Glutathione and related enzymes in fascioliasis before and after treatment with bithionol

The present work is an update evaluation of the glutathione status in patients with established fascioliasis before and after treatment with bithionol. Blood glutathione (GSH), erythrocyte glutathione S-transferase (GST) and serum gamma-glutamyl transferase (GGT) activities were studied. After treatment, the variations observed in these parameters were restored to the corresponding normal control values confirming the toxic features resulting from fascioliasis and suggesting no adverse effect of bithionol on the parameters studied. We recommend the use of serum GGT, blood GSH and erythrocyte GST for the early detection of therapeutic response in fascioliasis.     

Human fascioliasis in Egypt: effect of infection and efficacy of bithionol treatment

The present study was conducted on 14 patients with established fascioliasis. The effect of infection on the haematological and biochemical parameters was determined and the liver and gall bladder were studied by ultrasonography. Bithionol was given in the dose of 30 mg kg-1 body weight every other day for 5 doses. The therapeutic efficacy was assessed by egg and eosinophilic counts and quantitative estimation of antibody titres by indirect haemagglutination test. Results revealed that fascioliasis caused normocytic hypochromic anaemia and eosinophilia. Serum bilirubin, ALT and AST were within normal range. Ultrasonography showed a normal echogenic pattern of the liver and gall bladder. One case showed thickness of the gall bladder wall which was tender under the transiducer. Fasciola eggs disappeared completely after the 5th dose giving a cure rate of 100%. Antibody titres reached a normal level at the end of the 3rd month post treatment. Bithionol proved to be a potent fasciolicidal drug with minimal side-effects.     

Successful treatment of acute megakaryoblastic leukaemia

2 patients with acute megakaryoblastic leukaemia (AMKBL) were successfully treated with a combination of aclarubicin hydrochloride (an anthracycline), enocitabine (a derivative of cytosine arabinoside) and 6-mercaptopurine (6-MP) or 6-thioguanine (6-TG). They achieved a complete remission following 1 or 2 courses. They remained well and in complete remission throughout 3 courses of consolidation therapy, a total of 9 weeks. The results of remission induction therapy of AMKBL have been reviewed in the literature. 4 of 7 adult patients, including our cases, treated with 3 drugs, anthracycline, cytosine arabinoside or its derivative and 6-TG or 6-MP, achieved a complete remission. AMKBL may not have so poor a prognosis as previously believed.     

Successful treatment of acute myocardial ischaemia with teopranitol--a novel organic nitrate

The present study was designed to examine the effects of a neworganic nitrate, teopranitol, in acute myocardial ischaemia.Adult cats were subjected to 5 h of myocardial ischaemia bypermanent ligation of the left anterior descending coronaryartery (LAD). Teopranitol (10 mg kg^–1 x h) or physiologicalsaline (vehicle) was infused i.v., beginning 30 min after LADocclusion and continued until the end of the experiment. Allanimals subjected to myocardial ischaemia showed a significantelevation of the ST-segment within 20 min of LAD occlusion.In the LAD-vehicle group, the ST-segment elevation continuedto increase; teopranitol attentuated this increase and significantlyreduced the ST-segment elevation at 4 and 5 h (P<0.05). Theloss of creatine phosphokinase-specific activity from the ischaemicmyocardium was significantly reduced by teopranitol (P<0.05),indicating an improved preservation of myocardial tissue. Therewas a significant initial reduction in mean arterial blood pressureby teopranitol in sham-operated cats but no consistent changeof this parameter, heart rate or the computed pressure-rateproduct in LAD-occluded cats. Teopranitol did completely reversethe ischaemia induced formation of platelet aggregates at 1to 5 h (P<0.05). It is concluded that teopranitol exertsa significant protective effect in acute myocardial ischaemiain vivo that is independent of changes in systemic haemodynamicsand might be associated with the generation of an antiplateletactivity in vivo.     

Successful treatment of acute promyelocytic leukaemia during pregnancy

A case is reported of a pregnant 16-year-old-woman diagnosed with Acute promyelocytic leukaemia (APL) at 25 weeks gestation and treated with all-trans retinoic acid (ATRA) (45 mg/m2) for 25 days in combination with chemotherapy. She achieved a complete cytogenetic and molecular remission. Clinical course was complicated, with an intracerebral bleed, respiratory failure requiring ventilation and prolonged pancytopenia following initial chemotherapy. A live female infant was born at 28 weeks gestation who survived to discharge with significant pulmonary complications. She remains oxygen dependent at 6 months of age. ATRA has been used from the 3rd week of gestation, but fetal malformations are common during the first trimester. In contrast it seems to be safe in the second and third trimesters with regard to teratogenesis but can cause other side-effects. Most successful outcomes in treatment of APL during pregnancy are seen after treatment with ATRA and delivery of the baby at as late a stage as possible. Pregnancies terminated before remission has been obtained or those treated in the first trimester have a poor maternal outcome.     

Successful fibrinolytic treatment in a patient with acute mitral prosthetic thrombosis

A case is described of a 50 year-old man with an acute prosthetic dysfunction due to valve thrombosis and cardiogenic shock, on a prosthesis in the mitral position (Bjork-Shiley). The patient was promptly treated with a streptokinase in two infusions 1.5 x 10(6) UI over 180 and 90 minutes, respectively. Early clinical, fluoroscopy and echocardiography improvement was observed. The authors comment the present role of the thrombolytic therapy in front of surgery of prosthetic valve thrombosis.     

Successful treatment of acute myeloid leukaemia in a patient with ataxia telangiectasia

Ataxia telangiectasia (AT) is a rare autosomal recessive multisystem disorder characterised by cerebellar degeneration, immunodeficiency and cancer predisposition. Around 10% of AT patients develop lymphoid malignancies, but the development of myeloid leukaemia with AT (AT‐AML) is extremely rare, and there have been no previous publications regarding suitable therapies. Here, we first describe a successful therapeutic experience in a patient with AT‐AML (FAB‐M1) who attained remission after induction therapy and maintained stable disease for a year. To minimise therapy‐induced toxicity, low‐dose induction was applied first, though this was obviously insufficient and the patient subsequently responded well to dose‐intensified short‐term chemotherapy. In this report, we suggest a curative therapeutic approach for AT‐AML, though the issue of how best to manage patients with cancer complicated by immunodeficiency remains undecided.     

Successful treatment of postoperative acute hepatic artery obstruction with mesenteric arterioportal shunt

Fatal biliary complications and liver abscesses are likely in cases of acute hepatic arterial occlusion after hepatobiliary surgery with bilioenteric anastomosis. A 60-year-old man with hilar hepatic metastasis of gastric cancer underwent curative surgery. While the recurrent nodule was removed with the involved bile duct, vascular structures were preserved. Massive bleeding from the hepatic artery occurred suddenly on postoperative day 3, and the hepatic artery was ligated to stop bleeding. As Doppler ultrasonography indicated no arterial flow in the liver, a side-to-side mesenteric arterioportal shunt was created to prevent ischemic complications. Postoperative angiography showed fine patency of the shunt, and ischemic complications were avoided. However, the patient suddenly experienced massive hematemesis and fell into shock four months after the shunt operation. Upper gastrointestinal fiberoscopy showed serious varices throughout the whole esophagus. Angiographic examination indicated excessive shunt flow and markedly expanded mesenteric veins. The shunt was then occluded by coil embolization, but the patient did not recover from shock and eventually died. In the present case, the mesenteric arterioportal shunt appeared to be effective in relieving postoperative acute hepatic arterial occlusion. However, the shunt should be closed as soon as collateral blood flow is completed.     

Successful treatment with primary angioplasty of acute myocardial infarction during cerebellar hemorrhage

We describe a case of acute myocardial infarction related to a cerebellar hemorrhage. The infarction occurred just before the neurosurgical operation of ventricular drainage and was successfully treated by primary coronary angioplasty, with the implantation of coated stents and low doses of glycoprotein (GP) IIb/IIIa inhibitors. The patient recovered well from both interventions and the 6-month follow-up angiography showed a good result.     

Successful treatment of gefitinib-induced acute interstitial pneumonitis with corticosteroid and non-invasive BIPAP-ventilation

This is the case of a 63 year-old male who was diagnosed adenocarcinoma in the left upper lung with ipsilateral malignant pleural effusion. At diagnosis it had already spread to left pulmonary HLN (hilar lymph node) and left supraclavicular lymph node and mediastinal lymph nodes. The patient received combined chemotherapy with bevacizumab and GP (gemcitabine and carboplatin) for 6 courses. Disease progression on chest CT scan was recognized, daily treatment with oral gefitinib (250 mg/day) was commenced. One week later, he was admitted under the impression of gefitinib-related interstitial pneumonitis, gefitinib was discontinued immediately and methylprednisolone with BIPAP assisted ventilation were used. The patient was followed up for 2 months after the start of treatment with corticosteroids and BIPAP assisted ventilation and remained well.     

成功救治主动脉夹层并发急性脑梗死2例

DeBakey I型夹层因累及血管不同,可以出现脑卒中、急性心肌梗死及其他急性内脏缺血等不同临床表现,常容易出现误诊,出现上述并发症后医生及家属常常因风险高及费用巨大而放弃治疗,本文报告2例DeBakey I型主动脉夹层并发急性大面积脑梗死患者的成功治疗经验,希望为临床提供借鉴。     

Successful treatment of a pregnant woman with Philadelphia chromosome-positive acute lymphoblastic leukemia

The management of acute leukemia during pregnancy is challenging. Delays in treatment for acute leukemia can adversely affect maternal prognosis, but chemotherapy during pregnancy may induce severe adverse effects on the fetus. Here, we report a case of a pregnant woman with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph⁺ALL) who underwent remission induction therapy and successfully delivered a live infant after chemotherapy. The case is a 36-year-old woman diagnosed with Ph⁺ALL in the 27th week of pregnancy. She underwent remission induction therapy including daunorubicin, vincristine, cyclophosphamide, and prednisolone. Imatinib was not used in the induction therapy. She delivered the infant after one course of chemotherapy. The infant and the patient are both alive now, without any major complications.     

Successful percutaneous treatment of acute bilateral lower limb ischemia

Acute limb ischemia is a surgical emergency as a delay in reperfusion is associated with a high risk of irreversible tissue infarction potentially leading to limb loss and death. However, in medically compromised patients, perioperative morbidity and mortality remain high. An elderly woman with multiple comorbidities developed acute bilateral lower limb ischemia and was not felt to have a surgical revascularization option. Percutaneous restoration of reperfusion was successfully achieved by obtaining bilateral antegrade femoral arterial access followed by local infusion of fibrinolytic therapy and adjunctive thrombectomy resulting in bilateral lower extremity salvage.     

Successful treatment with imatinib mesylate for Philadelphia chromosome-positive refractory acute myeloid leukemia

A 51-year-old man was diagnosed as having Philadelpha (Ph) chromosome-positive acute myeloid leukemia (AML) with major-BCR/ABL mRNA. He achieved complete remission after induction chemotherapy. Five months later, he was again positive for the Ph chromosome despite additional chemotherapy. He was therefore treated with imatinib mesylate, a specific inhibitor of BCR/ABL tyrosine kinase, at a dose of 600 mg/day. However, the treatment was interrupted because of thrombocytopenia, skin eruption and face edema. After the patient recovered from these side effects, imatinib was readministered at a dose of 400 mg/day and a complete cytogenetic response was achieved. Imatinib is expected to be an effective drug for Ph chromosome-positive AML.     

Successful treatment with arsenic trioxide of a patient with ATRA-resistant relapse of acute promyelocytic leukemia

 Arsenic trioxide has recently been introduced as a promising new agent to treat refractory acute promyelocytic leukemia (APL). In the present study, arsenic trioxide was given intravenously for 42 days to a 56-year-old female patient suffering from chemotherapy/ATRA-resistant APL, with 43% APL blasts in the bone marrow and elevated D-dimers. During the first days of arsenic trioxide treatment a rapid decrease in the D-dimers was seen (normal values reached until day 7), together with a slight decrease in peripheral blood leukocytes. This initial coagulation response was followed by a second phase of hematological response (starting on days 15–20) characterized by leukocytosis, occurrence of myeloid progenitor cells in the peripheral blood, and a decrease in bone marrow blasts (<1% on days 28 and 36). Finally, the patient entered complete hematological and cytogenetic remission, although the PML-RARα fusion product was still detectable by PCR. These data confirm the therapeutic value of arsenic trioxide in relapsed/resistant APL. Received: February 10, 1999 / Accepted: March 29, 1999