Coronoid process hyperplasia: CT studies

Coronoid process hyperplasia is a disorder that causes restricted jaw movement due to enlargement of the coronoid process of the mandible, which impinges on the zygomatic arch with mouth opening. The cause is unclear. Computed tomographic (CT) findings in three patients with this disorder (two bilateral, one unilateral)--including a 3-year-old boy who may be the youngest patient with this disorder ever reported--include an enlarged coronoid process, with sclerosis and erosion of the zygomatic arch. CT is an effective and rapid method for establishing the diagnosis.     

Erythromycin-induced hepatitis: simulator of malignancy

A 67-year-old patient was admitted with a 2-week history of epigastric discomfort that began after an episode of upper respiratory tract infection treated with erythromycin. Results of liver function tests were abnormal. Abdominal ultrasound (US) and computed tomography showed multiple, poorly demarcated irregular lesions in both hepatic lobes, suggestive of diffuse metastatic invasion. Histologic examination of the biopsy specimen revealed drug-induced hepatitis. Ten weeks after withdrawal of the erythromycin, US showed complete resolution of the hyperechogenic liver lesions.     

Are phase I studies without drug level determination acceptable?

Summary— Among the main objectives of phase I studies, the definition of the safety profile of the new drug, its pharmacodynamic profile and the relationship between doses, concentrations and effects can be cited. The definition of these correlations is of paramount importance not only for a correct choice of the dose and dosing intervals in patients, but also for a more rational evaluation of the possible risk/benefit ratio at a clinical level. It is hence evident that drug level determination is a "necessary" step during phase I studies in volunteers. These concepts are discussed, with particular emphasis on the possible acceptability of phase I studies without drug level determination.     

Analyses bibliographiques

Sans résumé     

Use of Anti-Craving Agents in Soldiers with Alcohol Dependence Syndrome

Background

In a search for an effective ‘anti-alcohol pill’, three modern anti-craving agents have been studied in alcoholics of Army/ DSC, Air Force, Navy and Coast Guard.

Methods

129 patients of alcohol dependence syndrome were randomly assigned to three groups where topiramate, acamprosate and naltrexone were used as anti-craving agents in a year long prospective study. Of these 92 patients completed the study.

Result and Conclusion

Topiramate (76.3%) appears to be significantly more effective (p<0.01) in sustaining abstinence, though naltrexone (57.7%) and acamprosate (60.70%) offer moderate relapse-prevention efficacy. Side effects of all the three agents have been mild, transient and self-limiting. We recommend a trial of topiramate, before invaliding out of any alcoholic soldier.Key Words: Topiramate, Naltrexone, Acamprosate, Alcohol dependence syndrome