Subject(s)
Adrenal Gland Diseases/therapy , Neurosyphilis/therapy , Syphilis/therapy , Aged , Humans , MaleABSTRACT
Essential thrombocytosis is a myeloproliferative disease not known to have consistent cytogenetic abnormalities. A 46-year-old black woman with essential thrombocytosis and a Philadelphia chromosome is reported. Iron deficiency and tuberculosis were present but when effectively treated did not result in resolution of thrombocytosis. Megakaryocytic hyperplasia of bone marrow, abnormal platelet function studies and a compatible clinical state suggested the diagnosis of essential thrombocytosis. The diagnostic criteria for other myeloproliferative diseases were not met. The Philadelphia chromosome was consistently obtained from bone marrow preparations. We conclude that the Philadelphia chromosome may be found in essential thrombocytosis as well as other, previously reported, myeloproliferative diseases.
Subject(s)
Chromosome Aberrations/genetics , Philadelphia Chromosome , Thrombocytosis/genetics , Bone Marrow/pathology , Chromosome Aberrations/blood , Chromosome Aberrations/diagnosis , Chromosome Banding , Chromosome Disorders , Female , Humans , Karyotyping , Middle Aged , Thrombocytosis/blood , Thrombocytosis/pathologyABSTRACT
Initial experience with one strategy to modify selection of empiric antibiotic therapy by medical residents in presented. New orders for parenteral antibiotics written by residents before receiving culture results were randomly allocated to either a recommendation or a control group. Antibiotic orders from each group were compared with guidelines for antibiotic selection, and suggestions to change antibiotics were made only for orders from the recommendation group that did not match the guidelines. Recommendations for change appeared necessary for about 20% of the orders within each group. At follow-up, 78% of these orders had been changed as suggested in the recommendation group, whereas only 10% of the orders in the control group were changed (p less than 0.005). The mean difference in daily cost per order was a savings of $27.40 in the recommendation group and only $1.11 in the control group (p less than 0.01).
Subject(s)
Anti-Bacterial Agents/therapeutic use , Drug Utilization/economics , Internship and Residency , Pharmacy and Therapeutics Committee , Cost Control/methods , Hospital Bed Capacity, 300 to 499 , Humans , New JerseyABSTRACT
A 37-year-old man with blastic crisis of chronic myelogenous leukemia was admitted for chemotherapy. After treatment with an infusion of vincristine, he became leukopenic and febrile. Two episodes of gram-negative septicemia were treated with prolonged courses of antibiotics; however, fever persisted, and the patient developed the superior vena cava syndrome. Despite therapy with amphotericin B, the patient died. At autopsy a thrombus of Aspergillus was found completely occluding the superior vena cava.
Subject(s)
Aspergillosis/complications , Thrombosis/etiology , Vena Cava, Superior , Adult , Humans , Leukemia, Myeloid/complications , Leukemia, Myeloid/drug therapy , Male , Syndrome , Vincristine/therapeutic useSubject(s)
Bacterial Infections/drug therapy , Cefamandole/therapeutic use , Cephalosporins/therapeutic use , Adult , Aged , Female , Hospitalization , Humans , Male , Middle AgedSubject(s)
Cross Infection/microbiology , Dermatomycoses/epidemiology , Mucormycosis/epidemiology , Adult , Aged , Amphotericin B/therapeutic use , Bandages/adverse effects , Cross Infection/epidemiology , Dermatomycoses/microbiology , Dermatomycoses/therapy , Humans , Male , Middle Aged , Mucormycosis/microbiology , Mucormycosis/therapy , Rhizopus/isolation & purificationABSTRACT
Cefaclor, a new oral cephalosporin, was administered to 18 normal human volunteers in either single or multiple doses of 250 and 500 mg. Mean serum concentrations of 6.09 and 12.8 microgram/ml were achieved 1 hour after single oral doses of 250 and 500 mg, respectively. The serum concentrations declined rapidly and no drug was detected at 4 hours. Very high concentrations of cefaclor were found in urine during the first 8 hours after ingestion of the drug. Forty-three per cent of the total dose was excreted in urine during the first 8 hours. There was no accumulation of drug in serum during the multiple-dose studies.
