tbuckley/cabot-search huggingface dataset:
Hyponatremia in Legionnaires' Disease
Authors: VICTOR RICHARDS
Journal: Annals of Internal Medicine (1979)

Letters and Corrections1 January 1979Hyponatremia in Legionnaires' DiseaseVICTOR RICHARDS, M.D.VICTOR RICHARDS, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-90-1-132_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: The article of Dr. Kirby and associates (1) on legionnaires' disease mentions hyponatremia as a common laboratory finding in their 24 patients with Legionnaires' disease. They attribute this to possible inappropriate secretion of antidiuretic hormone secondary to bacterial pneumonia. Fourteen of their 24 patients had serum sodium levels of less than 130 meq/litre.I believe this may be otherwise explained, with the information given for 13 of the 14 patients. Six patients had evidence of renal impairment; five had cardiopulmonary disease, implying possible abnormal volume status, or the use of diuretics as part of their therapy; two...References1. KIRBYSNYDERMEYERFINEGOLD BKRS: Legionnaires' disease: clinical features of 24 cases. Ann Intern Med 89:297-309, 1978 LinkGoogle Scholar2. AGUSGOLDBERG ZM: Role of antidiuretic hormone in the abnormal water diuresis of anterior hypopituitarism in man. J Clin Invest 50:1478-1489, 1971 CrossrefMedlineGoogle Scholar3. HAYSLEVINE RS: Pathophysiology of water metabolism, in The Kidney, edited by BRENNER B, RECTOR S. Philadelphia, W. B. Saunders Company, 1976, pp. 594-595 Google Scholar1. KIRBYSNYDERMEYERFINEGOLD BKRS: Legionnaires' disease: clinical features of 24 cases. Ann Intern Med 89:297-309, 1978 LinkGoogle Scholar2. NUSSERTARKOFF RM: Legionnaires' disease causing adult respiratory distress syndrome. West J Med 128:443-448, 1978 MedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByA Novel Diagnostic Scoring System to Differentiate between Legionella pneumophila Pneumonia and Streptococcus pneumoniae PneumoniaHyponatraemia in Legionnaires' disease.Vertical Tube Evaporators 1 January 1979Volume 90, Issue 1Page: 132-133KeywordsAntidiuretic hormoneBacterial pneumoniaDiureticsHyponatremiaLegionellosisRenal diseasesResearch laboratoriesSodium Issue Published: 1 January 1979 PDF DownloadLoading ...
Long-term Topical Exposure to Toluene Diisocyanate in Mice Leads to Antibody Production and <i>In Vivo</i> Airway Hyperresponsiveness Three Hours after Intranasal Challenge
Authors: HELEEN SCHEERENS, THERESA L. BUCKLEY, THEA LEUSINK MUIS, JOHAN GARSSEN, JAN DORMANS, FRANS P. NIJKAMP, HENK VAN LOVEREN
Journal: American Journal of Respiratory and Critical Care Medicine (1999)

Toluene diisocyanate (TDI) is a low-molecular-weight compound which is known to cause occupational asthma in 5 to 10% of exposed workers. Previously, we developed a murine model to investigate TDI-induced occupational asthma. Short-term exposure to TDI (skin sensitization twice daily on Day 0 and Day 1 and intranasal challenge on Day 8) led to a nonspecific tracheal hyperractivity 24 h after the challenge in TDI-sensitized mice when compared with nonsensitized mice whereas no TDI-specific IgE antibodies were found in the serum. Because 20% of subjects with TDI-induced occupational asthma exhibit an increase in serum IgE antibodies, we exposed mice for a longer period of time to investigate whether this procedure could induce TDI-specific antibody production in exposed mice. Long-term exposure (skin sensitization on 6 consecutive weeks followed by intranasal challenge on Week 7) resulted in the production of total IgE and IgG and TDI-specific IgE and IgG antibodies. Airway reactivity to various agonists was also measured in vitro and in vivo in long-term exposed mice. TDI-sensitized mice exhibited in vitro tracheal hyperreactivity to carbachol 3 h after the challenge when compared with the nonsensitized mice. Moreover, in vivo airway hyperresponsiveness to serotonin (5-hydroxytryptamine [5HT]) was found 3 h after the challenge in TDI-sensitized mice. Interestingly, in vivo airway hyperresponsiveness was not observed at any time point in the mice exposed to TDI according to the short-term protocol. In conclusion, by altering the exposure time and/or cumulative dosage of TDI different biological reactions can be elicited in exposed mice. This important finding might be a reflection of the diversity of symptoms found in patients suffering from TDI-induced asthma. Both the short-exposure and the long-exposure model will be useful to further investigate the mechanisms of action of TDI.
Somatostatin Receptor Expressing Bilateral Ovarian Metastases Detected by 68Ga DOTANOC PET/CT
Authors: Saurabh Arora, Ramya Soundararajan, Prashant Joshi, Rakesh Kumar, Chandrasekhar Bal
Journal: Clinical Nuclear Medicine (2014)

Bilateral ovarian metastasis from neuroendocrine tumor (NET) is uncommon. Ovarian NET could be primary or metastatic, and if it is bilateral, then the chances of metastatic disease are from 88% to 94%. Proper identification and appropriate management become necessary in such patients. Somatostatin receptor imaging by Ga-labeled DOTANOC ([1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid]-1-NaI3-Octreotide) PET/CT can be used for localization, staging, and restaging of NET, and it also has an impact on appropriate clinical management of patients with NET. We present here a case of somatostatin receptor expressing bilateral ovarian metastases from NET demonstrated by Ga DOTANOC PET/CT imaging.
Monitoring drug resistance in hepatitis B virus-infected patients during antiviral therapy: multi-center evaluation of the INNO-LiPA HBV-DR
Authors: Erwin R. Sablon, Anna S. Lok, Stephen Locarnini, Fabien Zoulim, Alessandra Mangia, Karen De Vreese, Geert Maertens
Journal: Journal of Hepatology (2001)
Impact of Ethnicity and Gender Differences on Angiographic Coronary Artery Disease Prevalence and In-Hospital Mortality in the American College of Cardiology–National Cardiovascular Data Registry
Authors: Leslee J. Shaw, Richard E. Shaw, C. Noel Bairey Merz, Ralph G. Brindis, Lloyd W. Klein, Brahmajee Nallamothu, Pamela S. Douglas, Ronald J. Krone, Charles R. McKay, Peter C. Block, Kathleen Hewitt, William S. Weintraub, Eric D. Peterson
Journal: Circulation (2008)

Although populations referred for coronary angiography are increasingly diverse, there is limited information on coronary artery disease (CAD) prevalence and in-hospital mortality other than for predominately white male patients.We examined gender and ethnic differences in CAD prevalence and in-hospital mortality in a prospective cohort of patients referred for angiographic evaluation of stable angina (n=375,886) or acute coronary syndromes (ACS; unstable angina or myocardial infarction, n=450,329) at 388 US hospitals participating in the American College of Cardiology-National Cardiovascular Data Registry, an angiographic registry. Univariable and multivariable (with covariates that included risk factors, symptoms, and comorbidities) logistic regression models were used to estimate significant CAD, defined as > or = 70% stenosis, and in-hospital mortality. Within stable angina and ACS cohorts, 7% of patients were black, 2% were Hispanic, 0.3% were Native American, 1% were Asian, and 90% were white, respectively. In stable angina, the risk-adjusted OR for significant CAD was 0.34 for women compared with men (P<0.0001), with black women having the lowest risk-adjusted odds (P<0.0001) compared with other females. Among ACS patients, the risk-adjusted OR of significant CAD was 0.47 for women compared with men (P<0.0001); similarly, black women had the lowest risk-adjusted odds (P<0.0001) compared with other females. Higher in-hospital mortality was reported for white women presenting with stable angina (P<0.00001). White women had a 1.34-fold (95% CI 1.21 to 1.48) higher risk-adjusted odds ratio for mortality than white men with stable angina (P<0.0001), with higher rates noted for white women who were older or had significant CAD (both P<0.0001). Lower utilization of elective coronary revascularization, aspirin, and glycoprotein IIb/IIIa inhibitors (all P<0.0001) may have contributed to higher in-hospital mortality for white women. In ACS, higher in-hospital mortality was reported for Hispanic (P=0.015) and white (P<0.0001) women; however, neither white (P=0.51) or Hispanic (P=0.13) women had higher in-hospital risk-adjusted mortality.The likelihood for significant CAD at coronary angiography and for in-hospital mortality varied significantly by ethnicity and gender. Future clinical practice guidelines should be tailored to gender subsets of the population, in particular for black women, to improve the efficient use of angiographic laboratories and to target at-risk populations of women and men.
Visualization of subendocardial myocardial ischemia with myocardial contrast echocardiography in humans.
Authors: Y J Lim, S Nanto, T Masuyama, K Kodama, T Ikeda, A Kitabatake, T Kamada
Journal: Circulation (1989)

Previous studies indicate the degree of myocardial echo contrast enhancement may be related to regional myocardial perfusion. In this study, myocardial contrast echocardiography was used to characterize changes in the transmural myocardial blood flow distribution that were provoked by rapid atrial pacing in 11 patients with one-vessel coronary artery disease. Ten patients without coronary artery disease served as controls. Myocardial contrast echocardiography was performed by intracoronary injection of 2 ml hand-agitated amidotrizoate sodium meglumine (Urografin-76) and by imaging a short-axis view of the left ventricle with two-dimensional echocardiography before and during injection of the contrast agent. The two-dimensional echocardiographic images at end diastole, before and after injection of the contrast agent, were digitized off-line into a 512 x 512 pixel matrix with 256 gray levels/pixel to quantify the degree of the enhancement of the peak gray level after injection. Transmural myocardial blood flow distribution was evaluated by measuring the ratio of the enhanced gray level in the endocardial half (endo) to that in the epicardial half (epi) (endo:epi gray level ratio) in the anteroseptal, posterolateral, and inferior segments before and just after rapid atrial pacing in each patient. In patients without coronary artery disease, there were no differences in the endo:epi gray level ratio between any of the three segments both before and after pacing. Mean values of the three segments were 0.95 +/- 0.08 before pacing and 0.90 +/- 0.13 after pacing, respectively. In contrast, in patients with coronary artery disease, the endo:epi gray level ratio for the segment supplied with stenotic coronary artery decreased after pacing (0.40 +/- 0.21 vs. 0.93 +/- 0.18, p less than 0.01), probably reflecting subendocardial myocardial ischemia, whereas that for the segment supplied with nonstenotic coronary artery remained unchanged (0.88 +/- 0.20 vs. 0.99 +/- 0.23, NS). Thus, changes in transmural myocardial blood flow distribution with rapid pacing, which may be due to transient subendocardial ischemia, are visualized with myocardial contrast echocardiography.
Fortnightly review: Prophylaxis of venous thromboembolism
Authors: M Verstraete
Journal: BMJ (1997)

The incidence of deep vein thrombosis has for years been underrated because it is difficult to diagnose accurately by clinical history and physical examination. Minimal leg symptoms may be associated with extensive venous thrombosis whereas classic symptoms and signs of pain, tenderness, and swelling of the leg can be caused by non-thrombotic disorders. In patients without symptoms and signs of deep vein thrombosis, the diagnosis is most often revealed by a pulmonary embolism; indeed, less than 20% of patients with proved pulmonary embolism have clinical features compatible with venous thrombosis in the legs.1 Thromboembolism in lower venous systems usually occurs as a complication of major surgery or of a serious illness. Without antithrombotic prophylaxis objective diagnostic measures have shown that 8-15% of patients develop venous thrombosis after major general (including abdominal) surgery, 36-60% after surgery for hip fracture, 47-57% after total hip replacement, and 40-80% after total knee replacement.2 The frequency of deep vein thrombosis is less well documented in medical patients. A recent study using colour Doppler imaging detected an unexpectedly high rate of deep vein thrombosis of 33% in patients in an intensive medical care unit; 48% of these cases were proximal leg thromboses.3 The prevalence of deep vein thrombosis will probably increase in future because the average age of the population and the number of cancer patients is increasing, high age is becoming a lesser contraindication for major surgery, and many surgical patients, young and old, are being discharged from hospital before they are fully ambulant. #### Summary points
Discovering the causes of atopy
Authors: S. Shaheen
Journal: BMJ (1997)

The marked increase in the prevalence of childhood asthma, eczema, and hay fever in Britain over the past 30 years or more is largely unexplained. However, it is likely to be attributable to a rise in the prevalence of atopy. This is characterised by exaggerated Th2 cell responses to common allergens with production of raised concentrations of allergen specific IgE. Although we now understand more about the genetics of atopy and the role of Th1 and Th2 cells in the control of IgE, the environmental causes of atopy have eluded us. Of increasing interest is the potential roles that patterns of childhood infection and fetal growth and maturation might have in the inception of atopy.

The number of older siblings has been shown to be inversely related to the prevalence of adult hay fever and infant eczema.1 This observation led Strachan to propose in the BMJ in 1989 that atopy may have increased because of a fall in exposure to infections in early childhood through improved hygiene and reductions in family size and overcrowding in the home.1 Children are likely to experience more severe infections at an earlier age when the number of …
A Bell-Shaped Dose-Dependent Induction of Allergen-Specific Tetramer+ CD4 T Cells and Activated Lung ILC2s Following Epicutaneous Allergen Sensitization in HLA-DR4 Transgenic Mice
Authors: Christopher D. Rudulier, Daniel M. Moldaver, Tarandeep Singh, Ivan Nayve, Jennifer Wattie, Marianne van Hage, Eddie A. James, William W. Kwok, Mark Larché
Journal: Journal of Allergy and Clinical Immunology (2015)
Infection Risk with Nitrofurazone-Impregnated Urinary Catheters in Trauma Patients
Authors: Jakob Stensballe
Journal: Annals of Internal Medicine (2007)

Background: Urinary tract infection is one of the most common nosocomial infections in hospitalized patients. It is predominantly associated with indwelling urinary catheters. Objective: To determine whether nitrofurazone-impregnated urinary catheters reduce the incidence of catheter-associated bacteriuria and funguria (CABF). Design: Randomized, double-blind, controlled trial. Setting: Copenhagen Trauma Center, Copenhagen, Denmark. Patients: 212 consecutive adult trauma patients admitted between July 2003 and August 2005. Eligible patients needed a urinary catheter on arrival and were excluded if they were HIV positive, were pregnant, had a primary burn injury, or were receiving steroid treatment or if informed consent was unattainable. Interventions: Nitrofurazone-impregnated or standard silicone catheter throughout the duration of catheterization. Measurements: Catheter-associated bacteriuria and funguria, defined as at least 103 colony-forming units/mL, was assessed daily until removal of the catheter, with a prespecified minimum of 24-hour follow-up for the primary analysis. The microbiologist was blinded to study group assignment. Results: 1190 urine cultures were obtained over 1001 catheter-days. Catheter-associated bacteriuria and funguria occurred less frequently in the nitrofurazone catheter group than in the silicone catheter group (7 of 77 [9.1%] vs. 19 of 77 [24.7%]; incidence per 1000 catheter-days, 13.8 vs. 38.6; adjusted risk, 0.31 [95% CI, 0.14 to 0.70]; P = 0.005). Onset of CABF was delayed in the nitrofurazone group (P = 0.01), and nitrofurazone catheters led to fewer instances of new or changed antimicrobial therapy (adjusted risk, 0.27 [CI, 0.10 to 0.69]; P = 0.006). Limitations: The clinical significance of asymptomatic bacteriuria and funguria is unclear. Data were missing in 27% of patients, and the magnitude of effect of the nitrofurazone catheters varied by assumptions about outcomes in patients who did not complete 24-hour follow-up. Conclusions: Nitrofurazone-impregnated urinary catheters reduced the incidence of CABF in adult trauma patients, reducing the need to change or prescribe new antimicrobial therapy. ClinicalTrials.gov registration number: NCT00192985.
Elevation of Prostate-Specific Markers After Cardiopulmonary Resuscitation
Authors: Jeanette Koller-Strametz, Monika Fritzer, Marianne Gwechenberger, Alexander Geppert, Gottfried Heinz, Markus Haumer, Maria Koreny, Gerald Maurer, Peter Siostrzonek
Journal: Circulation (2000)

Background —Prostate-specific antigen (PSA), acid phosphatase (AP), and prostatic acid phosphatase (PAP) are serum markers for adenocarcinoma of the prostate gland. Previous studies indicated that prostatic ischemia may also produce elevations of PSA. Cardiopulmonary resuscitation (CPR) is frequently associated with profound tissue hypoperfusion. The present study investigated whether PSA, AP, and PAP are influenced by prolonged CPR. Methods and Results —PSA, AP, and PAP were assessed immediately, 12 hours, 24 hours, 2 days, 3 days, 5 days, and 7 days after prolonged CPR (&gt;5 minutes) in 14 male and 5 female patients. No changes were noted in women. In men, serum levels increased significantly after CPR and gradually decreased to near baseline values after 7 days. PSA, AP, and PAP values above the normal range were observed in 63%, 71%, and 64% of all patients, respectively. Compared with survivors, nonsurvivors exhibited higher peak serum levels of PSA (98.6±14.3 versus 1.1±2.2 μg/L; P &lt;0.03), AP (57.0±71 versus 8.6±8.8 U/L; P &lt;0.05), and PAP (47.0±62 versus 5.7±8.0 U/L; P =NS). Patients with poor neurological outcome exhibited higher peak serum levels of PSA (86.4±135.5 versus 12.0±23.8 μg/L; P &lt;0.05), AP (50.9±68.1 versus 8.7±9.6 U/L; P =NS), and PAP (41.6±59.5 versus 5.8±8.8 U/L; P =NS) than patients with good neurological outcome. Conclusions —Prolonged CPR is frequently associated with increases of PSA, AP, and PAP serum levels. Therefore, PSA cannot be used for diagnosis of adenocarcinoma of the prostate during the first weeks after CPR. Further evaluation of these parameters as additional prognostic markers after CPR is warranted.
Electroconvulsive Treatment in a General Hospital
Authors: Walter I. Tucker, Robert Fleming, Oscar Raeder
Journal: New England Journal of Medicine (1955)

ELECTROCONVULSIVE therapy was initiated at the New England Deaconess Hospital in August, 1953, since we believed that a need existed for such treatment in a general-hospital setting. The administration of the hospital has been most Cooperative and helpful, and this attitude we believe to be a most important factor in the success of the program. We have analyzed the results of such treatment for the first year, covering 157 patients, 100 outpatients and 57 inpatients, who received a total of 1690 treatments. The inpatients were admitted just as any medical or surgical patient in any part of the hospital and . . .
Error in dose of levothyroxine
Authors: S. S. Stoffer
Journal: JAMA (1978)

To the Editor.—  We were surprised to read in the QUESTIONS AND ANSWERS section (239:1205-1208, 1978) that the patient who had surgery for an autonomous hot thyroid nodule subsequently was treated with levothyroxine sodium (Synthroid), 0.5 mg/day. Our experience is consistent with Stock et al 1 and Cotton et al 2 in suggesting that the vast majority of hypothyroid patients are adequately treated, both from the clinical standpoint and in terms of restoration of elevated concentrations of serum thyroid-stimulating hormone to normal, with 0.2 mg or less of levothyroxine sodium daily. We have never found it necessary to exceed 0.3 mg/day. Therefore, we have questioned in the past the propriety of tablets too potent to be useful and perhaps too potent for human consumption. 3,4 We have encountered four patients for whom pharmacists erroneously dispensed tablets containing 0.5 mg rather than 0.05 mg of levothyroxine. Two of these patients had
Corrosive injury of the stomach: an unusual presentation
Authors: A. Somasundaram, R. Ravi, J. Venkataraman
Journal: Endoscopy (2009)

A 45-year-old male was evaluated for symptoms of epigastric pain and vomiting. He had consumed alcohol 24 hours prior to admission. Upper gastrointestinal endoscopy showed an erythematous antral mucosa. Following an alcohol binge, he presented again 15 days later with an upper gastrointestinal bleed that required blood transfusion. An endoscopy after resuscitation showed severe esophagitis and greenish-black sloughed deep ulceration in the distal body and antrum, completely encircling the lumen ([Fig. 1] and [2]). In addition, there were similar linear ulcers in the fundus of the stomach ([Fig. 3]). The duodenum was normal. The possibility of corrosive injury to the stomach was considered. However, the patient denied any history of ingestion of a corrosive substance and was managed supportively with sucralfate. The patient presented 4 weeks later with persistent vomiting. A repeat endoscopy showed an antral stricture ([Fig. 4]). At the time of writing, the patient was awaiting surgery.
Environmental sensitivities: prevalence of major symptoms in a referral center: the Nova Scotia Environmental Sensitivities Research Center Study.
Authors: M R Joffres, T Williams, B Sabo, R A Fox
Journal: Environmental Health Perspectives (2001)

Although the phenomenon of environmental sensitivities (ES) has no clear etiology nor well-accepted pathophysiology, affected individuals experience symptoms that cause varying levels of dysfunction. Through a dedicated, government-funded research and treatment center, a detailed questionnaire covering 217 symptoms in 13 systems was mailed in 1997-1998 to 812 individuals referred to the center by physicians. A total of 385 (47%) questionnaires were returned, and data were analyzed on 351 individuals. Participants tended to be women (80%), middle-aged individuals (37% age 40-49 years), and those in higher educational groups (28% completed university), but there was wide variation in demographic variables. General symptoms such as difficulty concentrating, fatigue, forgetfulness, and irritability dominated the overall prevalence of symptoms since the start of their illness. Those related to irritation such as sneezing, itchy or burning eyes, and hoarseness or loss of voice were more common after exposure to environmental irritants. Ranking of symptoms using severity scores was consistent between men and women. Overall scores were higher in women, in participants who were separated or divorced, and in low-income groups. The type and consistency of symptoms experienced after exposure to triggering substances may not fit a purely psychogenic theory.