Gene/Protein Disease Symptom Drug Enzyme Compound
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 23,468 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Seventy nine cases of sporadic, community acquired legionnaires' disease have been reviewed. Annual and seasonal variation in incidence was noted. The mean age of the patients was 53 years and 50 (63%) were male. Pre-existing chronic diseases were present in only 23 (29%), including two patients receiving immunosuppressive treatment. Common symptoms included unproductive cough, dyspnoea, chest pain, headache, confusion, nausea, vomiting, and diarrhoea. Respiratory symptoms were absent, however, in 17 (22%). Localising chest signs were present in 74 (95%) cases. Frequent laboratory findings included lymphopenia, high erythrocyte sedimentation rate, hyponatraemia, raised urea and creatinine concentrations, abnormal liver function, hypophosphataemia, hypoalbuminaemia, proteinuria, and haematuria. Thirteen patients died (16%), including nine of 20 who received assisted ventilation. The mortality rate in patients treated with erythromycin (11%) was lower than in those who received other antibiotics (23%), but this difference was not statistically significant. Of the features noted on admission, only a high plasma urea concentration was significantly associated with death. Sporadic community acquired legionnaires' disease is a not uncommon disorder, which with appropriate treatment has a prognosis similar to that of other forms of community acquired pneumonia.
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PMID:Legionnaires' disease: a review of 79 community acquired cases in Nottingham. 378 45

Cardiac and noncardiac side effects were studied in 293 consecutive patients referred for nonexercise stress thallium imaging with intravenous dipyridamole. Six minutes after the initiation of infusion, there was a mean 9-beat/min increase in heart rate and a mean 12-mm Hg decrease in systolic blood pressure. The largest increase in heart rate exceeded 20 beats/min in only 13% of patients and the largest decrease in systolic blood pressure exceeded 20 mm Hg in 31%. Noncardiac side effects were headache (11%), lightheadedness or dizziness (5%) and nausea (4%). Only 9 patients required intravenous aminophylline for relief of noncardiac side effects: severe headache in 7 and nausea in 2. Cardiac side effects included chest pain in 76 patients (26%), of whom 70% were given aminophylline for relief of symptoms. Sixty patients (20%) had ischemic ST-segment depression and 56 (19%) had arrhythmias (ventricular in 50 and atrial in 6). There were no deaths, myocardial infarctions or sustained arrhythmias due to dipyridamole administration. Among 62 patients also undergoing cardiac catheterization, side effects except for arrhythmias were unrelated to the number of vessels with coronary artery disease. Intravenous dipyridamole is safe for nonexercise stress testing and has few serious side effects. However, the possibility of ischemia requires careful selection of patients and monitoring of vital signs and the electrocardiogram during the test.
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PMID:Safety of intravenous dipyridamole for stress testing with thallium imaging. 381 27

A prospective study on 184 consecutive patients presenting with the chief complaint of recurrent chest pain (RP) for diagnostic coronary arteriography (CA) was conducted utilizing a simple questionnaire of historical, physical and electrocardiographic variables. A linear logistic regression analysis yielded a final data set of 13 variables. Concurrently, staff cardiologists who obtained the questionnaire data through direct questioning rendered a clinical diagnosis of either angina (coronary artery disease [CAD]) or noncardiac chest pain. Utilization of the regression analysis increased diagnostic accuracy from 69 to 86% (p less than 0.0003); sensitivity from 83 to 88% (NS) and specificity from 49 to 84% (p less than 0.0001). The best predictive variables for the presence or absence of obstructive CAD documented by CA were in order of decreasing value: age, electrocardiogram, pain aggravated by sex, sex (gender), pain aggravated by movement, diabetes mellitus, pain described as prickling, pain described as burning, pain relieved by rest, pain with radiation to both arms, associated nausea, associated dyspnea, and a history of a lipid disorder. Four variables were predictive of normal coronary anatomy (NCA), pain aggravated by movement, prickling, nausea, and dyspnea. Although this set of predictor variables may not apply equally well to all populations of cardiac patients, the availability and relative simplicity of the program allow for adding or deleting variables and thus provide for considerable potential in the diagnostic assessment of RP. An inexpensive pocket computer can utilize the coefficients generated by the logistic regression program to calculate the probability of CAD as the cause of RP.
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PMID:Analysis of historical variables, risk factors and the resting electrocardiogram as an aid in the clinical diagnosis of recurrent chest pain. 388 75

Although the exposure of human subjects to prostacyclin (PGI2) infusion has been broad, no systematic approaches have been made in order to investigate the dose-related side effects in patients with angina pectoris and coronary artery disease (CAD). We studied 25 patients with typical chest pain and overt CAD. All patients underwent a cycloergometer stress testing (25 W increments at 2-min intervals). PGI2 was infused in scalar doses up to 10 ng/kg/min. During the infusion 25 patients (100%) had facial flushing, 7 (28%) moderate headache and one (4%) had nausea. In addition, 4 patients experienced the typical chest pain and had significant (greater than or equal to 0.1 mV) ST segment depression at 8.10 ng/kg/min infusion rates. These patients had lower tolerance to exercise (6.7 +/- 1.7 vs. 8.8 +/- 1.9 min; p less than 0.05) and coronary artery lesions more severe than those observed in patients without drug-induced angina pectoris. Our data therefore indicate that PGI2 at therapeutic doses may induce myocardial ischemia in patients with angina pectoris, low tolerance to exercise and severe CAD. In patients with mild to moderate degree of CAD, PGI2 was found to be well tolerated. These findings suggest that patients with angina pectoris and low tolerance to exercise should be excluded from clinical studies directed at elucidating the effectiveness of PGI2 in cardiovascular disorders.
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PMID:Side effects of prostacyclin in patients with angina pectoris and coronary artery disease. 390 57

Stress thallium imaging with intravenous dipyridamole permits assessment of coronary artery disease (CAD) without the need for exercise. However, intravenous dipyridamole is available in the United States only on an experimental basis. To study the use of oral dipyridamole as a clinically available alternative to intravenous dipyridamole for this purpose, 100 patients underwent thallium imaging with oral dipyridamole. Each patient received 300 mg of pulverized tablets in a 30-ml suspension. Maximal increase in mean heart rate and decrease in mean blood pressure occurred 30 minutes after ingestion. At 45 minutes, 2 mCi of thallium was given intravenously and serial imaging was begun within 7 minutes. The serum dipyridamole level (mean +/- standard deviation) 45 minutes after 300 mg was administered orally (3.7 +/- 2.2 micrograms/ml) was similar to that 5 minutes after 0.56 mg/kg was given intravenously (4.6 +/- 1.3 micrograms/ml). Fifty-five patients had some adverse effects between 15 and 75 minutes after oral ingestion, including nausea, headache, dizziness, chest pain (25 patients) and electrocardiographic changes (14 patients). Intravenous aminophylline was used to resolve these adverse effects in 21 patients. There were no severe arrhythmias, myocardial infarctions or deaths. Of the 43 patients with angiographically documented CAD, 39 had an initial perfusion defect that redistributed on the delayed images. When the results in patients who had undergone catheterization were analyzed by individual segment, the presence of thallium redistribution was associated with normal or hypokinetic contrast left ventriculographic wall motion of that segment, whereas the presence of a persistent defect was associated with akinesia or dyskinesia (Fisher's standardized Z = 9.14).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Usefulness of oral dipyridamole suspension for stress thallium imaging without exercise in the detection of coronary artery disease. 395 32

Fourteen of 23 female members of a church group experienced an acute self-limited illness characterized by chills, fever, chest pain, cough, and nausea, consistent with the diagnosis of Pontiac fever. All 14 affected women had used a whirlpool located in the women's locker room during a racquetball party. Legionella pneumophila serogroup 6 was isolated from the women's whirlpool. Nine of 14 cases showed a seroconversion to heat-fixed antigen prepared from the L pneumophila serogroup 6 isolate. Aerosol size studies show that the whirlpool aerator produced water droplets small enough to travel deep into the tracheobronchial tree but large enough to transport L pneumophila. This outbreak demonstrated that Pontiac fever may be associated with L pneumophila serogroup 6, that whirlpools can serve as a reservoir for these organisms, and that seroconversion can occur in the absence of illness.
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PMID:An outbreak of Pontiac fever related to whirlpool use, Michigan 1982. 396 86

We questioned 113 patients with subsequently diagnosed sustained ventricular tachycardia (VT) regarding the symptoms that prompted their seeking hospital treatment, eliciting the following: 15% of patients had lost consciousness, 15% had near syncope, 35% had mild lightheadedness and 35% had no cerebral symptoms. Patients with preexisting congestive heart failure or a VT rate of 200 beats per minute or greater more often lost consciousness. Other symptoms included palpitations in 57% of patients, chest pain in 27%, dyspnea in 25%, weakness in 6%, nausea or diaphoresis in 3% each and flushing in 2%. In approximately 50% of patients who had mild lightheadedness or no cerebral symptoms, their condition was incorrectly diagnosed as supraventricular tachycardia based on the absence of severe symptoms during the tachycardia. In some patients, VT may be associated with mild or atypical symptoms. The differentiation of supraventricular from ventricular tachycardia should be based on electrocardiographic criteria and should not be influenced by the nature or severity of a patient's symptoms. The severity of cerebral symptoms is at least partially related to the VT rate and a patient's underlying heart disease.
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PMID:Clinical symptoms in patients with sustained ventricular tachycardia. 399 9

Following the ingestion of an alleged aphrodisiac known as "yo-yo," a 16-year-old girl experienced an acute dissociative reaction accompanied by weakness, paresthesias, and incoordination. Subsequent symptoms included anxiety, headache, nausea, palpitations, and chest pain. Hypertension, tachycardia, tachypnea, diaphoresis, pallor, tremors, and an erythematous rash were noted on physical examination. Serum epinephrine and norepinephrine levels were found to be elevated. Symptoms resolved spontaneously but lasted approximately 36 hours. The ingested substance was identified as yohimbine. The pharmacology of yohimbine and the treatment of yohimbine poisoning are discussed.
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PMID:Yohimbine: a new street drug. 403 64

One hundred women in preterm labor were randomly treated with ritodrine or terbutaline in a double-blind fashion. The drugs were comparably effective during intravenous therapy but, in women with intact membranes, an oral dose of terbutaline, 30 mg daily, was significantly more effective than ritodrine, 120 mg daily, in preventing recurrent labor during a 5-day course of oral therapy (one of 19 versus 12 of 23, p less than 0.001). In women with intact membranes, pregnancy was prolonged 40 +/- 25 days (mean +/- SD) in women receiving terbutaline orally and only 22 +/- 24 days in women receiving ritodrine orally (p less than 0.01). In women with intact membranes, a heart rate greater than or equal to 130 bpm occurred in in a higher proportion of women receiving intravenous treatment with ritodrine than among those receiving terbutaline (20 of 31 versus 8 of 27, p less than 0.05). Terbutaline-treated women, however, were significantly more likely to have a serum glucose level in excess of 140 mg/dl than were women treated with ritodrine (13 of 26 versus 6 of 29, p less than 0.05). Side effects commonly observed during intravenous therapy included nausea (22%), chest pain (15%), and shortness of breath (15%). Side effects were significantly (p less than 0.025) more likely to occur during periods when the infusion rate was being increased rather than during periods when the infusion rate was constant.
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PMID:A double-blind study comparing ritodrine and terbutaline in the treatment of preterm labor. 638 45

Ergonovine administration during coronary angiography is frequently used to rule out coronary spasm as a cause of chest pain. We performed this study to determine which electrocardiographic variables (other than ST segment elevation with pain) and which chest pain characteristics might be predictive of ergonovine test outcome in patients without obstructive coronary disease. Thirty-one patients had an electrocardiogram recorded during chest pain. Three of four patients (75%) who had an ischemic electrocardiogram with pain had a positive ergonovine test while only 1 of 27 (4%) patients who had a nonischemic electrocardiogram during chest pain had a positive ergonovine test (p less than 0.001) Pain that occurred predominantly at rest was present in five of five patients with positive ergonovine tests but pain occurring predominantly at rest was also present in 76% of patients with negative ergonovine tests (85%). Prompt relief of pain with nitroglycerine was also present in all patients with a positive ergonovine test but was also seen in 58% of patients with a negative test (NS). Association of chest pain with nausea, vomiting, diaphoresis, or radiation to left arm, jaw or neck were similarly poor predictors of ergonovine test outcome. We conclude that ergonovine testing in patients without obstructive coronary disease is of low yield if an electrocardiogram recorded during pain does not show evidence of ischemia. Historical features of the chest pain are not good predictors of test outcome.
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PMID:Provocative ergonovine testing in patients without obstructive coronary disease. 641 49


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