Biomedical subjects
Publications and source records attributed to K L Kumar.
Headaches are a common problem that can be disabling. The clinical features and treatment of migraine, cluster, and tension headaches are presented in this article. Emphasis is placed on the newer drugs available for acute and prophylactic treatment of these headaches. Features of headaches associated with intracranial aneurysms, temporal arteritis, cerebrovascular accidents, brain tumors, and temporomandibular disorders are also discussed.
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A frequent complication of the common cold, sinusitis is one of the most prevalent problems seen in general medical and emergency department practices. In addition, nosocomial sinus infection, particularly in intensive care units, is being recognized more frequently. Decision making about managing patients with sinusitis is based primarily on the history and, to a lesser extent, the findings of the physical examination.
I have discussed the pharmacokinetics, efficacies, and side effects of the various nonnarcotic drugs available for the treatment of patients who have headache. Sumatriptan, the newest one, is expensive but may be cost-effective for those who have failed traditional migraine treatment, who visit the ER frequently, who have potential for drug abuse, or who have to miss time from school or work due to the headache. Studies are in progress to compare sumatriptan with other available drugs such as DHE-45 and to determine its possible role in the prophylaxis of migraine. A new 5-HT1D receptor agonist with more efficacy and fewer side effects may be developed in the future. When sumatriptan and DHE-45 are contraindicated due to hypertension or coronary artery disease, other drugs such as metoclopramide, ketorolac, and butorphanol can be used as alternatives.
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Headaches associated with exercise, cough, and sexual activity may present a diagnostic challenge in the emergency room or primary care provider's office. The majority of these patients have no underlying intracranial pathologic condition and have a good prognosis. However, new onset of these types of headache, with or without accompanying neurologic deficit, is an indication to exclude life-threatening conditions such as subarachnoid bleeding with neuroimaging and CSF examination. Since the pathophysiology is poorly understood, treatment choices are limited. Further research is needed to elucidate the pathophysiologic mechanisms of these uncommon headaches and to assess the cost-effectiveness of various diagnostic and follow-up strategies.
An improved understanding of medical problems of alcoholic patients can be gained from commonly encountered laboratory test results. Liver function tests--such as measures of alkaline phosphatase, gamma-glutamyl transpeptidase, aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase--may provide evidence of altered hepatic activity of different types, such as obstruction and hepatocellular injury. Other test results may indicate impaired hepatic function, such as measurements of albumin, bilirubin, prothrombin time, and blood urea nitrogen. Alterations are also common in electrolytes, blood glucose, magnesium, phosphate, uric acid, and acid-base balance. Disturbances in hematologic function are not infrequent in alcoholic patients, including anemias from many causes, altered granulocyte responses, and thrombocytopenia.
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Forty-six consecutive cases of olecranon bursitis were prospectively analyzed during a 1-year period. Eleven cases were septic; 35 cases were nonseptic. In addition to bursal fluid analysis, the surface temperature over the involved olecranon bursa and the contralateral (control) olecranon process was obtained by using a surface temperature probe. We compared the temperature difference between the involved and control sides in all septic and nonseptic cases. In nonseptic cases, the mean surface temperature difference was 0.7 degree C vs 3.7 degrees C in septic cases. In all septic cases, the temperature difference was 2.2 degrees C or greater (range, 2.2 degrees C to 5.1 degrees C; SD, 1.1). Use of the surface probe temperature difference proved 100% sensitive and 94% specific in discriminating septic from nonseptic cases. It seems to be more helpful than the bursal fluid leukocyte count, the predominant cell type, or Gram's stain in the early differentiation of septic and nonseptic olecranon bursitis.
We enrolled 42 patients with nonseptic olecranon bursitis in a double-blind prospective treatment trial to compare the efficacy of an intrabursal steroid preparation with that of an oral anti-inflammatory agent. Patients were randomized into one of four treatment regimens: (1) methylprednisolone acetate (20 mg) intrabursal injection and oral naproxen (1 g/d for 10 days), (2) methylprednisolone acetate (20 mg) intrabursal injection and oral placebo for 10 days, (3) oral naproxen (1 g/d for 10 days), and (4) oral placebo for 10 days. The degree of swelling in millimeters was assessed at study introduction and at 1, 3, and 6 weeks. At 6 months, the number of patients requiring reaspiration for bursitis recurrence was tabulated. Data at 1 week indicated that patients treated with an intrabursal methylprednisolone acetate injection (20 mg) demonstrated the most rapid decrease in swelling. At 6 weeks, the methylprednisolone-treated groups demonstrated sustained improvement. At 6 months, the mean number of reaspirations per patient for reaccumulation of bursal fluid was higher in groups 3 (1.0 +/- 1.2) and 4 (0.4 +/- 0.7). An intrabursal methylprednisolone acetate 20-mg injection seems to be the most effective treatment regimen for nonseptic olecranon bursitis.
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Gynecomastia is common in obese or elderly men. Drug-induced breast enlargement is also frequent, whereas other causes of gynecomastia are relatively uncommon. Standardized measurement of breast tissue should be routinely performed in male patients. Diagnostic evaluation should be individualized on the basis of clinical suspicion. Therapy most often involves treating an underlying condition or discontinuing use of an offending drug.
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Alcoholism affects 3 to 10 per cent of the American population. Alcohol is toxic to all organ systems. This article summarizes current information about the hematologic sequelae of alcohol abuse. A brief summary of ethanol-related metabolic events is followed by discussion of specific disorders of erythrocytes, leukocytes, platelets, and the immune apparatus.
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To determine the efficacy of intravenous streptokinase in acute myocardial infarction, 52 patients were randomized to intravenous streptokinase or control groups. Time from onset of infarction to randomization was similar in the streptokinase group and control group, 4.9 +/- 2.1 hours vs 5.4 +/- 2.4 hours, respectively. The 28 streptokinase patients received an intravenous infusion of 700,000 units of streptokinase followed by full-dose anticoagulation. The 24 control patients received normal saline solution followed by full-dose anticoagulation. Of 28 streptokinase patients, 12 (43%) had noninvasive evidence of reperfusion by early peaking of serum creatine kinase (peak creatine kinase less than 16 hours after onset of infarction) vs 3 of 24 control patients (13%), p less than 0.02. Two streptokinase patients (7%) had reperfusion arrhythmias during streptokinase infusion. One streptokinase patient (4%) and two control patients (8%) died during hospitalization. At angiography (16 +/- 5 days after infarction) 22 of 26 streptokinase patients (85%) had a patent infarct-related coronary artery compared to 8 of 20 control patients (40%), p less than 0.01. Comparison of radionuclide left ventricular ejection fraction assessed acutely (28 +/- 10 hours after infarction) with left ventricular ejection fraction at hospital discharge (15 +/- 3 days after infarction) showed no significant improvement in either the streptokinase or control group, 0% and +1%, respectively. At follow-up 13 +/- 7 months after infarction, total mortality rate was similar in the streptokinase group and control group, 17.8% (5 of 28 streptokinase patients) and 20.8% (5 of 24 control patients), respectively.(ABSTRACT TRUNCATED AT 250 WORDS)