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Joel Sayfan - One of the best experts on this subject based on the ideXlab platform.
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Ergotamine‐induced anorectal strictures: report of five cases.
Headache, 2003Co-Authors: Joel SayfanAbstract:Dis Colon Rectum. 2002 Feb;45(2):271-2 Purpose: Ergotamine tartrate suppositories are used for treatment of migraine headache attacks. Chronic abuse may lead to severe anorectal complications such as ulceration, stricture, and rectovaginal fistula. These complications are rare, and only sporadic reports may be found. Nevertheless, awareness of this entity on the part of prescribing physicians and treating colorectal surgeons is essential for a successful outcome, because withdrawal of this Medication is an inherent part of treatment. Patients: Five female patients were referred for treatment of symptomatic strictures of the anal canal and lower rectum. All of these patients admitted prolonged, nearly daily use of three to seven ergotamine tartrate suppositories. Results: Three patients with severe stenosis of the anal verge and anal canal were treated by Y-V anoplasty, and two patients with circular stricture of the lower third of the rectum had balloon dilatations. In all patients the use of ergotamine suppositories was stopped, and Alternative Medication was instituted. Long-term follow-up (3-12 years) showed complete resolution of symptoms. Conclusion: In view of the availability of new effective drugs for treatment of migraine headache (serotonin agonists) and considering the potentially severe complications of chronic use of ergotamine, the use of this Medication should be abandoned. Comment: Ergotamine users beware of the sting in the tail! DSM.
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ergotamine induced anorectal strictures report of five cases
Headache, 2003Co-Authors: Joel SayfanAbstract:Dis Colon Rectum. 2002 Feb;45(2):271-2 Purpose: Ergotamine tartrate suppositories are used for treatment of migraine headache attacks. Chronic abuse may lead to severe anorectal complications such as ulceration, stricture, and rectovaginal fistula. These complications are rare, and only sporadic reports may be found. Nevertheless, awareness of this entity on the part of prescribing physicians and treating colorectal surgeons is essential for a successful outcome, because withdrawal of this Medication is an inherent part of treatment. Patients: Five female patients were referred for treatment of symptomatic strictures of the anal canal and lower rectum. All of these patients admitted prolonged, nearly daily use of three to seven ergotamine tartrate suppositories. Results: Three patients with severe stenosis of the anal verge and anal canal were treated by Y-V anoplasty, and two patients with circular stricture of the lower third of the rectum had balloon dilatations. In all patients the use of ergotamine suppositories was stopped, and Alternative Medication was instituted. Long-term follow-up (3-12 years) showed complete resolution of symptoms. Conclusion: In view of the availability of new effective drugs for treatment of migraine headache (serotonin agonists) and considering the potentially severe complications of chronic use of ergotamine, the use of this Medication should be abandoned. Comment: Ergotamine users beware of the sting in the tail! DSM.
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ergotamine induced anorectal strictures report of five cases
Diseases of The Colon & Rectum, 2002Co-Authors: Joel SayfanAbstract:PURPOSE: Ergotamine tartrate suppositories are used for treatment of migraine headache attacks. Chronic abuse may lead to severe anorectal complications such as ulceration, stricture, and rectovaginal fistula. These complications are rare, and only sporadic reports may be found. Nevertheless, awareness of this entity on the part of prescribing physicians and treating colorectal surgeons is essential for a successful outcome, because withdrawal of this Medication is an inherent part of treatment. PATIENTS: Five female patients were referred for treatment of symptomatic strictures of the anal canal and lower rectum. All of these patients admitted prolonged, nearly daily use of three to seven ergotamine tartrate suppositories. RESULTS: Three patients with severe stenosis of the anal verge and anal canal were treated by Y-V anoplasty, and two patients with circular stricture of the lower third of the rectum had balloon dilatations. In all patients the use of ergotamine suppositories was stopped, and Alternative Medication was instituted. Long-term follow-up (3–12 years) showed complete resolution of symptoms. CONCLUSION: In view of the availability of new effective drugs for treatment of migraine headache (serotonin agonists) and considering the potentially severe complications of chronic use of ergotamine, the use of this Medication should be abandoned.
A Amery - One of the best experts on this subject based on the ideXlab platform.
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Hormonal effects of the diuretic xipamide in healthy men
Cardiovascular Drugs and Therapy, 1991Co-Authors: Paul Lijnen, Ja Staessen, Robert Fagard, A AmeryAbstract:The effect of xipamide on plasma α-atrial natriuretic peptide and the renin-aldosterone-kallikrein system have been studied in 12 healthy men, using a double-blind cross-over design. After a run-in period on placebo of 1 week, the subjects were treated with either placebo (n = 6) or xipamide 20 mg once daily (n = 6) for 16 weeks and were then switched to the Alternative Medication for another 16 weeks. The plasma concentration of α-atrial natriuretic peptide fell after 1 week of xipamide administration and increased during prolonged xipamide administration but remained reduced. The changes in plasma α-ANP observed after 1 week of xipamide were negatively correlated with the changes in hematocrit and hemoglobin. Plasma renin activity (PRA), aldosterone concentration (PAC), and urinary excretion of aldosterone and kallikrein increased after 1 week of xipamide administration, levelled off during the second and fourth weeks, but remained elevated during further prolonged xipamide administration for 16 weeks. The xipamide-induced changes in PRA and PAC were positively correlated with the changes in the hematocrit and hemoglobin. The changes in plasma renin, aldosterone, and α-atrial natriuretic peptide during xipamide administration may be related to diureticinduced volume contraction.
David W Hardy - One of the best experts on this subject based on the ideXlab platform.
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zidovudine compared with didanosine in patients with advanced hiv type 1 infection and little or no previous experience with zidovudine
JAMA Internal Medicine, 1995Co-Authors: Raphael Dolin, Carla Pettinelli, Mohan Beltangady, Songheng Liou, Anne Cross, David A. Amato, Martin S Hirsch, Margaret A Fischl, Michael J Brown, David W HardyAbstract:Background: We conducted a trial to compare treatment with zidovudine or didanosine in patients with advanced human immunodeficiency virus type 1 (HIV-1) infection who had received little or no previous therapy with zidovudine. Methods: Six hundred seventeen patients with acquired immunodeficiency syndrome (AIDS), advanced AIDS-related complex (CD4 cell count, ≤0.30× 10 9 /L [300/μL]), or asymptomatic HIV (CD4 cell count, ≤0.20× 10 9 /L) received zidovudine, 500 mg/d of didanosine, or 750 mg/d of didanosine in a randomized, double-blind allocation, with cross-over to Alternative Medication after development of an end point or serious toxic effect. To be eligible, patients must have received either no or up to 16 weeks of zidovudine therapy before entry into the study. Primary end points were development of a new AIDS-defining event or death. Secondary clinical end points were new or recurrent AIDS-defining events, or death, and survival. Results: In the study as a whole, there were no differences in the relative risks (RRs) of the development of end points between treatment groups. However, there was a strong interaction between the relative efficacies of zidovudine and didanosine and previous experience with zidovudine. Among 380 patients with no previous zidovudine therapy, zidovudine was more effective than 750 mg/d of didanosine (RR, 1.43; 90% confidence interval [CI], 1.02 to 2.00), with a similar trend for zidovudine compared with 500 mg/d of didanosine (RR, 1.21; 90% CI, 0.86 to 1.71). However, among 118 patients with more than 8 weeks but no more than 16 weeks of previous zidovudine therapy, 500 mg/d of didanosine was more effective than zidovudine (RR, 0.48; 90% CI, 0.27 to 0.86); there was a similar trend for increased effectiveness of 750 mg/d of didanosine compared with zidovudine (RR, 0.61; 90% CI, 0.36 to 1.03). Among 119 patients who had some but no more than 8 weeks of previous zidovudine therapy, there were no significant differences among the treatment arms. Similar findings were noted in the analysis of the two secondary clinical end points. No significant differences were found in efficacy between the groups receiving 500 and 750 mg/d of didanosine. The major toxic effect associated with zidovudine was hematopoietic (granulocytopenia) and that associated with didanosine was pancreatitis (dosage, 750 mg/d). Conclusions: In patients with advanced HIV disease, zidovudine appears to be more effective than didanosine as initial therapy; however, some patients with advanced HIV disease may benefit from a change to didanosine therapy after as little as 8 to 16 weeks of therapy with zidovudine. (Arch Intern Med. 1995;155:961-974)
Osamu Ogawa - One of the best experts on this subject based on the ideXlab platform.
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anaphylaxis following administration of intravenous methylprednisolone sodium succinate in a renal transplant recipient
International Journal of Urology, 2004Co-Authors: Ryoichi Saito, Seiji Moroi, Hiroshi G Okuno, Osamu OgawaAbstract:Methylprednisolone sodium succinate (MPS) is widely used in the management of renal transplantation. Of interest is the rare occurrence of anaphylaxis and anaphylactoid reaction to MPS. We report on a patient who developed anaphylaxis following the intravenous administration of MPS during a renal transplant operation. Intracutaneous testing was carried out with MPS and a strong positive reaction was observed. Histamine and tryptase concentrations were high after the anaphylactic reaction. Including the present case, there have been 13 reports of anaphylactic or anaphylactoid reactions to MPS, occurring in renal transplant recipients. Clinicians should be aware of the potential risk of MPS administration. If transplant patients undergo skin testing against MPS prior to transplant, they may benefit from an Alternative Medication with other corticosteroids. To use MPS without severe adverse reactions, lower administration rates and dosages are very important.
Frederick G Strathmann - One of the best experts on this subject based on the ideXlab platform.
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cost and efficacy assessment of an Alternative Medication compliance urine drug testing strategy
Pain Medicine, 2016Co-Authors: Kelly Doyle, Frederick G StrathmannAbstract:Objective. This study investigates the frequency at which quantitative results provide additional clinical benefit compared to qualitative results alone. A comparison between Alternative urine drug screens and conventional screens including the assessment of cost-to-payer differences, accuracy of prescription compliance or polypharmacy/substance abuse was also included. Setting and Methods. In a reference laboratory evaluation of urine specimens from across the United States, 213 urine specimens with provided prescription Medication information (302 prescriptions) were analyzed by two testing algorithms: 1) conventional immunoassay screen with subsequent reflexive testing of positive results by quantitative mass spectrometry; and 2) a combined immunoassay/qualitative mass-spectrometry screen that substantially reduced the need for subsequent testing. Results. The qualitative screen was superior to immunoassay with reflex to mass spectrometry in confirming compliance per prescription (226/302 vs 205/302), and identifying non-prescription abuse (97 vs 71). Pharmaceutical impurities and inconsistent drug metabolite patterns were detected in only 3.8% of specimens, suggesting that quantitative results have limited benefit. The percentage difference between the conventional testing algorithm and the Alternative screen was projected to be 55%, and a 2-year evaluation of test utilization as a measure of test order volume follows an exponential trend for Alternative screen test orders over conventional immunoassay screens that require subsequent confirmation testing. Conclusion. Alternative, qualitative urine drug screens provide a less expensive, faster, and more comprehensive evaluation of patient Medication compliance and drug abuse. The vast majority of results were interpretable with qualitative results alone indicating a reduced need to automatically reflex to quantitation or provide quantitation for the majority of patients. This strategy highlights a successful approach using an Alternative strategy for both the laboratory and physician to align clinical needs while being mindful of costs.