Itraconazole treatment of coccidioidomycosis
Article Abstract:
Coccidioidomycosis (CM) is a fungal infection which can occur in the in lungs or throughout the body. The effectiveness of antifungal agents such as amphotericin B or ketoconazole has varied, and relapse rates as high as 60 percent have been reported. In addition, both drugs have major or intolerable side effects. Itraconazole is similar to, but more potent than, ketoconazole, and may be less toxic. The effectiveness of itraconazole treatment for CM was studied in 49 patients. Sixty percent of these patients had relapses after previous antifungal treatment, an indication that additional antifungal treatment will be only moderately successful. Out of 49 treated patients, 44 completed treatment and 57 percent (25 patients) of these had achieved remission. Four patients in remission experienced relapses. Responses in patients with lung, bone or joint, or skin or soft tissue disease were similar. Ten months of treatment were needed before significant remission occurred. Sixteen patients did not achieve remission and three patients had toxic reactions. The most common side effects were nausea and vomiting, but edema and high blood pressure also occurred. The three toxicity failures involved gastrointestinal problems, decreased white blood cells, or exacerbation of existing kidney disease which resolved following drug discontinuation. The effectiveness and relapse rates with itraconazole are as good or better than results of ketoconazole therapy, with much fewer side effects. However, further study of itraconazole toxicity at high doses is needed. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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Rectal administration of propylthiouracil in the treatment of Graves' disease
Article Abstract:
Graves' disease is characterized by enlargement and increased activity of the thyroid gland, bulging eyeballs, a rapid heart rate, tremors, elevated basal metabolism, nervous symptoms, and loss of weight. It is generally treated with iodine, iodized salt, and antithyroid drugs such as methimazole and propylthiouracil. A case is described of a 49-year-old woman with a history of heat intolerance, difficulty in swallowing, and double vision, who was admitted to the hospital in a condition of extreme nervousness and sweating. Upon examination, she was found to have symptoms of Graves' disease and was treated with propylthiouracil and iodine and then discharged. Almost a year later, the same patient was readmitted after five days of excessive vomiting, diarrhea, fever, and weight loss, and was later found to have an intestinal ulcer. After surgical repair of the ulcer, she had severe thyrotoxicosis, a toxic condition due to hyperactivity of the thyroid gland. Symptoms included abnormally high body temperature, rapid heart rate, decreased awareness, and increased thyroid hormone levels. Methylprednisolone and propranolol were given to control the symptoms, and propylthiouracil, administered rectally, decreased thyroid hormone levels within three days. The patient later died of a heart attack due to bacterial infection. Rectal administration of propylthiouracil is an easy, rapid, and effective treatment for thyrotoxicosis in patients for whom oral administration is impractical.
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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Recombinant gamma interferon in treatment of patients with atopic dermatitis and elevated IgE levels
Article Abstract:
Atopic dermatitis (AD) is a skin inflammation, accompanied by severe itchiness. Hospitalization may be required to control chronic AD, and treatment is directed toward control of symptoms. The cause of AD is not known, but it has been suggested that elevated levels of immunoglobulin E (IgE) may contribute to the condition. It has been reported that interferon gamma may suppress the synthesis of IgE. Laboratory experiments have suggested that this suppression is carried out by human peripheral blood mononuclear cells (PBMC). This study was designed to determine the effect of gamma interferon on IgE production in AD patients. Twenty-two patients with AD were treated with gamma interferon; 14 patients were treated with daily injections of various doses of IgE. There were no reductions in IgE levels at any dose level. However, clinical improvement increased with dose, and the condition worsened when therapy was discontinued. In part two of the study, eight patients were given gamma interferon daily for six weeks. These patients showed no decrease in IgE synthesis by PBMC, or in serum IgE levels. There was significant reduction in clinical disease severity, and this improvement continued during maintenance therapy. It is concluded that treatment with IgE may be effective in treating AD, and further research is warranted. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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