INTRODUCTIONLymphoedema results from impaired lymphatic transport leading to the pathologic accumulation of protein-rich lymphatic fluid in the interstitial space, most commonly in the extremities. Primary lymphoedema, a developmental abnormality of the lymphatic system, may become evident later in life when a triggering event exceeds the capacity of normal lymphatic flow.

CLINICAL PICTUREWe present a 3-year-old nephrotic syndrome patient with an unusual localisation for primary lymphoedema.

TREATMENT AND OUTCOMEThe patient was treated with conservative approach and she was cured.

CONCLUSIONIn this particular case, lymphoedema developed at an unusual localisation, which has not been recorded before.

Albumins ; administration & dosage ; Child, Preschool ; Diuretics ; administration & dosage ; Female ; Furosemide ; administration & dosage ; Humans ; Infusions, Intravenous ; Lymphedema ; drug therapy ; etiology ; Nephrotic Syndrome ; complications ; Oliguria ; etiology

OBJECTIVES: The aims of this study were to investigate the feasibility of isosorbide delivery into perilymph through the round window membrane (RWM), and to compare the intracochlear isosorbide concentration in perilymph after oral administration (PO) versus that after round window perfusion (RWP). METHODS: Sixteen male guinea pigs (32 ears) were used. Isosorbide, an osmotic diuretic, was administered via RWP or PO. First, to investigate the optimal perfusion time, perilymph sampling of scala tympani from the RWM was performed after RWP for 15, 30, or 60 minutes. Second, to compare the drug concentration after RWP versus that after PO, perilymph was aspirated at 3 and 6 hours after administration. Intracochlear concentration of isosorbide was analyzed by high-performance liquid chromatography coupled to refractive index detection. RESULTS: Isosorbide passed through the RWM into perilymph after RWP. After RWP for 15, 30, and 60 minutes, mean isosorbide concentrations in perilymph were 116.27+/-44.65, 245.48+/-112.84, and 279.78+/-186.32 mM, respectively. The intracochlear concentration after RWP for 30 minutes was higher than that after RWP for 15 minutes (P=0.043). At 3 and 6 hours after PO, isosorbide concentrations in perilymph were 28.88+/-4.69 and 12.67+/-2.28 mM, respectively. In contrast, the corresponding concentrations after RWP were 117.91+/-17.70 and 75.03+/-14.82 mM at 3 and 6 hours, respectively. Isosorbide concentrations in perilymph following RWP were significantly higher than those following PO at both 3 and 6 hours (P=0.025 and P=0.034, respectively). CONCLUSION: Isosorbide can rapidly pass through the RWM after RWP in guinea pigs, and 30 minutes of perfusion is considered to be appropriate. In addition, over a 6-hour period, RWP can deliver higher concentrations of isosorbide into perilymph than those achieved with PO.
Administration, Oral* ; Animals ; Chromatography, Liquid ; Diuretics, Osmotic ; Guinea Pigs* ; Humans ; Isosorbide* ; Male ; Membranes ; Meniere Disease ; Perfusion* ; Perilymph* ; Refractometry ; Scala Tympani

BACKGROUND/AIMS: The diagnosis of refractory ascites means a poor prognosis for patients with liver cirrhosis. The definition of refractory ascites has already been established, but using the dosage of diuretics that correlates with the definition of refractory ascites in an out-patient department will lower the compliance of the patient, as well as causing serious complications, such as hepatic encephalopathy and hyponatremia, as the dosage of diuretics is increased. Due to this fact, it is very difficult to apply this definition of refractory ascites to patients in a domestic out-patient department. In this study, in situations where there are difficulties in applying the diuretics dosage according to definition of refractory ascites, we tried to find out whether measuring the value of urine sodium after the administration of intravenous furosemide can be the standard in early differentiation of the response to diuretics treatment. METHODS: We reviewed 16 cases of liver cirrhosis with ascites and classified them into two groups by the response to diuretics. The diuretics-responsive ascites group was 8 cases and the diuretics-unresponsive ascites group consisted of 8 cases. After admission, we examined the patients' CBC, biochemical liver function test, spot urine sodium, and 24 hour creatinine clearance. After the beginning of the experiment, all diuretic therapy was stopped for 3 days. Daily we examined the patients' CBC, biochemical liver function test, and in the 3rd experiment day, we measured 24-hour urine volume and sodium. In the 4th experiment day, after sampling for ADH, plasma renin activity and plasma aldosterone level, we administrated the furosemide 80 mg I.V, and measured the amount of 8 hour urine volume and sodium. RESULTS: The plasma aldosterone level was significantly higher in the diuretics- unresponsive ascites group than in the diuretics-responsive ascites group. In the 4th experiment day, the amount of urine volume and sodium was very significantly lower in the diuretics-unresponsive ascites group than in the diuretics-responsive ascites group (1297.5 +/- 80.9 vs 2003.7 +/- 114.6 ml, p<0.005, 77.3 +/- 8.2 vs 211.8 +/- 12.6 mEq, p<0.001). CONCLUSIONS: In out-patient departments, the measurement of urine sodium 8 hours after administrating 80 mg of intravenous furosemide, will help in differentiating ascites patients with lower treatment response to diuretics.
Adult ; Aged ; Ascites/*drug therapy/etiology/urine ; Diuretics, Sulfamyl/*administration & dosage ; English Abstract ; Female ; Furosemide/*administration & dosage ; Humans ; Infusions, Intravenous ; Liver Cirrhosis/*complications ; Male ; Middle Aged ; Sodium/*urine

OBJECTIVETo observe the effects of navel-warming therapy on clinical efficacy in patients with yang-deficiency tympanites based on regular treatment of western medication.

METHODSOne hundred and twenty cases of yang-deficiency tympanites were randomly divided into a navel-warming therapy group and a western medication group, sixty cases in each one. The regular treatment of western medicine was applied in the western medication group, including oral administration of antiviral drug and diuretics as well as intravenous drip of hepatic protector. Based on western medicine treatment, the navel-warming therapy was applied in the navel-warming group. A medical cake was laid on Shenque (CV 8), and then a medical cylinder was placed above the medical cake and ignited. The treatment was given once daily. One month was considered as a treatment session in both groups and totally one session was required. The TCM symptom score, B-ultrasound ascites and temporary use of diuretics before and after treatment were observed in both groups; also the efficacy was evaluated.

RESULTSThe total effective rate was 81.7% (49/60) in the navel-warming therapy group, which was superior to 56.7% (34/60) in the western medication group (P < 0.05). After the treatment, the TCM symptom score and ascites were improved in both groups (all P < 0.05), which was more significant in the navel-warming therapy group (all P < 0.05). The temporary use of diuretics was statistically different between the two groups (P < 0.05), indicating the navel-warming therapy group could obviously reduce or stop the use of diuretics.

CONCLUSIONBased on regular treatment of western medication, the navel-warming therapy could significantly improve therapeutic efficacy, effectively relieve clinical symptoms and ease ascites.

Acupuncture Points ; Adult ; Aged ; Diuretics ; administration & dosage ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; administration & dosage ; chemistry ; Female ; Humans ; Male ; Middle Aged ; Moxibustion ; Yang Deficiency ; drug therapy ; Young Adult

OBJECTIVETo observe the therapeutic effect of Xuesaitong soft capsule (XST) and its effect on platelet counts, coagulation factor 1 (CF1) as well as hemorrheologic indexes in treating patients with acute cerebral infarction (ACI).

METHODSTwo hundred and four patients with ACI were assigned into two groups, the control group (n = 96) and the treated group (n = 108). They were all treated with conventional Western medicines, including mannitol, troxerutin, citicoline, piracetam and aspirin, while to the treated group, XST was given additionally through oral intake, twice a day, 2 capsules each time for 8 successive weeks. The clinical efficacy was evaluated according to the nerve function deficits scoring and the changes of platelet count. CF1 and hemorrheological indexes were measured before and after treatment.

RESULTSThe total effective rate was 87.0% in the treated group, and 87.5% in the control group, respectively, showing insignificant difference between them. But the markedly effective rate in the treated group (66.7%) was significantly higher than that in the control group (27.1%, P < 0.01). The count of platelet was not changed significantly in both groups after treatment, while CF1 in them evidently lowered at the end of the 4th and 8th weeks of treatment, but showed insignificant difference between the two groups. The hematocrit, whole blood viscosity and plasma viscosity in both groups were all improved significantly after treatment, but also showed insignificant difference in comparison of the two groups.

CONCLUSIONXST has good efficacy in auxiliary treatment of patients with ACI, though its mechanism remains to be further explored.

Acute Disease ; Adult ; Aged ; Aspirin ; administration & dosage ; Blood Viscosity ; drug effects ; Capsules ; Cerebral Infarction ; drug therapy ; physiopathology ; Cytidine Diphosphate Choline ; administration & dosage ; Diuretics, Osmotic ; administration & dosage ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Hematocrit ; Hemorheology ; Humans ; Male ; Mannitol ; administration & dosage ; Middle Aged ; Nootropic Agents ; administration & dosage ; Piracetam ; administration & dosage ; Platelet Aggregation Inhibitors ; administration & dosage

Bietti crystalline retinal dystrophy is a rare, inherited disorder whose hallmark is the presence of retinal crystal deposits associated with later chorioretinal degeneration. This condition may rarely be complicated by the development of cystoid macular oedema leading to rapid visual decline. Currently, treatment options for this complication of Bietti dystrophy are limited and the visual prognosis is poor. Here, we present a case of cystoid macular oedema associated with Bietti dystrophy that was successfully diagnosed using multimodal imaging techniques including optical coherence tomography and fluorescein angiography. These modalities confirmed the diagnosis of macular oedema and excluded other possible causes of oedema such as choroidal neovascularisation. In this patient, cystoid macular oedema was resolved with oral acetazolamide therapy, a treatment that has not been previously reported in this context. Acetazolamide treatment resulted in oedema resolution and improvement in visual function, and can be considered a therapeutic option for other patients with Bietti dystrophy who develop cystoid macular oedema.
Acetazolamide/*administration & dosage ; Administration, Oral ; Adult ; Corneal Dystrophies, Hereditary/*drug therapy/pathology ; Diuretics/*administration & dosage ; Humans ; Macular Edema/*drug therapy/pathology ; Male ; Retinal Diseases/*drug therapy/pathology ; Tomography, Optical Coherence ; Treatment Outcome

We report two cases of macular edema treated with the oral administration of furosemide. The first case presented here was a 78-year-old male patient with visual disturbance of the left eye. He had been taking an oral agent for diabetes and had chronic renal failure for 7 years. From 10 days prior to the visit, he had visual disturbance of the left eye accompanied by systemic edema. There were no specific findings in the anterior segment, but sub-retinal fluid was observed in the left fundus. Macular edema was observed on fluorescein angiography and optical coherence tomography; therefore, the oral administration of furosemide was initiated. After seven days, the sub-retinal fluid disappeared. The second case was a 43-year-old female patient with visual disturbance of the left eye who had been taking hypoglycemic agents for diabetes for 13 years. There were no specific findings in the anterior segment, but flame-shaped retinal hemorrhages were scattered over both posterior poles, neovascularization was observed in the left eye, and, of particular note, sub-retinal fluid was detected in the macula of the left eye. Macular edema was also observed on fluorescein angiography and optical coherence tomography, and oral administration of furosemide was initiated. After 3 weeks, the macular edema had significantly decreased.
Administration, Oral ; Adult ; Aged ; Diabetes Complications/diagnosis/*drug therapy ; Diuretics/administration & dosage/*therapeutic use ; Female ; Fluorescein Angiography ; Furosemide/administration & dosage/*therapeutic use ; Humans ; Macular Edema/diagnosis/*drug therapy ; Male ; Tomography, Optical Coherence

OBJECTIVEIn continuation to the growing evidence for therapeutical potential of Desmostachya bipinnata (Linn) Stapf, the current pharmacological study was carried out to evaluate the diuretic and laxative activity of its hydro-alcoholic extract in rats.

METHODSThe hydro-alcoholic extract of D. bipinnata whole plant was prepared by using Soxhlet extractor and subjected to analysis by standard preliminary phytochemical tests. Evaluation of both diuretic and laxative activity was carried out using standard methods as reported earlier. Frusemide (20 mg/kg) was served as positive control for diuretic activity and sennosides (10 mg/kg) served as negative control for laxative activity.

RESULTSThe hydro-alcoholic extract showed significant diuretic activity and was found to be the most potent in increasing the urinary output at 500 mg/kg when the effect was compared with that of the standard frusemide (P<0.01). Moreover, this extract was found to be most effective in increasing urinary electrolyte concentration (Na(+), K(+), and Cl(-)) at both doses tested. Whereas the results for laxative activity showed minimal increase of feces output at the dose of 500 mg/kg and the increase was negligible when compared with that of the standard drug sennosides.

CONCLUSIONAltogether, the above significant findings validate and support its folkloric diuretic use and lend pharmacological credence to the ethno-medical use of this plant in traditional system of medicine, which demands further studies to investigate its active constituents, as well as its use and safety.

Animals ; Constipation ; drug therapy ; Diuretics ; administration & dosage ; adverse effects ; Drug Evaluation, Preclinical ; Female ; Humans ; Laxatives ; administration & dosage ; adverse effects ; Male ; Plant Extracts ; administration & dosage ; adverse effects ; Poaceae ; chemistry ; Rats ; Rats, Wistar

The effects of antihypertensive drugs on the choroidal blood flow in rabbits were studied by an apparatus based on the principle of internal calorimetry of Grayson. Thermistors, as the sensing elements, were fastened on the scleral surface of the eye, and determinations were performed up to 60 minutes after intravenous administrations of drugs. The drugs studied were: ganglion blocking agents (pentholinium tartarate, 4 mg; hexamethonium bromide, 1 mg; and mecamylamine chloride, 0.15mg), alpha-methyldopa, 4 mg; guanethidine, 0.5 mg; reserpine, 0.2 mg; hydralazine, 5 mg; and diuretics (dichlorothiazide, 2.5 mg; frusemide, 2.5 mg). Except the diuretics, all the drugs employed produced considerable increase in the choroidal blood flow. The relationships between blood pressure, intraocular pressure and the choroidal blood flow were discussed and the clinical applications were suggested.
Administration, Intravenous ; Antihypertensive Agents* ; Blood Pressure ; Calorimetry ; Choroid* ; Dental Calculus ; Diuretics ; Furosemide ; Ganglion Cysts ; Guanethidine ; Hexamethonium ; Hydralazine ; Intraocular Pressure ; Mecamylamine ; Methyldopa ; Rabbits* ; Reserpine

OBJECTIVETo evaluate the significance of cerebral protection applied at carotid endarterectomy (CEA) at perioperation, intraoperation, and postoperation.

METHODSThirty patients underwent CEA with application of cerebral protection at perioperation, intraoperation, and postoperation in our hospital from January 2002 to August 2005. Perioperative carotid Doppler ultrasound and computed tomography angiography (CTA) were applied in 29 patients and carotid angiography applied in only one patient. The key methods of intraoperative cerebral protection included general anaesthesia, selective shunting, monitoring of transcranial Doppler, and careful manipulation. The methods of postoperative cerebral protection included leaving tracheal cannula and brain ice-bag, maintaining normal blood pressure, and applying dehydrant under guidance by monitoring of transcranial Doppler.

RESULTSAmong all the 30 patients, shunts were used in 10 patients (33%), and angioplasty by patch was applied in 17 patients (57%). No cranial nerve-associated complications or death was documented.

CONCLUSIONApplication of cerebral protection at CEA at perioperation, intraoperation, and postoperation can effectively prevent the occurance of cranial nerve-associated complications.

Aged ; Anesthesia, General ; Diuretics ; administration & dosage ; Endarterectomy, Carotid ; Female ; Follow-Up Studies ; Humans ; Intubation, Intratracheal ; Male ; Middle Aged ; Monitoring, Intraoperative ; Perioperative Care ; methods ; Treatment Outcome ; Ultrasonography, Doppler, Transcranial