Brachioradial pruritus successfully treated with gabapentin

Brachioradial pruritus (BRP) is a mysterious entity characterized by localized pruritus of the dorsolateral aspect of the arm. The precise etiology of BRP remains unknown, but sun exposure and/or cervical spine lesions seem to be triggering or at least aggravating factors. Many treatment alternatives including non‐steroidal anti‐inflammatory drugs, topical capsaicin, topical corticosteroids, photoprotection, carbamazepine and acupuncture have been used with different success rates. Recently, gabapentin, an antiepileptic agent, has been reported to be an effective therapeutic agent in BRP. Herein, we report a 64‐year‐old man with BRP who showed good response to gabapentin therapy.     

Tuberculous meningitis in children

Between May 1988 and November 1992 the data from 52 patients with tuberculous meningitis (TBM) were noted down for their symptoms and signs, BCG vaccines, PPD tests; clinical, laboratory, radiologic and microbiologic findings. These data were discussed by means of literature knowledge. Cranial computed tomography (CT) demonstrated hydrocephalus (HC) in 98% of the patients. There was a statistically significant difference among the clinical stages on admission in respect to prognosis (P < 0.05). In addition, there was also a significant relationship between prognosis and HC (P < 0.05). However, we did not find any significant relationship between parenchymal involvement, basilar meningitis and prognosis (P > 0.05).     

Testis sparing surgery for the treatment of a sequential bilateral testicular germ cell tumor

Standard therapy of sequential bilateral testis cancer is generally considered to be orchiectomy. We present a case of sequential bilateral testicular germ cell tumor treated with testis sparing surgery. The patient was disease free 50 months after surgery without local recurrence or distant metastases. Testis sparing surgery provides a better quality of life and may be considered a safe, feasible alternative in the treatment of carefully selected patients with bilateral testicular germ cell tumor.     

Comparison of Atrial Leads: Importance of Polarity and Fixation Mechanism

To compare the influence of polarity and fixation mechanism on atrial leads, we evaluated acute implantation and 12-month follow-up results in 211 patients, 138 male and 73 female, aged 63 ± 14 years, implanted with DDD (210) and AAI (1) pacemakers. Eighty patients had bipolar (B) active fixation (AF) leads (CPI-4266), 71 had unipolar (U) AF (Medtronic-6957J), 36 had B passive fixation (PF) (Medtronic-4512), and 26 had U PF (Medtronic-4511) leads. Acutely, capture thresholds were higher in the AF than the PF group (BAF: 1.0 ± 0.5 V; UAF: 0.9 ± 0.4 V; BPF: 0.6 ± 0.2 V; UPF: 0.5 ± 0.1V - P < 0.001). The BPF lead acute sensing threshold was superior to the AF leads (P wave sensing for BPF: 3.2 ± 1.5 mV; BAF: 2.2 ± 1.2 mV; UAF: 2.2 ± 1.1 mV - P < 0.003). In both AF and PF groups, lead polarity did not affect pacing and sensing thresholds. The difference in acute capture thresholds between AF and PF leads was abolished prior to discharge, and at subsequent follow-up over 12 months, no difference in chronic thresholds was observed. During the follow-up period, the chronic sensing thresholds of BAF leads were superior to the others. There was no significant difference in the complication rates of the four leads. Thus, all four leads proved satisfactory in clinical practice. No major impact of polarity and fixation mechanism was detected.     

Pulse methylprednisolone therapy in children with membranoproliferative glomerulonephritis

The effects of pulse methylprednisolone (PM) therapy were studied in 15 patients (aged 3–14 years) with biopsy proven membranoproliferative glomerulonephritis (MPGN). Patients were treated with intravenous PM 30 mg/kg (max 1 g) given over 30 min every other day for a mean of 9.8 days (3–15 days). Oral prednisolone therapy was continued at a dose of 1 mg/kg/24 h for 1 month and subsequently tapered off the following month. Eight patients had hematuria and six had medically controlled hypertension. Serum C₃ levels were low in 11 patients and all of the patients had proteinuria. Following PM therapy proteinuria was significantly reduced from 2602.9 ± 1852.5 mg/24 h to 1871.2 ± 2090.8 mg/24 h (P < 0.05) and at final evaluation, proteinuria was 774.33 ± 1225.67 mg/24 h which was significantly lower than pre- and post-PM therapy values (P < 0.05). Serum creatinine levels were high in five patients before PM therapy and remained high in one of the patients who progressed to end-stage renal failure. After PM therapy, high serum creatinine levels normalized in three patients and was reduced, but still above normal, in one. One patient, with initially normal serum creatinine, had elevated levels afterwards. Nine of the patients were considered responsive and six non-responsive according to our tentatively defined criteria. Mean follow-up period was 27.4 ± 24.1 months (6–84 months). Three patients were lost for follow-up, and 12 were re-evaluated. At final evaluation, all of the patients except one with end-stage renal failure had normal creatinine levels. There was no correlation between the clinical and laboratory features at onset and the outcome of the disease in the responder or non-responder patients. Results of our study show that PM therapy reduced proteinuria and may affect renal function positively in patients with MPGN. However, a prospective controlled study with repeat biopsies is required to draw a conclusion.     

Reversible Myoglobinuric Renal Failure Following Rhabdomyolysis as a Rare Complication of Cardioversion

CAVUSOGLU, Y., et al .: Reversible Myoglobinuric Renal Failure Following Rhabdomyolysis as a Rare Complication of Cardioversion. Reversible myoglobinuric renal failure following rhabdomyolysis that was related to repeated countershocks delivered for the treatment of refractory recurrent VT and VF attacks during acute myocardial infarction is presented in this case report, in which scan with technetium-99m pyrophosphate has been used for in the diagnosis of extensive skeletal muscle damage. (PACE 2003; 26[Pt. I]:645–646)