bluuebunny/crossref_metadata_2025 huggingface dataset:
Metronidazole Hypersensitivity
Authors: Knowles Sandra , Choudhury Taffik , Shear Neil H.
Published: January 2017

OBJECTIVE:

To report a case of a possible hypersensitivity reaction induced by metronidazole.

CASE SUMMARY:

An Asian woman with a history of recurrent vaginitis had previously developed localized erythema while on intravaginal metronidazole and nystatin. While receiving oral metronidazole for treatment of a current bacterial vaginosis, she developed chills, fever, generalized erythema, and a rash within 60 minutes of the first dose. Treatment with diphenhydramine was instituted. The following day while in the hospital, the patient's condition worsened; she experienced shortness of breath and increased edema of the extremities. Methylprednisolone was administered with diphenhydramine and her condition improved over the next 5 days. The patient's vaginitis was treated with gentian violet and she was discharged on a tapering dosage of prednisone.

DISCUSSION:

Metronidazole-induced cutaneous reactions and systemic hypersensitivity reactions are reviewed. Alternatives to metronidazole and other potential cross-reactive drugs are suggested for the treatment of recurrent vaginitis.

CONCLUSIONS:

Although the patient's initial reaction to metronidazole represented a rare event, written documentation and communication in the patient's native language may have prevented the subsequent severe hypersensitivity reaction.
Ondansetron for Treating Nausea and Vomiting in the Poisoned Patient
Authors: Reed Michael D. , Marx Celeste M.
Published: January 2017

OBJECTIVE:

To describe the efficacy of ondansetron for the treatment of poisoning-associated vomiting in two patients following drug intoxication.

PATIENTS:

Two self-poisoned adolescent patients.

INTERVENTION:

Intravenous ondansetron.

RESULTS:

Resolution of nausea and vomiting in both patients.

CONCLUSIONS:

Ondansetron appears to be a very effective antiemetic drug for use in selected intoxicated patients.
Lipoprotein(A): Physiologic Function, Association with Atherosclerosis, and Effects of Lipid-Lowering Drug Therapy
Authors: Spinler Sarah A. , Cziraky Mark J.
Published: January 2017

OBJECTIVE:

To review the structure and physiologic function of liipoprotein(a) [Lp(a)], review the association of Lp(a) with the development of atherosclerosis, and to critically evaluate the current literature regarding the effects of lipid-lowering drug therapy on Lp(a) serum concentrations.

DATA SOURCES:

English language clinical and animal studies, abstracts, and review articles pertaining to Lp(a).

STUDY SELECTION AND DATA EXTRACTION:

Relevant human and animal studies examining Lp(a)'s role in atherosclerosis and the effect of drug therapy on Lp(a) serum concentrations.

DATA SYNTHESIS:

Possible physiologic functions and potential atherogenic mechanisms of Lp(a) are discussed. Evidence supporting the association of Lp(a) with atherosclerosis is presented. Studies evaluating the effects of lipid-lowering drug therapy on Lp(a) concentrations are reviewed and critiqued.

CONCLUSIONS:

Lp(a) concentrations are correlated with the risk of atherosclerotic vascular disease (AVO) in both animal models and human studies. Drug therapies that have produced a consistent reduction in Lp(a) concentration include niacin alone or in combination with a bile acid sequestrant or neomycin. However, additional, larger studies are needed to evaluate the ability of drug therapies to specifically reduce elevated Lp(a) concentrations. Preliminary information suggests that reduction in Lp(a) concentrations may be associated with atherosclerotic plaque regression. Although drugs are available to lower Lp(a), one cannot conclude that lowering of Lp(a) is warranted until clinical trials demonstrating beneficial effects have been published.
Fluorouracil Cardiotoxicity
Authors: Anand Ajay J.
Published: January 2017

OBJECTIVE:

To review the clinical manifestations, postulated mechanisms, and therapeutic implications of fluorouracil-induced cardiac toxicity.

DATA SOURCE:

A MEDLINE search was used to identify pertinent literature.

STUDY SELECTION:

Studies and case reports on fluorouracil cardiotoxicity were identified through a MEDLINE search. A manual review of bibliographies of identified articles was performed to ensure that all pertinent articles were included.

DATA EXTRACTION:

Data pertaining to all aspects of fluorouracil cardiac toxicity, including pathogenesis, predisposing factors, clinical manifestations, and therapeutic implications, were evaluated.

DATA SYNTHESIS:

Estimates from large series suggest a 1.6–2.3 percent incidence of clinically demonstrated cardiotoxicity. Predisposing factors include the presence of coronary artery disease and concurrent radiotherapy. Postulated mechanisms include direct myocardial ischemia, coronary spasm, or cardiotoxic impurities in fluorouracil formulation, Clinical manifestations include chest pain, nausea, diaphoresis with typical ischemic electrocardiographic (ECG) changes, relieved to normal after stopping the drug therapy. Nitrates and calcium-channel blockers do not protect against cardiotoxicity.

CONCLUSIONS:

Fluorouracil cardiotoxicity may be much more common and clinically significant than previously thought. A high index of suspicion for cardiotoxicity must be maintained when the drug is administered, especially in the presence of heart disease and concomitant radiation therapy. In the presence of chest pain, it is mandatory to stop the infusion and, if possible, to replace fluorouracil with another chemotherapeutic agent.
Meropenem: A New Carbapenem Antimicrobial
Authors: Pryka Randy D. , Haig George M.
Published: January 2017

OBJECTIVE:

To describe and then compare an investigational carbapenem antibiotic, meropenem, with the only currently available antibiotic in this class, imipenem/cilastatin.

DATA IDENTIFICATION:

An English language search using MEDLINE (1988–1993); Abstracts of the 31st Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), 1991; and Abstracts of the 32nd ICAAC, 1992.

STUDY SELECTION:

All current scientific publications were reviewed for study design and quality. Emphasis was placed on susceptibility and pharmacokinetic analysis. Phase 3 clinical trials are now being completed and have only been published in abstract form. Hence, conclusions derived regarding efficacy were tempered.

RESULTS:

Meropenem is active against a broad spectrum of gram-positive and -negative pathogens including beta-lactamase producers. Meropenem appears to be two- to fourfold less active than imipenem against gram-positive organisms. Meropenem is two- to fivefold more active against enterobacteriaceae. The two compounds appear to be equally active against Pseudomonas aeruginosa. Pharmacokinetic disposition is also similar for imipenem and meropenem. Meropenem may exhibit greater tissue penetration. Meropenem is not labile to renal hydrolysis and can be administered without a competitive antagonist of dihydropeptidase, such as cilastatin. In clinical trials, meropenem appears to be as safe and effective as imipenem/cilastatin or ceftazidime in the treatment of infections involving soft tissue, urinary tract, upper respiratory tract, abdominal processes, and febrile neutropenic episodes.

CONCLUSIONS:

Meropenem is comparable to imipenem in terms of in vitro susceptibility pattern and pharmacokinetic disposition. Overall, meropenem seems to offer promise as the second of the carbapenem class of antibiotics. Clinical data are preliminary, and further data are needed.
Malabsorption of Digoxin Tablets, Gel Caps, and Elixir in a Patient with an End Jejunostomy
Authors: Ehrenpreis Eli D. , Guerriero Stephanie , Nogueras Juan J. , Carroll Maria A.
Published: January 2017

OBJECTIVE:

To report a case of malabsorption of digoxin from tablets, gel caps, and elixir in a patient with an end jejunostomy.

CASE SUMMARY:

A 69-year-old man with 18 cm of functioning jejunum following a surgical end jejunostomy was receiving oral digoxin. The patient presented on referral for short bowel syndrome, secretory diarrhea, and malabsorption. He was receiving digoxin tablets 0.75 mg/d with a serum digoxin concentration of 0.5 ng/mL. Attempts to achieve therapeutic digoxin serum concentrations of approximately 1.0 ng/mL by administration of digoxin in the form of liquid-filled gel caps and elixir were unsuccessful.

DISCUSSION:

Variable results have been presented in the literature regarding the ability to achieve therapeutic concentrations of digoxin following oral administration in patients with malabsorption syndromes. Several studies have suggested that changing the form of administered digoxin from tablet to elixir or liquid-filled gel caps may improve absorption in patients with small intestine malabsorption. Such changes in oral dosage form failed to achieve therapeutic digoxin serum concentrations in this case.

CONCLUSIONS:

The markedly diminished length and the lack of continuity of this patient's small intestine and colon likely resulted in severe malabsorption of orally administered digoxin. Some patients with end jejunostomies may require intravenous forms of medication because of inadequate absorption of orally administered medications.
Management of Bacterial Urinary Tract Infections in Adults
Authors: Hatton Jimmi , Hughes Melody , Raymond Claire H.
Published: January 2017

OBJECTIVE:

To provide a comprehensive review of the diagnosis and therapeutic management considerations in patients with urinary tract infections (UTIs).

DATA SOURCES:

A MEDLINE search was used to identify pertinent English language literature, including reviews. Infectious disease textbooks were used for background information.

STUDY SELECTION:

Clinical trials evaluating drug therapy in a variety of patient populations with UTIs were reviewed.

DATA EXTRACTION:

Background information was obtained from comprehensive reviews. Drug dosing strategies and efficacy comparisons were extracted from the investigations in this area.

DATA SYNTHESIS:

Information was processed to provide general guidelines and resources for practitioners to use in managing UTIs.

CONCLUSIONS:

There are a number of useful antibiotics for the management of UTIs. The distinctions between infection severity and underlying risk factors within a given population influence the appropriateness of drug selection and duration of treatment.
Meta-Analysis of Controlled Trials of Drug Therapy in Mild Chronic Asthma: The Role of Inhaled Corticosteroids
Authors: Milavetz Gary , Kelly H. William , Hatoum Hind T. , Schumock Glen T. , Kendzierski Donald L.
Published: January 2017

OBJECTIVE:

To determine the role of inhaled corticosteroids in the treatment of mild chronic asthma.

SOURCE OF STUDIES:

Searches of MEDLINE and Index Medicus for English language literature dealing with asthma and inhaled corticosteroids.

DESIGN:

All retrieved articles were subjected to predetermined criteria for inclusion in the meta-analysis. Inclusion criteria centered around randomized, double-blind studies reporting objective clinical endpoint(s) for subjects with mild chronic asthma who were treated for more than seven days. Studies that were included were not allowed to have any predetermined exclusion criteria.

RESULTS:

The literature search identified 129 articles, of which 41 satisfied some but not all of the criteria for inclusion. Five articles met all the criteria and were subjected to meta-analysis. The total number of subjects was 141. Peak expiratory flow rate (PEFR) was used as the objective endpoint for effect size calculation. Subjecting these five studies to quality review revealed a range of 0.607–0.741, with 1 as the highest attainable quality and 0 the lowest. Reported results for the different studies were found to be homogenous, thus allowing for the calculation of overall effect size. Inclusion of children in some of the studies added variance to the reported studies, but not to the point at which studies would be considered heterogenous. Effect sizes ranged between 0.41 and 0.89, and the overall weighted average effect size for PEFR was 0.59, with the calculated 95 percent confidence interval at 0.32 to 0.84. A tabulated display of binomial effect size for included trials provided ranges of success rates for treatment versus control values. Results of the studies were judged robust, as 92 studies reporting no significant effects are needed to turn the finding of the meta-analysis insignificant.

CONCLUSIONS:

Based on the results of the meta-analysis, the existing literature suggests a role for inhaled corticosteroids in the treatment of mild chronic asthma.
Probable Ticlopidine-Induced Cholestatic Hepatitis
Authors: Cassidy L. Jane , Schuster Brenda G. , Halparin Lawrence S.
Published: January 2017

Objective:

To report a case of probable ticlopidine-induced cholestatic hepatitis.

Case summary:

A 76-year-old man with no known history of liver disease developed painless jaundice approximately 3 weeks after starting ticlopidine 250 mg bid. After ticlopidine was discontinued, the jaundice resolved and serum liver enzyme concentrations returned toward normal. A diagnosis of probable ticlopidine-induced cholestatic hepatitis was made. The patient was not rechallenged with ticlopidine.

Discussion:

A literature search produced 6 case reports describing 7 patients in whom probable ticlopidine-induced cholestatic hepatitis had been diagnosed. Only 1 of these reports appeared in the North American literature. Jaundice developed within 1 to 3 months of starting ticlopidine at less than or equal to the recommended daily dose. In all cases, jaundice resolved and serum liver enzyme concentrations normalized over a period of months after drug discontinuation.

Conclusions:

Routine monitoring of serum liver enzyme concentrations is not recommended. However, patients should be instructed to watch for signs and symptoms of liver injury. Should they occur, patients should stop taking the ticlopidine and consult their physician immediately.
Suspected Ciprofloxacin-Induced Hepatotoxicity
Authors: Villeneuve Jean-Pierre , Davies Campbell , Côté Jean
Published: January 2017

Objective:

To report a case of probable ciprofloxacin-induced hepatotoxicity.

Case Summary:

A 44-year-old woman developed severe hepatitis 3 weeks after initiation of a 7-day course of oral ciprofloxacin therapy. Liver biopsy showed severe hepatic necrosis, and other causes of liver injury were excluded. Liver function test results returned to normal 4 months after the appearance of jaundice.

Discussion:

The time course of events suggested that ciprofloxacin was the cause of severe hepatitis in this patient, and other causes of hepatitis were ruled out. Hepatotoxicity has been reported with other fluoroquinolone antibiotics, and there have been previous unpublished reports to the manufacturer of possible hepatotoxicity caused by ciprofloxacin.

Conclusions:

It is suggested that ciprofloxacin can cause severe hepatic injury and that healthcare providers should be aware of this possible adverse drug reaction.
Amphotericin B Toxicity Reduced by Administration in Fat Emulsion
Authors: Anderson Robert P , Clark Douglas A
Published: January 2017

Objective:

To report a patient with intolerance to amphotericin B reversed by preparing the antifungal in fat emulsion 20% and to review the medical literature on innovative formulations of amphotericin B.

Case Summary:

A 51-year-old man diagnosed with acute myelogenous leukemia was treated with standard induction chemotherapy. Empiric antibiotic therapy was initiated 2 days postchemotherapy; however, the patient continued to be febrile until day 7. At this time amphotericin B 35 mg/250 mL D5W over 4 hours was administered. Despite premedication, the patient experienced severe rigors, chills, and fever. As the result of continuing infusion-related adverse events, the patient refused further therapy after the third daily dose. In an attempt to reduce the infusion-related events, a trial of amphotericin B 35 mg/35 mL of fat emulsion 20% was administered over 2 hours after patient consent was obtained. Premedication was administered and the patient tolerated therapy without adverse events. Amphotericin B dosage escalations to 50 and 70 mg were tolerated similarly. During this treatment the patient became afebrile and the serum creatinine concentration decreased to normal.

Discussion:

Despite significant toxicities and the development of newer antifungal agents, amphotericin B remains the drug of choice for the empiric coverage of suspected fungal infection in neutropenic patients. Amphotericin B often exacerbates the nephrotoxicity of other agents characteristically prescribed in these patients. Furthermore, infusion-related events, if not intolerable, can dramatically reduce the patient's quality of life. For these reasons, novel means of amphotericin B administration are being explored.

Conclusions:

The delivery of amphotericin B in a lipid diluent may have substantial benefit in reducing the nephrotoxicity and infusion-related events associated with the antifungal. Prospective clinical trials comparing lipid-complexed amphotericin B with liposomal and approved formulations of amphotericin B are essential to define potential differences in toxicity and efficacy.
Water Handling In Patients Receiving Haloperidol Decanoate
Authors: Rider Joan M , Mauger Theodore F , Jameson John P , Notman Douglas D
Published: January 2017

Objective:

To determine whether water handling in patients receiving haloperidol decanoate (HD) was impaired.

Design:

Prospective, controlled trial of water handling in patients without symptomatic hyponatremia receiving HD. Eligibility for study inclusion required that patients had received HD for at least 4 months, were not taking any medication reported to cause inappropriate antidiuretic hormone secretion or hyponatremia (excluding haloperidol), and would agree to participate in the study. An age- and gender-matched healthy control subject was enrolled for each study patient. Baseline laboratory values were obtained within 48 hours prior to the standard water-loading test to screen for abnormalities in electrolytes, kidney function, and liver function. A 20-mL/kg water-load test was administered to each patient. Urine volume and osmolality were measured every hour for 4 hours.

Setting:

A community mental health (CMH) outpatient psychiatric facility for the patients receiving HD and Saint Mary's Health Services for the controls.

Participants:

Fifteen patients receiving HD from the CMH facility and 15 age- and gender-matched control subjects were enrolled.

Main Outcomes Measures:

Impaired water handling was defined as a failure to dilute urine to less than 100 mmol/kg or a failure to excrete more than 65% of a water load in 4 hours.

Results:

Five patients receiving HD were excluded because of protocol refusal or violation. Five of 10 evaluable patients receiving HD had abnormal water handling. Two of these could not lower their urine osmolality to less than 100 mmol/kg, 2 could not excrete more than 65% of the water load, and 1 did not meet either criteria. None of the healthy volunteers had abnormal free water handling. The difference between the study patients and the control subjects was statistically significant (p = 0.0097).

Conclusions:

Fifty percent of our study patients receiving HD had abnormal free water handling. This finding, combined with our clinical observations of symptomatic hyponatremia in other patients receiving the drug, suggests the need to investigate the incidence of hyponatremia and to design a useful screening tool to identify patients at risk. In the meantime, clinicians should be aware of the potential for impaired water handling in patients receiving HD.
Gastrointestinal Complications Associated with Intramuscular Ketorolac Tromethamine Therapy in the Elderly
Authors: Maliekal James , Elboim Charles M
Published: January 2017

Objective:

To report 3 cases of gastrointestinal (GI) complications associated with the use of intramuscular ketorolac tromethamine therapy in elderly patients.

Case Summaries:

In case 1, an 88-year-old woman was taken to surgery for the management of an acute abdomen and repair of a 2+ cm perforated prepyloric gastric ulcer. The patient had received a total 16 doses of ketorolac 30 mg im. The patient died after surgery from complications associated with bacterial and candidal sepsis, as well as acute renal failure. In case 2, an 80-year-old woman with no known history of GI problems developed a prepyloric gastric ulcer, which perforated and penetrated into the pancreas after the patient received 13 doses of ketorolac 30 mg im. The patient died from complications associated with candidal sepsis, peritonitis, and cardiopulmonary collapse. In case 3, an 85-year-old man with a history of a gastric ulcer developed GI bleeding after receiving a total of 9 doses of ketorolac 30 mg im. The bleeding was stabilized and the patient was discharged 12 days later in stable condition.

Discussion:

Ketorolac tromethamine is a nonsteroidal antiinflammatory drug with potent analgesic properties. We report 3 cases of GI complications associated with intramuscular ketorolac therapy in the elderly. A temporal relationship was established with the development of gastric ulceration in 2 patients and the recurrence of a gastric ulcer in the third patient.

Conclusions:

We recommend that the manufacturer's guidelines be followed when ketorolac is used in elderly patients, and the drug should not be used in patients with a history of gastric ulcer disease. The use of misoprostol may be warranted as prophylactic therapy in high-risk patients who are receiving ketorolac.
Desogestrel, Norgestimate, and Gestodene: The Newer Progestins
Authors: Kaplan Barbara
Published: January 2017

Objective:

To review and compare the newer progestins desogestrel, norgestimate, and gestodene with regard to chemistry, pharmacokinetics, efficacy, and tolerability.

Data Sources:

Primary literature on desogestrel, norgestimate, and gestodene was identified from a comprehensive MEDLINE English-literature search from 1984 through 1994, with additional studies selected by review of the references. Indexing terms included progestins, desogestrel, gestodene, norgestimate, levonorgestrel, and norgestrel.

Study Selection:

Only human clinical and pharmacokinetic trials performed in Europe, Canada, and the US were included.

Data Extraction:

All available data from human studies were reviewed; both comparative and noncomparative studies were included because of the paucity of direct comparative information available.

Data Synthesis:

The newer progestins were designed to minimize the adverse effects (e.g., acne, hirsuitism, nausea, carbohydrate and lipid metabolism changes) observed with older oral contraceptives (OCs) while maintaining efficacy and good menstrual cycle control. Desogestrel, norgestimate, and gestodene have minimal amounts of androgenicity and antiestrogenic potential. All of these agents are pharmacokinetically similar to older agents: they are highly bioavailable when administered orally, hepatically metabolized, and obtain steady-state concentrations after 8-10 days of continuous administration. The newer agents have similar Pearl Indexes and slightly better cycle control. Furthermore, the new progestins appear to cause fewer adverse effects, such as acne and hirsuitism, and similar rates of weight gain, blood pressure changes, and lipid and carbohydrate metabolism changes.

Conclusions:

Desogestrel, norgestimate, and gestodene appear to offer clinical advantages because of their decreased androgenicity. Women whose cycles are currently well controlled with other OCs should not be switched to a newer progestin. However, any of the combination OC products that contain these progestins may be prescribed for women intolerant of older agents or to first-time users of OCs. The newer progestins appear to be efficacious and offer similar cycle control, improved safety and tolerability profiles, and comparable price with the older agents.
Changing Physician Behavior in Ordering Digoxin Assays
Authors: Fraser Gilles L , Wennberg David E , Dickens John D , Lambrew Costas T
Published: January 2017

OBJECTIVE:

TO assess the ability to modify physicians' use of serum digoxin assays in a sustained fashion through (1) an educational intervention by a clinical pharmacist, and (2) changes in the computerized medical information system.

DESIGN:

A before/after methodology was used to compare test use by hospital staff physicians in two phases. Phase 1 was an educational intervention conducted by a clinical pharmacist with an 8-month follow-up. Phase 2 was a medical information system intervention with a 12-month follow-up.

PATIENTS:

Adult inpatients from July 1990 through December 1993 who received either digoxin therapy or at least one serum digoxin assay.

MAIN OUTCOME MEASURE:

Digoxin assays per patient day while receiving digoxin (assays/digoxin day), in-hospital mortality, and length of stay were compared before and after implementation of the interventions.

RESULTS:

A total of 9468 patients received a digoxin and/or serum digoxin assay. Baseline use of serum digoxin assays was 0.178 assays/digoxin day. Following phase 1, the educational intervention, use declined 20.2% to 0.142 assays/digoxin day (p < 0.03). After phase 2, the implementation of changes in the medical information system, digoxin assay use was maintained at 16.3% less than that at baseline (p < 0.03). Patient mortality was unaffected.

CONCLUSIONS:

A low-intensity educational intervention by a clinical pharmacist supplemented by medical information system modification resulted in an important decrease in the use of digoxin assays. The change in physician behavior was sustained for more than 18 months. The model presented is not labor intensive, does not require continuous maintenance by healthcare personnel for a sustained effect, and may be widely applicable to healthcare providers.
Stability of Human Recombinant Epoetin Alfa in Commonly used Neonatal Intravenous Solutions
Authors: Ohls Robin K , Christensen Robert D
Published: January 2017

OBJECTIVE:

TO measure epoetin alfa concentrations after adding it to a variety of commonly used neonatal intravenous fluids to determine the stability of epoetin alfa over time.

DESIGN:

Epoetin alfa was added to the following fluids: sterile water; NaCl 0.9%; dextrose 10% in water; dextrose 10% with albumin at concentrations of 0.01 %, 0.05%, and 0.1 %; and total parenteral nutrition solution containing either 0.5% or 2.25% amino acids. The fluid was administered through intravenous tubing, a T-connector, and catheter, and samples were collected at 0,2,4, 8, and 24 hours.

MAIN OUTCOME MEASURES:

Epoetin alfa concentrations were compared with the measured original preinfusion concentration and recorded as the percentage recovered.

RESULTS:

Concentrations declined significantly in all fluids containing less than 0.05% protein, but remained stable over 24 hours in fluids containing 0.05% or more protein.

CONCLUSIONS:

We conclude that epoetin alfa should be mixed in intravenous fluids containing at least 0.05% protein.
Acute Management of Cancer-Related Hypercalcemia
Authors: Chisholm Marie A , Mulloy Anthony L , Taylor A Thomas
Published: January 2017

OBJECTIVE:

TO review the pathogenesis and pharmacologic treatment of acute hypercalcemia associated with malignancy.

DATA SOURCES:

A MEDLINE search (1966 to 1995) of the English-language literature pertaining to acute hypercalcemia was performed. Additional literature was obtained from reference lists of articles identified through the search.

STUDY SELECTION AND DATA EXTRACTION:

All articles discussing the etiology and medical management of cancer-related acute hypercalcemia were considered in the review. Clinical trials reporting efficacy and safety of antihypercalcemic agents were also included. Information selected in the review was based on the discretion of the authors.

DATA SYNTHESIS:

Hypercalcemia is a life-threatening disorder associated with malignancy. It occurs in approximately 10–20% of patients with cancer. A variety of medications have been used in the management of hypercalcemia including bisphosphonates, calcitonin, furosemide, gallium nitrate, glucocorticoids, NaCl 0.9%, and plicamycin. Each of these agents has been reviewed with consideration of pharmacologic mechanism of action, evaluation of clinical trials, recommended dosages, efficacy, safety, cost, and role in treating cancer-related acute hypercalcemia.

CONCLUSIONS:

Immediate management of cancer-related acute hypercalcemia to prevent death and provide symptomatic relief is warranted. Severity determined by symptoms, calcium concentrations, and the overall status of the patient are important considerations in selecting appropriate therapy. Although the specific role of individual agents may vary, hydration remains the cornerstone of therapy. NaCl 0.9%, calcitonin, and Pamidronate disodium have established roles as dominant first-line agents for the management of acute hypercalcemia associated with malignancy.
Amphotericin B Enzyme-Linked Immunoassay for Clinical Use: Comparison with Bioassay and HPLC
Authors: Cleary John D , Chapman Stanley W , Hardin Thomas C , Rinaldi Michael G , Lee Spencer J , Deng Jie , Pennick Gennethel J , Lobb Craig J
Published: January 2017

OBJECTIVE:

To evaluate a new enzyme-linked immunosorbent assay (ELISA) for amphotericin B in serum samples. Results are compared with those obtained by HPLC and bioassay.

DESIGN:

Comparison of results obtained by ELISA, HPLC, and bioassay.

METHODS:

We developed a new ELISA using a polyclonal rabbit antibody to measure serum amphotericin B concentrations. Blinded samples of amphotericin B in concentrations of 0.15–78 μg/mL were prepared in human serum and assayed simultaneously by the ELISA, HPLC, and bioassay. The results of each assay were derived from standard curves and evaluated by using the Table Curve 2D computer program. These data were compared by using correlation analysis with evaluation of Pearson's correlation coefficient by Student's t-est.

RESULTS:

ELISA and bioassay compared favorably at amphotericin B concentrations of 0.3–20 μg/mL with a correlation coefficient of r = 0.993, while ELISA and HPLC compared with a correlation coefficient of r = 0.944. The average coefficient of variation over the range 0.3–20.0 μg/mL was 28% ± 7% for HPLC, 26% ± 9% for ELISA, and 13% ± 4% for bioassay. Comparison of all three assays revealed the highest correlation with the ELISA assay (r = 0.998) for the range of concentrations (0.3–20 μg/mL) routinely achieved. Samples containing concentrations in excess of 20 μg/mL could be diluted. Desiccation for concentrations less than 0.3 μg/mL was not tested.

CONCLUSIONS:

The determination of serum amphotericin B concentrations by ELISA gave results similar to those obtained by a bioassay and HPLC technique. Although variability appears greater with ELISA, the ease of performing this assay expedites the evaluation of many samples. Finally, this assay may allow the determination of amphotericin B concentrations from lipid formulations without interference from coadministered antibacterials or azole antifungals.
Prejudice or Principled Conservatism? Racial Resentment and White Opinion toward Paying College Athletes
Authors: Wallsten Kevin , Nteta Tatishe M. , McCarthy Lauren A. , Tarsi Melinda R.
Published: January 2017

Despite its widespread use in studies of race and ethnic politics, there exists a long-standing debate about whether racial resentment primarily measures antiblack prejudice or ideological conservatism. In this paper, we attempt to resolve this debate by examining racial resentment’s role in shaping white opinion on a “racialized” policy issue that involves no federal action and no government redistribution of resources: “pay for play” in college athletics. Using cross-sectional and experimental data from the 2014 Cooperative Congressional Election Study and Amazon’s Mechanical Turk, we find evidence not only that racial resentment items tap racial predispositions but also that whites rely on these predispositions when forming and expressing their views on paying college athletes. More specifically, we demonstrate that racially resentful whites who were subtly primed to think about African Americans are more likely to express opposition to paying college athletes when compared with similarly resentful whites who were primed to think about whites. Because free-market conservatism, resistance to changes in the status quo, opposition to expanding federal power, and reluctance to endorse government redistributive policies cannot possibly explain these results, we conclude that racial resentment is a valid measure of antiblack prejudice.
Reconstruction of Achilles Tendon Defect with a Free Quadriceps Bone-Tendon Graft without Anastamosis
Authors: Mudgal Chaitanya S. , Martin Tamara L. , Wilson Michael G.
Published: January 2017

We report a method of Achilles tendon reconstruction using a free quadriceps bone-tendon graft. The patient had a prior repair of a re-ruptured Achilles tendon, following which he developed massive necrosis of his skin and Achilles tendon leaving a 10 cm defect. First stage reconstruction consisted of soft tissue coverage of the skin defect with a sural fasciocutaneous flap. Reconstruction of the Achilles tendon followed, with the patellar bone block fixed to the calcaneus and the quadriceps tendon sutured proximally.
Dynamic Pressures on the Diabetic Foot
Authors: Luger Elchanan , Nissan Moshe , Karpf Andrew , Steinberg Ely , Dekel Shmuel
Published: January 2017

A retrospective study was conducted in order to investigate the relation between increased plantar pressure and ulcers in the diabetic foot and contribute more information on this subject. Maximal plantar pressure (MPP) is reported on various areas of the plantar aspects of the feet in 328 diabetic patients and 75 healthy subjects. An increase in MPP under all plantar areas except for the heels was found to be related with increasing severity of the diabetes symptoms. There was also a significant decrease in the application of high pressures to the heels, the metatarsal heads II-IV and the toes.
Osteolysis of Structural Autograft after Calcaneocuboid Distraction Arthrodesis for Stage II Posterior Tibial Tendon Dysfunction
Authors: Conti Stephen F. , Wong Yue Shuen
Published: January 2017

Surgical treatment of stage II posterior tibial tendon dysfunction that fails nonoperative treatment is amenable to operative treatment. This commonly consists of a medial soft-tissue reconstruction and lateral column lengthening. We report on 32 patients undergoing distraction calcaneocuboid arthrodesis using an autogenous tricortical iliac crest graft. Almost 50% of patients did not go on to complete and uneventful incorporation of the graft at the arthrodesis site. Two different types of failure were noted. The first was classic nonunion which maintained structural integrity of the graft. The second was osteolysis and collapse of the graft accompanying the nonunion. Risk factors included smoking, K-wire fixation and possibly larger deformities requiring Achilles tendon lengthening. Complications of nonunion were salvageable with reoperation.
Endoscopic Plantar Fascia Release: A Case Series
Authors: Boyle R.A. , Slater G.L.
Published: January 2017

Plantar fasciitis is a common disabling condition that can be recalcitrant to treatment. Endoscopic Plantar Fascia Release (EPFR) has received greater attention in recent years as a viable, and possibly superior, alternative to established open procedures for the treatment of plantar fasciitis.

In a series of 17 patients (17 feet) with follow-up over an average of 16 months, we report a two portal endoscopic technique of partial release of the plantar fascia, as a successful, safe and reliable procedure for the treatment of plantar fasciitis in the patient group selected. The surgical results of 17 EPFR's performed by the same surgeon were reviewed. All patients had preoperative symptoms of subcalcaneal heel pain for greater than 12 months, all having undergone nonsurgical measures for at least 12 months.

Of 17 feet, all reported marked improvement of preoperative symptoms within two months. Patients' subjective assessment of the procedure was strongly supportive, 100% totally satisfied or satisfied with only minor restrictions. Postoperatively, 82.4% reported mild or no pain, and 100% had improvement in walking distance. Complications all resolved within two to six months; there were no re-operations and no infections.
Primary Fusion as Salvage following Talar Neck Fracture: A Case Report
Authors: Thomas Rhys H. , Daniels Timothy R.
Published: January 2017

For a 29-year-old man with a three-week-old Hawkins Type IV talar neck fracture, intra-operative reduction and fixation were not possible due to soft tissue contractures and severe comminution. A primary talonavicular and subtalar arthrodesis with the use of iliac crest bone graft was performed. Postoperative follow-up at 16 months demonstrated solid fusions, no avascular necrosis of the talus and a functional range of motion at the ankle. He was not capable of returning to his job of roof maintenance.
Outcome and Recurrence Rate of Diabetic Foot Ulcers Treated by a Total Contact Cast: Short-Term Follow-up
Authors: Matricali Giovanni A. , Deroo Kristoff , Dereymaeker Greta
Published: January 2017

Foot ulcers in patients with diabetes present an increasing burden to healthcare. Total contact cast (TCC) is a well established treatment option for many of these ulcers, but little seems to be known about the final outcome once healing has been reached. The study examined healing and final outcome after TCC treatment among patients with diabetes. During a 22-month period, 15 consecutive patients with a total of 17 ulcers started treatment with a TCC. Three patients (three ulcers) were lost to follow-up (FU). Average FU was 91 weeks. The patients were followed with emphasis on healing, complications during FU, footwear, compliance, and frequency of visits. All ulcers healed, some after additional surgery. During FU, control visits were performed at an average of one visit every 4.7 weeks. Notwithstanding this, a high frequency of ulcer recurrence and/or other complications was noticed. Only four patients out of 12 remained without any new (ulcer) problem during FU. TCC proved to be a very efficient tool to heal neuropathic foot ulcers, but the recurrence rate and frequency of other complications remained very high. These data show how difficult it is to achieve reliable (secondary) preventive general foot care, and to prescribe and manufacture reliable footwear.
Traumatic Rupture of Both Peroneal Longus and Brevis Tendons
Authors: Pelet Stéphane , Saglini Marco , Garofalo Raffaele , Wettstein Michael , Mouhsine Elyazid
Published: January 2017

Injuries of peroneal tendons are rare. Diagnosis of traumatic rupture is often late and presents as chronic ankle instability. A case of a complete traumatic rupture of both peroneal longus and brevis tendons with acute clinical and radiological diagnosis is presented. Surgical repair was performed by direct end-to-end suture on the 4th day after trauma, with excellent functional outcome at 1-year follow-up.
Metatarsal Neck Osteotomy With Proximal Interphalangeal Joint Resection Fixed With a Single Temporary Pin
Authors: Boyer Matison L. , DeOrio James K.
Published: January 2017

Background: Screws have been recommended for fixation of the site of the metatarsal osteotomy. Methods: A report is presented on one surgeon's experience with a temporary, single Kirschner wire instead of screws for fixation of metatarsal neck osteotomies combined with proximal interphalangeal (PIP) joint resection arthroplasty in patients with dislocated metatarsophalangeal (MTP) joints and severe hammertoe deformities. Eleven consecutive patients (13 toes) were treated between January 1999 and January 2002 (mean age, 69 years; range, 44–81 years; seven women, four men) at a tertiary care foot and ankle center. Records and radiographs were reviewed retrospectively, and all patients were examined at follow-up by one of the authors (mean follow-up, 13 months; range, 6–32 months). Results: All 13 metatarsal neck osteotomies had clinical and radiographic union by 6 weeks, with no evidence of nonunion, malunion, avascular necrosis of the metatarsal head, deep wound infection, pin-tract infection, broken pins, or other serious complications. Two metatarsals (18%) had minor residual plantar calluses beneath the metatarsal head. The mean postoperative American Orthopaedic Foot and Ankle Society score was 76 of 95 points possible. All patients were satisfied with the procedure and would do it again. Conclusion: The use of a single, temporary K-wire provides adequate fixation for combined PIP joint resection arthroplasty and metatarsal neck osteotomy in patients with central metatarsalgia and severe hammertoe deformity.
Challenges in Total Ankle Arthroplasty
Authors: Gill Lowell H.
Published: January 2017

In the past, total ankle arthroplasty was largely abandoned due to poor survivorship most often caused by loss of bone support. High complication rates were also reported. Despite this, there is renewed interest in ankle arthroplasty and encouraging results are seen in survivorship with midterm follow-up. The procedure, however, remains more challenging than total hip or total knee arthroplasty. With the limited soft tissue envelope, wound problems are not uncommon. Forces at the ankle are very large and yet the surface area for prosthetic support is small. Therefore, fixation can be more difficult. The strongest bone can be eccentric at the distal tibia. The tibial prosthesis can, therefore, tend to settle into the softer bone often laterally. Polyethylene needs to be sufficiently thick to maintain its integrity but that requires a larger bone resection, which weakens bone support. Polyethylene failure or wear leads to the majority of failures in hip and knee arthroplasty. There is a need for further basic science research in total ankle arthroplasty. The lessons learned from other arthroplasty should be considered in ankle arthroplasty design.
Percutaneous Repair of Acute Achilles Tendon Rupture
Authors: Gorschewsky Ottmar , Pitzl Martin , Pütz Andrej , Klakow Andreas , Neumann Wolfram
Published: January 2017

Various studies have shown that the operative treatment of a freshly ruptured Achilles tendon is generally considered to be more appropriate than a nonoperative regimen. However, complications in open reconstructions are reported to occur in 11–29%. The method used in this study reduced the risk of complications arising from operation, but simultaneously allowed early postoperative mobilization and functional treatment. It was a percutaneous repair of the Achilles tendon, using two Lengemann extension wires for coadaptation of the ruptured tendon. To fix the rupture site, the authors used a fibrin sealant. The spikes of the wire were hooked in at the fascia of the soleus muscle. Via a big, curved needle, the wire was placed in the distal stumps of the ruptured tendon and guided out laterally and medially above the calcaneus. After blocking the wires distally, the fibrin sealant was applied at the rupture site. The current report describes this method of treatment in 66 patients. The postoperative observation period was 1 year. Sixty-four patients were male and two were female. Their average age was 42 years. The Achilles tendon ruptures occurred during sporting activities and were treated by operation within 22 hours on average. The outcome was very good in 98%. One patient (2%) suffered a rerupture due to trauma. There were no other complications.
The Nutcracker Fracture of the Cuboid in Children: A Case Report
Authors: Hsu Jen-Chih , Chang Jen-Huei , Wang Shyu-Jye , Wu Shing-Sheng
Published: January 2017

The fracture of the cuboid in children is rarely diagnosed and has probably been underreported for nondisplaced fractures. The diagnosis is often missed, and overlooked cuboid fracture can lead to severe alterations in foot mechanics and function. This case report involves a displaced compression fracture of the left cuboid in a 9-year-old girl after a fall from a height, which was treated by open reduction, bone graft, internal fixation with pins, and plaster splint immobilization. Follow-up examination 2 years after the injury revealed good bone union and a very good functional result.
Review of Proximal Interphalangeal Joint Excisional Arthroplasty for the Correction of Second Hammer Toe Deformity in 100 Cases
Authors: O'Kane Claire , Kilmartin Timothy
Published: January 2017

Background: The main bony procedures used in the treatment of second hammertoe are excisional arthroplasty and arthrodesis of the proximal interphalangeal (PIP) joint. While a number of studies have reported the outcomes after PIP joint arthrodesis, there are few reports of the outcome of excisional arthroplasty of the PIP joint for the correction of second hammertoes. The purpose of this study was to evaluate the long-term outcome of PIP joint excisional arthroplasty. Methods: Seventy-five patients (100 toes) who had excisional arthroplasty of the PIP joint for the correction of second hammertoe were reviewed at an average followup of 44 months. All patients were seen in clinic and were physically examined to assess the alignment and function of each digit. The radiographs were evaluated preoperatively. The AOFAS clinical rating scale was used preoperatively and at final followup. Patients were asked to rate their satisfaction on a scale of 0 to 10 and were asked if they would be happy to have the surgery under similar circumstances again. Results: The mean preoperative AOFAS clinical rating scale was 46. At final followup this increased to 94, showing an average improvement of 48 points ( p < 0.0001). The mean satisfaction on a scale of 0 to 10 (with 0 equaling complete dissatisfaction and 10 complete satisfaction) was 9.3 (SD 1.3). One patient would not have been happy to undergo outpatient surgery again, because of a change in her social circumstances. Conclusion: In a group of 75 patients who had PIP joint arthroplasty for the correction of second hammertoe, high levels of satisfaction were achieved. No serious complications were encountered, and revision surgery was required in just two cases. Floating toe was the most common complication encountered, and although this did decrease the level of patient satisfaction in seven patients it was not a cause of footwear irritation or pain in any patient.