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PubMed2003

A case of relapsing polychondritis involving placement of an expandable metallic stent.

Relapsing polychondritis is a relatively uncommon disease characterized by recurrence of progressive inflammation of cartilaginous structures. Laryngotracheal involvement occurs in 50-70% of cases, and occasionally results in acute airway obstruction. We reported a case of relapsing polychondritis with severe tracheal stenosis that was treated by the placement of two expandable metallic stents. A 58-year-old man was hospitalized with fever and breathing difficulties. A tracheostomy was performed and a silicone T-tube was placed. A diagnosis of relapsing polychondritis was made based on the biopsy from auricular and tracheal cartilages. Two expandable metallic stents were placed in the trachea to bilateral main bronchus. This dilated the airway lumen and resulted in the dyspnea disappearing completely. However, 18 months later a sudden massive hemorrhage occurred through the tracheostoma, and he died of respiratory failure. Autopsy showed a tracheoinnominate artery fistula. We discuss the management of relapsing polychondritis with severe tracheal stenosis.

Airway Obstruction↗
PubMed1982

Adjuvant vinblastine, actinomycin D, bleomycin, cyclophosphamide and cis-platinum chemotherapy regimen with and without maintenance in patients with resected stage IIB testis cancer.

A total of 42 patients with stage IIB nonseminomatous germ cell tumors of the testis after orchiectomy and retroperitoneal lymph node dissection received adjuvant chemotherapy with the modified vinblastine, actinomycin D, bleomycin, cyclophosphamide and cis-platinum regimen. Of the patients 29 had N2B and 13 had N3 nodal categories. Adjuvant vinblastine, actinomycin D, bleomycin, cyclophosphamide and cis-platinum chemotherapy was given with maintenance in the first 24 patients and without maintenance (2 months of chemotherapy) in the subsequent 18. Chemotherapy with maintenance was given for 1 year and began with 2 inductions 3 to 4 weeks apart: 600 mg./m.2 intravenous cyclophosphamide, 30 mg. intravenous bleomycin, 1 mg./m.2 intravenous actinomycin D and 4 mg./m.2 intravenous vinblastine on day 1, 20 mg./m.2 bleomycin daily by continuous 24-hour induction on days 1 to 3 and 120 mg./m.2 intravenous cis-platinum with mannitol-induced diuresis on day 4. Maintenance with 6 mg./m.2 intravenous vinblastine and 1 mg./m.2 intravenous actinomycin D every 3 weeks was initiated 3 weeks after the second induction for the remainder of the year. Adjuvant vinblastine, actinomycin D, bleomycin, cyclophosphamide and cis-platinum chemotherapy without maintenance was given for 2 months and used 3 inductions identical to those described previously. Complete remission has been maintained in 41 of 42 patients: all 24 who received maintenance chemotherapy and 17 of 18 who did not. One patient had a relapse with sarcoma and 6 required broad-spectrum antibiotics for fever during myelosuppression. A temporary increase in the serum creatinine of more than 2 mg. per cent occurred in 1 patient. Chronic renal failure or pulmonary fibrosis was not seen. Our results show that vinblastine, actinomycin D, bleomycin, cyclophosphamide and cis-platinum chemotherapy is effective in the prevention of recurrences in patients with resected stage IIB disease, and suggest that adjuvant chemotherapy is equally effective with or without maintenance.

Adolescent↗
PubMed1993

Treatment of childhood brucellosis: results of a prospective trial on 113 children.

Treatment of childhood brucellosis is controversial and is currently dependent on inclusion of aminoglycoside antibiotics which are both costly and potentially toxic. Hence an alternate mode of therapy preferably dependent exclusively on oral agents is desirable because this decreases medical cost. In this study we prospectively treated 113 children with a combination of two oral agents, trimethoprim-sulfamethoxazole (10 to 12 mg/kg trimethoprim, 50 to 60 mg/kg sulfamethoxazole and rifampin 15 to 20 mg/kg in two divided doses for 6 weeks. The treatment was well-tolerated and all patients responded by defervescence of fever and resolution of all symptoms within 1 to 3 weeks. Relapse after 6 months occurred in four children all of whom responded to repeat therapy by the same agents. We conclude that the combination of trimethoprim-sulfamethoxazole and rifampin is both cost-effective and safe for the treatment of childhood brucellosis.

Administration, Oral↗
PubMed1993

2-Chlorodeoxyadenosine in the treatment of hairy cell leukemia and chronic lymphocytic leukemia.

More than 450 patients with hairy cell leukemia have been treated at the Scripps Clinic. Of 144 patients followed for a median of 14.2 months (range, 8.1-70 months), 123 (85%) obtained complete responses, 17 (12%) partial responses, 3 (2%) did not respond, and 1 patient was unevaluable. So far, 4 patients have relapsed at a median of 36 months (range, 12-48 months). Fever was the principal toxicity occurring in 43% of patients. Five patients resistant (3 patients) or intolerant (2 patients) to deoxycoformycin were also treated. Of these 5 patients, 4 obtained complete responses, including 2 patients resistant to deoxycoformycin, and 1 patient a partial response, suggesting a possible lack of cross-resistance between deoxycoformycin and 2-CdA in hairy cell leukemia. Other single-institution studies have documented similar response rates and toxicities. Ninety patients with advanced chronic lymphocytic leukemia were treated with 2-CdA administered either as a 0.1 mg/kg/day 7-day continuous intravenous infusion or as a 0.028-0.14 mg/kg/day 2-hour bolus for 5 consecutive days. Four patients (4%) obtained complete responses and 36 patients (40%) partial responses, using NCI-sponsored Working Group guidelines. Of the 50 patients who were non-responders, 27 (54%) had a > or = 50% sustained reduction in the absolute lymphocyte count. The ratio of deoxycytidine kinase to cytoplasmic 5'-nucleotidase was predictive of 2-CdA responsiveness. Fourteen patients with fludarabine-failed chronic lymphocytic leukemia were also treated. No responses were achieved and 2 patients had progressive disease. Six patients had a > or = 50% reduction in the absolute lymphocyte count.(ABSTRACT TRUNCATED AT 250 WORDS)

Cladribine↗
PubMed2002

Fixed-dose combination chemotherapy (Rifater/Rifinah) for active pulmonary tuberculosis in Taiwan: a two-year follow-up.

SETTING: Veterans General Hospital-Taipei, Taiwan. OBJECTIVE: To assess the efficacy and safety of a fixed-dose combination (FDC) of Rifater (RFT)/Rifinah (RFN) in the treatment of newly diagnosed smear-positive pulmonary tuberculosis. DESIGN: Patients were randomly assigned to two 6-month short-course chemotherapy regimens. One group of patients was treated with FDCs and another was given the four component drugs (INH, RMP, EMB and PZA) as separate formulations. RESULTS: The 105 patients enrolled in the study were divided into two treatment groups. Fifty-one patients who had completed treatment without interruption, 26 in the FDC group and 25 in the separate regimen, were eligible for analysis at the end of 2 years. Among the patients with a drug susceptibility test result available, four in the FDC group had bacilli resistant to pyrazinamide. In the separate regimen group, two patients had bacilli resistant to ethambutol and six had bacilli resistant to pyrazinamide. The two regimens were of similar effectiveness with regard to sputum conversion, compliance and radiological improvement. No patient with FDC treatment developed gastointestinal symptoms, visual disturbance or peripheral neuropathy (P < 0.05). However, FDC treatment resulted in drug-induced fever in one patient. One patient (3.8%) in the FDC group relapsed 5 months after completing treatment. CONCLUSION: This study suggests that the two regimens had similar effectiveness in the treatment of smear-positive pulmonary tuberculosis. However, the fewer adverse drug events among those patients treated with the FDC regimen suggests that it has a better safety profile.

Adult↗
PubMed1992

[Clinical and experimental study of xiao er ke cuan ling oral liquid in the treatment of infantile bronchopneumonia].

UNLABELLED: Xiao Er Ke Chuan Ling Oral Liquid (KCL) is a Chinese herbal preparation consisted of 10 herbs such as Prunus armeniacae, Scutelaria baicalensis, Lonicera japonica etc. 30 children suffering from bronchopneumonia and/or acute bronchitis were treated with KCL (treated group) and another 30 cases were treated with penicillin and aminophylline (control group). RESULTS: cure rate and effective rate in treated group was 26.6%, and 93.3% respectively. While in control group was 30% and 96.6% respectively. No significant differences were seen between them(P > 0.05). The pharmacodynamic experiment showed KCL had potent pharmacological action. The experiment on tracheal fragment of Guinea pig in vitro showed it caused moderately strong smooth muscle relaxation, through inhibition the effect of histamine and acetylcholine. Asthma induction experiment of Guinea pig in vivo showed KCL could significantly prolong the latent period of asthma and alleviate asthmatic symptom. Ammonium water cough induction experiment in mice showed it may apparently prolong cough latent period and reduce times of cough relapse and alleviate cough symptom. KCL had potent antipyretic effect on fever model induced by triple vaccine in rabbits. Bacteriostatic and antiviral experiment in vitro showed the drug had quite strong inhibitory effects for Streptococcus hemolyticus, Staphylococcus aureus, Flexners Dysentery bacillus, Diplococcus pneumoniae and Pseudomonas aeruginosa, and it could potently inhibit the respiratory syncytial virus. KCL is an effective drug in treating bronchopneumonia and acute bronchitis.

Animals↗
PubMed1981

[Hyperthermic ulcero-necrotic parapsoriasis "en gouttes" with naso-pharyngeal lesions].

The clinical history of a patient affected by a chronic relapsing eruption is presented. Successive papulopustular, necrotic and ulcerous lesions with fever and general distress appeared. There was no visceral affectation. The case corresponded to the necrotic and hyperthermic parapsoriasis "en gouttes" or acute pityriasis lichenoides as described by Degos and col., 1966. The presence of vasculitis with lymphohistiocytic inflammation invading the epidermis is described. The aspect was similar to the parapsoriasis "en gouttes" pattern even though a biopsy showed the presence of necrotizing angeitis of small vessels, as previously reported. The patient also presented oral and nasopharyngeal ulcerous lesions similar to those found in malignant midline granuloma and Wegener granulomatosis, even though histopathologically different. It is interesting to note the absence of any visceral involvement in a 12 years evolution.

Adult↗
PubMed1989

[Perineal infiltrates after amputation procedures in carcinoma of the rectum].

The authors present their experience with perineal infiltrates amputations on account of rectal carcinoma. In the course of 1986 in the Oncological Research Institute in Brno 58 patients with this diagnosis were hospitalized. After amputations three types of surgical complications were observed: 1. early inflammatory infiltrations, 2. late abscesses and 3. locoregional relapses of the primary tumour. Local relapses were detected first after five months and not later than three years after the radical operation. The authors draw attention to the fact that the first manifestation of the locoregional progress of the disease was a sensation of pressure or pain, which preceded the development of a resistance on the perineum and fever. The extent of tumourous infiltration was assessed by computed tomography. Reduction of locoregional relapses depends according to authors above all on a comprehensive approach to treatment. The usefulness of adjuvant irradiation is obvious. The authors assume that it is important to decide whether to irradiate before or after operation or to combine both methods and whether too combine irradiation with chemotherapy. Due to difficulties of therapeutic influencing of local relapses they emphasize above all the demand of respecting the rules of oncological surgery during the first operation.

Abscess↗
PubMed2001

Ear, nose and throat manifestations of relapsing polychondritis in a child.

Relapsing polychondritis is a rare disorder, that can present initially to Otolaryngologists and can easily be overlooked due to its relative rarity and atypical initial symptoms and signs. Here we report on a 12-year-old schoolboy who presented initially with ear, nose and throat manifestations, including stridor, cough, hoarseness, sore throat and fever. The other clinical signs such as nasal tip, depression and softening of right auricle, developed subsequently. The clinical features, laboratory investigations, diagnostic criteria and treatment options were discussed with a brief review of literature.

Antirheumatic Agents↗
PubMed1992

[Fenofibrate-induced acute hepatitis with pseudo-cholangitis].

We report the case of acute hepatitis probably due to fenofibrate. Clinical features included abdominal pain and fever. Serum aminotransferases and alkaline phosphatase activities were moderately increased. Rechallenge induced a relapse of the symptoms and liver test abnormalities. High levels of eosinophils were present in the blood and in the liver suggesting an immunoallergic mechanism. Fenofibrate withdrawal was rapidly followed by favorable outcome.

Abdominal Pain↗
PubMed1998

Cefepime versus imipenem-cilastatin as empirical monotherapy in 400 febrile patients with short duration neutropenia. CEMIC (Study Group of Infectious Diseases in Cancer).

This open, comparative, randomized, multicentre equivalence study compared cefepime 2 g bd and imipenem-cilastatin 1 g tds (50 mg/kg/day) as empirical monotherapy for febrile episodes in a homogeneous cohort of cancer patients with short duration neutropenia following chemotherapy for solid tumour, lymphoma or myeloma. The study was conducted in 17 French anti-cancer centres in 1995 and 1996. Response to monotherapy was assessed 7 days after treatment and was based on resolution of fever and signs and symptoms, eradication of pathogens, absence of new infection, relapse, and death of infectious origin, without addition of other antibiotics. Patients were treated for a minimum of 4 days. Of the 400 episodes randomized, 344 (86%) were evaluable for efficacy. Patient characteristics were comparable between treatment groups. Success of monotherapy was observed in 79% of episodes with cefepime and 72% with imipenem-cilastatin (equivalence, P <0.0001). The response rate for microbiologically documented infections was 66% with cefepime and 61% with imipenem-cilastatin (bacteraemic episodes: 63% for cefepime; 44% for imipenem-cilastatin). A second antibiotic (usually a glycopeptide) was added in 20% and 21% of the cases, respectively. Overall, the response to therapy, with or without an additional antibiotic, was 95% (cefepime) and 90% (imipenem-cilastatin). Survival was similar in both groups (95% and 98%, respectively). Cefepime treatment was better tolerated, with 9% of the patients experiencing related intercurrent events compared with 19% in the imipenem-cilastatin group (P = 0.003). Nausea/vomiting was significantly more frequent in the imipenem-cilastatin group (15%) than in the cefepime group (5%; P = 0.001). Cefepime monotherapy was as effective as, and better tolerated than, imipenem-cilastatin in the empirical treatment of fever during short duration neutropenia.

Antineoplastic Agents↗
PubMed1997

Comparison of two regimens for ciprofloxacin treatment of enteric infections.

A clinical trial was conducted in 50 patients with blood cultures positive for Salmonella typhi or Salmonella paratyphi to compare treatment with ciprofloxacin for seven days, 500 mg b.i.d. (Group 1, 25 patients), with treatment for ten days, 750 mg b.i.d. (Group 2, 25 patients). Clinical cure was defined as defervescence of fever by day 5 of treatment, with an absence of complications and no clinical relapse. The clinical cure rate was 84% for group 1 and 96% for group 2; the difference in these rates was not statistically significant. The blood cultures of all patients were sterile by day 2 of treatment and remained so until the sixth month of follow-up. It was concluded that ciprofloxacin treatment for ten days in enteric fever is not necessary. Further studies are needed to evaluate the efficacy of shortening the duration of antibiotic therapy.

Adolescent↗
PubMed1985

Antibiotic therapy for treatment in relapse of intestinal Crohn's disease. A prospective randomized study.

We have undertaken a prospective randomized trial of one month's antimicrobial therapy for patients with symptomatic relapse of Crohn's disease. Criteria for entry included two major symptoms: fever, abdominal pain, diarrhea, weight loss, abdominal mass or complications (excluding perianal disease); and two hematologic abnormalities: hemoglobin, ESR, albumin, C reactive protein, iron, or total iron binding capacity. Patients were monitored for the aforementioned clinical and hematologic (hemoglobin, albumin, CRP) parameters over six weeks and for changes in fecal flora. Randomization was to four groups: metronidazole alone (M), cotrimoxazole alone (C), metronidazole and cotrimoxazole (C plus M), or double placebo (P). Seventy-two patients entered the study (18 = M, 16 = C, 21 = C plus M, 17 = P). After two weeks, improvement was reported as follows: M = 67 percent, C = 17 percent, C plus M = 71 percent, P = 35 percent. In the metronidazole group, two patients required surgery and one had troublesome side effects. In the cotrimoxazole group, two had side effects. In the combined group (C plus M), four had troublesome side effects and two of the placebo group (P) required operation. By four weeks, there was no difference in response among the groups: (M = 44 percent, C = 62 percent, C plus M = 57 percent, P = 41 percent). Antimicrobials had no effect on fecal flora or hematologic parameters. These results indicate that antimicrobials have little therapeutic potential for relapse of intestinal Crohn's disease.

Adult↗
PubMed2004

The treatment of multidrug-resistant and nalidixic acid-resistant typhoid fever in Viet Nam.

Multidrug-resistant (MDR) Salmonella Typhi (resistant to chloramphenicol, ampicillin, and trimethoprim-sulphamethoxazole) and isolates with reduced susceptibility to fluoroquinolones (indicated by resistance to nalidixic acid, NaR) have caused epidemics and become endemic in southern Viet Nam during the 1990s. Short courses of ofloxacin have proved acceptable for treating MDR/NaS isolates of S. Typhi (ofloxacin MIC90 = 0.06 mg/l) causing uncomplicated disease. Ofloxacin (10-15 mg/kg/d) given for 2, 3, or 5 d cured >90% of patients with an average fever clearance time (FCT) of 4 d. Less than 3% of patients relapsed or had a positive post-treatment stool culture. In contrast, the response of NaR isolates (ofloxacin MIC90 = 0.5 mg/l) to such regimens is poor. For example, ofloxacin (20 mg/kg/d) given for 7 d cured only 75% of patients, with an FCT of 7 d, and 19% of patients had positive post-treatment faecal cultures. Currently available alternatives for NaR infections include ceftriaxone, cefixime, and azithromycin. These antimicrobials are reasonably effective but expensive. New, effective, and affordable regimens are needed to treat these NaR infections. Short courses of the new generation fluoroquinolones or combinations of the available antimicrobials are possible options.

Adolescent↗
PubMed2005

Comparison of home-based therapy with ready-to-use therapeutic food with standard therapy in the treatment of malnourished Malawian children: a controlled, clinical effectiveness trial.

BACKGROUND: Childhood malnutrition is common in Malawi, and the standard treatment, which follows international guidelines, results in poor recovery rates. Higher recovery rates have been seen in pilot studies of home-based therapy with ready-to-use therapeutic food (RUTF). OBJECTIVE: The objective was to compare the recovery rates among children with moderate and severe wasting, kwashiorkor, or both receiving either home-based therapy with RUTF or standard inpatient therapy. DESIGN: A controlled, comparative, clinical effectiveness trial was conducted in southern Malawi with 1178 malnourished children. Children were systematically allocated to either standard therapy (186 children) or home-based therapy with RUTF (992 children) according to a stepped wedge design to control for bias introduced by the season of the year. Recovery, defined as reaching a weight-for-height z score > -2, and relapse or death were the primary outcomes. The rate of weight gain and the prevalence of fever, cough, and diarrhea were the secondary outcomes. RESULTS: Children who received home-based therapy with RUTF were more likely to achieve a weight-for-height z score > -2 than were those who received standard therapy (79% compared with 46%; P < 0.001) and were less likely to relapse or die (8.7% compared with 16.7%; P < 0.001). Children who received home-based therapy with RUTF had greater rates of weight gain (3.5 compared with 2.0 g . kg(-1) . d(-1); difference: 1.5; 95% CI: 1.0, 2.0 g . kg(-1) . d(-1)) and a lower prevalence of fever, cough, and diarrhea than did children who received standard therapy. CONCLUSION: Home-based therapy with RUTF is associated with better outcomes for childhood malnutrition than is standard therapy.

Child, Preschool↗
PubMed1996

Recombinant human granulocyte colony-stimulating factor after allogeneic bone marrow transplantation.

OBJECTIVE: To examine the effect of rhG-CSF on allogeneic bone marrow transplantation. PATIENTS AND METHODS: One hundred and twenty patients with acute or chronic leukemia received HLA-A.B.DR identical and MLC negative sibling donor allo-BMT. Among them, 58 cases of were treated with recombinant human granulocyte colony-stimulating factor (rhG-CSF), while the other 62 cases of the 120 patients were treated as control. RESULTS: Clinical results showed that the time taken to reach an absolute neutrophil count > 0.5 x 10(9)/L was significantly faster in patients who received rhG-CSF compared with control patients (16.24 +/- 0.25 vs 25.20 +/- 0.16 days. P < 0.001), with significantly less early fever days in patients received rhG-CSF (1.17 +/- 1.10 vs 4.01 +/- 0.37 P < 0.001). We did not observe any increase in acute GVHD and relapse in myeloid leukemia patients. But 7 of 16 patients with ALL relapsed after allo-BMT in rhG-CSF group, while only 3 of 11 patients with ALL relapsed after allo-BMT in control grant (P > 0.05). This phenomenon has not been reported up to now. CONCLUSIONS: rhG-CSF can promote engraftment and reduce early fever days after BMT. rhG-CSF has not any effect on a GVHD. The effect of rhG-CSF on leukemia relapse needs to be further studied.

Adolescent↗
PubMed1982

Fever and bacteremia in children and adolescents with acute lymphoblastic leukemia.

The medical records of 318 children and adolescents with acute lymphoblastic leukemia (ALL) were reviewed to determine the relationship between the occurrence of fever, a positive blood culture, and the absolute neutrophil count (ANC) during induction, remission maintenance, and bone marrow relapse. On the day of diagnosis of ALL, almost one-third of the patients had a temperature higher than 38.5 degrees C, but only three (4.1%) had positive blood cultures. Following the initiation of induction chemotherapy, many patients had febrile episodes. Forty-six percent of the blood cultures obtained during this period were positive. Only patients with an absolute neutrophil count of 1000/mm3 or less were at risk of a positive blood culture during induction. Thirty-four percent of the admissions during remission maintenance for fever were associated with pneumonia. One-half of the episodes of pneumonia occurred during the first 150 days following the diagnosis of ALL. No patient with pneumonia during remission maintenance had a positive blood culture. Eighteen percent of the blood cultures obtained from patients admitted during periods of bone marrow relapse were positive. Gram-positive organisms predominated during induction, whereas gram-negative organisms predominated during periods of bone marrow relapse.

Adolescent↗
PubMed1999

Coxiella burnetii pericarditis: report of 15 cases and review.

Q fever is characterized by its clinical polymorphism, and pericarditis associated with Q fever has occasionally been described. Herein we report 15 cases of Coxiella burnetii pericarditis, 9 from our data bank and 6 encountered within the past 12 months. Three patients presented with life-threatening tamponade. We compare our cases with the 18 previously reported and with 60 Q fever-matched controls at our center. This study showed that Q fever pericarditis can present as acute as well as chronic disease; we describe relapse after 6 months in association with a serological profile compatible with the chronic form of disease (phase I C. burnetii IgG titer of > or = 800). Discriminant factors among patients and controls are age of > 52 years (adjusted odds ratio [OR], 5.66), the occurrence of general symptoms such as arthralgias or myalgias (adjusted OR, 6.54), and a normal erythrocyte sedimentation rate (adjusted OR, 16.37). No specific symptoms or underlying cardiac predispositions are observed.

Adolescent↗