In Rakhine State, on the western border of Myanmar, the efficacy of chloroquine (CQ) and pyrimethamine/ sulfadoxine (PS), the current treatments for uncomplicated Plasmodium falciparum malaria in this area, was evaluated in an open comparative study of 289 patients, stratified prospectively into 3 age groups. Chloroquine treatment was associated with more rapid clinical recovery (P = 0.03), but the overall cure rates were worse than for PS treatment; failure to clear parasitaemia or recrudescence within 14 d occurred in 72% (102/141) of cases treated with CQ compared to 47% (69/148) of those who received PS (P < 0.0001, adjusted for age). Failure rates at day 28 increased to 82% (116/141) in the CQ group and 67% (99/148) in the PS group (P = 0.003). The risk of treatment failure was significantly higher in children under 15 years old than in adults for both CQ (relative risk [RR] = 2.6; 95% confidence interval [95% CI] 1.3-5.2) and PS (RR = 2.2; 95% CI 1.4-3.3). Mefloquine (15 mg base/kg) proved to be highly effective as a treatment for CQ and PS resistant P. falciparum; only 2 of 75 patients (3%) had early treatment failures (< or = day 7), and the overall failure rate by day 42 was 7%. There is a very high level of chloroquine and PS resistance in P.falciparum on the western border of Myanmar, but mefloquine was effective in the area.

Adult↗

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Morphological and biochemical effects of intrahepatic alcohol injection in the rabbit.

The local and systemic effects, as well as the repair mechanisms, of sterile absolute ethyl alcohol injection were evaluated at a range of doses (0.1-2.0 mL/kg body weight) in rabbit liver in order to confirm the feasibility and safety of local treatment of tumours in man. Saline injection was used in the control animals. The animals were killed at varying intervals (range: 1-30 days after injection), and the liver was studied by gross and microscopic examination. The ethyl alcohol injection was well tolerated and did not induce significant systemic side-effects. All doses could induce necrosis and none proved to be lethal. The alcohol injection produced an area of coagulation necrosis, the size of which appeared to be dose-related, and which was surrounded by granulation tissue, gradually repairing the necrotic lesion; the adjacent tissue was intact, or had signs of mild steatosis. However, at higher doses (1.0 and 2.0 mL/kg bodyweight), necrotic lesions were observed in the liver both near and remote from the site of injection. Fine needle percutaneous alcohol injection is effective in producing necrotic lesions which appear to be dose-related; at higher doses, however, an unpredictable intrahepatic diffusion may occur.

Animals↗

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Acute disseminated intravascular coagulation syndrome in cancer patients.

Hemostatic abnormalities are rather frequent in cancer patients either in hematological or in solid tumors. Acute disseminated intravascular coagulation (DIC) is a rare coagulopathy in cancer patients, but when it develops it becomes rapidly fatal. Between June 1988 and December 1992 we observed 8 cases of acute DIC occurring in gastric cancer (4 patients), breast cancer (3 patients) and high-grade non-Hodgkin lymphoma (1 patient). In 3 patients affected by gastric carcinoma, acute DIC was the first manifestation of the presence of the tumor, while in the other patients DIC occurred during the course of the disease. All the patients were treated with heparin, fresh frozen plasma and platelet support, but only in 1 patient was a short duration improvement of clinical conditions and coagulation tests recorded. Acute DIC can be the first manifestation of gastric tumors and the presence of the hemorrhagic syndrome associated with thrombocytopenia, hypofibrinogenemia and fibrin/fibrinogen degradation products should initiate a search for gastric carcinoma.

Acute Disease↗

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HER-2/neu serum levels and menopausal status.

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Adult↗

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The clinical picture of diabetic retinopathy in the dog.

After an extensive review of the literature showing how the existence of diabetic retinopathy in the dog had been confirmed by various research workers and in particular by histological studies, a clinical picture of this retinopathy is given, together with a description of tis individual features based on opthalmoscopic examinations carried out on 13 dogs with diabetes and illustrated with the photographs taken with the KOWA retinograph.

Animals↗

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[Atrial fibrillation and acute ischemic cerebrovascular disease. Study of 500 cases of cerebral infarction and transient cerebral ischemic attacks].

The prevalence of chronic atrial fibrillation (AF) and the clinical features in 151 patients with transient ischemic attacks (TIA) and in 349 patients with cerebral infarct have been analyzed. AF was found in 11.9% of patients with TIA and in 14.9% of patients with cerebral infarct. The difference was not significant (NS). In patients without AF, the carotid artery TIAs represent 70.6% of all TIAs, while the vertebral basilar artery TIAs account for 29.4%. When AF is present, 88.9% of all TIAs belong to the carotid artery and 11.1% to the vertebral basilar artery circulatory system (NS). TIAs lasting less than 10 minutes are 42.1% when AF is not present, while when AF is present they are only 11.1% (p less than 0.001). In patients without AF 79% of TIAs last less than one hour, while in patients with AF the percentage goes down to 38.9% (p less than 0.001). In patients with or without AF, the chronic digitalis therapy before the hospitalization does not affect in any way the occurrence of TIA or cerebral infarct. These results suggest that emboli from the atrium are more likely to cause cerebral infarcts than TIAs and when they cause TIAs more usually they last hours than minutes.

Atrial Fibrillation↗

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[Reliability of Doppler ultrasonography in relation to computerized digital angiography in patients with carotid bruit].

The results of the carotid artery Doppler ultrasound examination were compared with those of digital subtraction angiography in 256 patients (187 men and 69 women) with carotid bruit. The hemodynamically significant stenoses of more than 50% and the occlusions in the 512 carotid arteries examined were considered and the sensibility, the specificity and the overall accuracy of the Doppler ultrasound examination were calculated. When a carotid stenosis was diagnosed a sensibility of 97%, a specificity of 95% and an overall accuracy of 96% was found, while, for the diagnosis of carotid occlusion, the extimated sensibility, specificity and overall accuracy was 95%. Therefore, the ability to recognize a normal or an occluded carotid artery was of 95% (we found 125 out of 131 normal carotid arteries and 52 out of 55 occluded carotid arteries), whereas a stenotic carotid artery was identified in the 97% of cases (316 out of 326 stenotic carotid arteries). When both diagnoses of carotid stenosis and carotid occlusion were considered together, the extimated sensibility, specificity and overall accuracy were of 98%, 95% and 98% respectively. So the probability of misdiagnosing was of 2% (we made 10 wrong diagnoses out of 512 carotid arteries examined).

Arterial Occlusive Diseases↗

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[Smoking and Parkinson's disease].

Reports that tobacco smokers are at a lower risk of incurring Parkinson's disease (PD) than are non smokers and that a high percentage of Parkinsonians stop smoking before the onset of the disease, were reinvestigated by study of 110 hospital patients with PD and 110 other patients. In contrast to controls, fewer patients ever smoked cigarettes (39.1% versus 7.3%); moreover, many Parkinsonians (82%) stopped smoking before the onset of the disease. The high percentage of patients with PD who stopped smoking might by explained by premorbid behavioural modifications related to the biochemical cerebral changes already present in the preclinical stage of the disease.

Adult↗

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[Smoking and acute cerebrovascular disorders of the ischemic type].

In order to define the relationships between cigarette smoking and occurrence of cerebrovascular disease, a retrospective study was undertaken regarding smoking habits of 187 patients (129 men and 58 women) with cerebral infarct of non-embolic origin and 85 patients (40 men and 45 women) with TIA (transient ischemic attacks). Each patient was matched with a control subject, of the same sex and age group, who showed no signs or symptoms of cerebrovascular disease. Results show a statistically significant association between smoking habits and cerebral infarcts only in male subjects who smoked more than 20 cigarettes a day.

Aged↗

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[Use of ticlopidine in patients with acute non-embolic cerebral infarcts].

Different dosages, varying from 250 to 500 mg/die, of ticlopidine per os have been employed in 46 patients (32 men and 14 women), average age 66, who had been admitted for acute non-embolic cerebral infarction. In the two clinical examinations, effected on average 5.4 and 18.3 days after the admission, significant alterations in 9 among the considered items have been noticed, i.e.: central deficit of the VIIth cranial nerve, motor function and gait impairment, Babinski's sign, loss of sensibility, dysarthria, visual field defect, cerebellar signs, motor and/or receptive dysphasia. A global improvement of these clinical signs has been noticed on average in 48.2% of the patients, while an exacerbation has occurred in 2.1% of the cases. None of the patients who have been considered in this study has decreased or has shown relapses of ischemic cerebral attacks during the observation. The treatment with ticlopidine has been discontinued in 3 cases (6.5%) for the occurrence of temporary adverse side-effects.

Acute Disease↗

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[Nyctohemeral incidence of acute cerebral vasculopathies].

The time of onset of the neurological symptomatology was studied retrospectively in 258 patients, 107 (41%) autopsized, affected by non embolic cerebral infarction (172 cases), cerebral haemorrhage (52 cases) and subarachnoid haemorrhage (24 cases). In the patients suffering from cerebral infarction or haemorrhage the symptomatology began more frequently in the morning hours (from 6 to 12 a.m.) while it was comparatively rare in the night (from 00 to 06 am.). and evening hours (from 6 to 12 p.m.). This difference was significant (p less than 0.01) at the chi-squared test. The patients with subarachnoid haemorrhage showed a more homogeneous distribution with a higher but not significant frequency in the morning hours. The nyctohemeral distribution does not significantly differ in the patients affected by cerebral infarction, cerebral haemorrhage and subarachnoid haemorrhage. The time of onset of the neurological symptomatology shows no significant variation in the patients with cerebral and subarachnoid haemorrhage after dividing them in normotensives and hypertensives, while in the hypertensive patients with cerebral infarction a significant higher frequency of strokes was observed in the night hours (from 00 to 06 a.m.).

Acute Disease↗

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[Dyslipidemias and ischemic cerebral vasculopathies].

The serum cholesterol and triglycerid levels have been studied in 50 patients affected by transient ischaemic attacks (TIA) and in 89 patients suffering from cerebral infarction of non embolic origin. In 25 patients with TIA and in 59 patients with cerebral infarction, the HDL-cholesterol level and the HDL-cholesterol and total cholesterol ratio have also been determined. Every patient was matched with a control of the same age and sex for statistical proposal. The mean total cholesterol concentration was significantly higher in the male patients affected by TIA and cerebral infarction. Dividing the patients according to age, the mean total cholesterol level remained significantly higher only in the male patients with TIA under the age of 60. The mean triglycerid concentration was significantly higher as compared with the controls in the male patients with TIA under the age of 50 and in the female patients with TIA aged from 60 to 70. The HDL-cholesterol level, though lower than in controls, showed no significant variation both in patients with TIA and with cerebral infarction, excepting the male patients affected by cerebral infarction over the age of 70. The HDL-cholesterol and total cholesterol ratio was insignificantly lower than in controls both in TIA and in infarct patients. These results seem to emphasize the role of total serum cholesterol level in the pathogenesis of ischaemic cerebrovascular diseases particularly in the male patients under the age of 60. Less striking appears to be the role of serum triglycerid level. Finally we can't show a significant HDL-cholesterol reduction in our patients as compared with controls.

Age Factors↗

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[Hematocrit value and hemoglobin concentration as possible risk factors in non-embolic acute cerebral infarcts].

The hematocrit and the concentration of hemoglobin have been studied in 197 patients (125 men and 72 women) suffering from acute cerebral infarction not due to embolism. The results have been analysed statistically and compared to those of a control group formed by 123 neurologic patients (68 men and 55 women) chosen at random, belonging to the same age range and with no cerebrovascular disease. The hematocrit was significantly higher in the patients who had a cerebral stroke of a non-embolic origin, both males and females, than in the control group, although it was within normal limits. As far as the concentration of hemoglobin is concerned, there is a significant statistical difference between patients with and without cerebral infarction, but only for the female patients.

Adult↗

PubMedDate not supplied

[The blood level of uric acid as a risk factor in transient cerebral ischemic attacks and in non-embolic acute cerebral infarct].

The serum uric acid level has been determined in 300 patients, both males and females. 125 of these suffered from transient cerebral ischaemic attacks and 175 from atherothrombotic brain infarction. The values obtained were compared with those determined, with the same technique, in a control group of patients with neurologic diseases, chosen at random, and with no clinical finding or historical data of cerebrovascular and/or cardiac disease. No significant statistical difference has been observed between the mean serum uric acid level in the patients with transient ischaemic attacks, or brain infarction, and the control group. All the patients examined were divided according to sex and age. As far as sex was concerned, males suffering from cerebral transient or completed focal ischaemia, had on average a lower serum uric acid level compared to the control group. The opposite happened with females. As far as age was concerned, significantly high serum uric acid levels, compared to the control group, were observed in women with either transient ischaemic attacks or brain infarction, but only in those whose age range was between 50 and 60. In conclusion, from this study, hyperuricemia does not appear to be a high risk factor in ischaemic cerebrovascular diseases.

Adult↗