Analysis of primary treatment and prognosis of spontaneous urticaria

Background

The prognosis of spontaneous urticaria in association with early treatment remains unclear. In this study, we retrospectively studied the prognosis of acute spontaneous urticaria in relation to age and treatments in a local clinic of dermatology.

A comparison between lovastatin and gemfibrozil in the treatment of primary hypercholesterolemia.

A randomized, multicenter, double-blind, prospective, 18-week comparison of lovastatin with gemfibrozil was performed to compare their efficacy and tolerability in adults with types IIa and IIb primary hypercholesterolemia. Sixty men and 44 women aged 24 to 78 years participated in the trial. Each treatment group of 52 patients was closely matched by the randomization procedure. All participants met national cholesterol education program guidelines for evaluation and treatment. In all, 94 (90%) completed the 18 weeks of study. After 18 weeks of diet-plus-active treatment, lovastatin decreased serum total cholesterol and low-density lipoprotein (LDL) cholesterol significantly better than gemfibrozil (adjusted mean decreases were 63 vs 35 mg/dl for total cholesterol and 67 vs 28 mg/dl for LDL; p = 0.0001). Gemfibrozil was more effective than lovastatin in increasing high-density lipoprotein (HDL) cholesterol (8 vs 5 mg/dl adjusted mean HDL cholesterol increases; p = 0.0086) after 18 weeks. No significant differences in the adjusted mean ratio of total to HDL cholesterol were noted, but the lovastatin group had a significantly greater adjusted mean reduction in the ratio of LDL to HDL cholesterol (1.8 vs 1.3; p = 0.0013). The gemfibrozil group achieved significantly greater reductions in very low density lipoprotein (VLDL) cholesterol and triglycerides compared with the lovastatin group (adjusted mean decreases were 14 vs 1 mg/dl for VLDL cholesterol and 71 vs 15 mg/dl for triglycerides). After 18 weeks of lovastatin therapy, 49% of patients achieved goal LDL cholesterol, whereas only 9% of those who took gemfibrozil achieved this goal (p = 0.0001).     

Serious cytomegalovirus disease in the acquired immunodeficiency syndrome (AIDS). Clinical findings, diagnosis, and treatment

Life-threatening opportunistic cytomegalovirus infection is a complication of the acquired immunodeficiency syndrome (AIDS) that occurs in 7.4% or more of patients with AIDS. Cytomegalovirus retinitis, colitis, esophagitis, and gastritis are the commonest manifestations of severe cytomegalovirus end-organ disease. Extensive trials with intravenous ganciclovir, a nucleoside analogue with myelosuppressive toxicity, have shown that ganciclovir halts the progression of cytomegalovirus retinitis and gastrointestinal disease. Since relapse is common when therapy is discontinued, most patients with AIDS need life-long maintenance therapy. The clinical response to ganciclovir therapy is usually accompanied by diminished shedding of the virus. Based on limited data, foscarnet, a pyrophosphate analogue, also appears to have some efficacy in treating cytomegalovirus infection. Unlike ganciclovir, foscarnet does not cause myelosuppression. An important direction for future clinical research is the development of more effective and less toxic therapy, as well as orally bioavailable drugs for maintenance therapy.     

Efficient management of diarrhea in the acquired immunodeficiency syndrome (AIDS). A medical decision analysis

STUDY OBJECTIVE: To compare the efficacy and cost effectiveness of alternative strategies for the evaluation and medical management of diarrhea in patients with the acquired immunodeficiency syndrome (AIDS). DESIGN: Medical decision analysis using a decision tree. METHODS: Three management strategies were compared: full evaluation, which included stool culture, ova and parasite examination, stain for protozoa, blood cultures, esophagogastroduodenoscopy with biopsy, and colonoscopy with biopsy; limited evaluation, which included stool culture, ova and parasite examination, stool stain for protozoa, and blood cultures; and minimal evaluation, which included only a stool culture. Treatment was based on the outcome of the diagnostic workup. Patients without a specific diagnosis were treated symptomatically with diphenoxylate hydrochloride. Nonrespondents to initial symptomatic treatment and patients with recurrent diarrhea after specific therapy were given the full evaluation. Average probabilities of diagnostic and therapeutic success were calculated from previous reports. Costs were compiled based on diagnostic and therapeutic expenditures. MEASUREMENTS AND MAIN RESULTS: Under baseline assumptions, the remission rates for diarrhea were 75.2%, 74.8%, and 74.8% in patients undergoing the full, limited, and minimal evaluations, respectively. The respective costs of the three strategies were $5419, $1997, and $1700 per patient in remission. A sensitivity analysis showed that the differences in efficacy and cost among the full, limited, and minimal strategies remained unchanged over a broad range of possible rates of diagnostic or therapeutic success. CONCLUSIONS: The minimal evaluation in all patients, with the full evaluation reserved only for nonrespondents to symptomatic treatment, is efficacious and is the most cost-effective strategy for managing AIDS-related diarrhea.     

Using acquired knowledge and new technologies in alcoholism treatment trials

This article represents the proceedings of a symposium held at the 2001 RSA meeting in Montreal, Canada. The organizer and chair was Barbara A. Flannery and the discussant was Raye Z. Litten. The presentations were (1) The use of biomarkers in alcohol-dependence treatment trials, by John P. Allen; (2) Strategies for enhancing patient compliance in clinical treatment trials, by Helen M. Pettinati; (3) The predictive utility of an alcohol-craving measure, by Barbara A. Flannery; (4) What should be the primary outcome measures in a clinical trial, by Damaris J. Rohsenow; (5) Innovative strategies for assessing functional outcomes in alcoholism treatment clinical trials, by Ron A. Cisler.     

A new antihistamine hc20-511 compared with dimetinden (fenistil retard) in the treatment of chronic urticaria and other pruritic dermatoses.

The new antihistamine, HC20-511 (Sandoz), was compared with Dimetinden (Fenistil retard) in a single-blind comparative study in 42 patients with dermatoses, 28 of whom suffered from chronic urticaria. HC20-511 had a better effect, especially in chronic urticaria, where pruritus, erythema and papules quickly disappeared. The effect appeared somewhat faster than and lasted as long as that of Dimetinden, although HC20-511 is not a retard-preparation unlike the Dimetinden preparation used for comparison. HC20-511 also caused less side effects.     

A multicenter comparison of lovastatin and probucol for treatment of severe primary hypercholesterolemia

A multicenter study was undertaken to compare the effects of lovastatin (given in 4 different dosage regimens) and probucol in patients with severe primary hypercholesterolemia. The subjects were 290 patients taking lipid-lowering diets who were randomly assigned to 1 of the following treatment regimens for 14 weeks: lovastatin, 40 mg once a day with the morning meal (qam); lovastatin, 40 mg once a day with the evening meal (qpm); lovastatin 80 mg qpm; lovastatin, 40 mg twice daily, or probucol, 500 mg twice daily. One-third of the patients received probucol, and the other two-thirds were equally divided between the 4 lovastatin treatment groups. The mean reductions in total cholesterol in the 5 groups were, respectively, 20, 25, 30, 33 and 10%. The corresponding values for low-density lipoprotein cholesterol were 25, 32, 37, 40 and 8%. High-density lipoprotein cholesterol increased by 9 to 12% in all the lovastatin groups, but decreased by 23% in the probucol group. Triglycerides were reduced by 17 to 25% in all the lovastatin groups, but did not change significantly in the probucol group. Both drugs were well tolerated; no serious adverse events could be attributed to either agent. It is concluded that lovastatin is a considerably more effective lipid-lowering agent than probucol. In addition, lovastatin is almost as effective when given in a single daily dose as when given in a divided dose. When a once-a-day regimen is used, lovastatin is more effective if taken in the evening rather than the morning.     

Successful treatment of primary cardiac lymphoma with monoclonal CD20 antibody (rituximab).

Primary cardiac malignant lymphoma is extremely rare and almost all patients die within weeks. Monoclonal CD20 antibody (rituximab) was administered to a patient with primary cardiac B-cell non-Hodgkin's lymphoma expressing a CD20 molecule. The results suggest that rituximab may be a safe and effective new therapy for primary cardiac B-cell lymphoma.     

Anatomy and pathology of the right ventricle (including acquired tricuspid and pulmonic valve disease).

With the increased availability of various imaging techniques to assess right ventricular structure and function, there has been a greater appreciation of the importance of right ventricular performance in the setting of left ventricular dysfunction as well as intrinsic ventricular diseases. This article discusses the pathology of the right ventricle, tricuspid valve, and pulmonic valve and concentrates on the major acquired and congenital conditions that manifest in an adult population.     

A new anti-inflammatory drug, proquazone, and ibuprofen in the treatment of degenerative joint disease of the knee (gonarthrosis). A double-blind comparative study.

The therapeutic effect and the tolerance of a new non-steriod anti-inflammatory compound, proquazone, were compared with those of ibuprofen in a double-blind, randomized study on patients with gonarthrosis. Totally 39 patients participated in the study: 19 patients in the proquazone group and 20 patients in the ibuprofen group. The two drugs were given in daily doses of 900 mg and 1200 mg respectively during 3 weeks. In both treatment groups a good result was achieved in more than 70% of the cases, but proquazone seemed to be more effective in reducing swelling and pain of knee. There were more side effects in the proquazone group than in the ibuprofen group, but they were generally mild and disappeared spontaneously. Only one patient in the proquazone group withdrew, because of epigastric discomfort.