Maternal smoking and the risk of polyhydramnios.

Background: Washington State birth certificates were used to conduct a population-based case-control study to assess the possible association of maternal smoking with polyhydramnios.

Methods: All singleton births complicated by polyhydramnios (n = 557) were identified from the vital records for the years 1984 to 1987. For comparison, 1671 records were randomly selected for the same years from singleton births uncomplicated by polyhydramnios.

Lovastatin-induced rhabdomyolysis in the absence of concomitant drugs.

Objective: Presentation of a case of lovastatin-induced rhabdomyolysis in the absence of other medications known to potentiate this adverse effect.

Methodology: Case report.

Results: A 60-year-old black man developed rhabdomyolysis after receiving lovastatin for 14 months.

A pharmacokinetic and endoscopic comparison of an oral and an experimental buccal piroxicam formulation.

We compared the endoscopic effects and pharmacokinetic profiles of an experimental buccal formulation of piroxicam to oral capsules in an attempt to determine whether nonsteroidal antiinflammatory drug-induced gastropathy is due to a local or systemic effect. Ten healthy subjects received 20 mg piroxicam daily in a double-blind, randomized, crossover, placebo-controlled study. Upper endoscopies were performed at the baseline and at the end of each 2-week dosing arm of the study.

Risk factors for tubal infertility. Influence of history of prior pelvic inflammatory disease.

In order to explore possible etiologic differences between tubal infertility in women who had been physician-diagnosed as having pelvic inflammatory disease ("overt" PID) and in women who had not ("silent" pelvic inflammatory disease), we made use of self-reported data from a large, population-based, case-control study of infertility in King County, Washington. Responses from 33 infertile women with no history of physician-reported PID and 129 infertile women with such a history were compared to those of 501 fertile women. No cultures or blood for antibody titers were obtained.

Vancomycin pharmacokinetics in acute renal failure: preservation of nonrenal clearance.

Introduction: The normal nonrenal clearance of vancomycin is reduced in patients with chronic renal failure (40 versus 6 ml/min). The nonrenal clearance of vancomycin in patients with acute renal failure has not been characterized extensively.

Purpose: To prospectively determine the pharmacokinetic profile of vancomycin in anuric patients with acute renal failure who are receiving continuous venovenous hemofiltration.

Continuous venovenous hemofiltration: an alternative to continuous arteriovenous hemofiltration and hemodiafiltration in acute renal failure.

Continuous venovenous hemofiltration (CVVH) has been used as an alternative to continuous arteriovenous hemofiltration (CAVH) and hemodiafiltration (CAVHD) in the management of critically ill patients with acute renal failure. This report describes our experience with the first 25 patients treated with CVVH at our institution. Vascular access was obtained through a single dual-lumen venous catheter.

The bleeding time effects of a single dose of aspirin in subjects receiving omega-3 fatty acid dietary supplementation.

Dietary supplementation with omega-3 fatty acids reduces platelet aggregation in subjects who usually eat a diet low in these fatty acids. Aspirin also has an antiplatelet effect. The clinical effects of the concomitant administration of these agents were examined in this double-blind controlled crossover trial.

Environmental factors and the risk for childhood pedestrian-motor vehicle collision occurrence.

In King County, Washington, during 1985-1986, 98 children aged less than 15 years involved in pedestrian-motor vehicle collisions resulting in death or injuries severe enough to require hospitalization were identified through the Trauma Registry at the Regional Trauma Center and the Medical Examiner's Office. Two age- and sex-matched controls were selected for each case, one through random digit dialing and the other from children undergoing appendectomy. Various environmental and traffic characteristics were ascertained from visits to the neighborhoods of all subjects.

Soft tissue calcification in renal failure.

Disorders of phosphorus, calcium, and vitamin D are common in patients with renal failure. Medical management, including dietary phosphorus restriction, administration of phosphate binding agents, and calcium and vitamin D sterol supplementation, must be instituted to control serum concentrations of these substances because of the loss of normal homeostatic mechanisms. If these measures are not employed, soft tissue calcification and hyperparathyroidism may result.

Ciprofloxacin penetration into human breast milk: a case report.

The concentration of ciprofloxacin achieved in human breast milk following oral administration of a single 500-mg dose was investigated. A 24-year-old white woman, 17 days postpartum, was being treated for resolving acute renal failure. Oral ciprofloxacin was prescribed for a suspected urinary tract infection.

Recreational drug use and the risk of primary infertility.

Recreational drug (marijuana, lysergic acid diethylamide or LSD, speed, cocaine, and "other") exposures of women with primary infertility were compared with those of a matched control group of women with proven fertility. Women who reported smoking marijuana had a slightly elevated risk for infertility due to an ovulatory abnormality (RR = 1.7, 95% CI = 1.

Impact of college of pharmacy-based educational services within the hospital.

Using a pharmacy intervention form, we measured the influence that university-based pharmacy educational personnel had on the pharmacy department's drug costs and on patient charges over a three-month period. A total of 278 interventions were made; 88.8 percent were implemented.

Drug use in trauma victims.

We examined the prevalence and characteristics of drug use in a large sample of fatally and nonfatally injured trauma victims. Routinely collected urine specimens from 452 emergency room patients and 160 persons autopsied at the Medical Examiner's Office (MEO) were analyzed for the presence of marijuana, cocaine, opiates and benzodiazepines using EMIT enzyme immunoassays. Blood alcohol levels were also measured.

Evaluation of potentially preventable deaths among pedestrian and bicyclist fatalities.

The prehospital, emergency department, and in-hospital care of 84 patients who died following a pedestrian- or bicycle-motor vehicle collision in a four-county area was retrospectively reviewed using a systematic, detailed scoring system. The purpose of the study was to examine the effectiveness of an advanced paramedic-regionalized trauma care system and to examine the usefulness of a systematic evaluation tool in identifying preventable and possibly preventable deaths. Among the 84 deaths, one was judged to be preventable and 18 possibly preventable.

Lack of endogenous crossreactivity with three digitoxin radioimmunoassays in adults with renal insufficiency.

The possibility of interference by apparent digitoxin-like immunoreactive substance (DTLIS) with three radioimmunoassays was studied in patients with renal insufficiency. From each of 25 adult patients with renal insufficiency and 25 age-matched and sex-matched control subjects with normal renal function, a single serum sample was obtained and assayed for digitoxin content by three commercially available radioimmunoassays (GammaCoat, Coat-A-Count, and the Wien assay). Although two of the three assays found measurable concentrations, the difference in apparent digitoxin concentrations between the control subjects and those with renal insufficiency was not significant.

Biological mechanisms and cardiovascular effects of omega-3 fatty acids.

The mechanisms and cardiovascular effects of omega-3 fatty acids are reviewed. Omega-3 polyunsaturated fatty acids are the major ingredient found in commercially available fish oil products. The incidence of many diseases, including coronary heart disease, diabetes mellitus, and psoriasis, is lower in Eskimos, who ingest diets rich in omega-3 fatty acids, compared with European controls.

Fatal pedestrian injuries to young children: a different pattern of injury.

All pedestrian vehicle collision fatalities to children less than five years of age in Washington State were evaluated for a five-year period using State death certificates, coroners' reports, and police records. Although the majority of pedestrian fatalities to older children have been shown to be due to "dart-outs" into traffic with the child being struck by an oncoming car, pedestrian fatality incident for children less than five tended to occur when the child was backed over in the home driveway by the family van or light truck driven by a parent. Prevention of pedestrian injuries in this age group requires strategies aimed at safeguarding the driveway and reassessing the safety of light trucks and vans as family vehicles.

Urban-rural location and the risk of dying in a pedestrian-vehicle collision.

Statewide data from two sources were used to compare the pedestrian-vehicle collision injury and fatality rates for urban and rural areas of Washington State from 1981 through 1983. Although the rates of pedestrian injuries are higher in urban areas, the pedestrian fatality rate in rural areas is higher for nearly all age groups, and at all posted speeds. Multiple logistic regression was carried out to measure the risk of dying once involved in a pedestrian-vehicle collision in rural areas compared to the risk for urban areas.

Postcoital test abnormalities in relation to contraceptive use.

Abnormalities of cervical mucus can have a bearing on a woman's fertility. One means of detecting the presence of such abnormalities is the postcoital test (PCT). As part of a population-based case control study of risk factors for infertility, the reproductive, contraceptive, medical, and sexual histories of women seeking treatment for infertility who had abnormal PCT results were compared with those of fertile controls.

Tubal pregnancy and the risk of subsequent infertility.

One hundred forty-one women with tubal infertility, all of whom had been pregnant at least once before, were interviewed concerning their reproductive, contraceptive, medical, and sexual histories. Their responses were compared with those of a control group of 467 fertile women. A higher percentage of cases (13%) than controls (1%) had had a tubal pregnancy.

Factors associated with pedestrian-vehicle collision injuries and fatalities.

Data from Washington State police records of pedestrian-vehicle collisions were used to tabulate injury and fatality rates for 1981 to 1983 and to investigate event characteristics associated with the occurrence of fatalities. Case-fatality rates are seen to be relatively higher when there is decreased visibility due to fog, lack of lighting or dark color of pedestrian clothing. Fatality rates from death certificate data for the same time period were compared with the police-reported rates.

Factors affecting individual injury experience among petroleum drilling workers.

To identify factors affecting the number of injuries experienced by petroleum drilling workers, we carried out a 44-month incidence density study on a cohort employed in January 1979 on mobile drilling units in the Gulf of Mexico. To control for job-related hazards, we computed a standardized ratio of observed to expected injuries for each worker based on his job history. The effect of personal and work history factors was then examined using analysis of variance.