Cluster headache in children and adolescents: ten years of follow-up in three pediatric cases.

BACKGROUND: Cluster headache (CH) is a rare cause of headache in children. Onset before 12 years of age is unusual, and long-term follow-up of pediatric cases has been not reported. OBJECTIVES: To report three cases of CH with onset at childhood and at least ten years of follow-up. METHODS: Case report. RESULTS: The first case is that of a 12-year-old boy with episodic CH with unilateral pain and striking, bilateral autonomic manifestations, remitted for over eight years. The second case is unique in that it reports a case of chronic CH in a 13-year-old boy with Down syndrome. The third case is that of a 9-year-old girl with episodic CH with remissions of 2 and 5 years. All cases had prominent autonomic features. The frequency and duration of the attacks were similar to those that have been reported in adults. Good response to indomethacin was obtained in two cases, although tolerability issues occurred in one. CONCLUSION: Sustained, long-term, medical and/or spontaneous remission occurs in CH of early onset. The phenotype and response to therapy in children, at least in these case examples, are similar to equivalent observations in adult patients with CH.

Dyspepsia in HIV-infected patients under highly active antiretroviral therapy.

BACKGROUND AND AIM: Upper gastrointestinal symptoms, mainly dyspepsia, are common adverse effects in patients under highly active antiretroviral therapy (HAART). Whether it is worthwhile to perform endoscopy early in their treatment is a matter of debate. We have done a prospective study of the prevalence and the etiology of endoscopic lesions in a large cohort of dyspeptic adult HIV-infected patients under HAART, according to their immunological status. METHODS: 528 (334 men and 194 women, mean age 38) HIV-infected patients under HAART with epigastric pain and/or nausea and vomiting underwent upper endoscopy. Patients were classified in two groups, according to CD4 cells counting (>200 cells/mm(3) or < or =200 cells/mm(3)). Gastric and duodenal biopsies were taken from normal mucosa and any lesion found. RESULTS: Gastric mucosa alterations were seen in 61.74% of patients (40.71% erythema, 18.38% erosion and 2.65% ulcer). Duodenum mucosa alterations were seen in 25.37% of patients, mainly erosions (19.50%) and ulcer (3.59%). There was no difference in endoscopic findings according to CD4 cell count groups. Chronic active gastritis was shown in 459 patients (86.93%). H. pylori infection was seen in 32.38%, and it was more prevalent in the group with CD4 > 200 (p < 0.01). Opportunistic infections and malignancies were seen exclusively in patients with CD4 < or = 200. CONCLUSIONS: Most of the endoscopic lesions in dyspeptic HIV-infected patients under HAART were not related to AIDS. Upper endoscopy was more helpful in dictating clinical treatment in patients with low CD4 counts (< or =200) and should be done earlier in this group.

Gastric emptying effect by 4-aminopyridine in patients with chronic spinal cord injury.

BACKGROUND: 4-Aminopyridine (4-AP) given to patients with chronic spinal cord injury (SCI) has shown beneficial effects in some somatic and autonomic functions, although patients often develop dyspeptic symptoms. 4-AP is a potassium-channel blocker capable of altering gastro-pyloric functions as demonstrated experimentally. Our objective was to examine the influence of 4-AP treatment on gastric emptying in patients with chronic SCI. METHODS: Gastric emptying was measured by the acetaminophen absorption test in 18 patients (9 with cervical and 9 with thoracic injury), and 9 healthy volunteers. Patients received increasing oral doses, 5 mg day(-1) of oral 4-AP (5-30 mg day(-1)), for 12 weeks. Patients were studied before and at the end of the last week of 4-AP treatment, whereas healthy volunteers (without 4-AP treatment) were studied only once. Whole blood samples of 2.5 mL were drawn at 0 (before 1 g of oral acetaminophen) and at 15, 30, 45, 60, 75, 90, 105 and 120 min postdose. Acetaminophen concentration in plasma was determined by high-pressure liquid chromatography. RESULTS: Treatment with 4-AP significantly delayed stomach emptying in patients with chronic SCI, considering the significant decreasing of acetaminophen absorption (t paired test, p <0.05). This effect did not correlate either to the level or ASIA score of the injury (linear regression correlation analysis, r(2) = 0.003 and 0.015, respectively). No significant differences were observed by comparing data of patients before 4-AP treatment with healthy volunteers. CONCLUSIONS: 4-AP intake in patients with chronic spinal cord injury significantly slowed gastric emptying regardless of level and ASIA score of the injury.

Valdecoxib provides effective pain relief following acute ankle sprain.

We sought to determine whether valdecoxib is as effective as diclofenac in treating acute ankle sprain. Patients (n=202) with acute first- and second-degree ankle sprain were randomized to valdecoxib (40 mg twice daily on day 1 followed by 40 mg once daily on days 2-7) or diclofenac (75 mg twice daily). The primary efficacy end-point was the Patient's Assessment of Ankle Pain visual analogue scale (VAS, 0-100 mm) value on day 4. Valdecoxib was as efficacious as diclofenac in treating the signs and symptoms of acute ankle sprain. The mean VAS reduction in ankle pain on day 4 was not different between groups; the two-sided 95% confidence interval for the between-group difference was within the prespecified limit for non-inferiority (10 mm). There were no significant differences between groups for all secondary efficacy end-points. The two treatments were similarly effective and well tolerated for treatment of acute ankle sprain.

Treatment of tinea pedis with a single pulse of itraconazole.

An open-design, prospective, non-comparative study was conducted to evaluate the efficacy and safety of itraconazole in the treatment of tinea pedis (interdigital-type, hyperkeratotic-type and the combination of both). Treatment consisted of one pulse of itraconazole, meaning that each patient received 400 mg/day for one week. Clinical and mycologic control examinations were performed at baseline and at the end of treatment; follow-up visits took place at 30 and 60 days after the last medication administration. A total of 44 patients were evaluated. The major causal agent isolated was Trichophyton rubrum (93%). At the final follow-up visit (60 days), 37 cases (84.4%) achieved clinical and mycologic cure; 5 (11.3%) had improvement and 2 cases (4.5%) failed. Three cases reported side effects attributable to itraconazole (6.6%); one patient had a moderate headache and two reported moderate dyspepsia. None of the 3 cases required discontinuation of the medication. We concluded that the administration of one pulse of itraconazole is an effective, safe and short regimen to treat tinea pedis.

Methotrexate in the treatment of ankylosing spondylitis.

The authors carried out an open prospective study analyzing methotrexate (MTX) efficacy and toxicity in 34 patients with ankylosing spondylitis (AS) for a period of one year. All the patients presented with active axial disease, characterized by inflammatory spinal pain, prolonged morning stiffness, erythrocyte sedimentation rate (ESR) > or = 25 mm, and failure on treatment with non-steroidal anti-inflammatory drugs for a period of more than two years. MTX was taken at a single weekly intramuscular dose of 12.5 mg. Thirty-one patients (91%) concluded treatment. Eighteen patients (53%) were considered responders to MTX; most of them presented peripheral arthritis. Despite clinical improvement, axial measures were unaltered at the end of the study. The mean value of ESR decreased significantly at the end of the treatment (p=0.0001), predominantly in the responders group. Side effects were observed in 23 patients (68%) and included dyspeptic syndrome, transient elevation of liver enzymes, and dizziness. The results of this one year open study suggest that MTX can be an efficient drug in the treatment of AS.

[Preliminary report on the effect of low doses of azidothymidine (AZT) in the treatment of patients with stage III infection by human immunodeficiency virus (HIV)]. / Informe preliminar del efecto de las dosis bajas de azidotimidina (AZT) en el tratamiento de pacientes con estadio III de infección por el virus de la inmunodeficiencia humana (VIH).

Ten patients with CDC stage III of infection by HIV were treated with AZT at doses of 300 mg/day (100 mg tid). There were 5 males and 5 females, the median age being 40.5 yr' (range 26-46). Seventy percent of them had transfusion-associated HIV infection and the rest had been infected by the sexual route. A positive clinical response was observed in 100% of the group after 16-24 weeks of treatment: the Karnofsky performance status increased from 64% to 94% (p less than 0.01), the white blood cell count raised from 3.7 to 6.0 K/microL (p less than 0.01), the number of helper lymphocytes (CD4+) also raised significantly from 248.2 to 470.7/uL (p less than .01). Only two patients required red blood cells transfusions. The life expectancy at 82 weeks was 90%. Toxicity was both moderate and transitory. It is concluded that low doses of AZT (300 mg/day) produce similar clinical results as doses of 1200-1500 mg/day. A larger study is needed to support our preliminary findings.