Mary Lee

Ethanolamine Sclerotherapy of a Renal Cyst

We report the effective use of 5% ethanolamine oleate to sclerose a large simple renal cyst. The comparative advantages of ethanolamine versus other sclerosants are discussed in terms of adverse effects, availability and convenience. Guidelines to optimize sclerotherapy with ethanolamine are provided.

Lymphocele Formation after Extraperitoneal Pelvic Lymphadenectomy: Possible Predisposing Factors

A retrospective review of 61 patients undergoing pelvic lymphadenectomy was performed to assess possible predisposing factors for lymphocele development. The procedure was done to facilitate staging of prostatic carcinoma in all of the patients. The complication occurred in 9 patients (14.8 per cent). Analysis revealed a statistically significantly higher incidence of lymphoceles in patients without drainage (p less than 0.05) and in patients whose lymph nodes had no metastatic disease (p less than 0.025). Furthermore, 9 patients (without drainage and with nodes that were free of tumor but who received mini-dose heparin therapy) as a subgroup had the highest incidence of lymphocele formation. Although these individual factors have been attributed to this complication after lymphadenectomy they may act synergistically.

Warfarin Resistance and Vitamin K

Excerpt To the editor: Recently, cases of warfarin resistance due to unrecognized vitamin K supplementation in liquid nutrition products have been described (1, 2). These reports came coincidentall...

Therapeutic effects of leuprorelin microspheres in prostate cancer

Leuprorelin has demonstrated effectiveness comparable to orchiectomy and oral diethylstilboestrol for the palliation of advanced prostate cancer. Unlike orchiectomy, leuprorelins effects are reversible; also leuprorelin is not associated with the cardiovascular or thromboembolic adverse effects of oestrogens. For these reasons, leuprorelin has been widely used as an alternative to surgical castration or to oestrogens in the treatment of metastatic prostate cancer. Sustained-release leuprorelin microsphere formulations have been developed which exhibit zero order release of active drug from the injection site, such that in the United States the 7.5 mg dosage strength is recommended to be administered once a month and the 22.5 mg dosage strength once every three months. Although most patients will have suppressed release of pituitary luteinizing hormone by the third or fourth week after the first dose of depot leuprorelin, 4-5% of treated patients have been reported to have delayed responses, taking many more weeks or months to respond. A transient biochemical hormone escape has also been reported, although worsening of clinical symptoms has not accompanied the elevation of serum testosterone levels during treatment. Usually, leuprorelin is initiated as monotherapy when patients with advanced prostate cancer become symptomatic. However, newer studies of combination therapy of luteinizing hormone releasing hormone analogs with antiandrogens suggest that early initiation of therapy, at the time of diagnosis of advanced disease, may be beneficial, particularly in a subgroup of patients with small volume disease and good performance status. Leuprorelin is also undergoing evaluation as neoadjuvant therapy prior to radical prostatectomy for localized prostate cancer. Preliminary studies suggest that neoadjuvant leuprorelin in combination with an antiandrogen may be effective in downstaging prostate tumours. Leuprorelin commonly produces several adverse effects: hot flashes, decreased libido and impotence, and tumour flare.

Safety and efficacy of intravesical aminocaproic acid for bleeding after transurethral resection of prostate

There appears to be no clinically significant difference in blood loss or transfusion requirements after transurethral resection of the prostate (TURP) when intravesical 0.5% aminocaproic acid is compared with 0.9% sodium chloride irrigation in patients during the first three days after surgery. This is probably because early post-TURP bleeding is due to inadequate hemostasis or perforation of the prostatic capsule, and not excessive local or systemic fibrinolysis. However, we suggest that intravesical aminocaproic acid might be a useful alternative to systemic antifibrinolytic therapy in patients with delayed, recurrent, excessive post-prostatectomy bleeding, which is thought to be due to fibrinolysis. Since aminocaproic acid is not systemically absorbed after bladder instillation, intravesical administration causes few side effects and does not necessitate screening patients for disseminated intravascular coagulation prior to treatment.

Overflow Urinary Incontinence Due To Carbamazepine

We describe the first well documented case of overflow urinary incontinence owing to prolonged carbamazepine treatment for temporal lobe seizures. Carbamazepine increased the bladder capacity to 1,700 ml. and was accompanied by symptoms of urgency and frequency. After carbamazepine was discontinued and the patient was given primidone the voiding symptoms disappeared. Post-voiding catheterization of the bladder showed minimal residual urine volume. In a review of urological adverse reactions of anticonvulsant drugs that are effective in the management of temporal lobe seizures we found that only primidone and phenobarbital have not been convincingly associated with such side effects. However, phenytoin and clonazepam have been linked with urinary incontinence, and valproic acid with enuresis.

Effect of piperacillin on tobramycin pharmacokinetics in patients with normal renal function.

Aminoglycosides are inactivated by extended-spectrum penicillins in vitro and in patients with end-stage renal failure. In this prospective controlled study, we determined the effect of piperacillin on tobramycin pharmacokinetics. In 10 clinically stable male patients with calculated creatinine clearances of greater than or equal to 60 ml/min, serial levels in serum of tobramycin alone and after single 4-g intravenous doses of piperacillin were determined. No statistically significant changes in the concentration of drug in serum, the half-life (t1/2), the elimination rate constant (Ke), the volume of distribution (Vd), or the area under the serum concentration-time curve (AUC0-oo) occurred when tobramycin was used concurrently with piperacillin. Therefore, this antibiotic combination will not result in a clinically significant interaction in patients with normal renal function.

Hemorrhagic complications of piperacillin therapy

Clinically significant hemorrhage associated with extended spectrum anti-Pseudomonas penicillins is uncommon. We describe 2 patients with bleeding complications owing to piperacillin. In addition, we review the incidence and mechanism of this adverse reaction, and make suggestions for the management of these patients.

Morbilliform skin eruption owing to diethylstilbestrol

We describe an unusual case of morbilliform skin eruption caused by diethylstilbestrol in a patient with stage D prostatic cancer. A widespread erythematous maculopapular rash and urticaria appeared with repeated challenges of diethylstilbestrol and resolved with drug withdrawal. In addition, the literature on various types of dermatitis medicamentosa in male patients with prostatic cancer treated with diethylstilbestrol is reviewed.

Elevated serum calcitonin associated with an extragonadal seminoma

AbstractWe describe the first case of elevated serum calcitonin associated with an extragonadal seminoma despite normocalcemia. In addition, we show how serial calcitonin levels were used to monitor response to chemotherapy.