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Biomedical subjects

R D Moore

Publications and source records attributed to R D Moore.

At least 109 records · Page 6Linked to original sources
PubMed1995

The impact of prophylaxis on outcome and resource utilization in Pneumocystis carinii pneumonia.

STUDY OBJECTIVE: Pneumocystis carinii pneumonia (PCP) is a major late complication of HIV infection associated with morbidity and mortality. Because chemoprophylaxis is highly effective, cases of PCP can be viewed as failures in the management of HIV disease. METHODS: We reviewed demographic, clinical, and cost data for all cases of confirmed HIV-related PCP at The Johns Hopkins Hospital in 1991 to determine consequences of missed prophylaxis. We also analyzed hospital discharge data for Maryland in 1991 to assess hospital charges, length of stay, and outcome for all patients with a principal diagnosis of HIV-related PCP. RESULTS: Pneumocystis carinii pneumonia was diagnosed in 79 patients. Of the 79 patients, 61 (77%) did not receive prophylaxis, including 26 who were not previously known to have HIV infection, 17 who did not have prophylaxis prescribed, and 18 who had prophylaxis prescribed, but were not compliant with the regimen. Patients not taking prophylaxis accounted for all 12 deaths ascribed to PCP. This group also accounted for 85% of the hospital days, 100% of the ICU days, and 89% of the inpatient charges. The total hospital charges were $849,540. Extrapolation of these figures for the state of Maryland suggest that the failure to receive prophylaxis in 1991 resulted in 62 patient deaths and a cost of approximately $4.7 million. CONCLUSION: Patients who developed PCP despite prophylaxis had a better outcome and used fewer resources than patients not receiving preventive therapy. This study emphasizes the impact of PCP prophylaxis on the morbidity, mortality, and economics of HIV health care.

AIDS-Related Opportunistic Infections↗
PubMed1995

Hepatomegaly and steatosis in HIV-infected patients receiving nucleoside analog antiretroviral therapy.

BACKGROUND: A syndrome of hepatomegaly with severe steatosis has been described in case reports and case series in HIV-infected patients receiving nucleoside analog antiretroviral therapy. We wished to quantitate the incidence of this syndrome in a well characterized, demographically heterogeneous cohort of HIV-infected patients followed longitudinally. METHODS: All patients enrolled into a comprehensive primary care HIV Clinic from July 1989 through July 1994 (N = 1836) were screened for evidence of steatosis and liver disease by assessment of hospital discharge diagnoses, pathology reports, out- and in-patient laboratory data, and clinic records. RESULTS: A total of 322 (18%) patients had evidence of a liver abnormality. In these patients, viral hepatitis and alcohol-induced liver disease were the most common diagnoses. Only two patients had hepatomegaly with moderate to severe steatosis and acidosis. Both cases occurred in white men with very advanced HIV disease who were receiving nucleoside analog antiretroviral therapy. The incidence of the syndrome was 1.3 per 1000 person-yr of follow-up in antiretroviral users in our cohort (95% confidence interval: 0.2, 4.5 per 1000 person-yr). CONCLUSION: The hepatic steatosis syndrome manifesting as a severe, potentially fatal complication of antiretroviral therapy in HIV disease is rare. Both men and women and patients in early and late stages of HIV infection appear to be susceptible. It is not currently known whether a milder form of this syndrome is occurring in a larger population.

Acidosis, Lactic↗
PubMed1994

Prophylaxis for opportunistic infections in patients with HIV infection.

OBJECTIVE: To review the efficacy of chemoprophylaxis for opportunistic infections in persons infected with human immunodeficiency virus (HIV). DATA SOURCES: English-language articles on the prevention of HIV-related opportunistic infections were identified through MEDLINE (1985 to 1993) and through review of abstracts presented at the International Conferences on AIDS, the Interscience Conferences on Antimicrobial Agents and Chemotherapy, and the National Conference on Human Retroviruses and Related Diseases. STUDY SELECTION: Importance was assigned in descending order to controlled clinical trials, uncontrolled trials and retrospective studies, and prospective observational studies. DATA SYNTHESIS: Persons infected with HIV who are at risk for Pneumocystis carinii pneumonia should receive prophylaxis, preferably with trimethoprim-sulfamethoxazole. Alternative agents are aerosolized pentamidine, dapsone, and dapsone-pyrimethamine. Patients who are seropositive for Toxoplasma gondii may benefit from primary prophylaxis against toxoplasmosis using trimethoprim-sulfamethoxazole or dapsone-pyrimethamine. Life-long secondary prophylaxis is indicated for all patients previously treated for toxoplasmic encephalitis. Long-term suppressive therapy is required for all patients with cryptococcal meningitis and histoplasmosis, and many patients with recurrent mucosal candidiasis also benefit from long-term suppression. The role of primary prophylaxis of fungal infections, however, is uncertain. Rifabutin has been approved to prevent disseminated infection with Mycobacterium avium complex and is indicated for all patients with CD4 counts less than 100/mm3. Chemoprophylaxis with isoniazid for 12 months is indicated in all patients infected with HIV who have or are at high risk for M. tuberculosis infection. No effective primary prophylactic agent is available for cytomegalovirus disease, although several investigational drugs are being studied. Acyclovir is effective in decreasing recurrences of herpes simplex virus infection. The incidence of common bacterial infections is decreased by trimethoprim-sulfamethoxazole. Pneumococcal polysaccharide vaccine is recommended for adult patients infected with HIV, and Haemophilus influenzae type b conjugate vaccine is recommended for children infected with HIV. CONCLUSIONS: A growing number of infections related to the acquired immunodeficiency syndrome are preventable with currently available agents. Issues of drug interactions, toxicity, and cost-effectiveness will become increasingly important in the management of patients with advanced HIV disease.

AIDS-Related Opportunistic Infections↗
PubMed1994

Racial differences in the use of drug therapy for HIV disease in an urban community.

BACKGROUND: Guidelines for drug therapy in human immunodeficiency virus (HIV) disease are based primarily on the stage of the disease. To determine whether sociodemographic characteristics of patients influence drug therapy in practice, we analyzed the use of antiretroviral therapy and prophylactic therapy for Pneumocystis carinii pneumonia (PCP) in an urban population infected with HIV. METHODS: All patients presenting for the first time to our HIV clinic from March 1990 through December 1992 were enrolled. Data on sociodemographic and clinical variables and on drug use were collected at the time of presentation and after six months. We asked whether patients with CD4+ cell counts of 500 or less per cubic millimeter were receiving antiretroviral therapy at the time of presentation, and whether patients with CD4+ cell counts of 200 or less per cubic millimeter were receiving PCP prophylaxis. RESULTS: Among the 838 patients enrolled, 656 (79 percent) were blacks, 167 (20 percent) were non-Hispanic whites, and 15 (2 percent) were Asian or Hispanic descent or were not racially classified. There were no racial differences in the stage of HIV disease at the time of presentation. However, there were racial disparities in the receipt of antiretroviral therapy: 63 percent of eligible whites but only 48 percent of eligible blacks received such therapy (P = 0.003). PCP prophylaxis was received by 82 percent of eligible whites but only 58 percent of eligible blacks (P < 0.001). There were no significant differences in the receipt of drug therapy with respect to age, sex, mode of HIV transmission, type of insurance, income, education, or place of residence. In a logistic-regression analysis, race was the feature most strongly associated with the receipt of drug therapy. When blacks were compared with whites, the adjusted relative odds were 0.59 (95 percent confidence interval, 0.38 to 0.93) for the receipt of an antiretroviral agent and 0.27 (95 percent confidence interval, 0.13 to 0.56) for the receipt of PCP prophylaxis. CONCLUSIONS: Among patients infected with HIV, blacks were significantly less likely than whites to have received antiretroviral therapy or PCP prophylaxis when they were first referred to an HIV clinic. This disparity suggests a need for culturally specific interventions to ensure uniform access to care, including drug therapy, and uniform standards of care.

AIDS-Related Opportunistic Infections↗
PubMed1994

Risk factors for Kaposi's sarcoma in patients with advanced human immunodeficiency virus disease treated with zidovudine. Zidovudine Epidemiology Study Group.

BACKGROUND: Although the cause of Kaposi's sarcoma (KS) is unknown, its unique epidemiology suggests that an infectious, sexually transmitted agent or agents may contribute to its pathogenesis. METHODS: To assess the natural history of KS associated with the acquired immunodeficiency syndrome and to identify factors associated with its development, data were analyzed from a multicenter, observational cohort study of 1044 persons with the acquired immunodeficiency syndrome or the acquired immunodeficiency syndrome-related complex and a total CD4 cell count of less than 0.25 x 10(9)/L who were treated with zidovudine between April 1987 and April 1988. Records were reviewed bi-monthly. Follow-up continued for 2 years or until death. RESULTS: One hundred thirty-one patients (13%) had KS a study enrollment, and 143 developed KS (14%) during follow-up, with a 2-year actuarial risk of 21%. The probability of KS at 2 years for patients with initial CD4 cell counts of less than 0.1 x 10(9)/L was 25%, compared with 15% for those with counts of 0.1 x 10(9)/L or more. By logistic regression, a baseline CD4 cell count of less than 0.1 x 10(9)/L (relative odds, 1.43; 95% confidence interval, 1.04 to 1.95), homosexuality (relative odds, 3.71; 95% confidence interval, 1.82 to 7.56), cytomegalovirus disease (relative odds, 1.56; 95% confidence interval, 1.01 to 2.41), and white race (relative odds, 1.64; 95% confidence interval, 1.11 to 2.43) were independently associated with KS. Median survival after KS was 408 days, and KS was an independent predictor of death (relative hazard, 1.78; 95% confidence interval, 1.26 to 2.52). CONCLUSIONS: Kaposi's sarcoma contributes to human immunodeficiency virus-related morbidity and mortality, especially among male homosexuals. This large cohort study provides further evidence for an association between risk for cytomegalovirus infection and KS.

AIDS-Related Complex↗
PubMed1994

Functional status of persons with HIV infection in an ambulatory setting.

The objective of this project was to study the functional status of HIV-infected persons seen in an ambulatory care setting. We reviewed baseline clinical and demographic data on patients with HIV infection presenting for care between December 1988 and May 1991 at the HIV Clinic of the Johns Hopkins Hospital, an urban, primary care institution. Functional status was assessed at baseline in a comprehensive psychosocial assessment. Patients were asked to report on their ability to perform six activities of daily living (ADL) and nine instrumental activities of daily living (IADL). The main outcome measures were dependency in one or more ADL and death as ascertained by review of clinic death records and Maryland State Death Registries. All 728 patients had assessments of functional status. Of these, 18% reported dependencies in one or more activity, with most of these (14%) reporting dependencies in IADLs only. Dependencies were more common in persons with an AIDS diagnosis (32% vs. 15%, p < 0.001). The majority of the dependencies reported by AIDS patients were also in IADLs. Mean CD4 counts were lower for persons reporting dependencies than for those who reported no dependencies (p = 0.02). No independent associations were found between functional limitation and demographic variables. The risk of death was greater in patients with dependencies than in patients with no dependencies, even when adjusting for CD4 count and AIDS diagnosis (O.R. = 2.32, p = 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1994

Zidovudine therapy and health resource utilization in AIDS.

We wished to determine whether antiretroviral therapy with zidovudine first received when a person is diagnosed with AIDS was associated with diminished or increased direct health resource utilization. As a measure of health resource utilization, we examined all Medicaid-administered health care charges to adult Maryland residents diagnosed with AIDS from 1987 to 1989 who were part of the Human Immunodeficiency Virus Information System. We specifically compared those persons who first received zidovudine therapy either prior to or within 60 days of diagnosis of AIDS (n = 101) with those who never received zidovudine therapy (n = 279). Median survival time after diagnosis of AIDS in those who received zidovudine was 605 days and in those who did not receive zidovudine 235 days. After diagnosis of AIDS, median per-person lifetime direct health care charges to Medicaid were $66,200 in those who received zidovudine and $31,300 in those who did not receive zidovudine. The median incremental charge per year of life gained in zidovudine users was $34,600 compared with nonusers. Adjusting by proportional hazards regression for age, gender, race/ethnicity, HIV transmission risk group, AIDS-defining diagnosis, and length of follow-up, lifetime Medicaid charges were higher in zidovudine receivers. Compared with patients who did not receive zidovudine, patients who first received zidovudine at the time AIDS was diagnosed incurred higher cumulative lifetime charges, associated principally with longer survival time. The rate of resource utilization was not decreased by zidovudine use.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Screening and assessment of alcohol and other drug abuse.

Studies in medical, surgical, and gynecologic practices indicate that the prevalence of alcohol and other substance abuse among patients ranges from 20% to 50%. Although physicians are in a unique position to detect alcohol or drug abuse in their patients, they often fail to do so. Physicians are particularly unlikely to identify substance abuse in its earliest stages, and thus miss major opportunities for intervening. Several screening questionnaires for early detection of alcohol and other substance abuse have been developed. Alcohol abuse questionnaires have been the most extensively validated and have good sensitivity and specificity. Those developed for nonalcohol drug abuse are not well validated, but may be useful in clinical populations. Early biological laboratory markers of alcohol abuse are routinely available but are not as sensitive or specific as the screening questionnaires. Early biological markers of nonalcohol drug abuse are not yet well defined.

Alcoholism↗
PubMed1994

Cystic hydatid lung disease in northwest Canada.

OBJECTIVE: To determine the optimal treatment of sylvatic cystic hydatid lung disease. DESIGN: Retrospective case study. SETTING: Five Edmonton hospitals serving northern Alberta and parts of the Northwest Territories. PATIENTS: Fourteen patients with cystic (Echinococcus granulosus) hydatid lung disease. INTERVENTIONS: Cyst enucleation, wedge resection and pulmonary lobectomy. MAIN OUTCOME MEASURES: Eradication of pulmonary hydatid disease and complications of treatment. RESULTS: Mean patient age was 32 years. Eight patients were symptomatic. Liver cysts were present in three patients. One of the three patients managed by observation required surgery for an expanding cyst. Surgery (13 procedures in 12 patients) was successful in eradicating pulmonary hydatid disease: 8 cyst enucleations, 3 wedge resections and 2 lobectomies were done. There was only one major postoperative complication (pneumatocele requiring repeat surgery). Intraoperative cyst rupture occurred in five cases, but anaphylaxis or seeding did not result. There were no bronchopleural fistulae. CONCLUSIONS: Sylvatic cystic hydatid lung disease is more benign than pastoral hydatid disease. Patients with asymptomatic cysts should be managed by observation. Surgery, consisting of endocyst enucleation or wedge resection, is indicated for symptomatic, enlarging or infected cysts.

Adolescent↗
PubMed1993

Net costs from three perspectives of using low versus high osmolality contrast medium in diagnostic angiocardiography.

OBJECTIVES: We conducted an economic analysis to assess the extent to which a reduction in adverse drug reactions induced by low osmolality compared with high osmolality contrast media during diagnostic angiocardiography would result in savings to hospitals, society and third-party payers that would offset the substantially higher price of low osmolality contrast medium. BACKGROUND: Substitution of low osmolality for high osmolality contrast media in the approximately 1 million diagnostic angiocardiographic procedures performed each year in the United States could substantially increase health care costs. Cost-effectiveness estimates should include savings that might occur through reduced costs of managing adverse drug reactions. METHODS: In a randomized clinical trial of 505 persons under-going diagnostic angiography with either high osmolality or low osmolality contrast medium, we measured and compared 1) material costs of contrast media, and 2) costs from three perspectives of incremental resources used to manage contrast-related adverse drug reactions. We also performed sensitivity analyses to examine the effect of different assumptions with regard to relative risk, absolute risk and costs of adverse drug reactions on estimates of net cost of use of high osmolality and low osmolality contrast media. RESULTS: One-hundred thirty-seven (54.2%) of 253 patients receiving high osmolality contrast medium and 44 (17.5%) of 252 patients receiving low osmolality contrast medium experienced adverse drug reactions. The average cost (from society's perspective) of resources used to manage adverse drug reactions per patient undergoing angiography was significantly (p = 0.0001) greater for high osmolality (mean $249) versus low osmolality (mean $92) contrast medium. Differential costs (from the hospital's perspective) were $67 greater for high osmolality contrast medium. Charges and professional fees (from the payer's perspective) were $182 greater for high osmolality (mean $312) than for low osmolality (mean $130) contrast medium (p = 0.42, NS). The higher differential and average costs of managing adverse drug reactions with high osmolality contrast medium offset 33% and 75%, respectively, of the $207 difference in mean material costs, but these estimates are sensitive to infrequent high cost cases. CONCLUSIONS: Although low osmolality contrast medium is not cost-saving in diagnostic angiocardiography, its higher price is partially offset by lower management costs of adverse drug reactions. The cost offset for the hospital is lower than that for society and may not be realized by third-party payers. These methods and results may be useful in establishing clinical and payment guidelines for use of alternative contrast media in diagnostic angiocardiography.

Angiocardiography↗
PubMed1993

Herpes zoster in patients with advanced human immunodeficiency virus infection treated with zidovudine. Zidovudine Epidemiology Study Group.

To determine the prevalence, incidence, and effects on disease progression and survival of herpes zoster in patients with advanced human immunodeficiency virus (HIV) disease, data from a multicenter observational cohort study of 1044 patients with AIDS or AIDS-related complex (ARC) and CD4 cell count < or = 0.25 x 10(9)/L treated with zidovudine were analyzed. Of 163 patients (16%) with a history of herpes zoster at enrollment, 22 (13%) had a recurrence during the 2-year follow-up. For those without prior herpes zoster, the probability of its development was 6.3% at 1 and 8.8% at 2 years. Progression to AIDS was not associated with herpes zoster. By proportional hazards analysis, an initial occurrence of herpes zoster was associated with prolonged survival independent of baseline CD4 cell count and disease stage; however, recurrence tended to be associated with death. Thus, herpes zoster is relatively common in advanced HIV infection and its initial occurrence late in disease may indicate improved prognosis.

AIDS-Related Complex↗
PubMed1993

Impact of the 1993 revision of the AIDS case definition on the prevalence of AIDS in a clinical setting.

OBJECTIVE: To determine the impact of the 1993 revision of the Centers for Disease Control and Prevention (CDC) AIDS surveillance case definition on the prevalence of AIDS. DESIGN: Review of prospectively collected baseline clinical and demographic data on HIV-infected patients presenting for care between December 1988 and May 1991. SETTING: The HIV Clinic of the Johns Hopkins Hospital, an urban, primary care institution. MAIN OUTCOME MEASURE: Diagnosis of AIDS by the 1987 (specific indicator diseases) or the 1993 (indicator diseases, pulmonary tuberculosis, recurrent bacterial pneumonia, cervical carcinoma, or CD4 lymphocyte count < 200 x 10(6)/l) CDC case definition. RESULTS: Of 955 patients evaluated, 122 (13%) had AIDS by the 1987 case definition at presentation. An additional 126 (13%) met the 1993 but not the 1987 case definition. Patients meeting only the 1993 case definition were more likely to be female [28 versus 14%; odds ratio (OR), 2.4; 95% confidence interval (CI), 1.2-3.0; P = 0.01] and intravenous drug users (40 versus 26%; OR, 2.0; 95% CI, 1.1-3.3; P = 0.02) than patients meeting the 1987 case definition. Fifty-five per cent of patients meeting only the 1993 case definition were asymptomatic, and 7% (nine patients) had new indicator diseases but CD4 counts > 200 x 10(6)/l. Median time to progression from a diagnosis of AIDS by the 1993 case definition to diagnosis by the 1987 case definition was 435 days. Patients with AIDS by the 1987 case definition had a median survival of 594 days from presentation (2-year survival, 42%), while median survival time for patients with AIDS by the 1993 case definition only was 947 days (2-year survival, 60%; P < 0.005). CONCLUSIONS: The proposed 1993 revision of the AIDS surveillance case definition would double the number of prevalent AIDS cases, with significant increases in the proportion of cases who are female, intravenous drug users, or asymptomatic. Survival of patients meeting the 1993 case definition is significantly longer than that of patients meeting the 1987 case definition. The new AIDS case definition will have a major impact both on AIDS surveillance and on medical and social service programs that use diagnosis of AIDS as a criterion for eligibility for services.

AIDS-Related Opportunistic Infections↗
PubMed1993

Screening for disulfiram-induced liver test dysfunction in an inpatient alcoholism program.

The objective of this study was to report the frequency of disulfiram-related elevations of four commonly used hepatic screening chemistries using a retrospective record review design. An inpatient alcoholism program was selected for the setting. Patients who had initial laboratory values within the normal range started daily supervised doses of disulfiram, then underwent follow-up testing after 2 and 4 weeks on the drug. The study population consisted of 108 patients receiving disulfiram and 27 patients who did not receive disulfiram (controls). The four screening serum chemistries performed were aspartate aminotransferase (SGOT), alanine aminotransferase (SGPT), alkaline phosphatase, and gamma-glutamyl transferase. Twenty-seven (25%) of the 108 patients who were taking 250 mg of disulfiram a day for 2 to 4 weeks had disulfiram-related elevations in alanine aminotransferase above the upper limit of normal, as opposed to one elevation in 27 patients (4%) for whom disulfiram was not prescribed. In the 108 patients (with initially normal serum chemistries) who were prescribed disulfiram, 32 were discontinued from the drug at 2 weeks and an additional 11 were discontinued from the drug at 4 weeks because of one or more abnormal serum chemistries. Alanine aminotransferase was the most specific and sensitive indicator of the four screening chemistries performed.

Adult↗
PubMed1993

Routine quality assurance of high frequency ultrasound breast scanners in a screening context.

The use of frequencies above 5 MHz for medical imaging is now commonplace and one example is in the context of routine breast screening. No satisfactory quality assurance (QA) procedures have been agreed for these systems hitherto but it is clear that techniques developed for lower frequencies are not necessarily relevant. The National Breast Screening Programme therefore commissioned the production of a new protocol for this purpose and this is described here. The work is divided between an experienced tester, equipped with a commercial test object (RMI 414B) and the routine user who is provided with a specified perspex block to provide routine measurements of certain parameters in a relative manner.

Breast Neoplasms↗
PubMed1993

Substance abuse-related admissions to adult intensive care.

The frequency of adult surgical and medical intensive care unit (ICU) admissions related to substance abuse was determined at a large community, trauma, and tertiary referral hospital. Of 435 ICU admissions, 14 percent (95 percent confidence interval [CI], 5 to 23 percent) were tobacco related generating 16 percent of costs, 9 percent (95 percent CI, 0 to 18 percent) were alcohol related generating 13 percent of costs, and 5 percent (95 percent CI, 0 to 14 percent) were illicit drug related generating 10 percent of costs. In all, 28 percent (95 percent CI, 20 to 36 percent) of ICU admissions generating 39 percent of costs were substance abuse related. Substance abuse-related admissions were significantly longer and more costly than admissions not related to substance abuse (4.2 days vs 2.8 days, p = 0.004; $9,610 vs $5,890, p = 0.001). Frequency of substance abuse-related admission was linked with the patient's insurance status (Medicare, private insurance, uninsured). In the uninsured group, 44 percent of admissions were substance abuse related (95 percent CI, 35 to 52 percent), significantly higher than in the private insurance and Medicare groups, and generating 61 percent of all ICU costs in the uninsured group. Large fractions of adult ICU admissions and costs are substance abuse related, particularly in uninsured patients.

Adult↗
PubMed1993

Adverse reactions to contrast media: factors that determine the cost of treatment.

OBJECTIVE: The purpose of this study was to determine the cost of treating adverse reactions to contrast material that occur in patients with different clinical characteristics, the characteristics of patients who have adverse reactions that are expensive (> $500) to treat, and the types of adverse reactions that are expensive to treat. The cost of patient care associated with treating complications of medical procedures is an important consideration when evaluating the cost effectiveness of medical practices. Information about the cost of treating complications can be useful in guiding the development and application of new and safer strategies for patient care. SUBJECTS AND METHODS: We performed an economic analysis of data collected in a clinical trial comparing the safety of low- vs high-osmolality radiologic contrast media in 1004 patients who underwent either cardiac angiography or contrast-enhanced body CT; 193 (19%) of these patients had at least one adverse reaction. By means of bivariate and multivariate analyses, we examined the association between the cost of treating adverse reactions to contrast material and the baseline characteristics (age, sex, race, radiologic procedure, contrast medium, preexisting disease) of patients and clinical features (type and/or number of different types) of these reactions. RESULTS: The mean cost per patient to the hospital of treating adverse reactions to contrast material among the 193 patients who sustained a reaction was $459 (range, $0-39,057). The mean cost varied with the type and number of reactions, ranging from $32 (+/- $13) for treatment of increased systolic blood pressure to $15,360 (+/- $7994) for treatment of thromboembolism. Bivariate and multivariate analyses showed the variables associated with higher cost of treating reactions: cardiac angiography vs body CT (mean cost, $476 vs $198), a history vs no history of unstable angina (mean cost, $930 vs $208), a history vs no history of renal insufficiency (mean cost, $2064 vs $152), two adverse reactions (mean cost, $221) or three or more reactions (mean cost, $3585) vs one reaction (mean cost, $161), and a thromboembolic reaction (mean cost, $15,360). These variables explained 38% of the variation in the costs of treating adverse reactions to contrast material (p < .0001). CONCLUSION: Costs of treating adverse reactions to contrast material vary, both overall and by type and extent of reaction. Cardiac angiography, a history of unstable angina or renal insufficiency, multiple (two or more types of) adverse reactions, and thromboembolism are major factors that contribute to the cost of such treatment. Future strategies of patient care should be directed at reducing the risk of adverse reactions to contrast material for patients with these characteristics and at reducing the cost of treating these particularly expensive adverse reactions.

Adult↗
PubMed1992

Intrathecally administered N-methyl-D-aspartate increases persistent hindlimb flexion in rat.

Persistent hindlimb flexion was induced in pentobarbital anesthetized rats using a prolonged, electrical stimulus. Intrathecal (i.t.) N-methyl-D-aspartate NMDA) (1 mM, 5 microliters) applied prior to stimulation increased flexion relative to stimulated controls subsequent to stimulation (156%); 3 days later (109%) and after spinalization at 3 days (91%). Pretreatment with MK-801 (3 mg/kg, i.p.) prevented the enhancement of flexion. Withdrawal latencies to a thermal stimulus also were measured. I.t. NMDA plus stimulation reduced mean latency relative to controls only subsequent to stimulation. Latencies were increased by MK-801 post-injection, post-stimulation and at 3 days. The results suggest that the induction of persistent hindlimb flexion depends upon spinal NMDA receptors.

Animals↗