Giant Cell Arteritis Presenting as an Ischaemic Upper Limb

Aim To present an interesting case of giant cell arteritis presenting as ischaemic upper limb. Methods Data was collected from the patient's chart and from radiology and laboratory systems in our institution. Results The patient had a temporal artery biopsy confirming the diagnosis of temporal arteritis. This was successfully treated with high dose steroids leading to resolution of symptoms in the arm. Conclusion Arteritis is an important consideration to consider in patients who present with limb ischaemia as it is a reversible cause which can be treated effectively.

Synthesis and antiviral evaluation of N-carboxamidine-substituted analogues of 1-beta-D-ribofuranosyl-1,2,4-triazole-3-carboxamidine hydrochloride.

Ten, hitherto unreported, analogues of 1-beta-D-ribofuranosyl-1,2,4-triazole-3-carboxamidine hydrochloride (2a, ribamidine) and methyl carboximidate 5 have been synthesized. These include the N-cyano (2b), N-alkyl (2c-e), N-amino acid (2f-h), N,N'-disubstituted (6, 7a,b), and the N-methylated carboxamide (1f) analogues of ribavirin. In addition, a new facile synthesis of carboxamidine 2a was also developed. All compounds were evaluated for biological activity against the following RNA viruses: Punta Toro (PT) and sandfly fever (SF) viruses (bunyaviruses); Japanese encephalitis (JE), yellow fever (YF), and dengue-4 viruses (flaviviruses); parainfluenza type 3 (PIV3), respiratory syncytial virus (RSV), and measles viruses (paramyxoviruses); influenza A and influenza B viruses (orthomyxoviruses); Venezuelan equine encephalomyelitis virus (VEE, alphavirus); human immunodeficiency virus type-1 (HIV-1, lentivirus); the DNA-containing vaccinia (VV) virus (poxvirus); and adeno type 5 (Ad5) viruses. All of the compounds except for 2b and 7a,b exhibited activity against the bunyaviruses such as that observed with 2a; however, higher IC50 values were generally observed. Glycine analogue 2f showed activity in PT-virus-infected mice in terms of increased survivors and decreased markers of viral pathogenicity. Carboxamidine 2a, carboximidate 5, and dimethyl amidine 6 exhibited activity against dengue type-4 virus. Monomethyl amidine 2c demonstrated activity against RSV, PIV3, and, to a lesser extent, influenza A and B. Activity of 2c generally required higher IC50 values than unsubstituted 2a. The latter exhibited hitherto unreported activity against RSV; therapeutic indices for 2a against RSV and PIV3 were greater than 64 and greater than 21. No substantial in vitro activity was observed for any of the compounds tested against Ad5, measles, JE, YF, VEE, or HIV-1. In addition, evidence is presented which argues in favor of a distinct antiviral mechanism of action for carboxamidines, e.g. 6, in contrast to a role as a carboxamide precursor.

Acute posterior ophthalmomyiasis interna treated with photocoagulation.

PURPOSE/METHODS: We studied a patient with subretinal myiasis with pain and rapidly progressive visual loss and found that prompt photocoagulation resulted in marked visual improvement. A 16-year-old boy had subconjunctival hemorrhage and periocular pain associated with progressive visual loss of 6/200 over a four-day period. RESULTS/CONCLUSIONS: A live maggot found crawling in the subretinal space was promptly photocoagulated with an argon green laser. Within one month, the visual acuity improved to 20/50. Laser treatment of a subretinal larva does not generally induce marked inflammation and often results in good visual recovery.

Intestinal absorption in patients with rheumatoid arthritis treated with methotrexate.

Twelve patients with rheumatoid arthritis treated for at least 12 months with methotrexate and 11 matched rheumatoid arthritis controls underwent a standard d-xylose absorption test. No patients had any pre-existing clinical of biochemical evidence of malabsorption. No significant difference was observed in the 1 hour plasma d-xylose estimation between methotrexate treated patients and controls. The 2 to 5 hour urinary excretion ratio, however, was significantly lower in the methotrexate-treated group compared with controls indicating a minor degree of malabsorption. Six of the methotrexate treated patients and 5 of the controls underwent endoscopic duodenal biopsy but neither group demonstrated any significant histological changes. In conclusion, methotrexate therapy in patients with rheumatoid arthritis produces mild intestinal malabsorption.

Contact transscleral Nd:YAG laser cyclophotocoagulation for the treatment of refractory pediatric glaucoma.

BACKGROUND AND OBJECTIVE: Nd:YAG contact transscleral laser cyclophotocoagulation (CTLC) has been used in the treatment of adult glaucoma patients. However, little information is available regarding the use of this modality in pediatric glaucoma. PATIENTS AND METHODS: We retrospectively studied 10 pediatric patients (ages 8 months to 13 years) treated with Nd:YAG CTLC for refractory glaucoma. All patients were treated using our standard technique in an outpatient setting. Average treatment energy was 190.5 +/- 35.0 J. RESULTS: The overall result was an average intraocular pressure (IOP) reduction of 48% +/- 6%. An IOP of less than 21 mm Hg was achieved in five patients (50%), and the average follow up was 15.5 +/- 5 months. Retreatment was required in 7 of 10 eyes. Loss of vision was seen in four patients, and one case of phthisis bulbi was noted. CONCLUSION: Nd:YAG CTLC effectively lowers IOP in refractory pediatric glaucoma.