Treatment of dermatomyositis with intravenous gammaglobulin
Article Abstract:
Dermatomyositis is a connective tissue disease characterized by muscle inflammation and deterioration, skin inflammation, and accumulation of tissue fluid. This condition is most often treated with prednisone (a steroid), although some patients have little or no response to steroid treatment. Other patients become dependent on steroids or develop drug-related side effects. Patients who do not respond to, or cannot tolerate, steroid treatment are given immunosuppressive agents, which reduce immune function. However, immunosuppressive drugs, such as methotrexate, azathioprine, cyclophosphamide, chlorambucil, and cyclosporin A have not been consistently effective in treating dermatomyositis and may cause toxic effects, particularly in children. High doses of intravenous gammaglobulin (IVGG), an immune protein preparation, have been effective in treating various immune disorders, including one reported case of infantile polymyositis, a condition occurring in children that is similar to dermatomyositis. The effectiveness of IVGG was assessed in five patients with juvenile dermatomyositis. Prior treatment with steroids did not improve muscle weakness in these patients and caused toxic effects in three patients. In addition, previous therapy with immunosuppressive agents caused toxic effects in two patients. Treatment with IVGG increased muscle strength and improved skin inflammation. Muscle strength was increased from 56 to 606 percent in the legs, and from 30 to 186 percent in the arms. The use of IVGG eliminated or reduced the need for steroid therapy. These findings show that IVGG is effective in treating juvenile dermatomyositis, reduces the need for steroid treatment, and may be considered as an alternative to traditional therapy for juvenile polymyositis. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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Immune function and anti-HTLV-I/II status in anti-HIV-1-negative intravenous drug users receiving methadone
Article Abstract:
Intravenous (IV) drug use is associated with an increased risk of infection with the human immunodeficiency virus (HIV). In addition, use of various street drugs, such as heroin, causes adverse effects on the immune system and thereby predisposes the drug abuser to bacterial and viral infection and various cancers. Methadone is used to treat drug dependence and methadone programs may contribute to the prevention of HIV infection among IV drug abusers. Methadone is a pain-relieving drug that is as effective as morphine in relieving pain, but produces less of a stupor than morphine. It can be habit-forming and its use should be supervised. The effects of methadone on the immune system are not clear and may be further confused in the presence of infection with human T-cell leukemia virus (HTLV). The HTLV-I subtype causes serious illness, including blood cancers and nerve-related disease. Infection with the HTLV-II subtype has been infrequently associated with hairy cell leukemia. HTLV-II infection is more frequent than infection with HTLV-I among IV drug users in the United States. Simultaneous infection with HTLV and HIV is associated with a three-fold increase in death rate. The relation between methadone treatment, HTLV infection, and impaired immune function was assessed among 24 IV drug users who were not infected with HIV. Methadone users had increased levels of certain types of lymphocytes (a type of immune cell) and impaired function of lymphocytes and NK cells, another type of immune cell. These abnormal immune changes were unrelated to infection with HTLV. These findings suggest that immune abnormalities in IV drug users may be related to methadone use, which is associated with impaired function of the immune system. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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Placebo-controlled trial of intravenous diphenylhydantoin for short-term treatment of alcohol withdrawal seizures
Article Abstract:
Diphenylhydantoin (phenytoin; dilantin) is a drug used in the treatment of seizure disorders. The effectiveness of phenytoin therapy in the prevention and treatment of seizures that occur during alcohol withdrawal is controversial. Although the seizures of alcohol withdrawal are self-limiting, anticonvulsant medication is helpful in the short-term management of patients with a history of alcohol withdrawal seizures. Ninety alcoholic patients experienced a seizure during alcohol withdrawal. Phenytoin was given to 45 of the patients within six hours of a seizure; the other 45 patients received a placebo drug. Other drugs known to lower the seizure threshold (increase vulnerability to having a seizure) were removed. In both groups, six patients had a recurrent seizure. The use of phenytoin offered no additional seizure protection over the placebo. Since intravenous phenytoin administration can cause reactions at the injection site, low blood pressure, abnormal heart beats and (rarely) sudden death, the risks of administering phenytoin to alcoholic patients for the treatment and prevention of alcohol withdrawal seizures exceed any potential benefit. Barbiturates, long-acting benzodiazepines, or calcium channel antagonists may offer improved seizure control for these patients. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1989
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