Leflunomide-induced peripheral neuropathy.

Two cases of leflunomide-induced peripheral neuropathy are described; in a 60-year-old woman with sero-negative polyarthralgia-myalgia syndrome and a 65-year-old man with sero-negative rheumatoid arthritis, both treated with leflunomide at 20mg/day. Nerve conduction studies and electromyogram showed sensorimotor axonal neuropathy in both cases. An alternative cause for the axonal neuropathy was excluded by extensive investigations, including cerebrospinal fluid examination and nerve biopsy in the second patient. Both patients stabilized symptomatically and electrophysiologically upon cessation of leflunomide. It is possible that leflunomide-induced peripheral neuropathy has been under-reported and under-recognized.

Synovialectomy and reconstruction of the retinaculum flexorum in median nerve decompression: technique and early results.

450 wrists in 362 patients underwent release of carpal tunnel compression combined with synovialectomy and reconstruction of the retinaculum flexorum between 1981 and 1989. To reconstruct the retinaculum flexorum, a "flap" of the antebrachial fascia continuous with the retinaculum flexorum, based radially and distally, was elevated and sutured to the hook of the hamate. This technique provides for carpal tunnel decompression while preserving the biomechanical role of the retinaculum flexorum and the normal anatomic relationship between the flexor tendons and the axial skeleton. The patients in this study appeared to recover function faster and more completely than those undergoing division of the retinaculum flexorum alone. No secondary procedures for recurrent carpal tunnel compression were necessary.

Treatment of Reye's syndrome at Sumber Waras Hospital.

Since 1974 we have seen 320 cases of Reye's syndrome in our department. There were 163 boys and 157 girls of a mean age of 20 months. While the number of Reye's syndrome patients admitted increased from 1979 to 1982, it has declined since 1984. Two different approaches to management were used. Prior to 1976 only simple supportive measures were given: Intravenous 10% dextrose solution and electrolytes (Darrow-glucose solution) in equal amounts at a rate of 50-100 ml/kg/day with or without dexamethasone (0.5 mg/kg/day). From 1976, in addition, measures were taken to lower the intracranial pressure by infusing mannitol 1-2 gm and glycerol 1 g/kg given at a frequency related to the severity of the illness, i.e., for grade II, the above combination was given 8 hourly, for grade III 6 hourly, and for grades IV and V 4 hourly, while for grade I only fluid and electrolytes were given. In all cases, clinical progress was closely followed. Intravenous dexamethasone was also given at a dose of 0.5 mg/kg/day. The fatality rate was 50 to 60% prior to 1976 and has fallen to around 20% at present. In contrast to reports from Western countries, we observed more convulsions, respiratory infections and gastrointestinal disorders but less vomiting and no chicken-pox.

Dengue hemorrhagic fever accompanied by encephalopathy in Jakarta.

Forty one cases of dengue hemorrhagic fever, confirmed by viral isolation, accompanied by neurological signs compatible to the diagnosis of acute encephalopathy were observed in 3 University Hospitals in Jakarta during the period November 1975 to December 1977. Two of these children showed typical signs and symptoms of Reye's syndrome confirmed by liver biopsy.

Dipyridamole in the treatment of dengue haemorrhagic fever.

Clinical studies in the treatment of 54 children suffering from DHF with a combination of dipyridamole and ASA as an adjuvant of our standard therapy consisted of fluid, electrolytes, blood, plasma and plasma expanders were evaluated. Heparin was administered in cases of DIC. It appeared that dipyridamole and ASA did not change the mortality significantly, but it prevented the progress of the severity of the disease from grade I and II to grade III and IV.