Uncommon headache syndromes can be classified into two broad categories: (1) urgent conditions, including subarachnoid hemorrhage, giant cell arteritis and bacterial meningitis, and (2) special syndromes, such as cluster headache, migraine with aura and
The etiology of primary nocturnal enuresis remains somewhat controversial but may include genetic factors, decreased functional bladder capacity, increased diuresis at night, and constipation. Deep sleep and emotional illness usually play only a minimal
In evaluating recurrent childhood infections, the physician must keep in mind the rarity of true immunodeficiency and the frequency of atopy, day care, exposure to cigarette smoke and anatomic variations as predisposing factors in recurrent childhood il
Recent reviews of the effect of estrogen on the cardiovascular system suggest that long-term estrogen replacement therapy after menopause may prevent cardiovascular disease in women who are at risk. Short-term effects of estrogen on coronary vascular re
Chlamydia trachomatis and Trichomonas vaginalis are common sexually transmitted infections associated with adverse pregnancy outcome. Since patients are frequently asymptomatic, diagnosis on the basis of symptoms or physical findings is unreliable. If m
Acute cholecystitis is a common abdominal condition resulting from chemical or bacterial inflammation of the gallbladder. It is generally related to gallstones and subsequent unresolved obstruction. Early surgery is the treatment of choice because of th
Lindane has been the primary therapy for scabies for more than 30 years. However, because of neurotoxic side effects attributed to this drug, alternative drugs such as 5 percent permethrin have been used, particularly in the pediatric population where t
Clodronate is a second-generation bisphosphonate that has shown the ability to induce substantial gains in bone mineral density when administered in a cyclical regimen in patients with osteoporosis. Because progressive gains in calcium balance and bone
Diagnostic imaging of the spinal canal in the pediatric population is primarily performed to evaluate the presence of congenital malformations, trauma, neoplasms and inflammation. Although magnetic resonance imaging (MRI) is considered the diagnostic mo
Nearly one-half of all spinal injuries occur in motor vehicle accidents, with falls, sports injuries and assaults comprising the remainder. One-half of all spinal injuries occur in the cervical region, with associated risks of quadriplegia. Patients wit
Date: August, 1991
Pneumocystis carinii pneumonia is the most important opportunistic infection in patients with the acquired immunodeficiency syndrome. Since the infection is usually restricted to the lungs, inhaled pentamidine has been shown to be effective in preventing relapse in patients who have had an episode of P. carinii pneumonia. While the use of inhaled pentamidine has been accepted in secondary prevention of P. carinii pneumonia, its use in primary prevention has not been well evaluated. In a European study, Hirschel and colleagues evaluated the efficacy of inhaled pentamidine in the primary prevention of P carinii pneumonia.
Included in the study were 223 patients who were seropositive for human immunodeficiency virus (HIV), had no history of R carinii pneumonia and had CD4 Tlymphocyte counts of less than 200 per mm 3(200 X 10.sup.6 per L). Patients received either 300 mg of pentamidine isethionate (114 patients) or 300 mg of sodium isethionate (109 patients) every 28 days by inhaler.
After one year, eight patients receiving pentamidine had an episode of P carinii pneumonia (an incidence of 8.6 percent per patient-year), compared with 23 patients receiving placebo (27.1 percent per patient-year). With the exception of occasional moderate to severe coughing, pentamidine was well tolerated.
The study findings indicate that inhaled pentamidine is 60 to 70 percent effective in preventing a first episode of P carinii pneumonia in patients with HIV infection. (New England Journal of Medicine, April 18, 1991, vol. 324, p. 1079.)
COPYRIGHT 1991 American Academy of Family PhysiciansCOPYRIGHT 2004 Gale Group