bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pulmonary Fibrosis Induced by Cyclophosphamide
Authors: Segura Angel , Yuste Ana , Cercos Ana , López-Tendero Pedro , Gironés Regina , Pérez-Fidalgo José A , Herranz Constantino 
Published: June 2003

OBJECTIVE: To report a case of pulmonary fibrosis resulting from use of cyclophosphamide as chemotherapy to treat a patient with breast cancer. CASE SUMMARY: We describe the case of a 52-year-old woman with breast cancer who developed pulmonary fibrosis after four cycles of chemotherapy that included cyclophosphamide. Pulmonary function tests revealed the presence of a severe ventilatory restriction. The open lung biopsy revealed pulmonary fibrosis with vascular sclerosis and signs of pulmonary hypertension. DISCUSSION: Cyclophosphamide is an alkylating agent that has been associated with interstitial pneumonia and pulmonary fibrosis. The frequency of these unwanted effects is '1%. The clinical picture consists of the progressive appearance of dyspnea and a nonproductive cough that progresses to severe pulmonary insufficiency. The risk factors described for these complications have been the use of chemotherapy regimens that include other drugs with known pulmonary toxicities, the cumulative total dose, the addition of radiotherapy, and the use of high doses of cyclophosphamide. CONCLUSIONS: Even though the frequency of pulmonary fibrosis in patients treated with cyclophosphamide-based chemotherapy regimens is low, the presence of dyspnea and an interstitial pattern in a patient makes it necessary to consider that possible drug toxicity. The open lung biopsy is the most accurate diagnostic technique for these cases. The discontinuation of cyclophosphamide and treatment with corticosteroids is usually followed by clinical recovery in approximately 50% of patients and, in some cases, reversal of the lung injury.
Lack of Tacrolimus-Induced Cardiomyopathy
Authors: Coley Kim C , Verrico Margaret M , McNamara Dennis M , Park Sang C , Cressman Michael D , Branch Robert A 
Published: June 2003

BACKGROUND: Hypertrophic cardiomyopathy (HCM) has been reported in pediatric transplant patients receiving tacrolimus. It is unclear whether tacrolimus is associated with HCM in adult transplant recipients. OBJECTIVE: To determine the prevalence of HCM in noncardiac adult transplant patients receiving tacrolimus. METHODS: A retrospective analysis of nonheart transplant recipients who received tacrolimus at our institution from January 1982 to April 1996 was conducted. Patients with left-ventricular hypertrophy (LVH) defined as a posterior or septal wall thickness ≥1.3 cm by echocardiography (ECHO) were independently evaluated. RESULTS: There were 3609 patients who met entry criteria including 2257 liver, 1333 kidney, and 19 other organ transplants. Of the 502 patients who had undergone ECHOs after transplantation, 171 had LVH. The etiology of LVH was categorized as valvular disease (36%), hypertensive disease (29%), ischemic heart disease (17%), or multifactorial (15%). There were six patients in whom, after detailed chart review, no underlying cause of LVH was evident. Five of these patients had HCM, representing an overall prevalence of 0.1% in the entire group of tacrolimus-treated patients, and 1% in patients referred for ECHO. CONCLUSIONS: The prevalence of HCM in our tacrolimus-treated adult transplant population is similar to that reported in general population studies. These data suggest that tacrolimus is not a risk factor for HCM in adult transplant recipients.
Failure of Tolterodine to Treat Clozapine-Induced Nocturnal Enuresis
Authors: English Brett A , Still Daniel J , Harper John , Saklad Steven R 
Published: June 2003

OBJECTIVE: To report the use and subsequent failure of the bladder-selective agent tolterodine, to treat clozapine-induced nocturnal enuresis in an adolescent patient with psychotic illness. CASE SUMMARY: A 16-year-old Hispanic girl was admitted to the state psychiatric hospital with a diagnosis of bipolar disorder with psychotic features. Clozapine therapy was initiated, and after three months of treatment the patient began experiencing episodes of nocturnal enuresis. The bladder-selective agent tolterodine was tried and subsequently failed to resolve the enuresis episodes. Desmopressin was initiated, which resulted in amelioration of symptoms. DISCUSSION: This is the first published report of using tolterodine to treat clozapine-induced nocturnal enuresis. Several methods to decrease clozapine-induced urinary incontinence have been used and typically include the addition of agents with high anticholinergic properties. Tolterodine is a bladder-selective anticholinergic agent indicated for the treatment of urinary urge incontinence and may be employed as a treatment for antipsychotic-induced incontinence. CONCLUSIONS: Nocturnal enuresis is an adverse effect that infrequently occurs with use of clozapine therapy. Although tolterodine was ineffective in our patient to treat clozapine-induced nocturnal enuresis, further trials are required to appropriately evaluate the effectiveness of tolterodine to treat this adverse drug reaction.
Trimethoprim/Sulfamethoxazole—Induced Toxic Epidermal Necrolysis
Authors: See Sharon , Mumford James M 
Published: June 2003

OBJECTIVE: To report a case of toxic epidermal necrolysis (TEN) associated with trimethoprim/sulfamethoxazole (TMP/SMX). CASE SUMMARY: A 34-year-old Asian woman developed a severe, desquamating mucocutaneous reaction (TEN) after six days of taking TMP/SMX to treat a presumed urinary tract infection (UTI). DISCUSSION: TMP/SMX is often recommended as first-line therapy for UTIs, sinusitis, bronchitis, and as prophylaxis and treatment for Pneumocystis carinii pneumonia. TEN is a rare, but severe condition associated with sulfonamide use. This article describes a typical case and offers an opportunity for review of this potentially serious reaction. CONCLUSIONS: Sulfonamides are often implicated in the majority of drug-induced cases of TEN. This case report illustrates the typical presentation of sulfonamide-induced TEN with a prodrome, characteristic rash, mucous membrane lesions, and systemic involvement. Practitioners should be aware of this rare adverse effect and closely observe patients for cutaneous manifestations or complaints. Any suspected drug should be discontinued if clinical evaluation leads to the suspicion of Stevens—Johnson syndrome or TEN.
Management of Childhood Acute Respiratory Infections at Private Pharmacies in Vietnam
Authors: Chuc Nguyen TK , Larsson Mattias , Falkenberg Torkel , Do Nguyen T , Binh Nguyen T , Tomson Goran B 
Published: June 2003

OBJECTIVE: To investigate the knowledge and practice among private pharmacy staff in Hanoi regarding case management of mild acute respiratory infection (ARI) in children. METHODS: Sixty private pharmacies in Hanoi were randomly selected. Knowledge was assessed through interviews with pharmacy staff using a questionnaire; practice was assessed through the Simulated Client Method. RESULTS: In the questionnaire, 20% of the pharmacy staff stated that they would dispense antibiotics. In practice, 83% of the pharmacies dispensed antibiotics. Only 36% of the cases were handled according to guidelines. In the questionnaire, 81% of interviewees stated that antibiotics are not effective in short therapeutic courses. In practice, 48% of the antibiotics were dispensed in courses less than five days. Traditional herbal medicines were dispensed in 41% of the encounters. In the questionnaire, 53% of the pharmacy staff stated that they would ask the patient about difficulty of breathing. In practice, questions related to difficulty of breathing were asked in less than 10% of the encounters. CONCLUSIONS: Dispensing of antibiotics for mild ARI was common practice among private pharmacies, and there was a significant difference between knowledge and practice. Interventions are needed to improve pharmacy practice in Hanoi.
Statin—Fibrate Combination Therapy
Authors: Shek Allen , Ferrill Mary J 
Published: June 2003

BACKGROUND: Precautionary warnings for severe myopathy and rhabdomyolysis from the coadministration of statins and fibrates have been well publicized. However, a recent cerivastatin labeling change made the combined use with fibric acid derivatives a contraindication. Practical recommendations for clinicians who care for patients with refractory mixed hyperlipidemia are needed. OBJECTIVE: To provide recommendations for clinicians in the treatment of refractory mixed hyperlipidemia. DATA SOURCES: A comprehensive MEDLINE (1966–July 2000) and bibliographic search was performed. DATA SYNTHESIS: Thirty-six published clinical trials and 29 case reports involving combination therapy with hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors and fibric acid derivatives regarding the occurrence of rhabdomyolysis or myopathy were reviewed. The literature review demonstrated that combination therapy with a statin and fibrate increases the risk of muscle damage, with an incidence of 0.12%. Risk factors that predispose patients to myopathy caused by combination statin—fibrate therapy include increased age, female gender, renal or liver disease, diabetes, hypothyroidism, debilitated status, surgery, trauma, excessive alcohol intake, and heavy exercise. CONCLUSIONS: Combination therapy with a statin and fibrate offers significant therapeutic advantage for the treatment of severe or refractory mixed hyperlipidemia. Although such a combination does increase the risk of myopathy, with an incidence of approximately 0.12%, this small risk of myopathy rarely outweighs the established morbidity and mortality benefits of achieving lipid goals. Nevertheless, a higher incidence of myopathy has been reported with statin monotherapy. When monotherapy with a statin fails to control mixed hyperlipidemia, combination therapy may be considered. Niacin may be added before a fibrate is considered, as it appears to have less risk of myopathy. Statin—fibrate combination therapy must be undertaken cautiously and only after careful risk—benefit analysis. Patient counseling on the risks and warning signs of myopathy is extremely important.
Systemic Hemostatic Medications for Reducing Surgical Blood Loss
Authors: Erstad Brian L 
Published: June 2003

OBJECTIVE: To review randomized trials involving the use of systemic hemostatic medications for reducing surgical blood loss. DATA SOURCES: Articles were obtained through searches of MEDLINE (1966–September 2000). The bibliographies of retrieved publications were reviewed for additional references. STUDY SELECTION: All randomized studies and pharmacoeconomic evaluations that involved medications used for systemic hemostasis in the perioperative period were included. DATA EXTRACTION: Randomized studies involving conjugated estrogens, aminocaproic acid, tranexamic acid, desmopressin, and aprotinin for systemic hemostasis were extracted. Studies of proton-pump inhibitors for upper gastrointestinal bleeding and octreotide for variceal bleeding were excluded, as were trials involving the use of any hemostatic agent for cardiovascular surgery. The primary outcome under review was a reduction in bleeding as defined by reduced transfusion requirements. DATA SYNTHESIS: There is limited efficacy and toxicity information concerning the use of conjugated estrogens for reducing surgery-related bleeding. Similarly, there are a limited number of randomized studies involving aminocaproic acid and tranexamic acid, and with the exception of tranexamic acid for reducing transfusion requirements with knee surgery, the study results are either conflicting or negative. For desmopressin, evidence from a substantial number of randomized trials documents its lack of efficacy. Aprotinin has reduced bleeding and transfusion requirements in a number of randomized studies involving patients undergoing orthopedic surgery, but cost-effectiveness studies are needed to better define its therapeutic role. Trials of aprotinin during hepatic surgery have yielded conflicting results. CONCLUSIONS: Most hemostatic medications used for reducing surgery-related bleeding have limited or contradictory evidence of efficacy.
Verteporfin for Age-Related Macular Degeneration
Authors: Messmer Karen J , Abel Steven R 
Published: June 2003

OBJECTIVE: To review the pharmacology, pharmacokinetics, clinical efficacy, adverse effects, drug—drug interactions, and the therapeutic issues concerning the use of verteporfin in patients with age-related macular degeneration (AMD). DATA SOURCES: Published articles and abstracts in English were identified by MEDLINE (1990–August 2000) searches using the search terms verteporfin, treatment of age-related macular degeneration, and photodynamic therapy (PDT). Additional references were identified from the bibliographies of the retrieved articles. Data were also obtained from approved product labeling. DATA EXTRACTION: The literature was assessed for adequate description of patients, methodology, and outcomes. DATA SYNTHESIS: Verteporfin is a synthetic benzoporphyrin derivative and a cytotoxic photosensitizing agent, which is one component of PDT. PDT involves administration of verteporfin for injection and nonthermal red light at a wavelength of 689 nm. It is metabolized, to a small extent, to its diacid metabolite by liver and plasma esterases. Information concerning drug interactions is limited. In clinical trials, verteporfin was effective in patients with wet AMD as demonstrated in standard visual acuity scores. Adverse events were related to injection site reactions and visual disturbances. CONCLUSIONS: Verteporfin is a welcome alternative to laser photocoagulation, which can result in damage to the retina and lead to visual loss. Although long-term trials have not been performed in humans, results from monkeys indicate possible improvement in vision following PDT with verteporfin.
Warfarin Pharmacodynamics Unaffected by Cilomilast
Authors: Kelly John , Murdoch Robert D , Clark David J , Webber Dawn M , Fuder Hermann 
Published: June 2003

OBJECTIVE: To demonstrate a lack of effect of steady-state concentrations of cilomilast, a new oral phosphodiesterase 4 inhibitor for the treatment of chronic obstructive pulmonary disease, on warfarin-induced anticoagulation. METHODS: This 28–day, randomized, double-blind, placebo-controlled, parallel-group study involved 36 healthy men. All volunteers received warfarin once daily on days 1 through 24 of the study. After a standard 5–mg loading dose on days 1 and 2, the warfarin dose was titrated between days 3 and 10 to achieve a stable prothrombin time, expressed as international normalized ratio (INR). Volunteers received either cilomilast 15 mg twice daily or placebo on days 18 through 24. The primary end point was the INR on day 24. RESULTS: On day 24, the mean ± SEM INR in subjects receiving concurrent warfarin and cilomilast was 1.35 ± 0.05, compared with 1.38 ± 0.07 in those receiving concurrent warfarin and placebo. The point estimate (90% CI) for the difference in day 24 INR values between cilomilast and placebo (adjusted for baseline) was 0.02 (90% CI −0.13 to 0.17), which translates to an INR ratio of 1.02 (90% CI 0.91 to 0.13). The 90% confidence interval for the ratio of mean INR (cilomilast:placebo) on day 24 was completely contained within the 25% equivalence range, indicating a lack of interaction between warfarin and cilomilast. The adverse event profiles of warfarin/placebo and warfarin/cilomilast were similar and favorable. CONCLUSIONS: The pharmacodynamics of warfarin are unaffected by coadministration of cilomilast at steady-state concentrations in healthy volunteers.
Fenoldopam in the Prevention of Contrast Media—Induced Acute Renal Failure
Authors: Chu Valery L , Cheng Judy WM 
Published: June 2003

OBJECTIVE: To examine the role of fenoldopam in prevention of contrast media—induced acute renal failure (ARF). DATA SOURCES: A literature search of MEDLINE (from 1966 to October 2000) was performed using the following title search terms: fenoldopam, contrast, and renal failure. STUDY SELECTION: English-language human studies, abstracts, and pertinent animal data were reviewed. DATA SYNTHESIS: Small trials using animals with artificially induced ARF receiving fenoldopam demonstrated improvement in renal function. Preliminary trials in healthy humans have also demonstrated similar results using doses not affecting systemic blood pressure. CONCLUSIONS: Fenoldopam may have a role in the management of ARF induced by contrast dye. However, due to the lack of a large-scale study, it cannot be routinely recommended.
Fibrinolytic Therapy in Intraventricular Hemorrhage
Authors: Andrews Carlota O , Engelhard Herbert H 
Published: June 2003

OBJECTIVE: To review the literature concerning intraventricular administration of fibrinolytic agents to treat patients with intraventricular hemorrhage (IVH). DATA SOURCES: An extensive literature search (MEDLINE, EMBASE, Conference Proceedings) was conducted to identify articles in English published between 1966 and May 2000 pertaining to the pathophysiology of IVH and its treatment by intraventricular administration of recombinant tissue plasminogen activator (alteplase) or urokinase (u-PA). The bibliographies of selected identified articles were also screened for publications not found in the computerized search. STUDY SELECTION: All pertinent publications were reviewed and considered. Those describing the intraventricular administration of fibrinolytic agents to patients with IVH were included. DATA SYNTHESIS: IVH has a poor prognosis, partly due to the mass effect of blood clots on the ventricular walls. The cerebrospinal fluid has a limited fibrinolytic system. Therefore, clots may remain in the ventricles for months after a hemorrhage. The management of IVH is primarily directed at controlling intracranial pressure through an external ventricular drain, but this catheter often becomes occluded by coagulated blood. To overcome this problem, and to dissolve the residual blood clot, investigators have administered alteplase or u-PA directly into the ventricles of patients with IVH. Complications of this therapy include infection and possible rebleeding. Clinical studies of fibrinolytic therapy for IVH have found a 30–35% reduction in mortality with treatment, but to date, have not clearly documented improved neurologic outcome of the survivors. CONCLUSIONS: Fibrinolytic therapy with alteplase or u-PA may be life-saving in severe cases of IVH. Yet many technical issues remain to be resolved, such as the optimal dose, frequency, method, timing, and duration of administration of the agent. Additional randomized, double-blind, placebo-controlled studies need to be performed so that the true value of this therapy can be assessed.
Compound Cardiac Toxicity of Oral Erythromycin and Verapamil
Authors: Goldschmidt Neta , Azaz-Livshits Tanya , Gotsman Israel , Nir-Paz Ran , Ben-Yehuda Arie , Muszkat Mordechai 
Published: June 2003

OBJECTIVE: To report a case of complete atrioventricular (AV) block and QTc prolongation following coadministration of high-dose verapamil and erythromycin. CASE SUMMARY: A 79-year-old white woman was admitted to the hospital due to extreme fatigue and dizziness. On admission, heart rate was 40 beats/min and blood pressure was 80/40 mm Hg. An electrocardiogram showed complete atrioventricular (AV) block, escape rhythm of 50 beats/min, and QTc prolongation 583 msec. This event was attributed to concomitant treatment with verapamil 480 mg/d and erythromycin 2000 mg/d, which was prescribed one week before admission. DISCUSSION: This is the first case published describing complete AV block and prolongation of QTc following coadministration of erythromycin and verapamil. CYP3A4 is the main isoenzyme responsible for metabolism of erythromycin and verapamil. Both drugs are potent inhibitors of CYP3A4 and of P-glycoprotein; this may be the basis for the pharmacokinetic interaction between erythromycin and verapamil. In addition to being a woman, our patient had other risk factors for QT prolongation: slow baseline heart rate (probably induced by verapamil), left-ventricular hypertrophy, and possibly ischemic heart disease. CONCLUSIONS: This life-threatening arrhythmia was probably the result of a pharmacokinetic and/or pharmacodynamic interaction of high-dose verapamil and erythromycin.
Treatment of Bulimia Nervosa with Ondansetron
Authors: Fung Stacey M , Ferrill Mary J 
Published: June 2003

OBJECTIVE: To evaluate ondansetron as a treatment for bulimia nervosa. DATA SOURCE: Literature was accessed through MEDLINE (1966–November 2000). Key terms included ondansetron, bulimia nervosa, binge eating, and eating disorders. DATA SYNTHESIS: Treatment of bulimia nervosa includes cognitive behavioral therapy and antidepressants. Fluoxetine is approved by the Food and Drug Administration for binge eating and vomiting behaviors in moderate to severe bulimia nervosa. An evaluation of ondansetron for bulimia nervosa was conducted. CONCLUSIONS: Ondansetron for bulimia nervosa was reported to be effective in three small trials by one group of investigators, and may be an option after failure of traditional therapies. Further studies will define the role of serotonin (5-HT3) receptor antagonists in the management of bulimia nervosa.
Hepatotoxicity after Short-Term Trazodone Therapy
Authors: Rettman Kristina S , McClintock Claudia 
Published: June 2003

OBJECTIVE: To report a case of severe hepatotoxicity from a four-day course of trazodone in a patient being treated according to protocol in a detoxification center. CASE SUMMARY: A 46-year-old HIV-positive man with a past medical history of intravenous drug abuse and hepatitis C, who was well controlled with HIV medications, was admitted for cocaine withdrawal. The patient was started on a standard protocol at the detoxification center with methadone 50 mg/d, clonidine 0.1 mg twice daily for four days, and trazodone 200 mg/d for four days. Laboratory results showed acute hepatitis and cholestasis five days following admission. Trazodone and clonidine were discontinued at that time. His methadone and HIV regimens remained unchanged. Liver function test results were greatly improved 10 days after trazodone and clonidine discontinuation. DISCUSSION: This is the first case report of trazodone-induced liver damage after only a few days of therapy. Previous reports describe hepatitis developing after weeks to months of trazodone therapy. All comorbidities thought to affect the described laboratory abnormalities were ruled out as a cause by a hepatologist. The observation of the sudden rise and fall of liver enzymes is characteristic of a drug reaction in the absence of trauma and severe shock. CONCLUSIONS: Due to the temporal relationship of the introduction and withdrawal of trazodone in the medication regimen and the elevations in liver enzymes, we conclude that this patient experienced acute hepatitis induced by trazodone 200 mg/d therapy for four days. The findings of this case warrant caution and closer monitoring in a patient with multiple risk factors for liver damage.