Theophylline as 'add-on' therapy to cetirizine in patients with chronic idiopathic urticaria. A randomized, double-blind, placebo-controlled pilot study

BACKGROUND: Chronic urticaria is a prevalent condition associated with substantial disability. Its pathogenesis is not clearly understood and is divided into autoimmune and chronic idiopathic urticaria (CIU). We investigated if the non-specific phosphodiesterase inhibitor theophylline could provide additional benefit to the histamine-1 receptor (H-1R) antagonist cetirizine in CIU. METHODS: This was a double-blind, placebo-controlled, parallel study. Patients were randomized to receive either cetirizine and theophylline (200 mg twice daily; group A, 67 subjects) or cetirizine and placebo for 6 months (group B, 67 subjects). Group A patients took theophylline for 6 more months. Response was assessed by visual analog scale (VAS) and treatment effectiveness score (TES). Blood theophylline levels were also determined at visit t=1 and t=7. RESULTS: The study was completed by 54 of the 67 patients (80.6%) in group A and 51 of the 67 patients (76.1%) in group B. The physician VAS values for group A were lower after t=3, while the patient VAS values were decreased after t=2. The physician and patient TES values in group A were statistically higher (p<0.05) at all time points except for t=1. At least 1 month of theophylline addition was necessary to obtain statistically significant benefit over cetirizine, and reducing theophylline by 50% during phase 2 did not alter this benefit. Pruritus values were reduced, but not statistically significant. CONCLUSIONS: Addition of theophylline to conventional H-1R antagonists was well tolerated without any adverse effects and provided considerable additional benefit in the management of CIU.     

The effects of age on the incidence of aneuploidy rates in spermatozoa of oligoasthenozoospermic patients and its relationship with ICSI outcome

The development of intracytoplasmic sperm injection (ICSI) for treatment of infertility as a result of severe male factor has improved the chances of achieving pregnancy in many infertile couples. However, concerns have been raised regarding the safety of this technique, because natural sperm selection is bypassed. In the present study, 25 oligoasthenozoospermic patients who were divided into two groups according to age: group A, 20-34 (n = 10) and group B, 35-50 (n = 15), were included. Pooling the data of the three semen parameters that were tested (volume, concentration and progressive motility) no statistically significant difference between the two age groups was found. A total of 50 883 decondensed spermatozoa was analysed using the dual and triple colour fluorescence in situ hybridization to estimate the rates of aneuploidy for chromosomes 13, 18, 21, X and Y in the two age groups. There was a significantly higher incidence of disomy for chromosome 21 compared to the other autosomes (chromosomes 13 and 18) in both age groups. The disomy rate of XY was significantly higher in the younger subject group (0.1%) compared to the older group (0.05%, p < 0.05). Statistically significant differences in the mean number of clinical pregnancies and abortions were not observed between the two age groups. The aneuploidy rates for all the analysed chromosomes did not differ significantly, both between and within the two age groups, and as a result there seems to be no effect of male age on chromosome numbers in the spermatozoa and on the ICSI outcome.     

Implantable direct-current bone stimulators in high-risk and revision foot and ankle surgery: a retrospective analysis with outcome assessment

Efficacy and morbidity of a surgically implanted direct-current bone stimulator were evaluated in 38 patients (40 feet) with fracture nonunion or at high risk for nonunion; 14 of these patients had Charcot (diabetic) neuroarthropathy. Union occurred in 26 (65%) of the 40 feet; complications other than nonunion occurred in 16 feet (40%). Two amputations (5%) were performed in cases of intractable neuritis and deep infection. Of the 6 cases of deep infection (15%), 5 resolved with device removal, and the sixth case required below-knee amputation. Use of a bone stimulator in patients with diabetes may be problematic, but the device did not have any adverse effects in other high-risk patients.     

Drug-induced pulmonary toxicity in a patient treated with mesalazine and azathioprine for ulcerative colitis

We report a case of an 18-yr-old male with high-grade persistent fever, productive cough, malaise, diarrhea and associated abnormal findings on chest radiography. The patient suffered from ulcerative colitis receiving mesalazine and azathioprine. After a further and scrutinized work-up the diagnosis of drug-induced pulmonary toxicity was made. His condition was improved after discontinuing both drugs and the administration of corticosteroids. This is a rarely reported case of eosinophilic pneumonia. Although it has not been reported previously, the possibility of mesalazine and azathioprine synergism cannot be excluded. The clinical, aetiological, diagnostic and therapeutic aspects of the disease are discussed demonstrating the paramount importance of bronchoalveolar lavage in the diagnosis of this disorder. One should be aware of this entity in patients with inflammatory bowel disease.     

Pseudohyperkalemia in serum: the phenomenon and its clinical magnitude

We investigated in detail the difference between serum and plasma potassium levels in patients with several conditions associated with pseudohyperkalemia. In total, 435 patients with either thrombocytoses, erythrocytoses, leucocytoses, or a mixed-type disorder and 30 healthy controls were included. In each case, the index Dk [serum potassium minus plasma potassium] and the index Dk100 (Dk x 100,000/platelets), which indicates the Dk value that corresponds to platelets of 100,000/mm(3), were estimated. Median Dk was significantly higher in the groups with platelet, erythrocyte, or mixed-type disorders than in the controls (P=0.001). Among these groups, Dk values were significantly higher in patients with thrombocytosis or mixed-type disorders compared with those with erythrocytosis (P<0.001, for both). Furthermore, no significant difference was observed in Dk values between controls and patients with white blood cell disorders (P=0.74). Dk values did not exceed 2.61 mmol/L, whereas Dk100 values were inversely related to platelet counts (r=-0.351, P<0.01). In conclusion, pseudohyperkalemia is mainly present in patients with thrombocytosis or mixed-type disorders, probably as a result of the degranulation of platelets, which offers a potassium load to the surrounding plasma at the time of clot formation in vitro. However, the degree of pseudohyperkalemia does not increase proportionally with the increase of platelet counts, which may be associated with transfer of part of potassium load from the plasma back into red and white blood cells.     

Thoracic Empyema After Laparoscopic Adjustable Gastric Banding. A Rare Complication

The laparoscopic adjustable gastric banding (LAGB) is a popular therapeutic option for morbid obesity. It is a minimally invasive procedure. The reported early morbidity is low and there are only few reports of respiratory complications. We report a case of empyema and lung abscess due to diaphragm perforation by a LAGB.     

Reproductive health and midwives: does occupational status differentiate their attitudes on assisted reproduction technologies from those of the general population?

BACKGROUND: Advancements within assisted reproduction technologies (ART) raise ethical questions; however, research on health care professionals' attitudes towards their application is limited. This study aimed at assessing certified (CMs) and Student (SMs) midwives' attitudes towards various aspects of ART as well as comparing them with public opinion. METHODS: The final sample included 567 female CMs and 605 women from the general population (age range: 25-62 years), 221 SMs and 209 female non-SMs (age range: 18-24 years). The questionnaire administered included socio-demographic information, items addressing knowledge issues and attitude statements. Data were analysed using principal components analysis, one-way analysis of variance and Friedman's test, as well as multiple linear regression. RESULTS: Four attitudinal factors emerged: 'genetic counselling' (GC), 'application of ART', 'moral dilemmas' and 'socio-ethical aspects'; occupational status did not affect attitudes towards GC, however SMs expressed more positive attitudes regarding the latter three factors (P<0.001: 17.49, 14.14 and 11.55). Student groups expressed more negative attitudes for multifetal pregnancy reduction (SMs: 1.88+/-0.83; non-SMs: 2.17+/-0.77) whereas the other two groups were least favourable towards embryo donation (2.30+/-0.80, CM; 2.32+/-0.83, general population). Sex selection and the use of ART by menopausal or homosexual women were the least acceptable practices for all groups (P<0.001). A high level of relevant knowledge was positively associated with 'application of ART' and acceptability of its use by specific population groups (b=0.469, b=0.19). Findings on factors influencing attitudinal patterns are further discussed. CONCLUSIONS: In this first attempt, it was revealed that CMs express the same conservative attitudes as the general population.