A prognostic score for postherpetic neuralgia in ambulatory patients.

The main objective was to develop a scoring system for easy use by the physician in daily clinical practice in deciding the appropriate treatment for his herpes zoster patient. Data from 635 patients who did not receive antiviral therapy were included in this analysis. Of these, 131 developed postherpetic neuralgia (PHN). Of the 29 variables tested univariately in this study, 15 showed a significant correlation with the incidence of PHN, but only six proved to contribute to the overall predictive power in the multivariate approach. Using two independent approaches, the model showed a very satisfactory performance in the validation sample. Patients without acute pain rarely developed PHN. In those with acute pain, being female, being over 50 years of age, having more than 50 lesions, having lesions of a hemorrhagic nature, having cranial or sacral localisation of the rash or having pain in the prodromal phase proved to be significant, multivariate factors. An easy-to-use scoring system used in a risk graph is proposed. These data should be useful in the individual treatment decision as well as in the design and analysis of therapeutic trials in herpes zoster.

Demography, symptomatology, and course of disease in ambulatory zoster patients. A physician-based survey in Germany.

This survey summarises the observations of physicians who prospectively recorded clinically relevant data on their patients with an episode of herpes zoster. These included demography of patients, signs and symptoms during the prodromal phase, relevant history, description of disease at the first visit, therapeutic measures and description of disease, and occurrence of postherpetic neuralgia (pain 4-5 weeks after crusting) at the second visit. A total of 2,063 patients were reported to the data management centre. The age distribution resembles that reported in the literature including the notable increase in zoster frequency with advancing age. Almost 20% of the patients, however, were 30 years old or less, and this contrasts markedly with the published literature. Age modifies the frequency of the dermatome afflicted: more cranial and less thoracic manifestations were observed with increasing age. Almost all patients reported symptoms which may be attributed to a prodromal phase, especially pain in the affected dermatome (82%). The incidence of postherpetic neuralgia was 28%. A complicated disease course such as visceral, ocular, or otological involvement, or progression to additional dermatomes was seen in almost 10% of the patients.

Histological examination of adult Onchocerca volvulus and comparison with the collagenase technique.

The methods used for the assessment of adult Onchocerca volvulus by histology are described. Based on the results of several studies, mainly in Liberia and Burkina Faso, the morphology of the adult filariae in histological sections is represented as far as it is relevant for the evaluation. Especially are described the morphological alterations due to old age of the worms, to chronic hyperreactivity of the human host (sowda) and effects of the macrofilaricidal suramin and of microfilaricidal drugs. Quantitative results are reported on untreated adult O. volvulus from various countries, the changes of the worm population during 12 years of vector control in Burkina Faso and the effects of suramin, diethylcarbamazine, metrifonate, and ivermectin. The data from the histological examinations are compared with those gained from the examination of worms isolated by the collagenase technique in the same studies.

[High-dosage cotrimoxazole therapy of disseminated Nocardia brasiliensis infection]. / Hochdosierte Cotrimoxazol-Therapie einer disseminierten Nocardia-brasiliensis-Infektion.

After a scraping injury to the skin a 47-year-old man developed a generalized Nocardia brasiliensis infection with cutaneous, pulmonary and cerebral dissemination. There was no predisposing underlying illness. High-dosage cotrimoxazol and short-term intrathecal and systemic gentamycin administration achieved extensive healing. This form of treatment would thus seem capable of reversing the otherwise poor prognosis of generalized N. brasiliensis infection.

Influence of retrograde volume and short time cholestasis on the biliary reabsorption of sulfobromophthalein sodium (BSP) and phenol 3,6 dibromphthalein disulfonate (DBSP) from the rat biliary tree after retrograde intrabiliary injection (RII).

The retrograde intrabiliary injection (RII) technique was used to study the reabsorption of equimolar doses (1,2 mumol) of sulfobromophthalein sodium (BSP) and its analogue phenol 3,6 dibromphthalein disulfonate (DBSP) from the rat biliary tree under the experimental conditions established in this study i.e. variation of retrograde volumes injected and of short time cholestasis. RII was performed with a microliter syringe joined to a cannula positioned in the proximal third of the common bile duct. This technique guaranteed accurate administration of microliter quantities, also free bile flow could be reinitiated 3 - 5 sec after RII. Bile samples were collected in 2, 5 min intervals up to the 5th min, then in 5 min intervals up to the 15th min, and the following 15 min up to the 30th min and analysed for compounds administered by RII. No significant differences in the biliary reabsorption of BSP and DBSP after RII could be detected. Increasing retrograde volumes of 20, 40, 60, 110, and 160 mul lead to decreasing percent recoveries in the bile in the first 2,5 min after RII (88,0 +/- 3,8 - 15,6 +/- 3,1) when bile flow was started at once after RII. An inverse correlation between retrograde volume and percent recoveries was found. Increasing duration of cholestasis (bile flow was started at once, 0,5 min, 3 min, 6 min, and 30 min after RII) results in decreasing percent recoveries of BSP and DBSP in the first 2,5 min after free bile flow was reinitiated (52,7 +/- 3,6 - 20,0 +/- 1,2). A time dependent proportional effect could be detected. Furthermore in the case of BSP concomitant with increasing cholestasis increasing amounts of BSP - conjugates were found in the bile supporting the idea of a continuing ductular - hepatocellular circulation even during complete obstruction of the common bile duct.