Doxycyline has been associated with pseudotumor cerebri.[1,2] Symptoms can be persistent headache and even diplopia (VI cranial nerve, abducens palsy).[3,4] Pseudotumor cerebri can resolve slowly.[5]
How ready for primetime is handheld or even desktop medication order-entry by computer (CPOE)? This Illinois Hospital Association site has several good links (scroll down to "Clinical Informatics"). One link points to a recent Archives of Internal Medicine article on excess computer alerts in order-entry software.
Effective dose of selected radiologic examinations (in answer to Jeff Donohoo's question)...
Examination: Radiation Dose (as mSv, where 1 Sv = 100 rem)
Head CT: 1–2
Chest CT: 5–7
Abdomen & pelvis CT: 8–11
Selective coronary angiogram: 3–5
PA/lateral chest X-ray: 0.04–0.06
Average annual background radiation in the United States: 3.6
Morin, RL. Physics and dosimetry in computed tomography. Cardiol Clin 2003;21(4)November:515-20 [pubmed]
At the Chest Conference today Dr. Wiltse pointed us to a recent Lemierre Syndrome review. See the March 4 New Engl J Med Clinical Problem Solving case. (1)
Brunaud in 2001 (1) reported that without "transmural necrosis" or perforation, non-operative management of mesenteric vein thrombosis was successful (no difference in mortality or morbidity). Mean length of stay for non-operative group was 23 days (n = 12); for the surgical group it was 52 days (n = 26). (While waiting for anticoagulation to work, how do we know when distension has progressed to transmural necrosis and the need for resection? Are usual signs of fever, leukocytosis, peritonitis sensitive?)
Dr. Kamth et al from the Mayo Clinic (2) review mesenteric vein thrombosis in the New Engl J Med 2001. (Correspondence [3] cites anecdotal evidence about a possible role for thrombolytic therapy.)
Menorrhagia? Think "von Willebrand Disease." Avoid my reflex to think only gynecologist.
In one small series, white patients with menorrhagia had a 16% prevalence of von Willebrand disease (n = 44). Black patients had a 1.4 % prevalence (n = 69).
It is not just me. Many of us do not think von Willebrand Disease. A Center for Disease Control (CDC) study of 75 women found a mean time to diagnosis of sixteen years.
Which Screening Test?
The American College of Gynecology and Obstetrics (ACOG) has recommended screening tests for women with menorrhagia "without another cause." They recommend the ristocetin cofactor assay of von Willebrand factor (vWF) activity. They cite a look-back study of 24 children with von Willebrand disease. PTT was normal in 70%. Bleeding time was normal in over 50%. The vWF activity was the most sensitive test (only one additional patient would have been diagnosed by the addition of PTT and bleeding time to the vWF activity test.)
Treatment
I have had no experience with treatment: nasal desmopressin DDAVP. (I would suspect that adherence to this regimen is low. I will look for references). One Italian study questions its biologic effect.
Public Awareness
Public education is underway. (1, 2)
What about Men?
How do men present with von Willebrand disease? The Hemophilia Center of Western Pennsylvania looked back at 42 men with von Willebrand disease. "The most common initial symptom was postoperative bleeding (26%). The most common bleeding symptoms ever were epistaxis (53%), bruising (50%), postoperative bleeding (47%), haematomas (29%) and oral bleeding (29%). Of postoperative bleeding, ear/nose/throat (44%), dental (17%) and circumcision bleeding (22%) occurred at a median 10 years of age, despite a previous bleeding or family history.
Dogs
Shelties, retrievers, scotties and other dogs have their run-in with this as well.