The American journal of the medical sciences
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Case Reports
Adverse effect of phenytoin on mineralocorticoid replacement with fludrocortisone in adrenal insufficiency.
Two patients with longstanding adrenal insufficiency developed severe mineralocorticoid deficiency during concomitant phenytoin treatment. A 64-year-old man with primary adrenal insufficiency of 41 years duration was treated with phenytoin for an acute seizure disorder. He subsequently developed mineralocorticoid insufficiency despite taking his customary dosages of cortisone acetate and fludrocortisone. ⋯ Her fludrocortisone requirement was ultimately established as 2.0 mg daily with a normal hydrocortisone requirement and clearance rate. Fludrocortisone thus appears to be another synthetic steroid whose metabolism is sensitive to drugs that increase hepatic 6-beta-hydroxylation, such as phenytoin. Treatment with these inducing drugs may markedly alter mineralocorticoid requirements in patients with primary adrenal insufficiency.
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Prophylactic platelet administration is indicated at counts below 20 X 10(9)/l. The bleeding tendency and severity were compared between thrombocytopenic patients with acute-lymphocytic leukemia (ALL) and acute non-lymphocytic leukemia (ANLL) in the ranges of 10-20 X 10(9)/l platelets, while prophylactic platelet administration was given only below 10 X 10(9)/l. The bleeding tendency for ALL was quite similar at platelet counts above or below 10 X 10(9)/l. ⋯ Stable or rising counts of platelets were associated with significantly lower bleeding tendency above 10 X 10(9)/l only in ANLL patients. The decision for prophylactic platelet administration at counts below 20 X 10(9)/l should be guided by the type of the leukemia (ALL vs. ANLL), the cause of thrombocytopenia (chemotherapy vs. leukemia per se), the trend of the platelet counts, presence of fever and patient's age (below or above 18 years).(ABSTRACT TRUNCATED AT 250 WORDS)
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Ibuprofen is a cyclo-oxygenase inhibitor that is alleged to have additional direct effects on leukocyte function. These properties suggest that Ibuprofen may be of potential therapeutic value for neutrophil (PMN)-mediated acute lung injury in humans such as that resulting from septicemia by gram-negative organisms. This study quantitated the effect of pretreatment with Ibuprofen on the intensity of acute neutrophilic alveolitis following endotoxemia. ⋯ In contrast, both 10 and 30 mg/kg of Ibuprofen prevented early hypoxemia following endotoxemia, suggesting that early hypoxemia and inflammation by neutrophils were not causally related. The dose of Ibuprofen required to suppress neutrophil alveolitis exceeds that required to inhibit cyclooxygenase in the model. Therefore, suppression of alveolitis by 30 mg/kg of Ibuprofen may depend on other pharmacologic properties of Ibuprofen such as its direct effect on neutrophil migration.
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Graves' dermopathy, affecting upper as well as lower extremities, is reported in a 50-year-old male patient addicted to multiple narcotic drugs. The narcotic drug administration routes include subcutaneous and intravenous injection in all limbs over a period of 29 years. ⋯ Other features of Graves' disease, ie, hyperthyroidism and ophthalmopathy were severe and required multiple modes of therapy. Although the pathogenesis of Graves' dermopathy is unclear, it is surmised that trauma to skin might exacerbate it and preventive measures for trauma might be helpful in the management of dermopathy.
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We tested our clinical impression that black hypertensives in our clinic population responded better to alpha-adrenergic blocking agents (clonidine and prazosin) than to beta-adrenergic blockers (atenolol, nadolol and propranolol). Compared to no effect from eight weeks of therapy with beta-blockers, clonidine significantly decreased erect mean arterial pressure (MAP) when assessed weekly for four weeks (p = 0.027 to 0.046). However, the decrease in supine MAP was not significant. ⋯ Supine MAP was significantly less than with beta-blockade (p = 0.032) at two weeks but not at four weeks and decrements in erect MAP were not significant. In this preliminary study, black hypertensives appeared to be more responsive to alpha-adrenergic antagonists than to beta-blockers, with clonidine more effective than prazosin. Elucidation of possible mechanisms of the difference and of its clinical importance warrant further study.