Rupatadine and levocetirizine in chronic idiopathic urticaria: a comparative study of efficacy and safety.

BACKGROUND: Chronic Idiopathic Urticaria is difficult to treat due to its persistent debilitating symptoms. New generation anti-histaminics are first line treatment for this condition. The aim of this study is to compare efficacy and safety of rupatadine and levocetirizine in chronic idiopathic urticaria. METHODS: A randomized, single blinded, single-centred, parallel group outdoor based clinical study was conducted in 70 patients of CIU to compare the two drugs. After initial clinical assessment and baseline investigations, rupatadine was prescribed to 35 patients and levocetirizine to another 35 patients for 4 weeks. At follow-up, the patients were re-evaluated and then compared using different statistical tools. Main outcome measures were DC eosinophil, Absolute Eosinophil Count (AEC), serum IgE, Total Symptom Score, Aerius Quality of Life Questionnaire score, and Global efficacy score. RESULTS: Rupatadine significantly improved patients' clinical condition including symptom score from baseline to day 28. In rupatadine group, there was 27.9 percent decrease (P=0.027) in DC eosinophil, 35.6 percent decrease (P=0.036) in AEC, 15.3 percent decrease (P=0.024) in serum IgE, 28.2 percent decrease (P=0.02) in Total Symptom Scoring, and 27.3 percent decrease (P=0.006) in Aerius Quality of Life Questionnaire score. Global efficacy score of rupatadine was found to be significantly greater (P=0.009) than levocetirizine. The overall incidence of adverse drug reactions was also found to be less in rupatadine group. CONCLUSION: Rupatadine is a better choice in CIU in comparison to levocetirizine due to better efficacy and safety profile.

Inflammatory abdominal aortic aneurysm: report of six cases.

Six cases of inflammatory aneurysm of the abdominal aorta are described. All patients were male, aged 59 to 80 years, and five had symptomatic atherosclerotic cerebrovascular or cardiovascular disease. In three the diagnosis of inflammatory aneurysm was suggested preoperatively on the basis of computed tomographic or ultrasonographic scanning. On gross examination the aneurysm wall was about 1 cm thick and included an inner narrow layer of atherosclerotic plaque, which was contiguous with the outer thick fibroinflammatory component. Microscopically, this component consisted of fibroblasts and collagen, which entrapped fat, nerves, and lymph nodes and was infiltrated by lymphocytes and plasma cells. Plasma cells, lymphocytes, and fibroblasts predominated in four patients, while two showed abundant dense collagen with fewer inflammatory cells and fibroblasts. There was associated vasculitis, predominantly phlebitis, in three. Inflammatory aneurysms represent a distinct group of abdominal aortic aneurysms.

Estimation of nongravid uterine volume based on a nomogram of gravid uterine volume: its value in gynecologic uterine abnormalities.

To facilitate accurate and standard methods of reporting pathologic uterine corpus enlargement, we constructed a nomogram using the gravid uterine corpus volumes from five to 20 weeks' gestation in 186 patients. The volume was calculated by measuring the maximum length and anteroposterior and transverse diameters of the uterine corpus, and using the formula for the volume of a prolate ellipsoid: V = 0.52 X (L X AP X T). Clinicians can use the nomogram for better understanding in assessing uterine volume.

The postmenopausal cystic adnexal mass: the potential role of ultrasound in conservative management.

Often ovarian cancer does not present clinically until the advanced stages. In the past, the presence of any cystic adnexal enlargement in postmenopausal women was an indication for surgical exploration. The ultrasound scans of 42 postmenopausal women with simple adnexal cysts were reviewed. We included only patients who were available for follow-up and who had cysts that were less than or equal to 5 cm in maximum diameter, unilocular (ie, without septations or solid components), and without ascites. Of these patients, 26 underwent prompt surgical exploration. All exhibited benign histopathology. In 16 patients, serial sonographic surveillance was performed every 3-6 months. Two of these patients had exploratory laparotomy at 6 and 9 months of observation; the first operation, for increasing size and septation, demonstrated a cystadenofibroma, and the second, for increasing pain, demonstrated a degenerating myoma. The remaining 14 patients were followed from 10-73 months without any change in size or character of the cyst. Small (less than 5 cm), unilocular postmenopausal cysts had a low incidence of malignant disease (0%) in this series of 28 surgical specimens. Therefore, serial ultrasound follow-up without surgical intervention may play a role in the clinical management of such patients.

Intramedullary spinal cord tumors in children: localization by intraoperative sonography.

Intraoperative sonography was performed in 20 children in order to localize intramedullary spinal cord tumors. It provided excellent visualization of the extent and consistency of the tumor before surgical opening of the dura mater. The sonographic findings were used in selecting the site and extent of myelotomy. Intraoperative sonography proved to be a valuable adjunct to spinal cord surgery.

Sonography of the spine and spinal cord.

Sonography has proved to be a valuable method for the examination of the spine in children with spinal dysraphism. It facilitates the diagnosis of meningocele, lipoma, and/or spinal cord tethering rapidly and noninvasively. It is suggested that sonography be utilized for screening infants with neurocutaneous signature of spinal dysraphism.

Diagnosis of adrenal ganglioneuroma in pregnancy with magnetic resonance imaging and ultrasonography. A case report.

A right adrenal gland mass was found during sonographic examination of the right upper quadrant during a workup for hyperemesis gravidarum. Magnetic resonance imaging was used to clarify the origin of the mass. The tumor was nonfunctional. Because of the possibility of a malignancy, the patient underwent a successful second-trimester exploratory laparatomy with right adrenalectomy. Pathology demonstrated a benign ganglioneuroma.

Ultrasonographic features of primary carcinoma of the gallbladder: report of five cases.

The sonographic features of primary carcinoma of the gallbladder in five patients are presented. Two sonographic patterns were seen depending on whether or not the lumen of the gallbladder was visualized. In two patients the gallbladder lumen was visualized and an irregular fixed nonshadowing soft tissue mass was seen arising from the wall and projecting into the lumen. In the remaining three patients a solid mass was seen in the predicted location of the gallbladder without visualization of gallbladder lumen. Ancillary findings such as local involvement of liver and signs of biliary obstruction supported the diagnosis.

Transcutaneous sonography of the postoperative spine.

Transcutaneous sonography of the spine was performed in 83 patients with prior laminectomies for tumors of the spinal canal and the spinal cord. These patients presented with signs or symptoms of recurrent tumor. When the spinal cord could be visualized, the sonographic examination provided information about the presence or absence of tumor, the character (solid or complex) of the tumor and its location, and associated findings in the extramedullary space. The correlation of the transcutaneous sonograms with other imaging methods and with intraoperative sonographic and surgical findings was excellent. Nonvisualization of the spinal cord was found to be related to age with a higher success rate (70% visualized) in the pediatric age group (to age 21) than in the adult group (52% visualized). A very short laminectomy was also found to cause problems in visualizing the full extent of a recurrent tumor. Nonetheless, the simplicity of the technique and the amount of information that can be gained from it make it a very valuable adjunct to other imaging methods for the postoperative spine. For the pediatric age group, it should be one of the first diagnostic methods employed.

Small angiomyolipoma of the kidney: sonographic-CT evaluation.

Small fat-containing intraparenchymal renal lesions, 0.5 to 1.3 cm in diameter, were detected by sonography and computed tomography in six patients. In five of the six cases, the lesions were found serendipitously. None of the patients underwent surgery. Follow-up studies, performed over a period of 6-24 months, showed no change in the size of the lesions. These small fat-containing nodules, hitherto unrecognized by imaging studies, are not an uncommon finding at routine autopsy. Since these lesions do not show growth in the adult population, surgical intervention does not seem to be indicated.

Renal transitional cell carcinoma: sonographic and pathologic correlation.

Sonography was utilized to assess six patients with renal transitional cell carcinoma and was correlated with gross pathology in five cases. The neoplasms were seen as discrete, solid masses causing separation of the central renal sinus echoes. The echogenicity of the tumors and the renal parenchyma was similar, but the neoplasms were separated from the renal parenchyma by a linear echogenic zone of renal sinus fat. Pelvicaliceal blood clots, when markedly echogenic, could be differentiated from transitional cell carcinomas. Sonography contributed most in evaluating unilateral nonvisualized kidney or in the presence of nonfilling of the affected pelvicalices on excretory urography.

Spinal cord imaging using real-time high-resolution ultrasound.

The myelographic evaluation of patients presenting with persistent or recurrent symptoms following surgery for an intrinsic spinal cord mass is difficult. Possible symptom-causing processes include tumor recurrence, intramedullary cyst formation, postirradiation effects, arachnoiditis, and spinal cord atrophy. Since tumor recurrence and syrinx formation may require further surgery, while the other entities generally do not, the distinction between these processes is clinically important. The authors have successfully employed commercially available high-resolution real-time ultrasound imaging systems to investigate a group of patients with these persistent or recurrent symptoms after surgery. The bony laminectomy defect provides an acoustic window for viewing intraspinal contents. Ultrasound can accurately differentiate between cystic and solid lesions and can clearly demonstrate whether a spinal cord is enlarged or atrophic.

Ultrasound findings in diffuse granulomatous cystitis in chronic granulomatous disease of childhood.

Chronic granulomatous disease (CGD) is a genetically inherited disease of childhood, which is characterized by repeated bacterial and/or fungal infections. The genitourinary tract is rarely involved. We report a case of CGD with involvement of the urinary bladder. Pertinent clinical and sonographic findings of this disease are described.

CT diagnosis of renal angiomyolipoma: the importance of detecting small amounts of fat.

Six patients were reviewed who had renal angiomyolipoma (1.2-4.0 cm) in which only minimal amounts of fat were evident on CT. The fat content of the lesion was appreciated because tissue attenuation measurements of small areas of low attenuation within the tumors were performed and because thin-section (5-mm) and nonenhanced CT scans were used. The fat content of the lesions could be identified on 10-mm sections in three cases but only on 5-mm sections in three others. In two cases, fat was seen only on the nonenhanced 5-mm thin sections. Careful sampling of low-density regions within the mass must be performed because a single region of interest over the entire tumor will produce an average attenuation in the soft-tissue range. The use of 5-mm thin sections and thin, nonenhanced CT sections increases spatial and density resolution and decreases susceptibility to partial-volume effects. In a correlative study, no areas of fat were detected in a review of 100 well-circumscribed (4.0 cm or smaller) renal cell carcinomas. Detecting the existence of fat in a renal lesion will establish the diagnosis of angiomyolipoma and is the only radiologic finding that can differentiate it from renal cell carcinoma. Thus, unnecessary surgery will be avoided in these cases.

Abdominal sonography in AIDS. A review.

Sonographic examination of the abdomen was performed in 155 patients with clinical diagnosis of AIDS. Approximately one half of the patients had hyperechoic (fatty) liver and splenomegaly. About one third of the patients had lymphadenopathy and hyperechoic kidneys. Intravenous drug abusers were more likely to have renal parenchymal changes, whereas patients with sexually transmitted AIDS have a greater incidence of splenomegaly. Lymphadenopathy is the most consistent finding that would question the immune competency of a patient in the appropriate clinical setting. The usefulness of sonography lies in the detection or exclusion of potentially treatable complications in AIDS.

Ultrasonic features of fallopian tube carcinoma.

With the routine use of sonography in the evaluation of patients with pelvic masses, it is essential to be familiar with the sonographic features of fallopian tube carcinoma so that diagnosis can be made early and thus contribute to prompt management of these patients. The authors present the clinical manifestations, sonographic features, and pathologic correlations in three cases of fallopian tube carcinoma.

[Intraoperative localization of space-occupying intracranial processes using ultrasound]. / Intraoperative Lokalisation raumfordernder intrakranieller Prozesse mittels Ultraschall.

During a two-year period, intra-operative ultrasonic explorations were performed in 44 patients for the purpose of localisation of intracranial masses. This facilitated accurate intraoperative assessment of the location and consistency of the mass. We consider operative ultrasound to be an invaluable adjunct to surgery of small intracerebral masses.

Sonographic evaluation of patients with portal hypertension.

The availability of real-time sonography has facilitated its use in the assessment of patients suspected of portal hypertension. Dilatation of the portal venous system may occur in portal hypertension, and a portal vein diameter greater than 13 mm is indicative of portal hypertension with a sensitivity of about 50%. Sonographic demonstration of lack of caliber variation of the portal system has a sensitivity of about 80%. The presence of venous collaterals can be demonstrated in about 90% of patients suitable for sonography. The coronary gastroesophageal varices can be seen in 90% when they are large sized, and in 65% when they are small sized. Other collaterals such as umbilical vein, duodenal varices, and gastrorenal and splenorenal varices can be detected. Sonography is a valuable screening procedure in the evaluation of portal hypertension and provides valuable information regarding the size and morphology of the liver and spleen, caliber and patency of the portal venous system, and the existence and location of the varices.

Subchorionic bleeding in threatened abortion: sonographic findings and significance.

Fifty-six patients with clinical threatened abortion were evaluated by sonography. In six patients, fetal cardiac activity was absent at or beyond 9 weeks of gestation, and fetal death was confirmed in all six cases. In the other 50 patients, fetal cardiac activity was present at or beyond 9 weeks of gestation. In 10 (20%) of these 50 patients, subchorionic bleeding was present in various degrees, appearing sonographically as an extrachorionic crescentic anechoic or complex collection. The final outcome in the 50 patients with fetal cardiac activity was as follows: In the absence of subchorionic bleeding, 100% of the pregnancies progressed to term; in the presence of subchorionic bleeding the positive outcome was reduced to 80%. In addition to signs of fetal life on sonography, subchorionic bleeding is an important factor affecting the outcome of gestations in patients with clinical threatened abortion.