Rational Treatment Choices Research Articles

Allergic rhinitis: a rational choice of treatment

Rhinitis describes an inflammatory condition of the nasal mucosa and is characterized by the symptoms of pruritis, sneezing, rhinorrhoea and nasal blockage. In practical terms the demonstration of tissue inflammation by biopsy is not required and the diagnosis is based on clinical history, clinical examination, nasal smear cytology and allergy testing. The differential diagnosis of allergic rhinitis is broad (Fig. 1). It will not be the purpose of this review to detail the clinical process of differentiating these potential conditions, as these are well covered in various texts (1-3). Instead the review will concentrate on aspects of the history, epidemiology and pathogenesis of the disease which have relevance to differing modes of treatment.

New anticonvulsants in pediatrics: Carbamazepine and valproate

The majority of patients with epilepsy have their first seizure during childhood and are first evaluated and diagnosed by their pediatrician. For many patients the medication selected by the pediatrician will be taken for an extended time period, perhaps even for a lifetime. The first job of the pediatrician is to be sure that the patient's recurrent attacks represent genuine epilepsy and not some other paroxysmal medical disorder such as migraine or cardiac arrhythmias. Epileptic seizures are then classified by a careful clinical description of the attacks in conjunction with the results of the physical and EEG examinations. Based on all of the information at hand, the clinician chooses the drug that is most likely to reduce or eliminate further seizures without exposing the child to unnecessary medical risk or behavioral-cognitive adverse effects. In properly selected patients, both carbamazepine and valproate are safe, physically well tolerated, and less likely to provoke chronic mental side effects than the pediatrician's “traditional” choices: phenobarbital or phenytoin. Although carbamazepine and valproate have been widely acclaimed by neurologists and epileptologists, practicing pediatricians have heretofore been less likely to initiate treatment with these drugs. Yet pediatricians have something of priceless value to offer the child with epilepsy: seizure control and a clear mind. The information in this monograph should assist the practicing pediatrician in the rational choice, initiation, and follow-up of treatment with these two excellent anticonvulsants.

Metrizamide-enhanced computed tomography of intracranial arachnoid cysts.

Between July 1981 and August 1983 the authors studied 21 patients with intracranial arachnoid cysts using metrizamide-enhanced CT. With this method we are able to determine the degree of communication between the cysts and the surrounding subarachnoid space as well as to assess the evolving character of some of these lesions. This information will allow a more rational choice of surgical treatment.