[Urolithiasis in the Long-Term GnRH Agonist Treatment of Patients with Paraphilia: 3 Case Studies]. / Urolithiasis bei der Langzeitherapie mit GnRH-Agonisten bei Paraphilien ­ 3 Fallberichte.

The outpatient forensic aftercare department of the Charité Berlin treated 32 paraphilic sex offenders with GnRH analogues within the past 5 years. Out of those patients, three men suffered from urolithiasis and were in need of treatment. All 3 patients had previously developed osteopenia/osteoporosis while on antiandrogen treatment.This article describes these 3 cases and suggests an intense consideration of the possible occurrence of urolithiasis in sex offenders on antiandrogen treatment.

A simple technique for testing the viability of cross-finger pedicle flaps.

A simple test to determine the viability of cross-finger pedicle flaps is described. This test can be performed in the office or operating theatre to help determine the optimal timing for division of the flap pedicle.

Effect of proximal phalangeal fracture deformity on extensor tendon function.

Extensor lag is a common sequella of proximal phalangeal fractures. Proximal phalangeal fractures frequently lead to extensor tendon dysfunction via adhesions and phalanx malunion with angulation and/or shortening. The primary purpose of this study was to quantify the influence of proximal phalangeal angulation and shortening on proximal interphalangeal (PIP) joint extension by examining the effect of isolated proximal phalangeal bone to extensor digitorum communis tendon discrepancy on PIP joint lag. The secondary goal was to determine the reserve of the extensor digitorum communis to overcome the PIP joint lag. A proximal phalangeal bone-extensor tendon discrepancy results in either a PIP lag or a potential lag that must be compensated for by another system, such as by overpull of the extrinsic extensor or by the pull of the intrinsics. Six cadaveric middle fingers were used, proximal phalangeal malunions were simulated, and the extensor lag was measured radiographically. A linear relationship between extensor tendon lengthening and the resulting PIP lag was observed. Similarly, a linear relationship between proximal phalangeal shortening and the lag was observed. For both, the average slope was 12 degrees of lag/mm of bone-tendon discrepancy. For average apex palmar angulations of 16 degrees, 27 degrees, and 46 degrees, PIP lags of 10 degrees, 24 degrees, and 66 degrees, respectively, resulted. The extensor tendon reserve was 2 to 6 mm. The sagittal bands became tight at the limits of the extensor tendon reserve. The results of this study quantify the importance of re-establishing the bone-tendon relationship for proximal phalangeal fractures.

SSEP monitoring during pelvic and acetabular fracture surgery.

Forty-one consecutive patients requiring surgery for pelvic or acetabular fractures were reviewed to compare the 20 patients (20 fractures) who had SSEP monitoring to the twenty-one patients (22 fractures) in whom monitoring was not available. In the unmonitored group, five patients had a preoperative neurologic deficit (three major/two minor), whereas in the monitored group there were nine patients with deficits (two major/seven minor). Intraoperatively, significant somatosensory evoked potential (SSEP) changes occurred in six of the monitored patients. In five patients the changes resolved on correction of the offending action and there was no postoperative deficit. In the remaining case, SSEP changes did not resolve and the patient awoke with a peroneal palsy. This one monitored patient with a new deficit compares with five patients with postoperative new deficits (or deteriorations) in the unmonitored group. The majority of intraoperative SSEP changes and iatrogenic deficits occurred during surgery through the ilioinguinal approach. During follow-up, the great majority of deficits resolved completely or had significant improvement.

[Duodenal bile acid output in gastroenterologic diseases]. / Duodenaler Gallensäurenoutput bei gastroenterologischen Erkrankungen.

The biliary secretion of bile acids was measured with the modified secretin-pancreozymin test in 50 patients with various gastroenterological diseases and in a control group. In the control group the highest bile acid output and the lowest G/T quotient was estimated. In comparison to the control group, the bile acid output in the patients with gastroenterological disorders was reduced significantly to a varying degree. Except in postcholecystectomy patients, it was proved that the G/T quotient was significantly increased compared to that in the control group. The estimation of bile acid output and the G/T quotient presented here shows an easier extension of the validity of the secretin-pancreozymin test which does not indice any additional burden to the patients.

[Pancreatico-biliary secretion in enteral hyperoxaluria]. / Die pankreatobiliäre Sekretion bei enteraler Hyperoxalurie.

The increased oxalic acid absorption is a well documented finding in gastroenterological diseases. The malabsorption of bile acids and fat is important in the pathogenesis of the hyperoxaluria. The enteric absorption of 14C-labelled oxalic acid was measured in 49 patients with different diseases. The dihydroxy-trihydroxy-ratio of bile acids is significantly decreased in patients with hyperoxaluria over 20% of the ingested dosage. We didn't find any correlation between the excretion of oxalic acid and the intraduodenal pancreatic lipase activity.

[Praziquantel in the treatment of opisthorchiasis in Southeast Asian refugees. Evaluation of 153 cases]. / Le praziquantel dans le traitement des opisthorchiases chez des réfugiés du Sud-Est asiatique. Bilan de 153 cas.

153 patients coming to France from Southeast Asia were treated with Praziquantel for Opisthorchiasis. All these patients, 52 children and 101 adults were examined 30 to 90 day after arrival in France. They came from Laos (118 cases), Vietnam (10 cases) and Cambodia (25 cases), generally via Thailand. 7 heavy (10.000-29.999 Eggs Per Gram of faeces, EPG), 55 moderate (1.000-9.999 EPG) and 91 light infections (1-999 EPG) were detected. Praziquantel was given at a dose of 25 mg/kg body weight, orally, three times on a single day at intervals of 4-6 hours. Clinical tolerability was perfect in 59 patients and pretty good in the 94 remaining cases. We only observed, for one or two days, lassitude, headache, drowsiness, nausea, epigastric pain or arthralgia-myalgia, always of weak or moderate intensity and for 1 or 2 days. The biological tolerability was excellent without any variation of the biological norm values (47 parameters). The therapeutic efficacy was remarkable with 100% cure in all patients, who were followed-up for 40 days. All earlier controls (7th, 20th days) were always negative except for two patients who were completely negative on day 40th and later.

The profile of the trematodicidal compound praziquantel.

From the start onwards of testing praziquantel (2 - cyclohexyl - carbonyl - 1,2,3,6,7,11 b - hexahydro - 4H - pyrazino[2,1-a]isoquinolin-4-one, EMBAY 8440, Biltricide) proved to be very promising. By testing numerous trematode species in different host animals, high efficacy was established. There were no limitations due to the geographical origin of all those parasite species. Pharmacokinetic studies in animals and man showed similarly favourable results. The compound passes the blood-liquor barrier into the brain. No toxic alterations of vital functions and organs were revealed. After demonstrating satisfactory tolerability in healthy volunteers, therapeutic trials were begun. As to schistosomiasis, studies started double-blind in close cooperation with WHO, Geneva, with emphasis on future large scale treatment campaigns. Up to now safe and successful treatment of over 25,000 patients has been documented in Africa, Asia and South America with single dose or single day dosage schemes against all five schistosome species pathogenic to man. The analysis of allegedly drug-related adverse reactions often revealed their presence before treatment already, particularly in intestinal schistosomiasis. Irrespective of origin all symptoms and reactions were generally mild, transient and did not require additional treatment. No drug-related risks were detectable in patients with hepatosplenic and other complications of advanced stages of infection. High cure rates were also obtained in infections due to C. sinensis, O. viverrini and Paragonimus species. Infections with Metagonimus yokogawai, Fasciolopsis buski and Heterophyes heterophyes responded well to treatment, too.(ABSTRACT TRUNCATED AT 250 WORDS)

Serum antibody levels in human paragonimiasis before and after therapy with praziquantel.

Enzyme immunoassays (ELISA) and indirect haemagglutination (IHA) were used to determine IgG and IgE serum antibody levels in 43 patients from Ecuador before and after therapy with praziquantel. ELISA indicated infection more sensitively than IHA. The tendency of increasing antibody levels between the first and second month after therapy was more distinct when measured by IHA, whereas the decreases of antibody levels between the third and sixth month after treatment was more distinct when measured by ELISA. The IgG ELISA for detecting long persisting antibody was more sensitive than IHA.

[Praziquantel in the treatment of Far Eastern hepatic distomiasis caused by Clonorchis sinensis or Opisthorchis viverrini]. / Le praziquantel dans le traitement des distomatoses hépatiques extrême-orientales a Clonorchis sinensis ou Opistorchis viverrini.

Forty-six patients infected with Opistorchis viverrini and/or Clonorchis sinensis, 24 males and 22 females, all Laotian or Vietnamese, aged 7 to 68, weighing 18 to 70 kg, were detected by parasitological stool examinations, numeration of Eggs Per Gram of feces (E.P.G.). In this manner we observed 23 light infestations (1-999 E.P.G.), 20 moderate infestations (10,000-29,999 E.P.G.). Before treatment, all these patients were submitted to a complete history and clinical examination with biological controls that totaled up 47 parameters. These controls were repeated daily from the eve of the treatment to 5 days after. The treatment was given orally at the dose of 75 mg/kg of body weight in three doses 4 to 6 hours apart during the same day. The tolerance was excellent in the children who did not have any trouble even minor. The adults had only slight side-effects such as fatigue (18 cases), dizziness (19 cases) and headaches (16 cases). Light or moderate, these troubles spontaneously disappeared after one or at the most two days. Biological controls did not show any significant variation. The therapeutic efficiency appears excellent with 100% cure in 46 patients treated who were controlled daily during the first week, at the 20th and 40th day and for some of them up to seven month after treatment. These results are all the more remarkable since certain patients were severely infected and that of all the far-eastern liver flukes O. viverrini is probable the most resistant to known drugs. Very efficient and very well tolerated, praziquantel offers the advantage of one day treatment in the cure of opistorchiasis and hospitalization is not necessary.

Trial designs for multicentre clinical studies of investigational phases I B to III with praziquantel.

Following very promising results with 2-cyclohexylcarbonyl-1,2,3,6,7,11b-hexahydro-4H-pyrazino[2,1-a] isoquinolin-4-one (praziquantel, EMBAY 8440, Biltricide) in animal experiments on toxicity and efficacy and after confirming excellent tolerability in healthy volunteers, WHO could be won over to the further clinical development of this compound. In close cooperation trial protocols and case report sheets standardised as far as possible were set up for intercontinental multicentre trials in investigational phases II A, II B, and III, respectively. Thus, in investigational phase II A, studies were conducted simultaneously in Africa, Asia and South America. In all those endemic areas not only good tolerability in patients but also high efficacy against local Schistosoma species could be confirmed in double blind trials. In the extended phase II B, patients were allotted to 3 strata of different intensity of infection in order to find out if differentiating dosages would be necessary according to degree of worm burden, patient's age, and occurrence of more frequent and/or severe adverse reactions in patients with hepatolienal complications. There is not yet a satisfactory answer to all of these questions. In the investigational phase III already under way we hope to fill those gaps and also to find the optimum dosage for large scale use under field conditions. The profile of praziquantel, however, has already been established to an extent that first community health projects have been successfully started and others are in an advanced stage of planning.

Multicentre trials of praziquantel in human schistosomiasis: design and techniques.

This paper outlines the experimental design and techniques used in the initial multicentre clinical experiences with praziquantel in the treatment of human infections due to Schistosoma haematobium, S. mansoni, and S. japonicum. Trials were conducted in Brazil, Japan, the Philippines, and Zambia.Close professional cooperation between informed representatives of the manufacturers of the drug and WHO led to the use of a standard clinical trial design and agreed technical protocols, although parasitological methods of therapeutic assessment varied with the species of infecting parasite. Double-blind studies of tolerance were conducted at three different dose levels and subsequently, in Brazil and Zambia, single-blind trials of parasiticidal efficacy were carried out. The results of the various trials are reported separately.This type of close professional cooperation is a useful model for initial clinicopharmacological studies of parasiticidal drugs-an area beset with difficulties for both industry and international agencies.