Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027947 (neutropenia)
 17,527 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Women experiencing their first episodes of genital herpes were treated, beginning within three days of the onset of lesions, with 5 X 10(4) units of human leukocyte interferon/kg of body weight for 12 doses over 14 days (total, approximately 3.6 X 10(7) units) or with placebo in equivalent volumes. Life-table analysis revealed quicker healing and significant reductions in the duration of shedding of virus in interferon-treated patients. Maximum daily geometric mean titers of virus and total area of unhealed lesions also decreased more quickly. No statistically significant difference in resolution of pain was seen between the two groups. Interferon had no effect on onset or frequency of subsequent recurrences recorded over one year of follow-up. Moderate, transient neutropenia occurred in 13 of 34 interferon-treated patients. A therapeutic effect of human leukocyte interferon on initial genital herpes was documented, but the clinical usefulness of interferon treatment of genital herpes is limited at this time.
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PMID:Leukocyte interferon for treating first episodes of genital herpes in women. 282 23

Of 760 AIDS patients seen at San Francisco General Hospital in 1986, 5.7 per cent had retinitis and 2.2 per cent had gastrointestinal disease caused by cytomegalovirus. We reviewed the records of 44 patients treated with ganciclovir for culture-confirmed cytomegalovirus retinal (31 patients) or gastrointestinal disease (17 patients) or both (four patients) in 1986. Retinitis stabilized or improved during initial treatment with ganciclovir in 22 of 27 (81.5 per cent) patients. Following a median 10-day induction course, 16 patients with retinitis continued to have serial ophthalmologic assessments: eight patients were maintained on treatment and eight had maintenance treatment deferred. Before treatment, the two groups were comparable in age, Karnofsky scores, hematologic assessment, visual acuity, and history with respect to Pneumocystis carinii pneumonia. Retinitis did not progress for a median 53.8 days in the immediate maintenance group compared to 18.8 days for the deferred maintenance group (p = 0.01). In 17 patients with CMV gastrointestinal disease, nine of 14 (64 per cent) had resolution of pain and eight of 11 (73 per cent) had resolution of diarrhea when treated initially with ganciclovir. In both retinitis and gastrointestinal disease patients, ganciclovir decreased recovery of CMV from urine and blood markedly. Ganciclovir also caused a decrease in mean absolute neutrophil counts to about half of baseline values; decreases in mean platelet count and hemoglobin were also noted but were less than 25 per cent. Neutropenia severe enough to require dose adjustment (less than 800 cells/microliters) occurred in 31 per cent of patients receiving maintenance ganciclovir.
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PMID:Retinal and gastrointestinal disease due to cytomegalovirus in patients with the acquired immune deficiency syndrome: prevalence, natural history, and response to ganciclovir therapy. 285 94

Amphethinile is a new spindle poison with a novel structure that has shown activity in the L1210, ADJ/PC6 and Walker carcinoma rodent tumours. In addition the agent appeared to have an improved therapeutic ratio compared to existing spindle poisons and is well absorbed when administered orally. The starting dose for the phase I study was 40 mg m-2 (1/10th mouse LD10) and further patients were studied at 200, 400, 800 and 1200 mg m-2, dose escalation being based on pharmacological monitoring. Significant toxic effects were seen only at 800 and 1200 mg m-2. At these doses patients experienced nausea and vomiting, light headedness during the infusion and varying degrees of lethargy following therapy. Two of six patients at 800 mg m-2 developed severe pain in the tumour bearing area 1-2 h after treatment and one experienced colicky abdominal pain. At 1200 mg m-2 two patients died within 48 h of treatment from what appeared to be vascular causes. Following these episodes the trial was discontinued. Neutropenia and alopecia occurred in two patients, one at 800 and one at 1200 mg m-2. These patients achieved the highest drug exposure in terms of area under the concentration x time curve. It was not possible to achieve an AUC consistently high enough to produce cytotoxic effects due to the occurrence of dose limiting toxicities thus amphethinile cannot at present be recommended for phase II testing by the i.v. route. The dose escalation scheme based on pharmacological monitoring resulted in a considerable saving in the duration of the trial. Further evaluation of this methodology is recommended.
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PMID:A phase I and pharmacokinetic study of amphethinile. 340 47

In an 18-month period candidal splenic abscesses were diagnosed and treated in eight patients. Predisposing factors consisted of recent exposure to cytotoxic chemotherapy, long-term use of prednisone, neutropenia, antibiotic therapy for greater than three weeks, and gastrointestinal tract colonization with Candida. The patients had a clinical profile of nontoxic appearance with a temperature of more than 38.5 degrees C that was unresponsive to antibiotics, pain and tenderness over the upper abdominal quadrants, focal defects visualized on ultrasound and/or computed tomographic scans, and an elevated alkaline phosphatase level. Candida infection was confirmed by histologic examination of the liver and/or spleen in all patients. Diagnosis was made by percutaneous biopsy in one patient and exploratory laparotomy in seven. Five patients had splenectomy and antifungal drugs. In three patients the fungal abscesses resolved with amphotericin B therapy alone. Seven of eight patients were cured of their splenic abscesses, and five of eight were long-term survivors.
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PMID:Diagnosis and treatment of splenic fungal abscesses in the immune-suppressed patient. 351 59

The differential diagnosis of aphthous stomatitis includes several viral diseases, such as gingivostomatitis herpetica, recurrent intraoral herpes simplex, herpangina, hand-, foot-and mouth disease, as well as drug eruptions, traumatic ulcers, and aphthoid lesions in neutropenia. The therapy of aphthous stomatitis is designed to control pain, shorten the course of present lesions, and prevent the development of new lesions.
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PMID:[Differential diagnosis and therapy of recurrent aphthae]. 361 54

Thirty episodes of presumed infectious esophagitis in immunocompromised patients were investigated by means of esophagoscopy. Indications for esophagoscopy included dysphagia, odynophagia, and retrosternal pain. Factors potentially predisposing patients to esophagitis included previous exposure to radiation, recent cytotoxic chemotherapy, recent antibiotic therapy, corticosteroid therapy, and neutropenia. Sixteen of the 18 barium esophagograms done before esophagoscopy was performed revealed abnormalities; in 14 cases the results were consistent with infectious esophagitis. Abnormalities were noted during 27 of 30 esophagoscopy procedures. Visual findings were consistent with candidal esophagitis in 18 cases, with viral esophagitis in four, and with both in one. Specific infectious diagnoses were established by culture or histology in 17 episodes: 12 of candidal esophagitis, two of herpes simplex esophagitis, two of concomitant candidal and herpetic esophagitis, and one of enteroviral esophagitis. Specific noninfectious diagnoses were made in two episodes, and the esophagus was found to be normal in three. No specific diagnosis was made in eight episodes although visual examination indicated the presence of esophagitis. The only postesophagoscopy complications recorded were isolated episodes of spiking fever in three patients. In this compromised-host population with presumed infectious esophagitis, esophagoscopy resulted in a rapid and specific infectious diagnosis in 57% of episodes.
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PMID:Esophagitis in the immunocompromised host: role of esophagoscopy in diagnosis. 382 20

Sixty-seven patients with complicated urinary tract infections were randomized in double-blind fashion to ceftazidime or moxalactam (MOX). A total of 54 patients were evaluable, 27 in each group. Patients received 500 mg of antibiotic intravenously every 12 h, except for those with Pseudomonas aeruginosa randomized to MOX who received 2 g intravenously every 12 h. Toxic effects with ceftazidime were experienced by the following number of patients: pain with infusion, one; posttherapy diarrhea, one; liver function test elevations, two; and neutropenia, one. Toxic effects with MOX were experienced by the following number of patients: liver function test elevations, two; and prolonged prothrombin time, one. All resolved. At 1 week posttherapy, bacteriologic results were 74% cured, 11% relapsed, 15% reinfection with ceftazidime and 52% cured, 33% relapsed, and 19% reinfection with MOX. Ceftazidime was effective for infections caused by MOX-resistant P. aeruginosa. P. aeruginosa resistant to MOX and other beta-lactams was isolated from one patient after MOX therapy. Enterococcal reinfection was common in both groups.
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PMID:Randomized, double-blind comparison of ceftazidime and moxalactam in complicated urinary tract infections. 391 59

A review of 58 patients with malignancies (age range, 14-73 years), who required surgical consultation for acute abdominal pain in the setting of neutropenia (granulocyte count less than 1000/mm3) after chemotherapy was conducted. Ninety percent had fevers greater than 37.8 degrees C, 30% had diarrhea or melena, and 25% had diminished bowel sounds. Five of the 29 patients (17%) with localized pain had surgical intervention; 3 of 29 patients (10%) with generalized pain underwent operations (2 for x-ray findings). All eight of these surgically treated patients survived to leave the hospital. Eighteen of the 29 patients with generalized pain were believed to have a similar syndrome of diarrhea (occasionally heme positive) and diffuse abdominal tenderness (some with peritoneal signs and distension), which was termed "neutropenic enteropathy." Eleven of these 18 patients had their symptoms resolve with antibiotic therapy, aggressive fluid replacement, and a return of their granulocyte count to normal. The other seven died of pneumonia (two), unknown causes (one), and diffuse enterocolitis throughout the intestinal tract (four documented at autopsy). The overall 30-day mortality rate in this series was 34%. Several factors correlated significantly with mortality: hypotension at the onset of pain (80% mortality), bacteremia (63% mortality), and fungemia (100% mortality). Absolute leukocyte count and absolute platelet count did not correlate with mortality. This study reaffirms that patients with neutropenic enteropathy are best treated conservatively. Patients with surgically correctable disease were identified by specific focal findings on examination or x-ray.
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PMID:Abdominal pain in neutropenic cancer patients. 394 98

Spontaneous clostridial myonecrosis occurred in 30- and 69-year-old patients with pancytopenia (after treatment of acute myelogenous leukemia) and diabetes with neutropenia respectively. They presented with fever and sudden onset of pain plus tenderness in involved muscles. They rapidly deteriorated and died within hours after admission. A review of the literature for previous reports of this condition disclosed 31 additional cases. Mean age of patients was 50 years, male to female ratio was 2.2:1, and an underlying condition was present in all of them. Presenting manifestations were spontaneously occurring excruciating pain in the involved muscle (67%), generalized sepsis and shock (24%), nonpainful swelling in the involved muscles (6%) and pain, swelling and shock (3%). Mortality rate was 91% (30/33). The clostridial strains associated with this condition were identified in 31 cases, with Clostridium perfringens and C. septicum causing 28 of them. Bacteremia was described in 10 cases. Awareness of this rare catastrophe may aid in early recognition and surgical intervention which are essential for patient survival.
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PMID:Characteristic manifestations of clostridium induced spontaneous gangrenous myositis. 405 70

Cephapirin sodium, a cephalosporin for parenteral use, was evaluated in vitro and in 27 patients. Cephapirin had activity equivalent to cephalothin against 25 strains each of Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, and Staphylococcus aureus; 10 strains each of Diplococcus pneumoniae, Pseudomonas species, and Enterobacter species; and 8 strains of Proteus species other than P. mirabilis. All strains of S. aureus and D. pneumoniae and most strains of E. coli, K. pneumoniae, and Proteus species were inhibited by concentrations of cephapirin achieved in the serum. Of 27 patients (20 with pneumonia, 2 with S. aureus empyema, and 5 with miscellaneous infections), 25 responded to cephapirin therapy. The only major toxicity thought to be drug-related occurred in a patient who developed reversible bone marrow depression with leukopenia, neutropenia, and anemia. Although cephapirin was painful on intramuscular injection, phlebitis and pain were absent in patients treated intravenously. In a controlled comparison of intravenously administered cephalothin and cephapirin in four additional patients, the latter caused much less pain than the former and caused no phlebitis.
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PMID:Clinical and in vitro evaluation of cephapirin, a new cephalosporin antibiotic. 459 41


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