Efficacy and complications of urinary drainage procedures in idiopathic retroperitoneal fibrosis complicated by extrinsic ureteral obstruction.

OBJECTIVE: To investigate the efficacy and complications of urinary drainage procedures in patients with idiopathic retroperitoneal fibrosis complicated by ureteral obstruction. METHODS: A retrospective study of 30 idiopathic retroperitoneal fibrosis patients involving 44 obstructed urinary units who underwent urinary drainage from January 2002 through April 2010 was carried out. Data of all diagnostic procedures, blood and urine cultures, and hospital admissions were collected and analyzed. RESULTS: In 12 of 44 (27%) cases, percutaneous nephrostomy was carried out at the first step. Attempted ureteral stenting at the first step was successful in 25 of 32 (79%) cases, of which 20 (80%) cases could be managed successfully by ureteral stenting alone throughout the study period. Successful prolonged urinary drainage with percutaneous nephrostomy alone was accomplished in 10 cases, three at the first step and seven at the second step after failed intraureteral stent insertion or after unsuccessful maintenance of urinary drainage with an intraureteral stent. A total of 21 urinary tract infection episodes occurred in 11 patients. The incidence and accumulated incidence of acute pyelonephritis was 0.062 episodes/100 person-days and 30%, respectively. The incidence and accumulated incidence of urosepsis was 0.015 episodes/100 person-days and 6.6%, respectively. The overall number of complications did not differ between external and internal urinary drainage procedures (percutaneous nephrostomy, 21% vs intraureteral stent, 17.9%; P = 0.79). CONCLUSION: Both intraureteral stent and percutaneous nephrostomy placement are a safe way to relieve urinary obstruction in idiopathic retroperitoneal fibrosis patients, and they have comparable complication rates. Over time, the need for using both management options in the same patient might be required. Hence, these techniques should be regarded as complementary.

[Diagnostic evaluation of ß-lactam antibiotic allergy]. / Diagnostiek van betalactamantibiotica-allergie.

Many patients report a ß-lactam allergy or hypersensitivity without actually having this allergy. Targeted questioning, in combination with an accurate description of the nature of the symptoms, leads to rejection of a large number of these presumed allergies. In a suspected allergic reaction one has to distinguish between the potentially life-threatening, acute type I mediated allergy and delayed type IV skin reaction. The diagnostic evaluation of a suspected allergy is described in this article. Three cases are presented of a presumed allergic reaction to ß-lactam antibiotics. Patient A was a 62-year-old woman with anaphylaxis triggered by amoxicillin/clavulanate who, after analysis, was advised to avoid all ß-lactam antibiotics. Patient B was a 58-year-old man with anaphylaxis triggered by amoxicillin/clavulanate as a result of a selective allergy to amoxicillin. Patient C was a 50-year-old man who had had a possible reaction to a penicillin in his childhood. Analysis in an allergology department can be useful for further treatment.

[Lower costs for anticancer drugs by safety margin around calculated dose and by fine-tuning on ampoule strength]. / Minder kosten voor antikankermiddelen door veiligheidsmarge rond de berekende dosis en door afstemming op ampulsterktes.

OBJECTIVE: To determine if the rational application of dose individualization of anticancer drugs leads to a reduction in costs. DESIGN: Data analysis. METHOD: At the Ikazia Hospital in Rotterdam, the Netherlands, over the first 19 weeks of 2006 the costs of the intravenous administration to patients of one or more anticancer drugs were determined. The costs of dosage based on body surface area (BSA) were calculated. Commercially available ampoule strengths were not taken into consideration. Using available pharmacokinetic data, it is reasonable to assume that a deviation of up to 10% based on an individualized dose calculated by body surface area, has a negligible effect on the outcome of treatment. For this reason drug costs by rounding off doses to whole ampoules were also investigated. A condition of this was that the rounded-off dose should not deviate by more than 10% from the dose calculated on body surface area. RESULTS: During the study period, 18 different anticancer drugs were administered a total of 939 times. If dosage had been based strictly on body surface area, drug costs would have been euro 509,664. Rounding off to whole ampoules with a dose margin of a maximum of 10% would have cost euro 465,619: a reduction in cost of 8.6%. CONCLUSION: The rational application of the dose individualization principle based on body surface area may result in a substantial reduction in expenditure on anticancer drugs.