Full recovery of a 13-year-old boy with pediatric Ramsay Hunt syndrome using a shorter course of aciclovir and steroid at lower doses: a case report

<p>Abstract</p> <p>Introduction</p> <p>Reports on children with Ramsay Hunt syndrome are limited in the literature, resulting in uncertainty regarding the clinical manifestations and outcome of this syndrome. Treatment for Ramsay Hunt syndrome is usually with antivirals, although there is no evidence for beneficial effect on the outcome of Ramsay Hunt syndrome in adults (insufficient data on children exists). Here, we report a case of Ramsay Hunt syndrome occurring in a child who inadvertently received a lower dose of aciclovir and steroid administered for shorter than is usual. Our patient made a full recovery.</p> <p>Case presentation</p> <p>A 13-year-old African boy presented to our out-patients department with an inability to move the right side of his face for one week. He had previously been seen by the doctor on call, who prescribed aciclovir 200 mg three times per day and prednisone 20 mg once daily, both orally for five days, with a working diagnosis of Bell's palsy. After commencement of aciclovir-prednisone, while at home, our patient had headache, malaise, altered taste, vomiting after feeds, a ringing sound in his right ear as well as earache and ear itchiness. Additionally, he developed numerous fluid-filled pimples on his right ear. On presentation, a physical examination revealed a right-sided lower motor neuron facial nerve palsy and a healing rash on the right pinna. On direct questioning, our patient admitted having had chicken pox about three months previously. Based on the history and physical examination, Ramsay Hunt syndrome was diagnosed. Our patient was lost to follow-up until 11 months after the onset of illness; at this time, his facial nerve function was normal.</p> <p>Conclusions</p> <p>This case report documents the clinical manifestations and outcome of pediatric Ramsay Hunt syndrome; a condition with few case reports in the literature. In addition, our patient made a full recovery despite inadvertently receiving a lower dose of aciclovir and steroid administered for shorter than is usual.</p

Corticosteroids as adjuvant to antiviral treatment in Ramsay Hunt syndrome (herpes zoster oticus with facial palsy) in adults.

BACKGROUND: Inflammation and oedema of the facial nerve due to viral infection by the herpes zoster virus are implicated in the aetiology and clinical manifestation of Ramsay Hunt syndrome (herpes zoster oticus with facial palsy). Corticosteroids, with their powerful anti-inflammatory effect, have a potential role to play in the reduction or minimisation of nerve damage when administered together with antiviral therapy, and therefore may improve the outcome for patients with Ramsay Hunt syndrome. OBJECTIVES: To determine the effectiveness of corticosteroids as an adjuvant to antiviral therapy in adult patients with Ramsay Hunt syndrome (herpes zoster oticus with facial palsy). SEARCH STRATEGY: We searched the Cochrane ENT Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), (The Cochrane Library Issue 4, 2007), MEDLINE (1950 to December 2007) and EMBASE (1974 to December 2007), CINAHL (1982 to December 2007), LILACS, KoreaMed, IndMed, PakMediNet, ZETOC, Cambridge Scientific Abstracts (Conference Proceedings Database), ISI Proceedings (Web of Science), the National Research Register (NRR), the UK Clinical Research Network Portfolio Database (UKCRN), the World Health Organization International Clinical Trials Registry Platform (ICTRP), the Research Findings Register (ReFeR) and the metaRegister of Controlled Trials (mRCT). SELECTION CRITERIA: All randomised controlled trials in which corticosteroids (by any route of administration at any dosage) were given as an adjuvant to antiviral agents in the treatment of Ramsay Hunt syndrome. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed eligibility and trial quality of the available studies, whether they were published or unpublished. No trials were found and therefore no data were analysed. MAIN RESULTS: This is an empty review as no trials were found that fulfilled the inclusion criteria. AUTHORS' CONCLUSIONS: Since no randomised controlled trials investigating the use of corticosteroids as an adjuvant to antiviral treatment in Ramsay Hunt syndrome were identified, such studies are needed to assess the effects of such therapy

A simple and fast sampling method for chemical analyses and densitometry of bones through rib biopsies in cattle

We developed and evaluated a fast and simple method to obtain suitable bone samples for densitometry and chemical analysis through biopsies of the 12th rib of cattle. The postoperative recovery, dry matter intake (DMI) and average daily weight gain (ADG) was evaluated in 36 Nellore steers, nine of which were randomly selected for the control group and 27 others were rib biopsied. Every 30 days, rib biopsy was performed in nine steers, using a corded-electric pistol-grip drill coupled with a hole saw of a 3mm diameter pilot drill bit. This rib biopsy technique provided a suitable sample obtained in a fast way and allowed the surgeon to work alone with the animal slightly sedated and restrained in the crush. Dry matter intake (DMI) was not affected in biopsied animals. At the end of the experimental period (116 days) the average daily weight gain (ADG) was similar in the steers biopsied or not. The described method provided rib samples from cattle suitable for densitometry and chemical analysis of bone tissue without effects on health and performance. This information could greatly increase the accuracy for the diagnosis of phosphorus deficiency in cattle raised on pasture and allow the evaluation of bone metabolism in experimental animals

A simple and fast sampling method for chemical analyses and densitometry of bones through rib biopsies in cattle

ABSTRACT: We developed and evaluated a fast and simple method to obtain suitable bone samples for densitometry and chemical analysis through biopsies of the 12th rib of cattle. The postoperative recovery, dry matter intake (DMI) and average daily weight gain (ADG) was evaluated in 36 Nellore steers, nine of which were randomly selected for the control group and 27 others were rib biopsied. Every 30 days, rib biopsy was performed in nine steers, using a corded-electric pistol-grip drill coupled with a hole saw of a 3mm diameter pilot drill bit. This rib biopsy technique provided a suitable sample obtained in a fast way and allowed the surgeon to work alone with the animal slightly sedated and restrained in the crush. Dry matter intake (DMI) was not affected in biopsied animals. At the end of the experimental period (116 days) the average daily weight gain (ADG) was similar in the steers biopsied or not. The described method provided rib samples from cattle suitable for densitometry and chemical analysis of bone tissue without effects on health and performance. This information could greatly increase the accuracy for the diagnosis of phosphorus deficiency in cattle raised on pasture and allow the evaluation of bone metabolism in experimental animals

Cyclooxigenase-2 expression in primary metastatic and non metastatic canine mammarian carcinomas

The aim of this study was to detect the expression of ciclooxigenase-2 (COX-2) in metastatic primary carcinoma and non metastatic carcinoma, taking into consideration the relation between COX-2 and the progression of cancer. Evaluation of the COX-2 expression was achieved by immunohistochemistry analysis, using the primary polyclonal antibody anti-PGHS-2, clone PG 27, (Oxford Biomedical Research). The number of marked cells by the COX-2 antibody was higher (P < 0.001) in the metastatic primary carcinoma (81.25%) than non-metastatic (60.3%). There was a positive correlation between the number of labeled cells

A simple and fast sampling method for chemical analyses and densitometry of bones through rib biopsies in cattle

ABSTRACT: We developed and evaluated a fast and simple method to obtain suitable bone samples for densitometry and chemical analysis through biopsies of the 12th rib of cattle. The postoperative recovery, dry matter intake (DMI) and average daily weight gain (ADG) was evaluated in 36 Nellore steers, nine of which were randomly selected for the control group and 27 others were rib biopsied. Every 30 days, rib biopsy was performed in nine steers, using a corded-electric pistol-grip drill coupled with a hole saw of a 3mm diameter pilot drill bit. This rib biopsy technique provided a suitable sample obtained in a fast way and allowed the surgeon to work alone with the animal slightly sedated and restrained in the crush. Dry matter intake (DMI) was not affected in biopsied animals. At the end of the experimental period (116 days) the average daily weight gain (ADG) was similar in the steers biopsied or not. The described method provided rib samples from cattle suitable for densitometry and chemical analysis of bone tissue without effects on health and performance. This information could greatly increase the accuracy for the diagnosis of phosphorus deficiency in cattle raised on pasture and allow the evaluation of bone metabolism in experimental animals