The American journal of medicine
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Multicenter Study Clinical Trial
Itraconazole treatment of disseminated histoplasmosis in patients with the acquired immunodeficiency syndrome. AIDS Clinical Trial Group.
Amphotericin B has been the treatment of choice for disseminated histoplasmosis in patients with acquired immunodeficiency syndrome (AIDS). Oral antifungal agents would be welcome alternatives to standard treatment of disseminated histoplasmosis in less severe cases. The purpose of this study was to assess the efficacy and safety of itraconazole therapy in patients with AIDS and disseminated histoplasmosis. ⋯ Itraconazole is safe and effective induction therapy for mild disseminated histoplasmosis in patients with AIDS, offering an alternative to amphotericin B in such cases. Patients with moderately severe or severe histoplasmosis should first be treated with amphotericin B and then may be switched to itraconazole after achieving clinical improvement.
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Clinical Trial
Adrenal insufficiency occurring during septic shock: incidence, outcome, and relationship to peripheral cytokine levels.
In patients with septic shock, to (1) determine the incidence of adrenal insufficiency (AI), (2) observe the effects of glucocorticoid therapy on outcome in those with impaired adrenal function, and (3) investigate a possible correlation between adrenal function and peripheral cytokine levels. ⋯ Adrenal hyporesponsiveness is a feature of septic shock in some patients. Its etiology is probably complex. Steroid supplementation appeared to improve short-term survival when AI occurred, although these patients' overall mortality was worse than that of patients with septic shock and AAR. The standard-dose (250 micrograms) rapid ACTH infusion test was adequate for detecting AI. Adrenal insufficiency should be suspected in patients with septic shock who do not respond to conventional treatment. Performing the ACTH infusion test and initiating a trial of stress doses of glucocorticoids pending the results is a reasonable strategy in this situation.
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To determine the frequency, recurrence patterns, and host factors associated with nongenital herpes simplex virus lesions. ⋯ Overall, 21% of patients with primary genital herpes will have or will subsequently develop a nongenital recurrence. Among patients with HSV-1, nongenital lesions tended to occur more often on the hand and face, whereas HSV-2 lesions appeared more often on the buttocks. Buttock lesions due to HSV recur less frequently but last longer than genital lesions.
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Prospective studies have shown that bone mass, measured by any method and at any site, is inversely related to a woman's risk of fracture. Most types of fractures are more frequent in women with low bone mass. Bone mineral density measured in the proximal femur appears to have a stronger relationship to risk of hip fracture than bone density measured in other sites. ⋯ A woman's lifetime risk of hip fracture can be estimated from bone mass measurements made in the perimenopausal period. Although an individual's level of bone mass may vary from site to site, the incremental value of measuring bone mass in more than one site is not certain. Bone mass measurements, perhaps in combination with other risk factors for fracture, help define individuals with a high risk of fracture who stand to benefit most from efforts to prevent fractures.
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The aim of the study was to investigate the mechanisms of myocardial catecholamine refractoriness in septic shock. ⋯ An increase in the expression of Gi alpha could also be important in conditions other than chronic heart failure, eg, septic shock. An increase of Gi alpha could play a pathophysiologically relevant role in catecholamine refractoriness in septic shock and could provide a target for pharmacologic treatment in this condition.