1/32. codeine intoxication in the neonate.Although opiates can provide patients with relief from pain and the discomfort of cough, the routine prescription of these drugs for infants demands caution and concern. Infants, particularly neonates, are not merely small adults requiring smaller dosages, but rather uniquely different patients. Neonates present with an immature physiology and biochemistry with respect to drug metabolism. We report a case of codeine intoxication in the neonate, in which the drug was prescribed for cough control during an emergency department visit.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
2/32. Perinatal vasoconstrictive renal insufficiency associated with maternal nimesulide use.A full-term newborn developed oliguric renal failure at 24 hr of life, which persisted for several days. Her mother ingested therapeutic doses of nimesulide, a non-steroidal anti-inflammatory (cyclo-oxygenase-2 inhibitor) drug, during the last 2 weeks of pregnancy. She was found at delivery to have developed oligohydramnion, esophagitis, and a bleeding peptic ulcer. The infant's fractional excretion of sodium was very low (0.5%) pointing for a severe vasoconstrictive mechanism involved. Renal sonogram showed hyperechogenic medullary papillae, which resolved during convalescence. This case emphasizes the importance of renal prostagandins in the control of vascular tone and sodium homeostasis. This is the first report of an adverse effect of fetal renal circulation by maternal ingestion of nimesulide.- - - - - - - - - - ranking = 0.33333333333333keywords = drug (Clic here for more details about this article) |
3/32. Bronchorrhea revealing cervix adenocarcinoma metastastic to the lung.Copious bronchorrhea can be related to bronchioloalveolar carcinoma, but reports of bronchorrhea related to lung metastasis are rare. We report the case of a woman presenting lung metastases of a cervical adenocarcinoma revealed by bronchorrhea, eventually identified as ectopic cervical mucus. Treatment included anticancer drugs and erythromycin, the latter in order to reduce the bronchorrhea, with eventually poor efficacy. This observation illustrates the importance of respiratory signs in the post-therapeutic follow up of cancer, especially cough and bronchorrhea in adenocarcinoma.- - - - - - - - - - ranking = 0.33333333333333keywords = drug (Clic here for more details about this article) |
4/32. Accidental busulfan overdose: enhanced drug clearance with hemodialysis in a child with wiskott-aldrich syndrome.A 4.6 kg infant with wiskott-aldrich syndrome received an accidental overdose of busulfan during preparation for allogeneic stem cell transplantation. Pharmacokinetic analysis of plasma busulfan levels alerted staff to the dosing error. Hemodialysis was immediately performed and resulted in accelerated clearance of busulfan. There were no acute neurologic and hepatic side-effects of the busulfan overdose, and despite 2 months of cough accompanied by rales, the patient is now free of pulmonary symptoms. Stable partial donor chimerism occurred after transplantation. At present, the patient is thriving and infection-free 12 months after transplantation, although his platelet count remains at the lower limit of normal.- - - - - - - - - - ranking = 1.3333333333333keywords = drug (Clic here for more details about this article) |
5/32. Chronic cough induced by abacavir apart from a context of hypersensitivity.We report the case of an hiv-infected woman, who presented with chronic and productive cough without sign of hypersensitivity (fever, cutaneous eruption, gastrointestinal disorders), while taking abacavir. All complementary exams being negative, the involvement of abacavir has been suspected. So the drug was stopped leading to a rapid disappearance of cough. It is the first report of chronic cough with abacavir apart of a context of hypersensitivity reaction.- - - - - - - - - - ranking = 0.33333333333333keywords = drug (Clic here for more details about this article) |
6/32. cough requiring discontinuance of angiotensin-converting enzyme inhibitors in an urban inner-city population.Angiotensin-converting enzyme (ACE) inhibitors are increasingly used to control hypertension although cough, sometimes severe enough to require discontinuance, is a well-described side effect of these drugs. Manufacturers' labeling indicates that this side effect occurs with a much lower frequency than is reported in the literature. This article describes the incidence of cough as a side effect of ACE inhibitors in a small inner-city practice and presents two reports of patients who required discontinuance of ACE inhibitors for this symptom. It is suggested that, consistent with the recent literature, the incidence of this symptom is more frequent than suggested by manufacturers' labeling, at least in this population.- - - - - - - - - - ranking = 0.33333333333333keywords = drug (Clic here for more details about this article) |
7/32. omeprazole-induced intractable cough.OBJECTIVE: To report a case of chronic, persistent cough induced by omeprazole therapy.CASE SUMMARY: A 42-year-old white woman presented with chronic, persistent cough after omeprazole initiation for treatment of postoperative heartburn. The cough was permanent, dry, and exhausting and worsened at night. omeprazole therapy was continued for 4 months because the persistent cough was thought to be related to gastroesophageal reflux disease (GERD). However, no cause of persistent, chronic cough was identified. After omeprazole discontinuation, the cough resolved. DISCUSSION: The most common causes of chronic cough in nonsmokers of all ages are postnasal drip syndrome, asthma, and GERD. However, persistent cough without bronchospasm or other pulmonary involvement may occur as a drug adverse effect. According to the US omeprazole package insert, cough is observed as an adverse reaction in 1.1% of patients, although this has not been mentioned in international drug information sources or medical literature. A medline search (1966-June 2003) using the terms cough, drug related, adverse effects, and omeprazole failed to find any data. In our patient, there was a temporal relationship between cough and medication use, suggesting a causal relationship. An objective causality assessment revealed that the adverse drug reaction was probable. The mechanism is unclear. CONCLUSIONS: Chronic, persistent cough may occur as an adverse effect of omeprazole therapy. Clinicians must be aware of this adverse effect to avoid useless and costly tests.- - - - - - - - - - ranking = 1.3333333333333keywords = drug (Clic here for more details about this article) |
8/32. If it is not cough, it must be dysgeusia: differing adverse effects of angiotensin-converting enzyme inhibitors in the same individual.Presented is an unusual case of a 66-year-old-resident of a long-term care facility, who manifested severe dysgeusia and impaired quality of life attributed to the angiotensin-converting enzyme (ACE) inhibitor enalapril; not realized at the time was the fact that he had an adverse reaction-cough-just weeks earlier from another ACE inhibitor in the same class, quinapril, thus illustrating different adverse effects to two antihypertensives in the same class. cough and dysgeusia are symptoms that may be easily overlooked as side effects of medications. As polypharmacy is common in nursing home settings, health care providers need to be vigilant about adverse drug reactions which are common, but preventable and often reversible.- - - - - - - - - - ranking = 0.33333333333333keywords = drug (Clic here for more details about this article) |
9/32. Spontaneous tracheal rupture: a case report.We report the case of a spontaneous posterior tracheal wall rupture following a cough. A 67-year-old woman with a history of longstanding treatment with corticosteroids (8 years) for giant cell arteritis had general anesthesia for cataract removal. Surgery and anesthesia were uneventful. In the recovery room, the patient coughed and soon after developed subcutaneous emphysema of the neck. Chest radiography confirmed the clinical diagnosis of marked subcutaneous emphysema and showed huge pneumomediastinum and minor right pneumothorax. A thoracic CT scan revealed a large laceration of the posterior tracheal wall (a 4 cm longitudinal tear), extending from the middle of the trachea to the level of the carina. Surgical repair consisted in closure of the dilaceration using an autologous pericardial patch. It seems reasonable to suspect the facilitating role of connective tissue fragility due to chronic corticosteroid administration in the development of this tracheal rupture following cough. Tracheal rupture is a potentially lethal injury, which can be repaired successfully if the diagnosis is made early. risk factors, diagnosis and principles of treatment of this lesion are discussed.- - - - - - - - - - ranking = 0.014268727705113keywords = closure (Clic here for more details about this article) |
10/32. Infectious disease capsules: a pox on your house.A 31-year-old, previously healthy white man presented to the emergency department with complaints of malaise, fevers, shortness of breath, a non-productive cough, and a "rash." His physical exam revealed a temperature of 100.2F, a pulse of 129 bpm, respiratory rate of 14 BPM, and blood pressure of 140/74 mm Hg. He was alert, oriented, and in no distress. His oropharynx was dry, his neck was supple, and cervical lymphadenopathy was absent. He had tachycardia, bilateral wheezes, and rhonchi with prolonged expirations. There was a diffuse vesicular eruption enveloping his entire body with involvement sparing his palms and soles (Figures 1 and 2). Laboratory values showed a hemoglobin of 16.0 g/dL and a white blood cell count of 7100 cells/pL, with 39%neutrophils, 23% bands, and 35% lymphocytes. His platelet count was mildly decreased to 86,000 x 103/pL. Chest radiograph revealed bilateral diffuse interstitial infiltrates. A diagnosis of acute varicella-zoster virus pneumonia (varicella pneumonia) was made, and the patient was started on IV acyclovir (10 mg/kg every 8 hours). Upon further questioning, the patient stated that his daughter had been diagnosed with "chickenpox" 7 days ago. The patient had numerous exposures to chickenpox in the past but had never developed clinical expressions of varicella. He was not at risk for hiv infection, not having multiple sexual partners, IV drug abuse, or blood transfusions. During the 1 day of in-hospitalization, his fever abated and the pulmonary signs diminished.Following discharge, IV acyclovir was replaced by valacyclovir to complete a 7-day course of therapy.- - - - - - - - - - ranking = 0.33333333333333keywords = drug (Clic here for more details about this article) |
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