[Hairy cell leukemia and Mycobacterium malmoense infection]

We describe a patient with hairy cell leukemia and protracted fever. The patient's condition deteriorated during treatment with alfa Interferon 2b, and his fever persisted. A slight widening of the upper mediastinum appeared after 2.5 months. Mediastinoscopy with lymph node biopsy revealed granulomatous infiltrates with acid-fast bacilli. Cultures of the lymph node material later showed growth of Mycobacterium malmoense. The patient was treated with rifampicin, doxycycline, etambutol and cycloserin for sixteen months and remains afebrile and is gaining weight. His general condition is still improving. An aggressive diagnostic approach is necessary in febrile patients with hairy cell leukemia.

Renal effects of trimethoprim in ciclosporin- and azathioprine-treated kidney-allografted patients

Sixteen stable renal transplant patients on chronic ciclosporin (CS, n = 8) or azathioprine (AZA, n = 8) treatment were given trimethoprim (TMP) 160 mg twice a day for 7 days. This TMP dose did not affect glomerular filtration, as 99mTc-DTPA clearance was unchanged in both groups. TMP did, however, increase serum creatinine and reduce creatinine clearance in all patients. This effect was most pronounced in CS-treated patients. We conclude that even at the moderate dosage, as employed presently, TMP blocks tubular secretion of creatinine. This route for creatinine excretion is quite important as the clearance ratio between creatinine and DTPA averaged 1.21 in CS-treated patients and 1.05 in AZA-treated patients before TMP treatment. During TMP the ratio was reduced to 0.95 and 0.99, respectively, suggesting a complete cessation of tubular creatinine secretion by TMP. TMP did not, however, significantly affect other markers of renal tubular function.

Renal effects of trimethoprim in ciclosporin- and azathioprine-treated kidney-allografted patients

Sixteen stable renal transplant patients on chronic ciclosporin (CS, n = 8) or azathioprine (AZA, n = 8) treatment were given trimethoprim (TMP) 160 mg twice a day for 7 days. This TMP dose did not affect glomerular filtration, as 99mTc-DTPA clearance was unchanged in both groups. TMP did, however, increase serum creatinine and reduce creatinine clearance in all patients. This effect was most pronounced in CS-treated patients. We conclude that even at the moderate dosage, as employed presently, TMP blocks tubular secretion of creatinine. This route for creatinine excretion is quite important as the clearance ratio between creatinine and DTPA averaged 1.21 in CS-treated patients and 1.05 in AZA-treated patients before TMP treatment. During TMP the ratio was reduced to 0.95 and 0.99, respectively, suggesting a complete cessation of tubular creatinine secretion by TMP. TMP did not, however, significantly affect other markers of renal tubular function.

Recent trends in drug prescribing rates and costs in New Zealand

Pharmaceutical benefit expenditure has grown rapidly and disproportionately in recent years to nearly 15% of Vote Health. Annual average increases in prescribed drugs of 3.1% by volume and of 6.9% in real prices have occurred since 1981. For the 1986/87 year volume and real price increases were 5.7% and 11.5% respectively, possibly due to the lifting of the price freeze and the effect of extending prescribing to three months from February 1985. Factors explaining these trends include the growth in numbers of general practitioners and the availability of new and more expensive drugs supported by promotional activities of pharmaceutical companies. There are almost no effective managerial, professional or educational strategies on the part of government to counter these influences. Pharmaceutical benefit expenditure and its growth is almost totally unmanaged and uncontrolled. With severe limits on government expenditure this growth could threaten other areas of health expenditure. Major changes are required in its management including a substantial part charge to the user, decentralisation to area health boards of primary health care services and funding, and professional mechanisms for better prescribing, supported by national policies for a comprehensive, computerised pharmaceutical and primary health care information system.

Septicemia due to Mycoplasma hominis

Mycoplasma hominis was recovered from the blood of 7 patients with various underlying disorders. One patient had a legal abortion, another a Caesarian section, both followed by septicemia. Three patients had genital infections in pregnancy, followed by septicemia and spontaneous abortion. M. hominis was also recovered from cervix and urethra in 2 of these women. High serum antibody levels against M. hominis were demonstrated in 3 women. One female developed septicemia after cancer surgery, one male after heart surgery. In the first 6 patients described the septicemia was of short duration and self-limiting, in the 7th patient it was of long duration and appropriate antimicrobial treatment was required. From this patient M. hominis was also isolated from infected operation wounds.