Muscle-related complaints and high creatine kinase (CK) blood levels have been reported in 16-51% of patients with acne treated with isotretinoin. It has been suggested that this retinoid and exercise have a synergistic effect on muscle. The presence of marked hyperCKemia during the treatment raises concern about rhabdomyolysis. The objective of this report was to evaluate the incidence, course and clinical significance of severe hyperCKemia in isotretinoin therapy for acne. Out of 442 patients on isotretinoin, we reviewed 7 patients (1.58%) with CK values above 5,000 IU/l. Only two of them had myalgia. Physical activity or intramuscular injection prior to blood testing was reported in 6 patients. CK values returned to normal within 2 weeks and all subjects except 2, completed treatment. In conclusion, marked hyperCKemia with or without muscle-related complaints in isotretinoin-treated patients with acne is a benign phenomenon.

Acne Vulgaris↗

PubMedDate not supplied

Asymptomatic liver injury due to erythromycin stearate.

A 73-year-old woman with rosacea, who had started treatment with erythromycin stearate 2 g/d, developed asymptomatic liver injury. The drug was discontinued and the laboratory findings of liver damage disappeared within 11 days. This is the first report of erythromycin stearate-induced asymptomatic hepatotoxicity.

Aged↗

PubMedDate not supplied

Blood pressure levels decrease during Mohs micrographic surgery.

BACKGROUND: A common practice is not to operate on patients with elevated blood pressure (BP) levels to avoid cardiovascular and cerebrovascular complications. We therefore designed a study to evaluate the effect of prolonged surgery under local anesthesia on BP levels, and to compare the outcome of patients with elevated BP to those with normal BP. METHODS: We studied 121 patients (65 males) with a mean age of 60 ++/-14 years (range 31-89) who were referred for Mohs micrographic surgery (MMS) during 2 consecutive months. Forty six patients had a history of hypertension. Blood pressure was measured in all subjects in the supine position with an automated device 5 times during surgery. RESULTS: Blood pressure decreased significantly during surgery from 152 +/- 2/85 +/- 1 mm Hg at baseline to 139 +/- 2/79 +/- 1 at the end of the surgery (p < .05). Forty two patients (34%) had elevated BP levels at baseline whereas only 18 patients had these levels at the end of the first stage. There was no difference in surgery outcomes between those with elevated and those with normal BP levels at baseline. CONCLUSIONS: Blood pressure levels decrease during MMS under local anesthesia and the outcome of patients with elevated BP is good. Thus, patients with elevated BP can safely undergo surgery under local anesthesia.

Adult↗

PubMedDate not supplied

I.v. amantidine sulfate for extrapyramidal crisis.

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Amantadine↗