bluuebunny/crossref_metadata_2025 huggingface dataset:
Excess Mortality from Breast Cancer in Relation to Mammography Screening in Northern Sweden
Authors: Lenner Per , Jonsson Håkan
Published: January 2017

Objectives—

Previous randomised studies of mammography screening have shown a significant effect on breast cancer mortality, particularly in women aged 50–Q69 at randomisation. Breast cancer mortality has traditionally been studied by judgments on causes of death, either from cause of death registers or from medical records. In this study an alternative method was used, estimating the excess mortality associated with breast cancer.

Setting—

In 1990 two counties of northern Sweden started population based mammography screening of women aged 40–74. The unscreened population in the two other counties of the same region were selected as controls.

Results—

Excess mortality associated with breast cancer was lower in the screened population, and was discernible three to four years after the start of screening. The relative risk estimate, based on the cumulative excess number of deaths from breast cancer during 1990–95 in the screened versus the control population aged 40–74 (at diagnosis of breast cancer), was 0.72 (95% confidence interval (CI) 0.53 to 0.99). For women aged 50–69 it was 0.67 (95% CI 0.46 to 0.99). In the 50–69 age group the estimated excess number of deaths from breast cancer during 1995 was 17.0 per 100 000 women (95% CI 5.0 to 29.0) in the screened counties and 51.1 per 100 000 (95% CI 30.2 to 71.9) in the unscreened counties.

Conclusions—

Population based routine screening has substantial effects on breast cancer mortality in women aged 50–69. Estimation of excess mortality can be used in future studies to evaluate the effects of mammography screening on breast cancer mortality.
General Practitioner Based Screening for Cervical Cancer: Higher Participation of Women with a Higher Risk?
Authors: Kant A C , Palm B T H M , Wentink E , van Weel C
Published: January 2017

Objective—

To test the hypothesis that a personal invitation for cervical screening by a woman's own general practitioner (GP) achieves a higher attendance of women with an increased risk for cervical cancer.

Setting—

Two general practices and the local health authority screening programme for cervical cancer, Nijmegen, The Netherlands.

Methods—

Attendance rates of women with an increased risk of cervical cancer were compared for two invitation strategies: (a) invitation by the woman's own GP, and ( b) invitation by a national call system through the local health authority. Data on risk profiles were gathered by questionnaire. Two hundred and thirty eight women eligible for screening were invited by their GPs (GP group), and 235 women by the local health authority (control group) in 1992.

Results—

The personal invitation by the GP resulted in an 18% higher overall attendance, and a 28% higher attendance of women with greater risk because of sexual behaviour and smoking.

Conclusion—

Greater involvement of the GP in inviting women for cervical cancer screening results in a higher attendance, particularly among women with increased risk, than a less personal health authority call system.
Trends in Invasive Cervical Cancer Incidence in East Anglia from 1971 to 1993
Authors: Gibson Lorna , Spiegelhalter David J , Camilleri-Ferrante Corinne , Day Nicholas E
Published: January 2017

Objective—

To study the trends in the incidence of invasive cervical cancer in East Anglia.

Design—

Statistical analysis of age specific incidence rate for the period 1971–93 using East Anglian Cancer Registry data.

Subjects—

All cases of invasive cervical cancer registered with the East Anglian Cancer registry, diagnosed in the period 1971–93.

Main outcome measures—

Changing incidence of cervical cancer.

Results—

For the 20 years 1971–90, trends varied widely by district and by age group, with little discernible overall effect of the increasing screening activity. Since 1990, rates have fallen sharply in the age groups targeted for screening, with a reduction of 34% (95% confidence interval 26% to 42%) from that expected based on 1971–90 trends. This fall was preceded by a rapid rise in the national uptake of screening. A shift to more favourable stage at diagnosis has also occurred.

Conclusion—

Changes in the organisation and management of the national screening programme introduced in 1988 and 1989 seem to have led to substantial improvements in effectiveness.
Book Review: Manishita Dass, Outside the Lettered City: Cinema, Modernity, and the Public Sphere in Late Colonial India
Authors: Chatterjee Ranita
Published: January 2017

Manishita Dass, Outside the Lettered City: Cinema, Modernity, and the Public Sphere in Late Colonial India New York: Oxford University Press, 2015, 248 pp., US$ 29.95, ISBN: 9780199394395
Neoliberalism, Laissez-Faire Capitalism and Economic Crisis: The Political Economy of Deindustrialisation in Hong Kong
Authors: Yeung Henry Wai-Chung
Published: January 2017

The search for an “institutional fix” to enable national and sub-national economies to survive global competition and change has attracted some attention from analysts of regional development and global political economy in recent years. Tracing the historical processes of industrialisation in Hong Kong prior to its reversion to China in July 1997, this paper aims to provide some empirical support for the contention that neoliberalism is a major contributor to the recent economic crisis of deindustrialisation in Hong Kong. In particular, this paper examines three areas in which the laissez-faire colonial state in Hong Kong has failed to provide the necessary institutional support for industrialisation: (1) quota restrictions; (2) technological upgrading and (3) outward investment Such a failure has resulted in the progressive decline of Hong Kong's industrial sector and the lagging performance of Hong Kong's manufacturing industries vis-à-vis counterparts in the other three Asian newly industrialised economies. On the one hand, the Hong Kong government has ceded its power to local big businesses whose financial and commercial interests are more faithfully represented in various political decision bodies. On the other hand, Hong Kong's industrial sector has faced serious competitive pressures from global economic change and concomitant industrial restructuring. The long term survival of the industrial sector in Hong Kong, to a large extent, rests on the role of a proactive state and its institutional capacities.
Labor Market and Industrial Change: The Competitive Advantage and Challenge of Harnessing Diversity
Authors: Ettlinger Nancy
Published: January 2017

Comparative cross-national analysis reveals that, irrespective of socio-cultural context, competitive production in the global economy has been predicated on homogeneity. As has been the case in the United States, labor market expansion and diversification is now occurring where alternatives to Anglo-American Taylorism have been considered competitive as well as socially progressive despite exclusionary employment systems. Specifically, in Japan, Germany, and Sweden, new entrants (notably women and immigrants) are increasing substantially in the work force; we may expect to find new entrants in workplaces in Japan and east Germany, and possibly in Sweden, in light of socially constructed labor shortages related to declines in traditional (native, middle-aged male) labor. Diverse workplaces challenge production systems based on homogeneity because the friction of difference counters foundational principles and negatively impacts productivity. Competitiveness in these contexts may require new rounds of corporate strategies that tap diversity while accommodating the needs of different workers. As in the United States, the public and private sectors of these countries to date have responded to increasing diversity by reinforcing existing systems via a deepening of labor market segmentation. Changing production to effectively manage diversity remains unsystematized and requires mechanisms to institutionalize change and sustain diversity; these formidable tasks must be understood as having economic, social, and political dimensions.
Bringing Competition In: Capitalist Development in South Korea and the Limits of Institutionalism
Authors: Lim Timothy C.
Published: January 2017

This paper has two key purposes. The first is to bring competition and power/politics directly into analyses of economic development in East Asia. In other words, the intention of this paper is to establish competition — defined as a historically constituted force — as integral part of the market process, the dynamics of which must be thoroughly analyzed and appreciated in order to adequately explain capitalist development in East Asia or anywhere else. My second, closely connected, purpose is to show just how and why a specific pattern of competition emerged and became embedded in South Korea's political economy. Briefly put, I contend that South Korea's rapid economic growth after the coup in 1961 was based — not on the establishment of a strong, developmental state per se — but on the emergence of an intense, but highly exclusionary form of competition, which I dub competition in closure.
The State and the Global City: Notes towards a Conception of Place-Centered Governance
Authors: Sassen Saskia
Published: January 2017

Re-examines the proposition of a declining signficance of the state in the global economy. Argues that this proposition has been fed by an over-emphasis on the hypermobility of capital and a conceptual background that posits a mutually exclusive relation between the national and the global. Shows that a) the state itself has been transformed by its participation in the design and implementation of global economic systems; and b) even the most global and hypermobile industries, such as finance and the advanced corporate services, are ultimately embedded in a global grid of linkages and sites with great concentrations of material facilities and work processes, many of them strategic to the operation of hypermobile capital. Because of its strategic character and the density of resources and linkages it concentrates, this global grid could be a space for focused regulatory activity by an inter-state system that has itself become more internationalized. But it would require considerable innovation in the frameworks for and objects of regulation.
The Crisis of Cost Recovery and the Waste of the Industrialised Nations
Authors: Williams Karel , Haslam Colin , Williams John , Johal Sukhdev , Adcroft Andy , Willis Robert
Published: January 2017

This paper argues the case for shifting the problem of advanced country competitivity onto the terrain of social accounting. It introduces new concepts such as cost recovery and social settlement, before presenting a range of empirical evidence which demonstrates the nature and extent of the current Western crisis about cash generation. The argument and evidence has important implications for policy. Under present conditions, free trade between high and low wage countries is likely to increase disemployment and encourage a pathological mutation of corporate behaviour and social institutions in the advanced countries.
“If You Want to Get Somewhere Else, You Must Run at Least Twice as Fast as That!”: The Roots of the East Asian Crisis
Authors: Kaplinsky Raphael
Published: January 2017

The primary hypothesis in this paper is that most East Asian economies have been following growth trajectories which involve ever-intensifying competition in external product markets. The financial crisis of 1997–98, whilst clearly having roots in the operations of both global and national financial systems, is in large part a reflection of these long-run growth trajectories. This is because the concentration by these economies in commodity-sectors with low barriers to entry has resulted in macro-economic policies which depend for their success on depreciations in real exchange rates. The crisis in 1997–98 reflects a return to these growth-paths after the divergent appreciation of real exchange rates in the early 1990s. Not all Asian economies have followed this path, with Japan, Singapore, Taiwan and perhaps Korea being the exceptions.

The analysis is pursued through the calculation of long-run terms of trade and real exchange rates, and through a case-study of the Korean electronics sector.
Using Innovative Technology to Overcome Job Interview Anxiety
Authors: Rockawin David
Published: January 2017

University career counsellors invest a lot of time and effort in the development of the skills and knowledge associated with self-reliance in job interviews. The resource-intensive nature of this approach needs to be reconsidered in the context of overall careers service delivery. More specifically, the key barriers to achieving a competent degree of self-reliance in job interviews need to be identified. When considering the benefits and weaknesses of existing interventions in overcoming job interview anxiety, it is important to consider emerging technological tools for career development and whether or not they can contribute to or ultimately replace current practices. The proposed introduction of InterviewStream will be analysed in this context, and its likely impact on career service delivery at the Australian National University (ANU) will be used to form the basis of discussion.
The challenge of ongoing education in multidisciplinary mental health services
Authors: Fielding John , Walterfang Mark , Dakis Jenepher
Published: January 2017

Objective:

To highlight the issues pertaining to ongoing professional education in multidisciplinary mental health services, and provide a framework in which this can occur.

Conclusions:

Ongoing education in multidisciplinary mental health services is a worthwhile objective. Clinician diversity, effective staff engagement and costs need to be taken into account when considering the variety of achievable ways a service can facilitate ongoing education for clinical staff.
Consultation-liaison psychiatry hits a midlife crisis
Authors: Macleod Sandy
Published: January 2017

Objective:

To illustrate the crisis affecting consultation-liaison psychiatry and its practitioners.

Conclusions:

There are several options that may be taken, or have already been taken, to secure a future for this psychiatric subspecialty. The need is apparent, and clinicians are willing, but funders are reluctant. The College's response has been critically important, but psychiatrists also need to develop new work skills and innovative job descriptions to ensure the continuation and future development of psychiatric services to general hospital patients.
Early Psychosis intervention by a community mental health team
Authors: Rowston William
Published: January 2017

Objective:

To describe some of the practical considerations and dilemmas that were faced in setting up an Early Psychosis program in the Noarlunga region of Adelaide, South Australia.

Conclusions:

The clients had high rates of illicit drug use and forensic problems and experienced rates of rehospitalisation of around 60% over the first two years after registration. It was noteworthy that 19% of admissions occurred within three months of registration. The therapeutic relationship between staff and clients with early psychosis was complex, and the ambivalence noted by clients in satisfying dependence/independence needs in the therapeutic relationship appeared to reflect the influences of illness and life stage development. Collaborative relationships with clients were supported by steps such as feedback from clients, leading to simplification of the content of the psychoeducation program, reduction in written information, and co-facilitation of the group by a client who had undergone a psychotic episode. A change in the venue to a local youth group was well received by clients. However, at other times, clients appeared to seek more direction from staff and possess more basic care needs, particularly when seriously ill. Maslow's ‘Hierarchy of Needs’ offered a useful framework for conceptualising many of these issues. A local community network of agencies was formed, allowing clients to address self-identified needs.
Attitudes of psychiatric inpatients to medical student interviews
Authors: Tunde-Ayinmode Mosunmola , Rajagopalan Mani , Little John
Published: January 2017

Objective:

The aim was to assess the attitudes of psychiatric inpatients to medical student interviews.

Method:

Psychiatric inpatients' experiences of being interviewed by fourth and fifth year medical students were ascertained through the use of a semi-structured questionnaire.

Results:

The majority of patients reported a positive interaction with medical students.

Conclusion:

Psychiatric inpatient involvement in medical student teaching was favourably received by patients in a rural area mental health service setting.
Cecal Vitamin Bezoar Formation Inducing Abdominal Discomfort
Authors: Hunt-Fugate Ann K. , Schmidt Harry J.
Published: January 2017

OBJECTIVE:

To document a case of cecal lecithin-vitamin B12 bezoar formation inducing abdominal discomfort.

DESIGN:

Case study.

SETTING:

500-bed, community teaching hospital

PATIENT:

81-year-old man with a history of multiple abdominal surgeries who presented with a chief complaint of abdominal pain. Flat plate X-ray of the abdomen revealed multiple capsule-shaped objects lodged in the cecum.

INTERVENTIONS:

Catharsis with bisacodyl, magnesium citrate, NaCl 0.9%; dissolution with heated, dilute barium administered rectally in conjunction with external manipulation; laparotomy.

MAIN OUTCOME MEASURES:

None planned; dissolution or transit of bezoar through gastrointestinal tract desired outcome.

RESULTS/DISCUSSION:

Classification of bezoars and treatment discussed in relation to this case report.

CONCLUSIONS:

Medicinal agents have been implicated in bezoar formation. Treatment options have included: cathartics, heated solvent enemas, and external manipulation and surgery.
Itraconazole in Antifungal Therapy
Authors: Cleary John D. , Taylor Jerry W. , Chapman Stanley W.
Published: January 2017

OBJECTIVE:

This overview compares and contrasts the pharmacotherapy of itraconazole with that of other antifungal agents.

DATA SOURCES:

Primary literature on itraconazole was identified through a medical literature search from 1976 through 1991. This search included journal articles, abstracts, conference proceedings, and reports of animal and human research published in the English language.

STUDY SELECTION:

All primary literature was reviewed regardless of the study design or outcome. Literature evaluations of efficacy were ranked using a literature rating scale (Dalen JE, Hirsh J. Arch Intern Med 1986;146:462–72), which was slightly modified to include case reports and observations.

DATA EXTRACTION:

All data were collected and represented with a primary focus on itraconazole's mechanism of action, pharmacokinetics, clinical efficacy in systemic mycotic infections, drug interactions, and adverse reactions. All articles were referenced in the final data presentation unless grouped data had been accurately reviewed and published.

DATA SYNTHESIS:

Despite the paucity of controlled comparative trials with itraconazole in patients with deep mycoses, results on efficacy are encouraging. It is still unclear what role itraconazole will have in the prophylaxis of fungal infections in immunocompromised hosts. The favorable pharmacokinetic profile permits once- or twice-daily administration and itraconazole appears to be safe and well tolerated.

CONCLUSIONS:

Itraconazole should prove to be a useful replacement for ketoconazole on hospital formularies. This recommendation is based on itraconazole's greater apparent safety and efficacy. Reevaluation of this agent will be necessary upon the release of newer imidazoles and triazoles.
Impact of Triplicate Prescription Program on Psychotropic Prescribing Patterns in Long-Term Care Facilities
Authors: Hartzema Abraham G. , Porta Miquel S. , Tilson Hugh H. , Zullich Sergio G. , Grasela Thaddeus H. , Fiedler-Kelly Jill B. , Gengo Francis M.
Published: January 2017

OBJECTIVE:

To assess the impact of the effect of the New York state triplicate prescription program on psychotropic prescribing patterns in selected long-term care facilities over a one-year period.

DESIGN:

Retrospective study for changes in psychotropic drug use patterns before and after implementation of the triplicate prescription program.

SETTING:

Eight private and two public long-term care facilities in the western New York area.

PATIENTS:

All residents in the long-term care facilities with complete medical records for a one-year period were reviewed.

OUTCOME MEASUREMENTS:

Charts were reviewed for changes in psychotropic drug patterns and incidence in adverse events such as falls, hip fractures, hospital admission, signs or symptoms of benzodiazepine (BZD) withdrawal syndrome, or behavioral outburst.

MAIN RESULTS:

BZD use declined precipitously from 25 percent of psychotropic drug orders to 10 percent six months after implementation of the program. The decline in BZD use was accompanied by an increase in the number of orders for alternative psychotropic agents. Although 22 percent of the patients previously receiving BZDs were discontinued from these drugs, more than half of these patients were switched to alternative therapy, including tricyclic antidepressants and antipsychotic drugs. The majority of patients who discontinued BZDs did so without tapering of the dosage; however, few experienced minor withdrawal symptoms and no patient experienced seizures or required hospitalization following discontinuation. The risk of falls, hospital admission for any reason, or combined events was not significantly altered despite a reduction in BZD use. There was a trend, however, for a reduction in falls after implementation of the program.

CONCLUSIONS:

This study documents that psychotropic drug prescribing patterns were significantly affected by the triplicate prescription program. BZD use declined; however, use of alternative psychotropic drugs increased. Despite changes in psychotropic prescribing patterns, we found no significant risk of adverse events. Further study to evaluate the long-term effect of alternative psychotropic drugs is necessary.
Mathematical Examination of Dual Individualization Principles (III): Development of a Scoring System for Pneumonia Staging and Quantitation of Response to Antibiotics: Results in Cefmenoxime-Treated Patients
Authors: Luzier Aileen , Goss Thomas F. , Cumbo Thomas J. , Schentag Jerome J.
Published: January 2017

OBJECTIVE:

In order to quantitatively express the important, time-related aspects of response to antimicrobial therapy in patients with pneumonia, we required validated measures of the time course of events during the infection. To quantitate the changes in clinical status in relation to changes in cultures, we developed a scoring system to be used for patient assessment during therapy.

DESIGN:

Retrospective data collection, prospective analysis of factors.

SETTING:

Intensive care unit, Millard Fillmore Hospital.

PATIENTS:

Twenty-eight patients with nosocomial pneumonia.

MAIN OUTCOME MEASURES:

Clinical parameters were assessed daily for the duration of antimicrobial therapy. Using linear regression, the rate of clinical change in each patient treated was quantified. Eradication of the pathogen was determined by serial cultures of the infection site.

RESULTS:

Seventeen of the patients demonstrated eradication of the organism, and 11 demonstrated persistence of the pathogen (7 were considered colonization). The system described the patients at baseline in that the mean baseline scores were similar in both groups of patients (p=0.79). Patients in whom the pathogen was eradicated showed a rate of clinical improvement significantly different from those who had persistence of the organism (p=0.04). In patients demonstrating eradication, the time to eradication inversely correlated with the rate of clinical improvement (p<0.05). Of the ten parameters descriptive of the disease, those most sensitive to change after eradication of bacteria were body temperature, bacterial Gram stain, white blood cell Gram stain, and volume of sputum.

CONCLUSIONS:

In this set of pneumonia patients, the scoring system effectively quantified both baseline and time-related changes in clinical status. The system distinguished between the clinical course of the patient with organism eradication versus organism persistence. A shorter time to eradication was associated with a better clinical response. Prospective study of the system will determine its sensitivity.
Possible Severe Thrombocytopenia Associated with a Single Dose of Plicamycin
Authors: Yamreudeewong Weeranuj , Henann Neil E. , Fazio Anthony , Rangaraj Uma
Published: January 2017

OBJECTIVE:

To report a case of possible severe thrombocytopenia associated with administration of a single dose of plicamycin.

CASE SUMMARY:

A 73-year-old man with prostate cancer was admitted to the hospital with hypercalcemia (total serum calcium concentration 4.02 mmol/L) and a low baseline platelet count (152 × 109/L). Because of his symptomatic hypercalcemia, he was treated with NaCl 0.9%, furosemide, oral inorganic phosphate, and a single dose of plicamycin (15 μg/kg). Five days after plicamycin administration his platelet count decreased to 52 × 109/L, and continued to decrease further even after the transfusion of four units of platelets to a nadir of 7 × 109/L (hospital day 20). A second transfusion produced a small increase in his platelet count. The patient's clinical status continued to deteriorate, however, and he subsequently died.

DISCUSSION:

Plicamycin and other drugs that may induce thrombocytopenia are reviewed. The time course between plicamycin administration and the development of thrombocytopenia in our patient is assessed. Other contributing factors such as a low baseline platelet count and advanced age are also addressed.

CONCLUSIONS:

It is likely that the severe thrombocytopenia experienced by our patient was caused by a single dose of plicamycin. Adjusting the dosage for a patient's renal function as well as close monitoring of the platelet count are necessary when administering this drug. We report this case to remind clinicians of the potential for the development of severe thrombocytopenia following administration of a single dose of plicamycin.
Toxicity Potential of Oral Lidocaine in a Patient Receiving Mexiletine
Authors: Geraets Douglas R. , Scott Shane D. , Ballew Kenneth A.
Published: January 2017

OBJECTIVE:

To report a case of toxicity from orally administered lidocaine in a patient with cardiomyopathy receiving concurrent mexiletine therapy.

DATA SOURCES:

Case reports, review articles, and studies identified by search of the MEDLINE database and Current Contents.

STUDY SELECTION:

All reports of toxicity from orally administered lidocaine were reviewed.

DATA SYNTHESIS:

Lidocaine, a local anesthetic, is widely used to treat cardiac arrhythmias. Toxicity with the parenteral form occurs frequently. In contrast, there are few reports of toxicity with oral lidocaine, most of them occurring in children receiving large doses relative to body weight. We report a case of intoxication in an adult with severe cardiomyopathy and concurrent mexiletine therapy who received only two doses of oral lidocaine.

CONCLUSIONS:

Although it is rarely reported in adults, clinicians must be alert to the possibility of toxicity from orally administered lidocaine. This is most likely to occur in patients with conditions known to reduce lidocaine clearance, when higher-than-usual doses are administered, or when concurrent therapy with oral lidocaine analogs may be present.
Adjunctive Medications in Patients Receiving Thrombolytic Therapy: A Multicenter Prospective Assessment
Authors: Gonzalez Edgar R. , Jones Lori A. , Ornato Joseph P. , Bleecker Giselle C. , Strauss Michael J. ,   Virginia Multicenter Thrombolytic Study Group
Published: January 2017

OBJECTIVE:

To describe the use of adjunctive therapies in patients with acute myocardial infarction receiving thrombolytic agents.

DESIGN:

Data were collected prospectively by the study-site investigator or the emergency department physician caring for the patient. Study participation did not influence thrombolytic regimen selection or the adjunctive therapies ordered.

SETTING:

Thirteen Virginia hospitals representing a cross-section of hospitals in the state. Eleven are urban medical centers; four have graduate medical education programs.

PARTICIPANTS:

Patients were included in the study if the decision to administer thrombolytic therapy was made in the emergency department.

MAIN OUTCOME MEASURES:

Concomitant medications administered during the first six hours after initiation of thrombolytic therapy.

RESULTS:

Two hundred ten patients (aged 57 ± 14.1 y) were evaluated. Ninety-five percent of these patients were treated with tissue plasminogen activator, 3 percent received anisoylated plasminogen streptokinase activator complex, and 2 percent received streptokinase. Ninety-one percent of the patients also received heparin, the most commonly used adjunctive medication; 77 percent concomitantly received lidocaine; 62 percent received aspirin; and only 19 percent received a beta-blocker.

CONCLUSIONS:

Our data provide a reference point for future studies to determine factors that influence the selection of adjunctive agents for treating patients with acute myocardial infarction receiving thrombolytics.
Assessment of the Drug Interaction between Intravenous Nitroglycerin and Heparin
Authors: Gonzalez Edgar R. , Jones Holly D. , Graham Susan , Elswick R.K.
Published: January 2017

OBJECTIVE:

To assess whether a clinically significant interaction occurs between heparin and nitroglycerin (NTG).

METHODOLOGY:

Activated partial thromboplastin time (APTT) was measured in patients with unstable angina who were stabilized on intravenous NTG and heparin just prior to weaning the NTG infusion, and one and four hours after stopping the NTG.

RESULTS:

In 22 heparin-treated patients (20 men, 2 women; aged 56.7 ± 10 years; weight 79.5 ± 15 kg), the APTT ratio was inversely related to the dose of NTG (slope = −0.003; p<0.05). However, there were no significant differences between the APTT values measured before and after discontinuation of NTG (p=0.8511).

CONCLUSIONS:

Our study demonstrates a clinically insignificant interaction between NTG and heparin at NTG doses commonly used in patients.
Seizures Associated with High-Dose Intravenous Morphine Containing Sodium Bisulfite Preservative
Authors: Meisel Steven B. , Welford Paula K.
Published: January 2017

OBJECTIVE:

To report a case of seizures occurring during administration of high-dose intravenous morphine containing sodium bisulfite as a preservative.

CASE SUMMARY:

A 56-year-old woman hospitalized with multiple myeloma developed myoclonic and tonic-clonic seizures following administration of intravenous morphine with sodium bisulfite preservative at doses exceeding 400 mg/h. These seizures resolved when the morphine was discontinued, anticonvulsants were administered, and the drug therapy was changed to intravenous fentanyl without preservative.

DISCUSSION:

The factors potentially associated with this adverse reaction are discussed and the literature concerning the adverse central nervous system effects of opiates and sulfites is reviewed.

CONCLUSIONS:

High doses of intravenous morphine with sulfite preservative may be associated with seizure development. If patients require high doses of intravenous morphine, a preservative-free formulation should be used to avoid possible additive or synergistic toxicities.
Erythromycin Base-Induced Rash and Liver Function Disturbances
Authors: Shirin Haim , Schapiro Jonathan M. , Arber Nadir , Pinkhas Jack , Sidi Yeheskel , Salomon Francis
Published: January 2017

OBJECTIVE:

To report a case of erythromycin base-induced rash and liver function disturbances.

CASE SUMMARY:

A patient with erythema nodosum and high antistreptolysin-O titers was treated with erythromycin on the assumption that occult streptococcal infection was the cause of the erythema nodosum. Forty-eight hours after the initiation of therapy the patient developed fever, severe generalized rash, pruritus, and cholestatic and hepatocellular liver function disturbances. Extensive evaluation to determine the cause of liver function disturbances was unrevealing. Marked improvement was noticed within days after cessation of erythromycin.

DISCUSSION:

Case reports in the literature on the adverse effects of erythromycin and its derivatives were reviewed. The possible immunologic mechanism involved is postulated.

CONCLUSIONS:

Erythromycin base must be added to the list of erythromycin derivatives that can cause rash and liver function disturbances. The concomitant appearance of fever, rash, jaundice, and liver function disturbances raises the possibility of hypersensitivity as the mechanism for the liver disturbances.
Hirudins: Antithrombin Anticoagulants
Authors: Stringer Kathleen A. , Lindenfeld Joann
Published: January 2017

OBJECTIVE:

To review the chemistry, pharmacology, available clinical data, and adverse effects of the hirudin anticoagulants.

DATA SOURCES:

A MEDLINE search and a review of recent scientific abstracts was conducted to identify pertinent literature.

STUDY SELECTION:

Focus was placed on studies conducted in humans. Because hirudin is still an investigational agent, however, relevant animal data, particularly pharmacokinetic studies and studies of preclinical efficacy, were also selected.

DATA EXTRACTION:

Data from both human and animal studies were evaluated; emphasis was placed on human trials.

DATA SYNTHESIS:

Hirudin has demonstrated potent anticoagulant effects. Although hirudin could have a significant impact on the therapeutic management of patients requiring anticoagulant therapy, only a limited number of human studies have been published to date. Trials comparing hirudin and heparin in specific patient populations are still ongoing.

CONCLUSIONS:

Although still in clinical trials, hirudin is a unique agent that may represent a breakthrough in anticoagulant therapy. The specific role that this agent will play in the management of patients has yet to be determined.
Oxygen Toxicity
Authors: Stogner Steven W. , Payne D. Keith
Published: January 2017

OBJECTIVE:

The objective of this article is to provide an overview of the biochemistry of oxygen metabolism, including the formation of free radicals and the role of endogenous antioxidants. Pathophysiologic correlates underlying the clinical manifestations of oxygen toxicity are reviewed and management strategies are outlined.

DATA SOURCES:

References from basic science and clinical journals were selected from the authors' files and from a search of a computerized database of the biomedical literature.

STUDY SELECTION:

Articles selected for review included both historical and current literature concerning the biochemistry and pathophysiology of oxygen toxicity in animals and humans.

DATA SYNTHESIS:

The benefits of oxygen therapy have been known for many years; however, its potential toxicity has not been recognized until the last two decades. The lungs, the eyes, and, under certain conditions, the central nervous system are the organs most affected by prolonged exposure to hyperoxic environments. Free radical formation during cellular metabolism under hyperoxic conditions is recognized as the biochemical basis of oxygen injury to cells and organs. Endogenous antioxidants are a primary means of detoxifying reactive oxygen species and preventing hyperoxia-induced cellular damage. When this defense fails or is overwhelmed by the excessive production of hyperoxia-induced free-radical species, distinctive morphologic changes occur at the cellular level. The amount of hyperoxia required to cause cellular damage and the time course of these changes vary from species to species and from individual to individual within the same species. Age, nutritional status, presence of underlying diseases, and certain drugs may influence the development of oxygen toxicity.

CONCLUSIONS:

There is currently no reliably effective drug for preventing or delaying the development of oxygen toxicity in humans. Use of the lowest effective oxygen concentration, the avoidance of certain drugs, and attention to nutritional and metabolic factors remain the best means currently available to avoid or minimize oxygen toxicity. Research is continuing into more effective ways to prevent, diagnose, and treat this disorder.
Effect of Xanthine-Related Compounds on a Theophylline Assay Using Theophylline Oxidase
Authors: Vaughan Leigh M. , Gottehrer Andrew
Published: January 2017

OBJECTIVE:

This study investigated a new, nonimmunologic, enzymatic-based theophylline assay for the possible interference of a clinically achievable serum theophylline concentration by four xanthine-related compounds: pentoxifylline, 1-methylxanthine, allopurinol, and oxypurinol.

RATIONALE:

The enzyme theophylline oxidase is used in this assay kit to convert theophylline to 1,3 dimethyluric acid in the presence of cytochrome C. Cytochrome C is reduced to ferrocyte C, which is then measured by ultraviolet spectrophotometry at one minute and again at five minutes. The rate of appearance of ferrocyte C over this time is then related to a one-point 20-μg/mL (111-μmol/L) theophylline standard provided with the kit and the concentration of theophylline is calculated. Xanthine-related compounds have the potential to interact with theophylline oxidase via: (1) structural similarity, and (2) inhibition of xanthine oxidase, which increases theophylline metabolite concentrations.

DESIGN:

Human serum was spiked with known, therapeutically achievable concentrations of pentoxifylline, 1-methylxanthine, allopurinol, and oxypurinol, both alone and in combination with theophylline in a concentration of 15 μg/mL (83.3 μmol/L). Two controls were used: human serum and human serum spiked with theophylline. Data were analyzed statistically with ANOVA, and clinically with ±10 percent control criteria.

RESULTS:

Means (± SEM) for the control samples were 2.0 (0.2) μg/mL for serum alone and 15.3 (0.3) μg/mL for theophylline-spiked serum. For the test specimens, the results ranged from 2.3 to 2.8 μg/mL and from 13.9 to 16.6 μg/mL when xanthine-related compounds were added to serum without and with theophylline, respectively.

CONCLUSIONS:

The results were not statistically or clinically significant for the four xanthine-related compounds at the concentrations studied.
Sorbitol Content of Selected Oral Liquids
Authors: Lutomski Dave M. , Gora Mary Lea , Wright Sharon M. , Martin Jill E.
Published: January 2017

OBJECTIVE:

Excipients in pharmaceuticals usually are considered inert, and may be overlooked in the differential diagnosis of diarrhea. Sorbitol-containing medicinal liquids are capable of inducing osmotic diarrhea. We reviewed the oral liquids in our formulary to determine their sorbitol content and to evaluate the availability of this information.

DESIGN:

The oral liquids stocked by our hospital were determined through a computer search and manual inspection of the pharmacy storeroom. Three common sources of drug information were consulted to determine each product's sorbitol content: Manufacturers' product information, American Hospital Formulary Service (AHFS) Drug Information 91, and Facts and Comparisons Drug Information. We then contacted each manufacturer by mail or telephone to verify the information.

SETTING:

The study was conducted at the University of Cincinnati Hospital, a tertiary-care, teaching hospital.

RESULTS:

A total of 129 products (98 chemical entities) were reviewed. Fifty-four (42 percent) of the products examined contained sorbitol. The frequency of sorbitol presence by liquid type was: Solutions (33 percent), suspensions (43 percent), syrups (59 percent), elixirs (43 percent), concentrates (67 percent), drops (33 percent), tinctures (0 percent), and emulsions (0 percent). The percentage of listings indicating the presence of sorbitol was: Manufacturer's product information (79 percent), Facts and Comparisons (52 percent), and AHFS Drug Information 91(13 percent). Only three of the 54 products had the exact sorbitol content stated in any source.

CONCLUSIONS:

Based on literature data, single doses greater than 10 g and total daily doses greater than 50 g of sorbitol would produce adverse gastrointestinal effects in a sizable number of adults. Many of the marketed products reviewed could deliver an adult laxative dose. Current labeling is insufficient for healthcare providers to assess the risk for individual patients.
Foscarnet-Induced Severe Hypomagnesemia and other Electrolyte Disorders
Authors: Gearhart Maureen O. , Sorg Timothy B.
Published: January 2017

OBJECTIVE:

To report a case of possible foscarnet-induced severe Hypomagnesemia and other electrolyte disorders.

CASE SUMMARY:

An AIDS patient experienced an exacerbation of cytomegalovirus retinitis and was treated with foscarnet. The patient experienced muscle twitches, tremulousness, and anxiety on day 17 of foscarnet therapy. Laboratory results indicated hypomagnesemia, hypocalcemia, hypokalemia, and hypophosphatemia. After electrolyte supplementation and discontinuation of foscarnet, the symptoms resolved and laboratory indices returned to normal.

DISCUSSION:

Electrolyte disorders associated with foscarnet are reviewed. Severe hypomagnesemia occurred in this patient and published literature is highlighted. In addition, known and/or possible mechanisms of the disorders are discussed.

CONCLUSIONS:

It is probable that foscarnet contributed to the electrolyte disorders and symptomatology in this patient. Electrolytes must be monitored frequently during foscarnet therapy. Also, concomitant therapy with antianxiety medications that may mask the symptoms of electrolyte disorders should be undertaken with caution.
Insect Repellent (N,N-Diethyl-m-Toluamide) Cardiovascular Toxicity in an Adult
Authors: Clem James R. , Havemann David F. , Raebel Marsha A.
Published: January 2017

OBJECTIVE:

To describe a case of N,N-diethyl- m-toluamide (DEET)-induced cardiovascular toxicity in an adult and reviews other cases that have been reported in the published literature. Human and animal data available on DEET pharmacokinetics are reviewed and factors that predispose an individual to DEET toxicity are identified.

DATA SOURCES:

Case report information was obtained through personal contact with the patient during hospitalization and by telephone, and also from the patient's medical records. Computerized literature searches were conducted with the following systems to obtain medical literature on DEET toxicity: TOXLINE, International Pharmaceutical Abstracts, and MEDLINE. Index Medicus was searched manually.

STUDY SELECTION:

All reported cases of DEET toxicity in children and adults were reviewed.

DATA EXTRACTION:

Case reports were evaluated for the quantity of the DEET exposure (topical or oral), the clinical manifestations of the exposure, and the outcome of the exposure.

DATA SYNTHESIS:

This case is similar in some aspects to those already in the literature; however, very few cases of DEET toxicity in adults have been reported. Cardiovascular toxicity in humans related to DEET application has not been previously reported in the published medical literature. DEET exposure (topical or oral) results in a highly variable clinical course. Whether the outcome is death or recovery without sequelae is difficult to predict.

CONCLUSIONS:

Adults, as well as children, are at risk for toxicity from insect repellents. The use of highly concentrated DEET-containing insect repellents should be avoided to reduce the risk of toxicity in both children and adults. The consequences of DEET toxicity are variable and unpredictable.
Capsaicin: Identification, Nomenclature, and Pharmacotherapy
Authors: Cordell Geoffrey A. , Araujo Oscar E.
Published: January 2017

OBJECTIVE:

To provide a brief overview of the chemical history, analysis, nomenclature, biology, pharmacology, and pharmacotherapy of capsaicin.

DATA SOURCES:

Chemical Abstracts, Biological Abstracts, and a MEDLINE search were used to identify pertinent literature; selected literature was used in this review.

DATA EXTRACTION:

Original articles, reviews, and abstracts of articles were used to select material pertinent to the objectives of the review. The volume of material available prohibits comprehensive data extraction.

CONCLUSIONS:

A history of the use of Capsicum spp. and the predominant active ingredient, capsaicin, the parent compound of a group of vanillyl fatty acid amides, is presented. Distinct structural differences are noted between this compound and the capsaicinoids, especially the synthetic analog nonivamide, which has appeared as an adulterant in capsaicin-labeled products. Analysis shows that although some of these synthetic analogs eventually may prove to be true natural products, conclusive evidence based on isolation and structure elucidation is still absent after decades of attempted isolation from several potential natural sources. Although the crude, dark oleoresin extract of capsicum contains over 100 distinct volatile compounds and therefore may function in many ways dissimilar to capsaicin, the oleoresin continues to be marketed in products with a high degree of variability in efficacy. Capsaicin as a pure white crystalline material, however, acts specifically by depleting stores of substance P from sensory neurons, and has been successful in the treatment of several painful conditions (e.g., rheumatoid arthritis, osteoarthritis, peripheral neuropathies).
Allopurinol Hypersensitivity Syndrome: A Review
Authors: Arellano Félix , Sacristán José A.
Published: January 2017

OBJECTIVE:

To review the pathophysiology, pathology, and clinical findings of allopurinol hypersensitivity syndrome (AHS), an infrequent but life-threatening adverse effect of allopurinol therapy.

DATA SOURCES:

A MEDLINE search (key terms hepatitis, interstitial nephritis, severe hypersensitivity, severe toxicity, vasculitis, toxic epidermal necrolysis, Lyell's syndrome, erythema multiforme, and Stevens-Johnson syndrome) was used to identify cases reported in the literature through the end of 1990.

STUDY SELECTION:

All cases evaluated met Singer and Wallace's diagnostic criteria for AHS.

DATA EXTRACTION:

We extracted data from 101 cases of AHS reported in the literature. The following information, when available, was analyzed: (1) patient data (age, gender, medical history), (2) treatment data (daily dosage of allopurinol, duration of treatment, indications, concomitant medications, and (3) adverse-event data.

DATA SYNTHESIS:

Patients were mostly middle-aged men with hypertension and/or renal failure receiving excessive doses of allopurinol primarily for asymptomatic hyperuricemia. Cutaneous rash and fever were the most common clinical findings.

CONCLUSIONS:

Although the pathophysiologic pathway leading to the development of AHS is unknown, it probably involves an immunologic mechanism following allopurinol accumulation in patients with poor renal function. Our findings suggest that the accepted diagnostic criteria for AHS may be too broad, and we recommend the application of more restrictive criteria. There is no effective treatment for AHS. The use of allopurinol only for accepted indications and in dosages adjusted for a patient's renal function may be the only means of minimizing the incidence of AHS.