In a 39-year-old woman an anticonvulsant therapy was initiated because of focal attacks in the left arm and face. The patient experienced generalized maculopapular skin rashes in response to each of four chemically similar anticonvulsant drugs: phenytoin, carbamazepine, primidone and clonazepam. During administration of carbamazepine the clinical features included fever, hepatitis and hematological eosinophilia in addition to the skin rash (anticonvulsant hypersensitivity syndrome). The anticonvulsant hypersensitivity syndrome is defined as an idiosyncratic reaction caused by disturbed drug metabolism. Positive lymphocyte-transformation tests with carbamazepine and phenytoin indicate an immunological mechanism underlying the rashes in our patient. Patch testing with the four anticonvulsant drugs gave positive results only with carbamazepine. Skin biopsy showed the histological features of a delayed-type allergy. The anticonvulsant therapy was continued with a chemically unrelated preparation, valproic acid; this drug is well tolerated and has proved appropriate for prevention of seizures.

Adult↗

PubMed1994

Kiwi fruit allergy: a new birch pollen-associated food allergy.

BACKGROUND: To determine the cross-reacting antigens of kiwi fruit and other foods and pollen, we investigated 22 patients allergic to kiwi fruit: 10 with severe systemic reactions and 12 with localized symptoms confined to oral and pharyngeal mucosa (oral allergy syndrome). Seven patients with birch pollen allergy who tolerated kiwi fruit were included as a control group. METHODS: All patients were evaluated by skin testing and RAST; three patients were evaluated by RAST inhibition assays. RESULTS: Prick tests showed positive reactions to kiwi fruit in all patients, whereas specific IgE to kiwi fruit could be demonstrated only in patients with generalized severe symptoms. Surprisingly, all 22 patients with clinical kiwi allergy showed positive prick test results and elevated IgE to birch pollen. Clinically, all complained of rhinitis during birch pollen season. Many patients showed sensitization to grass and mugwort pollen. Also, food allergy was found to be associated with kiwi allergy: we found strong reactions to apple and hazelnut; moderate reactions to carrot, potato, and avocado; and weak reactions to wheat and rye flour, pineapple and papaya, and their enzymes bromelain and papain. RAST inhibition studies revealed cross-reacting antigens between birch pollen and kiwi fruit. Interestingly, patients with birch pollen allergy without clinical signs of kiwi allergy had positive prick test reactions to kiwi. Patients with kiwi allergy showed higher concentrations to birch pollen IgE compared with patients with isolated birch pollen allergy. CONCLUSIONS: Our results indicate that kiwi allergy is a new manifestation of birch pollen-associated food allergy and is mediated by cross-reacting antigens in the kiwi fruit. Kiwi allergy can be expected in patients with birch pollen allergy exhibiting high levels of IgE to birch pollen.

Adolescent↗

PubMed1994

The involvement of nurses in clinical trials. Results of the EORTC Oncology Nurses Study Group survey.

The Oncology Nurses Study Group (ONSG) of the European Organization for Research and Treatment of Cancer (EORTC) initiated a survey to document the involvement of nurses in clinical trials. An English-language questionnaire was sent to 312 nurses in > 15 European countries. Results indicate that nurses lack training in oncology and in research methods. Nurses' tasks and activities are mainly oriented toward patient care. Nurses are rarely involved in activities related to protocol preparation and review. The circulation of information about clinical studies varies according to the center and the investigator responsible. Proposals to optimize nurse participation in clinical trials that were rated highly included (a) the availability of nursing protocol summaries translated into the local language, (b) contact with colleagues involved in the same trials, and (c) additional training in aspects of clinical trials related to nursing.

Adult↗

PubMed1993

Delayed-type hypersensitivity reactions to tumor-associated antigens in colon carcinoma patients immunized with an autologous tumor cell/Bacillus Calmette-Guérin vaccine.

Five different colon tumor-associated antigens (CTAA) were tested for their ability to induce an immune response in vivo and in vitro in ten colon carcinoma patients immunized with an irradiated autologous tumor cell/Bacillus Calmette-Guérin vaccine (active specific immunization) after resection of the primary tumor. The CTAA were defined by two different human monoclonal antibodies (MCA 1688 and MCA 28A32) derived by immortalization of peripheral blood B-lymphocytes from an active specific immunization patient. Delayed-type cutaneous hypersensitivity responses against a mixture of CTAA 28A32-50K and -32K were positive in seven of ten patients tested. In vitro T-cell responses upon stimulation with CTAA 28A32-32K were found to be positive in seven of ten patients and correlated with delayed-type cutaneous hypersensitivity responses to the antigen mixture. These data suggest that CTAA 28A32-32K might contain an important tumor-related T-cell epitope. Moreover, this method is suitable to define potential future candidates for antitumor vaccine development.

Animals↗

PubMed1993

13C NMR investigation of synovial fluids.

13C NMR spectra of synovial fluids from 20 patients suffering from rheumatic diseases have been recorded. Structural changes in hyaluronic acid, the main carrier of the viscoelastic properties of synovial fluid, could be observed in the NMR spectra of the native biological fluid. By comparing these spectra with those of purified hyaluronic acid, a rough estimation of the degree of depolymerization of synovial hyaluronic acid was possible. The patients with rheumatoid arthritis appeared to have a lower degree of polymerization compared to patients with osteoarthrosis. Thus, 13C NMR spectroscopy provides useful information about biophysical properties of synovial fluid.

Arthritis, Rheumatoid↗

PubMed1993

[Persistent pruritus after hydroxyethyl starch infusions. Retrospective long-term study of 266 cases].

In 266 patients receiving hydroxyethyl starch (HES) for otological indications, we retrospectively analysed the incidence of pruritus and its relationship to clinical and therapeutic parameters. We found that 32% of the patients developed pruritus, which characteristically appeared as pruritic crises. In 55% of pruritic patients onset after the HES medication had already been discontinued was reported. The symptoms persisted on average for 8.8 weeks. Pruritus was generalized, but with a predilection for the trunk and genitalia. Coincidental atopic disease or higher age did not promote pruritus. However, the incidence of pruritus correlated well with the cumulative dosage and also depended on the type and molecular weight of HES given (6% or 10%, mol.wt. 40 or 200 kDa). Light and electron microscopic assessment showed deposits of HES, especially within dermal macrophages and endothelial cells and adjacent to nerve fibres. Pathogenetically a histamine-independent pathway is probably responsible for the induction of pruritus. Hence, classic antihistaminic drugs had no therapeutic effect in our patients.

Adolescent↗

PubMed1992

[Immediate hypersensitivity to natural latex].

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Dermatitis, Contact↗

PubMed1992

[Long-term results of corpus cavernosum auto-injection therapy in treatment of patients with chronic erectile dysfunction].

From May 1985 to July 1989, 143 patients suffering from chronic erectile dysfunction (21-70 years old) underwent constant corpus cavernosum auto-injection therapy (CCAT) with papaverine alone (1257 injections) or with a standardized papaverine-phentolamine mixture (11035 injections). On the basis of these 12,292 protocol auto-injections and over 4 years' experience with intracavernosal auto-injection therapy we conclude: CCAT, especially with the papaverine-phentolamine mixture, constitutes an effective therapy (full rigidity in 95.9%) with tolerable side-effects for chronic erectile dysfunction when preceded by careful patient selection and thorough multidisciplinary evaluation, especially in the case of arterial and/or neurogenic aetiology of the erectile dysfunction; in addition, the contraindications must be strictly observed, the treatment and technique fully explained, and a regular system instituted. CCAT is generally well accepted by the patients and their partners (100%/98.3%) and has distinct positive effects on self-esteem (77.8%), performance anxiety (84.4%) and partnership (79.5%). The most serious side-effect was prolonged erection (25 out of 12,292 injections). In 3 patients reversible fibrotic changes near the tunica albuginea were observed.

Dose-Response Relationship, Drug↗

PubMed1991

Phase I study of spiroplatin.

Spiroplatin was investigated in a multicentre phase I study. 67 patients with advanced solid tumours received 151 cycles either by short-term or prolonged infusion, repeated every 3 weeks, at 2.5-40 mg/m2. Myelosuppression and renal toxicity were dose-limiting. Proteinuria, which was dose- and schedule-dependent, indicated glomerular and tubular damage. The maximum tolerated doses (MTD) for poor-risk and good-risk patients were 35 and 40 mg/m2, respectively. The area under the curve (AUC) at the MTD did not correspond with the AUC at the LD10 in mice with ratios of 0.3 for free platinum and 2.6 for total platinum; these were not suitable for predicting the MTD. 1 complete response was observed in a patient with breast cancer and lung metastases and 1 partial response in a patient with adenocarcinoma of the lung. The recommended dose for phase II studies was 30 mg/m2 by 4 h infusion every 3 weeks.

Adult↗

PubMed1991

Type IV allergy to amide-type local anesthetics.

The case of a 45-year-old woman is reported, who developed intense erythema and itching 1 day after subcutaneous (s.c.) injection of a local anesthetic containing mepivacaine and methylparaben. The reaction was attributed to a delayed-type sensitivity to mepivacaine, since mepivacaine gave a positive patch test response and also elicited a delayed sensitivity reaction after s.c. challenges, whereas prick and patch tests with methylparaben, as well as oral challenges, were negative. Interestingly, the patient also showed sensitization to lidocaine, a compound to which she had previously also been exposed.

Anesthetics, Local↗

PubMed1991

[Photoallergic reaction to olaquindox].

Olaquindox, an antibiotic belonging to the quinoxaline group, is a growth promoter used in pig breeding. A farmer developed a photoallergic contact eczema to it, which progressed to a persistent light reaction. Besides this, we found a photosensitivity to chlorpromazine, a tranquillizer that is also used in pig breeding. In addition, after using potent light-protective drugs containing UV-A and UV-B filters, this patient developed a (photo)allergy to different filter substances. The photoallergy to olaquindox was caused by mixing a food additive containing olaquindox with the pigswill for both young and adult animals. We point out the dangers (potent photoallergen, cancer induction) resulting from the widespread use of this substance in the EC.

Animal Husbandry↗

PubMed1991

Postoperative erectile dysfunction; evaluation and treatment with intracavernous vasoactive injections.

Explore the source record for details and available documents.

Aged↗

PubMed1991

[Nitroglycerin test for the diagnosis of erectile dysfunction].

In 33 patients with erectile dysfunction arterial inflow was measured by Doppler-sonography over the superficial dorsal and deep cavernous arteries in the proximal section after local application of 1.6 mg glycerol trinitrate (nitroglycerin) to the glans penis. With this test we were able to reveal a minimal increases in maximal systolic flow over both arteries at 29/66 measurement sites. This is thus an easier way of localizing penile vessels in the flaccid state. In no case did we see tumescence or rigidity.

Administration, Topical↗