tbuckley/cabot-search huggingface dataset:
Provocation of Bronchospasm by Eye Drops
Authors: CARMEN FRATTO
Journal: Annals of Internal Medicine (1978)

Brief Reports1 March 1978Provocation of Bronchospasm by Eye DropsCARMEN FRATTO, M.D., F.A.C.P.CARMEN FRATTO, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-88-3-362 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe importance of obtaining a thorough drug history cannot be overemphasized. Patients often do not regard eye drops as "medication" and omit this information from the history. Moreover, the physician may be given the information only to disregard it as irrelevant. Some topical eye preparations may be absorbed into the systemic circulation and cause potentially dangerous reactions. We present here the case of a patient with unexpected refractory bronchospasm that we could not control until a topical ophthalmic preparation was discontinued.A 60-year-old woman was admitted to the hospital with progressive shortness of breath and wheezing. There was a prolonged...References:1. DE ROETTHDETTBARNROSENBERGWILENSKYWONG AWPJA: Effect of phospholine iodide on blood cholinesterase levels of normal and glaucoma subjects. Am J Ophthalmol 59:586-592, 1965 CrossrefMedlineGoogle Scholar2. HUMPHREYSHOLMES JJ: Systemic effects produced by echothiophate iodide in treatment of glaucoma. Arch Ophthalmol 69:737-743, 1963 CrossrefMedlineGoogle Scholar3. HALLETTCULLEN MR: Intoxication with echothiophate iodide. JAMA 222:1414-1415, 1972 CrossrefMedlineGoogle Scholar4. AMA Drug Evaluations, 3rd ed. Littleton, Massachusetts, Publishing Sciences Group Inc., 1977, p. 923 Google Scholar5. GOLD W: Cholinergic pharmacology in asthma, in: Asthma: Physiology, Immunopharmacology and Treatment, edited by AUSTEN RF, LICHTENSTEIN LM. New York, Academic Press, 1973, p. 169 CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Maryland General Hospital Baltimore, Maryland PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byPediatric Glaucoma: Pharmacotherapeutic OptionsDrug induced pulmonary parenchymal diseaseEye Drops — The Hidden PoisonDrug-Induced BronchospasmMental status changes induced by eye drops in dementia of the Alzheimer type.Age-specific incidence rates for motor neuron disease.Drugs used in ocular treatment 1 March 1978Volume 88, Issue 3Page: 362-362KeywordsDrugsDyspnea Issue Published: 1 March 1978 PDF downloadLoading ...
STEPS: Similarity and Truth Estimation for Propagated Segmentations and its application to hippocampal segmentation and brain parcelation
Authors: M. Jorge Cardoso, Kelvin Leung, Marc Modat, Shiva Keihaninejad, David Cash, Josephine Barnes, Nick C. Fox, Sebastien Ourselin
Journal: Medical Image Analysis (2013)

Anatomical segmentation of structures of interest is critical to quantitative analysis in medical imaging. Several automated multi-atlas based segmentation propagation methods that utilise manual delineations from multiple templates appear promising. However, high levels of accuracy and reliability are needed for use in diagnosis or in clinical trials. We propose a new local ranking strategy for template selection based on the locally normalised cross correlation (LNCC) and an extension to the classical STAPLE algorithm by Warfield et al. (2004), which we refer to as STEPS for Similarity and Truth Estimation for Propagated Segmentations. It addresses the well-known problems of local vs. global image matching and the bias introduced in the performance estimation due to structure size. We assessed the method on hippocampal segmentation using a leave-one-out cross validation with optimised model parameters; STEPS achieved a mean Dice score of 0.925 when compared with manual segmentation. This was significantly better in terms of segmentation accuracy when compared to other state-of-the-art fusion techniques. Furthermore, due to the finer anatomical scale, STEPS also obtains more accurate segmentations even when using only a third of the templates, reducing the dependence on large template databases. Using a subset of Alzheimer's Disease Neuroimaging Initiative (ADNI) scans from different MRI imaging systems and protocols, STEPS yielded similarly accurate segmentations (Dice = 0.903). A cross-sectional and longitudinal hippocampal volumetric study was performed on the ADNI database. Mean ± SD hippocampal volume (mm3) was 5195 ± 656 for controls; 4786 ± 781 for MCI; and 4427 ± 903 for Alzheimer's disease patients and hippocampal atrophy rates (%/year) of 1.09 ± 3.0, 2.74 ± 3.5 and 4.04 ± 3.6 respectively. Statistically significant (p<10-3) differences were found between disease groups for both hippocampal volume and volume change rates. Finally, STEPS was also applied in a multi-label segmentation propagation scenario using a leave-one-out cross validation, in order to parcellate 83 separate structures of the brain. Comparisons of STEPS with state-of-the-art multi-label fusion algorithms showed statistically significant segmentation accuracy improvements (p<10-4) in several key structures.
Laboratory Diagnosis of Hemoglobinopathies
Authors: Robert M. Schmidt
Journal: JAMA (1973)

A successful voluntary hemoglobinopathy screening program should have as its goals effective, accurate counseling, preventive medicine, and education. Techniques that detect only the presence of hemoglobin S would not allow these goals to be fulfilled. The Center for Disease Control is currently offering training courses in laboratory methods of hemoglobinopathy detection for anyone involved in hemoglobinopathy screening. These courses, which are free, stress cellulose acetate electrophoresis as the initial screening test. Besides being inexpensive, the test is easy to perform, allows differentiation of sickle cell disease (eg, SS, SC) from the relatively benign carrier state, and detects other common hemoglobin abnormalities so that effective counseling is possible. The solubility (dithionite) test is used to confirm the presence of a sickling hemoglobin.
The Mediterranean diet improves hepatic steatosis and insulin sensitivity in individuals with non-alcoholic fatty liver disease
Authors: Marno C. Ryan, Catherine Itsiopoulos, Tania Thodis, Glenn Ward, Nicholas Trost, Sophie Hofferberth, Kerin O’Dea, Paul V. Desmond, Nathan A. Johnson, Andrew M. Wilson
Journal: Journal of Hepatology (2013)
The β-Agonist Lung Injury Trial (BALTI) and the Measurement of Extravascular Lung Water
Authors: Paul Frost, Matthew Wise
Journal: American Journal of Respiratory and Critical Care Medicine (2006)

Abundant experimental evidence has been reported indicatingthe possible value of -adrenergic agents in accelerating reab-sorption of ﬂuid from edematous lungs following various formsof injury in animals (1, 2). However, clinical studies have yetto document the usefulness of these agents in humans. It wastherefore gratifying to see a report by Perkins and colleaguesthat evaluated the efﬁcacy of intravenous salbutamol over a 7-dperiod in a group of 40 patients with acute lung injury/acuterespiratory distress syndrome (3). This study indicated a signiﬁ-cant decrease in lung water in treated patients relative to thosewho received placebo. In an accompanying editorial, Matthayand Abraham indicated that though the study appeared encour-aging, the thermal procedure used to make these measurementsneeded “validation,” and they were concerned that reductions inlung water were not matched by improvements in gas exchangeor mortality (4).The thermodilution approach can be traced to early studiesof Chinard and coworkers in which labeled water was injectedinto a systemic vein with dye, and arterial blood was collectedto estimate the amount of water in the lungs (5). Labeled waterwas subsequently replaced with a thermal signal, which can bereadily measured on line and is more diffusible than labeledwater. Although transpulmonary thermodilution represents aseductive extension of washout techniques long used by pulmo-nologists for measuring gas volumes in the lungs, there is reasonto believe that it will inevitably yield equivocal and potentiallymisleading information regarding lung water and should there-fore be abandoned (6). There are two unavoidable problemsassociated with the approach. First, a decrease in calculatedwatervolumescanreﬂectreducedperfusionofsomeareasofthelungs ratherthan a reduction inlung water. Thiscould representworsening ratherthan resolutionoflung injury.Second,becausethe thermal signal can recirculate to the lungs before washoutiscomplete,itisimpossibletodeterminetheoutﬂowpatternwithany degree of certainty. A predictable (e.g., monoexponential)washout pattern is assumed, but this would not be expectedin a lung with variable regions of edema and perfusion. Thesefundamental concerns led to the failure of comparable ap-proaches to gain widespread acceptance over the past four de-cades. Critical decisions regarding extension of clinical studiesof -adrenergic agents for treatment of lung injury should bebased on animal, clinical, and radiologic criteria, rather thanthermal dilution data.
Physical and Psychosocial Functioning of Women and Men After Coronary Artery Bypass Surgery
Authors: John Z. Ayanian
Journal: JAMA (1995)

To assess whether physical and psychosocial functioning differs between women and men after coronary artery bypass surgery.Observational cohort study.Major teaching hospital.A total of 454 consecutive patients who received coronary artery bypass surgery from June 1989 through March 1990.Nurse reviewers collected data on the severity of coronary artery disease and coexisting illnesses from medical records. A mailed survey measuring instrumental activities of daily living (IADLs), social activities, mental health, and vitality was completed by 306 (70.2%) of 436 patients who were alive 6 months after surgery. Functioning on each scale was adjusted for age, marital status, education, severity of angina, recent myocardial infarction, congestive heart failure, and coexisting illnesses at the time of surgery.Before surgery, women were much more likely than men to have had class IV angina (50.9% vs 30.4%), a recent myocardial infarction (32.1% vs 18.0%), and congestive heart failure (34.0% vs 17.6%) (all P < .002). On a range from 0 (severe impairment) to 100 (no impairment), adjusted postoperative functioning was equivalent for women and men in IADLs (86.7 vs 89.1), social activities (95.2 vs 95.3), mental health (72.6 vs 76.0), and vitality (58.1 vs 62.5) (all P > .20). Women reported similar or greater adjusted improvements than men for IADLs (27.2 vs 19.6, P = .08), social activities (20.8 vs 8.0, P = .002), mental health (11.2 vs 5.7, P = .05), and vitality (22.2 vs 12.9, P = .04).Women were more severely ill than men at the time of coronary artery bypass surgery, but women and men reported similar physical and psychosocial functioning 6 months after surgery. These findings demonstrate important functional benefits of this procedure among both women and men.
Intestinal Permeability, Gastric Intramucosal pH, and Systemic Endotoxemia in Patients Undergoing Cardiopulmonary Bypass
Authors: David W. Riddington
Journal: JAMA (1996)

<h3>Objective.</h3> —To examine the relationship between gastric intramucosal pH, intestinal permeability, endotoxemia, and oxygen delivery in patients undergoing cardiopulmonary bypass (CPB). <h3>Design.</h3> —Prospective, observational study. <h3>Setting.</h3> —Tertiary care center. <h3>Patients.</h3> —Fifty patients undergoing elective cardiac surgery and 10 patients awaiting elective cardiac surgery. <h3>Interventions.</h3> —Patients received chromium 51—labeled ethylenediaminetetraacetic acid (<sup>51</sup>Cr-EDTA) as a marker of intestinal permeability; insertion of a nasogastric tonometer to measure intramucosal pH (pHi); insertion of a pulmonary artery catheter to measure systemic oxygen delivery and consumption variables; arterial blood sampling for plasma endotoxin by the<i>Limulus</i>amebocyte lysate assay; and blood and urine sampling for measurement of<sup>51</sup>Cr-EDTA. <h3>Main Outcome Measures.</h3> —Systemic oxygen delivery, duration of gastric mucosal acidosis, absorption of<sup>51</sup>Cr-EDTA, appearance of systemic endotoxemia, renal dysfunction, and duration of hospital stay. <h3>Results.</h3> —Median (range) 24-hour urinary recovery of<sup>51</sup>Cr-EDTA in patients was 10.6% (2.1% to 40.2%) while that in controls was 1.2% (0.7% to 2.0%,<i>P</i>&lt;.001). Intestinal permeability increased during CPB. The median (range) for the lowest pHi after bypass was 6.98 (6.74 to 7.17). The pHi did not decline until CPB was discontinued and the heart took over the load of the circulation. Endotoxin was detectable (&gt;0.2 endotoxin unit per milliliter) in the plasma of 21 patients (42%) during the study, most of whom were endotoxemic by the end of CPB. There was no evident relationship between the degree of gut permeability, endotoxemia, gut ischemia, or systemic oxygen dynamics. <h3>Conclusions.</h3> —Cardiopulmonary bypass is associated with increases in gut permeability, which precede gut mucosal ischemia. In cardiac surgical patients, a low pHi is not necessarily indicative of an adverse clinical outcome. Endotoxemia as measured by the<i>Limulus</i>amebocyte lysate assay is common. The increased intestinal absorption of<sup>51</sup>Cr-EDTA and gastric mucosal acidosis occur as independent phenomena and are not related in severity or time of onset. (<i>JAMA</i>. 1996;275:1007-1012)
Metabolic Effects of the Steroid Antibiotic Fusidic Acid
Authors: V. Wynn
Journal: BMJ (1965)

Fusidic acid, the sodium salt of which is known as Fucidin, is an antibiotic which contains the cyclopentanoperhydrophenanthrene ring system and thus belongs to the steroids or tetracyclic triterpenes.Its empirical formula is C14H 0 6.The structure, which has been confirmed (Arigoni et al., 1964), is shown in Fig. 1.The formulae for the related antibiotics cephalosporin P. and helvolic acid are also shown in Fig. 1
Vitamin C Augments the Inotropic Response to Dobutamine in Humans With Normal Left Ventricular Function
Authors: Susanna Mak, Gary E. Newton
Journal: Circulation (2001)

Background —We studied the effect of an antioxidant, the intracoronary infusion of vitamin C, on basal and dobutamine-stimulated left ventricular (LV) contractility. Methods and Results —Nineteen patients with normal ventricular function participated in this study. A micromanometer-tipped catheter was inserted into the LV. In the experimental group (n=10), an infusion catheter was positioned in the left main coronary artery. LV peak +dP/dt (LV +dP/dt) was measured in response to the intravenous infusion of dobutamine before (Dob) and during (Dob+vit C) the intracoronary infusion of vitamin C. The intracoronary infusion of vitamin C had no effect on basal LV +dP/dt or any other hemodynamic parameter. The infusion of vitamin C augmented the LV +dP/dt response to dobutamine by 22±4% (Dob, 1680±76 mm Hg/s; Dob+vit C, 1814±97 mm Hg/s, P &lt;0.01). In the control group (n=9), LV +dP/dt was measured in response to sequential infusions of dobutamine (Dob, Dob-2) given at the same time intervals as in the experimental group but without the intracoronary infusion of vitamin C. In contrast to the experimental group, no difference in LV +dP/dt was observed between the 2 infusions of dobutamine (Dob, 1706±131 mm Hg/s; Dob-2, 1709±138 mm Hg/s, P =NS). Conclusions —The administration of the antioxidant vitamin C augments the inotropic response to dobutamine in humans. This suggests that redox environment contributes to the adrenergic regulation of ventricular contractility.
Rewarding Medicine: Good Doctors and Good Behavior
Authors: Robert M. Arnold
Journal: Annals of Internal Medicine (1990)

Many patients think that there are shortcomings in the ethical dimensions of patient care, and research supports their view. In this issue of Annals, Erde suggests that physicians' incomes should depend on patients' assessments of their ethical behavior in much the same way that waiters' incomes depend on patrons' tips. Although Erde's solution is satiric, the problem is a serious one. The experiences and perspectives of patients regarding their own illness are undervalued by physicians. A truly patient-centered care demands that physicians elicit, understand, and respond to patients' perspectives. Tying physicians' pay to measurements of patient satisfaction is unlikely to dramatically improve the ethical quality of patient care as long as attention to the patient's perspective is seen as peripheral to "good medical care." Rather than relying on a single, easy "fix," we must re-examine all of professional development and practice. We need to choose persons for medical careers who will find patient-centered care rewarding; we need to provide such persons with training and socialization that underscores the value of personalized medicine; and we need to build institutions and systems that facilitate and reinforce patient-centered practice. The best ways to achieve these objectives are as yet unclear, but if we, as physicians, are offended by Erde's "modest proposal," then we must respond by proposing and implementing our own ideas about how patient care can become more humane.
Role of Neurologists and Diagnostic Tests on the Management of Distal Symmetric Polyneuropathy
Authors: Brian C. Callaghan, Kevin A. Kerber, Lynda L. Lisabeth, Lewis B. Morgenstern, Ruth Longoria, Ann Rodgers, Paxton Longwell, Eva L. Feldman
Journal: JAMA Neurology (2014)

Distal symmetric polyneuropathy (DSP) is a prevalent condition that results in high costs from diagnostic testing. However, the role of neurologists and diagnostic tests in patient care is unknown.To determine how often neurologists and diagnostic tests influence the diagnosis and management of DSP in a community setting.In this retrospective cohort study, we used a validated case-capture method (International Classification of Diseases, Ninth Revision screening technique with subsequent medical record abstraction) to identify all patients with a new DSP diagnosis treated by community neurologists in Nueces County, Texas, who met the Toronto Diabetic Neuropathy Expert Group consensus criteria for probable DSP. Using a structured data abstraction process, we recorded diagnostic test results, diagnoses rendered (before and after testing), and subsequent management from April 1, 2010, through March 31, 2011.Changes in DSP cause and management after diagnostic testing by neurologists.We identified 458 patients with DSP followed up for a mean (SD) of 435.3 (44.1) days. Neurologists identified a cause of DSP in 291 patients (63.5%) before their diagnostic testing. Seventy-one patients (15.5%) had a new DSP cause discovered after testing by neurologists. The most common new diagnoses were prediabetes (28 [6.1%]), vitamin B12 deficiency (20 [4.4%]), diabetes mellitus (8 [1.7%]), and thyroid disease (8 [1.7%]). Management changes were common (289 [63.1%]) and usually related to neuropathic pain management (224 [48.9%]). A potential disease-modifying management change was made in 113 patients (24.7%), with the most common changes being diabetes management in 45 (9.8%), treatment with vitamins in 39 (8.5%), diet and exercise in 33 (7.2%), and adjustment of thyroid medications in 10 (2.2%). Electrodiagnostic testing and magnetic resonance imaging of the neuroaxis rarely led to management changes.Neurologists diagnosed the cause of DSP in nearly two-thirds of patients before their diagnostic testing. Inexpensive blood tests for diabetes, thyroid dysfunction, and vitamin B12 deficiency allowed neurologists to identify a new cause of DSP in 71 patients (15.5%). In contrast, expensive electrodiagnostic tests and magnetic resonance imaging rarely changed patient care.
PTH-187 A Novel Non-Invasive Approach to Diagnose Bile Acid Diarrhoea (Bad) using an Electronic Nose (E-Nose) and Field Asymmetric Ion Mobility Spectroscopy (Faims)
Authors: J Covington, E Westinbrink, M Thomas, N O’Connell, C Bailey, C Nwokolo, J Cullis, N Williams, K Bardhan, R Arasaradnam
Journal: Gut (2013)

<h3>Introduction</h3> A third of diarrhoea predominant irritable bowel syndrome (D-IBS) results from bile acid malabsorption (BAM); diagnosed by <sup>75</sup>SeHCAT retention test. We have previously demonstrated the ability of using an E-nose and FAIMS to detect inflammatory bowel disease (IBD) by shifts in the patterns of volatile organic compounds (VOCs) in the gases and vapours that emanate from urine samples. Here, we have extended our work to detect BAM from urine odours alone. <h3>Methods Technology Principles <i>- E-nose</i></h3> This uses an array of gas phase chemical sensors which are broadly tuned to different chemical groups. When a urine sample is presented to the sensor array, a unique response is produced. By taking all of the sensor responses together, a bio-odorant fingerprint is created. <i>FAIMS</i> operates on similar principles, but produces its fingerprint by measuring the differences in mobility of ionised chemicals in high electric fields. <h3>Subjects and patients</h3> BAM (7 day retention value of &lt; 15%): n = 15. Controls: ulcerative colitis in remission (SCAI score of &lt; 4): n = 20; healthy subjects: n = 7. Urine was collected in 10 ml aliquots and stored frozen in universal containers. For assay, the containers were first heated to 60 ± 0.1<sup>o</sup>C. The headspace (the air above the sample) was then pumped from the containers and analysed by an AlphaMOS FOX 4000 E-nose and FAIMS instrument. Discriminant Function Analysis and Fisher Discriminant Analysis (FDA) were used for statistical evaluation, respectively. <h3>Results</h3> The FOX 4000 E-nose plot (Figure 1) shows separate and distinct groupings of patients with BAM, UC, and healthy controls. FAIMS analysis gave a broadly similar pattern (not shown). <h3>Conclusion</h3> D-IBS related to BAM is a common condition and treatment with BA sequestrants is effective in the majority. The SeHCAT retention test makes diagnosis easy but is not available in all centres: our pilot data offers an alternative diagnostic approach with high potential. <h3>Disclosure of Interest</h3> None Declared.