bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quinine Clearance in Continuous Venovenous Hemofiltration
Authors: Davies J Graham , Greenwood Elizabeth F , Kingswood J Christopher , Sharpstone Paul , Street Martin K 
Published: January 2017

OBJECTIVE: TO describe a case involving the removal of quinine by continuous venovenous hemofiltration (CVVH) in a patient with malaria and acute renal failure and to present recommendations on the dosing of quinine in such patients. CASE SUMMARY: A 50-year-old white man developed Plasmodium falciparum malaria following a visit to Nigeria. Although he received intravenous quinine, his condition deteriorated and he required intensive care management, including CWH for the management of his acute renal failure. Quinine plasma concentrations were measured to determine both total body and extracorporeal clearance of the drug. DISCUSSION: TO our knowledge this is the first report quantifying the removal of quinine by CVVH. The drug is not significantly removed by this extracorporeal process. The filter clearance accounted for less than 1.5% of the total body clearance. CONCLUSIONS: Initially the dosage of quinine administered to patients presenting with P. falciparum infection should not be reduced because of renal failure. This is particularly important when cerebral involvement is suspected. Subsequent dosage modification should reflect the severity of the patient's clinical condition and the plasma quinine concentration achieved, and should not be limited by the degree of renal impairment present.
Acetazolamide in the Treatment of Seizures
Authors: Reiss William G , Oles Karen S 
Published: January 2017

OBJECTIVE: TO summarize the pharmacology, pharmacokinetics, efficacy, and safety of acetazolamide and to evaluate its therapeutic role in patients with epilepsy. DATA SOURCES: A computerized search of the MEDLINE (OVID) database (1966–1994) was used to identify publications regarding acetazolamide. The MEDLINE search was supplemented by information from textbooks. STUDY SELECTION: Included were English-language review articles, clinical trials, cohort studies, and case reports. Topics investigated included basic pharmacology, therapeutics, toxicology, adverse reactions, dosage, administration, and pharmacokinetics of acetazolamide. DATA SYNTHESIS: Acetazolamide, a carbonic anhydrase inhibitor, has been approved for the treatment of epilepsy since 1953. Acetazolamide is primarily used in combination therapy with other antiepileptic medications in both children and adults although it may be used as monotherapy. Drug concentration monitoring has not been found to be routinely beneficial. Adverse effects include kidney stones, metabolic acidosis, lethargy, appetite suppression, paresthesias, and rare blood dyscrasias. Partial tolerance may develop to the antiepileptic activity. CONCLUSIONS: Acetazolamide is a beneficial adjunctive agent in the pharmacotherapy of epilepsy and should be considered in refractory epilepsy. Although it may be useful in partial, myoclonic, absence, and primary generalized tonic—clonic seizures uncontrolled by other marketed agents, acetazolamide has been inadequately studied by current standards and its use has been limited.
Possible Interaction Involving Phenytoin, Dexamethasone, and Antineoplastic Agents: A Case Report and Review
Authors: Gattis Wendy A , May D Byron 
Published: January 2017

OBJECTIVE: TO describe a patient with subtherapeutic phenytoin concentrations and to review the literature regarding a possible interaction between phenytoin and chemotherapeutic agents as well as dexamethasone. CASE SUMMARY: A 29-year-old white man with brain metastases secondary to malignant melanoma consistently had suboptimal phenytoin concentrations while receiving chemotherapy consisting of cisplatin, carmustine, dacarbazine, and tamoxifen. In addition, this patient received dexamethasone, which may have influenced his phenytoin concentrations. DATA SOURCES AND STUDY SELECTION: Case reports were identified through a MEDLINE search and by cross referencing the articles identified. DISCUSSION: The available literature addressing suboptimal phenytoin concentrations in the setting of chemotherapy is reviewed. Aggressive dosing of phenytoin may be required to achieve therapeutic concentrations in patients who are concurrently receiving chemotherapy and/or dexamethasone, especially in patients who fall outside the predictive pharmacokinetic model for phenytoin. CONCLUSIONS: Subtherapeutic phenytoin concentrations may be decreased secondary to several proposed mechanisms: (1) the patient falls outside the predicted pharmacokinetic population parameters for phenytoin, (2) phenytoin absorption is decreased secondary to chemotherapy-induced gastrointestinal toxicity, and (3) metabolism of phenytoin is increased secondary to chemotherapy agents.
Pathophysiology and Management of the Serotonin Syndrome
Authors: Brown Thomas M , Skop Brian P , Mareth Thomas R 
Published: January 2017

OBJECTIVE: TO review the symptoms, pathophysiology, and treatment of the serotonin syndrome (SS). DATA SOURCES: A MEDLINE search (1957–1995) of the English-language literature pertaining to the SS was performed. Additional literature was obtained from reference lists of pertinent articles identified through the search. STUDY SELECTION AND DATA EXTRACTION: All articles were considered for possible inclusion in the review. Pertinent information, as judged by the authors, was selected for discussion. DATA SYNTHESIS: The SS, an occasionally fatal disorder, is characterized by symptoms such as mental status changes, seizures, myoclonus, and blood dyscrasias. Both the central and peripheral serotonergic systems and several serotonin receptor types are involved in the symptomatology of the SS. The pathogenesis of SS may be due to endogenous as well as iatrogenic deficits in peripheral serotonin metabolism, a stimulus for release of serotonin, and interactions with other neurotransmitter systems. Lorazepam, serotonin-blockers, and nitroglycerin have been used successfully to treat SS. CONCLUSIONS: The SS is increasingly recognized and reported in the literature. Clinical and basic science research have increased our understanding of the pathophysiology, conditions, and agents that may predispose to the development of the syndrome. Newer treatment strategies are discussed.
Site-Specific Pharmacokinetics and Pharmacodynamics of Intramuscular Meperidine in Elderly Postoperative Patients
Authors: Erstad Brian L , Meeks Mimi L , Chow Hsiao-Hui , Rappaport William D , Levinson Miriam L 
Published: January 2017

OBJECTIVE: To examine and compare the pharmacokinetics and pharmacodynamics of meperidine when administered intramuscularly at gluteal and deltoid sites in elderly postoperative patients. DESIGN: Prospective, randomized investigation. SETTING: Tertiary care university teaching hospital. PATIENTS: Fourteen patients 60 years of age or older who were undergoing general surgery. INTERVENTION: A single dose of meperidine 0.75 mg/kg given intramuscularly at either a deltoid or gluteal site. MAIN OUTCOME MEASURES: Pharmacokinetic (based on concentration—time curves) and pharmacodynamic (i.e., pain scales, need for additional pain medication) comparisons were made, based on site of meperidine injection. RESULTS: No statistically significant differences were found in the maximum plasma concentration, volume of distribution, or clearance of meperidine by site of injection. Substantial interpatient variability in pharmacokinetic parameters was noted for both sites (range of maximum concentrations: 191–500 ng/mL gluteal, 166–374 ng/mL deltoid). Although pain scores were similar for the two groups, four of the patients in the group given gluteal injection required additional breakthrough pain management within 4 hours of meperidine injection compared with one patient in the group given deltoid injection. CONCLUSIONS: There is no obvious relationship between meperidine pharmacokinetic and pharmacodynamic parameters, regardless of intramuscular injection site. Breakthrough pain is common when patients are given intramuscular injections postoperatively, particularly when the gluteal route is used. When meperidine is used for analgesia in elderly postoperative patients, consideration should be given to more rapid and predictable routes (e.g., intravenous injection) of meperidine administration.
Evaluation of Drug Interaction Document Citation in Nine On-Line Bibliographic Databases
Authors: Barillot Marine J , Sarrut Bernard , Doreau Christian G 
Published: January 2017

OBJECTTVE: To compare nine on-line bibliographic databases to obtain bibliographic references on specific drug interactions. DESIGN: Seven bibliographic databases were selected for their ability to provide information concerning drug interactions: EMBASE, MEDLINE, TOXLINE, BIOSIS, Chemical Abstracts (CAS), PHARMLINE, and International Pharmaceutical Abstracts (IPA). Two French on-line bibliographic databases (i.e., PASCAL, BIBLIOGRAPHIF) were also tested to compare them with the other international databases. Twenty drug interactions were selected randomly using the journal Reactions Weekly 1993. MAIN OUTCOMES MEASURES: The total number of references, the number of potentially relevant references, the number of case report references, the number of unique references in the total number of references, and the number of unique references between potentially relevant references were analyzed by using the Friedman two-way ANOVA by ranks. For each database, relevance and relative recall were calculated. RESULTS: For the total number of references, EMBASE was significantly more comprehensive than all other databases (p < 0.05). EMBASE had a significantly greater number of potentially relevant references than IPA, PHARMLINE, CAS, and BIBLIOGRAPHIF (p < 0.05). For the total number of case report references, only one significant difference, between EMBASE and BIBLIOGRAPHIF (p < 0.05), was observed. MEDLINE and TOXLINE had the lowest cost per potentially relevant reference. CONCLUSIONS: To obtain bibliographic references on drug interactions, the first step should be to search MEDLINE or TOXLINE; the second step, for completeness, should be to search EMBASE.
Metformin-Associated Nonketotic Metabolic Acidosis
Authors: Jurovich Mark R , Wooldridge John D , Force Rex W 
Published: January 2017

OBJECTIVE: To document a case of anion gap, nonketotic metabolic acidosis occurring in a patient with acute renal failure who was receiving metformin. CASE SUMMARY: A 67-year-old white man presented with a 9-day history of weakness, nausea, dizziness, and difficulty moving; he had also not eaten during the previous 2 days. The patient had numerous abnormalities on his serum chemistry panel and arterial blood gases, including a pH of 7.1 and an anion gap of 21 mEq/L. No ketones were detected in the urine. The patient was treated with intravenous fluids, sodium bicarbonate, insulin, and hemodialysis. All medications were discontinued. The acidosis resolved shortly after hemodialysis. The hospital course was complicated by the onset of atrial fibrillation occurring on day 2 that did not respond to chemical cardioversion. On day 6 the patient was discharged home with resolving acute renal failure and normal serum pH. CONCLUSIONS: The mortality rate of biguanide-induced lactic acidosis is approximately 50%; thus, early recognition and treatment are essential. Suspicion of lactic acidosis should be high when diabetic patients who are taking a biguanide present with acidosis. The majority of cases of metformin-induced lactic acidosis have occurred in patients with contraindications to the drug (i.e., renal dysfunction). Thus, it is important to maintain strict adherence to these contraindications and monitor patients for deteriorating renal function.
Nilutamide: An Antiandrogen for the Treatment of Prostate Cancer
Authors: Dole Ernest J , Holdsworth Mark T 
Published: January 2017

OBJECTIVE: To review the pharmacology, pharmacokinetics, efficacy, and adverse effects of nilutamide and to compare this agent with the currently marketed nonsteroidal antiandrogens (i.e., bicalutamide, flutamide) by critically analyzing the published literature. DATA SOURCES: MEDLINE (1980–1995) and CANCERLIT (1991–1995) were searched for English-language publications using the terms nilutamide, bicalutamide, and flutamide alone, and either nilutamide or androgen antagonists in combination with prostatic neoplasms. STUDY SELECTION AND DATA EXTRACTION: All articles with subject matter on nilutamide, bicalutamide, and flutamide were considered for inclusion. For studies published in more than one journal, the first publication was used unless a subsequent publication included additional or follow-up data, in which case the latter publication was cited instead. DATA SYNTHESIS: Nilutamide was effective in combination with orchiectomy in improving responses in patients with advanced prostate cancer. However, patient survival was not improved in these trials, and improvements in bone pain did not usually result in improved performance status in these patients. The few trials of nilutamide monotherapy or nilutamide in combination with a luteinizing hormone-releasing hormone analog are too small to draw meaningful conclusions regarding its efficacy or its role in the treatment of advanced prostate cancer. No comparative trials of nilutamide with other antiandrogens and no analysis of the impact of nilutamide on patient quality of life are currently available. Nilutamide appears to produce a higher frequency of adverse effects than the other currently marketed nonsteroidal antiandrogens, bicalutamide and flutamide. CONCLUSIONS: Nilutamide does not appear to represent a major advance in the treatment of advanced prostate cancer and appears to be somewhat inferior to both flutamide and bicalutamide with regard to adverse effects. Nilutamide should not be considered the antiandrogen of choice in the treatment of advanced prostate cancer.
“Isolated” Low High-Density Lipoprotein Cholesterol
Authors: Wilt Vickie M , Gums John G 
Published: January 2017

OBJECTIVE: To present information on the function, structure, and importance of high-density lipoprotein cholesterol (HDL-C) and to evaluate the current literature regarding the controversy of managing patients with an “isolated” low HDL-C concentration. DATA SOURCE: A MEDLINE search was performed (1966–June 1996) to identify English-language clinical and review articles pertaining to HDL-C. Some articles were identified through the bibliography of selected articles. STUDY SELECTION: All articles were considered for possible inclusion in the review. Pertinent information, as judged by the authors, was selected for discussion. DATA EXTRACTION: Important historical lipid studies, recent review articles, and clinical trials involving therapy for HDL-C were evaluated. DATA SYNTHESIS: The structure, function, and measurement of HDL-C and the state of an isolated low HDL-C are discussed for background. Lifestyle modification measures to increase HDL-C, medications to avoid, estrogen replacement, and lipid-altering agents used to raise an isolated low HDL-C are presented. CONCLUSIONS: An isolated low HDL-C concentration poses a risk for coronary heart disease. The management of this state is controversial. The first step in management is in agreement with experts and includes lifestyle modification (e.g., weight reduction, diet, smoking cessation, aerobic exercise). Estrogen replacement therapy and discontinuance of drugs that secondarily lower HDL-C are additional treatment options. The use of lipid-altering agents has been used in some patients. Nicotinic acid appears to be an effective agent for an isolated low HDL-C. A large clinical trial evaluating the effect of treating an isolated low HDL-C for primary and secondary prevention of coronary events is needed.
Foot and Ankle Survey in Adults with Diabetes Mellitus
Authors: Reveal Gregory T. , Laughlin Richard T. , Capecci Piero , Reeve Fredrick M. 
Published: January 2017

The purpose of this study was to examine the foot and ankle care patterns and shoe wear habits in patients with clinically proven diabetes mellitus who were attending diabetes education classes for the first time. One hundred subjects were recruited from outpatient adult diabetes education classes. No attempts were made to select patients on the basis of disease duration or severity. Each subject completed a questionnaire assessing life-style, shoe wear habits, health care status and interaction with healthcare providers. Thirty-seven percent of the subjects reported prior foot problems. Twenty percent had their feet examined regularly and 59% had never had their feet examined. Foot problems reported were: corns 11%, calluses 11%, bunions 3%, ulcers 1%, gout 1%. Sensation was tested using the 5.07 Semmes Weinstein monofilament across seven zones of the plantar surface of the foot. Subjects unable to feel this varied from 5% to 20% in each of the zones. Shoe wear was assessed for fit and style. Thirty percent of the patients had shoes that were too narrow and 81% of the patients with poorly fitting shoes were women. Shoe wear history and factors influencing shoe selection were recorded. Diabetes mellitus is a common disease, often affecting the feet. Preventive care can help patients deal with the manifestations of diabetic neuropathy. This study showed that a low percentage of subjects with diabetes regularly have their feet examined and that a relatively high percentage (31%) wear shoes that are too narrow. Identifying these patients early may allow modification of habits that put their feet at risk.
Development of a Nurse-Provided Health System Strategy for Diabetic Foot Care
Authors: Pinzur Michael S. , Keman-Schroeder Diane , Emanuele Nicholas V. , Emanuel MaryAnn 
Published: January 2017

A nurse-provided university health system diabetic foot screening/education/treatment program evaluated 403 patients in the initial 12 months of development. All patients were provided individualized foot-specific patient education, varying in intensity with the magnitude of their risk status. One hundred and forty-five (36%) were categorized as being at risk for the development of a diabetic foot ulcer. Improper footwear capable of producing foot ulceration was recorded in 268 (66.5%) of the enrollees. Seven patients with previously undiagnosed Charcot foot disorder were identified. Eighty-three of the enrollees were seen at least once in follow-up. Sixty-one (73%) used improper footwear at the initial evaluation, which was decreased to 36 (43%) at the first follow-up visit. Nurse-provided foot-specific diabetic screening and education, combined with protective footwear, has been shown to be a cost- and resource-effective method of decreasing the rate of diabetic foot ulcers, and the risk for eventual lower extremity amputation.
Visualization of Ankle Tendons and Ligaments with MR Imaging: Influence of Passive Positioning
Authors: Farooki Sheila , Sokoloff Ronald M. , Theodorou Daphne J. , Trudell Debra J. , Clopton Paul , Feng Sunah A. K. , Resnick Donald 
Published: January 2017

Purpose: To determine if passive positioning of the ankle influences the MR imaging appearance of ankle tendons and ligaments. Methods: A positioning device was used during imaging of 10 volunteers. Axial and coronal T1-weighted images were acquired in six positions of the ankle, and the appearance of the tendons and lateral ligaments was subjectively evaluated. Results: The peroneus longus (PL), peroneus brevis (PB), anterior tibialis (AT), extensor digitorum longus (EDL), and extensor hallucis longus (EHL) tendons were best visualized in 20° of plantarflexion and 20° of inversion (p<0.0001). The anterior talofibular (ATF) and calcaneofibular (CF) ligaments were best seen in 20° of plantarflexion (p<0.0001). Ten degrees of dorsiflexion was the least useful imaging plane for all of the aforementioned structures. Conclusion: When there is clinical concern regarding pathology of a specific structure about the ankle, passive positioning may allow optimal evaluation.
Tarsal Tunnel Syndrome Associated with an Accessory Muscle
Authors: Kinoshita Mitsuo , Okuda Ryuzo , Morikawa Junichi , Abe Muneaki 
Published: January 2017

Between 1986 and 1999, we surgically treated 41 patients (49 feet) with Tarsal Tunnel Syndrome (TTS) in whom seven (eight feet) were associated with an accessory muscle. An accessory flexor digitorum longus muscle was present in six patients, and an accessory soleus muscle was in one patient (both feet). Three of them were males and four females, with the mean age of 33.1 years (12 to 59 years). The mean interval from the onset of symptoms to operation was 7.5 months (range, six to nine months). All patients with an accessory muscle had a history of trauma or strenuous sporting activity. The diagnosis of TTS was made based on physical findings in all the patients (eight feet) and confirmed in five patients (six feet) by electrophysiological examination. Imaging examinations (radiography, ultrasonography, MRI) revealed abnormal bone and soft tissue lesions in and around the tarsal tunnel. Preoperative signs and symptoms disappeared average 4.1 months after decompression of the tibial nerve in addition to excision of the muscle. No functional deficit was observed at final follow-up (24 to 88 months).
Operative Repair of Fourth and Fifth Toe Corns
Authors: Coughlin Michael J. , Kennedy Michael P. 
Published: January 2017

Methods: We report a retrospective review of 57 consecutive patients (72 feet) over a period of 20 years who had been treated operatively for either a lateral fifth toe corn or an interdigital corn of the fourth interdigital space more than two years previously. Of these, 51 patients (62 feet) returned for a follow-up evaluation at a minimum of two years (average of over seven years) which included a review of the interval history since the surgery, a physical examination, a radiographic evaluation, and assessment of the patient's satisfaction with the alignment and results of surgery. Treatment of 31 lateral fifth toe corns involved either a lateral condylectomy and flexor tenotomy or a complete condylectomy. Treatment of 31 interdigital corns comprised either a single condylectomy, double condylectomy of adjacent corns, or a complete condylectomy (hammertoe repair) of a symptomatic corn. Treatment in each case was dependent upon the severity of the deformity. Results: There was found to be no significant difference in comparison of the two major groups (interdigital corns and lateral fifth toe corns) with the measurement of the relative length of the fourth and fifth metatarsals, toe malalignment, angulation of the fourth and fifth toes (MTP-4, MTP-5 angles), and the phalangeal-5 angle. Pain was relieved in 58 of 62 feet (93%) and subjective acceptable alignment was achieved in 54 of 62 feet (87%). At final follow-up 53 feet were rated by patients as excellent, seven as good, one as fair, and one as poor. Complications included numbness of the involved digit (six feet). There were two superficial infections. There were two cases of joint instability due to excessive bone resection. Joint stiffness was commonly observed (34/62 feet, 55%), but was not associated with diminished satisfaction at final follow-up. Mild asymptomatic recurrence of a callosity was noted in 10 feet and moderate or severe recurrence was noted in two feet. Dissatisfaction was associated with moderate or severe recurrence. Conclusion: In this retrospective study at an average of more than seven years, we achieved a high level of patient satisfaction treating both lateral fifth toe corns and interdigital corns with a partial and/or complete condylectomy, the choice depending upon the magnitude of the deformity and the callus, and the fixed nature of the lesser toe deformity.