Management of essential tremor

Essential tremor (ET) is the most prevalent tremor syndrome. It commonly affects the hands, head, voice, and other body parts. Appropriate management begins with correct diagnosis. Primidone and propranolol are the first-line medications for the treatment for ET, but several other medications may also provide benefit. In patients with medically refractory tremor, alternative therapies, including surgery or injections of botulinum toxin, may be considered.     

Experiencia en la implementación de un protocolo de verificación de la tasa de Kerma de referencia en aire de semillas de125I

This paper presents the experience in the use of a validation protocol for the¹²⁵I seeds reference air Kerma rate used in prostate treatments before being implanted. The method used employs a well-type ionization chamber that has been calibrated against an international standard at an accredited dosimetry calibration laboratory (ADCL), this is a direct traceability system. Then, as a quality control check on the well-chamber’s response, the calibration factors are assayed on an ADCL calibrated¹²⁵I seed, secondary traceability system. Before each assay procedure a long-lived source, which dosimetric characteristics are well known, is placed in the well-chamber as a redundancy program to verify that our dosimetry system has not changed with time. Finally the results of verifications over a 2-year period are discussed.     

Research highlights from the literature

AUTONOMIC NEWS

Research highlights from the literatureItalo Biaggioni, M. D.     

Immunochromatographic Brucella-specific immunoglobulin M and G lateral flow assays for rapid serodiagnosis of human brucellosis

To fulfill the need for a simple and rapid diagnostic test for human brucellosis, we used the immunochromatographic lateral flow assay format to develop two assays, one for the detection of Brucella-specific immunoglobulin M (IgM) antibodies and one for the detection of Brucella-specific IgG antibodies. The diagnostic values of these tests were examined. The tests are shown to detect acute, persistent, and relapsing disease and can be used to monitor treatment. The sensitivity of Brucella IgM and IgG flow assays calculated for the combined assay results is 96%, and specificity amounts to 99%. The flow assay requires neither specialized training nor equipment, the assay is very easy to perform and to read, and the components are stable without a requirement for refrigeration and well standardized. Together these characteristics indicate that the Brucella IgM and IgG flow assays are ideal for use in clinical settings in rural and suburban areas in which brucellosis is endemic.     

Development of a murine model of cerebral aspergillosis

Central nervous system (CNS) Aspergillus infection has a mortality rate in humans that approaches 95%. Because no animal models are available for studying this infection, we sought to develop a murine model of CNS aspergillosis. Inconsistent data were obtained for nonimmunosuppressed CD-1, C57BL/6, and DBA/2N mice after infection by midline intracranial injection of Aspergillus fumigatus. CD-1 mice given cyclophosphamide to produce immunosuppression had continuous pancytopenia. Dose-finding studies in CD-1 mice showed that infection with 5 x 106 conidia/mouse consistently caused 100% mortality by day 5-8; no mice died before day 3. Histologic examination of samples of brain tissue showed focal abscesses containing Aspergillus hyphae. Fungus burdens in brain were higher than those in other organs, although Aspergillus disseminated to the kidneys and the spleen. The model we established provides an opportunity to study immune responses to and therapeutic options for CNS disease in an immunologically defined, genetically manipulable, and inexpensive species.     

The immediate and long-term effects of mannitol and glycerol

Summary A prolonged experimental situation of focal vasogenic oedema, producing mild intracranial hypertension, was developed. The aim was to study the immediate and long-term effects of repeated infusions of mannitol and glycerol on intracranial pressure (ICP) and cerebral blood flow (CBF).Eighteen goats were operated on twice to implant: an epidural latex balloon in each cerebral hemisphere to measure ICP; an electromagnetic flowmeter around both internal maxillary arteries (the only cerebral blood input), after tying the extracranial branches, to measure the CBF; and two femoral catheters to measure blood pressure (BP) and for intravenous infusion (IV). Three groups of 6 goats each were formed: A) control; the BP and bilateral ICPs and CBFs were recorded under basal conditions and every 4 hours for 3 days after a cold injury (CI) was provoked; B) 20% mannitol solution 1 g/kg body weight injected every 12 hr starting at 24 hr post-CI; and C) 10,1% glycerol solution 0.5 g/kg body weight, administered as mannitol.Glycerol, as compared to mannitol, presents the following major differences among its immediate post infusion effects: a lesser decrease in ICP, but no rebound phenomenon; lesser elevation of BP; CBF increases more gradually and constantly. Long-term effects with mannitol consisted of a rebound phenomenon observed in ICP during the last 12 hr. In all 3 groups, it was observed that CBF increases in relation to the ICP level.     

Efficacy of albaconazole (UR-9825) in treatment of disseminated Scedosporium prolificans infection in rabbits

There are no effective therapeutics for treating invasive Scedosporium prolificans infections. Doses of 15, 25, and 50 mg/kg of body weight/day for the new triazole albaconazole (ABC) were evaluated in an immunocompetent rabbit model of systemic infection with this mold. Treatments were begun 1 day after challenge and given for 10 days. ABC at any dose was more effective than amphotericin B (AMB) at 0.8 mg/kg/day at clearing S. prolificans from tissue (P < 0.007). The percentages of survival at 25 mg of ABC/kg/day were similar to those obtained with AMB. Rabbits showed 100% survival when they were treated with 50 mg of ABC per kg (P < 0.0001 versus control group), and only this dosage was able to reduce tissue burden significantly in the five organs studied, i.e., spleen, kidneys, liver, lungs, and brain.     

In vitro interactions of approved and novel drugs against Paecilomyces spp

We have evaluated the in vitro activity of 15 combinations of antifungal drugs (amphotericin B, itraconazole, voriconazole, albaconazole, ravuconazole, terbinafine, and micafungin) against four isolates of Paecilomyces variotii and three of P. lilacinus. The interaction of terbinafine with the four azoles was synergistic for 53% of the combinations, while the interactions of both amphotericin B and micafungin with the rest of antifungal agents were mainly indifferent.     

Efficacy of liposomal amphotericin B in treatment of systemic murine fusariosis

We have compared the activities of liposomal amphotericin B (LAMB) at 3, 5, 10, and 20 mg/kg/day and amphotericin B deoxycholate (AMB) at 1.5 and 2.5 mg/kg/day in a murine systemic infection by Fusarium verticillioides. Survival was improved by all treatments except AMB at 1.5 mg/kg/day. The tissue burden in liver was reduced by LAMB at all dosages and by AMB at 2.5 mg/kg/day. The two highest dosages of LAMB showed significant reductions in the spleen.