Comparison of Diskus inhaler, a new multidose powder inhaler, with Diskhaler inhaler for the delivery of salmeterol to asthmatic patients. Canadian Study Group.

Administration of the long-acting beta 2-adrenoceptor agonist salmeterol from a new, easy-to-operate, multidose powder inhaler (Diskus) containing 60 sealed doses in a foil strip has been compared with administration from a Diskhaler inhaler in a multicenter, double-blind, double-dummy, parallel-group study. Asthmatic patients taking anti-inflammatory treatment, with baseline FEV1 > or = 60% and < or = 90% predicted were treated for 4 weeks with salmeterol 50 micrograms twice daily from either the Diskus or Diskhaler inhaler. The two treatments were equivalent (90% CLs for the difference in mean morning PEFR: -2.2, 8.7 L/min). The Diskus inhaler was rated easier to use and was preferred by more patients than the Diskhaler inhaler (73% vs. 15%).

[Excimer laser photorefractive keratectomy for myopia].

We have used excimer laser during the past year to correct refractive errors (myopia and hypermetropia) and to remove superficial corneal scars. 714 eyes underwent excimer laser photorefractive keratectomy for correction of myopia and 81% of the patients achieved uncorrected visual acuity of 6/12 or better without glasses. 17 patients underwent a second treatment to correct residual myopia and all of them had uncorrected visual acuity of 6/12 or better 6 months later. The results show that excimer laser photorefractive keratectomy is a safe and efficient procedure to correct myopia. The possibility of various postoperative complications appearing over the long term suggests cautious optimism.

Influence of subject age on the inhibition of oxidative metabolism by ciprofloxacin.

Case reports suggest that the magnitude of inhibition of oxidative metabolism produced by ciprofloxacin may be greater in elderly subjects. We examined the effect of oral ciprofloxacin on antipyrine disposition in 13 young (ages, 23 to 34 years) and 9 elderly (ages, 65 to 82 years) healthy volunteers. Ciprofloxacin decreased antipyrine oral clearance in young and elderly subjects (P less than 0.05), with the average decreases being similar in both groups (23.3% for the young subjects and 27.9% for the elderly subjects). Ciprofloxacin concentrations in serum were significantly higher (mean, 57%) in the elderly. The formation clearance of 4-hydroxyantipyrine and 3-hydroxymethylantipyrine was also significantly decreased in both groups of subjects; however, norantipyrine formation, accounting for 15 to 20% of antipyrine clearance, was reduced only in the elderly. These results suggest that elderly subjects are not more sensitive to the inhibitory effect of ciprofloxacin on antipyrine metabolism. However, careful clinical monitoring is necessary with all patients, irrespective of age, taking ciprofloxacin concomitantly with drugs primarily eliminated by the cytochrome P-450 system.

The triazole antifungal agents: a review of itraconazole and fluconazole.

Fluconazole and itraconazole are two investigational triazole antifungal agents that are currently undergoing clinical trials in the United States. Both are active orally, have favorable pharmacokinetics (i.e., good bioavailability, long half-life, low plasma protein binding), and possess activity against several systemic fungal pathogens. In addition, preliminary information suggests that these agents are substantially less toxic than currently available azole compounds. Fluconazole and, to a lesser degree, itraconazole have been shown to be highly effective for the treatment of cryptococcal meningitis. The potential for drug interactions is much lower with these agents compared to drugs such as ketoconazole.

Immunohistochemical diagnosis of a totally necrotic retinoblastoma: a clinicopathologic case.

An 8-month-old girl underwent enucleation of her right eye because of a calcified retrolental white mass filling the entire vitreous cavity. The conventional histological examination revealed a totally necrotic unidentifiable tumor, with scattered foci of calcification. In addition, we found two islands of viable small round cells, suspected to be retinoblastoma cells, which were located in the optic nerve behind the lamina cribrosa. These cells stained positively for neuron-specific enolase (NSE), but not for glial-fibrillary-acidic-protein (GFAP), supporting the diagnosis of retinoblastoma. Because one of the latter foci of viable tumor cells was located at the cut end of the optic nerve, the baby was treated by external beam irradiation.