. However, the laser is only available in certain centres, and interferon supplies are limited at present.

Treatment of respiratory papillomatosis with adenine arabinoside.

Nine children with respiratory papillomatosis have been treated with adenine arabinoside with limited success. No long term benefit was obtained in six, and although resolution was achieved in one and probably two others, this could not be attributed confidently to treatment.

The calorie intake and weight gain of low birth weight infants fed on fresh breast milk or a special formula milk.

The calorie intake and weight gain of 24 low birth weight (LBW) infants, less than 33 weeks gestation and less than 1500 g birth weight, was studied prospectively. Fourteen infants were fed on a commercially available LBW formula milk and ten were fed on their own mother's fresh unpasteurised expressed breast milk (EBM). The difference between the two feeding groups in the intake of milk and calories was not significant, but from the third week onwards those fed on the LBW formula gained weight faster. The mean (+/- SEM) weight increments for weeks 3-6 (inclusive) for LBW formula and EBM fed infants was 189.3 (+/- 7.9) and 139.6 (+/- 11.1) g/wk respectively (P less than 0.001). The LBW formula was well tolerated and is a suitable feed for LBW infants. However some babies thrived well on fresh EBM and so we are continuing to encourage mothers who wish, to breast feed their own preterm infants. When such infants fail to thrive it is appropriate to supplement with a LBW formula.

Paradoxical expansion of intracranial tuberculomas during chemotherapy.

4 patients with tuberculosis, 3 of whom had tuberculous meningitis, were noted to have tuberculomas on computed tomographic scanning. During antituberculous chemotherapy the intracranial lesions increased in size in all 4 patients at a time when the clinical state and cerebrospinal-fluid abnormalities were improving; in 2 of the patients the regional lymph nodes also enlarged greatly. Though the expansion of the cerebral lesions caused anxiety and led to some changes in chemotherapy, the lesions eventually diminished in size.