Penile angioedema possibly related to lisinopril.
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Aged↗
Biomedical subjects
J P Bracikowski
Publications and source records attributed to J P Bracikowski.
Single-dose antibiotic treatment for uncomplicated urinary tract infections. Less for less?
Because of the many differences among studies of single-dose antimicrobial therapy for uncomplicated urinary tract infection in women, we reviewed the 14 randomized controlled trials on this subject. Twelve concluded that single-dose therapy was as effective as conventional multiple-dose therapy. Although the studies were carefully conducted, none both reported and ascertained in a blinded manner the incidence of adverse drug reactions. Also, no study included enough patients to prevent type II error. To circumvent the problem of having too few patients in each study, we used a rational strategy for pooling the data from the reviewed studies. Single-dose amoxicillin (3 g) was significantly less effective than conventional multidose therapy (69% vs 84%), while single-dose sulfamethoxazole-trimethoprim (two or three double-strength tablets) was indistinguishable from multidose, although there still were too few patients to exclude type II error. More research on this subject is needed with greater attention to sample size and blinded ascertainment of adverse reactions.
Anti-Bacterial Agents↗
Campylobacter osteomyelitis.
We have reported a case of Campylobacter osteomyelitis, which we believe has not been previously reported. Symptoms and signs were nonspecific, but darkfield microscopy of a suspension of isolated bacteria was useful in making a presumptive diagnosis. Initial parenteral therapy based on sensitivity testing and prolonged oral doxycycline therapy was successful.
Aged↗
Ascending myeloencephalopathy due to intrathecal vincristine sulfate. A fatal chemotherapeutic error.
A case of fatal myeloencephalopathy secondary to accidental intrathecal administration of vincristine is reported in a 16-year-old boy. He underwent a progressive ascending chemical meningoencephalitis leading to coma, and died 36 days after the injection. Multiple samples of cerebrospinal fluid (CSF) and serum were assayed for vincristine sulfate. CSF levels of vincristine were consistently much higher than serum levels. At autopsy, all regions of the brain that had been in direct contact with the CSF were necrotic. The spinal cord was likewise necrotic throughout its length. Microscopically there was total neuronal loss with tissue destruction in the affected regions. The presence of numerous gemistocytic astrocytes, some in arrested mitosis, was a conspicuous feature in these areas. Three previous reports of intrathecal vincristine instillation are reviewed. No treatment for this devastating iatrogenic error exists, underscoring the importance of preventive measures in chemotherapy administration.
Adolescent↗