Arch Int Med Research Articles

Community-Acquired Pneumonia

Community-Acquired Pneumonia

Isoxsuprine in the Treatment of Sickle Cell Painful Crises: A Double-Blind Comparative Study with Narcotic Analgesic

Isoxsuprine is a tocolytic agent which improves erythrocyte deformability. It was accidentally found to be effective in the management of sickle cell disease (SCD) painful crises. The experience with the drug in the treatment of sickle cell disease is limited. This double-blind randomized comparative study was undertaken to test its efficacy and safety in the treatment of SCD painful crises. Forty-three SCD patients (33 males and 10 females) with 44 episodes of pain were included in the study (i.e., one patient was included twice). Only those with painful crises requiring hospital admission were included. Patients were randomized to receive either isoxsuprine 5-10 mg, or meperidine 50100 mg intramuscularly, according to body weight, every four hours. A random selection of 23 patients received isoxsuprine, and 21 received meperidine. Pain score, duration of crisis, hospital stay, and side effects were monitored. No significant difference was found in any parameter except for pain score at 30 and 60 minutes. We conclude that isoxsuprine appears to be effective in the treatment of sickle cell painful crises. Confirmation of its efficacy in studies involving a larger number of patients is warranted.

Radiological view of sclerosing peritonitis.

cause of the condition is unknown but may be related Sclerosing peritonitis to acetate buffer in the dialysate, recurrent infection, secondary hyperparathyroidism, or blood in the This is a rare condition characterized by thickening of dialysate (more specifically ferric ions) [6 ]. the peritoneum in patients undergoing continuous CT is the most sensitive early test for calcification, ambulatory peritoneal dialysis (CAPD). The process while ultrasound shows the bowel wall thickening starts gradually and presents with colicky abdominal most clearly. pain, progressive loss of dialysis, and eventually bowel obstruction [1,2]. The earliest signs may be seen on ultrasound, with trilaminar thickening of the bowel Suggested reading wall, adhesion of bowel to the anterior abdominal wall and small bowel dilatation [3]. This can be accompan1. Gandhi VC, Humayun HM, Ing JS et al. Sclerotic thickening ied by ascites after CAPD has ceased. Sampling may of the peritoneal membrane in maintenance peritoneal dialysis patients. Arch Int Med 1980; 140: 1201–1203 reveal clear, milky or blood-stained fluid. 2. Campbell S, Clarke P, Hawley C et al. Sclerosing peritonitis: The peritoneal thickening develops calcification, identification of diagnostic, clinical, and radiological features. often starting as a small plaque which gradually Am J Kid Dis 1994; 24 (5): 819–25 becomes widespread [4]. This can be seen on a plain 3. Hollman AS, McMillan MA, Briggs JD et al. Ultrasound changes in sclerosing peritonitis following continuous ambulatabdominal film and at an earlier stage by computerized ory peritoneal dialysis. Clin Radiol 1990; 41: 19–23 tomography (CT ). When obstruction occurs, the 4. Marichal JF, Faller B, Brignon P et al. Progressive calcifying presence of the thickened calcified peritoneum makes peritonitis: a new complication of CAPD. Nephron 1987; 45: laparotomy very difficult. By this stage the prognosis 229–232 is poor, death occurring within a few months [5]. 5. Loughrey GJ, Hawnaur JM, Sambrook P. Computed tomographic appearance of sclerosing peritonitis with gross peritoneal Sclerosing peritonitis was first reported in 1980, and calcification (case report). Clin Radiol 1997; 52: 557–558 complication by calcification in 1987. The differential 6. Lacey N, Matson M, Rankin S. Computed tomographic appeardiagnosis of the condition includes tuberculosis, periance of sclerosing peritonitis with gross peritoneal calcification toneal mesothelioma, and pseudomyxoma peritoneii in ( letter). Clin Radiol 1998; 53: 78 the adult, and meconium peritonitis in neonates. The

Normal Short Synacthen Test in Patients with Secondary Adrenal Failure

The short synacthen test (SST), first introduced by Wood et al. 1 in 1965, is widely used to confirm the diagnosis of primary adrenal insufficiency. The optimum method for the diagnosis of secondary adrenal insufficiency remains controversial. The insulin tolerance test (ITT) is accepted by most endocrinologists as the gold standard 2 for the assessment of the hypothalamic-pituitary-adrenal (HPA) axis, but is hazardous at times, with some morbidity and occasional mortality. The short synacthen test is gaining popularity, and by 1994, up to 50% of UK endocrinologists were using it to assess the HPA axis. 3 We describe two cases presenting with hyponatremia in whom hypoadrenalism was suspected, but with normal SST. The secondary adrenal insufficiency was later confirmed in these cases on clinical features, associated hormonal deficiencies, ancillary investigations and most important of all, the therapeutic response to replacement steroids. Case 1 A 63-year-old male presented with a history of six to seven episodes of fainting/loss of consciousness over the previous year-and-a-half. These episodes were never preceded by any palpitations or associated with seizure activity and/or incontinence of urine or feces. He also experienced occasional nausea with vomiting. He was labelled to have ischemic heart disease on the basis of ECG changes, but did not have angina and was taking diltiazem, moduretic (amiloride and hydrochlorothiazide), ranitidine and amitriptyline regularly. He appeared unwell upon admission, and was pale-looking, with a pulse of 90/min. His blood pressure was in the range of 120-140 mm Hg systolic and 70 mm Hg diastolic, but with a significant postural drop of 20 mm Hg. The rest of the examination was unremarkable. Routine investigations revealed serum sodium of 112 mmol/L, potassium of 3.3 mmol/L, and creatinine of 1.0 mg/dL. It was thought that electrolyte imbalance was due to diuretics and associated vomiting. He was rehydrated with normal saline and the

Blood Stream Infections: Micro-Organisms, Risk Factors and Mortality Rate in Qatif Central Hospital

Blood Stream Infections: Micro-Organisms, Risk Factors and Mortality Rate in Qatif Central Hospital

The Monitoring of Potential Long-Term Complications in Treated Adult Cancer Patients

A wide variety of long-term complications may be noted following conventional cancer treatment. These include overwhelming postsplenectomy sepsis syndrome, central and peripheral nervous system toxicity, cardiovascular complications, chronic liver damage, and secondary malignancy. Follow-up monitoring usually incorporates both physical examination and the result of radiological and laboratory investigations. Primary care physicians will often be responsible for the majority of the follow-up monitoring involving cured cancer patients and need to be aware of possible long-term therapy-related problems, especially those that present years after successful treatment of the original malignancy.

Survival after failed out-of-hospital resuscitation: Schoenberger RA, von Planta M, von Planta I. Arch Int Med. 1994;154:2433-7

Survival after failed out-of-hospital resuscitation: Schoenberger RA, von Planta M, von Planta I. Arch Int Med. 1994;154:2433-7

Stopping antihypertensive drug therapy in elderly people—a dangerous experiment?

Journal of Internal MedicineVolume 235, Issue 6 p. 577-579 Free Access Stopping antihypertensive drug therapy in elderly people—a dangerous experiment? Professor P. Lund-Johansen, Corresponding Author Professor P. Lund-Johansen Department of Heart Disease, Haukeland Hospital, University of Bergen, Bergen, NorwayDepartment of Heart Disease, 5021 Haukeland Hospital, Bergen, Norway.Search for more papers by this author Professor P. Lund-Johansen, Corresponding Author Professor P. Lund-Johansen Department of Heart Disease, Haukeland Hospital, University of Bergen, Bergen, NorwayDepartment of Heart Disease, 5021 Haukeland Hospital, Bergen, Norway.Search for more papers by this author First published: June 1994 https://doi.org/10.1111/j.1365-2796.1994.tb01264.xCitations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat References 1 Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure: the Fifth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNCV). Arch Int Med 1993: 153: 154– 83. 2 Zanchetti A., Chalmers JP, Arakawa K.. Gyarfas I., Hamet P., Hansson L., Julius S., MacMahon S., Mancia G., Menard J., Omae T., Reid J., Safar M. The 1993 guidelines for the management of mild hypertension: memorandum from a WHO/ISH meeting. Blood Pressure 1993: 2: 86– 100. 3 SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. JAMA 1991: 265: 3255– 64. 4 Veterans Administration cooperative study group. Return of elevated blood pressure after withdrawal of antihypertensive drugs. Circulation 1975: 51: 1107– 13. 5 Medical research council working party on mild hypertension. Course of blood pressure in mild hypertensives after withdrawal of long term antihypertensive treatment. Br Med J 1986: 293: 988– 92. 6 Levinson PD, Khatri IM, Freis ED. Persistence of normal BP after withdrawal of drug treatment in mild hypertension. Arch Intern Med 1982: 142: 2265– 8. 7 Ekblom T., Lindholm LH, Odén A. Dahlöf B., Hansson L., Wester P-O. et al. A 5-year prospective, observational study of withdrawal of antihypertensive treatment in elderly. J Intern Med 1994: 235: 581– 8. 8 Straand J., Fugelli P., Laake K. Withdrawing long-term diuretic treatment among elderly patients in general practice. Family Practice 1993; 10: 38– 42. 9 Langford HG, Blaufox D., Oberman A., Hawkins M., Curb JD, Cutter GR et al. Dietary therapy slows the return of hypertension after stopping prolonged medication. JAMA 1985: 253: 657– 64. 10 Devereux R., Alderman MH. Role of preclinical cardiovascular disease in the evolution from risk factor exposure to development of morbid events. Circulation 1993; 88 (Part 1): 1444– 55. 11 Lund-Johansen P., Omvik P. Hemodynamic patterns of untreated hypertensive disease. In: JH Laragh, B. Brenner, eds. Hypertension: Pathophysiology, Diagnosis and Management. New York: Raven Press, 1990: 305– 27. Citing Literature Volume235, Issue6June 1994Pages 577-579 ReferencesRelatedInformation

Management of clinically suspected acute venous thrombosis in outpatients with serial impedance plethysmography in a community hospital setting: Huisman MV, Buller HR, ten Cate JW, et al. Arch Int Med 1989:149:511-3

Management of clinically suspected acute venous thrombosis in outpatients with serial impedance plethysmography in a community hospital setting: Huisman MV, Buller HR, ten Cate JW, et al. Arch Int Med 1989:149:511-3

Behcet's Disease with Renal Amyloidosis: Report of a Case from Jordan with Review of the Literature

Behcet's Disease with Renal Amyloidosis: Report of a Case from Jordan with Review of the Literature

Pierre Mere Latham, 1789-1875.

Clinical CardiologyVolume 12, Issue 10 p. 609-611 Profiles in CardiologyFree Access Pierre Mere Latham, 1789–1875† W. B. Fye M.D., Corresponding Author W. B. Fye M.D. Cardiology Department, Marshfield Clinic, Marshfield, WI54449, USACardiology Department Marshfield Clinic 1000 N. Oak Avenue Marshfield, WI 54449, USASearch for more papers by this author W. B. Fye M.D., Corresponding Author W. B. Fye M.D. Cardiology Department, Marshfield Clinic, Marshfield, WI54449, USACardiology Department Marshfield Clinic 1000 N. Oak Avenue Marshfield, WI 54449, USASearch for more papers by this author First published: October 1989 https://doi.org/10.1002/clc.4960121012 † Adapted from an essay prepared for the Classics of Cardiology Library, Gryphon Editions, Birmingham. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL References 1 Spaulding WB: Peter Mere Latham (1789–1875): A great medical educator. Can Med J 104, 1109 (1971). 2 Stone DB: Peter Mere Latham. Arch Int Med 110, 516 (1962). 3 Medvei VC, Thornton JL: The Royal History of St. Bartholomew, 1123–1973. Royal Hospital of St. Bartholomew, London (1974). 4 Niebyl PH: The English blood-letting revolution. Or modern medicine before 1850. Bull Hist Med 51, 464 (1977). 5 Watson T: In Memoriam: Dr. Peter Mere Latham. In The Collected Works of Dr. P. M. Latham (Ed. R Martin). 2 vols. New Sydenham Society, London (1876) 1, xx. 6 Munk W: The Roll of the Royal College of Physicians of London, Comprising Biographical Sketches. 2nd ed., 3 vols. Royal College of Physicians, Londonl (1878) 3, 186, 187. 7 Jarcho S: Peter Latham on the uses of cardiac auscultation (1847). Am J Cardiol 16, 571 (1965). 8 WB Bean, Ed.: Aphorisms from Latham. Prairie Press, Iowa City, Iowa (1962), 83. 9 Latham PM: Lectures on Subjects Connected with Clinical Medicine, Comprising Diseases of the Heart. 2nd ed., 2 vols. Longman, Brown, Green, and Longmans, London (1846), vi, vii, 100, 101. 10 Leibowitz JO: The History of Coronary Heart Disease. Wellcome Institute of the History of Medicine, London (1970), 117. 11 Fye WB: The delayed diagnosis of myocardial infarction: It took half a century. Circulation 72, 262 (1985). Volume12, Issue10October 1989Pages 609-611 ReferencesRelatedInformation

Risk factors for nosocomial infection in intensive care. ‘Devices vs nature’ and goals for the next decade: Maki DG: Arch Int Med 149:30–35, 1989

Risk factors for nosocomial infection in intensive care. ‘Devices vs nature’ and goals for the next decade: Maki DG: Arch Int Med 149:30–35, 1989

Listeriosis in the United States: Ciesielski CA, Hightower AW, Parsons SK, et al: 1980–1982. Arch Int Med 148:1416–1419, 1988

Listeriosis in the United States: Ciesielski CA, Hightower AW, Parsons SK, et al: 1980–1982. Arch Int Med 148:1416–1419, 1988

Effects of sickle-cell anemia on conjunctival oxygen tension and temperature: Isenberg SJ, McRee WE, Jedrzynski MS, et al. Arch Int Med 1987; 147:67–69

Effects of sickle-cell anemia on conjunctival oxygen tension and temperature: Isenberg SJ, McRee WE, Jedrzynski MS, et al. Arch Int Med 1987; 147:67–69

Clinical summary and course of idiopathic anaphylaxis in 73 patients: Boxer M, Greenberger PA, Patterson R. Arch Int Med 1987; 147:269–272

Clinical summary and course of idiopathic anaphylaxis in 73 patients: Boxer M, Greenberger PA, Patterson R. Arch Int Med 1987; 147:269–272

Predicting the clinical course of intentional drug overdose: Brett AS, Rothschild N, Gray R, et al. Arch Int Med 1987; 147:133–137

Predicting the clinical course of intentional drug overdose: Brett AS, Rothschild N, Gray R, et al. Arch Int Med 1987; 147:133–137

Early treatment of acute, myocardial infarction with intravenous streptkoinase: Koren G, Luria MH, Weiss AT, et al. Arch Int Med 1987; 145:237–240

Early treatment of acute, myocardial infarction with intravenous streptkoinase: Koren G, Luria MH, Weiss AT, et al. Arch Int Med 1987; 145:237–240

Impact of computed tomography on stroke management and outcome: Hazelton AE, Earnest MP. Arch Int Med 1987;147:217–220

Impact of computed tomography on stroke management and outcome: Hazelton AE, Earnest MP. Arch Int Med 1987;147:217–220

Evaluating Sepsis in Critically III Patients

Sepsis remains one of the most common causes of death in critically ill patients. 1 Meakins JL Wickland B Forse RA McLean PH The surgical intensive care unit: current concepts in infection. Surg Clin N Am. 1980; 60: 117-132 Crossref PubMed Scopus (72) Google Scholar , 2 Shires GT Dineen P Sepsis following burns, trauma and intraabdominal infections. Arch Int Med. 1981; 142: 2012-2022 Crossref Scopus (23) Google Scholar It is defined as a systemic infection whose diagnosis is verified by positive blood cultures and/or identification of a primary infectious focus. The “sepsis syndrome” has been defined as the clinical presentation of a patient's response to the presence of dividing and invading organisms. 3 Ayres SM SCCM's New horizon's conference on sepsis and septic shock. Crit Care Med. 1985; 13: 864-866 Crossref PubMed Scopus (18) Google Scholar

Ventricular Parasystole with 2:1 Exit Block

Ventricular parasystole, a well-recognized arrhythmia, is the expression of an independent idioventricular pacemaker which is able to discharge regularly because it is protected from the impulses of the dominant pacemaker. The rhythm is characterized by varying coupling intervals, interectopic intervals in simple multiples of a common denominator, and frequent fusion beats. Occasionally, a parasystolic discharge does not become manifest, although its timing is such that it occurs during the responsive or non-refractory phase of the ventricular cycle. This phenomenon has been explained by postulating an exit block at the ectopic-ventricular junction. 1 Faltitschek F Scherf D Klinischer Beitrag zur Parasystoliefrage. Wien Arch Int Med. 1932; 23: 267-269 Google Scholar -6 Schamroth L Ventricular parasystole with slow manifest ectopic discharge. Br Heart J. 1962; 24: 731-737 Crossref PubMed Scopus (8) Google Scholar The following presentation reflects a ventricular parasystole where a consistent 2:1 exit block is not immediately apparent, but is revealed by analysis only.