ABSTRACT
A 38-year-old woman was treated for mutism with clozapine. After a week liver function disturbances developed, which disappeared when the treatment was discontinued. Histopathological investigation of a liver biopsy specimen revealed extensive liver cell necrosis. So far two patients have been described with cholestatic jaundice induced by clozapine, and one patient with toxic hepatitis due to clozapine.
Subject(s)
Clozapine/poisoning , Liver/drug effects , Liver/pathology , Adult , Clozapine/therapeutic use , Female , Humans , Liver Function Tests , Mutism/drug therapy , Necrosis/chemically inducedABSTRACT
Superinfections originating from a digestive tract colonized by abnormally high concentrations of aerobic microorganisms as a result of impaired resistance to colonization (CR) may complicate antibiotic therapy. In this study, patients with a moderate to severe systemic infection were randomized to receive either cefotaxime (CTX, n = 10) or cotrimoxazole (CTR, n = 10), 2 antibiotic regimens presumed to spare CR; or imipenem/cilastine (I/C, n = 19). The effect on CR was measured indirectly by comparing the aerobic faecal flora before antibiotic treatment with that on day 8 of treatment. An increase in aerobic faecal flora denotes a disturbed CR, whereas a decrease means that the organism is sensitive to the effective faecal concentration of the antibiotic. Imipenem/cilastine-treated patients showed a significant increase in enterococci and Candida spp., while the number of aerobic Gram-negative rods remained constant. Cefotaxime-treated patients had evidence of an increase in enterococci, but not of Candida spp., and Escherichia coli numbers decreased significantly. In these patients the concentration of other Gram-negative aerobic rods showed a slight increase in 6 patients with a resistant Pseudomonas strain. Cotrimoxazole-treated patients showed a significant decrease in aerobic Gram-negative rods, a significant increase in Candida spp. and no change in enterococci. It is concluded that all 3 antimicrobial agents impair colonization resistance. Whether or not this is followed by overgrowth with resistant micro-organisms depends on the active faecal concentration of the antimicrobial agent and the MIC of the aerobic micro-organisms. The risk of overgrowth of the bowel with resistant Gram-negative bacilli appears to be smaller following cotrimoxazole than following cefotaxime or imipenem/cilastine.
Subject(s)
Bacteria, Aerobic/drug effects , Cefotaxime/adverse effects , Digestive System/drug effects , Digestive System/microbiology , Imipenem/adverse effects , Trimethoprim, Sulfamethoxazole Drug Combination/adverse effects , Adult , Aged , Aged, 80 and over , Bacteria, Aerobic/isolation & purification , Candida/drug effects , Candida/isolation & purification , Enterococcus/drug effects , Enterococcus/isolation & purification , Feces/microbiology , Female , Gram-Negative Aerobic Bacteria/drug effects , Gram-Negative Aerobic Bacteria/isolation & purification , Humans , Male , Middle Aged , Superinfection/etiology , Superinfection/microbiologyABSTRACT
The tumour lysis syndrome, a combination of metabolic derangements, is a complication of intensive cytotoxic chemotherapy, especially in rapidly proliferating lymphoid malignancies. During the last three years we have encountered four cases with different forms of haematological neoplasms, all of whom developed tumour lysis, i.e. some degree of hyperuricaemia, hyperkalaemia, hyperphosphataemia or hypocalcaemia, resulting in renal, circulatory and/or respiratory failure. Relevant literature is reviewed.
Subject(s)
Antineoplastic Agents/adverse effects , Tumor Lysis Syndrome/etiology , Acute Disease , Female , Humans , Leukemia, Lymphoid/drug therapy , Leukemia, Myeloid/drug therapy , Lymphoma, B-Cell/drug therapy , Male , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Tumor Lysis Syndrome/metabolism , Tumor Lysis Syndrome/therapyABSTRACT
In a non-randomized study the efficacy of itraconazole in preventing fungal infections in neutropenic patients was investigated. Forty-seven patients with acute leukemia or advanced lymphoblastic lymphoma were enrolled. Ninety-two episodes of severe neutropenia after chemotherapy were observed. Mean duration of neutropenia was 24 days. Norfloxacin was administered as prophylaxis against gram-negative infections and itraconazole 200 mg b.i.d. as antifungal prophylaxis. Surveillance cultures of throat, urine, feces and vagina or prepuce were performed regularly. Four patients died, two patients due to heart failure, two patients due to staphylococcal pneumonia. Only in one case Candida albicans was cultured from bronchoalveolar lavage fluid. No systemic mycosis or Aspergillus fumigatus pneumonia was documented. In a similar group of patients treated in the preceding 18 months nystatin was used as antifungal prophylaxis. In this group of patients six cases of Aspergillus fumigatus pneumonia, two cases of Candida albicans fungemia and one case of Candida glabrata pneumonia occurred of which six patients died. Itraconazole seems to be effective in preventing fungal infections in neutropenic patients and is well tolerated.
Subject(s)
Antifungal Agents/therapeutic use , Ketoconazole/analogs & derivatives , Mycoses/prevention & control , Neutropenia/complications , Adolescent , Adult , Aged , Female , Humans , Itraconazole , Ketoconazole/therapeutic use , Male , Middle Aged , Mycoses/etiology , Nystatin/therapeutic use , Prospective StudiesABSTRACT
A patient known with acute intermittent porphyria who developed primary liver-cell carcinoma is described. No other risk factors were found. A possible association of acute intermittent porphyria with the development of primary liver-cell carcinoma has been suggested in recent, mainly Scandinavian literature. So far this association has never been described in The Netherlands.
