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PubMedDate not supplied

[Low-grade fever of protracted course. Retrospective study of 30 cases and reflections for a low-cost management].

The objects of this paper were the following: 1) to establish in a group of persistent (over four weeks) low grade fever (LGF) patients the percentage of cases in which a definite diagnosis could not be made; 2) where a definite diagnosis could be made, to describe the most commonly occurring diseases; 3) to follow up the uncertain diagnosis cases for at least two years. Thirty cases of persistent LGF were retrospectively studied. They did not include drug hyper-dysthermia and temporary and/or metabolic vasomotor reactions. The data suggest that: 1) two thirds of persistent LGF are likely not to be definitely diagnosed; 2) some certain diagnoses were: dental granulomas, mycobacteria infections, thyroiditis, factitious fever, rheumatic polymyalgia, Hodgkin's lymphoma and pulmonary thromboembolism; 3) in 14/19 undiagnosed cases the fever subsided permanently, without any treatment, within one year, whereas it persisted in 5/19, but no deterioration of the overall clinical status was observed; 4) although some of the undiagnosed cases were examined elsewhere, a certain diagnosis was never achieved in spite of their undergoing sophisticated and expensive clinical, laboratory and X-ray tests. Therefore it is concluded that: 1) persistent LGF should be managed more conservatively than fever of unknown origin so as to preserve resources; 2) some diseases should be included in the differential diagnoses from the beginning of the initial clinical work up; 3) undiagnosed LGF fever either subsides and returns to normal within one year or the fever persists, but no deterioration of the clinical and performance status is likely to occur.

Adolescent↗
PubMed1995

[Parkinson syndrome induced by veralipride].

Veralipride, an antidopaminergic drug commonly prescribed to counteract postmenopausal symptoms, may cause reversible parkinsonism. A 49-year-old healthy woman reported a 5 month history of progressive slowing of voluntary movements, postural changes, e.g. sit-to-stand manouevres, and gait. Clinical examination revealed moderate hypokinesia, hypomimia and plastic rigidity of the four limbs. Locomotor oscillations of the upper limbs were decreased. She had been taking 100 mg of veralipride daily to counteract postmenopausal symptoms (vasomotor flushes and irritability) for 17 months uninterruptedly. The drug was withdrawn. The patient's clinical picture fully normalized within 20 days. One year later she reported to be still asymptomatic. This seems to be a case of parkinsonism induced by veralipride, a drug known to cause other extrapiramidal signs such as bucco-facial or limb dyskinesia. To our knowledge, only one other such case has been published (a 77-year-old French woman who had been taking veralipride, prazepam and nicergolin). In both cases, the drug had been administered for longer and without intervals. In our patient the motor disturbances could not have been associated with either advanced age or interaction with concurrent medications. Therefore, this case is suspected for veralipride-associated parkinsonism. In conclusion, intoxication should be thought in case of parkinsonism arising in women taking this drug.

Dopamine Antagonists↗
PubMedDate not supplied

Some paradoxical aspects of the cardiovascular pharmacology of alpha-methyldopa.

In an effort to help explain why it is often difficult to demonstrate hypotension with alpha-methyldopa on an acute basis in normotensive anesthetized animals, the drug was administered intravenously in single doses of either 50, 100, or 200 mg/kg to chloralose-anesthetized cats while monitoring mean arterial pressure; the systolic pressor response in arterial pressure to bilateral occlusion of the common carotid arteries; hind limb vascular resistance in a vascularly isolated, extracorporeally perfused but neurally intact hind limb; and the response of hind limb vascular resistance to CCO. Alpha-methyldopa failed to cause any significant hypotension and also failed to affect vasomotor tone to the hind limb vasculature, but the drug augmented the pressor response to CCO on MAP and hind limb vascular resistance. Alpha-methyldopa also had no effect on hind limb vascular resistance when added directly to the extracorporeally perfused hind limb vascular resistance when added directly to the extracorporeally perfused hind limb circuit, indicating a lack of direct vascular smooth muscle dilating properties in these preparations. It is postulated that the augmented baroreceptor demonstrated may help th explain why it is difficult to record hypotension on an acute experimental basis with this drug. Such actions of alphamethyldopa might also provide a basis for understanding the development of tolerance to the antihypertensive effects of the drug and instances of paradoxical hypertension with it when these occur in the hypertensive human.

Animals↗
PubMed2004

Treatment of nonallergic perennial rhinitis.

Nonallergic perennial rhinitis (also commonly referred to as vasomotor rhinitis) is a chronic non-IgE-mediated condition that is characterized by symptoms which are similar to those seen in allergic rhinitis, but which persist for over nine months each year. Although treatment of vasomotor rhinitis involves the use of either intranasal corticosteroids or antihistamines, the corticosteroids are generally not effective in treatment of all the symptoms of vasomotor rhinitis and have generally been shown to be effective in patients with eosinophilia. With the exception of azelastine, the only topical antihistamine to be approved by the FDA for the treatment of nonallergic rhinitis, the antihistamines have also produced inconsistent results. While clinical studies of azelastine have demonstrated that this drug is highly efficacious in the treatment of all the symptoms of vasomotor rhinitis, mechanistic studies have demonstrated that azelastine has potent anti-inflammatory effects (in particular attenuation of the expression and synthesis of pro-inflammatory cytokines, leukotrienes, and cell adhesion molecules), which are likely to contribute to its clinical efficacy. Furthermore, pharamacokinetic studies have suggested that since azelastine has a more rapid onset of action, compared to most other antihistamines and intranasal corticosteroids, then azelastine nasal spray may be considered as primary therapy for patients with symptoms of both allergic and/or vasomotor (nonallergic perennial) rhinitis.

Anti-Allergic Agents↗
PubMed2000

How to manage the menopause following therapy for breast cancer. is raloxifene a safe alternative?

Raloxifene is a selective oestrogen receptor modulator (SERM) that has anti-oestrogenic effects on breast and endometrial tissue and oestrogenic actions on bone, lipid metabolism and blood clotting. In postmenopausal women raloxifene decreases bone turnover and increases bone mineral density, reducing the incidence of vertebral fractures. Unlike tamoxifen, raloxifene does not cause endometrial hyperplasia or cancer, as demonstrated by endometrial monitoring with ultrasonography and biopsy during treatment. Evidence suggests that raloxifene lowers total low-density lipoprotein cholesterol levels behaving like oestrogens, but does not increase high-density lipoprotein cholesterol levels. In randomised clinical trials on postmenopausal women with osteoporosis, raloxifene reduced the risk of newly diagnosed ER-positive invasive breast cancer by 76% during a median of 40 months of treatment. However, raloxifene does not alleviate early menopausal symptoms, such as hot flushes and urogenital atrophy, and may even exacerbate some of them. In conclusion, raloxifene may be an alternative for the prevention of long-term effects of oestrogen deficiency (osteoporosis and heart diseases) in women with previous breast cancer not having hot flushes. For symptomatic patients, the association of raloxifene with different drugs which have demonstrated efficacy in the control of vasomotor symptoms is now under evaluation.

Blood Coagulation Disorders↗
PubMed2001

[Idiopathic SUNCT (short lasting unilateral neuralgiform headache attacks with conjunctival injection, tearing, sweating and rhinorrhea) syndrome: 2 new cases].

The syndrome of short-lasting unilateral, neuralgiform attacks of pain in the peri orbital area associated with conjunctival injection and tearing (SUNCT) is a rare disorder affecting mainly males. We report two French patients (1 male and 1 female) with SUNCT syndrome, 27 and 28 years of age respectively. Both patients had short (30 sec), frequent (30-100/day) excruciating pain located at the peri orbital area, associated with conjunctival injection, tearing, rhinorrhea, ptosis and others vasomotor symptoms. Clinical examination and imaging were normal. Most drugs used in the treatment of migraine, cluster headache, trigeminal neuralgia, and other short-lasting headaches were not successful.

Adult↗