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Effects of naloxone infusions in patients with the pruritus of cholestasis
Journal of the AmericanAcademyof Dermatology Volume 34, Number 2, Part 1
Pearls of wisdom
279
Abstracts from the literature Virologic characteristics of subclinical and symptomatic genital herpes infections Wald A, Zeh J, Selke S, et al. N Engl J Med 1995; 333:770-5. Subclinical viral shedding was studied prospectively in 110 women with a history of genital herpes simplex. Daily specimens were collected from the vulva, cervix, and rectum for viral culture during a mean follow-up period of 105 days. The rate of subclinical shedding was higher than that reported previously and occurred on 2% of the days sampled overall. Of the 110 women, subclinical shedding of herpes simplex virus (HSV) was found on at least one day in 36 (55%) of the 65 women with HSV-2 infection, 16 of 31 (52%) with both HSV-1 and HSV-2 infection, and 4 of 14 (29%) with HSV-1 infection alone. Overall, subclinical shedding occurred in one third of the total days of reactivation of herpes. Subclinical shedding was correlated with recent activation of genital herpes and high frequency of clinical recurrences. Episodes of asymptomatic shedding occurred in clusters of days, half within 1 week of a recurrence of symptoms. Epidemiologic studies show that most new infections of genital herpes are acquired from partners with unrecognized infections, indicating the need for strategies to reduce asymptomatic shedding. Elizabeth A. Abel, MD
ceUulare as the causative agent in the majority of cases. This retrospective review reinforced the point that surgical excision of the affected lymph nodes is the treatment of choice. In this setting, antituberculous chemotherapy is usually ineffective. Kenneth J. Tomecki, MD
Effects of naloxone infusions in patients with the pruritus of cholestasis Bergasa NV, Ailing DW, Talbot TL, et al. Ann Intern M e d 1995; 123:161-7. In this study, a double-blind, placebo-controlled, crossover trial was performed of naloxone infusions in 29 patents with pruritus associated with liver disease. Each patient received as many as two naloxone and two placebo solution infusions consecutively in random order. Each infusion lasted 24 hours. Naloxone administration ameliorated the perception of pruritus and reduced scratching activity in patients with cholestasis when compared with that during placebo administration. These results suggest that a mechanism underlying the pruritus of cholestasis is modulated by endogenous opioids. Opiate antagonists could be useful in the management of this complication of jaundice. COMMENT:Perhaps a new approach for the treatment of other pruritic problems as well?
Nontuberculous mycobacterial infections of the head and neck
Neal S. Penneys, MD
Stewart MG, Starke JR, Coker NJ. Arch Otolaryngol Head Neck Surg 1994; 120:873-6. Twenty-six children with nontuberculous mycobacterial infections were hospitalized at Texas Children's Hospital, Houston, during a 5-year period (1987-1991). Myr avium-ino'acellulare was the most common isolate (17 patients). All children underwent surgery. Eleven had incisional biopsy or incision and drainage; of those, eight had a recurrence or a sinus tract that required further surgery. Fifteen had a complete excision, with only one recurrence. On the basis of this study, excisional biopsy was the diagnostic procedure and the treatment of choice for nontuberculous mycobacterial adenitis. COMMENT: Most nontuberculous infections of the head and neck occur in healthy persons, with M. avium-intra-
Generalized elastolysis (cutis laxa): case study illustrating associated medical and surgical conditions Polsen C, Netsher DT, Green L, et al. South Med J 1995;88:753-7. Curls laxa is a rare disease of elastic tissue that occurs in both inherited and acquired forms. The inherited types may be either autosomal dominant or autosomal recessive. Two acquired forms have been described. A 69year-old man with acquired curls laxa ptosis of the upper eyelid, laxity of the lower eyelid leading to epiphoria, "bloodhound" facies, excessive sagging of the abdominal skin, and a fight femoral hernia. He also had emphy-
Pearls of wisdom
279
Abstracts from the literature Virologic characteristics of subclinical and symptomatic genital herpes infections Wald A, Zeh J, Selke S, et al. N Engl J Med 1995; 333:770-5. Subclinical viral shedding was studied prospectively in 110 women with a history of genital herpes simplex. Daily specimens were collected from the vulva, cervix, and rectum for viral culture during a mean follow-up period of 105 days. The rate of subclinical shedding was higher than that reported previously and occurred on 2% of the days sampled overall. Of the 110 women, subclinical shedding of herpes simplex virus (HSV) was found on at least one day in 36 (55%) of the 65 women with HSV-2 infection, 16 of 31 (52%) with both HSV-1 and HSV-2 infection, and 4 of 14 (29%) with HSV-1 infection alone. Overall, subclinical shedding occurred in one third of the total days of reactivation of herpes. Subclinical shedding was correlated with recent activation of genital herpes and high frequency of clinical recurrences. Episodes of asymptomatic shedding occurred in clusters of days, half within 1 week of a recurrence of symptoms. Epidemiologic studies show that most new infections of genital herpes are acquired from partners with unrecognized infections, indicating the need for strategies to reduce asymptomatic shedding. Elizabeth A. Abel, MD
ceUulare as the causative agent in the majority of cases. This retrospective review reinforced the point that surgical excision of the affected lymph nodes is the treatment of choice. In this setting, antituberculous chemotherapy is usually ineffective. Kenneth J. Tomecki, MD
Effects of naloxone infusions in patients with the pruritus of cholestasis Bergasa NV, Ailing DW, Talbot TL, et al. Ann Intern M e d 1995; 123:161-7. In this study, a double-blind, placebo-controlled, crossover trial was performed of naloxone infusions in 29 patents with pruritus associated with liver disease. Each patient received as many as two naloxone and two placebo solution infusions consecutively in random order. Each infusion lasted 24 hours. Naloxone administration ameliorated the perception of pruritus and reduced scratching activity in patients with cholestasis when compared with that during placebo administration. These results suggest that a mechanism underlying the pruritus of cholestasis is modulated by endogenous opioids. Opiate antagonists could be useful in the management of this complication of jaundice. COMMENT:Perhaps a new approach for the treatment of other pruritic problems as well?
Nontuberculous mycobacterial infections of the head and neck
Neal S. Penneys, MD
Stewart MG, Starke JR, Coker NJ. Arch Otolaryngol Head Neck Surg 1994; 120:873-6. Twenty-six children with nontuberculous mycobacterial infections were hospitalized at Texas Children's Hospital, Houston, during a 5-year period (1987-1991). Myr avium-ino'acellulare was the most common isolate (17 patients). All children underwent surgery. Eleven had incisional biopsy or incision and drainage; of those, eight had a recurrence or a sinus tract that required further surgery. Fifteen had a complete excision, with only one recurrence. On the basis of this study, excisional biopsy was the diagnostic procedure and the treatment of choice for nontuberculous mycobacterial adenitis. COMMENT: Most nontuberculous infections of the head and neck occur in healthy persons, with M. avium-intra-
Generalized elastolysis (cutis laxa): case study illustrating associated medical and surgical conditions Polsen C, Netsher DT, Green L, et al. South Med J 1995;88:753-7. Curls laxa is a rare disease of elastic tissue that occurs in both inherited and acquired forms. The inherited types may be either autosomal dominant or autosomal recessive. Two acquired forms have been described. A 69year-old man with acquired curls laxa ptosis of the upper eyelid, laxity of the lower eyelid leading to epiphoria, "bloodhound" facies, excessive sagging of the abdominal skin, and a fight femoral hernia. He also had emphy-