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Biomedical subjects

P Adam

Publications and source records attributed to P Adam.

At least 91 records · Page 5Linked to original sources
PubMed1984

Optic nerve head drusen. High-resolution computed tomographic approach.

Optic nerve head drusen are rare, inherited concretions, which are almost always calcified; their appearance must be known because they represent one of the major causes of pseudopapilledema. The computed tomographic (CT) scan can show small and buried drusen, which are sometimes difficult to diagnose by the ophthalmoscopic examination. Four cases of drusen (two bilateral and two unilateral) were confirmed or diagnosed by high-resolution CT. The CT appearance of drusen is characteristic because the calcifications are well defined, punctate, and strictly located in the optic disc. The use of high-resolution CT scanners is very helpful.

Adult↗
PubMed1984

Retinitis pigmentosa associated with astrocytic hamartomas of the optic disc.

A case of retinitis pigmentosa associated with astrocytic hamartomas of the optic disc is described. The rarity of tuberous sclerosis in this association is discussed, as well as differences between optic nerve head drusen and astrocytic hamartomas ('giant drusen') which can both be associated with retinitis pigmentosa.

Adolescent↗
PubMed1984

[Central pontine myelinolysis with regressive development and x-ray computed tomographic interpretation].

A 68 year-old woman presented after rapid correction of a hyponatremia a clinical picture suggestive of central pontine myelinolysis. Clinical disorders regressed but serial CT scans showed the late development of a central pontine low density area which persisted for several months. Such a lack of correlation between clinical and CT scan data has been previously reported. On the present case the demyelination lesions appeared to have resulted principally from the rapid increase of natremia.

Aged↗
PubMed1983

[Acquired stenosis of the lumbar canal and vertebral hyperostosis].

The authors present 12 cases of symptomatic acquired narrowing of the lumbar canal (with multiple nerve root involvement) in patients suffering from typical vertebral hyperostosis. In each case, the lesion was transverse stenosis due to hypertrophy of the articular apophyses of the last three lumbar vertebrae (posteromedial apophyses). Amongst the radiological abnormalities detected, especially with the aid of the C.T. scan in 6 cases, the authors stress the frequency of irregular bony proliferations on the non-articular surface of the articular apophyses and the ossification of the ligamenta flava, which has already been observed in the thoracic region in cases of vertebral hyperostosis.

Aged↗
PubMedDate not supplied

A clinical trial of hypertonic saline nasal spray in subjects with the common cold or rhinosinusitis.

OBJECTIVE: To determine whether hypertonic saline nasal spray relieves nasal symptoms and shortens illness duration in patients with the common cold or acute rhinosinusitis. DESIGN: Randomized trial with 2 control groups. SETTING: Two family practice clinics. PARTICIPANTS: One hundred forty-three adult patients with a cold or sinus infection. Patients with allergic rhinitis, symptoms for more than 3 weeks, or other respiratory diagnoses were excluded, as were those who had used topical decongestants. INTERVENTION: Hypertonic saline or normal saline spray 3 times a day or observation. Subjects completed a 7-day symptom checklist that included a well-being question ("Do you feel back to normal?"). MAIN OUTCOME MEASURES: Nasal symptom score (sum of scores for nasal congestion, rhinorrhea, and headache) on day 3 and day of well-being (day of symptom resolution). RESULTS: Data were collected for 119 subjects. No difference was found in either primary outcome when hypertonic saline was compared with either normal saline or observation. Mean day of well-being was 8.3 (95% confidence interval [CI], 6.9-9.7), 9.2 (95% CI, 6.9-11.43), and 8.0 (95% CI, 6.7-9.3) days in the hypertonic saline, normal saline, and observation groups, respectively. Day 3 mean nasal symptom score was 3.8 (95% CI, 3.0-4.5) for hypertonic saline, 3.7 (95% CI, 2.9-4.5) for normal saline, and 4.1 (95% CI, 3.5-4.7) for observation. Only 44% of the patients would use the hypertonic saline spray again. Thirty-two percent noted burning, compared with 13% of the normal saline group (P = .05). CONCLUSION: Hypertonic saline does not improve nasal symptoms or illness duration in patients with the common cold or rhinosinusitis.

Administration, Intranasal↗
PubMedDate not supplied

Terbinafine pulse therapy is effective in tinea capitis.

Terbinafine pulse therapy was found to be effective and safe in the treatment of tinea capitis in an open study of 13 children (age range 3-13 years, mean 6.4 years, 7 males, 6 females, Tricohphyton tonsurans 7 patients, T. violaceum 6 patients). Each pulse of active therapy lasted 1 week with a 2 weeks off period between the first two pulses and a 3 weeks off period between the second and third pulses of treatment. The dosage of terbinafine was determined by the weight of the child: >40 kg, 250 mg/day, 20 to 40 kg, 125 mg/day and <20 kg, 62.5 mg/day. Twelve (92.3%) of 13 children achieved complete clinical and mycological cure when evaluated 12 weeks after starting therapy with the number of pulses for complete (clinical and mycological) cure being one pulse (two patients with mild severity of tinea capitis), two pulses (four patients with mild disease) and three pulses (mild disease: two patients, moderate disease: two patients, and severe disease: three patients). One child with moderate severity disease failed to clear after three pulses of terbinafine. There were no adverse effects observed in any of the 13 patients during the course of therapy. All the parents found it easy to administer therapy and the compliance was high.

Adolescent↗
PubMedDate not supplied

Itraconazole pulse therapy for tinea capitis: a novel treatment schedule.

Itraconazole 5 mg/kg/day given as pulse therapy, each of 1 week duration, for 1 to 3 pulses appears to be an effective and safe method of treating tinea capitis. The number of pulses of therapy may depend upon several factors, including the severity of disease and area of involvement. Controlled studies are needed to determine the number of pulses of itraconazole required to treat tinea capitis.

Antifungal Agents↗
PubMedDate not supplied

Onychomycosis in children: prevalence and management.

Onychomycosis in children is often accompanied by tinea pedis and a family history of onychomycosis. The prevalence of onychomycosis in children is substantially lower than that of adults; therefore it is important to confirm the clinical diagnosis. The most common presentation of onychomycosis is the distal and lateral subungual type. The organism most commonly isolated in North America is Trichophyton rubrum. Oral antifungal therapy is required, especially when the onychomycosis is of moderate to severe intensity, with nail matrix involvement. The new oral antifungal agents itraconazole, terbinafine, and fluconazole are being increasingly used for the treatment of onychomycosis. Review of the literature suggests that these agents are effective and safe in managing onychomycosis in children. The short duration of therapy required with these drugs should help improve compliance. The data suggest that the new oral antifungal agents have a role in the treatment of onychomycosis in children. Further experience will help us better position these drugs when evaluating the management of onychomycosis in children.

Administration, Oral↗
PubMedDate not supplied

Itraconazole oral solution for the treatment of onychomycosis.

The newer antifungal agents are increasingly being used for the treatment of onychomycosis. Tinea unguium is uncommon in children. In young children who are unable or unwilling to swallow capsules, the alternative to itraconazole capsules may be the oral solution. The pharmacokinetics of the itraconazole capsule when it is broken open and the contents sprinkled onto food has not been reported. Two sisters, ages 8 and 11 years, presented with fingernail dystrophy that was confirmed to be onychomycosis due to Trichophyton rubrum and T. soudanense, respectively. The patients were reluctant to swallow capsules and were treated with itraconazole pulse therapy using the oral solution, 3 mg/kg/day. The treatment regimen consisted of two pulses, each 1 week long, with a 3-week period between pulses. Both patients were clinically and mycologically cured with no adverse effects. Itraconazole oral solution (3 mg/kg/day) given as pulse therapy may be a consideration in the treatment of onychomycosis in some children.

Administration, Oral↗
PubMedDate not supplied

Tinea capitis: an overview with emphasis on management.

Tinea capitis is perhaps the most common mycotic infection in children. In North America the epidemiology of tinea capitis has changed so that Trichophyton tonsurans now predominates over Micro-sporum audouinii. With this transition the utility of the Wood's light for diagnosis has been reduced since T. tonsurans infection is Wood's light negative. Griseofulvin has been the mainstay of therapy for the last 40 years. The newer antifungal agents-itraconazole, terbinafine, and fluconazole-appear to be effective and safe for the treatment of tinea capitis. When tinea capitis is due to T. tonsurans or other endothrix species the following regimens have been used: itraconazole continuous regimen (5 mg/kg/day for 4 weeks), itraconazole pulse regimen with capsules (5 mg/kg/day for 1 week plus 1-3 pulses 3 weeks apart), and itraconazole pulse regimen with oral solution (3 mg/kg/day for 1 week plus 1-3 pulses 3 weeks apart). With terbinafine tablets the continuous regimen (>40 kg body weight, 250 mg/day; 20-40 kg, 125 mg/day; and <20 kg, 125 mg/day) is given for 2 to 4 weeks. Fluconazole tablets or oral suspension (6 mg/kg/day) were administered for 20 days in one trial. Another possibility may be 6 mg/kg/day for 2 weeks and evaluating the scalp 4 weeks later. An extra week of therapy (6 mg/kg/day) can be administered if clinically indicated at that time. A once-weekly regimen may also be effective. When ectothrix organisms (e.g., Microsporum canis) are present, a longer duration of therapy may be required. The data suggest that the newer agents are effective, safe with few adverse effects, and have a high benefit:risk ratio. It remains to be seen to what extent griseofulvin will be superseded for the treatment of tinea capitis. Adjunctive therapies may help decrease the risk of infection to other individuals. Appropriate measures should be taken to reduce the possibility of reinfection.

Antifungal Agents↗
PubMedDate not supplied

Therapeutic options for the treatment of tinea capitis caused by Trichophyton species: griseofulvin versus the new oral antifungal agents, terbinafine, itraconazole, and fluconazole.

Tinea capitis is a relatively common fungal infection of childhood. Griseofulvin has been the mainstay of management. However, newer oral antifungal agents are being used more frequently. A multicenter, prospective, randomized, single-blinded, non-industry-sponsored study was conducted in centers in Canada and South Africa to determine the relative efficacy and safety of griseofulvin, terbinafine, itraconazole, and fluconazole in the treatment of tinea capitis caused by Trichophyton species. The regimens for treating tinea capitis were griseofulvin microsize 20 mg/kg/day x 6 weeks, terbinafine [> 40 kg, one 250 mg tablet; 20-40 kg, 125 mg (half of a 250 mg tablet); < 20 kg, 62.5 mg (one-quarter of a 250 mg tablet)] x 2-3 weeks, itraconazole 5 mg/kg/day x 2-3 weeks, and fluconazole 6 mg/kg/day x 2-3 weeks. Patients were asked to return at weeks 4, 8, and 12 from the start of the study. Griseofulvin was administered for 6 weeks and the final evaluation was at week 12. Terbinafine, itraconazole, and fluconazole were administered for 2 weeks and the patient evaluated 4 weeks from the start of therapy. At this time, if clinically indicated, one extra week of therapy was given. There were 200 patients randomized to four treatment groups (50 in each group). At the final evaluation at week 12, the number of evaluable patients were griseofulvin, 46; terbinafine, 48; itraconazole, 46; and fluconazole, 46. Patients who discontinued therapy or were lost to follow-up were griseofulvin, 1/3; itraconazole, 0/4; terbinafine, 0/4; and fluconazole, 0/4. The causative organisms were Trichophyton tonsurans and T. violaceum species. Patients were regarded as effectively treated at week 12 if there was mycologic cure and either clinical cure or only a few residual symptoms. Effective treatment was recorded in, intention to treat, griseofulvin (46 of 50, 92.0%), terbinafine (47 of 50, 94.0%), itraconazole (43 of 50, 86.0%), and fluconazole (42 of 50, 84.0%) (p=0.33). Adverse effects were reported only in the griseofulvin group (gastrointestinal effects in six patients). Discontinuation from therapy due to adverse effects occurred only in the griseofulvin group (nausea in one patient). For the treatment of tinea capitis caused by the Trichophyton species, in this study, griseofulvin given for 6 weeks is similar in efficacy to terbinafine, itraconazole, and fluconazole given for 2-3 weeks. Each of the agents has a favorable adverse-effects profile.

Adult↗