Probable Rare Case of Cholecystitis After Exposure to Supratherapeutic Doses of Hydralazine.

Objective: To report a rare case of cholecystitis in a patient who received supratherapeutic doses of hydralazine for 1 month. Case Summary: A 79-year-old woman was admitted with severe right upper quadrant abdominal pain. Three weeks prior, she suffered a similar episode and was told she had a buildup of sludge in her gall bladder. For the past month, she had inadvertently received 400 mg of hydralazine per day instead of 150 mg; she was also prescribed fenofibrate 145 mg daily. Her workup was remarkable only for a slightly elevated white blood cell count and gall bladder sludge and distention without common duct obstruction. She was diagnosed with cholecystitis and underwent a laporoscopic cholecystectomy within 72 hours of admission. She was subsequently discharged a day later with the corrected hydralazine dose, and she has not been readmitted to the hospital. Discussion: Hydralazine is a direct acting vasodilator that may also potentiate the effects of nitric oxide. Nitric oxide has been linked to decreased gall bladder motility in in vivo and in vitro studies. The Naranjo algorithm indicates that this is a probable adverse event of fenofibrate and of hydralazine; the Drug Interaction Probability Scale indicates that this case of cholecystitis was a possible result of the interaction between hydralazine and fenofibrate. Based on the time course of the patient's medication use and symptoms, hydralazine is more likely to be the cause of her cholecystitis than her other medications. Conclusion: Clinicians should be aware that high doses of hydralazine may inhibit gall bladder motility and contribute to the buildup of bile sludge.

Disrupted biographies and gendered identities: A qualitative study exploring sexuality and blood cancer.

PURPOSE: This study examines how blood cancer impacts patients' sexuality and sense of gendered identity. METHODS: An interpretive epistemological framework necessitated a qualitative study design. Participants (6 male and 6 female), recruited from a hospital Haematology department in a large Northern English City, took part in semi-structured in-depth interviews to gather rich data about their subjective experiences. RESULTS: A key theme from the qualitative data was a sense of disruption in relation to several aspects of their gendered identities and sexual life. Participants explained disruption to their sexual function and sexual sense of self. They narrated concerns about future imagined relationships. The emotional burden of sexuality related concerns was strongly articulated. A gendered perspective enabled the similarities and differences between men and women to be explored. CONCLUSION: This study, drawing on rich qualitative data, documents the sexuality concerns of blood cancer patients; for some such concerns arise many years post treatment. The findings highlight the need for gender appropriate care around sexuality which should continue to be accessible well after diagnosis and treatment phases have ceased.

An integrated safety analysis of intravenous ibuprofen (Caldolor(®)) in adults.

Intravenous (IV) nonsteroidal anti-inflammatory drugs such as IV ibuprofen are increasingly used as a component of multimodal pain management in the inpatient and outpatient settings. The safety of IV ibuprofen as assessed in ten sponsored clinical studies is presented in this analysis. Overall, 1,752 adult patients have been included in safety and efficacy trials over 11 years; 1,220 of these patients have received IV ibuprofen and 532 received either placebo or comparator medication. The incidence of adverse events (AEs), serious AEs, and changes in vital signs and clinically significant laboratory parameters have been summarized and compared to patients receiving placebo or active comparator drug. Overall, IV ibuprofen has been well tolerated by hospitalized and outpatient patients when administered both prior to surgery and postoperatively as well as for nonsurgical pain or fever. The overall incidence of AEs is lower in patients receiving IV ibuprofen as compared to those receiving placebo in this integrated analysis. Specific analysis of hematological and renal effects showed no increased risk for patients receiving IV ibuprofen. A subset analysis of elderly patients suggests that no dose adjustment is needed in this higher risk population. This integrated safety analysis demonstrates that IV ibuprofen can be safely administered prior to surgery and continued in the postoperative period as a component of multimodal pain management.