Most of the potential major adverse events (myelosuppression, hepatotoxicity and pancreatitis) are well known.
Pulmonary toxicity is rare but severe and may lead to respiratory insufficiency and even death. We describe a case of a young woman with ulcerative colitis (UC) who developed respiratory symptoms and fever combined with nodular densities and ground glass areas in both lungs on CT scan. An infection was ruled out and the diagnosis azathioprine induced pneumonitis was made. The drug was stopped and within one week her fever and respiratory symptoms resolved. Clinicians should selleck be alert to this serious adverse event when treating patients with thiopurines. (C) 2009 European Crohn’s and Colitis Organisation. Published by Elsevier B.V. All rights reserved.”
“Post-cardiotomy delirium is common and associated with increased morbidity and mortality. No gold standard exists for detecting delirium, and evidence to support the choice of treatment is needed. Haloperidol is widely used for treating delirium, but indication, doses and therapeutic targets vary. Moreover, doubt has been raised regarding overall efficacy. The purpose of this study was to assess the effect of a combination of early detection and standardized treatment
with haloperidol on post-cardiotomy delirium, with the hypothesis that the proportion of delirium- and coma-free GS-9973 Angiogenesis inhibitor days could find more be increased. Length of stay (LOS), complications and 180-day mortality are reported.
Prospective interventional cohort study. One hundred and seventeen adult patients undergoing cardiac surgery were included before introduction of a screening and treatment protocol with haloperidol for delirium, and 123 patients were included after. Nurses screened patients using validated tools (the Delirium Observation Screening (DOS) scale and confusion
assessment method for the intensive care unit (CAM-ICU)). In case of delirium, a checklist to eliminate precipitating/ inducing factors and a protocol for standardized dosing with haloperidol was applied. Group comparison was done using non-parametric tests and analysis of fractions, and associations between delirium and predefined covariates were analysed with logistic regression.
Incidence of delirium after cardiac surgery was 21 (14-29) and 22 (15-30) %, onset was on postoperative day 1 (1-4) and 1 (1-3), duration was 1 (1-4) day and 3 (1-5) days, respectively, with no significant difference (Period 1 vs 2, all values are given as the median and 95% confidence interval). The proportion of delirium- and coma-free days was 67 (61-73) and 65 (60-70) %, respectively (ns). There was no difference in LOS or complication rate. Delirium was associated to increasing age, increased length of stay and complications.