Treatment of Allergic Bronchopulmonary Aspergillosis with Fluconazole and Itraconazole

Treatment of allergic bronchopulmonary aspergillosis (ABPA) has remained both problematic as well as controversial. Although the sheet anchor in treatment of ABPA still remains steroids, various workers have tried oral antifungals (fluconazole and itraconazole) with encouraging results. This study evaluates the effect of fluconazole or itraconazole in the treatment of ABPA patients and compares them with the patients who had received palliative therapy other than antifungals. Case records of 44 proven cases of ABPA treated at our referral service hospital during February 1998 to April 2001 were analyzed. In addition to oral and inhaled bronchodilators, 16 patients received fluconazole 150 mg OD and 13 patients itraconazole 200 mg OD for six months. Response to therapy was assessed clinically, radiologically and by spirometry every 3 months. Patients who did not receive antifungals had chronic course characterized by airway obstruction, recurrent pulmonary consolidation and obstructive defect on pulmonary function test (PFT). Patients treated with itraconazole had better control of asthma symptoms, less requirement of reliever inhalers, steroids and lesser exacerbations of asthma during follow-up even after stopping antifungal. Fluconazole group had better control of symptoms but improvement in other parameters was not statistically significant. From this study it was evident that itraconazole improved the symptoms of airway obstruction, pulmonary functions, pulmonary opacities and decreased exacerbations during follow up.Key Words: Allergic bronchopulmonary aspergillosis, Fluconazole, Itraconazole     

Adjuvant postoperative radiotherapy for colon carcinoma

BACKGROUND: The objective of this report was to review the role of adjuvant postoperative radiotherapy (RT) for patients with adenocarcinoma of the colon. METHODS: The authors reviewed the pertinent literature. RESULTS: Data suggested that locoregional postoperative RT improves both local control and survival for patients with T4N0-N1 tumors. There also may be a benefit for patients with T3N1-N2 tumors, but the data were equivocal. Whole abdominal RT may result in a similar benefit but is associated with increased toxicity. CONCLUSIONS: Postoperative RT should be considered for patients with T4N0-N1 colon carcinoma. Locoregional fields should be used.     

Acute renal failure due to acute tubulointerstitial nephritis

Acute interstitial nephritis (AIN) should be ruled out in children with unexplained acute renal failure. We present a 4 1/2 year old girl who presented with oliguric acute renal failure preceded by a febrile illness. Renal histopathology revealed features of drug induced AIN. She recovered with dialysis, other supportive treatment and a course of steroids.     

Epidural compared with general anaesthesia for caesarean delivery in conscious women with eclampsia

Objective To compare retrospectively the outcome of caesarean section under epidural anaesthesia with that of general anaesthesia in "stable" women with eclampsia.
Design Retrospective review.
Method Over the five–year study period, there were 533 women with eclampsia and of these 66 women (12.4%), fulfilled the criteria of being 'stable'. Of the 66 women, 37 received epidural, 27 general, and 2 spinal anaesthesia.
Results There were no major complications with either general or epidural anaesthesia. Epidural anaesthesia was associated with higher one–minute Apgar scores.
Conclusion This study indicates that both maternal and neonatal outcomes are not affected adversely by the use of epidural anaesthesia in selected cases of eclampsia.     

Attitude of unmarried girls towards family planning: a study in an Orissa City.

In 1987-88, 281 females from the Government Women's College in Berhampur, Ganfam District, Orissa State in India were surveyed to determine their knowledge and attitude toward family planning (FP). 80% came from urban areas. Educated fathers (72%) had considerable influence over the education of their daughters (p.001). Higher income families (70%) were more able to educate their children than lower income families (30%; p.001). 50% of the students had discussed FP and family ties with their parents. 91% recognized the need for FP. 95% did not favor early marriage (p.02). 66% knew the legal marriage age for females to be 18 years, but only 47% knew it to be 21 for males. In fact, 46% believed the age for males to be 25 years. 24% k new of only 1 FP method, 23% of 2 methods, and 14% of 3 methods. The leading method to be used after marriage according to the students was condoms (16%) followed by IUDs and oral contraceptives (OCs) (6%). The predominant method to use after childbirth was sterilization (13%) followed by IUDs (8%) and condoms and OCs (5%). Most students did not advocate using any method after marriage or after childbirth. 45% mentioned the best time to start FP was after 2 children and 26% after 1 child. Most, (83%) preferred 2 children (p.001) because of better child care and education (37%). 71% felt couples should wait 3 years before having another child. No one believed 1 or 4 years to be adequate birth spacing. Birth spacing was needed in the interest of the mother's health (30%) and for better health of the next child (29%). The mass media provided 50% of the students with FP knowledge. Most (70%) felt that insufficient FP education and basic education were the reasons for unplanned families. 82% believed the FP program would be successful in the future. 68% considered population control important to national development.     

Recurrent swelling of the upper lip. A case report

Recurrent swelling of the lips may be due to a number of causes. A case is presented of recurrent swelling of the upper lip caused by trauma from a displaced and apically dilacerated 1. There was abnormal development of 32 which were also displaced although 123 appeared unaffected. The surgical, endodontic and orthodontic management of this problem is discussed.     

Pulmonary histiocytosis X: comparison of radiographic and CT findings

The authors retrospectively evaluated radiographs, computed tomographic (CT) scans, and results of pulmonary function tests (when available) for 17 patients with biopsy-proved pulmonary histiocytosis X. In 11 patients, high-resolution CT was used. In 12 patients, CT demonstrated cystic air spaces, usually less than 10 mm in diameter. In three of these 12, cysts were the only abnormality, but in six others, nodules (usually less than 5 mm in diameter) were also present. Two patients had only nodules and one, only emphysema. CT showed that many lesions that appeared reticular on plain radiographs were actually cysts. CT showed no central or peripheral concentration of lesions, but it did reveal that many small nodules were distributed in the centers of secondary lobules around small airways. CT findings correlated better with the diffusing capacity (rho = -0.71) than did the plain radiographic findings (rho = -0.57). Thus, CT was better than radiography at showing the morphology and distribution of lung abnormalities.