Emergency department hemodialysis in a case of severe ethylene glycol poisoning

A 36-year-old man with a history of depression presented to the emergency department after ingesting approximately 3,000 mL of ethylene glycol antifreeze in a suicide attempt. The patient's ethylene glycol concentration, 1,889 mg/dL, was higher than any level previously documented in the medical literature. Although his course was complicated by nausea, emesis, lethargy, metabolic acidosis, and kidney failure, the patient survived without persistent kidney failure or other chronic problems. Sustained hemodialysis and ethanol infusion were instituted in the ED, on the basis of the patient's history, before laboratory confirmation of the ingestion was obtained.

Three perspectives on addiction

Three perspectives on addiction promulgated during the 1990s are reviewed, along with many earlier contributions to the understanding of addictive illness. It is suggested that these distinct yet overlapping formulations of the dynamics of addiction form a hierarchy for each patient suffering from an addiction. Assessment of a patient's ego strength, and of the relative importance of addictive behaviors in overall character structure, allows referral to various types of treatment, including psychoanalytic therapy. Case examples are presented, including material from the psychoanalysis of a woman addicted to heroin, methadone, cocaine, amphetamines, nicotine, alcohol, and shopping.

Blue-green algae toxicosis in cattle

Twenty-four of 175 heifers died after ingesting water from a stock pond containing blue-green algae (genus Microcystis) in southern Colorado. Affected cattle were found dead or had signs of nervousness, and were recumbent, weak, anorectic, and hypersensitive to noise when first examined. All cattle died within 3 days after the onset of signs. At necropsy, the rumen contained blue-green algae, and the liver was larger than normal, friable, and dark red. The most important histologic lesion was hepatocyte degeneration and necrosis. Intraperitoneal administration of lyophilized cell material from the bloom caused hepatic necrosis and death in mice, and water from the pond had clumps of cells surrounded by a clear calyx, consistent with the appearance of organisms of the genus Microcystis. Samples of pond water were examined by means of high-pressure liquid chromatography; microcystin-LR, one of the hepatotoxins produced by Microcystis spp, was found. Chromatography may be useful in the diagnosis of blue-green algae toxicosis.

Chronically mentally ill individuals re-entering the community after hospitalization

The purpose of this phenomenological study was to increase the understanding of the experiences of chronically mentally ill individuals who are re-entering the community after hospitalization. Ten individuals from an acute care psychiatric hospital who had had two or more admissions within a 12-month period were interviewed, shortly before discharge and subsequently between two and four times while in the community. Three interrelated themes emerged. First, at the time of discharge, the optimism of the participants about returning home was tempered by a realistic recognition of their problems. As time passed, their problems seemed to become their preoccupying focus and optimism faded. Second, for most of the participants, relationships with others, positive, negative or both, played an important role in their return to home and community. Third, participants who experienced more positive social relationships also described individual achievements and community involvement. The re-entry process was not a smooth transition for these individuals.

Medical reference databases used by Army primary care physicians in field environments

A cross-sectional survey of U.S. Army primary care physicians was done to answer two questions: (1) which medical reference materials are Army primary care physicians currently using when deployed to a field environment? and (2) what would they like to have for medical reference in a field environment? Of 740 surveys delivered to their intended recipients, 445 (60%) were returned. Currently, 96% of primary care physicians use books, 37% use journals, and 11% use computer software in their medical reference database. Of those now using books, 72% were satisfied with them, compared with 61% of those using journals and 45% of those using software. The most common book used was the Merck Manual. The most important characteristics desired in a field medical database were broad coverage, ease of use, and light weight. The majority of respondents believe that a good medial reference database is important but that current medical databases limit the quality of the medicine they practice in the field.

Barriers to seeking care following school vision screening in Rochester, Minnesota

School vision screening provides an effective way to identify children who require vision therapy, usually glasses. To benefit from screening, children with abnormal screening test results must receive follow-up eye care, but care may be delayed for months or years. This project used community focus groups in Rochester, Minn., to identify barriers that may delay seeking professional care following school vision screening. Major barriers identified included lack of community awareness about the frequency and potential effect of refractive errors in children, a parental perception of inadequate communication between schools and the parents and community, high cost of corrective lenses, limited availability of convenient eye care appointments, and adolescents reluctance to wear glasses. Program planners developed a community action plan to address the perceived barriers.

Influence of bubbles on scattering of light in the ocean

The scattering and backscattering properties of bubble populations in the upper ocean are estimated with Mie theory and a generalized bubble size spectrum based on in situ observations. Optical properties of both clean bubbles and bubbles coated with an organic film are analyzed; the results are compared with the corresponding optical properties of micro-organisms of similar size. Given a bubble number density (from ~10(5) to ~10(7) m(-3)) frequently found at sea, the bubble populations significantly influence the scattering process in the ocean, especially in oligotrophic waters. Bubbles appear to make a large contribution to the missing terms in constructing the observed total backscattering coefficient of the ocean. This contribution to backscattering is strongly enhanced if the bubbles are coated with organic film. The injection of bubbles will shift ocean color toward the green, resembling phytoplankton blooms, and hence introducing error in ocean color remote sensing if its effect is not corrected.

Determining cost drivers for pediatric home health services

A variety of cost constraints threaten the financial viability of home health agencies. Thus, tools must be developed that expand the critical information resources that will be the key ingredient in successfully navigating the challenges in the volatile home health market. Identifying and analyzing the core processes with the pediatric home care team provided a template that could be used with other agency patient populations by producing cost trajectories based on anticipated care requirements and capturing information that could be used for both internal and external benchmarking. The cost drivers of key processes and activities must be known so that they can be controlled and appropriate rates for capitation contracts can be established. Activity-based management uses cost driver analysis, activity analysis and performance analysis, to determine strategies for redirecting the work processes and agency activities to achieve lasting cost reductions.

Total parenteral nutrition via multilumen catheters does not increase the risk of catheter-related sepsis: a randomized, prospective study

The purpose of this study was to determine in a randomized, prospective manner whether administration of total parenteral nutrition (TPN) via multilumen catheters increases the risk of catheter-related sepsis (CRS). All patients receiving hyperalimentation during a 24-month period were randomized to receive either a double-lumen catheter (DLC) or a triple-lumen catheter (TLC). A total of 101 catheters were placed in 79 patients, of which 49 were DLCs and 52 were TLCs. The patients with DLCs received a total of 784 days of TPN, whereas patients with TLCs received a total of 754 days of TPN. CRS was associated with one (2.0%) of the 49 DLCs vs. one (1.9%) of the 52 TLCs. In comparison, the rate of CRS associated with single-lumen catheters (historical control) at our institution was 1.4% (P > .90). We conclude that the use of multilumen catheters in TPN therapy does not result in an increased risk of CRS.

Spontaneous thoracic spinal cord herniation through an anterior dural defect

A 44-year-old woman was examined for progressive left lower extremity weakness and spasticity. Thoracic spine MR imaging and CT myelography showed a ventral dural defect at T7-T8 with an extradural subarachnoid fluid collection and extradural herniation of the spinal cord. Intraoperative sonography confirmed the appropriate level for dural entry and the finding of spinal cord herniation. After reduction of the herniated spinal cord, the patient experienced gradual improvement in neurologic function.

Comparison of disease in calves dosed orally with oak or commercial tannic acid

Commercial tannic acid has been used as a substitute for leaves and acorns in studies of oak toxicosis in some species. The toxicity of a commercial tannic acid given orally to calves was determined, and the clinical signs, laboratory findings, and pyrogallol production were compared with those found in calves dosed orally with oak leaves. The oak-fed calves developed the clinical signs and lesions characteristic of renal failure. Proteinuria developed by 48 hours in 1 calf and by 72 hours in the other calf. Both calves developed hematuria on day 4 and glucosuria on day 5. The blood urea nitrogen and creatinine values increased markedly on day 6. Pyrogallol was detected in the serum only at 3 and 6 hours after the calves began ingesting the oak leaves. Pyrogallol was detected in urine from 1 calf until 60 hours and in the other calf until 48 hours after the beginning of oak intake. The 2 calves that were dosed with tannic acid at the same level as found in the leaves fed to the other calves did not develop clinical signs, abnormal laboratory findings, or pyrogallol production. Calves given high levels of tannic acid at doses of 4.4-5.5 g/kg developed methemoglobinemia rather than renal disease. Therefore, commercial tannic acid given orally cannot be used as a substitute for oak in studies of toxicosis in cattle.

Evidence for a luteinizing hormone surge center in the hypothalamus of the pig

Studies were conducted to determine whether there is an LH surge generator in the hypothalamus of the pig. In experiment 1, 157-day-old ovariectomized (OVX) gilts received 1.5 microg estradiol benzoate (EB)/kg BW i.m. every 12 h from 0 through 24, 48, 72, or 96 h. Blood was sampled every 6 h from 3 to 36 h and every 3 h from 36 through 144 h. One of 3, 4 of 4, 4 of 4, and 2 of 3 gilts displayed an LH surge after treatment for 24, 48, 72, and 96 h, respectively. With the exception that time to maximum LH concentration was greater in gilts treated for 96 h than in those treated for 72 h (p < 0.05), parameters of the surge were similar among all gilts. In experiment 2a, an Alzet osmotic pump containing EB or vehicle was inserted s.c. behind an ear of 124-day-old OVX gilts, resulting in the following daily doses of EB: 0, 0.75, 1.50, or 3.00 microg/kg BW. Blood was sampled at 0, 2, 4, 6, and 8 h and every 8 h thereafter through 168 h to evaluate surge secretion of LH, and every 15 min for 8 h starting at 168 h to evaluate pulsatile LH secretion. Zero of 3, 0 of 2, 3 of 3, and 3 of 3 gilts displayed an LH surge after 0, 0.75, 1.50, and 3.00 microg EB/kg BW, respectively. Parameters of the surge were similar among gilts. Pulsatile LH secretion, evaluated 7 days after pump insertion, was significantly suppressed for estradiol-treated gilts compared to controls. In experiment 2b, at 182 days of age, 10 gilts used in experiment 2a plus 2 additional gilts in the original group prepared but not used for experiment 2a, were randomly assigned in groups (n=3) to the following daily doses of EB: 0, 0.19, 0.38, or 0.75 microg/kg BW, administered again by osmotic pump. Treatment and blood-sampling schedules were the same as in experiment 2a. Zero, 0, 1, and 2 gilts displayed an LH surge after treatment with 0, 0.19, 0.38, and 0.75 microg EB/kg BW, respectively. Parameters of the surge were similar among gilts that displayed an LH surge. Pulsatile LH secretion was significantly suppressed for estradiol-treated gilts compared to controls. Thus, the LH surge resulted from positive feedback stimulation of a specific surge generator rather than attenuation or dissipation of negative feedback inhibition of estradiol on a pulse generator.

Differences in the luminance of the first and second displays affects visible persistence in opposite ways

Visible persistence was measured using a two-frame temporal integration paradigm. Most such studies match the brightness of the two frames, and find that equal increases in the brightness of the frames impairs performance on the task. This suggests that increases in frame brightness decrease the duration of visible persistence. Little is known about what happens when the frames differ in brightness. In this study, the luminance intensities of the first and second frames were set at five different intensity levels in a factorial arrangement. Increasing the intensity of the first frame improved performance, whereas increasing the intensity of the second frame impaired performance. These results suggest, contrary to the findings with brightness-matched frames, that increasing the intensity of one frame increases the duration of visible persistence of that frame. A mathematical model supports this conclusion.

Demonstration of dose-dependent global and regional cocaine-induced reductions in brain blood flow using a novel approach to quantitative single photon emission computerized tomography

Ischemic stroke is a common cause of morbidity and mortality in cocaine addicts. Because the previous semiquantitative single photon emission computerized tomography (SPECT) method for measuring brain blood flow does not quantify blood flow, the magnitude and specificity of cocaine's effects during drug taking has not been well established. Here, using a novel quantitative approach to SPECT, we established that intravenous cocaine administration to nine recently abstinent cocaine-dependent subjects was associated with significant decreases in global and regional brain blood flow to dopamine-rich areas such as the prefrontal, frontal temporal, and subcortical gray matter. Establishing the utility of this relatively new quantitative SPECT technique provides an important tool for the management of vascular disorders of the brain. Additionally, identifying the site-specific effects of cocaine provides targets for the development of putative therapeutic medications to attenuate or minimize ischemic stroke in cocaine addicts.

The personal and professional benefits of the ENT Nursing Foundation

SOHN created the ENT Nursing Foundation at the 21st Annual Congress. This article describes the Foundation, the basics of its operation, and the benefits to SOHN and donors.

Isradipine prevents global and regional cocaine-induced changes in brain blood flow: a preliminary study

The L-type calcium channel antagonist, isradipine, reduces brain ischemia in animal models of ischemic stroke. These effects of isradipine appear more pronounced in dopamine (DA) rich brain regions. These same DA-rich brain regions have also been shown to be the areas most affected by cocaine-induced ischemic changes. Using a novel quantified approach to single photon emission computerized tomography, we demonstrated that isradipine pre-treatment prevented cocaine-induced ischemic changes, especially in these DA-rich brain regions. This is the first demonstration that any medication, including isradipine, can prevent the ischemic effects of cocaine on brain blood flow. Isradipine may, therefore, be a useful therapeutic agent for the prevention of brain ischemia in cocaine addicts.

Extending the pipeline for minority physicians: a comprehensive program for minority faculty development

Medical schools must become more successful in training minority faculty. Minority faculty development programs at schools of medicine must involve trainees from the undergraduate years (if not before) through junior faculty and must involve MD and combine-degree (MD-PhD) students. The authors describe the comprehensive minority faculty development program at the University of Pennsylvania School of Medicine, which involves minority undergraduates, medical students, residents, fellows, and faculty. This program provides the administrative staff and research methodologists to assist trainees at all levels across all departments in the school of medicine. The principal student recruitment program is the undergraduate premedicine enrichment program. The medical student component provides general counseling, research development, and activities to enhance performance in the clinical courses. The components for advanced trainees (residents, fellows, and postdoctoral trainees) and faculty consist of training in research methods, mentoring, teaching skills, and scientific writing skills. Through this program, the University of Pennsylvania School of Medicine has increased the number of under-represented minority faculty by 32% since 1993-94 and created an environment conducive to the professional growth and development of minority faculty.

Colposcopy in evaluation of the adult sexual assault victim

The purpose of this study was to determine if the colposcope improves detection of genital trauma in adult women who are victims of sexual assault compared with gross visual examination alone. A prospective, 1-month pilot study was conducted of 17 women patients who presented consecutively to Charity Hospital New Orleans during April 1994 requesting sexual assault examinations. Use of the colposcope allowed documentation of trauma in 9 of the 17 sexual assault victims (53%), compared with 1 of 17 (6%) by gross visualization alone (statistically significant: chi2 = 0.64, P = .0114). The colposcope improved detection of genital trauma in adult female sexual assault victims as compared with gross visual examination alone at a statistically significant level.

Serum interleukin-6 levels in metastatic renal cell carcinoma before treatment with interleukin-2 correlates with paraneoplastic syndromes but not patient survival

PURPOSE

We sought to determine the frequency of interleukin-6 (IL-6) expression in renal cancer cell lines, the frequency of the detection of IL-6 in the serum of patients with metastatic renal cell carcinoma, whether serum IL-6 level correlates with the development of paraneoplastic syndromes and whether serum IL-6 level in patients with metastatic renal cancer correlates with response to treatment with interleukin-2 (IL-2) or patient survival.

MATERIALS AND METHODS

Conditioned media from 21 cell lines from 20 patients were examined for IL-6. We identified 2 matched groups of patients with metastatic renal cancer (30 responders and 29 nonresponders) to IL-2 based immunotherapy. Stored pretreatment serum specimens were evaluated for IL-6. Medical records were reviewed to determine the presence of paraneoplastic syndromes.

RESULTS

IL-6 was detected in 19 of 21 renal cancer cell lines (90%) obtained from 20 patients with metastatic renal cancer as well as in the serum of 33 of 59 patients (56%) with metastatic renal cell carcinoma. A significant association between serum IL-6 level and anemia (p = 0.0032), elevated platelet count (p = 0.01), decreased albumin (p = 0.034) and elevated alkaline phosphatase (p = 0.04) was found. A trend was noted of the association of increased serum IL-6 level and fever (p = 0.051). No correlation was found between pretreatment serum IL-6 level and survival or response to IL-2.

CONCLUSIONS

IL-6 was frequently secreted by renal cancer cell lines but it was only present in the serum of approximately half of the patients with metastatic renal cancer. Elevations of serum IL-6 were associated with paraneoplastic manifestations frequently seen in patients with renal cancer, including anemia, thrombocytosis, decreased albumin and elevations of alkaline phosphatase (Stauffer's syndrome). A weak relationship was noted between serum IL-6 level and fever but none was noted between that and survival or response to IL-2.