bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient-Controlled Analgesia versus Patient-Controlled Analgesia plus Continuous Infusion after Hip Replacement Surgery
Authors: Smythe Maureen A , Zak Margie B , O'Donnell Maureen P , Schad Randy F , Dmuchowski Carl F 
Published: January 2017

OBJECTIVE: To compare the efficacy and adverse effect profile of patient-controlled analgesia (PCA) versus PCA plus continuous infusion (PCACI) after hip replacement surgery. DESIGN: Prospective, randomized, open pilot study. SETTING: Large teaching institution. PARTICIPANTS: Thirty-four patients undergoing hip replacement or revision of hip replacement surgery. INTERVENTIONS: Patients were randomized to receive PCA morphine: 1 mg with 6-minute lockout, or PCACI, using the same dose, with a 0.5–1 mg/h continuous infusion. Pain intensity, sedation, narcotic use, injection/attempt ratio (I/A), and adverse effects were assessed. RESULTS: No significant differences in pain intensity were identified. Morphine use was not different between groups: PCA 61.8 ± 35.0 and PCACI 74.2 ± 54.9 mg (p = 0.394). A trend toward an increased 12-hour I/A ratio was evident in the PCACI group: PCA 0.73 ± 0.18 and PCACI 0.86 ± 0.17 (p = 0.073). Patient-reported adverse effects, sedation, and inability to sleep secondary to pain occurred similarly. Eight of 18 PCACI patients required discontinuation of either the continuous infusion mode or of PCA therapy entirely secondary to adverse effects. CONCLUSIONS: When compared with PCA therapy, PCACI was not associated with improved pain control and more patients receiving PCACI required discontinuation of therapy secondary to adverse effects.
Pseudomonas Bacteremia Precipitated by Ticlopidine-Induced Neutropenia
Authors: Geletko Sandra M , Melbourne Kathleen M , Mikolich Dennis J 
Published: January 2017

OBJECTIVE: To report a case of ticlopidine-induced neutropenia resulting in Pseudomonas bacteremia. CASE SUMMARY: An 83-year-old white man developed febrile neutropenia 5 days after initiation of ticlopidine therapy. At presentation, the patient's white blood cell count was 1.1 × 109/L with an absolute neutrophil count (ANC) of 0. Ticlopidine was discontinued and the patient was treated empirically with ceftazidime, gentamicin, and filgrastim. The patient's blood cultures were positive for Pseudomonas aeruginosa. By day 6 of antibiotic and filgrastim therapy, he was clinically improved and the ANC was 17 040 × 106 cells/L. The filgrastim and intravenous antibiotics were discontinued and oral ciprofloxacin was started. CONCLUSIONS: Ticlopidine-induced neutropenia can occur suddenly and may result in a serious infection, such as bacteremia.
Abciximab: A New Antiaggregant Used in Angioplasty
Authors: Genetta Tina B , Mauro Vincent F 
Published: January 2017

OBJECTIVE: To review the scientific literature on the pharmacology and clinical uses of abciximab. DATA SOURCES: MEDLINE, Index Medicus, and bibliographic literature searches of English-language articles pertaining to abciximab, 7E3, m7E3, and c7E3 were performed. Eli Lilly also provided unpublished results of the Evaluation of 7E3 for the Prevention of Ischemic Complications trial. DATA SELECTION: The selection of data presented focused on controlled trials using abciximab at doses currently approved by the Food and Drug Administration. DATA SYNTHESIS: Abciximab is a humanized chimeric Fab fragment of 7E3.7E3 is a murine antibody directed against the integrin glycoprotein IIb/IIIa receptor (GPIIb/IIIa) located on platelets. These receptors play an integral part in platelet aggregation by allowing fibrinogen to bind to them and interconnect platelets. When administered intravenously, abciximab binds to GPIIb/IIIa and hinders platelet aggregation. Bleeding times and activated clotting times are increased and the platelets' response to adenosine diphosphate is reduced with the use of abciximab. Clinical trials have indicated that abciximab can reduce the incidence of abrupt closure and restenosis associated with percutaneous transluminal coronary angioplasty (PTCA) performed in high-risk patients. Clinical trials also suggest that abciximab may have a role in the treatment of unstable angina and the acute therapy of myocardial infarctions. Complications associated with abciximab include bleeding and thrombocytopenia. The thrombocytopenia is likely related to immunologic mechanisms. In addition, the production of antimurine antibodies has been demonstrated with abciximab use. Abciximab is currently approved for the prevention of abrupt coronary closure associated with PTCA in patients at high risk for this event. CONCLUSIONS: Abciximab is effective in preventing platelet aggregation and has been proven to be of clinical benefit in selected high-risk patients receiving PTCA.
Pharmacotherapy of Aggressive Behavior
Authors: Pabis Derails J , Stanislav Steven W 
Published: January 2017

OBJECTIVE: To review the definition, clinical characteristics, prevalence, etiology, neurochemistry, and pharmacologic treatment of aggressive behavior, and provide recommendations regarding the use of specific pharmacologic agents for treating aggressive behavior. DATA SOURCES: Data from the scientific literature were analyzed, interpreted, and summarized. An English-language MEDLINE search yielded clinical trials, case reports, letters, and review articles addressing the etiology and pharmacotherapy of aggression. STUDY SELECTION: Because few well-controlled studies are available in aggression research, all literature addressing the pharmacologic treatment of aggressive behavior, as well as the neurochemistry and psychobiology of aggressive behavior, was reviewed. DATA EXTRACTION: The literature was reviewed on the basis of the particular pharmacotherapy and the specific population used. A separate review of the treatment of aggressive behavior in the elderly was included. DATA SYNTHESIS: The literature was assessed for applicability to clinical practice and usefulness to the general clinician. Recommendations were made from the primary literature in conjunction with trends in clinical practice. Pharmacotherapy is a primary mainstay of treatment for aggressive patients. In individuals for whom behavioral intervention alone is unsuccessful, drug therapy should be initiated along with continued nonpharmacologic intervention. Short-acting benzodiazepines and high-potency antipsychotic agents are effective in treating acute aggression on a short-term or as needed basis. Agents such as lithium, beta-adrenergic blockers, carbamazepine, valproic acid, buspirone, trazodone, serotonin reuptake inhibitors, and clozapine may be useful in the chronic management of aggressive behavior. Every attempt should be made to streamline drug therapy in patients with chronic aggression and comorbid psychiatric disorders. CONCLUSIONS: On the basis of available research and extensive clinical experience, lithium or propranolol should be considered as first-line antiaggressive agents in patients without comorbid psychiatric disorders. A minimum trial period for assessing drug efficacy should last at least 6–8 weeks at maximum tolerated dosages. Patients responding to pharmacotherapy should be reevaluated every 3–6 months, and periodic medication tapers and/or drug-free periods should be attempted.
Methemoglobinemia Induced by an Over-the-Counter Medication
Authors: Tush Gretchen M , Kuhn Robert J 
Published: January 2017

OBJECTIVE: To report a case of methemoglobinemia induced by benzocaine and resorcinol (Vagisil) cream, an over-the-counter medication that was used to treat diaper rash in a neonate. CASE REPORT: A 6-day-old, 3350-g white boy was found to be cyanotic with blue mucous membranes on presentation. He had a diaper rash that was red and irritated, which his mother had treated with Vagisil cream. Methemoglobinemia secondary to absorption of benzocaine and resorcinol (1,3-benzenediol) from the Vagisil was diagnosed, with a methemoglobin level of 35% on admission (normal 0.4–1.5). Intravenous methylene blue 3 mg (1 mg/kg) was given; the neonate's skin color returned to normal 45 minutes after the dose. DISCUSSION: Methemoglobinemia is a condition in which hemoglobin is oxidized to the ferric form. Oxidized hemoglobin, methemoglobin, is incapable of reversibly binding oxygen at the physiologic partial oxygen pressure. Main causes of methemoglobin formation are exposure to certain oxidizing agents and drugs, deficiency of one of the enzymes necessary for reduction of methemoglobin to hemoglobin, or the presence of an abnormal hemoglobin resistant to reduction. Clinical manifestations of methemoglobinemia include diffuse slate-gray cyanosis with low oxygen saturation in the absence of respiratory distress. A single intravenous dose of methylene blue 1–2 mg/kg is the treatment of choice. CONCLUSIONS: Newborn infants are at increased risk for methemoglobinemia due to diminished enzyme systems required to reduce ferrihemoglobin to ferrohemoglobin, as well as because fetal hemoglobin is more easily oxidized than is adult hemoglobin. It is important to recognize possible drug reactions and educate parents on the potential risks of treatment with over-the-counter medications, especially in neonates.
Bone Scintigraphic Findings of Os Trigonum: A Prospective Study of 100 Soldiers on Active Duty
Authors: Sopov Vladimir , Liberson Aharon , Groshar David 
Published: January 2017

PURPOSE: To determine the clinical significance of an increased uptake of 99mTc methylene-diphosphonate (Tc-MDP) in the os trigonum region seen on bone scintigrams of soldiers on active duty. PATIENTS AND METHODS: Radionuclide whole-body skeletal imaging and physical examination of the foot were carried out in 100 consecutive soldiers on active duty referred for evaluation of suspected stress-injury of the lower limbs, back pain, and different skeletal trauma. Lateral radiographs of the foot were performed in those with increased uptake of Tc-MDP at the site of os trigonum. Radiographic, scintigraphic, and clinical findings were correlated. RESULTS: Among 200 feet, 27 (13.5%) showed an increased uptake of Tc-MDP in the os trigonum region. The right side was affected in six patients, the left side in 11 and five patients had bilaterally increased uptake. On X-rays, 31 of 44 feet showed the os trigonum. Only 10 of these 27 feet (37%) had a symptomatic os trigonum. CONCLUSIONS: Our results suggest that increased uptake of Tc-MDP in the os trigonum region is a frequent finding among active soldiers and is of limited value in detecting symptomatic os trigonum.
Claudication as an ‘Orphan Disease’: Rationale and Goals of Drug Therapy for Peripheral Arterial Disease
Authors: Hirsch Alan T 
Published: January 2017

Patients with peripheral arterial disease are often perceived to suffer from a disorder whose pathogenesis and symptoms are not amenable to drug therapies. This clinical misperception remains prevalent despite an abundance of data suggesting that diverse pharmacotherapies may modulate the natural history of this disease. Patients with chronic limb arterial occlusive disease suffer from a disease that is characterized by: (1) a prolonged asymptomatic state that can be identified by simple physical examination and confirmed by measurement of the ankle brachial index; (2) a multi-year period of symptomatic claudication; and (3) a variable rate of progression to critical limb ischemia or acute arterial occlusion. This stage-dependent disease progression is mediated via the dynamic, but as yet incompletely understood, interaction of factors that elicit endothelial dysfunction, atherogenesis, and thrombosis. Current data suggest that each of these contributory disease processes can be modulated by extant pharmacotherapies. Additionally, many novel pharmacotherapeutic agents that are currently under investigation may further improve the ability of clinicians to modulate these fundamental biologic processes. Pharmacologic therapies should be targeted to decrease the rate of limb arterial disease progression, to improve limiting symptoms, and to prolong life. Symptoms of claudication can be objectively assessed via both exercise testing and disease-specific questionnaires. The presence of lower extremity atherosclerotic disease is predictive of the presence of coronary heart disease and a foreshortened five-year survival. Current data suggest that clinical investigations should be able to effectively stratify this relative risk via use of both clinical variables (e.g., age, diabetes mellitus, tobacco use, etc.) or by measurement of the ankle brachial index (ABI). The role of the physician is to decrease suffering and to prolong life. Judicious administration of medical therapies can play a critical role in helping the vascular practitioner accomplish these goals.
Severe Vascular Gunshot Injuries of the Extremities: A Ten-Year Nation-Wide Analysis from Finland
Authors: Mäkitie I. , Mattila V. M. , Pihlajamäki H. 
Published: January 2017

Background and Aims: Gunshot wounds affecting the main vessels of the extremities mostly threaten limb salvage. The purpose of this study was to analyse the nature and severity of civilian vascular gunshot injuries of the extremities using a nation-wide database. Material and Methods: Retrospective analysis of the Finnish Hospital Discharge Register, hospital records and death certificates over a 10-year period from January 1, 1990 to December 31, 1999. Results: Thirty-two individuals with the mean age of 33 years (17–68) sustained 43 severe vascular injuries to the extremities caused by gunshots. The incidence was 6.0 (95% CI: 4.1–8.5) per 10, 000, 000 person-years and did not change significantly during the period. Four of the injured died. The most common anatomical locations of vascular injuries were the femoral artery (6 lesions), popliteal artery (6) and superficial femoral artery (5). Use of alcohol was detected in ten cases (32% of patients) and of illegal drugs in seven cases (22%). Five patients (18% of non-fatal injuries) required vascular re-operation caused by post-operative problems. Five amputations were performed as primary treatment. Conclusions: Severe vascular gunshot injuries of the extremities are not common in Finland. The need for primary amputation or vascular re-operations is noteworthy.
The Role of Adrenal Scintigraphy in the Preoperative Management of Primary Aldosteronism
Authors: Volpe C. , Enberg U. , Sjögren A. , Wahrenberg H. , Jacobsson H. , Törring O. , Hamberger B. , Thorén M. 
Published: January 2017

Background and Aims: Differentiation between the two major subgroups of primary aldosteronism, bilateral hyperplasia and aldosterone producing adenoma is essential since therapy in the former is medical and in the latter surgical. The aim of the present study was to evaluate the clinical utility of adrenocortical scintigraphy in the management of primary aldosteronism. Material and Methods: [131I] norcholesterol (NP-59) scintigraphy with dexamethasone suppression for subclassification and lateralization of primary aldosteronism was evaluated in 49 patients with long-term follow-up after diagnosis and treatment Results: Thirty-three patients with the diagnosis of aldosterone producing adenoma were operated with adrenalectomy. Preoperative scintigraphy showed lateralized isotope uptake in 27/33 patients while 6 showed no uptake. Twenty-two were cured and three significantly improved. Thus, in 25/33 (76%), scintigraphy showed the correct side as the patients benefited of surgery. Two patients did not improve. Fourteen patients with a probable diagnosis of bilateral hyperplasia had normal scintigraphies. Conclusions: In the present retrospective study we found limited sensitivity of NP-59 scintigraphy. However, when a lateralized scintigraphic uptake is achieved it has a high accuracy. Scintigraphy may be used as an adjunct in cases where adrenal venous sampling is inconclusive.
The Role of Surgery in Crohn's Disease: A Retrospective Analysis from a Single Hospital
Authors: Aarnio M. T. , Mecklin J.-P. , Voutilainen M. 
Published: January 2017

Background: Traditionally, in Crohn's disease (CD), surgery has played an essential role in the treatment of complications. TNF-α-blockers have significantly improved results of conservative treatment but they do not definitely cure Crohn's disease. Aim: Our aim was to examine the prevalence of and indications for surgical procedures in CD in our hospital. Material and Methods: A retrospective survey included all CD patients diagnosed in our hospital referral area during a 10-year period in 1996–2005. Results: Altogether 114 new patients with CD were diagnosed, 56 (49%) males, 58 (51%) females. The median follow-up time was 5.0 years. In all, 31 (27%) patients underwent some surgical procedure, and of these, 12 (39%) underwent an emergency operation. The most common indication for surgery was bowel obstruction. The most frequent procedures were ileocolic resection in 12 (39%) patients and small bowel resection in 10 (32%). Conclusions: Almost one-third of CD patients needed surgical therapy in an early phase of their disease, and more than one-third of these underwent an emergency procedure. Obstructive symptoms were the most common indication for surgery in the early phase of CD.
Prevention of Rupture of Abdominal Aortic Aneurysm
Authors: Savolainen H. , Novak J. , Dick F. , Widmer M.K. , Carrel T. , Schmidli J. , Meier B. 
Published: January 2017

Background and Aims: Two thirds of patients with an abdominal aortic aneurysm (AAA) have relevant coronary artery disease (CAD). AAAs are prevalent in up to 16% of smokers with CAD. General screening of AAA is controversial. Aim was to assess the potential of finding AAA prior to rupture among patients with known CAD. Main endpoint was whether AAA could have been found during follow-up by sonography or at other time of cardiovascular evaluation. Material and Methods: Retrospective study. 213 consecutive, formerly unknown emergently operated AAAs, treated emergently for symptoms (n = 91) or rupture (n = 122) (rAAA) between January 1998 and June 2005. Patient charts were analysed and primary care physicians contacted. Results: At presentation, mean age was 71 (+/–9) years, twenty (9%) were female. AAA had a mean diameter of 7.6 cm. Two thirds (143) were clinically obese (BMI 27 +/–5). 137 (64%) were active smokers, 32 (15%) had diabetes, 151 (71%) were hypertensive, and 80 (38%) received statin treatment. CAD had been diagnosed in 95 (45%) 9 years earlier and followed up. Thirty-five (16%) had had myocardial infarction. Echocardiography had been performed in 52 (24%). Thirty day mortality after open surgery was 25 (21%). Conclusion: All patients with rAAA had been seen by a GP or cardiologist within a year prior to presentation. The cost effectiveness of selective AAA screening should be evaluated in a larger study.
Temporal Patterns of Death after Trauma: Evaluation of Circadian, Diurnal, Periodical and Seasonal Trends in 260 Fatal Injuries
Authors: Søreide K. 
Published: January 2017

Background: Temporal patterns of trauma deaths may indicate potential for prevention or systems improvement, but have been poorly investigated in the Scandinavian trauma population. This study examines patterns in trauma deaths to the occurrence in hour and time of the day, day and time in the week, and month and season. Materials and Methods: Investigation of the temporal patterns of death in 260 fatalities undergoing autopsy. Time of death were explored according to time of the day (hour; day/night), time of the week (day of week; weekday/weekend) and time of the year (month; season) and analyzed for difference in gender, age, injury type and severity, and mechanisms of injury and death. Results: A total of 260 trauma deaths were included, of which 125 (48%) died in hospital and 194 (75%) were male. No particular peak-hour of the day when deaths occurred was found. One-third of deaths occurred during weekends. For inhospital deaths during weekends, significantly more patients had respiratory distress (RR > 20 or < 16 in 72.5% for weekends and 47.0% for weekdays; p = 0.008) and hypotension (SBP < 90mmHg in 61% vs 40%; p = 0.048) during weekends. Deaths occurred with some monthly variance demonstrated with two monthly peaks in February/March and July/August, respectively. Overall, no statistically different seasonal differences in the occurrence of traumatic deaths, nor any differences in cause of death, type or severity of injury, nor in physiological parameters was found. However, a higher number of inhospital deaths presented with reduced consciousness level (GCS < 8) and severe head injuries (AIS-head ≥ 4) during spring and summer (P = 0.045, chi-square for trend) compared to winter and fall. Conclusions: Trauma deaths in a Scandinavian population did not demonstrate statistically significant differences in overall circadian, weekly or seasonal patterns of trauma death occurrence. However, the impact of fatal head injuries during spring and summer warrants further investigation.
Successful Use of Kidneys from Deceased Donors with Acute Renal Failure
Authors: Khader A. A. Al , Shaheen F. A. , Attar B. A. , Elamin K. M. , Ghamdi F. Al , Jondeby M. 
Published: January 2017

Background Kidneys from deceased donors with acute renal failure are not widely used. Objective To compare outcomes for recipients of kidneys from donors with acute renal failure at organ recovery with outcomes for recipients of kidneys from donors with normal serum levels of creatinine. Methods Records of deceased donors and recipients of their organs at the Saudi Center for Organ Transplantation from 2003 to 2005 were reviewed. A total of 33 donors (donating 65 kidneys to 65 recipients) with elevated serum levels of creatinine (>1.7 mg/dL) and 94 donors (donating 188 kidneys to 188 recipients) with normal (<1.1 mg/dL) serum levels of creatinine at organ recovery and their respective recipients were compared. Both groups had normal creatinine levels at admission. Results Recipients in both groups had similar renal function at discharge and follow-up. Delayed graft function occurred more often ( P= .009) in the recipients of kidneys from donors with acute renal failure (47.7%) than in recipients of kidneys from donors with normal creatinine levels (29.8%). Elevation of serum level of creatinine at organ recovery did not correlate significantly with kidney function at discharge or last follow-up or with graft survival. Conclusions Survival of patients or grafts at 1, 2, and 3 years did not differ significantly between the recipients in the 2 groups. Only the frequency of delayed graft function differed between the 2 groups.
A Pharmacoeconomic Analysis of Liver Transplant Charges
Authors: Clifford Timothy M. , Johnston Thomas D. , Jeon Hoonbae , Gedaly Roberto , Ranjan Dinesh 
Published: January 2017

Objective To analyze hospital charges for all liver transplant admissions to determine major cost drivers of the total charge. Study Design Retrospective review of hospital billing records. Methods Hospital charges were collected for all liver transplant admissions between July 1995 and December 2005 and 276 billing records were included in the analysis. Charges were itemized into pharmacy, inpatient room, laboratory, organ acquisition, and other. Results Despite maintaining a median length of stay of about 10 days, hospital charges increased from 1995 to 2005. Mean total pharmacy charges (± SEM) before a 1998 cost-containment initiative were $17 405 ±$4080 and constituted a 12% fraction of total charges, but had reduced to $11238 ±$2828 (7.8% of total charges) immediately thereafter, decreasing to $9891 ±$2351 (3.7% of total charges) for the most current period (2005). The increase in the total charge was largely driven by an increase in the organ acquisition charge and daily laboratory and room charges. Conclusions Pharmacy charges no longer are a major contributor to the total liver transplant charges at our institution. A major reduction in total liver transplant charge can now only be achieved by targeting other cost centers such as laboratory, room, and organ acquisition. The transplant team has limited control over these cost centers.