Liposomally-entrapped ganciclovir for the treatment of cytomegalovirus retinitis in AIDS patients

Treatment of retinitis by cytomegalovirus (CMV) in AIDS patients requires frequent repetitive injections of intravitreal ganciclovir (GCV). This study was undertaken to establish experimentally whether the intravitreal application of liposomally-entrapped GCV could prolong intraocular therapeutic levels when compared with the intravitreal injection of free GCV, and the clinical effectiveness of this approach in AIDS patients. Intraocular concentration of GCV was determined by means of an ELISA test in rabbit vitreous 2, 3, 7, and 14 days after a single intravitreal injection of either different doses of the free drug (0.2–20 mg) or 1 mg of liposomally-entrapped GCV. After 72 h, only the vitreous of rabbits injected with doses of free GCV greater than or equal to 5 mg showed therapeutic levels of the drug; no GCV was detected after 72 h with any of the doses applied. Moreover, the microscopic study revealed GCV-induced damage in retinal structures in the animals injected with a free GCV dose greater than or equal to 15 mg. Intravitreal injection to rabbits of 1 mg of liposomally-encapsulated GCV showed no retinal toxicity at any of the time points studied, and therapeutic levels were detected up to 14 days after injection (4.67 ± 0.39 g/ml). Five AIDS patients suffering CMV retinitis were injected with 0.5 mg of liposomally-entrapped GCV (2 mg of lecithin). Complete remission of the CMV retinitis was observed already at the third injection of 0.5 mg GCV (one per week) and relapse did not occur during the 2–4 month follow-up of the patients. In view of the results presented, it can be concluded that intravitreal injection of liposomally-encapsulated GCV increases the time period required for reinjections in the treatemnt of CMV retinitis.Abbreviations AIDS acquired immunodeficiency syndrome - AZT zidovudine - CMV cytomegalovirus - GCV ganciclovir     

Clinical characteristics of haemorrhagic fever with renal syndrome in children

From January 1988 to September 1989, seven patients (4 girls and 3 boys, aged 3–12 years) with haemorrhagic fever with renal syndrome (HFRS) were hospitalised at the University Children's Hospital in Belgrade. In four patients the disease appeared as a family outbreak, the others were sporadic cases. In six patients the clinical presentation was suggestive of HFRS, as they had fever with headache, myalgia, sore throat and gastrointestinal illness followed by renal abnormalities. However, severe haemorrhagic syndrome with petechia, haematoma, haematemesis and melaena was present in one patient only. Renal disease presented as nephritic syndrome and/or acute renal failure. Five patients recovered after 2–3 weeks without sequellae, one patient had decreased renal function 17 months after the start of the disease and the remaining patient died. In six patients the diagnosis of HFRS was confirmed serologically by a significant rise in antibody titres against hantaviruses, while in the patient with the fatal and fulminant course of the disease, the diagnosis was established on the basis of epidemiological and autopsy findings. We suggest that children living in endemic areas who develop an ill-defined, febrile and gastrointestinal disease with renal dysfunction should be evaluated for HFRS.     

Penfluridol: An open phase III study in acute newly admitted hospitalized schizophrenic patients

An open study was carried out in 17 acutely ill, newly admitted, floridly psychotic schizophrenic patients to a city hospital in New York. Penfluridol was given on a daily basis up to doses of 120 mg and patients were rated objectively by means of different psychometric evaluations; vital signs were monitored daily as were side effects.The drug was found to be a rapid acting, well-tolerated, and highly effective antipsychotic agent within the population of patients explored and within the dose range used. It was particularly effective in acutely agitated floridly paranoid schizophrenics; a statistically significant impact was achieved by 7 days and usually within 72 h after initiating treatment. The drug appears unique in that (1) its effects are realized without the untoward and usually trouble-some effects of nonspecific sedation attendant upon the use of many other neuroleptic medications, and (2) even within the relatively high doses used it produces no hypotensive effects. It is concluded that this appears to be a unique antipsychotic agent and a potentially important addition to the treatment armamentarium of both acute and chronic schizophrenic individuals.Dr. Klein was a research fellow who has since returned to the University of Munich, West Germany. Dr. Selzer was also a research fellow who is now in private practice     

A residual cystic lesion in acute disseminated encephalomyelitis

We report a case of acute disseminated encephalomyelitis (ADEM) with a residual cystic lesion on MRI. This seemed to be induced by Japanese encephalitis vaccination. Despite complete clinical improvement with high-dose steroid therapy, the cystic lesion has persisted for 3 years on MRI. There have been no previous reports of residual cystic lesions in ADEM. Received: 20 August 1999/Accepted: 11 November 1999     

推拿、针刺对急性脑梗死大鼠细胞凋亡相关基因蛋白表达的影响

从细胞凋亡及其相关基因蛋白表达方面探讨推拿、针剌治疗急性脑缺血的作用机理。用线栓法制成SD大鼠大脑中动脉阻塞再灌注模型，在阻塞2小时再灌注24小时后，应用TUNEL法和免疫组织化学法检测针刺、推拿治疗后大鼠脑组织细胞凋亡及Bel-2、Bax蛋白表达。结果：推拿、针刺均可减少缺血所致TUNEL阳性表达，提高梗死周边区皮层Bcl-2／Bax的比值。提示推拿、针刺对急性脑缺血的治疗作用可能与其可抑制细胞凋亡有关，从而保护脑神经细胞。     

突发性聋与铁代谢障碍疾病关系的临床调查

对１９７９年７月至１９９６年６月的突发性聋发病情况进行前瞻性研究与回顾性分析，探讨突聋与铁代谢障碍疾病的关系，前瞻性研究的对象分为铁代谢障碍疾病组２１８例，血液病组２１５例和正常对照组４８５０例；回顾性分析为１７年间资料完整的４２９例突聋患者史的代谢障碍疾病及其他血液病的发病情况。结果表明，铁代谢障碍疾病组的突聋调整年发病率显著高于血液病组以及正常对照组，４２９例突聋患者的无贫血缺铁，缺铁性人同血     

急性颅内血肿清除后继发对侧迟发性血肿

目的：急性外伤性颅内血肿清除的术中及术后，如及时发现对侧迟发性血肿并治疗可提高疗效。方法：在术中发生急性脑肿胀时应在对侧钻颅探查或术后病人恶化时行ＣＴ检查。结果：治疗３０例对侧迟发血肿病人其中１０例死亡，手术死亡率为３３．３％。结论：在清除急性外伤性颅内血肿时发生急性脑肿胀或术后病情恶化应想到对侧可能是迟发性血肿形成，宜尽早钻颅探查或复查ＣＴ，早诊早治可改善预后。     

急性上消化道出血112例临床疗效分析

采用国家中医药管理局颁布的《中医血证治疗常规》治疗急性上消化道出血112例，取得了较好疗效，总有效率达94．6％。进行了证和疗效，原发病和疗效，病情程度和疗关系的分析。说明中医血证治疗效常规在临床实践中是切实可行的。     

中西医结合治疗急性白血病存活十年以上5例

中西医结合是提高急性白血病长期存活的有效途径。笔者采用中药与化疗相结合的方法治疗３００余例急性白血病患者中，５例存活长达１０年以上，最长１例已存活２０年，至今皆高质量健康生存。现代药理学研究表明部分中药具有良好的抗白血病作用。     

Tunneling Schmorl’s nodes in an elderly woman treated for acute lymphoblastic leukemia

We present a 70-year-old woman with pre-B acute lymphoblastic leukemia in whom serial imaging studies showed the development of multiple vertebral collapse, and communicating superior and inferior Schmorl’s nodes creating a longitudinal channel (”tunneling” Schmorl’s nodes) through the anterior aspect of T12 to L3 vertebral bodies of her osteoporotic thoracolumbar spine. This was observed after achieving complete remission of the disease and during maintenance therapy. The finding is felt to be secondary to iatrogenic exacerbation of osteoporosis. Received: 26 May 2000 Revision requested: 23 June 2000 Revision received: 10 July 2000 Accepted: 13 July 2000