Biomedical subjects
Publications and source records attributed to J Mathews.
This brief article presents in table form the most commonly used ophthalmologic agents. Other information pertinent to these agents is included, such as how the medication is supplied, what are the adverse effects, the usual dosages, and the most probable use for each agent.
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In a double-blind trial lasting 4 months in 42 mentally handicapped patients, the effect of lithium on aggression was assessed in comparison with placebo. In the lithium-treated group, 73% of patients showed a reduction in aggression during treatment. There were significant differences in mean weekly aggression scores and in the frequency of aggressive episodes between the lithium and placebo groups. Side-effects were noted in 36% of the lithium group (and 20% of the placebo group), but were mainly transitory. There were no episodes of toxicity, and no patients had to be withdrawn from the trial. Lithium appears to be worth a 2-month trial in such patients, where repeated aggression has not been relieved by more appropriate placement, occupation or company.
Four patients are presented with malignant tumors involving both bone and adjacent soft tissue. In each of these neoplasms (two representing adenocarcinoma of the prostate, and one each of squamous cell carcinoma of lung and chondrosarcoma), the lesions were detected by accumulation of Tc-99m MDP. Involvement of both bone and soft tissue was confirmed by CT examination or surgery. It is probable that the lesions originated in bone and then extended to soft tissue.
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A review was made of the records of 24 consecutive trauma patients (aged 55-94 years) who had under gone radiographic examinations and a positive bone image of the femur or pelvis. There was considerable discordance between the radiographs and the bone images. Initially, 25% of the radiographs were interpreted as positive. Even after additional radiographs and retrospective. review, only 38% of the x-ray studies were positive. Bone imaging was a useful adjunct in these patients, both to confirm or exclude suspected fractures and to detect occult fractures. The necessity of delaying bone imaging for several days after the trauma was discussed.
An 81-year-old woman with carcinoma of the colon had a normal liver-spleen radiocolloid image at the time of surgery. Two years later, a defect was noted in the spleen on a follow-up radiocolloid study. A repeat examination showed that the mass was increasing in size. An abdominal CT examination also revealed an intrasplenic mass with spring of the liver. After splenectomy for a metastatic carcinoma of the colon, the patient has survived for over a year without symptoms referable to tumor spread. Mention is made of the apparent splenic "immunity" from metastases.
Two-hundred-and-twelve untreated subjects (mean age 52.3 +/- 0.8 years; 181 males and 31 females) with a diastolic blood pressure between 90 and 100 mmHg were recruited to the study. Subjects were seen fortnightly and, after 4 pre-diet visits, were randomized into a normal diet group (A, 55 subjects), a high-potassium diet group (B, 52 subjects receiving greater than 100 mmol K+/day) a reduced-sodium diet group (C, 52 subjects receiving 50-75 mmol Na+/day) or a high-potassium and low-sodium diet group (D, 53 subjects receiving same Na+ and K+ as groups B and C). Two-hundred subjects completed the diet phase of 12 weeks. Urine sodium fell to 86 +/- 7 mmol/day in group C and 73 +/- 6 mmol/day in group D, while daily potassium excretion rose to 96 +/- 5 mmol in group B and 87 +/- 4 mmol in group C. Systolic and diastolic blood pressure fell by 3.8 +/- 1.0 and 1.6 +/- 0.6 mmHg respectively in the normal diet group. The falls in systolic and diastolic blood pressures (mmHg) in the diet phase were 7.7 +/- 1.1 and 4.7 +/- 0.7 (B), 8.9 +/- 1.0 and 5.8 +/- 0.6 (C) and 7.9 +/- 0.9 and 4.2 +/- 0.7 (D). These falls were all greater than those in the control group on an intention-to-treat analysis (P less than 0.005) but did not differ from each other. Factorial analysis confirmed that the falls in pressure attributable to the low-sodium diet and high-potassium diet were not additive.(ABSTRACT TRUNCATED AT 250 WORDS)
Thirty-eight consecutive patients with liver scan evidence of hepatic metastases (and confirmation by other modalities) had blood levels of lactate dehydrogenase and alkaline phosphatase performed within two weeks. In 38% of the patients with small liver metastases, both alkaline phosphatase and lactate dehydrogenase were in the normal range. Even with large metastases present (one or more lesions over 2.5 cm in diameter), 19% of the patients had both enzyme tests within the normal range. Despite the lower cost of these enzyme assays, they failed to detect hepatic metastases in an appreciable portion of our patients.
A 70 year old woman had a [99mTc]sulfur colloid liver/spleen scan that showed splenomegaly and multiple intrasplenic defects. The lesions failed to concentrate radiogallium. Thirteen days later, after being on steroid therapy, the spleen had decreased in size and the lesions were only barely apparent. The intrasplenic process, due to non-Hodgkin's lymphoma, was thus markedly sensitive to steroids. It is uncertain if such rapid regression can be employed as a prognostic indicator in non-Hodgkin's lymphoma and suggests the need for further monitoring. The differential diagnosis of the rapid response of intrasplenic lesions to steroids is a limited one, and likely includes sarcoidosis.
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A male infant, with bronchopulmonary dysplasia and ventilator dependence, had lung ventilation (Xe-133 gas) and perfusion (Tc-99m MAA) imaging performed. The examination revealed a region that was ventilated but not perfused (mismatch) and a separate area that was perfused but not ventilated (reverse mismatch). The basis of both abnormalities is suspected to be related to bronchopulmonary dysplasia, atelectasis and/or mechanical ventilation. Ventilation/perfusion mismatches and reverse mismatches can occur in the same patient.
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Seventeen bone scintigrams, made after prostatectomy for proven or suspected carcinoma, showed a "cup defect" below the bladder. This defect was likely related to the volume of tissue removed at the time of transurethral prostatectomy. In two cases, the defect was not present on images made before prostatectomy but was clearly seen after the operation. The time of persistence of the "cup defect" is discussed, as well as the differential diagnosis of the finding.
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One hundred seventy patients with syncope presenting to an emergency department were studied prospectively. A checklist was used to supplement the physician's history and physical to ensure adequate recording of potentially useful data. Follow-up data were available in 89% of patients with a mean follow-up period of 6.2 months. Patients were categorized by presumed etiology using specific criteria. Typical vasovagal syncope occurred in 37.1% of patients. Other etiologies included first seizure (8.8%), orthostasis (7.6%), cardiac (4.1%), micturition (2.4%), hypoglycemia (1.8%), and psychogenic (0.6%). Syncope of unknown etiology accounted for 37.6% of the patients. The estimated duration of warning period was significantly shorter in patients with cardiac syncope compared to patients with vasovagal syncope. The yield of laboratory tests was low with the exception of the serum bicarbonate, which was decreased in 70% of our seizure patients. Recommendations regarding initial evaluation and admission are discussed.
Myasthenia gravis is an uncommon disease. The emergency physician should be cautious when prescribing medications to myasthenics for problems not related to myasthenia gravis. We have discussed some of those agents (Figure 3) that are recognized to cause exacerbation of MG or that may have the potential to exacerbate MG. We recommend that management of any medical or surgical problem of the myasthenic be done in consultation with a managing neurologist, and that either early follow-up or admission is necessary when these agents are used in the patient with myasthenia gravis.