RESUMO
OBJECTIVE: To summarize the evidence from randomized controlled trials on the effects of cysticidal therapy used for treating human cysticercosis. METHODS: Published and unpublished studies in any language identified through MEDLINE (1966 - June 1999) specialized databases, abstracts, proceedings and contact with experts were analysed. Those which compared, using randomized or quasi-randomized methods, any cysticidal drug with placebo or symptomatic therapy were entered in the study. Data were extracted independently by two reviewers and trial quality assessed. Meta-analysis using fixed effects models calculated provided there was no significant heterogeneity, expressed as relative risk. RESULTS: Four trials met the inclusion criteria, treating intraparenchymatous neurocysticercosis with either albendazole or praziquantel compared to placebo or no treatment. In the two trials reporting clinical outcomes, treatment was not associated with a reduction in the risk of seizures, although numbers were small (RR 0.95, 95% CI 0.59-1.51). Four trials reported radiological outcomes, and cysticidal treatment was associated with a lower risk of cyst persistence of scans taken within six months of start of treatment (RR 0.83, 95% CI 0.70-0.99). Subsidiary analysis assuming different outcomes in patients lost to follow-up did not alter the findings of the main analysis. CONCLUSIONS: There is insufficient evidence to determine whether cysticidal therapy is of any clinical benefit to patients with neurocysticercosis. The review does not exclude the possibility that more patients remain seizure-free when treated with cysticidal drugs. Further testing through placebo-controlled trials is required.
Assuntos
Anti-Helmínticos/uso terapêutico , Anticestoides/uso terapêutico , Neurocisticercose/tratamento farmacológico , Albendazol/efeitos adversos , Albendazol/uso terapêutico , Anti-Helmínticos/efeitos adversos , Anticestoides/efeitos adversos , Humanos , Neurocisticercose/diagnóstico por imagem , Praziquantel/efeitos adversos , Praziquantel/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Triclorfon/efeitos adversos , Triclorfon/uso terapêuticoRESUMO
Five patients, age 3 weeks to 11 years, presented with supraventricular tachycardia that remained uncontrolled following adequate digitalization. Four of these patients underwent invasive electrophysiologic studies to determine the mechanism of the arrhythmias. Of these four patients, three had concealed Wolff-Parkinson-White syndrome, and one patient had evidence of dual A-V nodal pathways. Propranolol was added to the medical treatment and was administered orally in doses ranging from 7 to 14 mg/kg/day (average 9 mg/kg/day). All five children remain free of their tachycardia except for one patient who occasionally has supraventricular tachycardia with febrile illnesses. No adverse reactions to these high doses of propranolol were encountered.
Assuntos
Propranolol/uso terapêutico , Taquicardia/tratamento farmacológico , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Doenças do Recém-Nascido/sangue , Doenças do Recém-Nascido/tratamento farmacológico , Masculino , Propranolol/administração & dosagem , Propranolol/sangue , Taquicardia/sangueRESUMO
Respiratory rate, tidal volume, dynamic lung compliance, functional residual capacity, and pulmonary resistance were measured withim 24 hours of cardiac catheterization in 25 infants, 12 of whom had increased pulmonary blood flow and 13 of whom had decreased PBF. There were no differences in the two groups of patients with respect to VT and FRC. Respiratory rate and pulmonary resistance were higher in infants with increased PBF. Lung compliance was significantly lower in infants with increased PBF (4.9 ml/cm H2O) than in those with decreased PBF (8.9 ml/cm H2O) (P less than 0.01). The decrease in CL in infants with increased PBF significantly correlated with mean pulmonary artery pressure (r = 0.798). No correaltion was found between CL and left atrial pressure or magnitude of the left-to-right shunt. Compliance was normal in patients with increased PBF and normal PAP, suggesting that PAP and not PBF is the primary factor that affects CL in patients with intracardiac left-to-right shunts.
Assuntos
Cardiopatias Congênitas/fisiopatologia , Pulmão/fisiopatologia , Circulação Pulmonar , Resistência das Vias Respiratórias , Função Atrial , Pressão Sanguínea , Cateterismo Cardíaco , Humanos , Lactente , Complacência Pulmonar , Artéria Pulmonar/fisiologia , Volume Residual , Respiração , Testes de Função Respiratória , Volume de Ventilação PulmonarRESUMO
His bundle and right ventricular apical endocardial electrograms were recorded in 18 patients, ages five to 17 years, of whom ten had atrial septal defect of the secundum type and eight had mild aortic stenosis. The H-RVA interval was assumed to approximate conduction time from the level of the His bundle along the RBB to the site of earliest activation in the right ventricle at the RVA. The H-V interval was normal in all patients (less than or equal to 40 msec). All patients in the ASD group had an rsR' or rSr' pattern in Vl with a mean duration of 99 +/- 9 msec (86 to 116 msec); the mean duration of the H-RVA intervals was 54 +/- 6 msec in this group. In patients with AS, the surface electrocardiograms were normal, with a mean QRS duration of 82 +/- 8 msec (70 to 95 msec); the H-RVA intervals averaged 52 +/- 6 msec. The difference in the H-RVA intervals in the two groups was not statistically significant (P greater than 0.50) despite the fact that patients with ASD had significant prolongation of QRS duration (P greater than 0.001). Moreover, when functional RBB block was induced by premature atrial stimulation in the ASD group, the prolongation of QRS duration was accompanied by an increase in H-RVA interval, indicating relatively intact function of the RBB. It is concluded that the rsR' or rSr' pattern in ASD is likely to be a manifestation of right ventricular overload rather than a true conduction delay in the RBB.