Follow-up of antibiotically treated and untreated neuroborreliosis.

Follow-up of 57 patients who suffered from antibiotically untreated acute, monophasic neuroborreliosis 5 to 27 years ago shows no significant difference in comparison with the follow-up of 66 patients who suffered from antibiotically treated acute, monophasic neuroborreliosis during the last 5 years. In both groups, the involution of clinical symptoms and the normalization of pathological CSF findings were nearly identical. We found no significant difference of sequelae between the groups. Following acute neuroborreliosis, neither the antibiotically untreated nor the antibiotically treated patients developed chronic neuroborreliosis. Only in rare cases of primary chronic neuroborreliosis with CNS involvement did we observe convincing effects of antibiotics, which were given mostly in combination with glucocorticosteroids.

Histopathological findings in the central and peripheral nervous systems in neuroborreliosis. A report of three cases.

Very little is known about tissue changes and pathophysiological mechanisms in Garin-Boujadoux-Bannwarth syndrome. We report histopathological findings in the central and peripheral nervous systems of three typical cases. In the acute stage of the disease mononuclear perivascular infiltrations with mainly T-helper cells were the prominent finding, whereas after treatment there was no vessel involvement. The fibre changes in the peripheral nervous system consisted of axonal degeneration. No Borrelia burgdorferi-specific antigen could be detected by immunohistochemical methods. Thus vasculitis might be one of the primary pathophysiological mechanisms for the involvement of the nervous system.

Treatment of Lyme borreliosis. Randomized comparison of doxycycline and penicillin G.

Seventy-five patients with neurological symptoms of Lyme borreliosis were randomly assigned to intravenous treatment with either penicillin G or doxycycline. After 12 months the treatments were equally effective regarding the clinical picture and laboratory findings. No patient was considered to be a treatment failure. However, one-third of the patients showed delayed recovery, particularly after a longer primary disease duration. A slow recovery, lasting years, was typical of subacute or chronic borreliosis.

Extrapyramidal features in central Lyme borreliosis.

We report 5 cases with an extrapyramidal syndrome resulting from Borrelia burgdorferi encephalitis which responded to antibiotic treatment. The acute onset of extrapyramidal features together with diffuse pain can be the leading symptoms of central borreliosis.

[Acute and chronic diseases in transmitted borreliosis by tick bite]. / Akute und chronische Erkrankungen bei zeckenvermittelter Borreliose.

We report on clinical and laboratory findings of 58 study patients with tick-bite burrelia burgdorferi-infection. In seven cases, chronic borreliosis like a tertiary metaluetic illness was recognized. All were treated either with high-dose penicillin intravenously or tetracycline. Results of treatment and recommendations are given.

Acute and chronic illness after tick-bite Borrelia burgdorferi-infections: results of treatment.

We report on clinical and laboratory findings of 28 patients with tick-bite Borrelia burgdorferi-infection. In 5 cases chronic tertiary metaluetic manifestations were recognized. All were treated either with high-dose penicillin intravenously or tetracycline. Results of treatment and recommendations are given.

A protocol for selecting patients with injured extremities who need x-rays.

To help curb excessive radiography, we developed a protocol for selecting patients with injured extremities who need x-ray examination, and we tested the protocol prospectively in 848 patients to determine its safety and effectiveness. Strict adherence to the protocol would have reduced x-ray usage by 12 per cent for upper extremities and 19 per cent for lower extremities. The actual reductions were 5 per cent and 16 per cent, respectively, since further reductions were limited by patient's demands for x-ray examinations. One fracture in 287 were missed, but the treatment was appropriate and the outcome satisfactory. By eliminating superfluous x-ray procedures, the protocol could reduce charges by $79 million to $139 million nationwide, without compromising quality of care or increasing malpractice liability. Nevertheless, even the best protocol cannot eliminate all negative x-ray studies. These results should serve as a stimulus for judicious use of radiography, but also as a warning to avoid overzealous cost-containment strategies that would reduce x-ray usage to below a safe threshold.

Meseclazone, 5-chlorosalicylic acid and acetylsalicylic acid. Comparison of their effects on in vitro and ex vivo platelet aggregation.

Meseclazone and its major metabolite, 5-chlorosalicylic acid (5-CSA) have been shown to possess anti-inflammatory, analgesic and antipyretic activity. The comparative effects of these compounds on pletelet aggregation were evaluated in vitro and ex vivo with acetylsalicylic acid (ASA). In vitro, meseclazone and ASA exhibited almost identical inhibitory potency of secondary phase ADP aggregation while 5-CSA was less effective. Moreover, collagen aggregation was inhibited by all three agents: ASA greater than meseclazone greater than 5-CSA. Thrombin-induced aggregation was inhibited to approximately the same extent by 5-CSA and ASA while meseclazone was inactive. The in vitro effects on the release-inducing aggregants were confirmed by ex vivo experiments in rats. These demonstrated that ASA and meseclazone inhibited collagen-induced aggregation 1 and 4 hr after oral administration although ASA was three to four times more active. ASA, but not meseclazone, was still effective 24 hr after administration. Bleeding times in rats 1 and 4 hr following oral administration of meseclazone and ASA were not altered. It is concluded that meseclazone and/or 5-CSA inhibit in vitro and ex vivo platelet aggregation initiated by the release reaction similar to ASA and other non-steroidal anti-inflammatory drugs.