Despite progress in decreasing the incidence of and improving the therapy for bacterial peritonitis in patients receiving peritoneal dialysis, fungal peritonitis has emerged as a relatively common infection. Hospitalization, recent prior episodes of peritonitis, and antibacterial therapy appear to predispose patients to this infection. Clinically, fungal peritonitis cannot be differentiated from bacterial peritonitis except by gram stain and culture of the dialysate. The most commonly made serious error is the "failure to initiate appropriate therapy quickly enough on the basis of these diagnostic parameters. For patients who no longer require dialysis, those for whom a change to hemodialysis is preferred, and those with concomitant life-threatening illnesses, the recommended therapy for fungal peritonitis is removal of the dialysis catheter and the institution of therapy with systemic antifungal agents. For patients who are hemodynamically and metabolically stable and for whom continued peritoneal dialysis is desirable, a trial of antifungal chemotherapy before removal of the catheter may be indicated.
Disease management (DM) is rapidly becoming an important force in the late 20th and early 21st century as a strategy for managing the chronic illness of large populations. Given the increasing visibility of DM programs, the clinical, economic and financial impact of this support are vital to DM program accountability and its acceptance as a solution to the twin challenges of achieving affordable, quality health care. Measuring and reporting outcomes in DM is difficult. DM programs must adapt to local market conditions and customer desires, which in turn limits generalizability, and still account for the overlapping/interlocking/multifaceted nature of the interventions included in any DM program. The Disease Management Association of America convened a Steering Committee to suggest a preferred approach, not a mandated or standardized approach for DM program evaluation. This paper presents the Steering Committee's "Consensus Statement" and "Guiding Principles" for robust evaluation. (Disease Management 2004;7:191–201)
Disease management (DM) is rapidly becoming an important force in the late 20th and early 21st century as a strategy for managing the chronic illness of large populations. Given the increasing visibility of DM programs, the clinical, economic and financial impact of this support are vital to DM program accountability and its acceptance as a solution to the twin challenges of achieving affordable, quality health care. Measuring and reporting outcomes in DM is difficult. DM programs must adapt to local market conditions and customer desires, which in turn limits generalizability, and still account for the overlapping/interlocking/multifaceted nature of the interventions included in any DM program. The Disease Management Association of America convened a Steering Committee to suggest a preferred approach, not a mandated or standardized approach for DM program evaluation. This paper presents the Steering Committee's "Consensus Statement" and "Guiding Principles" for robust evaluation. (Disease Management 2004;7:191–201)
Multiple sclerosis (MS) is a disease with an autoinmune pathophysiology. A new and promising treatment in this group of patients is the blood and marrow stem cells transplantation which is currently an experimental treatment with evident immuno-suppressant effects. It has not been demonstrated any effect on neurodegeneration and it is preferred to use this procedure as a non-conventional treatment of multiple sclerosis. Selection of patients should be strict, mainly in patients with moderate severity and an important inflammatory component. It is not a rescue treatment because its utility in progressive forms or advanced MS has not been demonstrated and the risk is high. This review includes an analysis of the current protocols and their results.
Clinical and pathologic findings in a 65‐year old woman with fever of unknown origin are described in this report. Generalized aspergiliosis with endocarditis was demonstrated at autopsy. The patient had no recognized risk factors for the development of fungal infection. A functional transvenous pacemaker lead, inserted 2 years previously, was completely encased in a Jarge infected thrombus and may have been the initial site of infection. Septicemia and endocarditis are rare but well‐described complications of cardiac pacing, and should be considered in the differential diagnosis of fever of unknown origin in patients with pacemakers.
Coagulase-negative staphylococci, part of the normal skin flora, frequently colonize bioprosthetic devices and are the most common cause of peritonitis in patients undergoing peritoneal dialysis. Using the API STAPH-IDENT® system (Analytab Products, Plainview, New York) and plasmid pattern analysis, we investigated the importance of chronic carriage of coagulase-negative staphylococci in the development of peritonitis due to these organisms. During a nine-month period, 182 surveillance cultures of pericatheter skin and anterior nares from 30 patients yielded 102 strains of coagulase-negative staphylococci. Twelve of these patients had 20 episodes of peritonitis due to these organisms. Staphylococcus epidermidis accounted for 75% of surveillance and 79% of peritonitis-associated strains. By plasmid pattern analysis of 47 surveillance and 16 peritonitis-associated strains, only three patients carried identical coagulase-negative staphylococci on two or more occasions, and only three patients developed peritonitis due to organisms cultured previously from body surface sites.
Letters and Corrections1 November 1981Vancomycin and Interstitial NephritisEDWARD S. EISENBERG, M.D., NOAH ROBBINS, M.D., MARGARET LENCI, M.D.EDWARD S. EISENBERG, M.D., NOAH ROBBINS, M.D., MARGARET LENCI, M.D.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-95-5-658_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: In the article on acute interstitial nephritis due to drugs (1), Linton and colleagues emphasized the presumed immunologic nature of the disease and the growing list of causative agents. Vancomycin—although documented to produce a wide variety of adverse reactions such as fever, chills, phlebitis, ototoxicity, hypotension, arthralgias, skin rashes, and anaphylaxis—has not been associated with interstitial nephritis (1, 2). Impurities present in the early preparations of the antibiotic may have been responsible for the nephrotoxicity initially reported but not subsequently observed (3). We report the first case of vancomycin-induced interstitial nephritis. A 28-year-old intravenous drug abuser was...References1. LINTON A, CLARK W, DRIEDGER A, TURNBULL D, and LINDSAY R. Acute interstitial nephritis due to drugs: review of the literature with a report of nine cases. Ann Intern Med. 1981;93:735-41. LinkGoogle Scholar2. COOK F and FARRAR W. Vancomycin revisited. Ann Intern Med. 1978;88:813-8. LinkGoogle Scholar3. APPEL G and NEU H. The nephrotoxicity of antimicrobial agents. N Engl J Med. 1977;296:722-8. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: EDWARD S. EISENBERG, M.D.; NOAH ROBBINS, M.D.; MARGARET LENCI, M.D.Affiliations: Montefiore Hospital and Medical Center Albert Einstein College of Medicine Bronx, NY 10467 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byCase Report: Vancomycin-Associated Tubulointerstitial Nephritis in Clinical Practice-Case Report and Review of LiteratureKidney biopsy findings in vancomycin-induced acute kidney injury: a pooled analysisGlycopeptide Hypersensitivity and Adverse ReactionsVancomycin-associated drug-induced hypersensitivity syndromeRare and Overlooked Causes of Acute Kidney InjuryVancomycin and the Risk of AKI: A Systematic Review and Meta-AnalysisMercaptoacetyltriglycine renal scan for the differential diagnosis of acute tubular necrosis and interstitial nephritis associated to vancomycinMercaptoacetyltriglycine renal scan for the differential diagnosis of acute tubular necrosis and interstitial nephritis associated to vancomycinVancomycin-Induced Acute Granulomatous Interstitial Nephritis: Therapeutic OptionsAcute Interstitial Nephritis Associated with Coadministration of Vancomycin and Ceftriaxone: Case Series and Review of the LiteratureFour cases of nafcillin-associated acute interstitial nephritis in one institutionBiopsy-Proved Acute Tubulointerstitial Nephritis and Toxic Epidermal Necrolysis Associated with VancomycinVancomycin-Induced Acute Interstitial NephritisDrug-Induced Acute Renal FailureReview: Acute tubulointerstitial nephritisInterstitial NephritisTubulointerstitial Nephritis Due to VancomycinVancomycin Ototoxicity and NephrotoxicityVancomycin-induced interstitial nephritisHYPERSENSITIVITY ANGIITIS WITH GRANULOMATOUS GLOMERULITIS IN A PATIENT WITH PREEXISTING IgA NEPHROPATHYImmunologically Mediated Nephritis Induced by Toxins and DrugsVancomycin and the KidneyDrug Information Analysis ServiceMiscellaneous antibiotics 1 November 1981Volume 95, Issue 5 Page: 658-658 Keywords Addicts Adverse reactions Antibiotics Arthralgia Drugs Fevers Hypotension Nephritis Rashes Vancomycin ePublished: 1 December 2008 Issue Published: 1 November 1981 PDF downloadLoading ...
