Rupatadine and levocetirizine in chronic idiopathic urticaria: a comparative study of efficacy and safety.

BACKGROUND: Chronic Idiopathic Urticaria is difficult to treat due to its persistent debilitating symptoms. New generation anti-histaminics are first line treatment for this condition. The aim of this study is to compare efficacy and safety of rupatadine and levocetirizine in chronic idiopathic urticaria. METHODS: A randomized, single blinded, single-centred, parallel group outdoor based clinical study was conducted in 70 patients of CIU to compare the two drugs. After initial clinical assessment and baseline investigations, rupatadine was prescribed to 35 patients and levocetirizine to another 35 patients for 4 weeks. At follow-up, the patients were re-evaluated and then compared using different statistical tools. Main outcome measures were DC eosinophil, Absolute Eosinophil Count (AEC), serum IgE, Total Symptom Score, Aerius Quality of Life Questionnaire score, and Global efficacy score. RESULTS: Rupatadine significantly improved patients' clinical condition including symptom score from baseline to day 28. In rupatadine group, there was 27.9 percent decrease (P=0.027) in DC eosinophil, 35.6 percent decrease (P=0.036) in AEC, 15.3 percent decrease (P=0.024) in serum IgE, 28.2 percent decrease (P=0.02) in Total Symptom Scoring, and 27.3 percent decrease (P=0.006) in Aerius Quality of Life Questionnaire score. Global efficacy score of rupatadine was found to be significantly greater (P=0.009) than levocetirizine. The overall incidence of adverse drug reactions was also found to be less in rupatadine group. CONCLUSION: Rupatadine is a better choice in CIU in comparison to levocetirizine due to better efficacy and safety profile.

Ultrasound findings in diffuse granulomatous cystitis in chronic granulomatous disease of childhood.

Chronic granulomatous disease (CGD) is a genetically inherited disease of childhood, which is characterized by repeated bacterial and/or fungal infections. The genitourinary tract is rarely involved. We report a case of CGD with involvement of the urinary bladder. Pertinent clinical and sonographic findings of this disease are described.

Abdominal sonography in AIDS. A review.

Sonographic examination of the abdomen was performed in 155 patients with clinical diagnosis of AIDS. Approximately one half of the patients had hyperechoic (fatty) liver and splenomegaly. About one third of the patients had lymphadenopathy and hyperechoic kidneys. Intravenous drug abusers were more likely to have renal parenchymal changes, whereas patients with sexually transmitted AIDS have a greater incidence of splenomegaly. Lymphadenopathy is the most consistent finding that would question the immune competency of a patient in the appropriate clinical setting. The usefulness of sonography lies in the detection or exclusion of potentially treatable complications in AIDS.

Renal cell carcinoma: earlier discovery and increased detection.

To document the earlier discovery and increased detection of renal cell carcinoma, the authors reviewed cases of renal cell carcinoma detected at their institution during 1974-1977 and 1982-1985, with particular emphasis on renal tumors 3.0 cm or smaller. Only 5.3% (four of 75) of renal cell carcinomas found during 1974-1977 but 25.4% (31 of 122) found during 1982-1985 were 3.0 cm or smaller, an increase of almost five times. Of the small tumors in the 1982-1985 group 96.7% (30 of 31) were incidentally discovered, and 77.4% (24 of 31) were initially detected with computed tomography (CT) or ultrasound (US). In the later series 48.4% (15 of 31) of the small renal tumors were treated with partial nephrectomy. Follow-up shows no recurrences. Many more small renal tumors are being detected because of the use of CT and US. This will undoubtedly increase the cure rate of renal cell carcinoma because these tumors are being detected when they are small and do not cause symptoms. Partial nephrectomy will increasingly be used in the management of these small tumors.

The use of preoperative localization of adenomas of the parathyroid glands by thallium-technetium subtraction scintigraphy, high-resolution ultrasonography and computed tomography.

Thirty-six patients with primary hyperparathyroidism were studied preoperatively by thallium-201 and technetium-99m pertechnetate subtraction (Tl-201/Tc-99m) scintigraphy, high-resolution real time ultrasonography and computed tomographic (CT) scanning. None of the patients had had previous surgical treatment of the parathyroid or thyroid glands. All of the patients underwent systematic bilateral exploration of the neck. All of the patients were successfully explored and 41 abnormal parathyroid glands were identified. Five patients had two adenomas. In six instances, adenomas were identified in ectopic anatomic sites. The sensitivity of correctly localizing the abnormal glands with these techniques was 49 per cent for the Tl-201/Tc-99m scintigraphy, 34 per cent for ultrasonography and 41 per cent for CT scanning. The Tl-201/Tc-99m scintigrams detected two of the six ectopically located adenomas, CT detected one, while ultrasound detected none. The five patients with multiple adenomas were not accurately identified as having multiple gland enlargement by any of these studies. Therefore, preoperative localization studies with these three techniques did not provide reliable information for initial bilateral exploration of the neck.

The postmenopausal cystic adnexal mass: the potential role of ultrasound in conservative management.

Often ovarian cancer does not present clinically until the advanced stages. In the past, the presence of any cystic adnexal enlargement in postmenopausal women was an indication for surgical exploration. The ultrasound scans of 42 postmenopausal women with simple adnexal cysts were reviewed. We included only patients who were available for follow-up and who had cysts that were less than or equal to 5 cm in maximum diameter, unilocular (ie, without septations or solid components), and without ascites. Of these patients, 26 underwent prompt surgical exploration. All exhibited benign histopathology. In 16 patients, serial sonographic surveillance was performed every 3-6 months. Two of these patients had exploratory laparotomy at 6 and 9 months of observation; the first operation, for increasing size and septation, demonstrated a cystadenofibroma, and the second, for increasing pain, demonstrated a degenerating myoma. The remaining 14 patients were followed from 10-73 months without any change in size or character of the cyst. Small (less than 5 cm), unilocular postmenopausal cysts had a low incidence of malignant disease (0%) in this series of 28 surgical specimens. Therefore, serial ultrasound follow-up without surgical intervention may play a role in the clinical management of such patients.

Diagnosis of adrenal ganglioneuroma in pregnancy with magnetic resonance imaging and ultrasonography. A case report.

A right adrenal gland mass was found during sonographic examination of the right upper quadrant during a workup for hyperemesis gravidarum. Magnetic resonance imaging was used to clarify the origin of the mass. The tumor was nonfunctional. Because of the possibility of a malignancy, the patient underwent a successful second-trimester exploratory laparatomy with right adrenalectomy. Pathology demonstrated a benign ganglioneuroma.

CT diagnosis of renal angiomyolipoma: the importance of detecting small amounts of fat.

Six patients were reviewed who had renal angiomyolipoma (1.2-4.0 cm) in which only minimal amounts of fat were evident on CT. The fat content of the lesion was appreciated because tissue attenuation measurements of small areas of low attenuation within the tumors were performed and because thin-section (5-mm) and nonenhanced CT scans were used. The fat content of the lesions could be identified on 10-mm sections in three cases but only on 5-mm sections in three others. In two cases, fat was seen only on the nonenhanced 5-mm thin sections. Careful sampling of low-density regions within the mass must be performed because a single region of interest over the entire tumor will produce an average attenuation in the soft-tissue range. The use of 5-mm thin sections and thin, nonenhanced CT sections increases spatial and density resolution and decreases susceptibility to partial-volume effects. In a correlative study, no areas of fat were detected in a review of 100 well-circumscribed (4.0 cm or smaller) renal cell carcinomas. Detecting the existence of fat in a renal lesion will establish the diagnosis of angiomyolipoma and is the only radiologic finding that can differentiate it from renal cell carcinoma. Thus, unnecessary surgery will be avoided in these cases.

Estimation of nongravid uterine volume based on a nomogram of gravid uterine volume: its value in gynecologic uterine abnormalities.

To facilitate accurate and standard methods of reporting pathologic uterine corpus enlargement, we constructed a nomogram using the gravid uterine corpus volumes from five to 20 weeks' gestation in 186 patients. The volume was calculated by measuring the maximum length and anteroposterior and transverse diameters of the uterine corpus, and using the formula for the volume of a prolate ellipsoid: V = 0.52 X (L X AP X T). Clinicians can use the nomogram for better understanding in assessing uterine volume.

Computed tomography of midline cysts of the prostate.

Midline cysts in the male pelvis are a confusing entity due to their relatively infrequent presentation and the uncertainty as to their origin and classification. We report on CT appearance of four cases of midline prostatic cysts. Ultrasound correlation was available in one case. Two patients presented with lower urinary tract symptoms (hematospermia and/or hematuria), and two were asymptomatic, with one case detected on physical examination and one found incidentally on CT. Computed tomography demonstrated a characteristic sharply marginated, low density, homogeneous midline cyst within the prostate. On ultrasound a well defined midline anechoic cystic mass was seen. These cases are illustrated and a discussion of cystic masses in the male pelvis is included.

Use of furosemide in pregnancies complicated by oligohydramnios.

To differentiate pregnancies complicated by oligohydramnios due to intrauterine growth retardation from those due to renal agenesis, the authors administered furosemide intravenously to eight pregnant women (19-25 weeks gestation) with oligohydramnios. The fetal abdomen was scanned with ultrasound to demonstrate the fetal urinary bladder. In six fetuses, sonography failed to demonstrate the bladder: two fetuses had growth retardation with normal kidneys and bladder, and four had renal anomalies. It is concluded that administration of furosemide to the mother fails to induce diuresis in growth-retarded fetuses of 19-23 weeks gestation and that failure to see the fetal bladder after furosemide administration does not necessarily indicate absent fetal kidneys.

Sonographic anatomy of the larynx, with particular reference to the vocal cords.

Sonographic images of the vocal cords were obtained in 41 healthy human subjects using a phased array realtime ultrasound scanner. The thyroid cartilage provides the acoustic window for sonographic visualization of the vocal cords. The false vocal cords appear as hyperechoic structures, while the true vocal cords are seen as hypoechoic structures. The symmetry of movement of the vocal cords during respiration becomes apparent on examination in real time. Sonography may prove to be a potentially useful technique for the examination of the vocal cords.

Intramedullary spinal cord tumors: MR imaging, with emphasis on associated cysts.

Fifteen magnetic resonance (MR) imaging studies in 16 patients with intramedullary spinal cord lesions were correlated with surgical findings in all patients and with results of intraoperative spinal sonography (IOSS) in eight. Tumor extent was defined accurately in all but two patients by MR imaging; these lesions were found at surgery to have been underestimated by one to two vertebral body segments. Most tumors had lengthened T1 and T2 relaxation times. Intratumoral cysts were detected by MR imaging in one of eight cases, and rostral and caudal cysts were defined in only two of ten cases. The poor detection rate is attributed to poor spatial and contrast resolution. Preoperative MR imaging to define the extent of cord enlargement and IOSS to define cystic structures appears to be the optimal method of tumor management pending our further study.

Deep venous thrombosis: detection by probe compression of veins.

The sonographic detection of echogenic, soft-tissue mass within the veins of the lower extremities assures the diagnosis of deep venous thrombosis (DVT). However, the sonographic diagnosis remains inconclusive when fresh thrombus and/or artifacts are present within the lumen of the vein. The present study attempts to augment the clinical utility of real-time sonography in the detection of DVT, based on the premise that total obliteration of the vein lumen by probe compression should not be possible in the presence of venous thrombi. Sonography and contrast venography of the lower extremity were performed in 20 patients with clinical suspicion of DVT. The presence of thrombi was confirmed in 14 patients. Probe compression failed to obliterate the lumen of the veins containing thrombi. The authors conclude that the technique of probe compression is useful for rapid and noninvasive detection of venous thrombi.

Transcutaneous sonography of the postoperative spine.

Transcutaneous sonography of the spine was performed in 83 patients with prior laminectomies for tumors of the spinal canal and the spinal cord. These patients presented with signs or symptoms of recurrent tumor. When the spinal cord could be visualized, the sonographic examination provided information about the presence or absence of tumor, the character (solid or complex) of the tumor and its location, and associated findings in the extramedullary space. The correlation of the transcutaneous sonograms with other imaging methods and with intraoperative sonographic and surgical findings was excellent. Nonvisualization of the spinal cord was found to be related to age with a higher success rate (70% visualized) in the pediatric age group (to age 21) than in the adult group (52% visualized). A very short laminectomy was also found to cause problems in visualizing the full extent of a recurrent tumor. Nonetheless, the simplicity of the technique and the amount of information that can be gained from it make it a very valuable adjunct to other imaging methods for the postoperative spine. For the pediatric age group, it should be one of the first diagnostic methods employed.

Sonography of the spine and spinal cord.

Sonography has proved to be a valuable method for the examination of the spine in children with spinal dysraphism. It facilitates the diagnosis of meningocele, lipoma, and/or spinal cord tethering rapidly and noninvasively. It is suggested that sonography be utilized for screening infants with neurocutaneous signature of spinal dysraphism.