Long-term efficacy and safety of dronabinol for acquired immunodeficiency syndrome-associated anorexia.

We studied the effects of long-term (12 months) dronabinol in 94 late-stage acquired immunodeficiency syndrome (AIDS) patients (mean CD4 count of 45/mm3) who previously participated in a 6-week study (placebo versus dronabinol). All patients received dronabinol orally-2.5 mg twice daily (90%) or 2.5 mg once daily (10%). Appetite was measured using a visual analogue scale for hunger (VASH). Dronabinol was associated with consistent improvement in mean appetite. Patients previously treated with dronabinol continued to show improvement in VASH (percent change from baseline of 6-week trial: 48.6-76.1% at each month), whereas those previously treated with placebo exhibited substantial improvement in mean appetite, particularly during the initial 4 months of treatment (48.5-69.9%). Thereafter, dronabinol was associated with a VASH change at least twice baseline. Patients tended toward stable body weight for at least 7 months. Adverse events were primarily related to known central nervous system effects of dronabinol. These data support long-term, safe use of dronabinol for anorexia associated with weight loss in patients with AIDS.

Dronabinol as a treatment for anorexia associated with weight loss in patients with AIDS.

The effects of dronabinol on appetite and weight were evaluated in 139 patients with AIDS-related anorexia and > or = 2.3 kg weight loss in a multi-institutional study. Patients were randomized to receive 2.5 mg dronabinol twice daily or placebo. Patients rated appetite, mood, and nausea by using a 100-mm visual analogue scale 3 days weekly. Efficacy was evaluable in 88 patients. Dronabinol was associated with increased appetite above baseline (38% vs 8% for placebo, P = 0.015), improvement in mood (10% vs -2%, P = 0.06), and decreased nausea (20% vs 7%; P = 0.05). Weight was stable in dronabinol patients, while placebo recipients had a mean loss of 0.4 kg (P = 0.14). Of the dronabinol patients, 22% gained > or = 2 kg, compared with 10.5% of placebo recipients (P = 0.11). Side effects were mostly mild to moderate in severity (euphoria, dizziness, thinking abnormalities); there was no difference in discontinued therapy between dronabinol (8.3%) and placebo (4.5%) recipients. Dronabinol was found to be safe and effective for anorexia associated with weight loss in patients with AIDS.

Efficacy and safety of intravenous cefotaxime for treating pneumonia in outpatients.

The treatment of bacterial pneumonia commands a large segment of hospital resources, and economic concerns are dictating shorter hospital stays. This study was designed to determine whether outpatient therapy with intravenous (IV) antibiotics (a third-generation cephalosporin, cefotaxime, delivered via an ambulatory delivery system [ADS]) is as effective as traditional hospital management of pneumonia. A subgroup of 62 patients from three centers, with bacterial pneumonia, were enrolled in a multicenter, open-label study of outpatient IV cefotaxime therapy. Doses of cefotaxime were 1 g IV every 12 hours, 1 g IV every 8 hours, or 2 g IV every 8 hours, based on severity of infection. Of 62 patients, 53 (85%) completed the study. All 22 bacteriologically evaluable patients showed eradication of pathogen or clinical cure with no obtainable follow-up culture; no relapses, reinfections, or superinfections were reported. Overall clinical success rate was 94.8% (satisfactory 75.9%; improved 19.0%, n = 58). Average length of hospital stay was 2.3 +/- 4.83 days. In conclusion, clinical success rates with outpatient IV cefotaxime therapy were comparable to previous studies with IV cefotaxime for pneumonia treatment in the hospital. Outpatient IV antibiotic therapy has the potential to significantly reduce length of hospital stay for pneumonia without sacrificing clinical efficacy.

Secondary bacterial infections in HIV-infected patients: an alternative ambulatory outpatient treatment utilizing intravenous cefotaxime.

The purpose of this study was to determine the safety and efficacy of home intravenous antibiotic therapy in treating secondary bacterial infections in patients infected with the human immunodeficiency virus (HIV). This study was a subset analysis of 22 patients with HIV, enrolled in two centers of a multicenter, open-label, prospective study. When necessary, patients were stabilized as inpatients, followed by home therapy. Enrolled patients had diagnoses of pneumonia, skin and soft-tissue infections, bacteremia/septicemia, or other infections requiring parenteral therapy. A third-generation cephalosporin, cefotaxime, 1-2 g every 8 hours, was delivered intravenously using an ambulatory delivery system (ADS). Home therapy with cefotaxime/ADS produced a clinical response rate of 95% and bacteriologic response of 88.2%. The requirement for and duration of inpatient therapy was markedly reduced compared with diagnosis-related group (DRG) allotments. In conclusion, home intravenous antibiotic therapy with cefotaxime in patients infected with HIV is effective and safe. It may improve quality of life by reducing the length of hospital stay.

Disfunción sexual y epilepsia / Sexual disfunction and epilepsy

Estudamos 100 pacientes do Ambulatório de Epilepsia do Hospital Docente Dr. Carlos J. Finlay, com o objetivo de conhecer sua atividade sexual. Como grupo controle, 100 pacientes com os seguintes requisitos: näo epilépticos, do mesmo sexo, a mesma ocupaçäo e a mesma faixa de idade dos epilépticos. As variáveis estudadas distribuiram-se em: dados gerais, características clínicas da doença e história sexual. Nos pacientes de ambos os grupos com disfunçäo sexual, para determinar se era funcional ou orgânica, realizamos: pletismografia digital peniana, índice pênis-braço e dosagem dos hormônios folículo estimulante e testosterona. Encontramos um número elevado de epilépticos sem parceiro sexual (Z>1.645) e um número menor com parceiro sexual estável. Näo encontramos nos epilépticos um maior número de disfunçöes sexuais do que no grupo controle, e estas näo guardaram relaçäo com o tipo de crise, nem com o tratamento

Necrotic testicle with increased blood flow on Doppler ultrasonic examination.

A twelve-year-old male with a five-day history of scrotal swelling and pain had increased blood flow on ultrasonic examination. A testicular flow and scan indicated an ischemic testicle. Surgical exploration revealed complete torsion of the spermatic cord. In chronic cases of torsion, the Doppler stethoscope may give a false negative result because of reactive hyperemia.

Bilateral breast uptake of 99mTc polyphosphate in a patient with metastatic adenocarcinoma.

Bilateral breast uptake of 99mTc polyphosphate was found in a patient with metastatic adenocarcinoma from the rectum. The metastatic breast lesion showed no radiographic evidence of calcification.

Combined use of ultrasound and nuclear medicine techniques in kidney disease.

Combined ultrasound and nuclear medicine procedures in the evaluation of urinary-tract disease are essentially limited to the kidneys. They are useful in the evaluation of patients with masses, renal failure, unilateral nonfunctioning kidney, trauma, and transplants. In our experience the combined use of these techniques has increased diagnostic accuracy and in many cases has obviated the need for more complex procedures associated with higher radiation doses. This is an especially important factor in children and in adults in the childbearing age group. We have achieved success with these modalities because of the constant communication between the referring physicians and the ultrasound and nuclear medicine divisions.