ISSN: 0032-5481 (Print) 1941-9260 (Online) Journal homepage: http://www.tandfonline.com/loi/ipgm20
Editor's Mail J. H. Renner, Richard A. Gleckman, William MacMillan Rodney & Stephen L. Green To cite this article: J. H. Renner, Richard A. Gleckman, William MacMillan Rodney & Stephen L. Green (1979) Editor's Mail, Postgraduate Medicine, 65:6, 42-43, DOI: 10.1080/00325481.1979.11715169 To link to this article: http://dx.doi.org/10.1080/00325481.1979.11715169
Published online: 07 Jul 2016.
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Date: 15 August 2017, At: 20:41
POSTGRADUATE MEDICINE 4530 West 77th Street Minneapolis, MN 55435
The Editor welcomes readers' comments, and selected letters are published each month. Letters must be signed and should be sent to Editor's Mail at the address shown. The journal reserves the right to condense letters if necessary for space.
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EDITOR'S MAIL Suggestions for treating recurrent urinary tract infections To the Editor: In regard to the article on recurrent urinary tract infections by Richard A. Gleckman, M 0, in the February issue (page 156), permit me to make a really helpful suggestion: Order restriction of desserts, juices, and fruits pronto and see the change. Also, I have found Urised (with gels) the most prompt and effective starting remedy. Then, if more help is needed, Gantrisin can be given for four to seven days-no more. J. H. Renner, MD
Cathedral City, California
Dr Renner's letter was sent to Dr Gleckman, whose reply follows: ·
Or Renner's suggestions that reduction of sweets in the diet and prescription of Urised, a methenamine-containing product, are helpful in eradication of recurrent urinary tract infections would have to be confirmed by scientific studies. Richard A. Gleckman, MD Boston
Hemophllla fellowship The National Hemophilia Foundation announces its 1980 Judith Graham Pool Research Fellowships for clinical and basic research relating to problems of hemophilia. Postgraduate applicants engaged in or planning research in related areas and disciplines are eligible. Fellowships are offered through medical and graduate schools on an annual basis for the academic year beginning July I, 1980. Grants are $15,000 a year. Applications must be received by October 1, 1979. Application forms and instructions can be obtained by writing to the National Hemophilia Foundation, 25 W 39th St, New York, NY 10018.
What's in a smell? To the Editor: As a former medical technologist whose apprenticeship included months of plating and then interpreting the biochemical characteristics of phlegm-producing microorganisms, may I respectfully make addition to Or Green's statement (Anaerobic Pleuropulmonary Infections, January, page 69) as to anaerobes being the only fetid odors in the bacterial world.
Other putridly malodorous bacteria certainly should include our friends capable of splitting urea to liberate ammonia: Klebsiella, Hemophilus, Proteus, Pseudomonas, and less commonly, Pasteurella, Brucella, Bordetella, and others. To the delicate nose, hydrogen sulfide producers (eg, Proteus) could pass for fetid any day. In fact, my delicate nose led me to family medicine, where we now are told that the telltale odor of Hemophilus 1•aginalis may represent a polymicrobial infestation, with rancid -smell in g. butyric-acid -li be rating anaerobes as the true culprits (N Engl J Med 298:1430, 1978). At any rate, Or Green's fine article is appreciated, and this comment comes by way of completeness. To those in the lab who anonymously endure all of the above, my best. William MacMillan Rodney, MD Los Angeles
Dr Rodney's letter was sent to Dr Green, whose reply follows:
Or Rodney makes an important point concerning the variety of odors produced by microorganisms other than anaerobes. I respect his experience as a medical technolocontinued
VOL 65/NO 6/JUNE 1979/POSTGRADUATE MEDICINE
Among antiarthritic prescribers...
6outof10 physicians in Chicago prescribe1 fast and reliable Butazolidin® alka
EDITOR'S MAIL CONTINUED
100 mg phenylbutazone USP 100 mg dr1ed alum1num hydrox1de gel USP 150 mg magnes1um tris1l1cate USP
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Important Note: Th1s drug is not a simple analgesic. Do not administer casually. Carefully evaluate patients before starting treatment and keep them under close supervision. Obtain a deta1led h1story. and complete phys1cal and laboratory examination (complete hemogram. urinalySIS, etc.) before prescribing and at frequent intervals thereafter. Carefully select patients. avoiding those responsive to routine measures. contraindicated pat1ents or those who cannot be observed frequently. Warn patients not to exceed recommended dosage. Short-term relief of severe symptoms with the smallest possible dosage IS the goal of therapy. Dosage should be taken w1th meals or a full glass of milk. Substitute alka capsules for tablets if dyspeptic symptoms occur. Patients should discontinue the drug and report 1mmed1ately any sign of fever. sore throat. oralles,ons (symptoms of blood dys· crasia); dyspeps1a. epigastriC pain, symptoms of anem1a. unusual bleed1ng. unusual bruismg. black or tarry stools or other ev1dence of mtest1nal ulcerat1on. skm rashes. sign1f1cant we1ght gain or edema. A one-week tnal per1od is adequate. DIScontinue in the absence of a favorable response Restrict treatment penods to one week m pat1ents over s1xty. Indications: Rheumatoid arthnt1s. osteoarthnt1s. bursitis. acute gouty arthritis and rheumatoid spondylitis. Contralndlcatlons: Children 14 years or less; senile patients; history or symptoms of G.l1n· flammation or ulceration includ1ng severe. recurrent or persistent dyspepsia; history or presence of drug allergy; blood dyscras1as; renal. hepat1c or cardiac dysfunction; hypertens1on: thyro1d diSease; systemic edema; stomatitis and salivary gland enlargement due to the drug; polymyalgia rheumat1ca and temporal artent1s; patients rece1v· ing other potent chemotherapeutic agents. or long-term anticoagulant therapy Warnings: Age, weight. dosage. duration of therapy. ex1stence of concomitant d1seases. and concurrent potent chemotherapy affect mcidence of toxic reactions. Carefully 1nstruct and observe the ind1v1dual pat1ent. especially the ag1ng (forty years and over) who have 1ncreased susceptibility to the tox1c1ty of the drug Use lowest effect1ve dosage. We1gh 1n1tially unpredictable benefits against potent1al nsk of severe. even fatal. reactions. The d1sease cond1t1on 1tself 1s unaltered by the drug. Use with caut1on m f1rst tnmester of pregnancy and in nursmg mothers Drug may appear 1n cord blood and breast milk. Ser1ous. even fatal. blood dyscras,as. includmg aplast1c anem1a. may occur suddenly desp1te regular hemograms, and may become man1fest days or weeks after cessat1on of drug. Any s1gn1f1cant change in total white count. relat1ve decrease 1n granulocytes. appearance of immature forms. or fall in hematocrit should signal1mmediate cessation of therapy and complete hematologic Investigation. Unexplamed bleeding 1nvolv1ng CNS. adrenals. and G.l tract has occurred. The drug may potentiate action of insul1n. sulfonylurea. and sulfonam,de-type agents. Carefully observe patients taking these agents. Nontox1c and tox'c gaiters and myxedema have been reported (the drug reduces iod1ne uptake by the thyroid). Blurred VISIOn can be a s,gn1f1cant toxic symptom worthy of a complete ophthaiMolog,cal exam,nation. Swelling of ankles or face in pat1ents under sixty may be prevented by reduc1ng dosage. If edema occurs 1n pat1ents over s1xty. discont1nue drug. Precautions: The follow,ng should be accomplished at regular intervals: Careful detailed hiStory for d1sease bemg treated and detect1on of earliest s1gns of adverse react1ons; complete
phys1cal exam1nat1on includ1ng check of pat1ent's we1ght: complete weekly (espec,ally for the agmg) or an every two week blood check; pert1nent laboratory stud1es. Caution pat1ents about part1C1pat1ng 1n act1v1ty requ1nng alertness and coord1nat1on. as dnv1ng a car, etc. Cases of leukem1a have been reported 1n pat1ents w1th a history of short- and long-term therapy The majonty of these pat1ents were over forty. Remember that arthnt1c-type pa1ns can be the presentmg symptom of 1eukem1a. In some pat1ents. Butazolidin, brand of phenyl· butazone. may cause an activat1on of symptoms of systemic lupus erythematosus. In such cases. the drug should be d1scont1nued Adverse Reactions: Th1s is a potent drug. 1ts misuse can lead to serious results. Rev1ew de· ta1led 1nformat1on before beg,nmng therapy. Ul· ceratlve esophag1t1s. acute and react1vated gastnc and duodenal ulcer w1th perforat1on and hemorrhage. ulceration and perforation of large bowel. occult G I bleedmg w1th anema. gastnt1s. ep1gastr1c pa1n. hematemes1s. dyspepsia. nausea. vom,!lng and diarrhea. abdominal d1stent10n. agranulocytosis. aplast1c anemia. hemolyt1c anem1a. anem1a due to blood loss 1nclud1ng occult G 1 bleed,ng. thrombocytopenia. pancytopenia. leukem1a. leukopen1a. bone marrow depression. sod1um and chlonde retent1on. water retention and edema. plasma d11ut1on. respiratory alkalOSIS. metabolic acidOSIS. fatal and nonfatal hepat1t1s (cholestas1s may or may not be prominent). petech1ae. purpura without thrombocytopenia. toxic pruntus. erythema nodosum. erythema multiforme. Stevens-Johnson syndrome. Lyell's syndrome (toxic necrotizmg ep1dermolys1s). exfoliative dermatitis. serum s1ckness. hypersensitivity angi1tis (polyarteritiS). anaphylactic shock. urt1cana. arthralgia. fever. rashes (all allerg1c reactions require prompt and permanent Withdrawal of the drug). prote1nuna, hematuna. ol1guna, an una. renal fa11ure w1th azotem1a. glomerulonephritis. acute tubular necrOSIS. nephrotiC syndrome. bilateral renal COrtical necros1s. renal stones. ureteral obstruction w1th ur1c ac1d crystals due to uncosunc act1on of drug. 1mpaired renal funct1on. card1ac decompensatiOn. hypertens1on. pencard1tis. d1ffuse 1nterst1t1al myocard1t1s w1th muscle necros1s. per1vascular granulomata. aggravation of temporal artent1s m pat1ents with polymyalg1a rheumatlca. opt1C neuritis. blurred vis1on. ret1nal hemorrhage. tox1c amblyopia. retinal detach· ment. heanng loss. hyperglycemia. thyroid hyperplasia, tox1c gaiter. assoc,at1on of hyperthyroidiSm and hypothyroidism (causal relationShip not establiShed). agitation. confusional states. lethargy: CNS reactions assoc1ated with overdosage. includmg convulsions. euphona, psychosis. depression. headaches. halluCinations. g1ddiness. vertigo, coma. hyperventilation. 1nsomn,a; ulcerat1ve stomatitis. salivary gland enlargement. (8)667151 (Rev. 1177) C76-72
For complete details. including dosage and admmlstration, please see full prescribing information. 1 Based on a survey of General Practitioners. lnternists and Osteopaths m pnvate practice Data on f1le at Ge1gy Pharmaceuticals.
Geigy GEIGY PharmaceutiCals D1v1S10n of CIBA-GEIGY Corporation Ardsley. New York 10502
gist but hasten to add that many of the odors he encountered in that capacity may have arisen from in vitro culturing. The odors encountered in this situation can be quite different from those produced by the same organism in vivo. Anaerobes are in fact capable of producing an odor quite distinct from that of other bacteria, such that their presence in purulent discharges is easily recognizable (Surgery 11:374, 1942). The term "fetid" applies to any rank or disagreeable smell. Perhaps a better way of describing this characteristic odor might be to refer to it as feculent, since anaerobes, outnumbering other colonic organisms by at least 100: I, are responsible for the characteristic odor of stool.
Stephen L. Green. MD Hampton. Virginia
Correction In table I of the article "Alcohol Intoxication and the Alcohol Withdrawal Syndrome" by Clive C. Robertson, BM, BCh, and Edward M. Sellers, MD, PhD (December, page 137), the dosage of phenytoin for severe withdrawal with history of previous seizures (point 2, third column) should read: "If patient has taken phenytoin within I week, 100 mg po q8h; if patient not taking phenytoin, 300 mg po initially, then 100 mg q8h."
VOL 65/NO 6/JUNE 1979/POSTGRADUATE MEDICINE