[Pathogenetic ground of including reamberin and cycloferon combination into the therapy program for patients with severe cases of acute tonsillitis of a mixed viral/bacterial etiology]

The increase of severe cases of acute tonsillitis (AT) is presently marked. Severe cases of AT disturb immune and metabolic homoeostasis initiating the development of disease. Therapy optimization is required to select the best treatment. In patients with severe cases of AT of mixed viral/bacterial etiology before the treatment it is revealed the increase of general activity of lactatedehydrigenase (LDH) and increase of the level of cathode "anaerobic" factions LDH4+5 and the decline of concentration ATP in the blood. There was a compensatory rise of level of ADP and АМP. The substantial decline of serum interferon (CIF) activity and diminishing maintenance of α-interferon (α-IFN) and γ-interferon (γ-IFN) in the blood of the patients, that testified to oppressing of interferonogenesis. Treatment of severe cases of AT of mixed viral/bacterial etiology of modern detoxic preparation reamberin and immunoactive preparation cycloferon combination positively influences the studied laboratory indexes. The improvement of power metabolism is marked, that was characterized by normalization of level adenine nucleotides (ATP, АDP, АМP) and general activity of LDH and its izoenzimes spectrum. At the same time the increase of CIF level is set, maintenances α-IFN and γ-IFN in the blood, that testified to the improvement of interferonogenesis. The results demonstrate the therapeutic potential of reamberin and cycloferon combination for treatment of patients with AT of mixed viral/bacterial etiology.

[Liver detoxifying function disorders in children with chronic hepatic disease and their correction]

In the present study liver detoxifying function state in children with chronic hepatitis and pigmentary hepatosis was examined. An endogenous intoxication level increase, peroxide processes and biotransformation system activation were established against the background of endotoxicosis substrate accumulation in blood. The dynamics of clinical symptoms and liver detoxifying function indicators was estimated against the background of the complex treatment with Reamberin. In our study we have noticed detoxication mechanisms improvement, and that fact has been confirmed by a decrease of endogenous intoxication level and significant middle-mass molecules decreasing in blood plasma as well as intoxication index and glutathione enzymes activity in blood.

Monitoring the reverse to normal of clinico-pathological findings and the disease free interval time using four different treatment protocols for canine leishmaniosis in an endemic area

Twenty-four dogs naturally infected by Leishmania spp. were treated with four different protocols using meglumine antimoniate (aNm) and allopurinol in combination or in monotherapy. Aiming to compare the efficacy of the different treatments the reverse to normal of clinico-pathological findings and the disease free interval time (DFIT) were evaluated. Treated dogs were monitored for 1 year and, in absence of relapses, the DFIT was postponed to the last available follow-up. Seven dogs treated with aNm alone showed relapses during the year of observation. In the group of dogs treated with the combination of aNm (50 mg/kg/SC 12 hourly up to clinico-pathological recovery) and allopurinol (15 mg/kg/PO 12 hourly administered for 6months) no relapses were registered in the year of monitoring and the DFIT reached up to 65 months. Our results showed that this combination represents the best choice to treat canine leishmaniosis compared to other protocols.

[Clinical efficiency of reamberin - cycloferon combination in treatment of hepatic cirrhosis associated with chronic HCV infection]

The clinical efficiency of a reamberin and cycloferon combination for the treatment of hepatic cirrhosis (HC) associated with chronic HCV infection has been studied. Immunological investigation of patients carried out before the treatment revealed a significant increase in the level of proinflammatory cytokines (CK) in serum, whereas the level of anti-inflammatory CK changed rather insignificantly. Use of the reamberin - cycloferon combination provided faster clinical-biochemical remission and, in respect of the pathogenetic state, ensured normalization of the CK profile in the blood. Based on these data, it can be considered as pathogenetically proved and clinically feasible and promising to use the reamberin - cycloferon combinations for a complex treatment of patients with HC associated with chronic HCV-infection.

[Oxygenation state of brain in children upon reamberin infusion during post-anesthesia recovery]

The effect of reamberin (1.5% solution of succinic acid and ion complex) on the oxygenation status of the brain was studied in children aged 1 - 14 years during recovery from anesthesia. It is established that reamberin in a dose of 2 ml/kg administered twice at the end of an operation increases the fraction of oxidized hemoglobin and cytochrome oxidase and enhances the regional saturation of brain tissue with oxygen, which is indicative of an increase in the potential of metabolism activation in neurons.

[Effectiveness of 3-hydroxypyridine and succinic acid derivatives in complex treatment of primary open-angle glaucoma]

Prospective, placebo-controlled, single-blind, randomized clinical investigation of the influence of domestic 3-hydroxypyridine and succinic acid derivatives (emoxipin, reamberin, mexidol) on the effectiveness of a complex treatment of primary open-angle glaucoma (POAG) has been performed in a group of patients. It is established that intravenous infusion of 3-hydroxypyridine derivatives (emoxipin and mexidol) for two weeks, beginning 14 days after the start of POAG treatment, produced a retinoprotective action, with three months postponed changes in the central retinal artery (CRA) blood velocity. The retinoprotective effect of emoxipin (single dose, 150 mg) was manifested by reduction in the horizontal size of blind spot in two weeks, with the subsequent reduction of the CRA end-diastolic blood velocity observed three months after finish of the infusion therapy. The administration of mexidol (single dose, 300 mg) after 14 days of treatment led to widening of the summarized field of vision (test-object square, 16 mm), accompanied by a decrease in the electrosensitivity threshold of the optic nerve and the intensity of POAG-associated hypothymia. All indices of CRA blood velocity increased three months after termination of mexidol infusions. Reamberin (single dose, 400 ml 1,5% solution of reamberine, containing polyelectrolyte and meglumine succinate mixture) did not show retinoprotective action, but caused proatherogenic changes of blood lipids and 3 months postponed CRA end-diastolic blood velocity increase. The effect of mexidol (which is a derivative of both 3- hydroxypyridine and succinic acid) exceeds that of separate 3-hydroxypyridine (emoxipin) and succinic acid (reamberin) derivatives in the degree of retinoprotection and positive effect on the optic nerve condition and mood of POAG patients.

[The role of reamberin in combined therapy of abstinence syndrome in alcoholics]

Clinical efficacy of 7 day reamberin therapy of abstinence syndrome was compared in 32 alcoholics with concomitant exogenous organic brain lesions (F 10.2, mean age 41.2 +/- 6.3 YR) and 46 control patients given no treatment. Reamberin accelerated reduction of somatovegetative manifestations of abstinence syndrome with subsequent normalization of its affective components. It is concluded that combined therapy including reamberin significantly reduced severity of endogenous intoxication in alcoholics suffering exogenous organic brain lesions.

[The use of reamberin for the correction of endogenous intoxication syndrome associated with salmonellosis]

The aim of the work was to study characteristics of endogenous intoxication (EI) associated with salmonellosis under conditions of basal therapy and its supplementation by detoxicant reamberin. The study included 66 patients with the gastroenteric variant of moderately severe S. enteriditis infection. The infection was accompanied by well-apparent manifestations of EI (increased leukocyte index, elevated level of medium weight molecules, and reduced detoxification potency of albumin) Persistent EI promotes development of secondary immunodeficiency; the recovery from the disease does not exclude long-term carriage of the pathogen and the development of chronic gastrointestinal diseases. It requires new approaches to the treatment of salmonellosis, such as the use of detoxicants like reamberin that decrease the severity of EI. It is concluded that introduction of reamberin in the combined treatment of salmonellosis can be recommended as a promising option for the management of infectious diseases.

[Efficacy of combined immunocorrection in the treatment of chronic viral hepatitis C]

AIM

To assess efficacy of combined immunocorrection in the treatment of patients with chronic viral hepatitis C (CVHC).

MATERIAL AND METHODS

Routine clinicobiochemical tests, examination of immunological homeostasis (cellular immunity, the level of circulating immune complexes - CIC and their molecular composition, macrophagal phagocyting system - MPS) were made in two groups of CVHC patients: the study group (n=68) and control group (n=66). The control patients received standard treatment, the study group received also cyclopheron in combination with reamberin. Cyclopheron was given per os in a single daily dose 600 mg 2 days, then 3 times a week in a dose 150 mg for 48 weeks. Reamberin infusions in a single daily dose 400 ml were made for 5 - 7 days.

RESULTS

CVHC in exacerbation phase is characterized by the presence of secondary immunodeficiency running with T-lymphopenia, low count of peripheral blood lymphocytes with CD4+ phenotype and low immunoregulatory index CD4/CD8, depression of functional activity of T-cells as evidenced by lymphocyte blast transformation test with phytohemagglutinin, inhibition of phagocyting activity of monocytes and inhibition of dermal macrophages. This shows subnormal functional activity of MPS. CVHC runs with accumulation of CIC in blood serum primarily due to increased content of most pathogenic mid- and low-molecular .ifactions of immune complexes. Addition ofcyclopheron and reamberin in combined treatment of CVHC patients promotes normalization of immunological homeostasis which clinically occurs in parallel with achievement of persistent and long-term CVHC remission.

CONCLUSION

The results of the above investigation support pathogenetic validity and prospects of cyclopheron and reamberin inclusion into combined treatment of CVHC.

Disposition of antimony in rhesus monkeys infected with Leishmania braziliensis and treated with meglumine antimoniate

Antimony (Sb) disposition and toxicity was evaluated in Leishmania braziliensis-infected monkeys (Macaca mulatta) treated with a 21-d course of low (LOW) or standard (STD) meglumine antimoniate (MA) dosage regimens (5 or 20 mg Sb(V)/kg body weight/d im). Antimony levels in biological matrices were determined by inductively coupled plasma mass spectrometry (ICPMS), while on-line ion chromatography coupled to ICPMS was used to separate and quantify Sb species in plasma. Nadir Sb levels rose steadily from 19.6 ± 4 and 65.1 ± 17.4 ng/g, 24 h after the first injection, up to 27.4 ± 5.8 and 95.7 ± 6.6 ng/g, 24 h after the 21st dose in LOW and SDT groups, respectively. Subsequently, Sb plasma levels gradually declined with a terminal elimination phase half-life of 35.8 d. Antimony speciation in plasma on posttreatment days 1-9 indicated that as total Sb levels declined, proportion of Sb(V) remained nearly constant (11-20%), while proportion of Sb(III) rose from 5% (d 1) to 50% (d 9). Plasma [Sb]/erythrocyte [Sb] ratio was >1 until 12 h after dosing and reversed thereafter. Tissue Sb concentrations (posttreatment days 55 and 95) were as follows: >1000 ng/g in thyroid, nails, liver, gall bladder and spleen; >200 and <1000 ng/g in lymph nodes, kidneys, adrenals, bones, skeletal muscles, heart and skin; and <200 ng/g in various brain structures, thymus, stomach, colon, pancreas. and teeth. Results from this study are therefore consistent with view that Sb(V) is reduced to Sb(III), the active form, within cells from where it is slowly eliminated. Localization of Sb active forms in the thyroid gland and liver and the pathophysiological consequences of marked Sb accumulation in these tissues warrant further studies.

[Using of reamberin on patients with cerebral deficiency due to severe forms of acute poisonings]

The aim of work was to test the using of reamberin on patients with cerebral deficiency due to severe forms of acute poisonings. The investigation was made on 60 patients (38 men and 22 women), whose average age was 34.7 +/- 2.6 (for men) and 28.4 +/- 3.2 (for women). The main group was divided into two parts, which had compared age, sex and gravity of condition. The first one was given reamberin with standart therapy (I - 32 patients), the second - only standart therapy (II - 28 patients). It was revealed that using of reamberin in complex therapy of acute cerebral deficiency lead to decrease of intensity of cerebral deficiency and to increase of speed of cerebral activity rehabilitation. These changes lead to improvement of clinic tendency of cerebral deficiency, what was illustrated by decrease of comatose period from 55.0+/- 2.2 to 33.0 +/- 2.6 hours, decrease of the time of being in reanimatology department from 69.1+/- 3.6 to 53.4+/- 4.3 hours.

[Effectivity of detoxification preparation reamberin in complex treatment of the patients with chronic cholecystitis combined with chronic pancreatitis on background of HCV-infection]

Effectivity of detoxic preparation reamberin at complex treatment of the patients with acuting of chronic cholecystitis combined with chronic pancreatitis on background of HCV-infection was detected. It was set that before treatment took place increase "average molecules", lipid peroxidation products--malondialdehyde and dien conjugates and increase of circulatory immune complexes in serum. Including of reamberin provided to normalization clinical-biochemical indexes.

MRI of colorectal cancer liver metastases: comparison of orally administered manganese with intravenously administered gadobenate dimeglumine

OBJECTIVES

To compare the sensitivity of MRI to detect colorectal cancer liver metastases (CRLM) after ingestion of manganese-based contrast agent (CMC-001) with that of a comprehensive intravenous gadobenate dimeglumine protocol, and to assess the safety and acceptability of oral manganese.

METHODS

20 patients suspected of having 1-6 CRLM were included prospectively in this randomised cross-over study. Liver MRI was performed with a one-week interval at 1.5 T and included T1-w VIBE and T2-HASTE, before and after administration of 1.6 g CMC-001 or 0.1 mmol/kg gadobenate dimeglumine. The metastasis-to-liver signal intensity (SI) ratio was calculated. Standard of reference was histopathology after surgery, or combination of other imaging studies and/or follow up. Adverse events (AE) and clinicolaboratory tests were monitored.

RESULTS

Of 44 metastases, 41 were detected after CMC-001 (93%) and 42 after gadobenate dimeglumine (95%). Fifteen false-positive lesions were found after CMC-001 and 2 after gadobenate dimeglumine. The metastasis-to-liver SI ratio was significantly higher after CMC-001 than after gadobenate dimeglumine (0.51 and 0.21 respectively, P < 0.0001). More AE occurred after manganese compared to gadobenate dimeglumine.

CONCLUSIONS

CMC-001 is as sensitive as an extensive intravenous gadobenate dimeglumine protocol in detecting CRLM. It was relatively well tolerated but had higher rates of gastrointestinal AE.

KEY POINTS

• Liver MRI after ingestion of manganese is highly sensitive for detecting metastases • High false-positive rate necessitates further evaluation, in some cases • The MR examination time is short • Oral ingestion of manganese seems safe and relatively well tolerated by patients • Manganese compounds may be useful for liver metastasis surveillance after colorectal cancer.

[Systemic inflammatory reaction and indices of the organ hepatic dysfunction in patients with abdominal sepsis]

In 26 patients in complex of treatment of abdominal sepsis there was applied a 1.5% solution of reamberin intravenously in 400 ml dose during 5 days. The results of treatment were estimated, studying indices of systemic inflammatory reaction (SIR) and hepatic tests. Reamberin application have promoted rapid normalization of the parameters studied. The authors consider, that efficacy of reamberin is caused not only by positive impact on the SIR course, but by hepatoprotective action of the preparation as well.

[Efficacy of reamberin in patients with acetic acid poisoning]

Efficacy of reamberin infusion therapy was estimated in 38 patients with severe acetic acid intoxication. Reamberin was shown to have positive effect on certain end-points of the treatment, viz. caused a 2-fold decrease in duration of exotoxic shock (which allowed to use smaller volumes of infusion solutions), 3-fold decrease in the frequency of pneumonia, 5-fold reduction in the frequency of delirium and acute renal insufficiency in the early post-traumatic period. The use of reamberin allowed to reduce duration of patients' stay in intensive therapy and resuscitation wards by 1.2 times and mortality rate by 18.5%.

[Free radical processes in patients with the acute calculous cholecystitis]

The role of the free radical processes (FRP) is shown and objectified in the development of the acute calculous cholecystitis (ACC). It is revealed on the first day of hospitalization already. In catarrhal and phlegmonic ACC free radical processes changes apply mostly to the oxygen part of the oxidation process. The greatest imbalance of the FRP is registered in the gangrenous ACC. It appeared like decrease of the oxygen and activation of the lipid FRP disregulation. On the first day FRP changes refer to the oxygen part of the oxidation process only. Starts with a second day from the disease début changes in the lipid component of the oxidative stress join the disregulation process. It is proved by the decrease of the antiperoxidant activity of plasma and increase of malondialdehyde. Malondialdehyde level and its rate of rise serve as prognostic criteria of the course and outcome of disease. FRP changes correlate with the clinical presentations of disease. They last till the patient's discharge. The high efficiency of the energetic corrector reamberin in a dose of 400-800 ml was shown in patients with ACC.

[Free radical processes in patients with the gastro-intestinal bleedings]

The role of the free radical processes (FRP) is shown and objectified in the development of the ulcer gastro-intestinal bleedings (UGIB). It is revealed on the first day of hospitalization already. The greatest imbalance of the FRP is registered in heavy patients with acute UGIB. It appeared like decrease of the oxygen and activation of the lipid FRP disregulation. Unheavy patients have FRP changes refer to the oxygen part of the oxidation process only. Intensification FRP in process of increase of weight disease consists in decrease activity oxygen and increase a lipid disbalance. FRP disbalance has long time proceeds, last till the patient's discharge. Results of the research prove as much as possible early inclusion in a complex of medical actions antoixidant therapy. The high efficiency of the energetic corrector reamberin in a dose of 400-800 ml was shown in patients with UGIB.

[Oxidative stress in patients with mechanical jaundice of different origin and severity]

This randomized clinical study included 118 patients with mechanical jaundice (MJ) of different origin and severity. It highlighted the role of free radical-generation processes (FRP) in the development of the disease within 1 day after its onset. Disbalance of FRP affects oxygen and lipid components of oxidative stress and is especially well pronounced in severe cases and in patients with tumours. It becomes increasingly apparent with time from the onset of jaundice and endotoxicosis. FRP disbalance precedes clinical manifestation of jaundice and persists for a long time even after alleviation of its clinical symptoms. Certain signs have a prognostic values. Therapy with reamberin at a daily dose of 400 ml is shown to effectively correct oxidative stress associated with MJ of tumorous and non-tumorous origin regardless of the severity of the disease. Positive effect of antioxidative therapy is accompanied by the improvement of laboratory characteristics, clinical picture, and outcome of the disease.

[Efficacy of reamberin in treating heavy acute intestinal infection in children]

The current health conditions dictate the need to reduce the time of patient treatment in hospital and require rational use of drugs. Reduction of the duration of intoxication syndrome in severe forms of intestinal infections in children depends on infusion therapy and choice of solutions for intravenous administration. Reamberin is generation IV infusion preparation for intensive care, representing a balanced isotonic detoxicant infusion solution based on succinic acid. Using reamberin ensures a significant decrease in the time of stay in hospital for children with severe forms of intestinal infections, which is achieved by reducing the duration of endogenous intoxication.

[Antihypoxic effect of 3-hydroxypyridine and succinic acid derivatives and their nootropic action in alloxan diabetes]

Relationship between the antihypoxic effect of 3-hydroxypyridine and succinic acid derivatives (emoxipine, reamberin and mexidol) and their effect on conditional learning, glycemia, and lipidemia was studied in rats with alloxan-induced diabetes. In parallel, the analogous relationship was investigated for alpha-lipoic acid that is regarded as a "gold standard" in treatment of diabetic neuropathy. It was established that single administration of emoxipine and mexidol in mice in doses equivalent to therapeutic-range doses in humans produces antihypoxic effect manifested by increased resistance to acute hypoxic hypoxia in test animals. Alpha-lipoic acid is inferior to emoxipin and mexidol in the degree of antihypoxic action. Reamberin does not exhibit this effect. The introduction of emoxipin, reamberin, mexidol, and alpha-lipoic acid in rats with alloxan diabetes during 7 or 14 days in doses equivalent to therapeutic-range doses in humans corrects conditional learning disorders in direct relationship with the antihypoxic activity of these drugs. The development of the nootropic effect of emoxipin, mexidol, and alpha-lipoic acid is related to a decrease in hyperglycemia and hyperlipidemia in rats with alloxan diabetes. The nootropic action of reamberin is accompanied by a transient hypoglycemizing effect and aggravation of dyslipidemic disorders. The antihypoxic activity of investigated drugs determines the direction and expression of their lipidemic effect, but is not correlated with the hypoglycemizing action these drugs on test animals with alloxan diabetes.

Optimization of single injection liver arterial phase gadolinium enhanced MRI using bolus track real-time imaging

PURPOSE

To measure contrast agent enhancement kinetics in the liver and to further evaluate and develop an optimized gadolinium enhanced MRI using a single injection real-time bolus-tracking method for reproducible imaging of the transient arterial-phase.

MATERIALS AND METHODS

A total of 18 subjects with hypervascular liver lesions were imaged with four dimensional (4D) perfusion scans to measure time-to-peak (TTP) delays of arterial (aorta-celiac axis), liver parenchyma, liver lesion, portal, and hepatic veins. Time delays were calculated from the TTP-aorta signal, and then related to the gradient echo (GRE) k-space acquisition design, to determine optimized timing for real-time bolus-track triggering methodology. As another measure of significance, 200 clinical patients were imaged with 3D-GRE using either a fixed time-interval or by individualized arterial bolus real-time triggering. Bolus TTP-aorta was calculated and arterial-phase acquisitions were compared for accuracy and reproducibility using specific vascular enhancement indicators.

RESULTS

The mean bolus transit-time to peak-lesion contrast was 8.1 ± 2.7 seconds following arterial detection, compared to 32.1 ± 5.4 seconds from contrast injection, representing a 62.1% reduction in the time-variability among subjects (N = 18). The real-time bolus-triggered technique more consistently captured the targeted arterial phase (94%), compared to the fixed timing technique (73%), representing an expected improvement of timing accuracy in 28% of patients (P = 0.0001389).

CONCLUSION

Our results show detailed timing window analysis required for optimized arterial real-time bolus-triggering acquisition of transient arterial phase features of liver lesions, with optimized arterial triggering expected to improve reproducibility in a significant number of patients.

[Pharmacological protection of the myocardium with reamberin in coronary artery bypass grafting in patients with postinfarction angina]

AIM

To assess efficacy of reamberin in preoperative preparation and after coronary bypass (CB) in patients with macrofocal myocardial infarction (MI) complicated with postinfarction angina.

MATERIAL AND METHODS

A total of 45 patients with Q-positive MI complicated with postinfarction angina pectoris entered the trial. The study group consisted of 20 (44.4%) patients given 200-400 ml injections of 1.5% reamberin solution for 3 days before coronary artery bypass grafting (CABG) and 3-5 days after it. The control group consisted of 25 (55.6%) patients given basic therapy without cardioprotection. ECTG-60, echocardiography, CM-ECG, laboratory tests were made before CABG. CABG was made in conditions of artificial blood circulation in all the patients.

RESULTS

Clinical stabilization was observed after direct myocardial revascularization in hospitalized 25 (100%) patients of the study group and 22 (88%) patients of the control group. Early postoperative acute cardiac failure (ACF) developed in 3 (12%) patients from the study group and 9 (36%) from the control group (p = 0.04), arrhythmia occurred in 2(8%) and 8(32%) patients, respectively (p = 0.03). Two (8%) control patients died in early postoperative period from acute cardiac failure. Perioperative MI occurred in 2(8%) control patients. After 12 months of the follow-up, patients of the study group had no recurrent angina pectoris, while among the controls 4(16%) patients had recurrent angina of FC III. After surgical intervention at discharge and 12 months after treatment patients of both groups improved systolic and diastolic functions of the left ventricle. Normalization of the diastolic function was registered in 80% patients of the study group (p < 0.001) and in 44% from the control group (p < 0.001) after 1 year follow-up.

CONCLUSION

Reamberin reduces the number of postoperative complications, ischemic damage to the myocardium, significantly improves systolic and diastolic functions of the left ventricle.

[Metabolic therapy and pulmonary disfunction in patients with obstetric sepsis]

The role of reamberin, a succinate-containing infusion preparation in correlation of pulmonary metabolic and respiratory disturbances in patients with obstetric puerperal sepsis was estimated. The prospective randomized study enrolled 43 patients with puerperal obstetric sepsis complicated by polyorganic deficiency (SOFA 8-10). Nineteen patients of the 1st group and 24 patients of the 2nd group were additionally treated with reamberin in a dose of 800 ml/day for 8 days. The venous and arterial difference by glucose, lactate, pyruvate, diene conjugates, malondialdehyde and ceruloplasmin was investigated. The blood gases were determined with the Ciba Corning 45 apparatus. Lower metabolic activity of the lungs with prevalence of the glucose anaerobic metabolism and lower activity of the intrapulmonary antioxidant protection were observed in the patients with obstetric sepsis. The use of reamberin in the complex therapy of obstetric sepsis promoted maintenance of the initial balance and anaeroibic and aerobic pulmonary metabolism, thus providing shorter terms of the decompensation and recovery of the lungs respiratory function.

[Neuroprotector therapy of patients with decompensated diabetes mellitus type 1]

The influence of actovegin and reamberin on diabetic ketoacidotic crises has been studied on a group of 128 patients with severe diabetic ketoacidosis on the background of diabetes mellitus type 1 with disorders ranging from consciousness to coma or precoma states. Patients of group 1 received standard intensive therapy of diabetic ketoacidosis. In group 2, an intensive therapy for neuroprotection by actovegin was added. In group 3, patients received reamberin on the background of standard therapy. In group 4, the neuroprotective therapy using actovegin and reamberin was combined. The mental status was estimated upon recovery from coma, on 5th and 28th days from the beginning of treatment, by taking into consideration cognitive functions such as attention, memory, mentality. The results showed that the use of neuroprotective drugs, including the combination of actovegin and reamberin, allowed to the restore the compensatory-adaptive reaction of patients to ketoacidotic crisis, accelerate the restoration of consciousness within 19.2 +/- 3.8 h, restore the cognitive functions with exceeding norm for patients with diabetes mellitus in compensation stage and maintain their high level on 28th day after crisis.

[Changes of blood rheological properties and its correction under surgical and drug treatment in patients with phlegmons of maxillofacial area]

Blood theological properties in patients with phlegmons of maxillofacial area before treatment, immediately after surgical treatment and after surgical treatment combined with reamberin therapy were examined in the study. Negatively changed theological profile values somewhat improved after operation, mainly because of blood and serum viscosity decrease by 10-11% and blood transport capability enhancement. But significant positive macro- and microrheological changes was only received by surgical treatment combined with reamberin. Reed blood cells (RBC) incubation with reamberin proved direct microrheological effect of reamberin due to RBC deformability increase (by 10%, p < 0.05) and aggregation decrease (by 11%, p < 0.05). Positive theological changes associated with favorable clinical outcome.

[Reamberin administration for early postnarcosis recovery in children]

The possibility of using 1.5% succinic acid solution (reamberin) in order to activate recovery from anesthesia was studied in a group of 91 patients aged 1-14 years. Based on clinical data and BIS-index, it is established that the administration of reamberin during exit from anesthesia stage shortens the wake-up period, decreases the time of restoration of the motor activity and adequate respiration, and accelerates brain function recovery.

Pediatric visceral leishmaniasis in Albania: a retrospective analysis of 1,210 consecutive hospitalized patients (1995-2009)

Background

Little information is available about infantile visceral leishmaniasis (VL) in Albania as regards incidence, diagnosis and management of the disease.

Methodology/Principal Findings

Demographic data, clinical and laboratory features and therapeutic findings were considered in children admitted to University Hospital of Tirana from 1995 to 2009, and diagnosed as having VL. The diagnosis was based on bone-marrow microscopy/culture in 77.5% of patients, serology in 16.1%, and ex juvantibus in 6.4%. A total of 1,210 children were considered, of whom 74% came from urbanized areas. All patients were in the age range 0–14 years, with a median of 4 years. Hepatosplenomegaly was recorded in 100%, fever in 95.4% and moderate to severe anemia in 88% of cases. Concomitant conditions were frequent: 84% had bronchopneumonia; diarrhea was present in 27%, with acute manifestations in 5%; 3% had salmonellosis. First-line therapy was meglumine antimoniate for all patients, given at the standard Sb^v dosage of 20 mg/kg/day for 21 to 28 days. Two children died under treatment, one of sepsis, the other of acute renal impairment. There were no cases of primary unresponsiveness to treatment, and only 8 (0.67%) relapsed within 6–12 months after therapy. These patients have been re-treated with liposomal amphotericin B, with successful cure.

Conclusions

Visceral leishmaniasis in pediatric age is relatively frequent in Albania; therefore an improvement is warranted of a disease-specific surveillance system in this country, especially as regards diagnosis. Despite recent reports on decreased responses to antimonial drugs of patients with Mediterranean VL, meglumine antimoniate treatment appears to be still highly effective in Albania.

Albania is a developing country that is rapidly improving in social, economic and sanitary conditions. The health care system in still in progress and the impact of some infectious diseases remains poorly understood. In particular, little information is available on incidence, clinical features and response to treatment of visceral leishmaniasis (VL) in childhood. We performed a retrospective analysis of data recorded from 1995 to 2009 at the national pediatric reference hospital of Tirana where any child suspected for VL is referred for specific diagnosis and treatment. Epidemiology, clinical features and management of the disease were considered. The main findings can be summarized as follows: i) The incidence of the disease in Albanian children (25/100,000 in the age group 0–6 years) is much higher than in developed Mediterranean countries endemic for VL; ii) The disease is associated with poor sanitary conditions as suggested by the high rate of severe clinical features and frequency of co-morbidities; iii) The cheapest drug available for Mediterranean VL treatment (meglumine antimoniate) is highly effective (99% full cure rate) and well tolerated. Limitations were identified in the low standard laboratory diagnostic capability and unsatisfactory medical surveillance in less urbanized areas. An improvement is warranted of a disease-specific surveillance system in Albania.

[Correction of antioxidant system disorders in children with acute intestinal infection]

Administration of reamberin leads to rapid reduction of the intoxication symptoms, improves general condition, and reduces fever stage duration. The dynamics of inflammatory symptoms is characterized by decreasing duration of hemocolitis in comparison that in patients receiving glucose-salt solutions. Reamberin accelerates normalization of the chemiluminescence indices, reduces the intensity of oxidative processes (to within 3-5 days) in patients with high level of free-radical oxidation, and leads to decreasing endogenous intoxication on early terms of the disease. Removal of the dysbalance between oxidation and antioxidant systems, especially in cases of serious shigellosis and in patients with high level of lipid peroxidation, favors a decrease in the damaging action of free radicals and eliminates metabolic disturbances in children within early reconvalesce period.

[Reamberin in combined therapy of general peritonitis]

Randomized studies of combined treatment of 138 patients with toxic phase of general peritonitis were accomplished. We demonstrated a significant decrease in electric activity of the intestine and alteration of free-radical processes in patients with generalized purulent peritonitis. Administration of reamberin which contains succinic acid promoted restoration of the intestine's peristalsis to the 3rd day of postoperative period and effective correction of imbalance in free-radical processes system. Usage of reamberin in combined treatment of general peritonitis let lethality to be diminished from 16.49 to 9.76%.

[Clinical efficacy of reamberine in therapy for influenza]

AIM

To evaluate the tolerance and therapeutic effectiveness of 1.5% reamberine (RB) solution infusions in complex therapy for pneumonia-complicated pneumonia and acute respiratory diseases (ARD).

SUBJECTS AND METHODS

133 patients aged 18 to 60 years with pneumonia-complicated influenza and ARD were examined. The investigators measured the dynamic serum levels of metalloproteins (MP), such as transferrin, lactoferrin, and ceruloplasmin, and the activity of superoxide dismutase. They also studied the concentration of secondary lipid peroxidation products (malondialdehyde) by the so-called thiobarbituric acid test.

RESULTS

Dropwise intravenous RB infusions exerted a modifying effect on MP content, contributed to more pronounced stabilization of a serum antioxidant potential (versus olifen, vitamin E, and basic therapy) and to enhanced nonspecific protection, which was accompanied by a significant clinical improvement.

CONCLUSION

The study revealed the high clinical efficacy of 1.5% RB solution infusions (300 ml for 4-5 days) in the treatment of 74 patients with pneumonia-complicated influenza, stabilized serum antioxidant potential, and the body's enhanced nonspecific resistance.

[Reamberin for pathogenetic therapy of acute and chronic viral diseases of the liver]

The study including 427 patients with acute and chronic viral hepatitis was designed to assess results of clinical and laboratory diagnostics of hepatic problems and the state of thiosulfide antioxidative system. It was shown that infusion of succinate-containing preparation reamberin (400 ml/day for 10 days) took less time to eliminate clinical manifestation of the disease (dispeptic and asthenovegetative syndromes) than conventional therapy. Simultaneously the levels of biochemical markers of hepatic cytolysis and cholestasis significantly decreased while serum antioxidative potential recovered. The normal size of the liver was achieved 3.4 times more frequently than in control. No side effects or adverse reactions other than listed in the instruction for use of reamberin occurred. The preparation had to be withdrawn only in one patient.

[Side effects of meglumine antimoniate in cutaneous leishmaniasis: 15 cases]

BACKGROUND

Leishmaniasis is wide spread parasitic disease considered to be endemic in 88 countries in both old and new world. The standard treatment remains Meglumine antimoniate.

AIM

We study the side effects of systemic meglumine antimoniate in cutaneous leishmaniasis.

METHODS

We conduct a retrospective study covering 3-year period (2002- 2005). All medical reports of cutaneous leishmaniasis treated by systemic Meglumine antimoniate are reviewed.

RESULTS

The study comprise 63 patients all treated by systemic meglumine antimoniate at the dose of 60 mg/kg/day for 10-15 days. Side effects were noted in 15 cases (12 females and 3 males). The subject's age range from 11 to 78 years. Stibio-intolerance (fever, rash, arthralgia, abdominal pain) was observed in 12 cases and stibiotoxicity in 3 cases: precordialgies 1 case, hyperamylasemia and increase liver enzyme: 1 case, pancytopenia, renal and hepatic failure leading to death: 1 case, skin eruption: 7 cases, pruritus and erythema in the site of injection: 5 cases, urticaria: 1 case. Meglumine antimoniate was stopped in 13 cases.

CONCLUSION

Meglumine antimoniate is the generally recommended treatment of cutaneous leishmaniasis. In spite of the rarity of Glucantime's side effects, we recommend a careful survey especially in older patients.

Comparative study of the efficacy of oral ketoconazole with intra-lesional meglumine antimoniate (Glucantime) for the treatment of cutaneous leishmaniasis

BACKGROUND

Cutaneous leishmaniasis (CL) is a vector-borne parasitic disease caused by a range of Leishmania species. Many treatment modalities have been proposed, although pentavalent antimonials are still considered to be the first-line treatment of CL. However, due to the high cost and adverse effects of antimonials, as well as an increase in the number of resistant strains of CL to antimonials, this study was conducted to compare the efficacy of oral ketoconazole with intralesional meglumine antimoniate (Glucantime, Specia, Paris, France) for the treatment of CL.

METHODS

A total of 96 patients with CL were enrolled in the study. The diagnosis of CL was confirmed parasitologically using direct skin smears or skin biopsies. The patients were randomly allocated to two treatment groups. Group A (64 patients) was treated with ketoconazole 600 mg/day for adults and 10 mg/kg per day for children for 30 days. Group B (32 patients) was treated with 6-8 biweekly intra-lesional injections of meglumine antimoniate (Glucantime). Both groups were followed for 6 months after termination of treatment.

RESULTS

The results showed complete clinical cure in 89% of cases in Group A (treated with oral ketoconazole) and 72% of cases in Group B (treated with intra-lesional Glucantime). This difference was statistically significant (p < 0.05). No significant side effects were observed in either treatment group.

CONCLUSION

Oral ketoconazole can be an effective treatment modality in CL, especially in children afflicted with this disease.

Drug hypersensitivity syndrome induced by meglumine antimoniate

We report a case of drug hypersensitivity syndrome (drug reaction with eosinophilia and systemic symptoms [DRESS]) induced by parenteral meglumine antimoniate (Glucantime) in a 40-year-old man who traveled to Bolivia and was treated for mucocutaneous leishmaniasis. Two weeks after starting therapy, the patient had fever, joint pain, a cutaneous eruption, and hypereosinophilia (1,358 cells/mm(3)). These symptoms resolved after drug withdrawal but reappeared upon reintroduction of the drug. Pentavalent antimonials should be definitively withdrawn in patients with hypereosinophilia > 1,000 cells/mm(3) accompanied by systemic manifestations consistent with DRESS.

Multicenter, double-blind, randomized, intra-individual crossover comparison of gadobenate dimeglumine and gadopentetate dimeglumine in MRI of brain tumors at 3 tesla

PURPOSE

To prospectively compare 0.1 mmol/kg doses of gadobenate dimeglumine and gadopentetate dimeglumine for contrast-enhanced MRI of brain lesions at 3 Tesla (T).

MATERIALS AND METHODS

Forty-six randomized patients underwent a first examination with gadobenate dimeglumine (n = 23) or gadopentetate dimeglumine (n = 23) and then, after 2-7 days, a second examination with the other agent. Contrast administration (volume, rate), sequence parameters (T1wSE; T1wGRE), and interval between injection and image acquisition were identical for examinations in each patient. Three blinded neuroradiologists evaluated images qualitatively (lesion delineation, lesion enhancement, global preference) and quantitatively (lesion-to-brain ratio [LBR], contrast-to-noise ratio [CNR], % lesion enhancement). Differences were assessed using Wilcoxon's signed-rank test. Reader agreement was determined using kappa (kappa) statistics.

RESULTS

There were no demographic differences between groups. The three readers preferred gadobenate dimeglumine globally in 22 (53.7%), 21 (51.2%), and 27 (65.9%) patients, respectively, compared with 0, 1, and 0 patients for gadopentetate dimeglumine. Similar significant (P < 0.001) preference was expressed for lesion border delineation and enhancement. Reader agreement was consistently good (kappa = 0.48-0.64). Significantly (P < 0.05) higher LBR (+43.5- 61.2%), CNR (+51.3-147.6%), and % lesion enhancement (+45.9-49.5%) was noted with gadobenate dimeglumine.

CONCLUSION

Brain lesion depiction at 3T is significantly improved with 0.1 mmol/kg gadobenate dimeglumine.

Localized cutaneous leishmaniasis of the plantar region: a 40-year outcome

We report the case of a 78-year-old male Brazilian farmer, who presented with an extensive ulcer on the right foot that had an erythematous and raised border. This ulcer involved most of the right plantar region and had persisted for more than 40 years. Satellite erythematous papules and tumor-like growths were also seen on the right ankle. Extracutaneous involvement was not found. Light microscopy showed epithelial hyperplasia and diffuse histiocyte infiltration with intense plasmocytosis. Cultures for fungi and Leishmania were negative. The polymerase chain reaction with specific primers for Leishmania was performed using DNA extracted from the lesions; it showed an amplification of 120 pB. The patient had an excellent response after two 20-day cycles of intra-venous N-methylglucamine antimonate (15 mg/Kg/day). Leishmaniasis should be highly considered in the differential diagnosis of chronic ulcers in endemic areas.

Childhood cutaneous leishmaniasis: Experience of a Moroccan unit of dermatology

OBJECTIVE

We undertook a monocentric retrospective analysis of childhood leishmaniasis in order to describe the epidemio-clinical profile, therapeutic characteristics and clinical outcomes of affected patients.

PATIENTS AND METHODS

The files of all children treated for cutaneous leishmaniasis (CL) in the Dermatology Department of Ibn Sina University Hospital over an 11-year period were reviewed.

RESULTS

A total of thirteen children were included. The mean age was 10.2 years and the sex ratio (F/M) was 5.5. All patients lived or had stayed in an endemic area. The average delay of diagnosis was 11.8 months. The most frequent clinical finding consisted of ulcers (61.5%), usually located on the face (69.2%). The clinical diagnosis was confirmed by parasitologic smear in 76.9 percent of cases. The treatment used was intralesional meglumine antimoniate in twelve cases. The outcome was favorable in all cases.

CONCLUSION

Our series is characterized by a female predominance and the patients presented with a single lesion. The lesions were frequently located on the face and a favorable outcome was obtained after treatment with intralesional meglumine antimoniate.

Comparison of Thymus vulgaris (Thyme), Achillea millefolium (Yarrow) and propolis hydroalcoholic extracts versus systemic glucantime in the treatment of cutaneous leishmaniasis in balb/c mice

BACKGROUND & OBJECTIVES

Leishmaniasis is a parasitic disease transmitted by sand flies. Many investigations are performed to find an effective and safe treatment for leishmaniasis. In this study, we evaluated the efficacy of herbal extracts of Thymus vulgaris (Thyme) and Achillea millefolium (Yarrow), propolis hydroalcoholic extract and systemic glucantime against cutaneous leishmaniasis in Balb/c mice.

METHODS

A total of 45 mice were randomised into five groups each including nine mice. They were treated with pure ethanol 70 degrees, systemic glucantime, Achillea millefolium hydroalcoholic extract, Thymus vulgaris hydroalcoholic extract and propolis hydroalcoholic extract for six weeks. The statistical tests including student t-test were used for analysis. Data were analyzed by SPSS software, ver 13.00.

RESULTS

Mean of ulcer size reduction were -17.66, -22.57, 43.29, 36.09 and 43.77% for the alcohol, glucantime, yarrow, thyme and propolis groups, respectively. The results were suggestive that Thymus vulgaris, Achillea millefolium and propolis hydroalcoholic extracts were significantly more effective in reduction of ulcer size as compared with glucantime (p = 0.006, 0.002 and 0.008, respectively).

INTERPRETATION & CONCLUSION

Our results are suggestive that Thymus vulgaris, Achillea millefolium and propolis extracts are effective for treatment of cutaneous leishmaniasis in mice. Regarding these results, we suggest that efficacy of these extracts alone or in combination are evaluated against human cutaneous leishmaniasis as a randomized clinical trial.

A comparative study between the efficacy of systemic meglumine antimoniate therapy with standard or low dose plus oral omeprazole in the treatment of cutaneous leishmaniasis

BACKGROUND & OBJECTIVES

Pentavalent antimony compounds are the first line of drugs in the treatment of cutaneous leishmaniasis. However, because of their potential toxic effects, many investigations are performed to find an effective and safe treatment for cutaneous leishmaniasis patients. Our objective in this investigation was to compare the effect of oral omeprazole and low dose systemic meglumine antimoniate (MA) and standard dose of systemic MA in the treatment of cutaneous leishmaniasis.

METHODS

This was a randomized double-blinded clinical trial. In 150 patients with cutaneous leishmaniasis who were randomly divided into three groups and were treated with: (i) MA 60 mg/kg/day/ IM and oral placebo for three weeks; (ii) MA 30 mg/kg/day/IM and oral omeprazole 40 mg/day for three weeks; and (iii) MA 30 mg/kg/day/IM and oral placebo for three weeks. All the patients were visited every two weeks from the beginning of the trial up to six weeks and then at 8 and 12 weeks. The effectiveness of the treatment was classified in three levels as complete response, partial response and no response. Data were analyzed by SPSS 10 using KI square, Mann-Whitney, Kaplan-Mayer and ANOVA tests.

RESULTS

Rate of complete response for three months (12 weeks) after starting the treatments was 93% for the group treated with standard dose of glucantime and placebo, 89% for the group treated with omeprazole and low dose glucantime and 80% for the group treated with low dose glucantime and placebo and these differences were significant (p < 0.05). The highest response rate was for the group treated with standard dose of glucantime and placebo.

INTERPRETATION & CONCLUSION

Although oral omeprazole and low dose of systemic MA showed less efficacy in comparison to standard dose of systemic MA in the treatment of cutaneous leishmaniasis, it still can be considered as a replacement therapy in high risk patients (such as patients with heart, kidney and/or liver disease) under close supervision of physician.

Electrocardiographic changes in patients with cutaneous leishmaniasis treated with systemic glucantime

INTRODUCTION

Antimonial compounds are regarded as the treatment of choice for cutaneous leishmaniasis (CL). Systemic administration of these drugs has some side effects including cardio toxicity and electrocardiogram (EKG) changes. The objective of our study was to evaluate EKG changes in the patients with CL treated with systemic glucantime.

MATERIALS AND METHODS

One hundred and thirty-one patients were enrolled in this prospective study. All of the selected patients had confirmed CL and were candidates for treatment with systemic glucantime. The patients were treated with systemic glucantime and EKG was performed before, during (weekly) and 1 month after cessation of the treatment. All of the collected data were analysed using SPSS software.

RESULTS

The most common change was prolonged QT interval that was seen in 19% of the patients. ST depression occurred in 6.1% of the patients. Minimal ST elevation occurred in 3% and inverted T was observed in 7.4% of the patients. Single premature atrial contraction (PAC) and single premature ventricular contraction (PVC) occurred in 0.7% and 2.29% of patients, respectively. Bradycardia was observed in 10.6% and left bundle branch block in 0.7% of the patients. All of these changes reversed after stopping the treatment except 1 case with left bundle branch block that lasted for 1 month after the treatment.

CONCLUSIONS

Our results showed that treatment with glucantime can induce many ECG changes as QT prolongation have significant risk. We suggest that ECG monitoring should be performed in high-risk patients undergoing glucantime treatment with special attention to ECG changes mostly prolonged QT interval.

[Antianemic effect of reamberin in rats with acute alloxan-induced diabetes]

The influence of reamberin on hematological indices in the acute period of alloxan-induced diabetes has been studied. It is established that anemia develops within 72 hours after alloxan injection at a diabetogenic dose in rats, which is related to bone marrow erythropoiesis suppression and is accompanied by inflammatory leukocytosis. Single administration of reamberin in a dose equivalent to the human therapeutic dose produces correction of the leukocyte content in the blood, normalizes the bone marrow erythropoiesis, and prevents anemia development in rats with alloxan-induced diabetes. The antianemic action of reamberin is not related to its influence on carbohydrate metabolism in experimental diabetes mellitus.

Real-time PCR assay in Leishmania-infected dogs treated with meglumine antimoniate and allopurinol

A real-time PCR assay was exploited for monitoring the Leishmania DNA load in different tissues from 18 naturally-infected dogs before and after treatment with a combination of meglumine antimoniate (100mg/kg/day, subcutaneously) and allopurinol (10mg/kg/day, orally) for 30 days. After the combined therapy, allopurinol was continued at the same dose until the end of the observation period. Whole blood samples, lymph node aspirates, and skin biopsies were collected at the time of diagnosis, 1 month after starting therapy, and every 3 months for 2 years. In six dogs parasite load assessments continued every 6 months for a further 3 years. At each assessment, the dogs were examined for signs of disease and a clinical score was recorded. At diagnosis, the highest Leishmania DNA load was detected in lymph node aspirates. From 1-6 months post-therapy a general improvement in clinical conditions was recorded in all dogs, which correlated with a decrease in the parasite DNA load in all tested tissues, even though it was less pronounced in lymph node aspirates. In the period from 9-24 months post-therapy, a re-increase in parasite load was observed in the tissues of some dogs, concomitant with a disease relapse. The results show that the combined therapy with meglumine antimoniate and allopurinol promoted a clinical improvement which was accompanied by a reduction in the parasitic load in the blood, skin and lymph nodes but, even after long period of allopurinol administration alone, Leishmania may persist in dog tissues.

Focal liver lesions: Whether a standard dose (0.05mmol/kg) gadobenate dimeglumine can provide the same diagnostic data as the 0.1mmol/kg dose

OBJECTIVE

Gadobenate dimeglumine (Gd-BOPTA) is a liver-specific contrast agent also showing a distribution in the extracellular compartment which is recommended to be used at standard dose (0.05 mmol/kg) in magnetic resonance imaging (MRI) of liver lesions. However, its use at 0. 1mmol/kg is gradually increasing in recent clinical practice. Which dose should we use in routine MRI of liver lesions from now on? This study investigated the efficacy of Gd-BOPTA at a standard dose versus 0.1 mmol/kg dose in demonstrating diagnostic data in MRI of focal liver lesions.

MATERIALS AND METHODS

The study included 47 patients with focal liver lesions. Twenty-two patients received standard dose and 25 patients received 0.1 mmol/kg dose Gd-BOPTA intravenously. MRI of both groups was carried out with T1-A FLASH-2D and T2-A TURBO spin echo before contrast injection and T1-A FLASH-2D sequences in dynamic and late phase (90th minute) after the contrast injection. The lesion conspicuity for each image was evaluated qualitatively. Liver signal to noise ratio (SNR), absolute lesion-liver contrast to noise ratio (CNR), mean lesion-liver CNR and contrast enhancement rate of the liver obtained from both groups were compared quantitatively.

RESULTS

While liver contrast enhancement rate in the group receiving standard dose Gd-BOPTA were 41%+/-42 in the arterial phase, 66%+/-58 in the portal phase, 45%+/-45 in the venous phase and 42%+/-88 in the late phase, these values were 43%+/-59, 86%+/-73, 63%+/-75 and 61%+/-105, respectively, in the group receiving the dose of 0.1 mmol/kg. There were no statistically significant differences between the means of both groups. While the absolute lesion-liver CNR values were 18+/-15 precontrast, 22+/-18 in the arterial phase, 19+/-17 in the portal phase, 15+/-10 in the venous phase and 24+/-26 in the late phase in the group receiving the standard dose Gd-BOPTA, these values were 13+/-11, 18+/-15, 15+/-15, 13+/-13 and 19+/-21, respectively, in the group receiving the 0.1 mmol/kg dose. There were no statistically significant differences between the means of both groups (p>0.05). However, when the mean lesion-liver CNR values were compared, there was statistically significant difference between each arterial and portal phases of metastases in both groups (p<0.05). There was no statistical difference found in other lesions. When lesion conspicuity scores were compared, there were no significant differences between the two groups.

CONCLUSION

In liver lesions, similar diagnostic data are obtained in dynamic and late phase MRI with either standard dose Gd-BOPTA or with a dose of 0.1 mmol/kg. Because there was a difference in only metastases in both groups, in oncological patients who are being investigated for liver metastasis, it is expedient to use a dose of 0.1 mmol/kg.

Efficacy of miltefosine for Bolivian cutaneous leishmaniasis

Oral miltefosine (2.5 mg/kg/d for 28 days) was compared with intramuscular antimony (20 mg/kg/d for 20 days) in the treatment of cutaneous leishmaniasis caused by Leishmania braziliensis in Palos Blancos, Bolivia. The cure rates with 6 months of follow-up were statistically similar: 36 of 41 evaluable miltefosine patients (88%) versus 15 of 16 (94%) evaluable antimony patients. However, antimony cured more rapidly, because, by 1 month after therapy, 31 of 44 miltefosine patients (70%) compared with 16 of 16 antimony patients (100%) had achieved cure. The two conclusions from this work are that oral miltefosine can be used for cutaneous disease in this part of Bolivia and that miltefosine was more effective for L. braziliensis in this region than for L. braziliensis in Guatemala. Chemotherapy needs to be evaluated in each endemic region, even if the "same" species of Leishmania causes disease in these locales.

Clinical efficacy of intramuscular meglumine antimoniate alone and in combination with intralesional meglumine antimoniate in the treatment of old world cutaneous leishmaniasis

Treatment of cutaneous leishmaniasis is often difficult. Even though most cutaneous lesions will heal spontaneously, their duration cannot be predicted in an individual case. In general, only large, multiple or diffuse lesions of the face, head and neck need to be considered for therapeutic intervention. Pentavalent antimonials (sodium stibogluconate and meglumine antimoniate) administered intralesionally or parenterally (IM or IV) are the mainstays of systemic therapy despite the toxicity associated with their use. The objective of this study was to compare the clinical efficacy of intramuscular pentavalent antimonial compound meglumine antimoniate alone and in combination with intralesional therapy in the treatment of Old World cutaneous leishmaniasis. Study was conducted as a case controlled interventional prospective study. On the basis of demonstration of Leishmania tropica (LT) bodies in the skin slit smears/skin biopsies, 60 patients with cutaneous leishmaniasis were included in the study. The patients were randomly allocated to three groups of 20 patients each: group 1 treated with intramuscular injection of meglumine antimoniate (20 mg Sb/kg/day, maximum 850 mg) for 21 days; group 2 treated with intralesional injection of meglumine antimoniate (0.5 mL, 42.5 mg of Sb) into each lesion along with intramuscular injection of meglumine antimoniate (20 mg Sb/kg/day, maximum 850 mg) for 21 days; and group 3 as a control group. The patients were followed-up for therapeutic safety and efficacy at 10, 20 and 90 days. The rate of complete cure was 55% in group 1, 75% in group 2 and 10% of spontaneous cure cases in group 3. The conclusions derived from this study are limited by the relatively small number of patients. The combination of intramuscular meglumine antimoniate along with intralesional administration of the agent is superior therapy to intralesional administration of meglumine antimoniate alone.

A randomized clinical trial comparing oral azithromycin and meglumine antimoniate for the treatment of American cutaneous leishmaniasis caused by Leishmania (Viannia) braziliensis

Azithromycin was compared with meglumine antimoniate for treatment of patients with cutaneous leishmaniasis. Patients were randomized to receive oral azithromycin, 500 mg/day (22 patients) or intramuscular meglumine antimoniate, 10 mg Sb/kg/day (23 patients), both for 28 days, with a second cycle of 15 days if necessary, and followed-up for one year after completion of treatment. Efficacy, defined as complete re-epithelization without relapse for 12 months after completing therapy, was 82.6% (95% confidence interval [CI] = 67-98%) for meglumine antimoniate and 45.5% (95% CI = 25-66%) for azithromycin. All patients who failed treatment with azithromycin were treated with meglumine antimoniate and clinically cured. Azithromycin was well tolerated; meglumine antimoniate caused arthralgias and local symptoms in 78% of the patients. In 17 cases, species identification was obtained; Leishmania (Viannia) braziliensis was identified in all of them. For the treatment of American cutaneous leishmaniasis caused by L. (V.) braziliensis, meglumine antimoniate is significatively more efficacious than azithromycin, which was clinically curative in almost half of the patients and well-tolerated.

[Clinical and histological study of lupoid cutaneous leishmaniasis (16 cases)]

INTRODUCTION

Zoonotic cutaneous leishmaniasis (CL) is characterised by a major clinical polymorphism, especially the lupoid type. The aim of our study was to precise the anatomic and clinical particularities of this clinical form of CL.

MATERIALS AND METHODS

The present work was a prospective 1-year study. In all patients, the epidemiologic and clinical characteristics were identified, together with those regarding disease progression. Standard cutaneous biopsies were carried out for all study patients.

RESULTS

The lupoid form was observed in 15% of the patients. It was clinically characterised by a lupoid aspect with papular and squamous placard surrounded by a satellite papule, a short duration of disease progression (28 months in average) and a preferential localisation at the level of the face and the elbow, statistically proven. At the histological level, epidermic hyperplasia was found in 93.8% of the cases; an inflammatory polymorphic dermic infiltrate consisting of lymphocytes and plasmocytes was found in all patients; granulomas were noted in 50% of the cases, and isolated epitheloid cells were observed in the derm of 3 patients. Amastigotes were rarely observed.

DISCUSSION

In our series, the lupoid form was characterised with a short and non chronic evolution and two preferential sites for the affection: the face and the elbow. At the histological level, the lupoid type of CL appeared characterized by a high frequency of granuloma, usually organized, and rare amastigotes. However, the histology of authentic lupoid forms can be non granolomatosic.

Ultrasound guidance for puncture and injection in the radiocarpal joint

BACKGROUND

The use of intra-articular contrast agent has been shown to increase the diagnostic accuracy of wrist magnetic resonance (MR) in patients with suspected trauma of the wrist ligaments. Traditionally, the contrast agent has been applied under fluoroscopic guidance.

PURPOSE

To present a method based on ultrasound guidance for the injection of intra-articular contrast agent in wrist MR.

MATERIAL AND METHODS

One hundred eight patients (56 female and 52 male, mean age 36 years) referred for wrist MR arthrograms due to suspected ligament rupture were included in this retrospective study. The preferred injection point is about 1 cm distal to Lister's tubercle in the distal radius. A correct positioning of the injection needle can be ensured using ultrasound guidance.

RESULTS

Using this technique, the injection was intra-articular in 93.5% of the 108 injections over a 2-year learning period.

CONCLUSION

Ultrasound guidance of the contrast injection in radiocarpal MR arthrograms is a cost-effective and safe alternative to fluoroscopically guided procedures. Furthermore, the use of ultrasound guidance provides clues about possible fluid collections within the joint.