Tonic clonic seizures and tachycardia induced by fluoxetine (Prozac) overdose.

Use of the serotonin uptake antidepressants is growing. These agents are thought to be safer than the tricyclic antidepressants, but clinicians should be aware that with overdoses, seizure activity and cardiac dysrhythmias have been reported in the medical literature. Physicians should be prepared to recognize and manage these overdosages.

Nursing education planning: a Delphi study.

The purpose of this study was to assess the Delphi technique as a viable method for forecasting future events in nursing education by determining the degree of accuracy of previously predicted events and identifying the circumstances that delayed or accelerated occurrence of the predicted events. Data were collected by three rounds of questionnaires distributed to 33 administrative heads of all nursing education programs in a southeastern state. The use of simple statistics concluded the Delphi technique was a valid instrument in nursing education planning: 22 of 26 events occurred as predicted, resulting in an 84.

A prospective controlled study of the efficacy of short-term anticoagulation therapy in patients with deep vein thrombosis of the lower extremity.

Purpose: The long-term risk for recurrent deep venous thrombosis (DVT) and the incidence of post-thrombotic syndrome (PTS) after long-term anticoagulation (LTA) therapy have been widely debated. In this study, we compare the results of short-term anticoagulation therapy versus conventional LTA therapy in patients with DVT of the lower extremity.

Methods: Baseline assessments of DVT symptoms and risk factors were recorded in 105 patients.

T-Helper 1 and T-helper 2 cytokine responses in gut-associated lymphoid tissue following enteric reovirus infection.

Enteric infection of mice with reovirus serotype 1 elicits antibody and cytotoxic T-lymphocytes in gut-associated lymphoid tissue (GALT). This led to the hypothesis that T-helper 1 (Th1) and T-helper 2 (Th2) responses develop in GALT. Reverse transcriptase-polymerase chain reactions on RNA from Peyer's patches (PP), intraepithelial lymphocytes (IEL), and lamina propria (LP) lymphocytes demonstrated that interferon (IFN)-gamma message was increased in PP and IEL, but not in LP following infection.

Etiology of peripheral arterial thromboembolism in young patients.

Background: No prior studies have explored the etiology of peripheral arterial thromboembolic events (PATE) in younger patients. Therefore, we analyzed the sources of these events in patients <50 years of age over a recent 10-year period. Diagnostic and work-up strategies will be proposed based on the presence of cardiac or atherosclerotic risk factors.

Acute low back pain findings and management in an academic medical center.

To compare medical records of patients treated for acute low back pain in the departments of Family Medicine, Internal Medicine, Occupational Medicine and Emergency Medicine in an academic medical center to determine if there was variation in patient population, diagnostic and treatment procedures and outcomes. Records were randomly reviewed using a standardized form for patients diagnosed with ICD 9 codes pertaining to back pain. Of the 96 patients with acute back pain seen in outpatient areas, 66 were seen by Family Medicine, 26 by Medical Group Practice (MGP), and four by Occupational Medicine.

Utilization of nicotine nasal spray in smoking cessation.

It is widely accepted that nicotine replacement therapy can help patients to quit smoking. Recent approval by the US Food and Drug Administration of a nicotine nasal spray gives clinicians greater flexibility in choosing the best replacement therapy for a particular patient. Four types of smoking cessation therapy are currently available (gum, patch, nasal spray, and bupropion).

Prospective randomized trial of carotid endarterectomy with primary closure and patch angioplasty with saphenous vein, jugular vein, and polytetrafluoroethylene: long-term follow-up.

Purpose: This study examines the long-term clinical outcome and the incidence of recurrent stenosis (> or = 50%) after carotid endarterectomy (CEA) with primary closure (PC) versus vein patch closure (VPC), saphenous (SVP), and jugular vein (JVP) and polytetrafluoroethylene patch closure (PTFE-P).

Methods: A total of 399 CEAs were randomized into the following groups: 135 PC, 134 PTFE-P, and 130 VPC (SVP alternating with JVP). Postoperative duplex ultrasound scans were performed at 1, 6, and 12 months and every year thereafter.

Age-related susceptibility to immunotoxicants: animal data and human parallels.

There are numerous examples, of both the identical and different effects of animals exposure to toxic agents, which can be compared in both, exposed prenatal/neonatal animals and exposed adults. In some instances, although the chemical and its metabolites are stored for long periods in adipose tissue, adult exposure (short of acute poisoning) has little effect on the immune system (Johnson et al., 1986.

Keratoconus and Turner's syndrome.

Purpose: To report the association of keratoconus and Turner's syndrome in three patients and to review the ophthalmic manifestations of Turner's syndrome.

Methods: Three patients with keratoconus and Turner's syndrome were identified and reported in a retrospective review.

Results: These three cases represent the first series of patients with keratoconus and Turner's syndrome.

Simple method of multipurpose airway access through percutaneous tracheostomy in rabbits (Oryctolagus cuniculus).

Before percutaneous tracheostomy, rabbits were anesthetized and placed in the supine position with the head extended. A needle cricothyroidotomy was then performed. With the help of a guidewire and vessel dilator, a sheath introducer with sideport extension was secured into the airway.

Outcome and cost of child abuse.

Objective: To compare the cases of child abuse (CA) with other admissions in a pediatric intensive care unit (PICU) for differences in patient-specific health care costs, severity of illness (SI) and mortality, and describe their outcome.

Method: A retrospective cohort study of all patients admitted to the PICU between January 1991 and August 1994. Discharge diagnosis, age, SI, mortality rate, length of stay, hospitalization charges ($Hosp), and mortality were retrieved.

The immunomodulatory effects of the herbicide propanil on murine macrophage interleukin-6 and tumor necrosis factor-alpha production.

Intraperitoneal (i.p.) exposure to propanil (3,4-dichloropropionanilide) has previously been shown to affect macrophage cytotoxicity.

Inhibitory effect of 3,4-dichloro-propionaniline on cytokine production by macrophages is associated with LPS-mediated signal transduction.

Our previous studies demonstrated that both in vivo and in vitro 3,4-dichloro-propionanilide (propanil) exposure inhibited interleukin-6 (IL-6) and tumor necrosis factor (TNF) production by adherent thioglycollate-elicited peritoneal cells (macrophages) after lipopolysaccharide (LPS) stimulation. In this study, we report that IL-6 and TNF-alpha message is reduced by propanil in a concentration-dependent pattern, yet the stability of cytokine mRNA is not affected. In addition, exposure of macrophages to propanil after a relatively short period of LPS stimulation significantly reduced the production of IL-6 and TNF.

Fulminant hepatitis during herpes simplex virus infection in apparently immunocompetent adults: report of two cases and review of the literature.

Two apparently immunocompetent adult patients developed acute fulminant hepatitis during presumptive primary herpes simplex virus type 1 (HSV-1) infection without any visible mucocutaneous lesions. HSV hepatitis was not suspected in the case of patient 1, who died without treatment. Patient 2 was empirically treated with acyclovir because of the triad of high fever, leukopenia, and markedly elevated levels of aminotransferases, and this patient survived.

Cost containment in anesthesiology: a survey of department activities.

Study Objective: To survey cost containment activities in anesthesiology and to determine to what extent departments use cost policies and guidelines.

Design: Mail survey.

Setting: Academic and large nonacademic anesthesiology departments.

Peak expiratory flow rate in normal pregnancy.

Objective: To determine whether peak expiratory flow rate changes with pregnancy and advancing gestation.

Methods: We measured the peak expiratory flow rate in 57 women during each trimester of pregnancy and postpartum. During four visits, all subjects exhaled forcefully three times into a peak flow meter.

Pharmacoeconomic impact of factors affecting compliance with antibiotic regimens in the treatment of acute otitis media.

Background: The total cost of treating otitis media in the United States alone is estimated at > 3.5 billion dollars annually. Therefore treatment approaches that reduce the cost of managing otitis media can have a large impact on overall health care costs.

Overall cost in the treatment of otitis media.

Background: Numerous antimicrobial agents are available for treatment of otitis media (OM); however, little is known about the relative cost effectiveness of these drugs.

Methods: We developed a noninvasive, observational model to assess the total costs (direct and indirect) associated with commonly used antibiotics in the therapy of OM. We also gathered data on recurrence rates, which can significantly affect costs.

Prospective randomized trial of carotid endarterectomy with primary closure and patch angioplasty with saphenous vein, jugular vein, and polytetrafluoroethylene: perioperative (30-day) results.

Purpose: The early outcomes of carotid endarterectomy (CEA) with primary closure (PC) versus vein patch closure (saphenous vein [SVP] and jugular vein [JVP]) and polytetrafluoroethylene patch closure (PTFE-PC) were compared.

Methods: Three hundred ninety-nine CEAs were randomized into the following groups: 135 PC, 134 PTFE-PC, and 130 vein patch closure (SVP alternating with JVP). Surviving patients underwent a carotid color duplex ultrasonographic scan 1 month after surgery.

3,4-Dichloropropionanilide-induced atrophy of the thymus: mechanisms of toxicity and recovery.

The herbicide 3,4-dichloropropionanilide (propanil) has several well-documented neurotoxic and immunotoxic effects on mice. We report here a detailed characterization of the effects of propanil exposure on the thymus. We found that at doses of 100-200 mg/kg, propanil induces significant thymic atrophy between 2 and 7 days postexposure.

Salivary glands, glycoconjugates and diabetes mellitus.

It is generally accepted that glycoconjugates secreted by salivary glands are important in the protection of the oral environment. Studies with diabetic rodents have shown that their salivary glands are adversely affected. Little effort has been made to determine whether altered synthesis and/or secretion of glycoconjugates occur in salivary glands of diabetic individuals, either human or non-human.

Management options for post carotid endarterectomy stroke.

Background: Management of acute thrombosis of the carotid artery has been controversial. This retrospective study reviews the etiology and analyzes the management options of post carotid endarterectomy stroke.

Methods: Diagnosis was made using oculopneumop-lethysmography (OPG/Gee), duplex ultrasound, computed tomography (CT) scanning, and carotid exploration.

AAEM minimonograph #46: neurogenic muscle hypertrophy.

Muscle hypertrophy occurs uncommonly in several neurogenic disorders including neuropathies, radiculopathies, spinal muscular atrophy, and post-polio syndrome. Its pathogenesis varies in different circumstances. In the presence of generalized myokymia and neuromyotonia (Isaacs' syndrome), symmetrical hypertrophy appears to be the result of continuous spontaneous electrical stimulation of myofibers and, in some cases, results in type 1 myofiber preponderance.