Treatment of trigeminal and thoracic zoster with idoxuridine.

A double-blind random selection comparison was made of the therapeutic effects in acute herpes zoster of 40% idoxuridine (IDU) dissolved in dimethyl sulphoxide (DMSO) compared with DMSO and saline flavoured with garlic. Thoracic (80 patients) and trigeminal (42 patients) zoster were investigated separately. The patients were evaluated daily until skin healing and then at 1, 3 and 6 months by registering pain, paraesthesia and sensitivity disturbances as well as by clinical and photographic evaluation of the skin lesions. Duration of pain was positively correlated to age, to delayed healing and to elevated temperature in the acute phase of zoster. The period of pain before skin eruption was considerably longer in thoracic than in trigeminal zoster, while the latter was associated with a more severe inflammatory reaction, more neurologic sequelae, but also by a faster healing of the skin lesions. IDU was highly effective in shortening the period of pain and improving skin healing in trigeminal zoster, while no effect of IDU was observed in thoracic zoster. The reason for this difference is presently not understood.

Contact allergy to idoxuridine. Sensitization following treatment of herpes zoster.

A total of 45 of 60 patients with herpes zoster previously treated with topical idoxuridine 5-40% in dimethylsulfoxide were patch tested 2 years later with idoxuridine 0.5% and 5% in petrolatum. Three (7%) showed positive reactions. Idoxuridine is considered a weak sensitizer, but in strong concentrations and in active solvents, which increases absorption, there seems to be a risk of sensitization.

Treatment of herpes zoster with idoxuridine ointment, including a multivariate analysis of symptoms and signs.

A double-blind, random selection comparison was made of the therapeutic effects in acute herpes zoster of (A) 40% idoxuridine (IDU) dissolved in dimethyl sulphoxide (DMSO), or one of the following ointments: (B) a basis of polyethylene glycol, (C) a basis with 60% DMSO, (D) a basis with 5% IDU and 60% DMSO, and (E) a basis with 40% IDU and 60% DMSO. Each group comprised 20 patients. The patients were evaluated daily until skin healing and then at 1,3, and 6 months by registering 4 neurological signs, 5 clinical evaluations of skin pathology and 4 photographic evaluations of the skin lesions. A 'profile' of the effect of each treatment was computed by calculating normalized means for each of the 13 variables. A non-random distribution of the clinical and photographic variables indicated a statistically significant, but small therapeutic effect of treatment A on skin healing, whereas no convincing effect on pain or sensitivity disturbances was established. Treatments B-E were without positive effects. The information given by the highly interdependent variables were computed for each variable and for groups of variables after appropriate scoring. It was found that the photographic evaluation contributed evidence independent of the clinical evaluation of skin pathology. A multiple correlation analysis revealed that age was positively correlated to the duration of pain and to delayed healing, that rapid healing was intimately connected to no or short-lived pain, and surprisingly that zoster in the trigeminal area healed faster than in other locations without being correlated to less pain. Treatment A must necessarily be reevaluated taking into account proper controls as well as age and affected dermatomes.

Tubular reabsorption and urinary excretion of acetoacetate and 3-hydroxybutyrate in normal subjects and juvenile diabetics.

The renal handling of acetoacetate (AA) and 3-hydroxybutyrate (3-HB) has been examined in 8 normal subjects and 7 insulin-treated juvenile diabetics before and after i.v. infusion of sodium DL-3-hydroxybutyrate. In both normals and diabetics and ketone bodies were reabsorbed. At low filtration rates of AA and 3-HB the reabsorption was nearly complete. With increasing filtration rate both the tubular reabsorption rate and the urinary excretion rate of AA and 3-HB increased linearly. A maximal tubular reabsorption rate could not be demonstrated. In spite of higher filtration rates of AA and 3-HB in the diabetics, the mean reabsorption percentage of either ketone body did not differ from that found in the normals.

Liver biopsies in epileptics during anticonvulsant therapy.

Liver function tests, performed in 11 epileptics under antiepileptic treatment for 10-35 years, showed a slight increase in serum alanine amino-transferase in six patients and a marked increased level of serum alkaline phosphatases in four. Liver biopsies revealed few uni- or paucicellular necroses in five patients. Granulomatous hepatitis was found in one patient in whom sarcoidosis was later diagnosed. None of the biopsies showed signs of permanent liver damage.

Blood ketone body disappearance rate in diabetics and normals after rapid infusion of dl-3-hydroxybutyrate. Studies before and after diabetic treatment.

Ketone body tolerance has been studied in 26 newly diagnosed diabetics and 9 normal control persons after rapid i.v. infusion of DL-3-hydroxybutyrate. In juvenile diabetics with high initial fasting concentrations of ketone bodies, disappearance rates of acetoacetate and total ketone bodies in blood were low before diabetic regulation. Insulin treatment normalized disappearance rates. In the non-obese maturity onset diabetics, on the other hand, ketone body disappearance rates remained abnormally low after treatment with glibenclamide. In the obese maturity onset diabetics, disappearance rates, being normal before diabetic regulation, decreased during phenformin treatment, the rate constants becoming significantly lower than in the normals. Decreased tissue uptake of ketone bodies thus seems to contribute to the increased ketone body level in blood in this group of diabetics. Disappearance rates were not correlated to preinfusion ketone body concentration. In the normals, no change in serum insulin was observed following the infusion, while a significant decrease was seen in plasma glucose.

The influence of diabetic regulation on the diurnal variation in blood and the urinary excretion of ketone bodies. Studies in newly diagnosed diabetics.

A typical diurnal variation of blood ketone bodies (acetacetate+3-hydroxybutyrate) has been found in 23 newly diagnosed, untreated diabetics regardless of diabetic type. It was characterized by high morning concentrations, followed by a fall, and later on a rise in concentration during the evening and night. Satisfactory diabetic regulation, judged from glucose measurements, did not change this diabetic pattern, which differed fundamentally from the normal diurnal variation. In the regulated state the morning concentration of ketone bodies in blood was still abnormally high in the juvenile and the non-obese maturity onset diabetics, while the concentration in the phenformin-treated diabetics had increased on each sampling time. The 24-hour urinary excretion of ketone bodies also remained abnormally high in the phenformin-treated patients.

The concentration of ketone bodies, free fatty acids, and glycerol in the blood of obese perons after injection of insulin and glucose. Studies before and during absolute fasting.

The blood patterns of acetoacetate (AA), 3-hydroxybutyrate (3-HB), free fatty acids, and glycerol were registered after intravenous injection of insulin or glucose in seven obese persons. In each individual investigated the study with insulin was carried out first and that with glucose 2 days later. Both sets of studies were repeated after 8 and 10 days of absolute fasting. In the studies both before and during fasting the concentration of AA and 3-hb in blood varied independently of lipolysis. It is concluded that determination of only one of the ketone bodies is an insufficient expression for changes in total ketone body concentration ana that the peripheral metabolism of AA during the fasting studies was less than the production of AA after injection of insulin or glucose, whereas the opposite was the case in the prefasting studies.