bluuebunny/crossref_metadata_2025_split huggingface dataset:
Iatrogenic adrenal insufficiency as a side-effect of combined treatment of itraconazole and budesonide
Authors: Skov M. , Main K.M. , Sillesen I.B. , Müller J. , Koch C. , Lanng S. 
Published: October 2002

A recent case of iatrogenic Cushing's syndrome and complete suppression of the pituitary-adrenal-axis in a patient with cystic fibrosis (CF) and allergic bronchopulmonary aspergillosis treated with itraconazole as an antifungal agent, and budesonide as an anti-inflammatory agent led to a systematic assessment of this axis and gonadal function in all patients treated with itraconazole in the authors' CF centre. Itraconazole can inhibit CYP3A, thus interfering with synthesis of gluco- and mineralocorticoids, androgens and oestradiol as well as the metabolism of budesonide. The aim of this study was to evaluate adrenal and gonadal function in patients treated with itraconazole with or without budesonide.An adrenocorticotrophic hormone (ACTH) test (250 µg tetracosactid) was performed in 25 CF patients treated with both itraconazole and budesonide, and in 12 patients treated with itraconazole alone (six patients with CF and six with chronic granulomateous disease). Mineralocorticoid and gonadal steroid function were evaluated by measurements of plasma-renin, follicle stimulating hormone, luteinising hormone, progesterone, oestradiol, testosterone, serum-inhibin A and B. ACTH tests performed as part of a pretransplantation programme in an additional 30 CF patients were used as controls.Eleven of the 25 patients treated with both itraconazole and budesonide had adrenal insufficiency. None of the patients on itraconazole therapy alone nor the control CF patients had a pathological ACTH test. Mineralocorticoid and gonadal insufficiency was not observed in any of the patients. Only one patient with an initial pathological ACTH-test subsequently normalised, the other 10 patients improved but had not achieved normalised adrenal function 2–10 months after itraconazole treatment had been discontinued.Suppression of the adrenal glucocorticoid synthesis was observed in 11 of 25 cystic fibrosis patients treated with both itraconazole and budesonide. The pathogenesis is most likely an itraconazole caused increase in systemic budesonide concentration through a reduced/inhibited metabolism leading to inhibition of adrenocorticotrophic hormone secretion along with a direct inhibition of steroidogenesis. In patients treated with this combination, screening for adrenal insufficiency at regular intervals is suggested.
Does long-term oxygen therapy reduce hospitalisation in hypoxaemic chronic obstructive pulmonary disease?
Authors: Ringbaek T.J. , Viskum K. , Lange P. 
Published: October 2002

The aim of this study was to determine whether long-term oxygen therapy (LTOT) reduces hospitalisation in hypoxaemic patients with chronic obstructive pulmonary disease (COPD). The circumstances of initiation of LTOT (start during hospitalisationversusstart as an outpatient) and compliance with oxygen were also investigated (continuous oxygen therapy (COT) ≥15 h dailyversusnoncontinuous oxygen therapy (NCOT) <15 h daily).A total 246 COPD patients were studied, with each patient acting as their own control. Patients were divided into four groups: 125 patients on COT who started LTOT in conjunction with hospitalisation, 37 patients on COT who started LTOT as outpatients, 58 patients on NCOT who started LTOT in conjunction with hospitalisation and 26 patients on NCOT who started LTOT as outpatients. Admission rates, days spent in hospital and number of patients with at least one hospitalisation (ever hospitalised) were compared in two periods of 10 months before and after initiation of LTOT.Overall during the LTOT period, in comparison with the preoxygen period, the admission rates, hospital days and “ever hospitalised” were reduced by 23.8%, 43.5% and 31.2%, respectively. Among patients who started LTOT as outpatients, a tendency towards a higher effect in the compliant group was observed.This study shows that in hypoxaemic chronic obstructive pulmonary disease patients, long-term oxygen therapy is associated with a reduction in hospitalisation.
Nutritional depletion in patients on long-term oxygen therapy and/or home mechanical ventilation
Authors: Cano N.J.M. , Roth H. , Court-Fortuné I. , Cynober L. , Gérard-Boncompain M. , Cuvelier A. , Laaban J-P. , Melchior J-C. , Pichard C. , Raphaël J-C. , Pison C.M. 
Published: October 2002

The purpose of this study was to estimate the prevalence of malnutrition in outpatients on long-term oxygen therapy or home mechanical ventilation, to determine the relationships between malnutrition and impairment/disability and smoking and also to identify relevant tools for routine nutritional assessment.In 744 patients (M:F 1.68, aged 65±15 yrs) with chronic obstructive pulmonary disease (COPD, 40%), restrictive disorders (27%), mixed respiratory failure (15%), neuromuscular diseases (13%) and bronchiectasis (5%), body mass index (BMI), fat-free mass (FFM), serum albumin, transthyretin, 6-min walking test, forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and blood gases were recorded.FFM was the most sensitive parameter for detecting malnutrition, being abnormal in 53.6% of patients, while BMI was <20 in 23.2%, serum albumin <35 g·L−1in 20.7 %, and serum transthyretin <200 mg·L−1in 20%. FFM depletion predominated in neuromuscular, bronchiectasis and restrictive disorders. BMI and FFM were correlated with FEV1, FVC and 6-min walking test. In multivariate analysis a BMI<20 was related to FEV1and smoking habits, and a low FFM to smoking, FEV1and female sex.Malnutrition is highly prevalent in home-assisted respiratory patients and is related to causal disease, forced expiratory volume in one second, smoking and disability. Fat-free mass appeared to be the most sensitive and relevant nutritional parameter according to impairment and disability.
Low-dose pulse methylprednisolone for systemic lupus erythematosus flares is efficacious and has a decreased risk of infectious complications
Authors: Badsha H , Kong K O , Lian T Y , Chan S P , Edwards C J , Chng H H 
Published: October 2002

We sought to test our clinical impression that using a low dose methylprednisolone pulse (MEP; µ1500 mg over 3 days) in treating flares of systemic lupus erythematosus (SLE) was effective and associated with fewer serious infections. We retrospectively studied SLE patients who received MEP between 1989 and 2000. A ‘low dose’ group of 26 patients who had received 1–1.5 g and a ‘high dose’ group of 29 patients who received 3–5 g of MEP were identified. SLEDAI scores and prednisolone doses were recorded at the time of MEP pulses and 6 months later. All serious infections (requiring admission and i.v. antibiotics) occurring during this 6 month period and their outcomes were recorded. Both groups had similar demographic data, initial SLEDAI scores, i.v. cyclophosphamide use, and SLE organ involvement. Despite high-and low-dose MEP being efficacious in controlling disease activity (lowering of SLEDAI scores and subsequent prednisolone dose) there were only nine episodes of serious infection in seven patients in the low-dose group compared with 20 episodes in 17 patients from the high-dose group (P ^ 0.04). In both groups a majority of infections (75 and 77% in the high-and low-dose groups) occurred in the first month after MEP. Those with a low serum albumin (< 20 g/l) had an increased risk of mortality (OR 44, 90% CI 6.19–312.98) and a trend towards greater numbers of infections. Low-dose MEP was effective in controlling SLE flares and associated with fewer serious infections than traditional high-dose MEP.
Estimating the incidence of systemic lupus erythematosus in a tropical region (Natal, Brazil)
Authors: Vilar M J Pereira , Sato E I 
Published: October 2002

The objective of the study was to evaluate the incidence of Systemic Lupus Erythematosus (SLE) in a tropical urban community (Natal city, Brazil). Only patients living in Natal, a city in the northeastern area of Brazil, older than 15 years, and who fulfilled at least four of the American College of Rheumatology criteria between 1 January 2000 and 31 December 2000, were included. Four sources were used to identify new cases of SLE: (1) the University Hospital; (2) ‘health units’ and hospitals of the public health network; (3) specialists at private hospitals and outpatient clinics; and (4) three laboratories performing antinuclear antibody (ANA) determination. Census data from 2000 for Brazilian population was used to calculate incidence rate. The standardized mortality ratio (SMR) method and 95% confidence intervals (95% CI) were calculated. Forty-three patients were diagnosed as new SLE cases in 2000. The calculated incidence was 8.7/100 000/year (95% CI 6.3–11.7). Thirty-eight patients were female 14.1/100000/year (95% CI 10.0–19.3) and five were male 2.2/100 000/year (95% CI 0.7–5.2). The mean age of new SLE cases was 31.8 years old. (95% CI 27.8–35.8). The mean age for females was 31.4 and for males was 35.0 years old. The median of disease duration (time between onset of the first ACR criterion for SLE and diagnosis) was 10 months (1–72 months). This study demonstrated a high incidence of SLE in Natal, apparently higher than reported in other places. The mean age at diagnosis seems lower than referred by other studies. The observed differences may be due to ethnic and/or environmental factors.
Use of drugs, alcohol and tobacco by people with schizophrenia: case–control study
Authors: McCreadie Robin G. 
Published: October 2002

BackgroundSpecialised services should be developed to help people with schizophrenia and associated substance misuse. The extent of the problem therefore needs to be known.AimsTo determine the use of drugs, alcohol and tobacco by people with schizophrenia drawn from rural, suburban and urban settings, and to compare use by general population control subjects.MethodPeople with schizophrenia (n=316) and general population controls of similar gender distribution, age and postcode area of residence (n=250) were identified in rural, urban and suburban areas of Scotland. Use of drugs and alcohol was assessed by the Schedules for Clinical Assessment in Neuropsychiatry, and use of tobacco by a questionnaire.ResultsMore patients than controls reported problem use of drugs in the past year (22 (7%)v.5 (2%)) and at some time before then (50 (20%)v.15 (6%)) and problem use of alcohol in the past year (42 (17%)v.25 (10%)) but not at sometime previously (99 (40%)v.84 (34%)). More patients were current smokers (162 (65%)v.99(40%)).ConclusionsProblem use of drugs and alcohol by people with schizophrenia is greater than in the general population, but absolute numbers are small. Tobacco use is the greatest problem.
Ethics Seminars: Teaching Professionalism to “Problem” Residents
Authors: Marco Catherine A. 
Published: October 2002

AbstractProfessional skills, which include communication, compassion, honesty, integrity, altruism, service, commitment, suspension of self‐interest, commitment to excellence, authority, and accountability, are essential skills that should be taught during residency. A variety of approaches can be used, which include didactic teaching, bedside teaching, leadership, evaluation, and individualized mentorship. Deficiencies in professional skills should be identified early in the residency program, and should be addressed on an individual level.
Bench to Bedside: Pathophysiology of Acute Coronary Syndromes and Implications for Therapy
Authors: Brogan Gerard X. 
Published: October 2002

AbstractOur understanding of the pathophysiology of unstable angina (UA) and non—ST‐segment elevation (NSTE) myocardial infarction (MI) [commonly referred to as NSTE acute coronary syndrome(s) (ACS)] has evolved considerably over the years, with atherothrombosis playing a pivotal role. This review discusses the molecular interactions in coronary thrombosis that may serve as therapeutic targets for more effective management of these syndromes. The purposes of this review are: 1) to discuss current understanding of the pathophysiology of NSTE ACS; 2) to describe recent studies with novel antithrombotic agents [e.g., low‐molecular‐weight heparin, thienopyridines, glycoprotein (GP) IIb‐IIIa inhibitors] in patients with NSTE ACS; and 3) to highlight recommendations for management of patients with NSTE ACS in the recently updated American College of Cardiology (ACC)/ American Heart Association (AHA) guidelines, including the appropriate use of antithrombotic therapies.
An Alternate Light Source to Detect Semen
Authors: Nelson David G. , Santucci Karen A. 
Published: October 2002

AbstractThe Wood's lamp (WL) has been used in sexual assault evaluations. Recent data have shown that semen does not fluoresce with a WL and that physicians are unable to differentiate semen from other common medicaments using a WL. Objectives: To determine whether physicians could differentiate semen from other products using an alternate light source (ALS), and to investigate whether a brief training period with the ALS would enhance physicians' ability to differentiate between semen and other commonly used products. Methods: An ALS, Bluemaxx BM500, was found to cause semen to fluoresce. Physicians were first asked to use this ALS to identify semen and then to distinguish between a semen sample and other products. Physicians then received a training class on the use of the ALS and were then asked to differentiate semen from other products. Results: All physicians identified the semen as fluorescing and 25% successfully differentiated the semen from the other products using the ALS. Products most commonly mistaken for semen were a hand cream, Castille soap, and bacitracin. After the training session, 83% of the physicians successfully differentiated the semen from other products. The ALS, while not specific for semen identification, was 100% sensitive for it. Conclusions: Physicians instructed in the use of an alternate light source (BM 500) are able to identify semen as fluorescing and can differentiate semen (after a training session) from other commonly used products.
Etiology and Weekly Occurrence of Alcohol‐related Seizures
Authors: Rathlev Niels K. , Ulrich Andrew , Shieh Ted C. , Callum Michael G. , Bernstein Edward , D'Onofrio Gail 
Published: October 2002

Abstract Objectives: 1) To determine the prevalence of identifiable causes of alcohol‐related seizures other than alcohol withdrawal. 2) To test the hypothesis that patients with alcohol‐related seizures present with greater frequency following Sundays when alcohol is not commercially available. Methods: This was a retrospective chart review of 140 consecutive patients presenting with alcohol‐related seizures during a six‐month period. Identifiable causes of seizures other than alcohol withdrawal and the day of the week of presentation were documented. Results: One hundred forty individual patients were eligible for study. Identifiable causes of seizures other than alcohol withdrawal were found in 53.6% of patients, and they were distributed as follows: 1) current or past history of significant head trauma 25.7%, 2) idiopathic seizure disorder 15.7%, 3) cerebrovascular accident 5.7%, 4) nontraumatic intracranical lesion 3.6%, and 5) toxic/metabolic abnormalities 2.9%. Alcohol is not available for purchase on Sundays because of the “Blue Laws” in Massachusetts. A total of 34.5% of patients with alcohol withdrawal seizures presented on Mondays (p < 0.001). Of patients with identifiable causes of seizures other than alcohol withdrawal, only 16% presented on Mondays (p > 0.10). Conclusions: Approximately 50% of seizures in alcohol‐dependent patients are potentially unrelated to alcohol withdrawal. Patients with alcohol withdrawal seizures presented withgreater frequency on Mondays following the 24‐hour period when alcohol was not commercially available in Boston. This suggests that patients with alcohol withdrawal seizures may present with greater frequency following periods of decreased availability of alcohol.
Manual Measurement of QT Dispersion in Patients with Acute Myocardial Infarction and Nondiagnostic Electrocardiograms
Authors: Calder Kirsten K. , Tomongin Chris , Mallon William K. , Genna Tammy , Bretsky Philip , Henderson Sean O. 
Published: October 2002

Abstract Objective: To determine whether manually measured QT dispersion (QTD) may be a useful diagnostic adjunct for acute myocardial infarction (AMI) in emergency department patients with chest pain (CP) and nondiagnostic initial electrocardiograms (ECGs). Methods: This was a retrospective review of a cohort of patients admitted to the coronary triage unit (CTU) at a large urban facility over a two‐year period (1997‐1999). Cases included all patients with nondiagnostic initial ECGs diagnosed as having AMI by enzymatic criteria. Controls consisted of patients admitted to the CTU who received a final diagnosis of “musculoskeletal pain” at discharge. The QT intervals were measured on the ECGs obtained on presentation. The ECGs were included only if the QT interval could be measured on at least eight out of 12 leads. The QTD was calculated as the difference between the longest and shortest QT intervals in all measured leads. All measurements and calculations were done by a single individual. The QTDs were compared for cases versus controls using 50 msec as a cutoff for the presence of AMI. Results: The study cohort consisted of 36 cases and 124 controls. The QTDs between the two groups were markedly different, with the mean for the cases at 85.5 msec [range: 40 to 200; ±standard deviation (SD) = 39.6] and for the controls 47.1 msec (range: 0 to 120; ±SD = 20.4). The unadjusted odds ratio (OR) of having a QTD greater than 50 msec in the setting of AMI and a nondiagnostic initial ECG in this cohort was 11.9 [95% confidence interval (95% CI) = 5.0 to 28.4; p < 0.0001] and was 12.5 (95% CI = 4.8 to 32.3; p < 0.0001) adjusted for age, gender, and ethnicity. Conclusions: Manually measured QTD is significantly greater in patients with AMI and nondiagnostic ECGs versus healthy controls with musculoskeletal CP. Along with other data, QTD may serve as a useful diagnostic and decision‐making tool in patients with acute CP and nondiagnostic ECGs.
Phase I Study of Temozolomide in Relapsed/Refractory Acute Leukemia
Authors: Seiter Karen , Liu Delong , Loughran Thomas , Siddiqui Ahmad , Baskind Paul , Ahmed Tauseef 
Published: October 2002

PURPOSE: To determine the dose-limiting toxicity and maximum-tolerated dose of temozolomide in patients with acute leukemia. PATIENTS AND METHODS: Twenty patients (16 with acute myelogenous leukemia, two with acute lymphoblastic leukemia, and two with chronic myelogenous leukemia in blastic phase) received 43 cycles of temozolomide. Patients began treatment at two different dose levels: 200 mg/m2/d for 7 days or 200 mg/m2/d for 9 days. RESULTS: Prolonged aplasia was the dose-limiting toxicity, and the maximum-tolerated dose was 7 days of temozolomide. Overall treatment was well tolerated: hospitalization was required in only nine of 43 courses, and there were no treatment-related deaths. Two patients obtained a complete response, and two others met criteria for complete response except for platelet recovery. Overall, nine of 20 patients had a significant decrease in bone marrow blasts after temozolomide treatment. CONCLUSION: Temozolomide was well tolerated and had significant antileukemic activity when administered as a single agent. Further studies of temozolomide in hematologic malignancies are indicated.
Initial Clinical Trial of Oral TAC-101, a Novel Retinoic Acid Receptor-Alpha Selective Retinoid, in Patients With Advanced Cancer
Authors: Rizvi Naiyer A. , Marshall John L. , Ness Elizabeth , Hawkins Michael J. , Kessler Craig , Jacobs Helena , Brenckman Wayne D. , Lee Jin S. , Petros William , Hong Waun K. , Kurie Jonathan M. 
Published: October 2002

PURPOSE: The goals of this study were to determine the safety, toxicity, and pharmacokinetics of TAC-101, a novel synthetic retinoic acid receptor-alpha (RAR-α) selective retinoid, in patients with advanced cancer. PATIENTS AND METHODS: Twenty-nine patients at two centers received oral TAC-101 at doses ranging from 12 to 34 mg/m2/d. Pharmacokinetic sampling was performed on days 1 and 28. RESULTS: The most frequent toxicities were myalgia/arthralgia, fatigue, and triglyceridemia. No dose-limiting toxicities were observed within the first 28 days up to 28 mg/m2. However, seven of 21 patients experienced venous thromboembolic events (VTEs) during TAC-101 treatment. Eight additional patients who received 34 mg/m2 were treated after a hypercoagulable work-up to exclude potential risk factors for VTE, and two of eight patients subsequently experienced VTEs. The maximum tolerated dose was exceeded at 34 mg/m2/d within the first 28 days, with one grade 3 hypertriglyceridemia, two grade 3 myalgia/arthralgia, and one grade 3 fatigue. One patient with advanced non–small-cell lung cancer had a complete response. No other responses were observed. No autoinduction of metabolism was observed with dosing over 28 days. CONCLUSION: This is the first human clinical study with TAC-101, a RAR-α selective retinoid. Musculoskeletal toxicity and hypertriglyceridemia were observed characteristics of previously studied retinoids. The recommended phase II dose is 24 mg/m2 with this treatment schedule. Alternative treatment schedules and prospective evaluation of thrombotic risk will be investigated in subsequent studies.
Alendronate in the Treatment of Primary Hyperparathyroid-Related Osteoporosis: A 2-Year Study
Authors: Parker C. R. , Blackwell P. J. , Fairbairn K. J. , Hosking D. J. 
Published: October 2002

We investigated the effect of alendronate on calcium, PTH, and bone mineral density in 27 female and 5 male patients with primary hyperparathyroidism. The treatment group [n = 14; T score ≤ −2.5 sd at the femoral neck (FN) or T ≤ −1.0 sd plus previous nonvertebral fracture] was given alendronate 10 mg/d for 24 months. The second group (n = 18; T score &gt; −2.5 sd at the FN) was untreated. Biochemistry was repeated at 1.5, 3, 6, 12, 18, and 24 months, and dual-energy x-ray absorptiometry at 12 and 24 months.There were no significant between-group baseline differences in calcium, creatinine, or PTH. Alendronate-treated patients gained bone at all sites [lumbar spine (LS), 1 yr gain, +7.3 ± 1.7%; P &lt; 0.001; 2 yr, +7.3 ± 3.1%; P = 0.04). Untreated patients gained bone at the LS over 2 yr (+4.0 ± 1.8%; P = 0.03) but lost bone elsewhere. Calcium fell nonsignificantly in the alendronate group between baseline (2.84 ± 0.12 mmol/liter) and 6 wk (2.76 ± 0.09 mmol/liter), with a nonsignificant rise in PTH (baseline, 103.5 ± 14.6 ng/liter; 6 wk, 116.7 ± 15.6 ng/liter). By 3 months, values had reverted to baseline.In primary hyperparathyroidism, alendronate is well tolerated and significantly improves bone mineral density at the LS (with lesser gains at FN and radius), especially within the first year of treatment. Short-term changes in calcium and PTH resolve by 3 months.