Use of Complementary and Alternative Medicine in Patients with Primary Immunodeficiency: a Multicentric Analysis of 101 Patients.

The term complementary and alternative medicine (CAM) describes a broad spectrum of health care practices that are not an integral part of the conventional health care system. Many patients worldwide use CAM on their own initiative, often in combination with their conventional medical therapy. CAM use is attractive especially to patients with primary immunodeficiency, since they suffer from frequent infections and autoimmunity. Those are frequently addressed by CAM providers. The aim of this multicentric study was to collect information on the use of CAM by these patients and to define characteristics that are associated with the use of CAM. A total of 101 patients with primary immunodeficiencies at German hospitals were surveyed on their CAM use (further 14 patients rejected to participate). Multiple psychological tests (MARS-D, WHO-5, PHQ9, EFQ) were conducted to investigate variations among personality traits associated with CAM use. Additionally, clinical and sociodemographic patient data was collected. A total of 72% of patients used CAM to treat their primary immunodeficiency. The three most frequently used methods were physical exercise or fitness training (65%), dietary supplements (58%), and homeopathy (49%). Most patients did not discuss CAM use with their doctors, mostly because they felt that there was no time for it. CAM plays an important role for patients with primary immunodeficiency in a high-resource health care setting such as Germany. In clinical practice, doctors should create a platform to discuss needs that go beyond conventional therapy.

Homeopathy as Therapy for Mycosis Fungoides: Case Reports of Three Patients.

BACKGROUND: Mycosis fungoides (MF) is an uncommon, indolent, form of cutaneous T cell lymphoma, of which there are various types according to international classification. Various treatment modalities are available; however, these are fraught with potentially severe adverse effects. METHODS: Three cases of immunohistochemically confirmed MF were treated with classical individualized homeopathy. Each case was followed up with photographic documentation and was reported according to the criteria set out in the HOM-CASE guidelines. Based on the WHO-EORTC (World Health Organization-European Organization for Research and Treatment of Cancer) criteria, the patients were classified as T1b, T1a/T1b and T2b respectively. RESULTS: All cases remitted following homeopathic treatment and remained in remission. Side effects were not reported in these cases. CONCLUSIONS: MF may respond to individualized homeopathic medicine. Although the case number here is small, MF is not a common disorder, spontaneous remission is not usually expected, and the disease may progress to a more severe form. Hence, these findings could serve as a basis for further research into the role of individualized homeopathic medicine in the treatment of MF.

Atopic dermatitis: an overview.

Atopic dermatitis, also known as atopic eczema, is a chronic pruritic skin condition affecting approximately 17.8 million persons in the United States. It can lead to significant morbidity. A simplified version of the U.K. Working Party's Diagnostic Criteria can help make the diagnosis. Asking about the presence and frequency of symptoms can allow physicians to grade the severity of the disease and response to treatment. Management consists of relieving symptoms and lengthening time between flare-ups. Regular, liberal use of emollients is recommended. The primary pharmacologic treatment is topical corticosteroids. Twice-daily or more frequent application has not been shown to be more effective than once-daily application. A maintenance regimen of topical corticosteroids may reduce relapse rates in patients who have recurrent moderate to severe atopic dermatitis. Pimecrolimus and tacrolimus are calcineurin inhibitors that are recommended as second-line treatment for persons with moderate to severe atopic dermatitis and who are at risk of atrophy from topical corticosteroids. Although the U.S. Food and Drug Administration has issued a boxed warning about a possible link between these medications and skin malignancies and lymphoma, studies have not demonstrated a clear link. Topical and oral antibiotics may be used to treat secondary bacterial infections, but are not effective in preventing atopic dermatitis flare-ups. The effectiveness of alternative therapies, such as Chinese herbal preparations, homeopathy, hypnotherapy/biofeedback, and massage therapy, has not been established.

Epidermolysis bullosa: report of three cases treated with homeopathy.

Epidermolysis bullosa (EB) is a group of rare genetic disorders characterized by recurrent blistering as a result of even minor traction of epithelial lined tissues, most remarkably the skin. Associated morbidity is serious for all patients affected due to the presence of large areas of denudated skin thus susceptible to infection. There is currently no available treatment in conventional medicine. This article reports the case of 3 children successfully treated with individualized homeopathic medicines.

Blisters and homeopathy: case reports and differential diagnosis.

Blisters are skin lesions characterized by accumulation of fluid between the layers of the skin. Their severity varies from the common blisters caused by friction to severe autoimmune and congenital bullous disorders, some of them currently without treatment in conventional medicine or requiring drugs with potentially severe side-effects. This article reports cases of blistering diseases successfully treated with homeopathic medicines, which represent an alternative for the treatment of such disorders.

Diagnoses and visit length in complementary and mainstream medicine.

BACKGROUND: The demand for complementary medicine (CM) is growing worldwide and so is the supply. So far, there is not much insight in the activities in Dutch CM practices nor in how these activities differ from mainstream general practice. Comparisons on diagnoses and visit length can offer an impression of how Dutch CM practices operate. METHODS: Three groups of regularly trained physicians specialized in CM participated in this study: 16 homeopathic physicians, 13 physician acupuncturists and 11 naturopathy physicians. Every CM physician was asked to include a maximum of 75 new patients within a period of six months. For each patient an inclusion registration form had to be completed and the activities during a maximum of five repeat visits were subsequently registered. Registrations included patient characteristics, diagnoses and visit length. These data could be compared with similar data from general practitioners (GPs) participating in the second Dutch national study in general practice (DNSGP-2). Differences between CM practices and between CM and mainstream GP data were tested using multilevel regression analysis. RESULTS: The CM physicians registered activities in a total of 5919 visits in 1839 patients. In all types of CM practices general problems (as coded in the ICPC) were diagnosed more often than in mainstream general practice, especially fatigue, allergic reactions and infections. Psychological problems and problems with the nervous system were also diagnosed more frequently. In addition, each type of CM physician encountered specific health problems: in acupuncture problems with the musculoskeletal system prevailed, in homeopathy skin problems and in naturopathy gastrointestinal problems. Comparisons in visit length revealed that CM physicians spent at least twice as much time with patients compared to mainstream GPs. CONCLUSIONS: CM physicians differed from mainstream GPs in diagnoses, partly related to general and partly to specific diagnoses. Between CM practices differences were found on specific domains of complaints. Visit length was much longer in CM practices compared to mainstream GP visits, and such ample time may be one of the attractive features of CM for patients.

Drug abuse profile - patient delay, diagnosis delay and drug resistance pattern - among addict patients with tuberculosis.

Socioeconomic problems limit the access of drug users to health-care services. This descriptive cross-sectional study was carried out by making use of the medical records of new case tuberculosis (TB) patients hospitalized at Masih Daneshvari Hospital, the national referral centre in Iran, from 2003 to 2006. Demographic and personal characteristics of the patients and type of disease were collected and categorized. Of the 944 patients with confirmed TB, 143 (15.1%) were drug users, among whom 140 (97.9%) were men with just three women drug users. The mean age of the drug users group was 43.04 +/- 13.81 years. The type of drug used was opium in 100 cases (69.9%), heroin in 29 (20.3%), opium and heroin together in four (2.8%) and all three, opium, heroin and crack, in two (1.4%). For 238 high-risk patients, an HIV test was performed and HIV infection was confirmed in 33 cases. Patient delay was longer in drug users (P = 0.000) against other patients, whereas diagnosis delay was shorter (P = 0.007). Drug susceptibility tests were performed for 515 patients with positive cultures. One hundred and thirty-three (14.1%) were found to have 'any resistance' to anti-TB drugs, and 10 (1.1%) individuals had multidrug-resistant TB. Twenty-six (19.5%) of the individuals who showed resistance to first-line agents were drug users. There was no significant relation between drug resistance and drug use (P = 0.4). In conclusion, it seems that active case finding for TB and HIV in addict cases must be contained in harm reduction packages. Moreover, the manifestations of the disease should be considered seriously regardless of attributing them to drug use.

[Obturatory abscess and pelvic pain caused by Brucella melitensis]. / Brucella melitensis'in neden oldugu obturator apse ve pelvik agri.

Brucellosis which is a systemic infection, is seen endemically in Turkey. Although there a lot of complications related to brucellosis, soft tissue involvement is rare. In this case report a patient with mature cystic teratoma and a Brucella related obturatory abscess, was presented. A 21-year-old female patient with bilateral pelvic pain was admitted to the hospital with complaints of weakness, backache and ab- dominal swelling. Pelvic examination revealed bilateral adnexial sensitive masses. There were no history of systemic complaints or other organ involvement. The patient had no history of contact with infected animals, intramuscular injections or consumption of non-pasteurized foods. A mass of 56 x 63 mm with regular margins and hyperechogenic segments at the left side was detected at ultrasonographic examination. Left ovarian cystectomy and mass excision at the left side were performed during laparotomy. Histopathological examination of the mass revealed chronic granulomatous inflammation characterized by central necrosis, histiocyte and lymphocyte infiltration and formation of giant cells, compatible with brucellosis. Brucella melitensis was isolated from the capsule of pelvic mass on the fifth day of culture in BacT/ALERT Selectlink (Organon Teknika, U.S.A.) system. Brucella Wright agglutination titer which was 1:80 at the admittance, rose to 1:2560 at the sixth week of the follow-up. The patient was treated successfully with the excision of the abscess and 6 weeks course of oral doxycycline and rifampicin. Brucellosis should be considered in the differential diagnosis of pelvic pain and obturatory abscess, especially in endemic areas for brucellosis.

New repertory, new considerations.

The criteria for entering medicines in repertory rubrics are unclear and partly incorrect. A new repertory should be based on clear and objective criteria. Retrospective and prospective assessment of medicines and symptoms by the Dutch Committee for Methods and Validation gives an indication of the validity of existing repertory entries. Reliance on the experience of one expert is the cause of part of the shortcomings of the repertory. This experience is highly influenced by chance. Another part is due to the use of absolute rather than relative occurrence of symptoms. Yet another part is caused by not comparing prevalence in the population 'cured' by a medicine with the remainder of the population. In many cases we need better definitions of symptoms. A clear protocol and prospective research could overcome many shortcomings of the repertory. Statistics help to get more objective criteria, but we still need to reach consensus about how to handle probabilities of outcomes of our assessments.

Chronic endometritis in an Asian elephant (Elephas maximus).

A 48-yr-old female Asian elephant with a history of pododermatitis developed recurrent hematuria beginning in 2002. Transrectal ultrasonography and endoscopic examination in 2004 identified the uterus as the source of hematuria and excluded hemorrhagic cystitis. Treatment with Desloreline implants, antibiotics, and homeopathic drugs led to an improved general condition of the elephant. In July 2005, the elephant was suddenly found dead. During necropsy, the severely enlarged uterus contained about 250 L of purulent fluid, and histopathology revealed ulcerative suppurative endometritis with high numbers of Streptococcus equi ssp. zooepidemicus and Escherichia coli identified on aerobic culture. Additional findings at necropsy included: multifocal severe pododermatitis, uterine leiomyoma, and numerous large calcified areas of abdominal fat necrosis. Microbiologic culture of the pododermatitis lesion revealed the presence of Streptococcus agalactiae, Streptococcus equi ssp. zooepidemicus, Staphylococcus sp., Corynebacterium sp., and Entercoccus sp.

Quadriplegia due to lead-contaminated opium--case report.

PURPOSE: Utilization of lead-contaminated opium may lead to severe motor neuron impairment and quadriplegia. CASE REPORT: Forty years oriented old male, opium addict, was admitted to the ICU, with headache, nausea and abdominal pain, and weakness in his lower and upper extremities without definitive diagnosis. The past medical and occupational history was negative. Laboratory investigation showed; anemia (Hb 7.7 g/dl), slightly elevated liver function tests, elevated total bilirubin, and ESR. Abdominal sonography and brain CT scan were normal. EMG and NCV results and neurologic examination were suggestive for Guillain-Barre. He underwent five sessions of plasmapheresis. Blood lead level was > 200 microg/dl. He received dimercaprol (BAL) and calcium disodium edetate (CaEDTA) for two five days session. Upon discharge from ICU all laboratory tests were normal and blood lead level was reduced, but he was quadriplegic. CONCLUSION: The delayed treatment of lead poisoning may lead to irreversible motor neuron defect.

Pancreatitis del surco (groove) que imita cáncer de páncreas: presentación de un caso y revisión de la literatura / Groove pancreatitis mimicking pancreatic cancer: Case report and literature review

Resumen La pancreatitis del surco (PS) o "groove pancreatitis", es una forma de pancreatitis crónica infrecuente; nombrada así por su localización en el surco pancreatoduodenal. Suele predominar en varones con antecedente de ingesta de alcohol. Es de gran importancia realizar diagnóstico diferencial con cáncer de páncreas, dada su ubicación. Los avances en los métodos diagnósticos, como la ultrasonografía endoscópica, han permitido un abordaje más certero, sin embargo, no se cuenta con guías de manejo y las aproximaciones terapéuticas siguen siendo basadas en patologías similares.

Abstract Groove pancreatitis (GP) is a rare form of chronic pancreatitis located in the pancreaticoduodenal groove, hence its name. It is predominant in males with a history of alcohol intake. Making a differential diagnosis between this condition and pancreatic cancer is highly relevant given its location. Advances in diagnostic methods, such as endoscopic ultrasonography, have allowed a more accurate approach. However, no management guidelines are available and therapeutic approaches are still based on similar pathologies.

Death in a legal poppy field in Spain.

Opium is a substance extracted from Papaver somniferum L. Opium latex contains morphine, codeine, and thebaine and non-analgesic alkaloids such as papaverine and noscapine. In Spain opium growing is allowed only for scientific or pharmaceutical purposes and harvest is supervised by the Spanish Health Ministry. This work describes a sudden fatality involving opium consumption in a legal poppy field. The toxicological and autopsy findings, previous disease, paraphernalia, and scenario are discussed in order to clarify cause and manner of death. A 32-year-old white caucasian male was found unresponsive in a legal poppy field in the South of Spain. The emergency medical services responded to the scene where he was pronounced dead. The friends explained that the deceased had presented with about 30min of convulsions; in spite of trying to keep his airway tract open they noted that "he stayed airless". According to them the victim suffered from epilepsy. Tools found beside his body consisted of plain wood sticks with a blade razor, a fabric handle, and paper. A comprehensive toxicological screening for abuse and psychoactive drugs was performed in the deceased samples. This included ethanol and volatile analysis by HS-GC-FID in peripheral blood and urine, enzyme immunoassay in urine by CEDIA, and a basic drug screening in all samples (including paraphernalia) by GC-MS using modes full scan for screening/confirmation and selected ion monitoring for quantitation. The peripheral blood, urine, vitreous, and gastric content contained the following concentrations of opiates expressed in mg/L (gastric content additionally also expressed in mg total): 0.10, 7.12, 0.23, and 14.80 (2.81mg total) of thebaine, 0.13, 4.50, 0.13, and 6.60 (1.25mg total) of morphine (free), 0.48, 0.88, 0.17, and 1.50 (0.28mg total) of codeine. These tree opiates were also detected in the tools (paraphernalia) used by the deceased for opium consumption. Other toxicological findings were metabolites of cocaine and cannabis. Apparently the victim stole poppy capsules and ingested an unknown quantity of the latex with the goal to obtain euphoric effects. The cause of death was considered poly-drug toxicity with a preponderant role of thebaine and morphine. In addition, the epileptic condition of the deceased could have played a role. As far as we know, there are no previous reports of fatalities occurring in legal poppy fields.

Triple gastric peptic ulcer perforation.

Patients with advanced or metastatic cancer have compromised nutritional, metabolic, and immune conditions. Nevertheless, little is known about gastroduodenal perforation in cancer patients. Described in the present report is the case of a 41-year old woman with stage IV recurrent laryngeal cancer, who used homeopathic anticancer therapy and who had triple peptic ulcer perforation (PUP) that required surgical repair. Triple gastric PUP is a rare complication. Self-administration of homeopathic anticancer medication should be strongly discouraged when evidence-based data regarding efficacy and toxicity is lacking.

Neglected foreign body aspiration mimicking bronchial carcinoma.

Foreign body aspiration can occur in any age group, but it is more commonly seen in children. In adults, there is usually a predisposing condition that poses a risk of aspiration. If aspiration occurs, prompt diagnosis and extraction of the foreign body is needed to prevent early and late complications. We report a rare case of neglected foreign body aspiration in a 45-year-old schizophrenic opium addicted patient, which resulted in an occlusive lesion in the bronchus, mimicking bronchial carcinoma.

[Ocular deviation as the cause of "psychiatric" problems]. / Onderliggende oogaandoening als oorzaak van psychiatrisch geduide klachten.

We describe two cases with complaints of atypical headache who were initially diagnosed as having psychiatric problems, but who, after careful evaluation, were found to have an underlying eye disorder. Both patients were known to have an ophthalmic history. Patient A, a 21-year-old female, presented with severe headache, which was so disabling that she was declared unfit for work. A diagnosis of tension headache was made and she received psychological treatment with neurofeedback, homeopathy and acupuncture, which had no effect. Patient B, a 26-year-old male, complained of extreme photophobia, nausea and dizziness. The patient was diagnosed as having a conversion disorder and was admitted to a psychiatric clinic and given psychotropic treatment. Careful ophthalmological examination revealed that an ocular deviation was causing the symptoms in both patients and could be treated appropriately with strabismus surgery. These cases emphasise the importance of a thorough general medical and ophthalmic history and proper examination at all times without putting a psychiatric stigma on the patient.

Multianalytical system (MAS): software for enzyme-linked immunosorbent assay (ELISA) data processing with applications to screening and diagnostic tests.

A microcomputer software package for determining the concentration of either the antibody or antigen from ELISA data for IBM PC compatible is presented. In the program optical densities (OD) and fluorescence obtained from 96-well ELISA plate can be input either directly, by interfacing with different brands of microplate reader such as Multiskan II Plus and Organon Teknika to the computer or manually. This software utilizes some mathematical and statistical models to fit the standard curve of each assay and interpolate analyte concentration using data from OD or fluorescence measurements. Cubic spline (Guardabasso et al., 1988), bezier and polynomial (Rodbard, 1979; Baud et al., 1991) interpolation formulas can be used to fit the data over the entire range for estimating the antibody or antigen concentration of the unknown samples whose OD or fluorescence is beyond the entire range. This software package, based on the concentration values of the analyte determined in different fluids (Núnez et al., 1994; Morales et al., 1994) and with some rules and algorithms, is used to calculate the parameters of screening and diagnostic tests such as sensitivity, specificity and predictive values (Coughlin et al., 1992). With the construction of the Receiver Operating Characteristic (ROC) curve it is possible to analyse different values of the sensitivity and specificity of the screening and diagnostic tests. A comparative statistical test for two populations that are non-normally distributed using a non-parametric Mann-Whitney test is provided. This software is an expandable tool designed for general use in clinical and experimental applications, including diagnostic and screening tests.

Reliability of urinary pregnancy tests in the diagnosis of ectopic pregnancy.

Recently a new generation of urinary pregnancy tests with increased sensitivity and specificity for beta-human chorionic gonadotropin (beta-HCG) was introduced. The clinical sensitivity of seven of these tests was evaluated in patients with surgically proven ectopic pregnancy. Two enzyme-linked immunosorbent assays (Tandem Visual, Hybritech; Mod C1, Monoclonal Antibodies), with a sensitivity of 50 mIU of beta-HCG, were positive in 90% of ectopic pregnancies. The three-tube tests (Sensitex, Roche; UCG Beta Stat, Wampole; beta-Neocept, Organon), with a sensitivity of 150-250 mIU of beta-HCG, were positive in 81-85% of ectopic pregnancies. Two slide tests (UCG Beta Slide, Wampole, and Sensislide, Roche), with a sensitivity of 500-800 mIU of beta-HCG, were positive in 51-61% of ectopic pregnancies. Both the immunosorbent assays and the tube tests were statistically more sensitive than the slide tests (P less than .001). There was no statistically significant increase in sensitivity between the tube tests and the immunosorbent assays. The sensitivities of these tube tests in ectopic pregnancy are similar to those of tube tests from other manufacturers previously reported on.