15 citations found

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Links: Am J Emerg Med

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Am J Emerg Med 2002 Mar;20(2):127-8

Simultaneous bilateral posterior dislocation of shoulder.

Hashmi FR, Pugh M, Bryan S

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PMID: 11880881, UI: 21868151


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Br J Dermatol 2001 Dec;145(6):1026-7

Acute generalized exanthematous pustulosis induced by icodextrin.

Al-Hoqail I A, Crawford R I

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PMID: 11899129, UI: 21894237


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Br J Dermatol 2001 Dec;145(6):1008-14

Vitiligo-like leucoderma during photochemotherapy for mycosis fungoides.

Mimouni D, David M, Feinmesser M, Coire C I, Hodak E

Department of Dermatology, Rabin Medical Centre, Petah Tikva, Israel. mimouni@post.tau.ac.il

We describe four patients with mycosis fungoides (MF) in whom depigmentation, and also leucotrichia in one, occurred following the resolution of the eruption during phototherapy (psoralen plus ultraviolet A treatment in three patients, climatotherapy in one). In all cases, the depigmentation was localized to the area of the pre-existing MF lesions. There was no clinically obvious phototoxicity. Biopsy study including S100 staining in all cases, and electron microscopy in one case, demonstrated the total absence of melanocytes, with no evidence of MF. It is suggested that the phototherapy may have activated a cell-mediated immunity leading to destruction of the melanocytes. We recommend that vitiligo-like leucoderma be added to the list of untoward effects of phototherapy in MF.

PMID: 11899124, UI: 21894232


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J Hepatol 2001 Aug;35(2):309-10

Hepatotoxicity induced by fosinopril.

Romero-Gomez M, Miralles EJ, Garcia Diaz E, Robles A, Suarez E, Castro M

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PMID: 11580159, UI: 21463874


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J Hepatol 2001 Aug;35(2):308-9

Acute fatal hepatitis related to levofloxacin.

Spahr L, Rubbia-Brandt L, Marinescu O, Armenian B, Hadengue A

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PMID: 11580158, UI: 21463873


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J Hepatol 2001 Aug;35(2):290-4

Liver biopsy in elevated liver functions tests? An old question revisited.

Bianchi L

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PMID: 11580154, UI: 21463869


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J Hepatol 2001 Aug;35(2):200-7

Alpha B-crystallin expression in human and rat hepatic stellate cells.

Cassim D, Roskams T, van Pelt J, Libbrecht L, Aertsen P, Crabbe T, Vankelecom H, Denef C

Laboratory of Cell Pharmacology, University of Leuven, Belgium. david.cassiman@med.kuleuven.ac.be

BACKGROUND/AIMS: We searched for factors implicated in early hepatic stellate cell (HSC) activation in diseased liver, by means of suppression subtractive hybridization (SSH). METHODS: SSH was performed between messenger RNA (mRNA) from normal rat HSC and mRNA from HSC, isolated from rats with acute D-galactosamine (Gal)-induced hepatitis. RESULTS: One of the potentially upregulated factors which we found was alpha B-crystallin (ABCRYS), a small heat-shock protein and a chaperone known to protect the cell against protein degradation in conditions of cellular stress and known to associate with various types of intermediate filaments. Upregulation of ABCRYS mRNA in HSC, following Gal-intoxication (3.5-fold) as well as by culturing the HSC on plastic (20-30-fold), was confirmed by quantitative real-time reverse transcription polymerase chain reaction. The expression of ABCRYS protein in human and rat HSC was demonstrated by immunohistochemistry, in vitro and in vivo, in normal and diseased liver. Double-staining co-localized ABCRYS immunoreactivity with alpha-smooth muscle actin immunoreactivity in human liver and with desmin immunoreactivity in rat liver. In vivo upregulation of ABCRYS protein following Gal-intoxication was also shown, by comparison with desmin expression. CONCLUSIONS: Human and rat HSC express ABCRYS mRNA and protein. Both are rapidly upregulated following HSC activation.

PMID: 11580142, UI: 21463857


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J Hepatol 2001 Aug;35(2):187-94

Rat liver slices as a tool to study LPS-induced inflammatory response in the liver.

Olinga P, Merema MT, de Jager MH, Derks F, Melgert BN, Moshage H, Slooff MJ, Meijer DK, Poelstra K, Groothuis GM

Department of Pharmacokinetics and Drug Delivery, University Centre for Pharmacy, Groningen, The Netherlands. p.olinga@farm.rug.nl

BACKGROUND/AIMS: Inflammation in the liver is a complex interaction between parenchymal and non-parenchymal cells, and therefore can not be studied in vitro in pure cultures of these cells. METHODS: We investigated whether Kupffer cells in the liver slice are still responsive to an inflammatory stimulus of lipopolysaccharide (LPS), and evoke an inflammatory response in the hepatocytes. RESULTS: TNFalpha, IL-1beta and IL-10 were significantly elevated in culture medium of LPS-stimulated rat liver slices. Nitric oxide (NO) production of LPS-treated slices gradually increased from 5 to 24 h (24 h: 81+/-5 microM vs. 14+/-2 microM in control P < 0.05), paralleled by inducible nitric oxide synthase (iNOS) in the hepatocytes, iNOS mRNA was induced after 3 h. NO production but not iNOS induction was significantly inhibited by NOS inhibitors S-methylisothiourea and N(G)-nitro-L-arginine methylester. Both pentoxifylline and dexamethasone inhibited TNFalpha and IL-1beta production, albeit to a different extent, iNOS induction and, as a result thereof, NO production. CONCLUSIONS: These results imply that non-parenchymal cells in liver slices are viable and can be activated by LPS. In addition, it is concluded that the upregulation of iNOS in hepatocytes by LPS is caused by cytokines produced by Kupffer cells because inhibition of TNFalpha and IL-1beta production attenuated iNOS induction.

PMID: 11580140, UI: 21463855


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J Neurol 2001 Sep;248 Suppl 3:III32-6

Relationship between lesion location and the outcome of pallidotomy for Parkinson's disease.

Yokochi F, Okiyama R, Taniguchi M, Takahashi H, Hasegawa N, Hamada I

Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fucyu, Japan.

The relationships between lesion location and clinical outcome following posteroventral pallidotomy for Parkinson's disease were studied. Forty-four patients were operated forty-six times and studied with neurological and psychological examinations before and after pallidotomy. Lesion location was confirmed using films with a coagulation electrode which were X-rayed during the operation. Changes of intelligence were observed in the patients with anteromedial lesions. Wearing-off phenomenon in four patients and dopa-induced dyskinesia in three patients were not improved following pallidotomy in twenty patients with severe wearing-off and dyskinesia. Lesions in the patients with no improvement of wearing off were located more lateral and those in the patients with sustained severe dyskinesia were located more dorsal in the internal part of the globus pallidus. It may be concluded that clinical outcome is related to lesion location.

PMID: 11697686, UI: 21554041


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J Neurol 2001 Sep;248 Suppl 3:III28-31

Drug-induced psychotic symptoms in Parkinson's disease. Problems, management and dilemma.

Kuzuhara S

Department of Neurology, Mie University School of Medicine, Tsu, Mie-ken, Japan. kuzuhara@clin.medic.mie-u.ac.jp

Psychotic symptoms develop in 20-30% of patients with Parkinson's disease (PD) receiving chronic anti-PD medications, and visual hallucinations with or without delirium and paranoid delusions are the most frequent symptoms. Psychotic symptoms disturb ADL and QOL of PD patients and tax caregivers far more than the motor disabilities do, and good management of drug-induced psychotic symptoms is potentially important. Withdrawal of anti-PD drugs relieves the patients from psychotic side effects, but worsens the parkinsonian motor symptoms. The first step of treatment is to eliminate triggering factors other than anti-PD drugs, such as infections, metabolic disorders, subdural hematoma, and hallucinogenic drugs. The second step is to eliminate anti-PD drugs in the following order; first anticholinergics, amantadine and selegiline, second dopamine agonists, and finally levodopa/carbidopa. Anti-PD medications should be reduced to the point of improving psychotic side effects without drastically worsening parkinsonian motor symptoms. When the above adjustments fail to sufficiently alleviate psychotic side effects, the third step is consideration of antipsychotic drugs although they have potential capacity to antagonize dopamine D2 receptors and worsen parkinsonism. Atypical antipsychotics such as clozapine and olanzapine are recommended, though the former is not available in Japan.

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PMID: 11697685, UI: 21554040


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Med J Aust 2002 Feb 18;176(4):162-5

Paracetamol recall: a natural experiment influencing analgesic poisoning.

Balit CR, Isbister GK, Peat J, Dawson AH, Whyte IM

NSW Poisons Information Centre, The Children's Hospital, Westmead.

OBJECTIVES: To determine whether the occurrence of paracetamol and non-paracetamol analgesic deliberate self-poisoning (DSP) and accidental paediatric poisoning was affected by two periods of recall of paracetamol products. DESIGN: Retrospective, observational audit of proportions of poisonings with tablet and capsule formulations of paracetamol, ibuprofen and aspirin products during two recall periods compared with the number of poisonings during the same periods of the previous three years. SETTING: A national poisons information centre and a regional toxicology service. MAIN OUTCOME MEASURES: Rates of DSP and accidental paediatric poisoning with paracetamol, ibuprofen and aspirin. RESULTS: During the two recall periods, there was a significant increase in ibuprofen DSP calls to the poisons information centre (RR, 1.86; 95% Cl, 1.41-2.44; P = 0.001). There was no significant change in paracetamol or aspirin DSP calls over the two recall periods. However, there was a non-significant reduction in DSP calls with paracetamol in the first recall period alone (P = 0.057). There was a significant increase in the proportion of aspirin DSP presentations for the toxicology service (RR, 3.33; 95% CI, 0.97-11.4; P = 0.043), but no significant changes in paracetamol and ibuprofen DSP presentations. For accidental paediatric ingestions there was a significant increase in the proportion of ibuprofen calls (RR, 2.35; 95% CI, 1.85-2.98; P = 0.001), but no significant change in paracetamol or aspirin calls. CONCLUSIONS: Reduced paracetamol availability increased poisoning with alternative analgesics, but had little effect on the incidence of paracetamol poisoning. Restriction of paracetamol-containing products may inadvertently increase poisoning with potentially more toxic agents.

PMID: 11913916, UI: 21910635


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Links: [N Engl J Med]

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N Engl J Med 2002 Mar 21;346(12):945-6; discussion 945-6

Cutaneous anthrax infection.

Nelson LS, Hanner R, Hoffman RS

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PMID: 11907300, UI: 21904844


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Pediatr Emerg Care 2001 Oct;17(5):398

Is attempting suicide an adverse effect of oxybutynin in a child with enuresis nocturna?

Coskun S, Yuksel H, Onag A

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PMID: 11673723, UI: 21530254


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Pediatr Emerg Care 2001 Oct;17(5):351-3

Iatrogenic cardiopulmonary arrest during pediatric sedation with meperidine, promethazine, and chlorpromazine.

Brown ET, Corbett SW, Green SM

Department of Emergency Medicine, Adventist Medical Center, Portland, Oregon, USA.

The pediatric sedative combination of meperidine, promethazine, and chlorpromazine (MPC) has been widely used for more than 40 years. Despite its relatively poor efficacy and questionable safety profile, many emergency departments (EDs) continue to stock specially formulated mixtures of these three agents. We report a case of iatrogenic cardiac arrest in a 2-month-old infant in whom a consulting resident administered too much MPC (10 times the expected dose) by the wrong route (intravenous instead of intramuscular). The child was successfully resuscitated with no apparent neurologic deficit. Subsequently, we have removed MPC entirely from our ED and instituted a policy restricting ED procedural sedation privileges to emergency physicians. We urge other EDs to do likewise.

PMID: 11673713, UI: 21530244


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Pediatr Emerg Care 2001 Oct;17(5):321-3

Use of an observation unit by a pediatric emergency department for common pediatric illnesses.

Scribano PV, Wiley JF 2nd, Platt K

Department of Pediatrics, University of Connecticut School of Medicine, Connecticut Children's Medical Center, Hartford, Connecticut 06106, USA. pscriba@ccmckids.org

OBJECTIVE: To describe the use of a pediatric observation unit (OU), including relapse rates for common pediatric illnesses, and to assess effectiveness of OU utilization. DESIGN: Retrospective, cohort of all emergency department (ED) visits, OU and inpatient unit (IU) admissions. SETTING: Tertiary care children's hospital. PARTICIPANTS: All children evaluated in the ED and subsequently admitted to either the OU or IU over a 2-year period. MAIN OUTCOME MEASURE: Rates with 95% confidence intervals (CI) for OU use and need for subsequent IU admission from OU, and odds ratios (OR) with 95% CI for use of the OU for specific pediatric disorders. RESULTS: During 10/1/96-9/30/98, there were 44,459 ED visits, 1798 (4.0%) OU admissions, and 3241 (7.3%) inpatient admissions (IA) from the ED. OU mean length of stay was 15.6 +/- 6.1 hours; mean age was 6 +/- 5.3 years with 31% under 2 years of age. Of the total admissions (IU and OU), diagnoses with high OU utilization were: asthma 274/575, 48%; croup 76/125, 61%; enteritis/dehydration 284/470, 60%; poisonings 82/118, 70%; and seizures 80/204, 39%. The likelihood of an OU admission for these illnesses versus IU (adjusted for subsequent need for IU admission) was: asthma OR 1.3 (1.1, 1.5), P < 0.005; croup OR 2.3 (1.6, 3.3), <0.001; enteritis/ dehydration OR 2.8 (2.1, 3.0), P < 0.001; poisonings OR 3.8 (2.5, 5.7), P < 0.001; and seizures OR 0.8 (0.6, 1.2), P = 0.28. For these diagnoses, OU admissions resulting in IU admission occurred for asthma 45/274, 16.4%; croup 7/76, 9.2%; enteritis/ dehydration 13/284, 4.6%; poisonings 3/82, 3.7%; and seizures 15/80, 18.8%, resulting in an overall need for further hospitalization to the IU for these diagnoses of 83/796, 10.4%, (95% CI 8.3, 12.6). CONCLUSION: Admissions to the observation unit comprised over one third of all admissions from a pediatric ED. Certain pediatric illnesses appear to be well suited for admission to the observation unit, with low likelihood of the need for subsequent admission to the inpatient unit. Given the current trends in third-party payer reimbursements for short (<24 hours) admissions, observation unit use provides a more attractive alternative to inpatient admission for many pediatric patients.

PMID: 11673706, UI: 21530237


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