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Drug-induced ciliary body oedema: a new theory.

Drug-induced oedema of the ciliary body is rare, and occurs predominantly following exposure to sulphonamides. In a 31-year-old patient in her 37th week of pregnancy, we observed reversible myopia of -4.75 dioptres following the ingestion of chlorthalidone. In a second case report we describe, in a 61-year-old patient suffering from aspirin-sensitive asthma, recurrent ciliary body oedema with a marked spastic component which was triggered by the medications acetazolamide, dipivefrine and pilocarpine. We explain oedema of the ciliary body on the basis of the eicosanoids. We believe that the oedema is caused mainly by prostaglandins and that leucotrienes are predominantly responsible for the spastic component. We postulate a drug-induced elevation in eicosanoid concentrations, as well as certain interrelationships between ciliary body oedema and aspirin-sensitive asthma.

Acetazolamide↗

The trouble with teething--misdiagnosis and misuse of a topical medicament.

For many clinicians and parents "teething" remains a convenient diagnosis to explain all manner of local and systemic upset in the young child. Many therapies are on the market to help alleviate the symptoms of primary tooth eruption. In this article we highlight the problems of "teething" as a diagnosis by presenting a case where an initial misdiagnosis of teething compromised a patient's life. The same patient then suffered from topical analgesic misuse during the recovery period.

Anti-Inflammatory Agents, Non-Steroidal↗

Premenstrual syndrome. Tailoring treatment to symptoms.

Despite the interest in premenstrual syndrome (PMS) taken by the media and the public in recent years, some women still do not recognize the cyclic nature of their symptoms. Thus, PMS continues to elude diagnosis. Dr Nader discusses the major categories of symptoms and when they occur, summarizes theories on the cause of PMS, and comments on how well these theories have been substantiated by testing. Choosing agents for treatment on the basis of symptoms to be controlled is also described.

Bromocriptine↗

A fatal case of amlodipine poisoning.

A fatal case attributed to amlodipine intoxication is presented. The deceased was a 15-year-old girl who allegedly ingested 14 10-mg Istin tablets. Amlodipine concentration in peripheral blood was determined (2.7 mg/L) and was compared with published therapeutic and toxic data for amlodipine and some other dihydropyridine calcium channel-blocking agents. Amlodipine concentrations in liver, blood, and stomach contents were also determined.

Adolescent↗

Pulmonary function and respiratory symptoms in wildland firefighters.

We studied cross-seasonal changes in pulmonary function and respiratory symptoms in 52 wildland firefighters in Northern California. The mean cross-seasonal change in forced expiratory volume in 1 second (FEV1) was -1.2% (95% confidence interval [CI] -0.5%, -2.0%) with a corresponding mean change in forced expiratory volume (FVC) of -0.3% (95% CI 0.4%, -1.0%). Decreases in FEV1 and FVC were most strongly associated with hours of recent fire-fighting activity (P = .002 and .01, respectively). When the study group was divided into three categories based on recent fire-fighting activity, firefighters in the high activity category (mean +/- SE, 73 +/- 7 hours of fire-fighting in previous week) had a -2.9% (130 mL) change in FEV1 and a -1.9% (102 mL) change in forced vital capacity (FVC). There was a significant cross-seasonal increase in most respiratory symptoms evaluated. Several symptoms (eye irritation, nose irritation, and wheezing) were associated with recent fire-fighting. These findings suggest that wildland firefighters experience a small cross-seasonal decline in pulmonary function and an increase in several respiratory symptoms. Research is under way to identify the fire conditions and specific components of exposure that produce pulmonary irritants, and to examine the potential reversibility of acute pulmonary change.

Adolescent↗

Prostanglandins enhance spread of herpes simplex virus in cell cultures.

Stimuli such as u.v. light or trauma which induce recurrence of herpes simplex may act by affecting virus replication in the skin. Such stimuli release pharmacologically active agents in the skin, including prostaglandins (PGs) such as PGE2. These agents, and other compounds which alter levels of adenosine cyclic monophosphate (cyclic AMP), were tested for their effect on the replication of herpes simplex virus (HSV) in Vero cells. Prostanglandin E2 (PGE2) and prostaglandin F2alpha both increase the size of HSV plaques; PGE2 also increases the yield of virus inoculated at low m.o.i. Moreover, inhibitors of prostanglandin synthesis decrease plaque size and inhibit the growth of virus inoculated at low m.o.i.; such inhibition can be partially overcome by adding PGE2. Analysis of the results suggest that prostaglandins can enhance cell-to-cell spread of HSV, but that cyclic AMP is probably not involved in this effect.

Cell Line↗

Do non-steroidal anti-inflammatory drugs have an effect on gastric cell turnover?

AIM: To study the effect of non-steroidal anti-inflammatory drugs (NSAIDs) on gastric cell turnover using an in vitro immunohistochemical method of bromodeoxyuridine (BrDU) uptake. METHODS: Thirty patients undergoing routine upper gastrointestinal endoscopy were studied. Sixteen had taken NSAIDs daily for more than 3 months and there were 14 age-matched controls. Endoscopic gastric antral biopsies were obtained and stained immediately using the BrDU technique. Cell proliferation was expressed as a labelling index percentage (LI%) defined as the number of BrDU-labelled nuclei in 10 gastric glands, expressed as a percentage of the total cells in the gastric gland. RESULTS: Gastric infection with Helicobacter pylori was excluded in all patients. Of the 16 patients on NSAIDs, four had gastritis, four had erosions or ulceration and eight had a normal examination. Endoscopy was normal in all patients in the control group. The LI% (mean +/- S.E.M.) in the entire NSAID group was 4.09 +/- 0.29 and in the control group 3.57 +/- 0.29. No significant difference was observed. In the NSAID patients with gastritis and erosions or ulceration, the LI% was 4.99 +/- 0.61 and 3.07 +/- 0.32, respectively. There was no significant difference in LI% between the endoscopic subgroups of patients on NSAIDs or between patients on NSAIDs who had normal endoscopy and the control patients. CONCLUSION: These results provide evidence that refutes the hypothesis that the prevalence of NSAID gastropathy is due to an effect on gastric cell turnover.

Administration, Oral↗

Effect of flunixin meglumine on prostaglandin F2 alpha synthesis and metabolism in the pig.

The effect of flunixin meglumine on prostaglandin synthesis and metabolism was evaluated in the pig in vivo. It was found that the prostaglandin metabolite, 15-ketodihydro-PGF2 alpha, was decreased in the peripheral circulation within 20 min of injection of the drug. In therapeutic doses in the pig the drug had no effect on the metabolism of PGF2 alpha. Flunixin was compared with some other non-steroidal anti-inflammatory drugs in an in vitro test system utilizing sheep vesicular gland microsomes. It was concluded that this drug is a potent inhibitor of prostaglandin synthesis.

Animals↗