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Seven subjects, who experienced systemic allergic reactions after the ingestion of a newly marketed food supplement, were evaluated to identify the responsible ingredient. Skin testing with extracts prepared from ingredients in the food supplements revealed marked sensitization of all of the subjects to cottonseed protein. Double-blind, placebo-controlled food challenges performed in two subjects with cottonseed flour produced reactions consisting of oropharyngeal pruritus, rhinitis, nausea, diaphoresis, dyspnea, cough, and a fall in pulmonary function tests of 45% or more. All placebo challenges were negative. Because of the reactions observed during these challenges, other subjects were not challenged orally with cottonseed protein but consumed without incident other ingredients in the supplement to which they were skin test positive. Our evaluation strongly incriminates cottonseed protein as the cause of the systemic allergic reactions in these subjects and is consistent with earlier articles in the literature describing the potent allergenicity of cottonseed protein.
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PMID:Cottonseed hypersensitivity: new concerns over an old problem. 340 64

Rhodamine B is a red colored dye that is used in cosmetic products. We report a case of 17 patients who were exposed to aerosolized Rhodamine B inside a maintenance shop. The mean duration of exposure was 26 minutes (range 2-65). Sixteen of the patients (94%) complained of acute symptoms including: burning of the eyes (82%), excessive tearing (47%), nasal burning (41%), nasal itching (35%), chest pain/tightness (35%), rhinorhea (29%), cough (29%), dyspnea (29%), burning of the throat (24%), burning/pruritic skin (24%), chest burning (12%), headache (6%), and nausea (6%). All of the patients had resolution of their symptoms within 24 hours (less than 4 hours in 63%). Acute exposure to Rhodamine B resulted in transient mucous membrane and skin irritation without evidence of serious sequellae.
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PMID:Acute exposure to rhodamine B. 344 24

Because of a hydrocephalic fetus, the 27 year old mother opted for abortion. This was done in the 21st week of pregnancy by ordinary intracervical application of 0.25 mg prostaglandin e2 gel. 30 minutes later the patient began to complain of nausea and dyspnea. Laboratory analysis revealed leukocytosis of 20800/ml and thrombocytopenia of 22000/ml, down from 150,000 ml before the procedure. There were no clinical indications of bleeding. The leukocytosis lasted 2 days and thrombocytopenia roughly 6 days. Treatment included administration of acetylsalicylic acid 3 x 0.5 g and dipyrimadol tablets 3 x 25 mg/day. After thrombocyte count was normalized, abortion was induced by means of spasmolysis and oxytocin i.v. In this case partial resorption of the prostaglandin indicates a systemic effect. Since the half life of E and F group prostaglandins is usually 1-3 minutes, and it is almost completely eliminated after passing through the liver and lungs, a direct prostaglandin effect leading to thrombocyte aggregation lasting several days is unlikely. Absence of thrombocyte antibodies point to a drug induced immune process in which the prostaglandin molecule could appear as a hapten. Ultimately the thrombocyte aggregation described here and normochromic anemia are of unclear origin. Changes in the patients' coagulation system are probably of no functional relevance. The initial leukocytosis must be considered a nonspecific immediate reaction.
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PMID:[Thrombocytopenia following intracervical prostaglandin priming]. 346 25

A previously healthy 27 year-old male plumber presented with six days of fever, nausea, vomiting, malaise and headache. The subsequent development of cough, dyspnoea and pleuritic pain coincided with the simultaneous development of progressive bilateral cavitary pneumonia with pleural effusion. Leucocytosis, thrombocytopenia, hyponatraemia, hypoalbuminaemia, hypophosphataemia and hypoxaemia were the main laboratory abnormalities. Clinical suspicion of Legionnaires' disease was confirmed by the presence of serum antibody to Legionella pneumophila (titre 1:512) by an indirect fluorescent antibody test. Treatment with erythromycin and rifampicin resulted in clinical recovery with minimal residual bilateral pleural effusion six months after presentation. This patient is the first to acquire Legionnaires' disease in Singapore.
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PMID:Legionnaires' disease--report of Singapore's first local case. 355 84

Despite much recent research, there is still little systematic information about the phenomenology of panic attacks, and their possible causes remain obscure. We investigated panic attacks in the natural environment using an event sampling approach. Twenty-seven panic attack patients and 19 matched normal controls kept panic attack and self-exposure diaries for 6 days and wore an ambulatory heart rate/physical activity recorder for 3 days. Patients reported 175 attacks, generally of moderate severity. The most frequent symptoms were palpitations, dizziness/lightheadedness, dyspnea, nausea, sweating, and chest pain/discomfort. The results did not support the classification of panic attacks recently proposed by Sheehan and Sheehan, which requires three symptoms as a cutoff for panic attacks. Panic attacks classified by the patients as situational (i.e., occurring in feared situations) were more severe and occurred in situational contexts different from spontaneous attacks, but were otherwise phenomenologically similar. Heart rates did not change during spontaneous attacks and were only mildly elevated during situational attacks or during the 15 minutes preceding these attacks. These heart rate changes were interpretable as effects of anxiety, although physical activity showed a similar pattern of changes. Some normal control subjects reported on the panic diary primarily situational anxiety episodes that were phenomenologically similar to, albeit less severe than, the patients' episodes. Panic patients may sometimes fail to perceive environmental triggers for their attacks because many attacks classified as spontaneous occurred in classical "phobic" situations. Furthermore, the comparison of concurrent diary and retrospective interview and questionnaire descriptions showed that panic patients have a tendency toward retrospective exaggeration. Implications for the assessment, definition, and classification of panic attacks are discussed.
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PMID:Panic attacks in the natural environment. 365 82

Studies have attempted to define predictive indicators of diagnosis and/or prognosis for acute myocardial infarction (AMI) in the emergency department and to identify the need for hospital admission in patients with chest pain. Because prehospital predictors have not been defined, dispatchers, paramedics, and base station physicians continue to triage based on patient history. We reviewed 401 patients presenting in one year to an urban paramedic system with chest pain, normal vital signs, and stable rhythms to identify predictors of AMI and unstable angina. Thirty-one percent (123) had a diagnosis of AMI, 26% (105) unstable angina, and 43% (173) "other" diagnoses. Two-hundred seventy-eight patients required nitroglycerin administration, 182 required IV morphine, 14 developed arrhythmias requiring lidocaine, and two suffered cardiac arrest in the field. Nine other patients had a cardiac arrest after arrival in the ED. When comparing AMI and unstable angina patients to the "others," 64% (132) versus 36% (74) had radiation of pain (P less than .003), 72% (95) versus 28% (37) had diaphoresis (P less than .0001). Neither difficulty breathing, nausea/vomiting, vital signs, initial rhythm, nor past history of myocardial infarction were helpful in discriminating AMI and unstable angina from others. Comparing AMI alone versus others, the presence of ST segment elevation on lead II was present in 15% (18) AMIs, 3% (3) unstable angina, and 8% (14) others (P = .005). Diaphoresis also was a predictor of diagnosis with 51% (63) of the AMIs and 25% (69) of others exhibiting this sign (P less than .001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Limitations of prehospital predictors of acute myocardial infarction and unstable angina. 368 92

This part examines the symptoms and diseases of neurotics with either a schizoid (38) or a hysterical (70) personality structure, comprising 5% and 10% respectively of the first admissions in 7 years. Compared to the hysterical structure, schizoids more frequently show the following characteristics: they are men and have as their secondary component a mixed character structure, an earlier age of onset, a longer duration of illness but earlier referral for psychotherapy. They suffer mainly from psychic symptoms--depressive states and contact difficulties as the indicating signs. Further complaints are defective concentration, feelings of apprehension and difficulty in working, also bulimia and the inability to breathe deeply. They were mostly born between 1940 and 1959. Their relatives suffered from psychiatric disorders. Compared to the schizoids, hysterically structured individuals are almost exclusively women, their second most important structural component being obsessive-compulsive. They develop their illness later, have it for a shorter time and are referred for psychotherapy later. Their indicating signs manifest themselves more often somatically, less frequently as anxiety states or phobias. The symptoms occur simultaneously in several organ systems, particularly the respiratory tract, the gastrointestinal tract and the musculoskeletal system. Common symptoms are dyspnea and/or hyperventilation tetany, nausea, weight gain, frigidity and fluor as well as crying fits. They formerly suffered from gynecological disorders and had to undergo operations. They were mainly born between 1920 and 1939. Their relatives had cardiac disorders and their symptoms were identical or similar to those of their father.
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PMID:[Schizoid versus hysterical personality structure. I: Symptoms and diseases]. 376 12

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

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

In nonanesthetized young pigs, the influence of prednisolone sodium succinate therapy on a 65% lethal dose of Escherichia coli endotoxin was studied by evaluating clinical signs, several hemodynamic variables, survival rate, and changes seen at necropsy. Endotoxin infusion induced reproducible clinical signs characterized by nausea, vomiting, dyspnea, cyanosis, and moderate excitement followed by severe CNS depression. Among the hemodynamic variables, there were decreases in arterial blood pressure and cardiac output and increases in pulmonary arterial pressure, heart rate, and total peripheral and pulmonary vascular resistances. Core temperature and arterial pH did not change significantly. Survival rate at 30 hours after the start of the endotoxin infusion was 35%. According to the necropsy, marked edema and hemorrhages were in several organs. Treating the experimental animals with prednisolone sodium succinate (3 injections of 10 mg/kg of body weight after the start of the endotoxin infusion) did not influence any of the monitored hemodynamic variables, except for arterial blood pressure, which was higher at the end of the hemodynamic recording period (270 minutes after the start of the endotoxin infusion). Clinical signs, survival rate, and changes at necropsy were similar in both treated and nontreated pigs. This lack of effect can be due to an inappropriate dosage of the steroid or failure of steroid treatment to alleviate endotoxin-mediated effects.
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PMID:Endotoxic shock in the awake young pig: absence of beneficial effect of prednisolone sodium succinate treatment. 389 34


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