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 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Calcium channel blockers are assuming increasingly important roles in the practice of emergency medicine. Two cases and a review of the literature relating to treatment of hypertensive emergencies with nifedipine are presented. Nifedipine has a rapid onset of action (buccal, 10-15 minutes; oral, 30-45 minutes) and peak effect (buccal, 30 minutes, oral, 60 minutes). The duration of effects is four to six hours regardless of the route of administration, with a mean arterial pressure reduction of 21.6% (248/134 mm Hg to 165/87 mm Hg). In patients with severe hypertension and left ventricular failure, a consistent reduction in systemic vascular resistance (2,088 dynes/sec/cm-5 to 1242 dynes/sec/cm-5) and cardiac index (2.76 l/min/m2 to 3.77 l/min/m2) has been reported. The patients in this study had severe hypertension (systolic blood pressure greater than 180 mm Hg, diastolic blood pressure greater than 120 mm Hg) and end organ involvement (including heart failure, left ventricular strain, headache, confusion, dizziness, and shortness of breath). Nifedipine (10 mg) was administered buccally with prompt reduction of blood pressure and resolution of the patients' symptoms. Nifedipine appears to be a safe, effective agent for the management of hypertensive emergencies. Its pharmacokinetic profile and routes of administration make it particularly valuable in the practice of emergency medicine.
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PMID:Nifedipine in the management of hypertensive emergencies: report of two cases and review of the literature. 406 18

In this discussion of infection control in patients with acquired immune deficiency syndrome (AIDS), attention is directed to nursing. Due to the fact that the majority of individuals who suffer with AIDS will be homosexual, intravenous drug users, or both, it is essential that the nurse historian be aware of his/her own feelings about the lifestyles of these patients. History-taking should be done in a nonjudgmental manner. A major pitfall to be avoided when taking a history is making assumptions about an individual's sexual preferences or activities based on the response to a simple question about marital status. It is important to note whether or not the person has a monogamous relationship or leads a polyandrous lifestyle. Another area that should be tactfully but explicitly explored when interviewing an individual who is homosexual or bisexual is the number of different sexual partners that he/she has been involved with on a weekly or monthly basis. Whether the patient has a history of sexually transmitted diseases should be determined. The use of recreational drugs should be explored. When taking the history of a client who uses intravenous drugs, it is important for the nurse to record the agents and sites of injection as well as to note whether the individual uses his/her own equipment. When reviewing the major body systems and the presence or absence of related symptoms, the nurse should note whether the client has experienced skin rashes/lesions, swollen lymph nodes, fever, extreme fatigue, weight loss, shortness of breath, changes in bowel habits, cuts or bruises that do not heal, and headaches, dizziness, blurred vision, or stiff neck. The physical examination of the individual with AIDS and an opportunistic infection usually will reveal positive findings in the central nervous system, respiratory system, gastrointestinal system, and/or the integumentary system, as well as the lymphatic system. As the leading cause of morbidity in the compromised host is infection, infection prevention should be regarded as a pragmatic necessity. 2 major things that nurses can do in the acute care setting to control infection are to limit the frequency of invasive or traumatic procedures and to reduce the acquisition of new potential pathogens.
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PMID:Infection control in the patient with AIDS. 608 77

A double-blind randomized study of 45 climbers on Mt. Rainier was conducted to test the effectiveness of antacids in preventing acute mountain sickness. All 45 climbed to 3353 m, and 31 continued to the summit. Ten climbers listed acute mountain sickness as the reason for not attaining the summit. Of symptoms monitored throughout the climb, neither headache, nausea, dizziness, pounding heart, nor shortness of breath differed in severity between antacid-treated and placebo-treated groups. In both groups vital capacity decreased significantly with ascent (p less than 0.05), while peak flow (p less than 0.005) and minute ventilation (p less than 0.001) increased significantly. The 7 climbers with the most severe AMS symptom scores above 4000 m had significantly lower peak flow at sea level prior to ascent compared with the other 25 climbers who completed sea level tests (p less than 0.005). The results of this study fail to document efficacy for antacid use for the prevention of acute mountain sickness.
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PMID:Acute mountain sickness, antacids, and ventilation during rapid, active ascent of Mount Rainier. 634 73

Praziquantel (2-cyclohexylcarbonyl-1,2,3,6,7,11b-hexahydro-4H-pyrazino[2,1-a]++ +isoquinolin- 4-one, EMBAY 8440, Biltricide) has been used in 4853 patients with Opisthorchis viverrini infection. 786 patients were treated as inpatients with extensive clinical evaluation and the rest were out-patients. A cure rate (evaluated with 5 faecal samples) of 100% was obtained in groups given 6 X 25 mg/kg on 2 days and 3 X 25 mg/kg on 1 day, while in groups given 2 X 25 mg/kg, 1 X 25 mg/kg and 1 X 40 mg/kg all on 1 day the cure rates were 88, 44 and 91%, respectively. With one sample evaluation the parasitological cure rate was 96% in further 96 patients excreting the geometric mean (GM) of 5394 eggs per gram (EPG) and receiving 1 X 40 mg/kg. Another 68 patients with an egg output of 26044 (GM/EPG) and treated with 1 X 50 mg/kg showed a cure rate of 97% by similar evaluation. Side effects were mild and transient and were more frequent in higher dosage groups. They included anorexia, nausea, vomiting, abdominal pain, epigastric pain, rumbling in the abdomen, diarrhoea, lassitude, myalgia, headache, dizziness, sleeplessness, sleepiness, "hot sensation", shortness of breath, and skin rash in a few cases. Headache (30.7%) was most common in the 6 X 25 mg/kg group. In 53 patients with severe jaundice the side effects were similar. There was no evidence of toxicity. Remarkable was one patient treated with 1 X 50 mg/kg who expelled 5636 O. viverrini worms, most of which were elongated and damaged. When a single dose is prescribed it should be given at bed time to reduce the side effect of sedation.
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PMID:Opisthorchis viverrini: clinical experience with praziquantel in Hospital for Tropical Diseases. 654 86

A case is presented of a 32-year old gravida 3, para 1, ab 1, presented at 26 weeks with chief complaints of periorbital edema, headaches, and blurred vision for about 1 week. 2 weeks prior to admission she had experienced shortness of breath and decreased fetal movement. Admission was at 28 weeks with uncontrolled hypertension, blood pressure 190/120, pulse 100/min. Temperature was 98.8 degrees. Attempted induction of labor with oxytocin was unsuccessful. A hydralazine infusion decreased the blood pressure to 180/100 and a 20 mg prostaglandin (PG) E2 suppository was inserted. A few hours later the blood pressure had dropped to 100/60 and the hydrazaline infusion was discontinued. About 3 hours later a stillborn female infant was born; post delivery examination revealed a large gap in the wall of the uterus extending into the lateral vaginal fornix. A total abdominal hysterectomy and right salpingo-oophorectomy was then performed and recovery was uneventful. PGE2 reliably initiates labor even in the presence of an "uninducible cervix" and is prone to increase intrauterine pressure to a level beyond that of normal labor with a lag in cervical changes. The 2 most common traumata reported following PG administration for therapeutic abortion are either cervico-vaginal fistulas or lateral tears. In this case since there was no indication of any congenital weakness of the uterine wall, it is reasonable to assume that the mechanism leading to the rupture was intense and prolonged uterine contractions combined with a rigid cervix.
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PMID:Uterine rupture associated with the use of vaginal prostaglandin E2 suppositories. 658 51

Almitrine bismesylate was administered to young, healthy, non-smoking male subjects as single oral doses, multiple oral doses and multiple oral doses with food. A variety of physiological parameters and blood parameters were tested at specified times in relationship to drug ingestion, and multiple blood samples for plasma almitrine bismesylate levels were obtained. Evaluation of the data revealed almitrine bismesylate to be safe at all doses tested, up to 400 mg per day, with symptoms of mild nausea and headache occurring most frequently when the drug was administered in the fasting state. A striking complaint of shortness of breath on exertion was reported by subjects, with increased frequency and severity related to total amount of drug ingested and level of physical activity. Increased oxygen uptake and tidal volume were found after multiple oral dosing. Plasma almitrine bismesylate levels were highly variable, and marked individual differences in peak levels and terminal phase rate constants and half lives were found. Multiple oral dosing, either fasting or with food, significantly prolonged the terminal phase half life when compared to single oral dosing.
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PMID:Effects and handling of almitrine bismesylate in healthy subjects. 658 42

Twenty-one subjects exposed to formaldehyde (at levels between 0.12 and 1.6 parts per million [ppm]) in two mobile trailers and the remaining 18 unexposed workers of the same workforce were examined by questionnaire and spirometry. Symptoms of eye and throat irritation and increased headache and fatigue were significantly more common among the exposed group than the comparison group. Irritation of the nose, chest tightness, and shortness of breath were also more common among the exposed. Spirometry revealed no decrease in ventilatory function among the exposed workers. The significant increase in frequency of individuals with symptoms indicated an adverse health effect from exposure to formaldehyde at levels between 0.12 and 1.6 ppm. This may have implications regarding the adequacy of the US permissible exposure limit value and suggests the need for further examination of the health effects of formaldehyde in the nonoccupational environment.
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PMID:Health effects of low-level exposure to formaldehyde. 665 25

M. pneumoniae is a common cause of pneumonia. The diagnosis is suspected when the patient presents with symptoms suggesting primary atypical pneumonia including cough, fever, chills, headache, and malaise in association with a segmental or subsegmental pulmonary infiltrate(s), the white blood cell count is normal or only slightly elevated, and the Gram stain of the sputum (if any can be obtained) reveals polymorphonuclear leukocytes and few bacteria. The diagnosis is more difficult when the patient presents with symptoms not suggestive of pneumonia including lethargy, dyspnea, and a 1- to 4-week history of shortness of breath without cough or fever in association with diffuse reticulonodular or interstitial pulmonary infiltrates. The disease in the previously healthy host is usually benign and self-limiting. However, the course is shortened by the administration of tetracycline derivatives or erythromycin. M. pneumoniae pneumonia can occur in association with other diseases including sickle cell anemia, sarcoidosis, systemic lupus erythematosus, Hodgkin's disease, and various other immunodeficiency states. In these patients mycoplasma pneumonia can be very serious. Although there is no pathognomonic clinical or radiographic presentation, careful consideration of epidemiologic, clinical, laboratory, and radiographic data are usually sufficient to suggest the diagnosis in most patients.
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PMID:Mycoplasma pneumonia. 676 79

Sixty-four climbers participated in a randomized clinical trial of acetazolamide prophylaxis for acute mountain sickness (AMS) during rapid, active ascent of MT Rainier. Twenty-nine (93.6%) of 31 climbers receiving acetazolamide and 25 (75.8%) of 33 receiving placebo attained the summit. Time spent ascending from sea level to the summit (4,394 m) averaged 33.5 hours (range, 23 to 48 hours). On the summit AMS was less common in climbers receiving acetazolamide, and they experienced less headache, nausea, drowsiness, shortness of breath, and dizziness and a greater sense of satisfaction and psychological well-being. Minute ventilation on the summit was significantly greater in subjects taking acetazolamide (24.9 +/- 2.0 L/min compared with 16.9 +/- 3.8 L/min). Expired vital capacity was also greater on the summit in the acetazolamide group (6.9 +/- 0.4 L compared with 5.8 +/- 0.4 L). We conclude that acetazolamide is effective in the prophylaxis of AMS for climbers attempting rapid, active ascent. Increased ventilation at altitude, producing an increased alveolar oxygen tension, may be related to the observed amelioration of symptoms.
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PMID:Acute mountain sickness and acetazolamide. Clinical efficacy and effect on ventilation. 704 33

A 22-year-old woman with systemic lupus erythematosus experienced generalized pruritus, shortness of breath, pleuritic chest pain, visual blurring, severe photophobia, a stiff neck, an occipital headache, and a temperature of 39.4 degrees C within one hour after taking sulindac (Clinoril). Findings from a CSF examination disclosed a notable elevation of protein and a polymorphonuclear pleocytosis. All symptoms disappeared within 24 hours. Inhibition of prostaglandin synthesis did not seem to be the mechanism of this adverse reaction, since the patient tolerated aspirin.
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PMID:Sulindac-induced aseptic meningitis. 705 20


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