Infliximab therapy for HIV positive Crohn's disease: A case report

Anti-TNF-alpha is now established as a major player in the treatment of Crohn's disease, however the use of anti-TNF-alpha therapy in patients concomitantly having HIV infection and Crohn's disease is a relatively unexplored subject. There is generally some apprehension and anxiety to use infliximab in patients with HIV. One case has been reported in literature of usage of anti-TNF-alpha in HIV positive patient with Crohn's disease who was on anti-retroviral therapy. We report for the first time the successful usage of infliximab in treating Crohn's disease in an HIV positive patient who is not on any anti-retroviral treatment.

Regression of primary high-grade gastric B-cell lymphoma following Helicobacter pylori eradication

The causative association between Helicobacter pylori and gastric mucosal inflammation is well established. The inflammatory process leads to the acquisition of mucosa-associated lymphoid tissue (MALT) by the stomach. Evidence links H. pylori gastritis with the development of low-grade primary gastric lymphoma with a phenotype specific for lymphoma of MALT type. It is now accepted that primary low-grade MALT lymphomas regress with H. pylori eradication therapy. However, the response of primary, diffuse, large-cell gastric lymphoma to H. pylori eradication therapy is still not established. We report a case of a primary high-grade gastric lymphoma regressing after H. pylori eradication therapy.

Randomised trial of single-dose ciprofloxacin for travellers' diarrhoea

Diarrhoea is the most common illness affecting travellers to developing countries. Our study was designed to compare the efficacy of a single 500 mg dose of ciprofloxacin with placebo for treatment of acute diarrhoea in travellers. British troops who were within their first 8 weeks of deployment in Belize and who presented within 24 h of the onset of diarrhoea, were randomized to receive either ciprofloxacin 500 mg or placebo. Every subject recorded the number and consistency of stools and presence of any other associated symptoms for 72 h or until recovery. Of 88 subjects enrolled, 83 were evaluable, of whom 45 received ciprofloxacin and 38 placebo. Groups did not differ with regard to duration or severity of diarrhoea at randomisation. Mean (SE) duration of diarrhoea, as assessed by time to the last liquid and last unformed stool, was reduced from 50.4 (4.5) h and 53.5 (4.4) h, respectively, in the placebo group to 20.9 (3.4) h and 24.8 (3.8) h in those receiving ciprofloxacin (p < 0.0001). Mean number of liquid stools was reduced from 11.4 (1.2) in the placebo group to 5.0 (0.7) in the ciprofloxacin-treated group (p < 0.0001). The cumulative percentages of subjects with no unformed stool after 24 h, 48 h, and 72 h were, respectively, 64%, 82%, and 93% in the ciprofloxacin group and 11%, 42%, and 79% in the placebo group (p < 0.0001, p < 0.001, and not significant, respectively). A single 500 mg dose of ciprofloxacin was an effective empirical treatment for reducing the duration and severity of diarrhoea in travellers. The regimen should maximise compliance and reduce the cost and duration of therapy.

Percutaneous endoscopic gastrostomy in a military hospital

Percutaneous endoscopic gastrostomy (PEG) is a simple, relatively safe and cost effective means of establishing enteral access for patients requiring long term nutritional support. PEG has several advantages over surgical gastrostomy and should be considered the procedure of choice for long term enteral therapy in appropriate patients. At the Queen Elizabeth Military Hospital (QEMH) between June 1992 and October 1993 thirteen percutaneous endoscopic gastrostomies were successfully performed. Eight were performed in soldiers, seven of these were following major neurological trauma. The procedure is described and the literature is reviewed.

Chronic inflammatory demyelinating polyneuropathy

Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) is a rare neurological disease. Definitive therapy is not yet established. We report our use of intravenous Immunoglobulin (iv IgG) in two cases of CIDP and review the therapeutic options available. Intravenous IgG is a ubiquitous practical treatment particularly in patients who do not respond to steroids and where a rapid response is required.

Prediction of outcome in patients with acute variceal haemorrhage

Prediction of outcome in 87 patients following acute bleeding oesophageal and gastric varices due to portal hypertension from chronic liver disease was studied at our hospital over a 30-month period. The overall mortality rate was 26 per cent (23/87), with the operative mortality rate (50 per cent) being more than triple the non-operative mortality rate (14 per cent). The initial prothrombin time ratio (PTR) alone was significantly different in survivors and non-survivors both in the operated and non-operated patients. The only survivor in the whole material with a PTR greater than or equal to 2.2 was a patient who was transferred and underwent successful liver transplantation elsewhere. Among operated intensive care unit (ICU) patients, the Glasgow predictor gave a mean probability of discharge of 0.81 (s.d. 0.15) in 13 survivors and of 0.35 (s.d. 0.35) in the 15 non-survivors (P less than 0.001). In the 11 non-operative ICU patients, who had failed sclerotherapy, the Glasgow predictor could not be validated. Fourteen ICU deaths were associated with significant hypotension defined as a systolic blood pressure less than 90 mmHg for greater than 1 h.

Exchange transfusion in severe falciparum malaria

Three cases of severe falciparum malaria with high parasitaemia, one of them complicated by disseminated intravascular coagulation, were treated with exchange transfusion in addition to conventional chemotherapy. All three made a good recovery. There are few previous reports of this treatment which deserves wider attention and further assessment.