1/12. Recurrent acute nitrofurantoin-induced pulmonary toxicity.nitrofurantoin may be used for prophylaxis of recurrent urinary tract infections in women; however, this agent has been associated with acute, subacute, and chronic pulmonary adverse reactions. The acute reaction occurs in about 1/5,000 women after their first exposure to the drug. We report the occurrence of two successive, highly probable (by Naranjo score) nitrofurantoin-induced acute pulmonary reactions in the same patient. On day 4 of prophylaxis with nitrofurantoin 100 mg/day (to prevent urinary tract infections), the patient developed intense substernal pain and pressure. On day 8, she experienced intense substernal burning. She went to the emergency department, where she vomited and was hypotensive and febrile. Her chest radiograph showed bilateral infiltrates. The patient was diagnosed with pneumonia and was prescribed levofloxacin; she stopped taking the nitrofurantoin. Her symptoms subsided over the next 3 days. Ten days later, the patient restarted the nitrofurantoin, and she returned to the emergency department after again experiencing sudden intense substernal burning, nausea, vomiting, shivering, and weakness. nitrofurantoin was discontinued; her symptoms resolved quickly, and prophylaxis with trimethoprim-sulfamethoxazole was begun. After 1 year, the patient had experienced no further pulmonary symptoms or urinary tract infections. Drug toxicity must be considered in patients who develop pulmonary symptoms while taking nitrofurantoin. Symptoms are often misdiagnosed as other ailments, potentially subjecting patients to unnecessary treatments and delaying discontinuation of nitrofurantoin. patients should be advised to contact a physician if breathing difficulties or unusual symptoms develop while taking nitrofurantoin, as this could result in earlier recognition of this drug reaction.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/12. Acute neurological deficits caused by cefipime: a case report and review of literature.Cefepime (Maxipime) is a fourth-generation cephalosporin commonly used to treat a variety of infections. Its controversial side effect profile is not well appreciated by first-line practitioners. We report a case of urinary tract infection treated with cefepime in a 91-year-old woman. The acute onset of conscuous disturbance was noted on the 9th day of cefepime treatment. Computed tomogram and magnetic resonance image of the brain showed no specific findings. The neurological symptoms and signs such us conscious disturbance, ocular bobbing, asterexis disappeared after discontinuation of cefepime. We suggest that physicians should cefepime as a possible cause of reversible neurological deficits.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/12. Special considerations in the management of a patient with multiple sclerosis and a burn injury.The purposes of this report were to describe a successful treatment of a burn injury in a patient with multiple sclerosis as well as to outline specific aspects of therapy that contributed to minimizing the risk of complications in this challenging patient. multiple sclerosis is the leading cause of neurologic morbidity and death among young adults. It is an inflammatory disease of the central nervous system that involves the autonomic and somatic components and is characterized by a primary destruction of myelin. The demyelinated nerves exhibit an increased temperature sensitivity that accounts for the adverse effects of elevated core temperature on the neurologic signs and symptoms of this disease. Because burn injury, infection, and vigorous exercise elicit an elevation of core temperature with an accompanying deterioration in neurologic function, lowering the elevated core body temperature is mandatory. The dysautonomias of multiple sclerosis may be as devastating as their somatic counterparts and may have life-threatening implications. In recent years, advances in our understanding of the pathophysiology of central nervous system dysfunction have enabled physicians to improve dramatically the management of symptoms in multiple sclerosis without significantly altering the progressive long-term course of the disease.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/12. haemophilus influenzae infections in adults: report of nine cases and a review of the literature.haemophilus influenzae is an aerobic pleomorphic gram-negative coccobacillus that requires both X and V factors for growth. It grows poorly, if at all, on ordinary blood agar unless streaked with Staph. aureus. It grows well on chocolate agar. Because this medium is often not used in culturing specimens from adults and because the organism may be overgrown by other bacteria, the frequency of H. influenzae infections has undoubtedly been seriously underestimated. This is aggravated by the failure of many physicians to obtain blood cultures in suspected bacterial infections and the failure of many laboratories to subculture them routinely onto chocolate agar. H. influenzae, along with streptococcus pneumoniae, is a major factor in acute sinusitis. It is probably the most frequent etiologic agent of acute epiglottitis. It is probably a common, but commonly unrecognized, cause of bacterial pneumonia, where it has a distinctive appearance on Gram stain. It is unusual in adult meningitis, but should particularly be considered in alcoholics; in those with recent or remote head trauma, especially with cerebrospinal fluid rhinorrhea; in patients with splenectomies and those with primary or secondary hypogammaglobulinemia. It may rarely cause a wide variety of other infections in adults, including purulent pericarditis, endocarditis, septic arthritis, obstetrical and gynecologic infections, urinary and biliary tract infections, and cellulitis. Antimicrobial susceptibility testing is somewhat capricious in part from the marked effect of inoculum size in some circumstances. in vitro and in vivo results support the use of ampicillin, unless the organism produces beta-lactamase. Alternatives in minor infections include tetracycline, erythromycin, and sulfamethoxazole-trimethoprim. For serious infections chloramphenicol is the best choice if the organism is ampicillin-resistant or the patient is penicillin-allergic.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/12. prostatitis. A continuing enigma.After all is said and done, prostatitis is still a syndrome often difficult to interpret and with an unclear etiology and pathogenesis in many patients. However, if approached intelligently by an interested, knowledgeable, and honest physician, prostatitis in its different variations can be diagnosed correctly and the adequate treatment adjusted accordingly wherever possible. When no specific treatment is available, reassurance and general supportive measures will often alleviate the condition remarkably.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/12. Evaluation of gross and microscopic hematuria.In summary, hematuria, either gross or microscopic and with or without any accompanying symptoms, should always alert the clinician to the possibility of serious urologic disease and should virtually always trigger a thorough urologic investigation. This can be done by immediate referral to the urologist, or it can be done by the primary care physician initiating the diagnostic work-up in children by obtaining studies for acute poststreptococcal glomerulonephritis and in adults by obtaining excretory urograms with physiologic voiding films and also by urine cytologic studies and urine cultures. Appropriate referral to a urologist can then be made for additional studies that might be indicated, such as cystoscopy and cystourethroscopy and for meticulous follow-up of any abnormal findings. The physician who delays or defers a careful investigation into the cause of a given patient's hematuria (gross or microscopic) does the patient a disservice at best and, at worst, may inadvertently permit a significant disease process to become more extensive.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
7/12. schistosomiasis haematobium.In our patient, schistosomiasis haematobium was not diagnosed and was treated as a urinary tract infection by several physicians. physicians are urged to become increasingly aware of the need to recognize strange and exotic diseases normally not present in this country.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/12. The occurrence of acute renal failure in patients with neuropathic bladders.A group of patients with neuropathic bladders, who developed acute renal failure, is described. In each instance, sepsis from the urinary tract, its consequences or its treatment was implicated in the aetiology of the renal failure. Aggressive management of acute renal failure in the patients in our study showed their survival and functional renal recovery to be no worse than for similar patients without paraplegia. This illustrates that these patients presenting with a rare and serious complication of paraplegia should not be abandoned, since aggressive treatment along conventional lines in consultation with renal physicians and urologists was successful in four out of five of our patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/12. Symptomatic bacterial urinary tract infections in men: limitations of quantitative urine cultures.Occasionally, physicians have discarded the diagnosis of acute symptomatic bacterial urinary tract infection when the urine coutn failed to approach or exceed 100,000 organisms per ml. Previous studies done in women have established the fact that sole reliance cannot be placed on this value to exclude the diagnosis of symptomatic bacterial urinary tract infection. A retrospective analysis of the charts of male patients, with an unequivocal diagnosis of symptomatic bacterial urinary tract infection, demonstrates the limitations of the urine colony count as a diagnostic test in men.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/12. Lessons learned from a patient. Changing concepts rather than facts.Many concepts pertaining to urinary tract infections and considered to be established or dogma are, in fact, incorrect or subject to modification. The physician should not be too rigid in his thinking regarding this disorder, as new knowledge constantly becomes available, disproving previously cherished beliefs. The case described appears to underscore this better than any hypothetical situation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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