Prehospital prophylactic lidocaine for uncomplicated acute myocardial infarction.
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Emergency Medical Services↗
Biomedical subjects
M Smith
Publications and source records attributed to M Smith.
Profound atelectasis following alkaline corrosive airway injury.
We report a case of life-threatening acute atelectasis following intubation for alkaline corrosive injury to the upper airway. The risk factors for and diagnosis of acute atelectasis as well as current methods of treatment are reviewed. It is important for emergency physicians to be familiar with this potentially fatal respiratory emergency during care for acutely ill and injured patients.
Bronchi↗
Fatal pancreatitis as a complication of therapy for HIV infection.
Acute pancreatitis in HIV-infected patients with or without AIDS has been reported with increasing frequency over the past several years. Drugs used to treat HIV-infected patients are often the cause. We report a case of a 46-year-old HIV-infected man who presented to the emergency department with abdominal pain and was diagnosed with acute pancreatitis. The patient had recently begun taking 2',3'-dideoxyinosine (ddI). He died shortly after admission to the hospital; CT scan and autopsy confirmed the cause of death as hemorrhagic pancreatitis. We briefly review the literature on the incidence and severity of pancreatitis in association with ddI and pentamidine therapy.
Abdominal Pain↗
Acupuncture has been used primarily as an adjunct to existing chemical dependency treatment protocols.
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Acupuncture Therapy↗
Acupuncture as a detoxification treatment: an analysis of controlled research.
The research literature on the use of acupuncture as a substance abuse treatment is reviewed. In recent years numerous descriptive reports have been published concerning the efficacy of acupuncture in alleviating withdrawal symptoms with substance abusers attempting abstinence. While a limited number of experimental design studies have been conducted in this area, results from controlled studies generally support that acupuncture can be effective in assisting active drug and alcohol users become abstinent. Controlled, experimental research on acupuncture and related techniques used as substance abuse treatments are reviewed. An overview regarding acupuncture and related procedures used as substance abuse treatments is first provided. Animal and human studies on acupuncture's usefulness in alleviating opiate withdrawal symptoms are presented, followed by studies concerning other substance abuse problems (i.e., alcohol, tobacco and cocaine). Possible physiological mechanisms related to acupuncture's effects are reviewed.
Acupuncture Therapy↗
Acupuncture for crack-cocaine detoxification: experimental evaluation of efficacy.
Anecdotal studies have reported acupuncture alleviating the severity of withdrawal symptoms associated with cocaine abuse. The efficacy of auricular (ear) acupuncture in reducing cocaine/crack craving and consumption was examined via a single-blind, placebo experiment. One hundred and fifty individuals seeking treatment for cocaine/crack abuse were randomly assigned to receive either experimental or placebo acupuncture treatments. Treatments were provided in an outpatient setting for a one-month period. Placebo treatments involved acupuncture at ear locations not used for drug treatment. Subjects provided urine specimens for drug content analysis after each acupuncture session. Urinalysis results over the one-month study period favored the experimental group. Experimental subjects in treatment over 2 weeks had significantly lower cocaine metabolite levels relative to placebo subjects in treatment for a comparable period. Treatment retention with both groups was similar. Relative to pretreatment usage, a significant decrease in cocaine consumption was reported by both groups. Self-report outcomes did not indicate significant between-groups differences.
Acupuncture Points↗
Molecular genetic analysis of human alcohol dehydrogenase.
Human alcohol dehydrogenase (ADH) consists of a complex group of isozymes encoded by at least five non-identical genes, two of which have previously been shown through enzymatic analysis to possess polymorphic variants. Using a cDNA probe the ADH2 gene encoding the beta subunit of human ADH was mapped to human chromosome 4. The cDNA probe for ADH2 was also used to detect a restriction fragment length polymorphism present in human populations. This polymorphism may help establish whether certain ADH allelic variants are linked with certain types of altered alcohol tolerance observed in various individuals. The restriction fragment length polymorphism may also be of use in genetic linkage studies of other genes located near ADH on human chromosome 4.
Alcohol Oxidoreductases↗
Biochemical genetic analysis of human and rodent aldehyde dehydrogenase (ALDH).
ALDH isozymes have been characterized in terms of substrate and coenzyme specificity, heat stability, tissue distribution and electrophoretic properties. The activity of the isozymes has also been examined in rodent-human somatic cell hybrids in order to map the structural genes to specific chromosomes and to study the control of gene expression. One isozyme, designated ALDH3, which is very active against benzaldehyde, was found to show variable expression in hybrids made between rat hepatoma cells and human fibroblasts or fetal liver. Segregation analysis of these hybrids indicates that the structural locus for human ALDH3 may be on chromosome 17. The expression of rodent ALDH3 in these hybrids was extremely variable and not correlated with the appearance of the human enzyme. In hybrids expressing human and rodent ALDH3 no heteromeric isozymes were observed. The human "cytosolic" ALDH1 and "mitochondrial" ALDH2 isozymes did not appear to be expressed in any of the somatic cell hybrids examined.
Aldehyde Dehydrogenase↗
The occlusion rate of pancreatic stents.
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Humans↗
Clinical response to amitriptyline and chlordiazepoxide-amitriptyline (Limbitrol) in anxiety-depressive states. A double-blind study.
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Administration, Oral↗
Nurse to nurse: consultation in geriatric nursing practice.
The complexity of clients in today's health care environment requires a close, collaborative working relationship among disciplines. However, nurses, who are often key decision-makers in the planning, management, and movement of clients throughout the health care system, may not use the expertise of their best allies: nurses in other settings, institutions, and specialty areas. Many care problems-at home or in the hospital, nursing home, or rehabilitation center-can be effectively resolved by nurse-to-nurse consultation. The importance and benefit of nurses relying on their own profession to answer nursing care questions are illustrated with vignettes that apply a model of consultation to the practice of geriatric nursing.
Consultants↗
Human studies on polyglycerol polyricinoleate (PGPR).
A series of toxicology studies was conducted in the 1950s and 1960s to investigate the toxicity of ADMUL WOL, a brand of polyglycerol polyricinoleate (PGPR). A component of these investigations included studies in human subjects. During 1964 and 1965, PGPR was fed to 19 human volunteers whose diet contained constant levels of fat and protein. Up to 10 g/day PGPR was fed to each volunteer in soups, cakes and toffee bars for 2 weeks. Pre-exposure normal values of biochemical parameters were established. Fat balance tests confirmed that digestion and absorption of PGPR took place. No consistent effect of PGPR on the various biochemical parameters was observed, nor had PGPR any toxic effect on liver and kidneys. The consumption of PGPR by humans produced no adverse effects. The quantities consumed, up to 10g/day, was equivalent to approximately 63 times the estimated maximum per capita mean daily intake by man of 2.64 mg kg body weight/day. It is therefore concluded from this study that the consumption of ADMUL WOL, a brand of PGPR, has no adverse effects in man.
Administration, Oral↗
A three-generation reproduction study on polyglycerol polyricinoleate (PGPR) in Wistar rats.
A series of toxicology studies were conducted in the 1950s and 1960s to investigate the toxicity of ADMUL WOL, a brand of polyglycerol polyricinoleate (PGPR). Included as part of these investigations was a three-generation reproduction study in rats. The control rats received a commercial pelletted stock diet and the treated rats were given the same diet ground with 1.5% (w/w) PGPR. A continuous breeding protocol was adopted, in which the breeding pairs were maintained until the female had produced five litters or when it became evident that breeding had ceased. The main focus of the study design was to observe any effect on breeding. The parameters measured in each of the three generations included number of litters per dam, average litter size, average weaning weights of males and females, litters per group showing 100% survival and total survival (%) at day 21. Growth was normal throughout the three generations and there were no deaths or clinical signs associated with the consumption of PGPR. The only significant change in breeding performance was a reduction in the percentage of animals weaned in the second generation, but as this occurred in the control group to a similar extent it was concluded that this was due to an unknown environmental factor and was not treatment related. A histological examination of selected tissues from those rats continued for 1 year failed to show any lesions which could be ascribed to the consumption of PGPR. In conclusion, rats fed 1.5% (w/w) PGPR showed no evidence of a cumulative effect on breeding performance over three generations.
Administration, Oral↗
Synthetic oligodeoxyribonucleotides as tools in molecular genetics: the characterization of the CYC1 (iso-1-cytochrome c encoding) locus of Saccharomyces cerevisiae.
The use of synthetic oligodeoxyribonucleotides as tools for the isolation, characterization and mutagenesis of eukaryote genes has played a major role in the molecular definition of the CYC1 locus of Saccharomyces cerevisiae, which is the structural gene for the apoprotein of iso-1-cytochrome c. Thus, the possibility of using a synthetic oligodeoxyribonucleotide as a probe to identify and monitor the isolation of a specific gene was first established by model studies which defined the melting temperatures (TmS) for duplexes of oligonucleotides of different lengths and base compositions. This led to the isolation of the CYC1 locus using a synthetic 13 nucleotide probe. A more convenient strategy for determination of DNA sequences by the Sanger method was provided by using synthetic oligodeoxyribonucleotides as primers with denatured double-strand plasmid DNA as template. By this means, the sequence of the CYC1 locus was determined by "walking" along the gene without isolating restriction fragments of the DNA or separating DNA strands. Synthetic oligodeoxyribonucleotides, used as primers for reverse transcriptase with mRNA as template, were also used to precisely define the 5'- and 3'-ends of the iso-1-cytochrome c mRNA. Yet another application of synthetic oligodeoxyribonucleotides is their use as specific mutagens after in vitro incorporation into double-stranded DNA. In the case of iso-1-cytochrome c, this mutagenic strategy is being used to define the role of conserved amino-acids in cytochrome function.(ABSTRACT TRUNCATED AT 250 WORDS)
Chromosome Mapping↗
Correlates of occasional cigarette and marijuana use: are teens harm reducing?
This paper examines characteristics that distinguish heavy and occasional cigarette and marijuana use among U.S. high school seniors. High school seniors who completed the 1994 Monitoring the Future survey (N = 15,929) were classified as nonusers, occasional users, and heavy users of cigarettes and marijuana. Level of use was examined with regard to degree of perceived risk of regular use, perceived risk of occasional use as well as several psychosocial factors previously shown to be associated with use (e.g., peer use, close friends' approval of use, and self-esteem). Involvement with other drugs and high-risk behaviors across levels of use was also examined. Heavy users of cigarettes or marijuana reported significantly lower perceived risk of regular use of each substance compared to occasional users. Heavy and occasional users did not generally differ with regard to perceived risk of occasional use. Compared to heavy users, occasional cigarette or marijuana users reported significantly lower rates of illicit drug use, heavy alcohol use, and high-risk driving behaviors as well as fewer problem behaviors and higher grades. Some adolescents may moderate their cigarette and marijuana use to minimize harmful effects they associate with heavier use (i.e., they may be practicing harm reduction). Additional research is needed to better understand controlled substance use, and incorporate this information into prevention and cessation programs.
Adolescent↗
Reducing substance abuse during pregnancy. Discriminating among levels of response in a prenatal setting.
Providers in prenatal care settings are well-positioned to help pregnant women with substance abuse problems take the first steps toward recovery. This study reports the results of the ANGELS Program, a program of enhanced prenatal care designed to reduce substance use among pregnant women. In a suburban office serving a broad range of pregnant women, certified nurse-midwives (CNMs) and on-site addictions counselors addressed substance abuse during prenatal care. This paper describes a cohort of 77 pregnant women who were identified as abusers of alcohol and/or other drugs at the start of pregnancy. According to a level of change rating assigned by the CNM at delivery, 51% of women were able to be largely abstinent during their pregnancy, 35% had reduced their use somewhat, and 14% had shown no change in use. Discriminant analysis techniques were used to learn what characteristics differentiated women in these three level of change groups. Baseline variables that differentiated the groups included severity of cocaine and cannabis use, psychosocial stressors, and initiation of prenatal care. Significant process variables included number of prenatal visits and contact with the addictions counselors. Clinical vignettes illustrate the differences among women in the three level of change groups. Implications of the results are discussed.
Adult↗
Domoic acid: neurobehavioral and neurohistological effects of low-dose exposure in adult rats.
Adult rats treated IP with domoic acid at 0, 0.22, 0.65, or 1.32 mg/kg were tested for passive avoidance (PA), auditory startle (AS), or conditioned avoidance (CAR) behaviors. Clinical signs were observed only at the 1.32 mg/kg dose level. Within 24 h of dosing, rats surviving a dose of 1.32 mg/kg exhibited transient decreased body weight and exaggerated AS responding. Startle latency and habituation, PA, and CAR were not affected. Examination of brains from six rats per group revealed a subset (2/6) of animals receiving 1.32 mg/kg domoic acid with degenerating neurons in the hippocampal CA1/CA3 subregions and gliosis. The decreased body weight and increased startle suggest a hyperreactivity syndrome possibly related to neuronal degeneration in the hippocampus. In a separate experiment, domoic acid at an IP dose of 0.93 mg/kg was found to produce hypomotility in addition to a decrease in body weight. Both effects were reduced by pretreatment with scopolamine (2 mg/kg), but not with caffeine (30 mg/kg), indicating a possible cholinergic involvement in domoate's toxicity.
Acoustic Stimulation↗
Correlation between objective and subjective measures of hand function in patients with rheumatoid arthritis.
The association between the Sollerman test of hand grip and the Sequential Occupational Dexterity Assessment (SODA) and their relationship to impairment and subjective disability measures were examined. Twenty-five patients with rheumatoid arthritis affecting their hands participated in a clinical and subjective evaluation. Clinical evaluation included the use of the two hand function instruments and measurement of finger range of motion. Subjective evaluation was done by means of a patient questionnaire comprising 20 questions from the Health Assessment Questionnaire and by visual analog scales for rating pain severity and hand function. Results confirmed a strong association between the Sollerman test of hand grip and the SODA. Both instruments were found to correlate significantly with subjectively assessed hand function. Associations between the results of the two hand function tests and subjective pain and disability assessments in global daily tasks were weak. The SODA instrument more consistently correlated to the limitations in finger motion than did the Sollerman test of hand grip. This study demonstrates that the SODA and the Sollerman test of hand grip produce similar information under controlled conditions in this patient group despite their differences in conceptual development and measurement properties. A generalized measure such as the Health Assessment Questionnaire or the pain visual analog scale alone is insufficient to represent what patients can do with their hands in daily life.
Activities of Daily Living↗