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Biomedical subjects

M D Katz

Publications and source records attributed to M D Katz.

At least 37 records · Page 2Linked to original sources
PubMed1992

Danazol increases the anticoagulant effect of warfarin.

OBJECTIVE: To report two cases demonstrating an interaction between danazol and warfarin, resulting in the potentiation of warfarin's effect and bleeding complications. DATA SOURCES: Case reports, review articles, and studies identified by MEDLINE. STUDY SELECTION: All published English-language reports involving danazol and warfarin interactions were reviewed. DATA SYNTHESIS: Danazol, a synthetic testosterone derivative, is used in the treatment of endometriosis, fibrocystic breast disease, menorrhagia protein C deficiency, and hemophilia. We describe two cases including an interaction between danazol and warfarin, resulting in bleeding complications. There are at least two other reported cases of this interaction. This interaction may be attributable to several mechanisms. Danazol may inhibit the metabolism of warfarin and/or it may have a direct effect on the coagulation and fibrinolytic systems. CONCLUSIONS: Based on this report and other published cases, clinicians must be aware that danazol may increase the anticoagulant effect of warfarin. Patients receiving warfarin who are prescribed danazol must be monitored closely to prevent excessive anticoagulation and subsequent bleeding. Studies are needed to determine the frequency of this interaction and its underlying mechanisms.

Adult↗
PubMed1989

Effects of passive smoking on theophylline clearance.

Theophylline disposition was examined in seven passive smokers, defined as nonsmokers with long-term exposure to cigarette smoke, and seven age-matched nonsmokers with minimal smoke exposure. Subjects were given an intravenous infusion of aminophylline (6 mg/kg) and blood samples were drawn before and during the 48-hour postinfusion period. Clearance for passive smokers was 6.01 x 10(-2) L/hr.kg and for nonsmokers, clearance was 4.09 x 10(-2) L/hr.kg (p less than 0.025). Terminal elimination half-life for passive smokers was 6.93 hours versus 8.69 hours for nonsmokers (p less than 0.05). The mean residence time for passive smokers was 9.89 hours. For nonsmokers, the mean residence time was 13.11 hours (p less than 0.05). These measurements were statistically different, whereas there was no difference in volume of distribution between the groups, suggesting that passive smokers metabolize theophylline more rapidly than nonsmokers. Plasma and urine cotinine and nicotine concentrations were measured in all subjects. There was a significant difference between the subject groups in plasma (p less than 0.004) and urine (p less than 0.002) cotinine concentrations. Theophylline clearance correlated with both plasma (r = 0.73, p less than 0.01) and urine (r = 0.79, p less than 0.01) cotinine concentrations. Additional studies should be conducted to further define the pharmacokinetic characteristics of passive smokers and to assess the effects of passive smoking on drugs metabolized by the mixed function oxidase system.

Adult↗
PubMed1989

Octreotide, a new somatostatin analogue.

The chemistry, pharmacology, pharmacokinetics, clinical uses, adverse effects and drug interactions, dosage, availability and cost, and indications for use of octreotide, a new synthetic analogue of the peptide hormone somatostatin (SS), are reviewed. Like SS, octreotide suppresses secretion of pituitary growth hormone (GH) and thyrotropin and decreases release of a variety of pancreatic islet cell hormones including insulin, glucagon, and vasoactive intestinal peptide (VIP). Octreotide also reduces splanchnic blood flow, gastric acid secretion, GI motility, and pancreatic exocrine function and alters the absorption of water, electrolytes, and nutrients from the GI tract. The elimination half-life of i.v. octreotide is 72-98 minutes, compared with 2-3 minutes for i.v. SS. Usual administration of octreotide is by the i.v. or s.c. route. Octreotide has been studied in the treatment of hormone-secreting pituitary tumors and pancreatic islet cell tumors. Octreotide therapy lowers GH secretion and improves clinical symptoms in patients with acromegaly and may suppress clinical symptoms to a greater degree than bromocriptine. Patients with carcinoid syndrome and VIP-secreting tumors (vipomas) have had substantial improvement in clinical symptoms with administration of octreotide. This agent does not appear to be effective in the treatment of nonvariceal upper GI bleeding and acute pancreatitis; its relative usefulness in the treatment of variceal bleeding is not established. Adverse effects associated with octreotide therapy generally have been mild, including pain or burning at the injection site, abdominal pain, and diarrhea. Octreotide has been shown to interfere with absorption of oral cyclosporine. Standard initial therapy is octreotide acetate 50-100 micrograms s.c. every 8-12 hours, with titration based on clinical and biochemical effects. Up to 3000 micrograms/day of octreotide acetate has been administered to patients with acromegaly without serious adverse effect. Octreotide is marketed under the brand name Sandostatin and is available in 1-mL ampuls containing 50, 100, and 500 micrograms of octreotide acetate. Because the conditions for which octreotide appears to be most effective are uncommon, the drug should be considered for addition to the formulary in tertiary-care institutions only; addition of octreotide to the formulary of a community hospital is probably unnecessary. The synthetic analogue octreotide is longer acting and more specific in pharmacologic action than SS.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1988

Treatment of severe cryptosporidium-related diarrhea with octreotide in a patient with AIDS.

Cryptosporidiosis commonly causes severe diarrhea in immunosuppressed patients. There currently are no antiparasitic drugs consistently effective for this infection. This case describes a 26-year-old hemophiliac patient with acquired immunodeficiency syndrome and cryptosporidiosis whose diarrhea improved with continuous intravenous administration of a long-acting somatostatin analog, octreotide. Somatostatin has a variety of inhibitory effects on gastrointestinal hormones as well as a possible nonspecific effect on gastrointestinal mucosal fluid and electrolyte secretion. The somatostatin analog should be considered for patients with secretory diarrhea refractory to other forms of therapy.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Acute interstitial nephritis associated with intermittent rifampin use.

Rifampin is a widely used antimicrobial agent, most commonly administered in the treatment of tuberculosis. Since its introduction in the late 1960s, rifampin has become a standard agent in the treatment of tuberculosis, especially with the acceptance of short-course chemotherapy in the U.S. Rifampin also is being used with increasing frequency in the treatment of nontuberculous infections, especially serious staphylococcal infections. While rifampin usually is well tolerated in most patients, adverse effects, including serious forms of toxicity, have been reported. Some of these adverse effects include liver toxicity and various immunologic reactions such as skin rashes, eosinophilia, and interstitial nephritis. This report documents a case of acute interstitial nephritis, most likely secondary to intermittent rifampin administration.

Acute Disease↗
PubMed1986

Baclofen overdose with cardiac conduction abnormalities: case report and review of the literature.

Cardiac conduction abnormalities and hypertension developed in a patient who ingested approximately 500 mg of baclofen (Lioresal). The patient also exhibited the more common features of baclofen overdose including coma, respiratory depression, hypotonia, and hyporeflexia. A review of the literature and a discussion of the interesting manifestations and treatment of baclofen overdose are included.

Adult↗
PubMed1982

Inconsistency and institutional review boards.

To assess the adequacy of peer review for research on human subjects, identical research protocols in oncology and anesthesiology were submitted to 32 institutional review boards (IRBs) at major universities with medical colleges. Each of the protocols posed serious ethical issues, contained flaws in scientific design, and provided an incomplete consent form. Twenty-two IRBs participated in the investigation, which revealed (1) consistency in the nonapproval of the three protocols, (2) substantial inconsistency among IRBs in the reasons offered in support of similar decisions, and (3) substantial inconsistency in the application of ethical, methodological, and informed-consent standards for individual review boards. This evidence suggests that revision of the protocols to satisfy particular objections would result in approval of flawed investigations.

Clinical Trials as Topic↗
PubMed1980

Infection in a functioning ventriculoperitoneal shunt treated with intraventricular gentamicin.

A case of successful treatment of a functioning ventriculoperitoneal (VP) shunt infection with high doses of intraventricular gentamicin sulfate is reported. The VP shunt reservoir of a four-month-old girl with hydrocephalus became infected. The scalp wound was debrided and intravenous methicillin sodium, 200 mg every six hours, was administered. When culture and sensitivity tests later showed Enterobacter cloacae, methicillin was discontinued. Intraventricular gentamicin, 2 mg/day, and intravenous carbenicillin, 400 mg/kg/day, were administered. Gentamicin dosage was increased twice over the next eight days to 6 mg/day. The trough cerebrospinal fluid (CSF) gentamicin level at 2 mg/day was 1.7 micrograms/ml, at 4 mg/day was 0.7 microgram/ml and at 6 mg/day was 19.6 micrograms/ml. Gentamicin was discontinued after 14 days; carbenicillin was continued for 7 more days. For a second shunt infection with Klebsiella pneumoniae, intraventricular gentamicin and intravenous chloramphenicol were given for 21 days. Previous reports of ventricular shunt infections are reviewed. The report indicates that it is possible to achieve therapeutic CSF levels of gentamicin in patients with patent VP shunts by administering 2--5 times (depending on ventricle size) the usual intraventricular dose.

Cerebrospinal Fluid Shunts↗
PubMedDate not supplied

Strut interlocking of titanium Greenfield vena cava filters and its effect on clot capturing: an in vitro study.

PURPOSE: To determine the influence of filter leg-interlocking on filtering efficiency of titanium Greenfield inferior vena cava filters in an in vitro model. METHODS: Titanium Greenfield filters (TGF) were placed in an inferior vena cava (IVC) flow phantom with no interlocking legs, or with one or two pairs of legs interlocked. Clot emboli of varying sizes were introduced into the stream of flow, and the frequency of successful captures by the deformed filters was recorded. RESULTS: Interlocking filter legs diminished the filtering efficiency of the TGF by up to 80% with the flow phantom in a horizontal position; no such compromise existed when the phantom was in a vertical position. CONCLUSION: When leg interlocking is verified radiographically, the filtering efficiency of the TGF is reduced, and placement of a second IVC filter may be indicated.

Embolism↗
PubMedDate not supplied

A new curved peel-away sheath for central venous catheter placement.

A new 10F peel-away sheath with a preformed curve is now available. The procedure for insertion of central venous catheters remains the same, with the new curved sheath replacing the straight version. In our experience, this modification facilitates the placement of central venous catheters and decreases the incidence of catheter tip malposition and kinking.

Catheterization, Central Venous↗
PubMedDate not supplied

Bird's nest filter placement within an enlarged hemiazygos vein for prevention of pulmonary embolism.

Thrombosis of the inferior vena cava (IVC) may result in considerable enlargement of paravertebral, azygos, and hemiazygos collateral veins that may in turn serve as pathways for thromboemboli to the pulmonary circulation. Herein we describe the transfemoral placement of a Bird's Nest filter within an enlarged hemiazygos vein to provide prophylaxis against pulmonary embolism in a patient with right femoral venous thrombosis who could not tolerate systemic anticoagulation. There had been earlier transjugular placement of a Greenfield filter within the suprarenal IVC.

Femoral Vein↗
PubMedDate not supplied

Intentional occlusion of a transjugular intrahepatic portosystemic shunt.

The transjugular intrahepatic portosystemic shunt (TIPS) procedure is a well-described means of treating portal hypertension and its complications. Occasionally, the consequences of this shunt prompt the desire for its subsequent obliteration. We report one unsuccessful and one successful method of TIPS occlusion.

Aged↗
PubMedDate not supplied

Gastrointestinal hemorrhage due to duodenal erosion by a biliary wallstent.

A self-expanding metallic stent (Wallstent) was used to relieve obstruction of the common bile duct in a young male with a desmoplastic small cell tumor of the abdomen. Two months after insertion and following a course of chemotherapy the lower end of the stent eroded the mucosa of the second part of the duodenum causing severe gastrointestinal hemorrhage which necessitated laparotomy and trimming of the stent. This complication may have been due to shrinking of the tumor as well as thrombocytopenia following chemotherapy.

Abdominal Neoplasms↗