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The nephrology nurses in collaboration with the nephrologist worked closely to avoid severe symptomatology related to calcium phosphorus imbalance. The surgical team support was discontinued 48 hours after the removal of the autotransplant. The patient exhibited classic signs of secondary hyperparathyroidism, as indicated by laboratory tests, anemia, and pruritus. Despite the level of anemia, the patient did not complain of fatigue or dyspnea. A hypocalcemic crisis was avoided by the ongoing assessment and intervention the patient received from the nursing staff. Four of the five stated goals were met. The patient is free of disability as evidenced by steady gait, normal range of motion, and adequate muscle strength. The calcium and phosphorus levels and the calcium phosphorus product are within acceptable ranges (see Figure 1). J.I. has always had information about diet and medication management but has demonstrated variable adherence to the regimen. However, the nephrology nurses plan to continue with counseling and education as needed.
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PMID:Patient, nurses, and physicians collaborating in the management of a patient following autotransplant parathyroidectomy. 932 98

Hypersensitivity to buckwheat allergen frequently causes anaphylactic type reactions including urticaria, wheezing, dyspnea and/or shock. Though the susceptible pupil would be recommended to be careful for school lunch and picnic meals, the prevalence of buckwheat allergy in school children has not yet been elucidated. In this study, data on the children allergic to buckwheat were collected by sending questionnaire to 341 nurses in elementary school in Yokohama. Among the total subjects of this investigation, 92,680 children, the incidence of buckwheat allergy was determined 0.22% (140 boys and 54 girls). This percentage was not so low level besides the prevalence of such allergic diseases as bronchial asthma, atopic dermatitis, allergic rhinitis, allergic conjunctivitis and food allergy was 5.6%, 4.2%, 3.1%, 1.6%, and 1.3%, respectively. Although a large majority of clinical symptoms of buckwheat allergy were urticaria (37.3%), skin itching (33.3%), and wheezing (26.5%). Four children (3.9%) experienced anaphylactic shock having a need of medical emergency treatment. The incidence of anaphylactic shock due to buckwheat was higher than those due to egg and milk allergy. Actually 7 pupil was provoked allergic reaction by buckwheat noodle served at school lunch, and 1 pupil at picnic meals. Thus, school children allergic to buckwheat is not rare, and it is important to withdraw buckwheat food from school lunch and picnic meals.
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PMID:[Buckwheat allergy in 90,000 school children in Yokohama]. 952 62

We report a patient with recurrent generalized itching and urticaria due to inhalation of nicotine in tobacco smoke. A skin prick test with nicotine base (1:10 w/v) was negative but an intradermal test with nicotine base (1:100 w/v) was strongly positive. Intradermal tests with nicotine base (1:100 w/v) performed on 10 healthy controls were negative. A provocation test with a nicotine patch showed the same symptoms and signs including generalized itching, weals and flares, and mild dyspnoea, which occurred when he was exposed to tobacco smoke. Nicotine in tobacco smoke can act as an inhalant allergen and induce urticaria in hypersensitive persons.
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PMID:Urticarial reaction following the inhalation of nicotine in tobacco smoke. 958 Aug 5

In the past 2 years, a 4 year-old boy has had an anaphylactic reaction whenever he contacted food prepared with fish. The symptoms included intense itching in the throat and eyes, which progressed to generalized urticaria and facial angioedema. This was accompanied by cough, wheezing and dyspnea. Many fish preparations caused these episodes including several different kinds of fish (cod, tuna, salmon, trout, eel...), fish soup, chopsticks contaminated with fish preparations and canned fish. Elevated levels of total serum IgE (224 IU/ml) and specific IgE for cod (93.1 IU/ml), tuna (> 100 IU/ml), salmon (> 100 IU/ml), trout (64.4 IU/ml), mackerel (41.2 IU/ml) and eel (28.1 IU/ml) were found by the Pharmacia CAP system RAST FEIA in our allergy clinic. A skin prick test for mixed fish extracts (contain flounder, cod and halibut) was positive. A fish challenge test for cod, tuna, salmon, trout and eel all showed anaphylactic reactions. His allergic symptoms stabilized gradually after strictly avoiding ingestion of fish and using drug treatment. He also had a similar anaphylactic reaction to frogs. The best treatment for fish allergy is avoidance. Avoidance of fish may need to include both ingestion and inhalation of cooking vapors.
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PMID:Fish induced anaphylactic reaction: report of one case. 968 28

Allergy to cow's milk proteins has been defined as any adverse reaction mediated by immunological mechanisms to one or several of these proteins. The diagnosis can be made based on clinical manifestations supported by immune activation of in vitro parameters. Reactions to cow's milk have been classified according on their onset as immediate (< 45 min) or delayed-type (from 2 h to days). We describe a patient with late respiratory manifestations after milk intake, probably due to more than one immunological mechanism. He was an 18-year-old male who since infancy had presented serous rhinorrea, sneezing, nasal blockade, oropharyngeal pruritus and occasional dyspnea 12 to 48 h after ingestion of milk and its derivates. We performed skin prick and intradermal tests with whole milk and fractions. Patch tests were also carried out with whole milk purchased at a supermarket and with the extracts described, in their original form and vehiculized in vaseline. Total and serum specific IgE and IgG4 to milk fractions, histamine release test (HRT) to milk fractions, and precipitating antibodies by contraimmunoelectrophoresis against milk fractions were also measured. As a control we repeated this test in a patient with IgE-mediated manifestations to milk proteins and in two healthy controls. We performed a single-blind placebo controlled challenge with whole milk. Skin prick and intradermal tests were negative. Patch test (48 h) was positive for whole milk and whole milk vehiculized in vaseline, and for alpha-lactalbumin. Total IgE was 559 kU/l; serum-specific IgE was negative; IgG4 was positive (9.48% for alpha-lactalbumin; 7.41% for beta-lactoglobulin and 9.85% for casein). HRT was positive for casein (34%). We found precipitating antibodies to the three milk fractions in our patient and in the atopic control. In the challenge test, 10 h after milk intake the patient presented serous rhinorrea, sneezing and nasal blockade. IgG4 was involved as a blocking or anaphylactic antibody and as an immunological epiphenomenon reflecting a permanent antigenic stimulus. We find this last explanation to be the most coherent in this case.
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PMID:Delayed reaction to cow's milk proteins: a case study. 977 41

As patients with HIV/AIDS are living longer with the illness, pain and symptom management are increasingly important health issues. This article will discuss the assessment and management of such common problems as pain, fatigue and weakness, dyspnea and cough, anorexia and weight-loss, nausea and vomiting, sleep disorders, dry mouth, diarrhea, itching, and fever and night sweats.
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PMID:Palliative care: pain and symptom management in persons with HIV/AIDS. 992 83

Symptoms can markedly influence the hemodialysis patients well-being and quality of life. The aim of this paper is to study the frequency of symptoms at home and how these relate to biochemical and treatment variables. Seventy-three hemodialysis patients were questioned on the absence, occasional presence or daily recurrence (score = 0, 1, 2) of 14 symptoms and a record was made of their biochemical parameters, age, time on treatment and KtIV as a function of each symptom. The following relationships were detected: thirst with high Osm and BUN; asthenia with old age and hypoalbuminemia; insomnia with hypercalcemia; hypersomnia with hypoxemia and hypernatremia; anorexia with hypokalemia; dyspnea with old age, hypernatremia and hypokalemia; dysgeusia with hypoxemia; nausea with alkalemia, hypoxemia and low BUN; vomiting with alkalemia. Pruritus, arthralgia, restless legs syndrome, cramp and tremor showed no relationships. Monitoring acid-base balance and plasma electrolytes could help to alleviate symptoms and ameliorate quality of life of hemodialysis patients.
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PMID:Symptoms in hemodialysis patients and their relationship with biochemical and demographic parameters. 998 55

The diagnostic value for allergies of the low affinity IgE receptor and its soluble circulating fragment (sCD23) remains unclear. In particular, little is know about seasonal influences on serum sCD23 levels in subjects with pollen allergy. In the present study, to gain insight into pathophysiological role of sCD23, we have analyzed, in blood from patients allergic to Parietaria sCD23, IgE, and eosinophil cationic protein (ECP) serum levels. IgE were assessed as atopy markers and ECP as an inflammation marker. Patients were studied during and out of pollen season, and results were compared to those obtained in nonallergic subjects. The study population included 42 nonsmoking outpatients, living in Palermo (Sicily, Italy) or in other west Sicilian towns, with a clinical diagnosis of seasonal asthma or rhinitis and monopositive skin test to Parietaria pollen. The group of asthmatic subjects consisted of 25 patients who had one or more of the usual asthma symptoms (wheezing, dyspnea, and cough) only during the pollen season. The group of rhinitis patients consisted of 17 patients, who, during pollen season, had the nasal symptoms (nasal blockage, sneezing, nasal itching, and rhinorrhoea) but no signs of asthma. As a control group, we studied 10 nonatopic subjects from laboratory staff. They had no history of seasonal or perennial rhinitis, asthma, or urticaria and had negative skin tests to a panel of allergens. Soluble CD23, IgE, and ECP were assessed in blood during and out of pollen season. Total serum IgE levels were clearly higher in atopic patients, as classically established. Concerning sCD23 serum levels, a similar pattern of results was obtained. Accordingly, significant correlations were shown between the levels of sCD23 and IgE in all groups of patients. A completely different pattern was observed by analyzing serum ECP levels because ECP levels were significantly increased only in asthmatic patients during pollen season. Accordingly, no significant correlations were observed between the levels of sCD23 and those of ECP. Identifying immune factors associated with the development of atopy can enhance our understanding of the in vivo mechanisms involved and may have utility in paradigms designed to prevent diseases. As demonstrated by the close correlation with total serum IgE values and the lack of correlation with serum ECP values, serum levels of sCD23 appear to be an additional marker for the diagnosis of atopy but not for the follow-up of allergic diseases.
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PMID:Serum levels of soluble CD23 in patients with asthma or rhinitis monosensitive to Parietaria. Its relation to total serum IgE levels and eosinophil cationic protein during and out of the pollen season. 1020 90

The aim of this study is to evaluate the prevalence of dermo-respiratory symptoms from lung-function spirometer values and serum IgE levels in farmers who have been exposed to pesticides in the United Arab Emirates (E.A.U.). The study was a comparison of 98 farmers with 98 non-farmers, the two groups were equivalent in age, sex and selected regions--the town of Al-Ain and in the Emirates of Dubai, Sharjah and Fujairah. Most of the farmers were illiterate or poorly educated (p < 0.0001). Most lived in prefabricated houses (50.5%). Use of chemical substances (70.9%) and a mixture of pesticides by the farmers (60.2%) was very high. The results revealed that the farmers had a very high prevalence of chronic dermo-respiratory symptoms. These differences are statistically significant when compared with the reference group, particularly for the following symptoms: cough (p < 0.003), pharyngitis (p < 0.0003), bronchitis (p < 0.02), asthma (p < 0.008), respiratory insufficiency (p < 0.006), pneumonia (p < 0.003), dyspnea (p < 0.006), nasal catarrh (p < 0.001), sinusitis (p < 0.05), pharyngeal irritation (p < 0.01), nasal irritation (dryness, sneezing and secretions) (p < 0.005), ocular irritation (p < 0.05), cutaneous pruritus (p < 0.002), and contact dermatitis (p < 0.02). The spirometer tests (all parameters together) measured in the farmers were significantly reduced by comparison with the reference group. In conclusion, the authors suggest that a high prevalence of dermo-respiratory symptoms, supported by reduced spirometer tests and high serum IgE, is associated with exposure to pesticides. These results are clearly useful for establishment of work-related reduced exposure in the future.
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PMID:Respiratory symptoms, skin disorders and serum IgE levels in farm workers. 1021 28

Patients with pancreatic cancer have multiple symptoms from both disease and treatment. Pain, anorexia, nausea, vomiting, weight loss, fatigue, pruritus, and dyspnea are the most common symptoms. Until better treatments are found, patients with pancreatic cancer need effective symptom management to improve their quality of life.
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PMID:Symptom management for patients with pancreatic cancer. 1023 59


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