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p-Aminohippuric Acid/ME; Adult; Blood Pressure/DE; Comparative Study; Dopamine/ME/*PD; Female; Heart Rate/DE; Human; Hypertension/*ME; Infusions, Intravenous; Inulin/ME; Kidney/*DE; Male; Middle Age.

Enhanced dopamine renal responsiveness in patients with hypertension.

JOURNAL ARTICLE.

The purpose of the study was to compare the renal effects of low doses of exogenous dopamine to assess the responsiveness of renal dopaminergic receptors in normotensive and hypertensive subjects. Eight hypertensive patients and seven normotensive volunteer subjects were studied. Inulin and para-aminohippuric (PAH) clearances, natriuresis, and fractional excretion of sodium increased significantly after intravenous dosing with dopamine (2 micrograms/min/kg) in both groups. These increases were significantly higher in hypertensive than in normotensive subjects: 31.8% +/- 3.7% vs. 16.2% +/- 1.2% for inulin clearance (P less than 0.01), 83.3% +/- 10.5% vs. 41.1% +/- 3.4% for PAH clearance (P less than 0.01), and 331% +/- 38% vs. 216% +/- 26% for natriuresis (P less than 0.01). These findings suggest hyperresponsiveness to dopamine during hypertension. This enhanced response to exogenous dopamine can be considered as a further argument favoring the existence of a deficit in dopaminergic activity during hypertension. Dopamine also induced a significant reduction in blood pressure and increased heart rate in hypertensive subjects but no significant change in blood pressure and heart rate occurred in normotensive subjects.

Andrejak M; Hary L.

Clin Pharmacol Ther 8703; 40(6):610-4

Acetylation; Adult; Amrinone/AA/BL/*ME/UR; Human; Infusions, Intravenous; Kinetics; Male; Phenotype.

Effect of the acetylator phenotype on amrinone pharmacokinetics.

JOURNAL ARTICLE.

Ten healthy male subjects were phenotyped with isoniazid for their acetylator status and then received intravenous amrinone at a dose of 75 mg during a period of 10 minutes. Blood samples were drawn at specified times during a 24-hour period after dosing. Plasma concentrations of amrinone were determined by a specific HPLC method. The plasma concentration data were fitted to a biexponential model by nonlinear regression. The mean apparent first-order elimination t1/2 for amrinone in the slow acetylators was 4.4 hours, whereas it was 2.0 hours in the fast acetylators (P less than 0.05). There was little difference in the volume of distribution at steady state. Clearance was lower in the slow acetylators, 16.6 L/hr, than in the fast acetylators, 37.2 L/hr (P less than 0.05). The AUC was higher for the slow acetylators, 4.96 micrograms X hr X ml-1, than for the fast acetylators, 2.20 micrograms X hr X ml-1 (P less than 0.01). Concentrations of amrinone and its N-acetyl metabolite in the urine from each volunteer were determined. The ratio of N-acetylamrinone to amrinone was calculated and, as expected, the fast acetylators had a higher ratio than did the slow acetylators (P less than 0.01).

Hamilton RA; Kowalsky SF; Wright EM; Cernak P; Benziger DP; Stroshane RM; Edelson J.

Clin Pharmacol Ther 8703; 40(6):615-9

Adult; Diazepam/ME/*PD; Double-Blind Method; Drug Evaluation; Drug Interactions; Human; Kinetics; Psychomotor Performance/*DE; Pyrimidines/ME/*PD; Random Allocation.

Combined effects of buspirone and diazepam on objective and subjective tests of performance in healthy volunteers.

JOURNAL ARTICLE.

The combined effects on performance of two anxiolytics with different mechanisms of action were evaluated double-blind and crossover in 12 healthy students. Objective (tracking, divided attention, Maddox wing, etc.) and subjective (visual analogue scales and questionnaires) tests were done before and twice after single oral doses. Diazepam (0.15 and 0.30 mg/kg) impaired performance dose relatedly and rendered the subjects drowsy, calm, mentally slow, and clumsy. Buspirone (15 mg) proved inactive in objective tests but matched diazepam (0.30 mg/kg) subjectively. In combinations, buspirone added to the effects of diazepam in Maddox wing and letter cancellation but tended to counteract diazepam effects on divided attention and learning acquisition. Subjectively buspirone prolonged diazepam-induced sedation. Increased calmness caused by diazepam was not affected by concomitant buspirone. It is suggested that combining small doses of buspirone to diazepam does not cause any additional decrement in psychomotor performance. Possible advantages of the diazepam-buspirone combination in therapeutic use are discussed.

Mattila M; Seppala T; Mattila MJ.

Clin Pharmacol Ther 8703; 40(6):620-6

Adolescence; Adult; Chromatography, Gas; Drug Interactions; Human; Kinetics; Male; Platelet Aggregation/*DE; Prostaglandin Endoperoxides, Synthetic/PD; Random Allocation; Thromboxane A2/*AA/*AI/BL/PD.

Quantitation of drug levels and platelet receptor blockade caused by a thromboxane antagonist.

JOURNAL ARTICLE.

SQ 28,668 is a structural analog of thromboxane A2. It inhibits the effects of thromboxane in vitro. Fifty-six healthy male subjects were given either placebo or three equal daily doses of SQ 28,668 ranging from 25 to 1200 mg. Plasma drug concentrations increased in a dose-dependent manner. The shape of the plasma drug concentration-time curve was consistent with enterohepatic recirculation. The effects of SQ 28,668 on ex vivo platelet aggregation suggested that SQ 28,668 is a specific competitive antagonist of thromboxane A2 with a platelet receptor dissociation constant (estimated by Schild analysis) of about 19 nmol/L. Approximately 94% occupation of thromboxane receptors by SQ 28,668 was required to produce a small but measurable increase of the template bleeding time. Dose-ranging studies of antithrombotic drugs are difficult and expensive. For this reason, a method was developed that allows estimation of the dose of a thromboxane receptor antagonist that would be expected to be therapeutically equivalent to a given dose of aspirin.

Friedhoff LT; Manning J; Funke PT; Ivashkiv E; Tu J; Cooper W; Willard DA.

Clin Pharmacol Ther 8703; 40(6):634-42

Adult; Blood Pressure/DE; Debrisoquin/*ME/PD; Drug Interactions; Guanidines/BL/*ME; Human; Isoquinolines/*ME; Kinetics; Liver/DE/*ME; Liver Cirrhosis/*ME; Male; Metabolic Clearance Rate/DE; Middle Age; Phenotype; Pulse/DE; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..

Effect of cirrhosis and debrisoquin phenotype on the disposition and effects of pinacidil.

JOURNAL ARTICLE.

Pinacidil is an investigational vasodilator currently undergoing clinical trials as an antihypertensive agent. It is metabolized in humans to pinacidil N-oxide. To determine whether pinacidil's metabolism or effects were influenced by either liver disease or the subject's debrisoquin phenotype, eight patients with chronic stable cirrhosis and 13 healthy subjects were studied. Seven of the healthy volunteers were extensive metabolizers of debrisoquin, whereas six were of the poor metabolizer phenotype. Neither the clearance of pinacidil nor the production of the N-oxide was altered by the subjects' debrisoquin phenotype. Cirrhosis produced a 50% reduction in pinacidil's clearance (20.7 +/- 1.4 vs. 42.1 +/- 5.1 L/hr; P less than 0.0005) and a prolongation in the elimination t1/2 from 3.9 +/- 0.3 to 6.1 +/- 0.6 hours (P less than 0.01). Less pinacidil was metabolized to the N-oxide metabolite in the patients with cirrhosis than in the normal individuals. Thus pinacidil's metabolism and clearance are reduced in patients with cirrhosis but are independent of debrisoquin phenotype.

Shaheen O; Patel J; Avant GR; Hamilton M; Wood AJ.

Clin Pharmacol Ther 8703; 40(6):650-5

Blood Proteins/ME; Chromatography, High Pressure Liquid; Female; Fetal Blood/*AN; Fetus/*ME; Human; Infant, Newborn; Kinetics; Maternal-Fetal Exchange; Pregnancy; Ritodrine/BL/*ME; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..

Ritodrine pharmacokinetics.

JOURNAL ARTICLE.

The purpose of this study was to add to the limited information available regarding the pharmacology of ritodrine in the peripartum period when treatment fails and labor is not inhibited. Plasma or urine samples from eight parturients and 13 infants were studied; in addition plasma samples at delivery were obtained from a total of 26 mothers and infants. All the mothers received ritodrine in the 24 hours before delivery. Plasma and urine ritodrine (free and conjugated) were determined with HPLC by electrochemical detection. In maternal plasma, an apparent rapid distribution phase with a t1/2 of 32 +/- 21 minutes was followed by a prolonged equilibrium phase with a t1/2 of 17 +/- 10 hours. Seventy-six percent of the ritodrine excreted by the mother was in the form of a conjugate. Ninety percent of the ritodrine excreted by the neonate was also excreted in the form of a conjugate.

Kuhnert BR; Gross TL; Kuhnert PM; Erhard P; Brashar WT.

Clin Pharmacol Ther 8703; 40(6):656-64

Adolescence; Adult; Aged; Aging; Cimetidine/*PD; Comparative Study; Drug Evaluation; Gastric Acid/*SE; Gastric Mucosa/*DE; Human; Hydrogen-Ion Concentration; Infusions, Intravenous; Male; Middle Age; Random Allocation; Ranitidine/*PD.

The effect of single intravenous doses of cimetidine or ranitidine on gastric secretion.

JOURNAL ARTICLE.

Intravenous cimetidine, 300 mg or 400 mg, or ranitidine, 50 mg, was administered as a single dose to 36 volunteers in a randomized, crossover fashion. Aspirates of gastric juice were obtained after dosing, and the pH, titratable acidity, gastric fluid volume, and gastric acid output were determined from baseline through 71/2 hours for each subject. Each intervention significantly increased pH and suppressed hydrogen ion concentration, gastric fluid volume, and gastric acid output. Both the magnitudes of the changes when compared with baseline and the time of the mean maximum effects were similar in all three drug regimens. The effect of all three interventions on gastric fluid volume and gastric acid output diminished sharply after 6 hours. The data indicate that the gastric secretory response to all three interventions did not differ substantially.

Frank WO; Peace KE; Watson M; Seaman JJ; Szego PL; Braverman A; Mico B; Dickson B.

Clin Pharmacol Ther 8703; 40(6):665-72

Absorption; Adult; Aerosols; Blood Glucose; Comparative Study; Double-Blind Method; Epinephrine/AD/BL/*ME; Heart Rate/DE; Human; Injections, Subcutaneous; Male; Potassium/BL; Random Allocation; Tremor/CI.

Systemic absorption of inhaled epinephrine.

JOURNAL ARTICLE.

To determine the systemic absorption of epinephrine when it is given by inhalation, six normal volunteers were given 15 puffs, followed by 30 puffs, of epinephrine from a pressurized aerosol (160 micrograms epinephrine/puff). The peak mean (+/- SE) plasma epinephrine levels were 1.50 (+/- 0.61) and 4.22 (+/- 1.93) nmol/L 1 minute after each dose, respectively. The effect on physiologic finger tremor correlated with the plasma epinephrine level and returned to baseline 20 minutes after taking the higher dose. There was a small fall in mean plasma potassium levels of 0.45 mmol/L and a small rise in plasma glucose levels of 0.81 mmol/L. On a separate occasion an injection of 0.3 ml of 1/1000 (300 micrograms) epinephrine was given subcutaneously to the same individuals. This caused a peak plasma epinephrine level of 2.43 (+/- 0.47) nmol/L at 10 minutes, and this was still raised at 2.05 (+/- 0.41) nmol/L after 40 minutes. The maximum fall in the mean plasma potassium level was 0.43 mmol/L after the injection.

Warren JB; Doble N; Dalton N; Ewan PW.

Clin Pharmacol Ther 8703; 40(6):673-8

Adult; Blood Pressure/DE; Drug Therapy, Combination; Echocardiography; Female; Heart Rate/DE; Heart Ventricle/DE; Human; Hydrochlorothiazide/TU; Hypertension/*DT; Male; Middle Age; Nitrendipine/*TU; Propranolol/TU; Support, Non-U.S. Gov't.

Effect of the calcium channel blocker nitrendipine on left ventricular mass in patients with hypertension.

JOURNAL ARTICLE.

Reductions in left ventricular (LV) mass have been reported after antihypertensive therapy with certain sympatholytic agents and converting enzyme inhibitors, but little or no improvement has been noted after vasodilator therapy. In this study we evaluated the effect of the calcium channel blocker nitrendipine on echocardiographic LV mass. During a 12-month period, nitrendipine was used as monotherapy in 30 patients and in combination with propranolol or a diuretic in an additional 28 patients. Nitrendipine monotherapy lowered supine blood pressure from 148/97 to 136/83 mm Hg, but LV mass did not change significantly. Supine blood pressure decreased from 155/103 to 134/86 mm Hg in patients receiving combination therapy but, again, changes in LV mass were not significant. These data suggest that nitrendipine is effective in lowering blood pressure, but this is not associated with a significant decrease in LV mass in patients with mild hypertension.

Drayer JI; Hall WD; Smith VE; Weber MA; Wollam GL; White WB.

Clin Pharmacol Ther 8703; 40(6):679-85

Age Factors; Aged; Analeptics/TU; Antidepressive Agents, Tricyclic/*AD/AE/BL; Depression/BL/CO/DI/*DT/TH; Depressive Disorder/BL/*DT/TH; Electroconvulsive Therapy; Female; Human; Kinetics; Male; Memory Disorders/DI; Middle Age; Monoamine Oxidase Inhibitors/TU; Nutrition Disorders/ET; Prognosis; Psychotherapy; Suicide.

Treatment of depression in the elderly.

JOURNAL ARTICLE.

Reductions in left ventricular (LV) mass have been reported after antihypertensive therapy with certain sympatholytic agents and converting enzyme inhibitors, but little or no improvement has been noted after vasodilator therapy. In this study we evaluated the effect of the calcium channel blocker nitrendipine on echocardiographic LV mass. During a 12-month period, nitrendipine was used as monotherapy in 30 patients and in combination with propranolol or a diuretic in an additional 28 patients. Nitrendipine monotherapy lowered supine blood pressure from 148/97 to 136/83 mm Hg, but LV mass did not change significantly. Supine blood pressure decreased from 155/103 to 134/86 mm Hg in patients receiving combination therapy but, again, changes in LV mass were not significant. These data suggest that nitrendipine is effective in lowering blood pressure, but this is not associated with a significant decrease in LV mass in patients with mild hypertension.

Grossberg GT; Nakra BR.

Compr Ther 8703; 12(10):16-22

Anticoagulants/TU; Arterial Occlusive Diseases/*DT/ET; Basilar Artery/*/PP; Cerebellum/BS; Cerebral Infarction/PP; Embolism/PP; Fibrinolytic Agents; Human; Migraine/ET; Subclavian Artery/PP; Vertebral Artery/*/PP; Vertebrobasilar Insufficiency/*DT/ET.

Treatment of patients with vertebrobasilar occlusive disease.

JOURNAL ARTICLE.

Reductions in left ventricular (LV) mass have been reported after antihypertensive therapy with certain sympatholytic agents and converting enzyme inhibitors, but little or no improvement has been noted after vasodilator therapy. In this study we evaluated the effect of the calcium channel blocker nitrendipine on echocardiographic LV mass. During a 12-month period, nitrendipine was used as monotherapy in 30 patients and in combination with propranolol or a diuretic in an additional 28 patients. Nitrendipine monotherapy lowered supine blood pressure from 148/97 to 136/83 mm Hg, but LV mass did not change significantly. Supine blood pressure decreased from 155/103 to 134/86 mm Hg in patients receiving combination therapy but, again, changes in LV mass were not significant. These data suggest that nitrendipine is effective in lowering blood pressure, but this is not associated with a significant decrease in LV mass in patients with mild hypertension.

Caplan LR.

Compr Ther 8703; 12(10):23-8

Aging; Benzodiazepine Tranquilizers/TU; Circadian Rhythm; Diagnosis, Differential; Female; Human; Insomnia/DI/DT/*ET/PP/TH; Male; Myoclonus/CO/DT; Prognosis; Psychophysiologic Disorders/DT; Restless Legs/CO/DT; Sleep Apnea Syndromes/CO/TH.

Clinical aspects of insomnia.

JOURNAL ARTICLE.

Reductions in left ventricular (LV) mass have been reported after antihypertensive therapy with certain sympatholytic agents and converting enzyme inhibitors, but little or no improvement has been noted after vasodilator therapy. In this study we evaluated the effect of the calcium channel blocker nitrendipine on echocardiographic LV mass. During a 12-month period, nitrendipine was used as monotherapy in 30 patients and in combination with propranolol or a diuretic in an additional 28 patients. Nitrendipine monotherapy lowered supine blood pressure from 148/97 to 136/83 mm Hg, but LV mass did not change significantly. Supine blood pressure decreased from 155/103 to 134/86 mm Hg in patients receiving combination therapy but, again, changes in LV mass were not significant. These data suggest that nitrendipine is effective in lowering blood pressure, but this is not associated with a significant decrease in LV mass in patients with mild hypertension.

Browman CP; Winslow DH.

Compr Ther 8703; 12(10):29-35

Arteriosclerosis/*SU; Human; Lasers/MT/*TU.

Laser angioplasty.

JOURNAL ARTICLE.

Reductions in left ventricular (LV) mass have been reported after antihypertensive therapy with certain sympatholytic agents and converting enzyme inhibitors, but little or no improvement has been noted after vasodilator therapy. In this study we evaluated the effect of the calcium channel blocker nitrendipine on echocardiographic LV mass. During a 12-month period, nitrendipine was used as monotherapy in 30 patients and in combination with propranolol or a diuretic in an additional 28 patients. Nitrendipine monotherapy lowered supine blood pressure from 148/97 to 136/83 mm Hg, but LV mass did not change significantly. Supine blood pressure decreased from 155/103 to 134/86 mm Hg in patients receiving combination therapy but, again, changes in LV mass were not significant. These data suggest that nitrendipine is effective in lowering blood pressure, but this is not associated with a significant decrease in LV mass in patients with mild hypertension.

Ferris EJ; McCowan TC; Baker ML.

Compr Ther 8703; 12(10):3-5

Electroconvulsive Therapy; Female; Human; Patient Care Team; Pregnancy; Pregnancy Complications/DT/*PX/TH; Psychotherapy; Psychotic Disorders/*CO/DT/TH; Psychotropic Drugs/TU; Recurrence.

Psychosis and pregnancy.

JOURNAL ARTICLE.

Close, continuous collaboration among the obstetrician, the psychiatrist, and nurses in both disciplines is required to improve the mental health of a patient whose psychosis is associated with pregnancy. These most complex cases require not "either/or" management but the combined attention of specialists in both disciplines.

Chang SS; Renshaw DC.

Compr Ther 8703; 12(10):36-41

Dopamine/AI; Drug Interactions; Human; Intestinal Absorption; Kinetics; Schizophrenia/DI/*DT; Tranquilizing Agents, Major/AE/ME/*TU.

Schizophrenia and antipsychotic drugs.

JOURNAL ARTICLE.

A variety of effective drugs are available for the treatment of schizophrenia. Knowledge of the side-effect spectrum of the various classes of antipsychotic drugs is necessary for the clinician to arrive at a rational choice of medication. In general, the preferred drug will be a high-potency neuroleptic. The following basic principles of clinical psychopharmacology should be followed: Consider risk and benefits; clinical experience is prerequisite; establish the diagnosis; select the appropriate class of psychotropic drug for the primary diagnosis; within drug class, the drugs are usually equally effective for patients with the diagnosis; give a dose that is high enough to be effective; choose target symptoms that can be monitored to indicate when to stop or increase the drug; avoid use of multiple drugs when possible; drugs are only one element in a comprehensive treatment strategy. Other modalities need equally careful consideration, e.g., psychotherapy, group therapy, family treatment, and vocational rehabilitation; and consultation with other subspecialists should be sought readily when indicated.

Nurnberg HG; Levine PE.

Compr Ther 8703; 12(10):42-52

Aged/*; Anxiety/CO/DI/*DT; Depression/CO; Diagnosis, Differential; Female; Human; Male; Propranolol/TU; Tranquilizing Agents, Minor/CL/ME/TU.

Management of anxiety in the elderly.

JOURNAL ARTICLE.

Clinicians need to be aware of the cardinal manifestations of clinical anxiety in their geriatric patients. A variety of psychotherapeutic, behavioral, and chemical interventions can effectively and safely treat anxiety in geriatric patients and thereby greatly diminish morbidity and mortality.

Nakra BR; Grossberg GT.

Compr Ther 8703; 12(10):53-60

Acute Disease; Dyskinesia, Drug-Induced/ET; Dystonia/CI; Female; Human; Male; Movement Disorders/*CI; Neuroleptic Malignant Syndrome/ET; Parkinson Disease, Symptomatic/CI; Psychomotor Agitation/CI; Tranquilizing Agents, Major/*AE.

Clinical and neurobiologic implications of antipsychotic-induced movement disorders.

JOURNAL ARTICLE.

Clinicians need to be aware of the cardinal manifestations of clinical anxiety in their geriatric patients. A variety of psychotherapeutic, behavioral, and chemical interventions can effectively and safely treat anxiety in geriatric patients and thereby greatly diminish morbidity and mortality.

Rubin EH; Zorumski CF.

Compr Ther 8703; 12(10):61-7

Depressive Disorder/TH; Electroconvulsive Therapy/*AE; Evaluation Studies; Human; Risk; Seizures/*ET; Support, U.S. Gov't, P.H.S..

Electrically induced seizures (ECT).

JOURNAL ARTICLE.

Clinicians need to be aware of the cardinal manifestations of clinical anxiety in their geriatric patients. A variety of psychotherapeutic, behavioral, and chemical interventions can effectively and safely treat anxiety in geriatric patients and thereby greatly diminish morbidity and mortality.

Milstein V; Small JG; Small IF.

Compr Ther 8703; 12(10):68-72

Alprazolam/TU; Anxiety/*DI/DT/ET; Behavior Therapy; Brain/ME; Fear/*; Female; Human; Lactates/ME; Male; Monoamine Oxidase Inhibitors/TU; Oxidation-Reduction; Panic/*; Phobic Disorders/DI/TH; Pyruvates/ME.

Panic anxiety: diagnosis, etiology, and treatment.

JOURNAL ARTICLE.

Clinicians need to be aware of the cardinal manifestations of clinical anxiety in their geriatric patients. A variety of psychotherapeutic, behavioral, and chemical interventions can effectively and safely treat anxiety in geriatric patients and thereby greatly diminish morbidity and mortality.

Raj A; Sheehan DV.

Compr Ther 8703; 12(10):7-15

Adult; Case Report; Dermatitis, Contact/*ET; Facial Dermatoses/ET; Female; Food Handling; Human; Hypersensitivity, Immediate/*ET; Occupational Dermatitis/ET; Shellfish/AE; Shrimp/*; Urticaria/*ET.

Regional variation in elicitation of contact urticaria syndrome (immediate hypersensitivity syndrome): shrimp.

JOURNAL ARTICLE.

Clinicians need to be aware of the cardinal manifestations of clinical anxiety in their geriatric patients. A variety of psychotherapeutic, behavioral, and chemical interventions can effectively and safely treat anxiety in geriatric patients and thereby greatly diminish morbidity and mortality.

Maibach HI.

Contact Dermatitis 8703; 15(2):100

Adult; Case Report; Dermatitis, Contact/*ET; Female; Food Handling; Food Hypersensitivity/*ET; Human; Vegetables/*AE.

Contact allergy caused by bamboo shoots.

JOURNAL ARTICLE.

Clinicians need to be aware of the cardinal manifestations of clinical anxiety in their geriatric patients. A variety of psychotherapeutic, behavioral, and chemical interventions can effectively and safely treat anxiety in geriatric patients and thereby greatly diminish morbidity and mortality.

Kitajima T.

Contact Dermatitis 8703; 15(2):100-2

Allergens/*; Animal; Azo Compounds/*AE; Dermatitis, Contact/*ET; Dyes/*AE; Guinea Pigs; Textiles.

Disperse blue 106, a strong sensitizer.

JOURNAL ARTICLE.

Clinicians need to be aware of the cardinal manifestations of clinical anxiety in their geriatric patients. A variety of psychotherapeutic, behavioral, and chemical interventions can effectively and safely treat anxiety in geriatric patients and thereby greatly diminish morbidity and mortality.

Hausen BM; Menezes Brandao F.

Contact Dermatitis 8703; 15(2):102-3

Dermatitis, Contact/*ET; Hair Dyes/*AE; Hair Preparations/*AE; Human; Phenylenediamines/*AE.

Paraphenylenediamine-free hair coloring mousse.

JOURNAL ARTICLE.

Clinicians need to be aware of the cardinal manifestations of clinical anxiety in their geriatric patients. A variety of psychotherapeutic, behavioral, and chemical interventions can effectively and safely treat anxiety in geriatric patients and thereby greatly diminish morbidity and mortality.

Maibach HI.

Contact Dermatitis 8703; 15(2):103

Aged; Case Report; Dermatitis Medicamentosa/DI/*ET; Dermatitis, Contact/*/DI/*ET; Human; Ibuprofen/*AE; Male; Patch Tests.

Contact dermatitis to ibuprofen.

JOURNAL ARTICLE.

Clinicians need to be aware of the cardinal manifestations of clinical anxiety in their geriatric patients. A variety of psychotherapeutic, behavioral, and chemical interventions can effectively and safely treat anxiety in geriatric patients and thereby greatly diminish morbidity and mortality.

Veronesi S; de Padova MP; Bardazzi F; Melino M.

Contact Dermatitis 8703; 15(2):103-4

Adult; Case Report; Catgut/*AE; Dermatitis, Contact/*ET; Female; Human; Sutures/*AE.

Catgut dermatitis.

JOURNAL ARTICLE.

Clinicians need to be aware of the cardinal manifestations of clinical anxiety in their geriatric patients. A variety of psychotherapeutic, behavioral, and chemical interventions can effectively and safely treat anxiety in geriatric patients and thereby greatly diminish morbidity and mortality.

Gola M; Francalanci S; Campolmi P; Sertoli A.

Contact Dermatitis 8703; 15(2):104-5

Benzydamine/*AE; Case Report; Dermatitis Medicamentosa/*ET; Dermatitis, Contact/*ET; Human; Male; Middle Age; Patch Tests; Pyrazoles/*AE.

Contact dermatitis from benzydamine hydrochloride.

JOURNAL ARTICLE.

Clinicians need to be aware of the cardinal manifestations of clinical anxiety in their geriatric patients. A variety of psychotherapeutic, behavioral, and chemical interventions can effectively and safely treat anxiety in geriatric patients and thereby greatly diminish morbidity and mortality.

Balato N; Lembo G; Patruno C; Bordone F; Ayala F.

Contact Dermatitis 8703; 15(2):105

Adult; Azo Compounds/*AE; Case Report; Dermatitis, Contact/*; Dyes/*AE; Female; Human; Patch Tests; Textiles.

Contact dermatitis to basic red 46.

JOURNAL ARTICLE.

Clinicians need to be aware of the cardinal manifestations of clinical anxiety in their geriatric patients. A variety of psychotherapeutic, behavioral, and chemical interventions can effectively and safely treat anxiety in geriatric patients and thereby greatly diminish morbidity and mortality.

Foussereau J.

Contact Dermatitis 8703; 15(2):106

Acrolein/AA/*AE; Aged; Aged, 80 and over; Aldehydes/*AE; Case Report; Cheilitis/*CI; Dermatitis, Contact/DI/*ET; Female; Human; Patch Tests; Sunscreening Agents/*AE; Toothpaste/AE.

Cheilitis: occult allergy to cinnamic aldehyde.

JOURNAL ARTICLE.

Clinicians need to be aware of the cardinal manifestations of clinical anxiety in their geriatric patients. A variety of psychotherapeutic, behavioral, and chemical interventions can effectively and safely treat anxiety in geriatric patients and thereby greatly diminish morbidity and mortality.

Maibach HI.

Contact Dermatitis 8703; 15(2):106-7

Aged; Case Report; Dermatitis Medicamentosa/*ET; Dermatitis, Contact/DI/*ET; Eyelid Diseases/CI; Human; Male; Patch Tests; Phenylephrine/*AE.

Allergic contact dermatitis to phenylephrine.

JOURNAL ARTICLE.

Clinicians need to be aware of the cardinal manifestations of clinical anxiety in their geriatric patients. A variety of psychotherapeutic, behavioral, and chemical interventions can effectively and safely treat anxiety in geriatric patients and thereby greatly diminish morbidity and mortality.

Ducombs G; de Casamayor J; Verin P; Maleville J.

Contact Dermatitis 8703; 15(2):107-8

Adult; Case Report; Dermatitis, Contact/*ET; Hand Dermatoses/*CI; Human; Male; Music; Resins/*AE.

Allergic contact dermatitis to colophony in a violoncellist.

JOURNAL ARTICLE.

Clinicians need to be aware of the cardinal manifestations of clinical anxiety in their geriatric patients. A variety of psychotherapeutic, behavioral, and chemical interventions can effectively and safely treat anxiety in geriatric patients and thereby greatly diminish morbidity and mortality.

Angelini G; Vena GA.

Contact Dermatitis 8703; 15(2):108

Adult; Aged; Dermatitis Medicamentosa/*ET; Dermatitis, Contact/*ET; Female; Human; Leg Ulcer/DT; Male; Middle Age; Triterpenes/*AE.

Contact allergy to Centelase.

JOURNAL ARTICLE.

Clinicians need to be aware of the cardinal manifestations of clinical anxiety in their geriatric patients. A variety of psychotherapeutic, behavioral, and chemical interventions can effectively and safely treat anxiety in geriatric patients and thereby greatly diminish morbidity and mortality.

Vena GA; Angelini G.

Contact Dermatitis 8703; 15(2):108-9

Anti-Inflammatory Agents, Topical/*AE; Case Report; Child; Dermatitis Medicamentosa/*ET; Dermatitis, Contact/*ET; Human; Male; Patch Tests; Triamcinolone/*AA/AE.

Contact allergy to amcinonide.

JOURNAL ARTICLE.

Clinicians need to be aware of the cardinal manifestations of clinical anxiety in their geriatric patients. A variety of psychotherapeutic, behavioral, and chemical interventions can effectively and safely treat anxiety in geriatric patients and thereby greatly diminish morbidity and mortality.

Kubo Y; Nonaka S; Yoshida H.

Contact Dermatitis 8703; 15(2):109-11

Agricultural Workers' Diseases/*CI; Animal; Animal Feed; Case Report; Dermatitis, Contact/DI/*ET; Human; Male; Middle Age; Occupational Dermatitis/*ET; Patch Tests; Photosensitivity Disorders/*DI; Quinoxalines/*AE; Swine.

Occupational photocontact dermatitis from Olaquindox.

JOURNAL ARTICLE.

Clinicians need to be aware of the cardinal manifestations of clinical anxiety in their geriatric patients. A variety of psychotherapeutic, behavioral, and chemical interventions can effectively and safely treat anxiety in geriatric patients and thereby greatly diminish morbidity and mortality.

Francalanci S; Gola M; Giorgini S; Muccinelli A; Sertoli A.

Contact Dermatitis 8703; 15(2):112-4

Adolescence; Adult; Aged; Amantadine/AA/AE; Antiviral Agents/*AE; Dermatitis Medicamentosa/*ET; Dermatitis, Contact/*ET; Female; Herpes Labialis/DT; Herpes Zoster/DT; Human; Idoxuridine/AE; Male; Middle Age.

Contact allergy to antiviral agents.

JOURNAL ARTICLE.

Clinicians need to be aware of the cardinal manifestations of clinical anxiety in their geriatric patients. A variety of psychotherapeutic, behavioral, and chemical interventions can effectively and safely treat anxiety in geriatric patients and thereby greatly diminish morbidity and mortality.

Angelini G; Vena GA; Meneghini CL.

Contact Dermatitis 8703; 15(2):114-5

Dermatitis, Contact/DI/*ET; Female; Human; Male; Perfume/*AE.

Allergy to perfume mixture.

JOURNAL ARTICLE.

Clinicians need to be aware of the cardinal manifestations of clinical anxiety in their geriatric patients. A variety of psychotherapeutic, behavioral, and chemical interventions can effectively and safely treat anxiety in geriatric patients and thereby greatly diminish morbidity and mortality.

Rudzki E; Grzywa Z.

Contact Dermatitis 8703; 15(2):115-6

Adult; Agricultural Workers' Diseases/DI/*ET; Animal; Case Report; Cattle/*; Dermatitis, Contact/DI/*ET; Human; Male; Occupational Dermatitis/DI/*ET; Patch Tests; Radioallergosorbent Test; Saliva/*.

Contact eczema from cow saliva.

JOURNAL ARTICLE.

Clinicians need to be aware of the cardinal manifestations of clinical anxiety in their geriatric patients. A variety of psychotherapeutic, behavioral, and chemical interventions can effectively and safely treat anxiety in geriatric patients and thereby greatly diminish morbidity and mortality.

Camarasa JG.

Contact Dermatitis 8703; 15(2):117

Agricultural Workers' Diseases/*ET; Dermatitis, Contact/*ET; Human; Hydroxybenzoic Acids/AE; Lichens/*; Male; Photosensitivity Disorders/*ET.

Photosensitivity to oak moss [letter]

LETTER.

Clinicians need to be aware of the cardinal manifestations of clinical anxiety in their geriatric patients. A variety of psychotherapeutic, behavioral, and chemical interventions can effectively and safely treat anxiety in geriatric patients and thereby greatly diminish morbidity and mortality.

Fernandez de Corres L.

Contact Dermatitis 8703; 15(2):118

Adult; Case Report; Dental Alloys/*AE; Dermatitis, Contact/*DI/PA; Female; Human; Middle Age; Mouth Diseases/*DI/ET/PA; Mouth Mucosa/PA; Nickel/AE; Patch Tests/IS/*MT; Skin Tests/*MT.

A new method for intraoral patch testing.

JOURNAL ARTICLE.

Intraoral patch testing was performed in 3 subjects, 2 of whom were contact sensitive to nickel. Maxillary acrylic plates carrying test pieces containing 66% nickel were applied for 48 h, and readings were performed 24 h after removal. Few if any clinical signs were detected, but biopsies from the mucosal contact sites showed lichenoid reactions. Biopsies from control sites showed no or slight non-specific inflammatory reactions.

Axell T; Spiechowicz E; Glantz PO; Andersson G; Larsson A.

Contact Dermatitis 8703; 15(2):58-62

Dermatitis, Contact/DI/*ET; Female; Human; Male; Occupational Dermatitis/DI/*ET; Patch Tests; Quinazolines/*AE.

Dermatitis from quinazoline oxide.

JOURNAL ARTICLE.

Dermatitis from 2-chloromethyl-4-phenyl-6-chloroquinazoline-3-oxide, an intermediate product in the preparation of chlorodiazepoxide, is described in 29 workers at a pharmaceutical plant. All were patch test positive to quinazoline oxide (1%) and six to 0.05%. In most patients, the face was earlier and more severely involved than the hands. Some were sensitized even if they did not have much contact with it, doing such work as washing the clothing of other workers, or working at a distance of 100 m from the production line building.

Rebandel P; Rudzki E.

Contact Dermatitis 8703; 15(2):63-5

Adult; Case Report; Cyclohexanecarboxylic Acids/*AE; Dermatitis, Contact/DI/*ET; Epoxy Compounds/*AE; Ethers, Cyclic/*AE; Human; Industrial Oils/*AE; Male; Middle Age; Occupational Dermatitis/DI/*ET; Patch Tests.

Allergic contact sensitization to the glycidyl ester of hexahydrophthalic acid in a cutting oil.

JOURNAL ARTICLE.

Allergic contact dermatitis is reported in 5 machine operatives working with a cutting oil containing an epoxy compound used as a stabilizer. Positive patch test reactions to this compound were obtained in all 5 men and were negative in 25 controls.

English JS; Foulds I; White IR; Rycroft RJ.

Contact Dermatitis 8703; 15(2):66-8

Color; Dermatitis, Contact/DI; Hemoglobins/AN; Human; Patch Tests/*; Skin/AN/*PP; Skin Tests/*; Spectrophotometry/*; Support, Non-U.S. Gov't.

Skin reflectance measurements of patch test responses.

JOURNAL ARTICLE.

Skin reflectance values were used as an objective measure of skin haemoglobin content at patch test sites to facilitate quantification of the erythematous response to contact allergens in patients with allergic contact dermatitis. Reflectance measurements of patch test responses correlated well with the clinical scoring and provided a numerical measure of reaction severity. Experimental contact allergen formulations were also evaluated by this method.

Mendelow AY; Forsyth A; Feather JW; Baillie AJ; Florence AT.

Contact Dermatitis 8703; 15(2):73-8

Adult; Dermatitis, Contact/DI/*ET; Female; Gloves, Surgical/*; Human; IgE/AN; Latex/AE/IM; Male; Middle Age; Patch Tests; Powders; Radioallergosorbent Test; Rubber/*AE/IM; Sorbic Acid/AE; Support, Non-U.S. Gov't; Sweat; Urticaria/DI/*ET.

Discomfort from rubber gloves indicating contact urticaria.

JOURNAL ARTICLE.

Rubber glove intolerance is a common dermatological problem and hypersensitivity of both delayed and immediate types occur. In order to study immediate skin reactions induced by rubber gloves, 15 patients with discomfort and itch produced by rubber gloves were examined. The patients were provoked by wearing rubber gloves, scratch tested with gloves, rubber chemicals and powders. RAST-tests were performed using an extract from the rubber tree (Hevea brasiliensis). In 6/15 patients, contact urticaria was confirmed, in 3 of whom IgE antibodies to latex were demonstrated.

Wrangsjo K; Mellstrom G; Axelsson G.

Contact Dermatitis 8703; 15(2):79-84

Adult; Chlorohydrins/*AE; Dermatitis, Contact/*ET/PC; Epichlorohydrin/*AE; Epoxy Resins/*AE; Human; Male; Middle Age; Occupational Dermatitis/*ET/PC; Patch Tests; Phenols/AE.

Sensitization to epichlorohydrin and epoxy system components.

JOURNAL ARTICLE.

In an epoxy resin manufacturing plant, 26 of 228 (11.4%) workers had work-related eruptions; 19 were patch tested. The test series consisted of chemicals used in the manufacturing process, a standard battery and some other sensitizers. The prevalence of sensitization to epichlorohydrin and/or epoxy resins in the whole group was 6.1%. A relatively high prevalence (3.5%) of epichlorohydrin sensitization was found. 10 cases of sensitization to liquid epoxy resin (MW about 385) were observed, in 7 cases combined with allergy to solid epoxy resin (MW 980). Sensitization to Bisphenol A was not seen.

Prens EP; de Jong G; van Joost T.

Contact Dermatitis 8703; 15(2):85-90

Administration, Topical; Case Report; Cephalexin/AD/*AE; Dermatitis Medicamentosa/*ET; Dermatitis, Contact/DI/*ET; Female; Human; Leg Ulcer/DT; Middle Age; Patch Tests.

Contact dermatitis to cephalexin.

JOURNAL ARTICLE.

In an epoxy resin manufacturing plant, 26 of 228 (11.4%) workers had work-related eruptions; 19 were patch tested. The test series consisted of chemicals used in the manufacturing process, a standard battery and some other sensitizers. The prevalence of sensitization to epichlorohydrin and/or epoxy resins in the whole group was 6.1%. A relatively high prevalence (3.5%) of epichlorohydrin sensitization was found. 10 cases of sensitization to liquid epoxy resin (MW about 385) were observed, in 7 cases combined with allergy to solid epoxy resin (MW 980). Sensitization to Bisphenol A was not seen.

Milligan A; Douglas WS.

Contact Dermatitis 8703; 15(2):91

Acrylic Resins/*AE; Adult; Case Report; Chloramphenicol/AE; Dermatitis, Contact/*ET; Female; Human; Middle Age; Neomycin/*AE; Occupational Dermatitis/*ET; Ophthalmology/*; Polyurethanes/*AE; Tetracaine/*AE.

Occupational contact sensitivity in oculists.

JOURNAL ARTICLE.

In an epoxy resin manufacturing plant, 26 of 228 (11.4%) workers had work-related eruptions; 19 were patch tested. The test series consisted of chemicals used in the manufacturing process, a standard battery and some other sensitizers. The prevalence of sensitization to epichlorohydrin and/or epoxy resins in the whole group was 6.1%. A relatively high prevalence (3.5%) of epichlorohydrin sensitization was found. 10 cases of sensitization to liquid epoxy resin (MW about 385) were observed, in 7 cases combined with allergy to solid epoxy resin (MW 980). Sensitization to Bisphenol A was not seen.

Rebandel P; Rudzki E.

Contact Dermatitis 8703; 15(2):92

Acrylates/*AE; Adult; Case Report; Dermatitis, Contact/*ET; Human; Male; Occupational Dermatitis/*ET.

Allergic contact dermatitis from UV-curing acrylate in the manufacture of optical fibres.

JOURNAL ARTICLE.

In an epoxy resin manufacturing plant, 26 of 228 (11.4%) workers had work-related eruptions; 19 were patch tested. The test series consisted of chemicals used in the manufacturing process, a standard battery and some other sensitizers. The prevalence of sensitization to epichlorohydrin and/or epoxy resins in the whole group was 6.1%. A relatively high prevalence (3.5%) of epichlorohydrin sensitization was found. 10 cases of sensitization to liquid epoxy resin (MW about 385) were observed, in 7 cases combined with allergy to solid epoxy resin (MW 980). Sensitization to Bisphenol A was not seen.

Maurice PD; Rycroft RJ.

Contact Dermatitis 8703; 15(2):92-3

Benzoates/*AE; Case Report; Dermatitis, Contact/DI/*ET; Female; Human; Middle Age; Patch Tests; Sunscreening Agents/AE.

Allergic contact dermatitis from isopropyl dibenzoylmethane.

JOURNAL ARTICLE.

In an epoxy resin manufacturing plant, 26 of 228 (11.4%) workers had work-related eruptions; 19 were patch tested. The test series consisted of chemicals used in the manufacturing process, a standard battery and some other sensitizers. The prevalence of sensitization to epichlorohydrin and/or epoxy resins in the whole group was 6.1%. A relatively high prevalence (3.5%) of epichlorohydrin sensitization was found. 10 cases of sensitization to liquid epoxy resin (MW about 385) were observed, in 7 cases combined with allergy to solid epoxy resin (MW 980). Sensitization to Bisphenol A was not seen.

English JS; White IR.

Contact Dermatitis 8703; 15(2):94

Adult; Antifungal Agents/*AE; Case Report; Dermatitis Medicamentosa/*ET; Dermatitis, Contact/*ET; Female; Human; Pyridones/*AE.

Contact dermatitis due to cyclopyroxolamine.

JOURNAL ARTICLE.

In an epoxy resin manufacturing plant, 26 of 228 (11.4%) workers had work-related eruptions; 19 were patch tested. The test series consisted of chemicals used in the manufacturing process, a standard battery and some other sensitizers. The prevalence of sensitization to epichlorohydrin and/or epoxy resins in the whole group was 6.1%. A relatively high prevalence (3.5%) of epichlorohydrin sensitization was found. 10 cases of sensitization to liquid epoxy resin (MW about 385) were observed, in 7 cases combined with allergy to solid epoxy resin (MW 980). Sensitization to Bisphenol A was not seen.

Goitre M; Bedello PG; Cane D; Pulatti P; Forte M; Cervetti O.

Contact Dermatitis 8703; 15(2):94-5

Adult; Case Report; Dermatitis, Contact/DI/*ET; Female; Human; Hypersensitivity, Delayed/DI/ET; Hypersensitivity, Immediate/DI/*ET; Nickel/*AE; Patch Tests.

Immediate hypersensitivity to nickel.

JOURNAL ARTICLE.

In an epoxy resin manufacturing plant, 26 of 228 (11.4%) workers had work-related eruptions; 19 were patch tested. The test series consisted of chemicals used in the manufacturing process, a standard battery and some other sensitizers. The prevalence of sensitization to epichlorohydrin and/or epoxy resins in the whole group was 6.1%. A relatively high prevalence (3.5%) of epichlorohydrin sensitization was found. 10 cases of sensitization to liquid epoxy resin (MW about 385) were observed, in 7 cases combined with allergy to solid epoxy resin (MW 980). Sensitization to Bisphenol A was not seen.

Tosti A; Melino M; Labanca M; Ragazzi R.

Contact Dermatitis 8703; 15(2):95

Adult; Case Report; Dermatitis, Contact/DI/*ET; Ethambutol/*AE; Hand Dermatoses/ET; Human; Male; Occupational Dermatitis/DI/*ET; Patch Tests.

Contact dermatitis to ethambutol.

JOURNAL ARTICLE.

In an epoxy resin manufacturing plant, 26 of 228 (11.4%) workers had work-related eruptions; 19 were patch tested. The test series consisted of chemicals used in the manufacturing process, a standard battery and some other sensitizers. The prevalence of sensitization to epichlorohydrin and/or epoxy resins in the whole group was 6.1%. A relatively high prevalence (3.5%) of epichlorohydrin sensitization was found. 10 cases of sensitization to liquid epoxy resin (MW about 385) were observed, in 7 cases combined with allergy to solid epoxy resin (MW 980). Sensitization to Bisphenol A was not seen.

Holdiness MR.

Contact Dermatitis 8703; 15(2):96-7

Acetamides/*AE; Case Report; Cosmetics/*AE; Dermatitis, Contact/*ET; Facial Dermatoses/*CI; Female; Human; Middle Age.

Contact allergy to chloroacetamide in an "anti-wrinkle serum".

JOURNAL ARTICLE.

In an epoxy resin manufacturing plant, 26 of 228 (11.4%) workers had work-related eruptions; 19 were patch tested. The test series consisted of chemicals used in the manufacturing process, a standard battery and some other sensitizers. The prevalence of sensitization to epichlorohydrin and/or epoxy resins in the whole group was 6.1%. A relatively high prevalence (3.5%) of epichlorohydrin sensitization was found. 10 cases of sensitization to liquid epoxy resin (MW about 385) were observed, in 7 cases combined with allergy to solid epoxy resin (MW 980). Sensitization to Bisphenol A was not seen.

de Groot AC; Weyland JW.

Contact Dermatitis 8703; 15(2):97-8

Adult; Case Report; Dermatitis, Contact/DI/*ET; Human; Male; Patch Tests; Plants/*.

Contact dermatitis to Pastinaca sativa.

JOURNAL ARTICLE.

In an epoxy resin manufacturing plant, 26 of 228 (11.4%) workers had work-related eruptions; 19 were patch tested. The test series consisted of chemicals used in the manufacturing process, a standard battery and some other sensitizers. The prevalence of sensitization to epichlorohydrin and/or epoxy resins in the whole group was 6.1%. A relatively high prevalence (3.5%) of epichlorohydrin sensitization was found. 10 cases of sensitization to liquid epoxy resin (MW about 385) were observed, in 7 cases combined with allergy to solid epoxy resin (MW 980). Sensitization to Bisphenol A was not seen.

Picardo M; Cristaudo A; de Luca C; Santucci B.

Contact Dermatitis 8703; 15(2):98-9

Adolescence; Adult; Age Factors; Aged; Aged, 80 and over; Automatic Data Processing; Child; Dermatitis/*EP; Dermatitis, Atopic/EP; Dermatitis, Contact/EP; Female; Foot Dermatoses/EP; Hand Dermatoses/EP; Human; Male; Middle Age; Occupational Dermatitis/EP; Patch Tests; Sex Factors.

An analysis of 501 consecutive contact clinic consultations.

JOURNAL ARTICLE.

A simple micro-computer program was used to analyse the results of testing 501 consecutive patients attending a patch test clinic. 64% of males and 71% of females had positive tests; 17% of males and 12% of females had occupational dermatitis; 16% of males and 15% of females had irritant contact dermatitis; and 13% of males and 19% of females had a history of atopic eczema.

Vestey JP; Gawkrodger DJ; Wong WK; Buxton PK.

Contact Dermatitis 8703; 15(3):119-25

Adult; Australia; Case Report; Dermatitis, Contact/*ET; Female; Human; Male; Patch Tests; Plants, Toxic/*; Rhus.

Contact dermatitis from Grevillea 'Robyn Gordon'.

JOURNAL ARTICLE.

Grevillea 'Robyn Gordon' is an Australian hybrid plant which may cause allergic contact dermatitis. Over the past 8 years, it has been planted extensively in Australia and is now being exported to the United States and other Western countries. Recently, an explosion in incidence of contact dermatitis due to this plant has been seen. 24 patients who were suspected of being sensitive to it were patch tested to fresh plant and extracts with confirmation of sensitivity. A cross sensitivity to Toxicodendron was demonstrated clinically and on patch testing. The allergen in Toxicodendron, 3 pentadecylcatechol, is closely linked in chemical structure to 5-pentadecylresorcinol, present in Grevillea banksii and tridecylresorcinol in Grevillea robusta. Patch testing in patients sensitive to Grevillea 'Robyn Gordon' with tridecylresorcinol produced positive reactions, thus implicating the sensitizing role of long chain alkyl resorcinols in Grevillea 'Robyn Gordon' allergy. There is a likelihood that this sensitizing potential extends to other plants of the Grevillea genus, e.g., Grevillea robusta. With the spread of Grevillea 'Robyn Gordon' to other markets, this problem will become increasingly common.

Menz J; Rossi ER; Taylor WC; Wall L.

Contact Dermatitis 8703; 15(3):126-31

Dermatitis, Atopic/CO; Dermatitis, Contact/CO; Female; Food Service, Hospital; Hand Dermatoses/*EP; Human; Maintenance and Engineering, Hospital; Male; Occupational Dermatitis/*EP; Patch Tests; Personnel, Hospital/*; Psoriasis/CO.

Occupational skin disease in hospital cleaning and kitchen workers.

JOURNAL ARTICLE.

Skin disorders were reported in 33% of catering staff and 35% of women cleaners who returned a questionnaire, and were employed in a large hospital. Hand dermatitis occurred in 15% of the caterers and 12% of the cleaners. In the majority, the dermatitis was irritant in origin and related to their wet work occupations. Cleaners had a high prevalence of jewellery dermatitis. Limited patch testing revealed a majority positive to nickel, but a third were negative, indicating that jewellery reactions often but not invariably predict nickel sensitivity. Few subjects were atopic, but some psoriatic patients with hand problems were encountered. Most workers were able to carry on in their occupations despite having hand dermatitis.

Gawkrodger DJ; Lloyd MH; Hunter JA.

Contact Dermatitis 8703; 15(3):132-5

Adolescence; Adult; Age Factors; Aged; Child; Chromates/AE; Dermatitis, Contact/*EP; Female; Human; Male; Middle Age; Nickel/AE; Patch Tests; Retrospective Studies; Sex Factors.

Age and sex incidence of allergic contact dermatitis.

JOURNAL ARTICLE.

A retrospective study of patients patch tested between 1968 and 1970 was undertaken and case records of 200 patients with unequivocal positive patch tests were studied for age and sex distribution. There was an overall female preponderance (61%), with 2 peaks of incidence in the 10-20 and 40-50 year age groups in females, but only 1 peak of incidence in the 40-50 year age group in males. There was a steady decline in all sensitivities after the 6th decade of life in both sexes. Nickel sensitivity was more common in females (92%), whereas dichromate sensitivity predominated in males (64%). Of the 200 patients, only 5(2.5%) were atopics, all of whom were females.

Walton S; Nayagam AT; Keczkes K.

Contact Dermatitis 8703; 15(3):136-9

Adult; Case Report; Dermatitis, Contact/*ET; Female; Hand Dermatoses/*CI; Household Products/AE; Human; Sodium Hypochlorite/*AE.

Sensitization to sodium hypochlorite causing hand dermatitis.

JOURNAL ARTICLE.

2 patients are reported with chronic hand dermatitis related to sensitization to sodium hypochlorite, as the active component in a bleaching product. To avoid irritant reactions in patch testing, a sodium hypochlorite concentration of 1.0% appeared to be useful. It is concluded that with regard to the frequent use of bleaching agents, allergy to sodium hypochlorite must be considered in certain cases of unidentified chronic allergic hand dermatitis.

Habets JM; Geursen-Reitsma AM; Stolz E; van Joost T.

Contact Dermatitis 8703; 15(3):140-2

Animal; Dermatitis, Contact/*ET/PA; Epidermis/PA; Female; Guinea Pigs; Irritants/*; Solvents/TO; Support, Non-U.S. Gov't.

Animal model for assessment of skin irritancy.

JOURNAL ARTICLE.

Irritant skin reactions from repeated open applications of low concentrations of sodium lauryl sulphate (SLS) have been studied macroscopically and microscopically in guinea pigs. After 3 applications daily for 3 days, 2% SLS aqueous solutions gave a naked eye assessment, increase in epidermal thickness and total dermal inflammatory cell response, which was greater than for a 1% SLS solution. The dermal inflammatory cell response was mainly mononuclear (lymphocytic) in nature. With the SLS reactions as control, various organic solvents were studied and ranked against the SLS reactions and internally. Trichlorethylene was the most irritant solvent, ranking as high as 2% SLS. Other chlorinated hydrocarbons and aromatic hydrocarbons tested caused irritant reactions. The alcohols and acetone gave no reaction. White spirit was as irritant as trichlorethylene. Thinners were less irritant, around the level of the 1% SLS control reaction. The 4-day experimental design is a convenient and suitable animal model for screening irritant potential, and provides information relevant to the pathogenesis of irritant contact reactions.

Anderson C; Sundberg K; Groth O.

Contact Dermatitis 8703; 15(3):143-51

Adult; Aged; Female; Glycine/*AA/TO; Herbicides/*TO; Human; Irritants/*; Male; Middle Age; Patch Tests/MT; Photosensitivity Disorders/*CI.

Irritation, sensitization, photoirritation and photosensitization assays with a glyphosate herbicide.

JOURNAL ARTICLE.

Glyphosate, a widely utilized herbicide, was evaluated for acute irritation, cumulative irritation, photoirritation and allergic and photoallergic contact potential in 346 volunteers. The herbicide was less irritant than a standard liquid dishwashing detergent and a general all purpose cleaner. There was no evidence for the induction of photoirritation, allergic or photoallergic contact dermatitis. 10% glyphosate in water is proposed as a diagnostic patch test concentration.

Maibach HI.

Contact Dermatitis 8703; 15(3):152-6

Animal; Coumarins/*TO; Dermatitis, Contact/*ET; Female; Freund's Adjuvant/AD; Guinea Pigs; Irritants; Skin Tests/MT; Support, Non-U.S. Gov't.

The sensitizing capacity of coumarins (I).

JOURNAL ARTICLE.

10 coumarins used in perfumery, cosmetics and ointments, have been investigated by 2 different methods to determine their sensitizing capacity. Only 1 of the compounds, 4-methyl-esculetin, which serves as a sunscreen agent, was found to be a weak sensitizer. All other coumarins were negative. It is assumed that this dihydroxycoumarin becomes a sensitizer when it is enzymically oxidized to the corresponding orthoquinone in the skin.

Hausen BM; Schmieder M.

Contact Dermatitis 8703; 15(3):157-63

Acne/*CI/PA; Adult; Case Report; Chlorophenols/*AE; Human; Male; Occupational Dermatitis/*ET/PA; Pentachlorophenol/*AE/AN; Tetrachlorodibenzodioxin/AA/AN; Wood/*.

Chloracne from pentachlorophenol-preserved wood.

JOURNAL ARTICLE.

A patient is presented who developed chloracne after exposure to lumber which was pressure-treated with pentachlorophenol (PCP). It was presumed that his disease arose via percutaneous absorption of polychlorinated aromatic compounds (dioxins and furans) which are known to contaminate technical grade PCP. The patient's condition improved after treatment with oral isotretinoin.

Cole GW; Stone O; Gates D; Culver D.

Contact Dermatitis 8703; 15(3):164-8

Asia; Cobalt/AE/*AN; Construction Materials/*; Human; Nickel/AE/*AN; Occupational Dermatitis/EP; Solubility; Spectrophotometry, Atomic Absorption; Support, Non-U.S. Gov't.

Cobalt and nickel content of Asian cements.

JOURNAL ARTICLE.

The total cobalt and nickel concentration of 11 brands of Asian cement ranged from 8.1 to 14.2 micrograms/g and 14.9 to 28.5 micrograms/g, respectively. These metals exist mainly as insoluble salts; the water-soluble concentration of cobalt and nickel in the cements ranged from 0.39 to 0.65 micrograms/g and from 0-1.2 micrograms/g, respectively. 1.5% (4/272) of construction workers in a prefabrication construction factory had cobalt sensitivity. All had allergic contact dermatitis from chromate in cement. No worker had isolated cobalt sensitivity and cement dermatitis. It appeared that sensitization to cobalt in cement occurs only secondarily to an existing cement dermatitis. 1.8% (5/272) workers had nickel sensitivity: 2 with allergic contact dermatitis to nickel in their watches, 2 were asymptomatic and 1 had allergic contact dermatitis to chromate and cobalt in cement. The low prevalence of cobalt and nickel sensitivity from cement was probably related to the low concentration of soluble cobalt and nickel salts in the cement. However, these insoluble salts can form soluble complexes with body fluids on eczematous skin and sensitize the skin.

Goh CL; Kwok SF; Gan SL.

Contact Dermatitis 8703; 15(3):169-72

Female; Human; In Vitro; Ions; Nickel/*ME; Permeability; Skin Absorption/*.

Permeation of nickel salts through human skin in vitro.

JOURNAL ARTICLE.

The impact of occlusion and the role of the counter ion on the permeation of nickel ions through skin have been examined using excised human skin. A highly sensitive electrochemical method was used to quantify the amount of nickel permeating the skin. The investigations show that nickel ions are capable of permeating the skin barrier when applied under occlusion. The process is slow, having a lag time of approximately 50 h. The permeation rate, and thus the physical amount being bioavailable, is considerably increased when aqueous nickel chloride is used in comparison with aqueous nickel sulphate. With respect to nickel permeation of the skin, we conclude that the choice of salt is an important consideration in patch testing.

Fullerton A; Andersen JR; Hoelgaard A; Menne T.

Contact Dermatitis 8703; 15(3):173-7

Adult; Aged; Aged, 80 and over; Dermatitis, Atopic/*DI; Dermatitis, Contact/*DI; Eyelid Diseases/*ET; Female; Hand Dermatoses/CO; Human; Male; Middle Age; Patch Tests.

Eyelid dermatitis: the role of atopy and contact allergy.

JOURNAL ARTICLE.

Patients with eyelid dermatitis were studied with patch tests and a clinical point method for the diagnosis of atopic skin disease. In 38 patients, contact allergy was found in 11. The dermatitis was an expression of atopic dermatitis in 15 patients.

Svensson A; Moller H.

Contact Dermatitis 8703; 15(3):178-82

Asthma/*CI; Case Report; Dermatitis, Contact/*ET; Dyes/*AE; Human; Male; Middle Age; Occupational Dermatitis/ET; Occupational Diseases/*CI.

Contact dermatitis and asthma from reactive dyes.

JOURNAL ARTICLE.

Patients with eyelid dermatitis were studied with patch tests and a clinical point method for the diagnosis of atopic skin disease. In 38 patients, contact allergy was found in 11. The dermatitis was an expression of atopic dermatitis in 15 patients.

Thoren K; Meding B; Nordlinder R; Belin L.

Contact Dermatitis 8703; 15(3):186

Adult; Case Report; Dermatitis, Contact/*ET; Fungicides, Industrial/*AE; Human; Male; Nitriles/*AE; Occupational Dermatitis/ET; Paint/*AE.

Contact dermatitis from tetrachloroisophthalonitrile in paint.

JOURNAL ARTICLE.

Patients with eyelid dermatitis were studied with patch tests and a clinical point method for the diagnosis of atopic skin disease. In 38 patients, contact allergy was found in 11. The dermatitis was an expression of atopic dermatitis in 15 patients.

Meding B.

Contact Dermatitis 8703; 15(3):187

Adolescence; Adult; Aged; Case Report; Dermatitis Medicamentosa/*ET; Ethylmercury Compounds/*AE; Female; Human; Pharmaceutic Aids/*AE; Preservatives, Pharmaceutical/*AE; Thimerosal/*AE.

Systemic reactions due to thiomersal.

JOURNAL ARTICLE.

Patients with eyelid dermatitis were studied with patch tests and a clinical point method for the diagnosis of atopic skin disease. In 38 patients, contact allergy was found in 11. The dermatitis was an expression of atopic dermatitis in 15 patients.

Tosti A; Melino M; Bardazzi F.

Contact Dermatitis 8703; 15(3):187-8

Administration, Oral; Adult; Case Report; Cimetidine/*AE; Dermatitis Medicamentosa/*ET; Human; Hypersensitivity, Delayed/*CI; Male.

Delayed hypersensitivity to oral cimetidine.

JOURNAL ARTICLE.

Patients with eyelid dermatitis were studied with patch tests and a clinical point method for the diagnosis of atopic skin disease. In 38 patients, contact allergy was found in 11. The dermatitis was an expression of atopic dermatitis in 15 patients.

Peters K.

Contact Dermatitis 8703; 15(3):190-1

Adult; Case Report; Human; Male; Medicine, Oriental Traditional/*; Purpura/*ET; Suction/*AE; Vacuum.

Puhang-induced purpura.

JOURNAL ARTICLE.

Patients with eyelid dermatitis were studied with patch tests and a clinical point method for the diagnosis of atopic skin disease. In 38 patients, contact allergy was found in 11. The dermatitis was an expression of atopic dermatitis in 15 patients.

Eun HC; Park HB; Lee YS.

Contact Dermatitis 8703; 15(3):191

Acne/DT; Adult; Allergens; Case Report; Decanoic Acids/*AE/TU; Dermatitis, Contact/*ET; Drug Combinations/TU; Erythromycin/TU; Human; Male; Vehicles/*AE; Zinc/TU.

Allergic contact dermatitis due to diisopropyl sebacate.

JOURNAL ARTICLE.

Patients with eyelid dermatitis were studied with patch tests and a clinical point method for the diagnosis of atopic skin disease. In 38 patients, contact allergy was found in 11. The dermatitis was an expression of atopic dermatitis in 15 patients.

Dooms-Goossens A; De Veylder H; De Boulle K; Maertens M.

Contact Dermatitis 8703; 15(3):192

Female; Human; Male; Patch Tests/*MT; Resins/AD/*AE; Skin Tests/*MT; Vehicles.

Patch testing with colophony at 60% concentration.

JOURNAL ARTICLE.

Patients with eyelid dermatitis were studied with patch tests and a clinical point method for the diagnosis of atopic skin disease. In 38 patients, contact allergy was found in 11. The dermatitis was an expression of atopic dermatitis in 15 patients.

Bruze M; Dahlquist I; Fregert S.

Contact Dermatitis 8703; 15(3):193

Dermatitis Medicamentosa/*ET; Human; Hypersensitivity, Delayed/*CI; Patch Tests.

Rash from oral codeine [letter]

LETTER.

Patients with eyelid dermatitis were studied with patch tests and a clinical point method for the diagnosis of atopic skin disease. In 38 patients, contact allergy was found in 11. The dermatitis was an expression of atopic dermatitis in 15 patients.

van Ketel WG.

Contact Dermatitis 8703; 15(3):195

Blood Transfusion/*AE; Complement Activation; Complement 3/*AN; Human; Prospective Studies; Respiratory Distress Syndrome, Adult/*ET; Risk; Septicemia/*CO; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..

C3a and adult respiratory distress syndrome after massive transfusion.

JOURNAL ARTICLE.

We compared the degree of complement activation in 15 patients receiving massive blood transfusions and 21 patients with the septic syndrome and examined its association with other risk factors for adult respiratory distress syndrome (ARDS). Patients with massive transfusion (n = 8) as their only risk factor for ARDS had lower C3a levels (250 +/- 80 ng/ml) and a lower incidence of ARDS (0%) than patients with massive transfusion plus other risk factors (n = 7; C3a, 600 +/- 120 ng/ml; ARDS, 55%) or patients with the septic syndrome (n = 21; C3a, 540 +/- 80 ng/ml; ARDS, 19%). In our patients, the degree of complement activation appeared to reflect the presence of complicating clinical conditions.

Ketai LH; Grum CM.

Crit Care Med 8703; 14(12):1001-3

Animal; Conjunctiva/ME; Dogs; Hemodynamics; Hemorrhage/PP/*TH; Oxygen Consumption/*; Resuscitation/*.

Cardiorespiratory and conjunctival oxygen tension monitoring during resuscitation from hemorrhage.

JOURNAL ARTICLE.

Placement of an unheated miniaturized oxygen electrode against the palpebral conjunctiva permits noninvasive measurement of tissue oxygen tension. In this study, the relationship between conjunctival oxygen tension (PcjO2) and standard cardiorespiratory variables was examined during a sequential resuscitation protocol after acute hemorrhage. Anesthetized dogs were rapidly bled to a mean arterial pressure of 40 mm Hg and then retransfused with the shed blood in a stepwise fashion. PcjO2 fell to 2% of control values after hemorrhage and did not return to prehemorrhage values until more than 90% of the shed blood had been reinfused. PcjO2 was among the last set of cardiorespiratory variables to return to control values during resuscitation and was the last noninvasive variable to normalize. The ratio of PcjO2 to arterial oxygen tension decreased from a prehemorrhage value of 0.76 +/- 0.05 (SEM) to 0.02 +/- 0.003 after hemorrhage, and did not increase to values greater than 0.50 until resuscitation was more than 90% complete. Conjunctival oxygen monitoring may play an important role in assessing the adequacy of resuscitation after acute hemorrhage.

Abraham E; Fink S.

Crit Care Med 8703; 14(12):1004-9

Adult; Aged; Cerebrovascular Disorders/*ME; Epinephrine/UR; Female; Human; Male; Middle Age; Norepinephrine/UR; Oxygen Consumption.

Metabolism in acute cerebrovascular disease.

JOURNAL ARTICLE.

Oxygen consumption (VO2), CO2 production, respiratory quotient, resting metabolic expenditure (RME), and urine catecholamine levels were measured in 52 patients with acute cerebrovascular disease. RME correlated positively with urinary norepinephrine and epinephrine excretion; its maximum value was 187% higher than expected for an uninjured resting person of equivalent age, sex, and size. VO2 correlated positively with the urinary catecholamine excretion. These facts imply that the sympathetic nervous system might directly influence VO2 and RME. Moreover, the hypermetabolic state should be taken into consideration when caring for patients with cerebrovascular disease, as malnutrition might cause weight loss and a decrease in immunity.

Touho H; Karasawa J; Sawada T.

Crit Care Med 8703; 14(12):1023-5

Acquired Immunodeficiency Syndrome/*CO/MO; Adult; Critical Care; Female; Human; Intensive Care Units; Male; Medical Records; Opportunistic Infections/*CO; Prognosis; Respiratory Insufficiency/*CO/MO; Sarcoma, Kaposi's/CO.

ICU survival of patients with the acquired immunodeficiency syndrome.

JOURNAL ARTICLE.

The ICU records of 31 patients with the acquired immunodeficiency syndrome were reviewed. Of 23 (74%) patients admitted for respiratory failure requiring intubation and mechanical ventilation, 20 (87%) patients had Pneumocystis carinii and/or cytomegalovirus pneumonia. Of the eight patients admitted without respiratory failure, five (63%) were monitored after brain biopsy. Respiratory failure patients remained in the ICU for 10 +/- 1 days, compared to 5 +/- 1 days for those without respiratory failure (p less than .05). Overall mortality was 24 patients (77%); 21 (91%) of 23 respiratory failure patients died, compared to three (38%) of the eight without respiratory failure (p less than .01). All seven ICU survivors lived to hospital discharge.

Schein RM; Fischl MA; Pitchenik AE; Sprung CL.

Crit Care Med 8703; 14(12):1026-7

Equipment Design/*; Human; Intubation/*IS; Tidal Volume; Work of Breathing/*.

Work of breathing through different sized endotracheal tubes.

JOURNAL ARTICLE.

The ability to breathe spontaneously through an endotracheal tube is a usual prerequisite before an intubated patient can have it removed. Other researchers have measured air flow resistance through endotracheal tubes. In this study, we evaluated work of breathing in joules per min and tension-time index while three normal volunteers breathed through different sized endotracheal tubes. Four 27.5-cm endotracheal tubes were used. Subjects breathed with a constant tidal volume of 500 ml. By increasing respiratory frequency, minute ventilation was increased from 5 to 30 L/min. As tube diameter decreased, work and the tension-time index increased. Changes were magnified at higher minute ventilations through the 6- and 7-mm endotracheal tubes, and the tension-time index critical fatigue level of 0.15 was approached or exceeded.

Shapiro M; Wilson RK; Casar G; Bloom K; Teague RB.

Crit Care Med 8703; 14(12):1028-31

Adolescence; Adult; Aged; Critical Care/*; Dobutamine/*TU; Female; Hemodynamics/*DE; Human; Male; Middle Age; Oxygen Consumption/*DE; Postoperative Period.

Hemodynamic and oxygen transport effects of dobutamine in critically ill general surgical patients.

JOURNAL ARTICLE.

The effects of dobutamine on hemodynamic and oxygen transport were evaluated in 43 studies on 34 critically ill general (noncardiac) surgical patients. Dobutamine, beginning at a low dose (2.5 micrograms/kg X min) significantly increased cardiac index (CI), oxygen delivery (DO2), and oxygen consumption (VO2), while decreasing mean arterial pressure, pulmonary artery and wedge pressures, and systemic and pulmonary vascular resistances; blood gases, pH, and pulmonary shunt were not significantly changed. These effects were seen in postoperative and septic patients, as well as in patients with normal, low, and high control CI. These responses were poor in terminally ill and hypovolemic patients; however, when the latter were given additional fluids, their responses were markedly improved. The hemodynamic effects of dobutamine are well known, but the DO2 and VO2 effects, which suggest improved tissue perfusion, have not been appreciated.

Shoemaker WC; Appel PL; Kram HB.

Crit Care Med 8703; 14(12):1032-7

Adult; Aged; Cardiac Output/*; Cardiography, Impedance/*; Comparative Study; Critical Care; Electrodes; Female; Human; Intensive Care Units; Male; Middle Age; Plethysmography, Impedance/*; Pulmonary Wedge Pressure; Thermodilution/*.

Comparison of transthoracic electrical impedance and thermodilution methods for measuring cardiac output.

JOURNAL ARTICLE.

Cardiac output was measured 120 times in 27 critically ill patients using the thermodilution and transthoracic electrical impedance methods. Both the minimum and mean values for the distance between the inner electrodes, and a variety of values for the resistivity of blood (rho) were substituted in the Kubicek's empiric formula for calculating cardiac output by transthoracic electrical impedance. Using the mean distance between the inner electrodes and a rho-value of 150 ohm X cm gave the best agreement between the methods (mean difference 0.17 +/- 2.4 L/min). Ventilation alone or with positive end-expiratory pressure did not significantly affect the bias of the estimate, but both affected its precision when compared with measurements in spontaneously breathing patients (SD of mean difference 2.4 and 3.2 L/min, respectively, vs. 1.5 L/min). The pulmonary artery wedge pressure was significantly higher in patients with an abnormal diastolic impedance waveform (zero-wave), but there was no relationship between wedge pressure and base impedance per unit length between the measuring electrodes.

Donovan KD; Dobb GJ; Woods WP; Hockings BE.

Crit Care Med 8703; 14(12):1038-44

Birth Weight; Blood Pressure/DE; Dopamine/*TU; Female; Heart Rate/DE; Human; Infant, Newborn; Infant, Newborn, Diseases/*DT; Male; Prospective Studies; Retrospective Studies; Support, U.S. Gov't, P.H.S.; Urination/*DE.

Effect of high-dose dopamine on urine output in newborn infants.

JOURNAL ARTICLE.

To achieve adequate arterial BP, adequate capillary filling time, and adequate peripheral pulses, hypotensive newborn infants often require higher doses of dopamine that reportedly reduce urine output in adults. Whether these larger doses of dopamine also reduce urine output in newborns is not known. Therefore, we determined the effects of administering high-dose dopamine (more than 20 micrograms/kg X min) on the urine output of 15 newborn infants. Five infants were studied prospectively and ten retrospectively. In the prospective study, urine output was determined as the dose of dopamine was increased; in the retrospective study, urine output was determined as the infants were being weaned from high doses of dopamine. Both data sets demonstrate that administering high-dosage dopamine does not reduce the urine output of sick newborn infants. Therefore, we conclude that doses of dopamine previously reported to decrease urine output in adults do not do so in sick newborn infants. Consequently, when necessary, high doses of dopamine may be used in sick newborn infants to achieve cardiovascular stability without reducing urine output.

Perez CA; Reimer JM; Schreiber MD; Warburton D; Gregory GA.

Crit Care Med 8703; 14(12):1045-9

Blood Gas Analysis; Blood Gas Monitoring, Transcutaneous/*; Comparative Study; Human; Infant, Newborn; Monitoring, Physiologic; Patient Transfer/*; Respiration, Artificial; Respiratory Distress Syndrome/*BL/TH.

Transcutaneous carbon dioxide monitoring during neonatal transport.

JOURNAL ARTICLE.

We studied the value of transcutaneous carbon dioxide (PtcCO2) monitoring during neonatal transport. Thirty-two neonates with respiratory distress were alternately enrolled in an experimental group (results of PtcO2 and PtcCO2 available for clinical management) and a control group (results of only PtcO2 available). Although differences were not significant, infants in the experimental group had more changes in the intermittent mandatory ventilation (IMV) settings during transport, and more such infants arrived at the receiving hospital with acceptable pH and PCO2 values. On arrival at the receiving hospital, two patients in the control group had acidosis and hypercarbia and were placed on IMV immediately on arrival. No such patients were encountered in the experimental group. For patients needing IMV during transport, the percentage of study time spent with PtcCO2 measurements in the normal range (35 to 45 torr) was greater for the experimental group (p less than .02). Continuous PtcCO2 monitoring during transport offers the opportunity to further decrease the risks of transporting a critically ill neonate.

Jacob J; Rose D; Stilson M; Davis RF; Gilbert D.

Crit Care Med 8703; 14(12):1050-2

Child; Child, Preschool; Fibronectins/*BL/DF; Human; Infant; Prognosis; Purpura/*BL/CO; Shock/BL/CO.

Plasma fibronectin in severe infectious purpura of children.

JOURNAL ARTICLE.

Plasma fibronectin levels were determined in 34 children admitted with severe infectious purpura. Fibronectin concentration was decreased in severe infectious purpura as in other sepsis, but there was no significant difference between shock and nonshock patients. Fibronectin levels were lower in children with ecchymotic or necrotic purpura on admission than in those with petechial purpura; they were lower in those who developed cutaneous sequelae, but it is not known if correction of fibronectin deficiency may limit the extent of purpura and prevent the cutaneous sequelae.

Leclerc F; Martinot A; Beuscart R; Chenaud M; Diependaele JF; Mazurier C.

Crit Care Med 8703; 14(12):1053-4

Anuria/TH; Blood/*; Case Report; Child, Preschool; Critical Care/*; Equipment Design; Female; Hemodialysis/*; Human; Infant; Infant, Newborn; Kidney Failure, Acute/*TH; Male; Peritoneal Dialysis; Ultrafiltration/*.

Early experience with continuous arteriovenous hemofiltration in critically ill pediatric patients.

JOURNAL ARTICLE.

The applicability of continuous arteriovenous hemofiltration (CAVH) for renal replacement therapy was evaluated in three infants and two young children with catastrophic medical and surgical illnesses. In the first four patients, CAVH was used in conjunction with either peritoneal or hemodialysis. In the fifth patient, CAVH was the sole renal replacement therapy employed; in this critically ill anuric infant, we were best able to evaluate the ability of CAVH to continuously control fluid, electrolyte, and acid-base balance, and allow the administration of adequate parenteral nutrition. The difficulties encountered were related to anticoagulation, establishment of adequate vascular access, and selection of an appropriate hemofilter for the performance of the technique. Despite the application of suction-assistance, we were unable to effectively employ a prototype pediatric hemofilter to attain a level of plasma ultrafiltration consistent with the objectives of therapy. However, we were able to effectively and safely employ an adult hemofilter for these purposes; modifications were made in the adult hemofilter system before its application in the smallest pediatric patients. Our experience suggests that, even in critically ill infants, CAVH can be successfully applied as an effective renal replacement therapy. However, further experience is required before its potential impact on patient survival can be assessed.

Leone MR; Jenkins RD; Golper TA; Alexander SR.

Crit Care Med 8703; 14(12):1058-63

Adult; Cardiac Output/*; Case Report; Equipment Failure/*; Female; Heart Catheterization/*; Human.

Spuriously high cardiac output from injecting thermal indicator through an ensheathed port.

JOURNAL ARTICLE.

The applicability of continuous arteriovenous hemofiltration (CAVH) for renal replacement therapy was evaluated in three infants and two young children with catastrophic medical and surgical illnesses. In the first four patients, CAVH was used in conjunction with either peritoneal or hemodialysis. In the fifth patient, CAVH was the sole renal replacement therapy employed; in this critically ill anuric infant, we were best able to evaluate the ability of CAVH to continuously control fluid, electrolyte, and acid-base balance, and allow the administration of adequate parenteral nutrition. The difficulties encountered were related to anticoagulation, establishment of adequate vascular access, and selection of an appropriate hemofilter for the performance of the technique. Despite the application of suction-assistance, we were unable to effectively employ a prototype pediatric hemofilter to attain a level of plasma ultrafiltration consistent with the objectives of therapy. However, we were able to effectively and safely employ an adult hemofilter for these purposes; modifications were made in the adult hemofilter system before its application in the smallest pediatric patients. Our experience suggests that, even in critically ill infants, CAVH can be successfully applied as an effective renal replacement therapy. However, further experience is required before its potential impact on patient survival can be assessed.

Stoller JK; Herbst TJ; Hurford W; Rie MA.

Crit Care Med 8703; 14(12):1064-5

Critical Care/*; Euthanasia/*; Euthanasia, Passive/*; Hospitals, Teaching; Human; Resuscitation/*.

Patient care categories: an approach to do-not-resuscitate decisions in a public teaching hospital.

JOURNAL ARTICLE.

The applicability of continuous arteriovenous hemofiltration (CAVH) for renal replacement therapy was evaluated in three infants and two young children with catastrophic medical and surgical illnesses. In the first four patients, CAVH was used in conjunction with either peritoneal or hemodialysis. In the fifth patient, CAVH was the sole renal replacement therapy employed; in this critically ill anuric infant, we were best able to evaluate the ability of CAVH to continuously control fluid, electrolyte, and acid-base balance, and allow the administration of adequate parenteral nutrition. The difficulties encountered were related to anticoagulation, establishment of adequate vascular access, and selection of an appropriate hemofilter for the performance of the technique. Despite the application of suction-assistance, we were unable to effectively employ a prototype pediatric hemofilter to attain a level of plasma ultrafiltration consistent with the objectives of therapy. However, we were able to effectively and safely employ an adult hemofilter for these purposes; modifications were made in the adult hemofilter system before its application in the smallest pediatric patients. Our experience suggests that, even in critically ill infants, CAVH can be successfully applied as an effective renal replacement therapy. However, further experience is required before its potential impact on patient survival can be assessed.

Davila F; Boisaubin EV; Sears DA.

Crit Care Med 8703; 14(12):1066-7

Case Report; Coma/*CI/TH; Critical Care; Female; Human; Ibuprofen/*PO; Middle Age; Suicide, Attempted.

Coma caused by ibuprofen overdose.

JOURNAL ARTICLE.

The applicability of continuous arteriovenous hemofiltration (CAVH) for renal replacement therapy was evaluated in three infants and two young children with catastrophic medical and surgical illnesses. In the first four patients, CAVH was used in conjunction with either peritoneal or hemodialysis. In the fifth patient, CAVH was the sole renal replacement therapy employed; in this critically ill anuric infant, we were best able to evaluate the ability of CAVH to continuously control fluid, electrolyte, and acid-base balance, and allow the administration of adequate parenteral nutrition. The difficulties encountered were related to anticoagulation, establishment of adequate vascular access, and selection of an appropriate hemofilter for the performance of the technique. Despite the application of suction-assistance, we were unable to effectively employ a prototype pediatric hemofilter to attain a level of plasma ultrafiltration consistent with the objectives of therapy. However, we were able to effectively and safely employ an adult hemofilter for these purposes; modifications were made in the adult hemofilter system before its application in the smallest pediatric patients. Our experience suggests that, even in critically ill infants, CAVH can be successfully applied as an effective renal replacement therapy. However, further experience is required before its potential impact on patient survival can be assessed.

Chelluri L; Jastremski MS.

Crit Care Med 8703; 14(12):1078-9

Adult; Bacteroides melaninogenicus; Bacteroides Infections/*DI/DT; Case Report; Clindamycin/TU; Diagnostic Errors; Epiglottitis/DI/*MI/TH; Human; Laryngitis/*MI; Male; Tracheotomy.

Acute epiglottitis in the adult.

JOURNAL ARTICLE.

Acute epiglottitis in the adult is uncommon. This case reports a young man with acute epiglottitis secondary to a Bacteroides melanogenicus supraglottic abscess. This pathogen has not been previously described as being causitive of epiglottitis.

Devita MA; Wagner IJ.

Crit Care Med 8703; 14(12):1082-3

Anesthesia/*AE; Human; Intraoperative Period; Monitoring, Physiologic/*MT; Respiration, Artificial/*AE.

Anesthetic and ventilator mishaps: prevention and detection [editorial]

EDITORIAL.

Acute epiglottitis in the adult is uncommon. This case reports a young man with acute epiglottitis secondary to a Bacteroides melanogenicus supraglottic abscess. This pathogen has not been previously described as being causitive of epiglottitis.

Weingarten M.

Crit Care Med 8703; 14(12):1084-6

Adult; Aged; Aged, 80 and over; Amputation; Angiography; Arterial Occlusive Diseases/RA/SU; Arthropathy, Neurogenic/DI/ET/TH; Diabetes Mellitus/*CO/PP; Diabetic Neuropathies/DI/ET/SU/TH; Foot Diseases/DI/*ET/PC/PP/RA/SU/TH; Gangrene/ET/SU; Human; Intermittent Claudication/ET/SU; Ischemia/DI/ET/PP/SU/TH; Middle Age; Tibia/BS.

The diabetic foot.

JOURNAL ARTICLE.

Acute epiglottitis in the adult is uncommon. This case reports a young man with acute epiglottitis secondary to a Bacteroides melanogenicus supraglottic abscess. This pathogen has not been previously described as being causitive of epiglottitis.

Corson JD; Jacobs RL; Karmody AM; Leather RP; Shah DM.

Curr Probl Surg 8703; 23(10):721-88

Ascitic Fluid/PA; Axilla/SU; Breast Neoplasms/SU; Female; Gastrointestinal Neoplasms/SU; Groin/SU; Head and Neck Neoplasms/SU; Human; Intestinal Perforation/SU; Male; Neoplasms/*SU; Omentum/*SU/TR; Ovarian Neoplasms/SC; Pelvic Neoplasms/SU; Peritoneal Neoplasms/SC/SU; Postoperative Complications; Support, Non-U.S. Gov't; Surgical Flaps; Thoracic Surgery.

The greater omentum: its applicability to cancer surgery and cancer therapy.

JOURNAL ARTICLE.

Acute epiglottitis in the adult is uncommon. This case reports a young man with acute epiglottitis secondary to a Bacteroides melanogenicus supraglottic abscess. This pathogen has not been previously described as being causitive of epiglottitis.

Williams R; White H.

Curr Probl Surg 8703; 23(11):789-865

Dyspnea/*DT/ET; Human; Lung Diseases, Obstructive/CO; Psychotropic Drugs/AE/*TU.

Treatment of dyspnea with psychotropic agents [editorial]

EDITORIAL.

Acute epiglottitis in the adult is uncommon. This case reports a young man with acute epiglottitis secondary to a Bacteroides melanogenicus supraglottic abscess. This pathogen has not been previously described as being causitive of epiglottitis.

Rice KL.

Chest 8703; 90(6):789-90

Amyloidosis/*PA/TH; Human; Lung Diseases/*PA/TH; Prognosis.

Clinical aspects of pulmonary amyloidosis [editorial]

EDITORIAL.

Acute epiglottitis in the adult is uncommon. This case reports a young man with acute epiglottitis secondary to a Bacteroides melanogenicus supraglottic abscess. This pathogen has not been previously described as being causitive of epiglottitis.

Gertz MA; Greipp PR.

Chest 8703; 90(6):790-1

Bronchi/PA; Exudates and Transudates/PA; Human; Irrigation/*; Lung Diseases/IM/MI/*PA; Pulmonary Alveoli/PA.

Bronchoalveolar lavage can be clinically useful [editorial]

EDITORIAL.

Acute epiglottitis in the adult is uncommon. This case reports a young man with acute epiglottitis secondary to a Bacteroides melanogenicus supraglottic abscess. This pathogen has not been previously described as being causitive of epiglottitis.

Baughman RP; Thorpe JE.

Chest 8703; 90(6):791-2

Airway Obstruction/*CO; Anesthesia, Inhalation/*AE; Case Report; Human; Intubation, Intratracheal/*AE; Male; Middle Age; Obesity/CO; Pulmonary Edema/*ET/PP; Risk.

Post-extubation pulmonary edema following anesthesia induced by upper airway obstruction. Are certain patients at increased risk?

JOURNAL ARTICLE.

Pulmonary edema due to upper airway obstruction can be observed in a variety of clinical situations. The predominant mechanism is increased negative intrathoracic pressure, although hypoxia and cardiac and neurologic factors may contribute. Laryngospasm associated with intubation and general anesthesia is a common cause of pulmonary edema in children. However, only seven cases of pulmonary edema presumably due to laryngospasm have been reported in adolescents and adults. Five of the seven had other risk factors for upper airway obstruction, and in four, the diagnosis of "laryngospasm" could be explained by other factors. Patients with underlying risk factors for upper airway obstruction, such as a forme fruste of sleep apnea or nasopharyngeal abnormalities, appear to be at increased risk for the development of pulmonary edema in the setting of intubation and anesthesia. This form of pulmonary edema usually resolves rapidly without the need for aggressive therapy or invasive monitoring.

Lorch DG; Sahn SA.

Chest 8703; 90(6):802-5

Catheterization/AE/*MT; Extravasation of Diagnostic and Therapeutic Materials/ET; Hemothorax/ET; Human; Intensive Care Units/*; Phlebitis/ET; Pneumothorax/ET; Prospective Studies.

Central vs peripheral venous catheters in critically ill patients.

JOURNAL ARTICLE.

A prospective study of 2,209 intravenous catheters was performed in a multidisciplinary intensive care unit to determine when and why catheters were removed and which sites of insertion were associated with the least morbidity. Techniques of insertion were vigorously supervised. Central and peripheral catheters were cared for by identical protocols. Overt phlebitis or inflammation around the site was 14 times as common with peripheral catheters (353/1,024) than with centrally inserted central catheters (18/713), even though peripheral catheters were removed on the average at 2.9 days and centrally inserted central catheters at 6.2 days. Pneumothorax occurred in seven out of 713 patients with centrally inserted central catheterization, one with hemothorax and two with pneumothoraces requiring thoracostomy tubes. Five were treated successfully with simple catheter aspiration. Three patients out of 1,496 with peripheral or peripherally inserted central catheters required phlebectomy for suppurative thrombophlebitis. We concluded that overall morbidity in critically ill patients is lower from centrally inserted central catheters than peripheral intravenous catheters, with peripherally inserted central catheters in an intermediate position. Supervision of techniques of insertion has to be kept at a high level to keep complications of central catheterization at an acceptable level. Peripheral catheter sites would be better maintained with more frequent replacement of the catheter.

Giuffrida DJ; Bryan-Brown CW; Lumb PD; Kwun KB; Rhoades HM.

Chest 8703; 90(6):806-9

Adult; Anthropometry; Human; Male; Medroxyprogesterone/*AA/TU; Middle Age; Sleep Apnea Syndromes/*DT; Sleep, REM; Support, U.S. Gov't, Non-P.H.S.; Tidal Volume; Transducers, Pressure; Vital Capacity.

Effects of medroxyprogesterone acetate in obstructive sleep apnea.

JOURNAL ARTICLE.

We studied the effects of medroxyprogesterone acetate, a respiratory stimulant, on the incidence and duration of episodes of apnea and disordered breathing in 13 nonhypercapnic men with obstructive sleep apnea. Nocturnal polysomnography was done before and after four weeks of treatment with medroxyprogesterone acetate (60 mg/day) and one week after cessation of treatment. There were no significant (p less than 0.05) differences in the mean frequency of apneic episodes per hour of sleep before (31.3 +/- 5.7 [+/- SE]), during (26.8 +/- 6.6), or after (23.6 +/- 7.0) treatment, or in the mean number of disordered breathing episodes per hour of sleep before (19.4 +/- 5.6), during (21.4 +/- 5.8), or after (23.1 +/- 6.3) the period of treatment. Medroxyprogesterone did not alter significantly the total time of apnea or the total time for disordered breathing, expressed as percentages of total sleep time. Arterial oxygen desaturation during apnea and disordered breathing did not change with treatment. Medroxyprogesterone increased the minute ventilation and occlusion pressure responses to hypercapnia measured in the awake state; however, the results of this study demonstrate that medroxyprogesterone does not improve the breathing disorders during sleep in the nonhypercapnic patient with obstructive sleep apnea.

Rajagopal KR; Abbrecht PH; Jabbari B.

Chest 8703; 90(6):815-21

Adult; Aged; Amyloid/ME; Amyloidosis/*PA/SU; Birefringence; Bronchial Diseases/PA; Female; Human; Lung Diseases/*PA/SU; Lung Neoplasms/PA; Male; Microscopy, Polarization; Middle Age; Tissue Distribution; Tracheal Diseases/PA.

Amyloidosis of the lower respiratory tract. Clinical and pathologic features in a series of 21 patients.

JOURNAL ARTICLE.

Twenty one cases of amyloidosis of the lower respiratory tract were seen at a single center. In three patients, multifocal bronchial amyloid plaques led to stenosis and atelectasis, and in two, small pseudotumor masses were an incidental bronchoscopic finding. Two patients had nodular parenchymal amyloidosis, in one of whom the lesions were progressive and in the other static. Fifteen patients had diffuse parenchymal amyloidosis. Two of these had severe interstitial involvement and died in respiratory failure; eight had congestive cardiac failure, and parenchymal amyloidosis was a post-mortem finding; two had senile cardiorespiratory amyloidosis, also found at autopsy; and in three, the amyloidosis was associated with malignancy. The degree of respiratory embarrassment seemed to be related to the amount of amyloid in the gas diffusion zones, irrespective of the etiology of amyloidosis.

Cordier JF; Loire R; Brune J.

Chest 8703; 90(6):827-31

Aged; Alprazolam/AE/*TU; Double-Blind Method; Drug Evaluation; Dyspnea/*DT/PA; Exertion/*; Female; Human; Lung Diseases, Obstructive/*DT/PP; Male; Middle Age; Random Allocation; Respiratory Function Tests; Statistics; Support, Non-U.S. Gov't.

Effect of alprazolam on exercise and dyspnea in patients with chronic obstructive pulmonary disease.

JOURNAL ARTICLE.

To evaluate the efficacy of a mild anxiolytic, alprazolam, in relieving dyspnea, we conducted a randomized, placebo-controlled double-blind study on patients with chronic obstructive lung disease. Twenty-four patients had alprazolam (0.5 mg bid) or placebo administered for one week, followed by placebo for one week, then either placebo or alprazolam for the third week. Assessment tests were performed at the outset, end of the first and second weeks, and finally end of the third week. The parameters measured were: pulmonary function, exercise testing on a bicycle ergometer, and the distance covered in a 12 minute walk. Subjective sensations of dyspnea at rest and during guarded exercise, as well as subjective feelings of calmness or anxiety were also recorded. There was no difference in mechanical lung function, but the PO2 tended to decrease and PCO2 to increase after alprazolam administration. The maximum exercise level attained and the distance covered in the 12 minute walk was unchanged. The subjective perception of dyspnea was the same before and after alprazolam, at rest and during exercise. We conclude that alprazolam is not effective in relieving exercise dyspnea in patients with obstructive lung disease.

Man GC; Hsu K; Sproule BJ.

Chest 8703; 90(6):832-6

Adult; Aged; Cardiac Output; Female; Half-Life; Human; Kinetics; Lidocaine/*ME; Liver/*ME; Male; Middle Age; Regional Blood Flow; Respiration; Respiration, Artificial/*; Support, Non-U.S. Gov't.

Effect of mechanical ventilation on hepatic drug pharmacokinetics.

JOURNAL ARTICLE.

Mechanical ventilation was able to induce a decrease in cardiac output and regional blood flow, especially hepatic flow. Thus, hepatic elimination of drugs with a high hepatic-extraction ratio, which was linked to alteration in hepatic blood flow, could be reduced during mechanical ventilation. The aim of this work was to determine the effect of mechanical ventilation on pharmacokinetic parameters of lidocaine, which is a well-known nonrestrictive elimination drug at the hepatic level. Five patients (mean age, 58 years) with normal hepatic function and quite similar gasometric parameters before and after weaning from mechanical ventilation were studied. With a washout period of 48 hours between mechanical ventilation and spontaneous ventilation, each patient was submitted to the following protocol: lidocaine in a bolus (1.5 mg/kg intravenously), followed by infusion (1.0 to 1.7 mg/min for 120 minutes). The results were that the peak plasma concentration after the bolus during mechanical ventilation was 3.22 +/- 0.37 mg/L (mean +/- SE) vs 2.40 +/- 0.35 mg/L during spontaneous ventilation (p less than 0.02). Steady-state plasma concentration during mechanical ventilation was 2.10 +/- 0.20 mg/L vs 1.64 +/- 0.16 mg/L during spontaneous ventilation (p less than 0.01). Total clearance was 604.2 +/- 87.0 ml/min during mechanical ventilation vs 775.0 +/- 112.1 ml/min during spontaneous ventilation (p less than 0.01). Elimination half-life was 245.2 +/- 50.6 minutes during mechanical ventilation vs 160.0 +/- 40.6 minutes during spontaneous ventilation (p less than 0.05). Distribution volume was 188.6 +/- 50.2 L during mechanical ventilation and 183.0 +/- 50.8 L during spontaneous ventilation (not significant). These preliminary data clearly demonstrated a decrease in lidocaine elimination in patients submitted to mechanical ventilation, but the magnitude of dosage adjustment of such a highly hepatic-extracted drug in patients submitted to mechanical ventilation remains to be investigated.

Richard C; Berdeaux A; Delion F; Riou B; Rimailho A; Giudicelli JF; Auzepy P.

Chest 8703; 90(6):837-41

Adult; Angiography; Angioplasty, Transluminal/*; Case Report; Graft Occlusion, Vascular/RA/*TH; Human; Internal Mammary Artery Implantation/*; Male; Middle Age; Myocardial Revascularization/*.

Percutaneous transluminal angioplasty of right and left internal mammary artery grafts.

JOURNAL ARTICLE.

Four patients with recurrent severe angina and evidence of myocardial ischemia two to six months after surgical coronary revascularization have been submitted to percutaneous transluminal angioplasty of the distal insertion of internal mammary artery grafts or of the recipient vessel distal to it. These cases illustrate the feasibility and safety of transluminal angioplasty of right and left internal mammary artery grafts, using the mammary artery as a way of access.

Steffenino G; Meier B; Finci L; von Segesser L; Velebit V.

Chest 8703; 90(6):849-51