Leukoencephalopathy induced by levamisole alone for the treatment of recurrent aphthous ulcers

We report imaging and clinical findings of leukoencephalopathy occurring after levamisole. The lesions were hypoattenuating on CT and appeared as multifocal oval or elliptical foci in the white matter or along the subependymal veins on MRI. Most lesions resolve after prompt withdrawal of levamisole. Detailed history taking is important for diagnosing levamisole-induced leukoencephalopathy because multiple sclerosis and acute disseminated encephalomyelitis cannot be differentiated by neuroimaging findings alone.

Leukoencephalopathy induced by levamisole alone for the treatment of recurrent aphthous ulcers

We report imaging and clinical findings of leukoencephalopathy occurring after levamisole. The lesions were hypoattenuating on CT and appeared as multifocal oval or elliptical foci in the white matter or along the subependymal veins on MRI. Most lesions resolve after prompt withdrawal of levamisole. Detailed history taking is important for diagnosing levamisole-induced leukoencephalopathy because multiple sclerosis and acute disseminated encephalomyelitis cannot be differentiated by neuroimaging findings alone.

The effect of ciprofloxacin in the prevention of bacterial infection in patients with cirrhosis after upper gastrointestinal bleeding

OBJECTIVES

Cirrhotic patients with upper gastrointestinal bleeding are prone to bacterial infection. The aim of this study was to investigate the efficacy of prophylactic intestinal decontamination with oral ciprofloxacin for the prevention of bacterial infections in cirrhotic patients with upper gastrointestinal bleeding.

METHODS

A total of 120 cirrhotic patients with acute upper gastrointestinal bleeding were enrolled. Sixty patients received ciprofloxacin 500 mg twice daily given orally or through nasogastric tube immediately after upper gastrointestinal endoscopic examination; drug administration continued for 7 days. The remaining 60 patients, who received placebo, served as controls.

RESULTS

The incidence of proven bacterial infection in the ciprofloxacin-treated group was significantly lower than that of placebo group (10% vs 45%, p < 0.001). The incidences of bacteremia, spontaneous bacterial peritonitis, and urinary tract infection in the ciprofloxacin-treated group were significantly lower than those in the placebo group (0% vs 23%, 3.3% vs 13%, and 5% vs 18%, respectively; p < 0.05, respectively). Multivariate logistic regression analysis showed that a lack of prophylactic treatment with ciprofloxacin and severity of cirrhosis were the independent significant predictors for cirrhotic patients with acute gastrointestinal bleeding with infection.

CONCLUSIONS

Prophylactic intestinal decontamination with oral ciprofloxacin is effective in the prevention of bacterial infections in patients with cirrhosis who were suffering from acute upper gastrointestinal hemorrhage.

Ovarian steroids reduced apoptotic death in SV40 temperature-sensitive mutant virus transformed uterine epithelial cells

Ovarian steroids have been shown to inhibit uterine cell death in vivo. In this study, we investigated whether ovarian steroids regulated cell death in an uterine epithelial cell line transformed with SV40 temperature-sensitive (ts) mutant virus. To assess cell death rate, cells were grown at permissive temperature (34 degrees C) and pulsed with 3H-thymidine. The retention of incorporated radioactivity was then examined after a temperature shift to nonpermissive temperature (40 degrees C) in the absence or presence of estradiol and progesterone. When cells were continuously cultured at 34 degrees C, cell number increased rapidly and most of radioactivity was retained in the attached cells. However, the temperature shift from 34 degrees C to 40 degrees C resulted in a decrease in cell number and radioactivity in attached cells. Estradiol and progesterone attenuated this temperature shift-induced cell death. Morphological examination with Hoechst 33258 staining revealed that the temperature shift increased the percentage of apoptotic death. The treatment of ovarian steroids reduced the extent of apoptotic death. Our studies demonstrated that ovarian steroids could act directly on uterine epithelial cells to reduce apoptotic death in culture.

Prazosin-induced first-dose phenomenon possibly associated with hemorrhagic stroke: a report of three cases

A small initial dose of prazosin ranging from 0.5 to 1 mg has been recommended to avoid the first-dose phenomenon characterized by a sudden and severe drop in blood pressure after the administration of the first dose of prazosin. However, even with an initial dose of 0.5 mg, hypotension with consciousness disturbance developed in three hypertensive patients with recent cerebral hemorrhage. We present this report to alert physicians and pharmacists about the potential risk of the first-dose phenomenon even at the recommended initial doses of prazosin in hypertensive patients who have suffered a recent stroke.