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Background: Current guidelines recommend antifungal prophylaxis for children at high risk for invasive fungal disease (IFD), but the use of polyenes and triazoles may not be feasible in some patients due to toxicities and drug-drug interactions. Micafungin is well tolerated, with intravenous daily dosing being the current standard. Recent reports indicate safety and efficacy of intermittent dosing of micafungin. Methods: We analysed safety, efficacy and micafungin serum concentrations of children at high risk for IFD receiving prophylactic micafungin between 3 and 4 mg/kg twice weekly. All children were intolerant or had contraindications to polyenes and triazoles. Results: A total of 21 children (median age = 9 years) at high risk for IFD were included in the analysis. No significant clinical adverse event occurred, and end of treatment values of parameters of renal and hepatic function in serum were not different from baseline. Proven or probable breakthrough IFD did not occur in any of the patients. In 9 out of 11 patients in whom plasma micafungin concentrations were assessed, the first trough concentration exceeded 150 ng/mL, a concentration proposed to be effective for prophylaxis. Conclusions: Our data indicate that micafungin administered twice weekly at a dosage of 3 - 4 mg/kg of bodyweight could be a convenient, safe and efficient alternative for antifungal prophylaxis in children at high risk for IFD. [ABSTRACT FROM AUTHOR]

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Background: The hypoxemia of the hepatopulmonary syndrome, seen in patients with severe chronic liver dysfunction, results from widespread pulmonary vasodilation. No established drug therapy is available for this condition.Objective: To study the effect of methylene blue, a potent inhibitor of guanylate cyclase, in patients with severe hepatopulmonary syndrome.Design: Open, uncontrolled trial.Setting: Medical intensive care unit at the university hospital in Vienna, Austria.Patients: 7 patients with advanced cirrhosis and severe hepatopulmonary syndrome with PaO(2) of 60 mm Hg or less.Intervention: Insertion of a pulmonary artery catheter and an arterial indwelling catheter; intravenous administration of methylene blue, 3 mg/kg of body weight, over a 15-minute period.Measurements: Serial measurements of gas exchange and hemodynamic variables.Results: After methylene blue administration, PaO(2) increased in all patients (from a baseline mean +/- SD of 58 +/- 2.5 mm Hg to 74 +/- 11.5 mm Hg 5 hours after infusion; P = 0.006) and the alveolar-arterial difference for partial pressure of oxygen (PAO(2) - PaO(2) ) decreased in all patients, with a maximum effect achieved after 5 hours (from 49 +/- 3.3 mm Hg to 30 +/- 10.4 mm Hg; P = 0.003); even after 10 hours, PAO(2) - PaO(2) was still significantly reduced compared with baseline (P = 0.041). Oxygenation improved because of reduction in shunt fraction (from 41% +/- 3.1% to 25% +/- 4.5%; P < 0.001). Mean pulmonary artery pressure increased (from 20 +/- 5.2 mm Hg to 23 +/- 3.6 mm Hg; P = 0. 028), as did pulmonary vascular resistance (from 58 +/- 23 dyne/sec. cm(-5) to 115 +/- 56 dyne/sec. cm(-5); P = 0.012). Arterial blood pressure did not change significantly. Cardiac output decreased (from 10.6 +/- 2.2 L/min to 8.6 +/- 2.7 L/min; P = 0.008) and systemic vascular resistance increased (from 527 +/- 144 dyne/sec. cm(-5) to 729 +/- 222 dyne/sec. cm(-5); P = 0.037). Heart rate, central venous pressure, and pulmonary capillary wedge pressure remained unchanged.Conclusion: Intravenous methylene blue improved hypoxemia and hyperdynamic circulation in patients with liver cirrhosis and severe hepatopulmonary syndrome. [ABSTRACT FROM AUTHOR]

The article presents several case studies related to the treatment of pathological gambling (PG) with disulfiram. The 44-year-old married male presented with intensive craving for gambling and conflicts with his wife has reported complete remission of sedation and reduction of craving after one week of discontinued use of disulfiram. Meanwhile, the 56-year-old divorced and unemployed male has developed a psychotic syndrome after 10 days of disulfiram medication.

The article presents a case study of an old man diagnosed with duodenal adenocarcinoma and treated with adapted Kausch-Whipple operation with gastro-pancreatic anastomosis. It notes that a vacuum drainage system was placed inside the stomach of the patient and was put on full oral nutrition. It points out that his perianastomotic drain was removed.

The article presents an overview of a study which examined rapid eye movement (REM)-sleep behavior disorder (RBD) in a controlled clinical trial. Two groups of patients who were given placebo and melatonin during the treatment period. Polysomonograpahy and REM-sleep score are used. A contrast between clonazepam and melatonin as treatment for RBD is considered.

Presents a summary of the report 'Methylene blue improves the hepatopulmonary syndrome,' published in 'Annals of Internal Medicine,' November 7, 2000 issue.

Background Meta-analyses comparing the short-term clinical outcomes of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) and electroconvulsive therapy (ECT) in major depression produced conflicting results. The aim of the current study was to summarise the results of these meta-analyses. Methods A systematic literature search of PubMed and PsycInfo (any time – 13.01.2016) identified k = 4 systematic reviews (published in 2010–2014) comparing the clinical outcomes of ECT and HF-rTMS in major depression using quantitative meta-analysis. The short-term outcomes were the standardised mean change scores (baseline – last stimulation) on depression scales and odds or risk ratios of response, remission, and acceptability (dropout) rates. Since different meta-analytical approaches were used, we have pooled the effects using random-effects model with inverse-variance weights based on data shown in reviews. Results The k = 4 reviews included different combinations of k = 8 open-label or single-blind, randomised primary studies with major depression patients. Most studies utilised right unilateral ECT (2.5 times the seizure threshold, 6–12 sessions) and HF-rTMS (10–20 Hz) of the left dorsolateral prefrontal cortex (90–110% of the resting motor threshold, 10–20 sessions). The pooled weighted effects favoured ECT over HF-rTMS in terms of reduction in depression severity (change scores in k = 2 reviews), while response and acceptability rates of both methods were similar (in k = 2 and k = 3 reviews respectively), and remission rates were inconsistent in k = 3 reviews (possibly due to heterogeneous definitions of remission). The individual study effect sizes favoured ECT over HF-rTMS in terms of reduction in depression severity and remission rate in studies with psychotic major depression patients. Conclusion Uniform meta-analytical approaches suggest that ECT might be clinically superior to HF-rTMS in psychotic major depression, while the clinical outcomes tend to be similar in non-psychotic major depression in the short-term treatment. Future blinded randomised trials are required to compare the long-term clinical outcomes of both methods in clinically-homogeneous samples with major depression. [ABSTRACT FROM AUTHOR]

Survival from a malignant hyperthermia (MH) crisis is highly dependent on early recognition and prompt action. MH crises are very rare and an increasing use of total i.v. anaesthesia is likely to make it even rarer, leading to the potential risk of reduced awareness of MH. In addition, dantrolene, the cornerstone of successful MH treatment, is unavailable in large areas around the world thereby increasing the risk of MH fatalities in these areas. The European Malignant Hyperthermia Group collected and reviewed all guidelines available from the various MH centres in order to provide a consensus document. The guidelines consist of two textboxes: Box 1 on recognizing MH and Box 2 on the treatment of an MH crisis. [ABSTRACT FROM PUBLISHER]