Pulmonary problems in pregnancy

Pregnant women with asthma and pulmonary infections should be treated essentially the same as nonpregnant women with similar disease severity. Definitive diagnosis and prompt treatment with heparin should be used for patients with pulmonary thromboembolism.     

Positive direct antiglobulin tests due to clavulanic acid.

Clavulanic acid, a beta-lactamase inhibitor, was found to be associated with the development of a positive direct antiglobulin test. Of 23 antibiotic courses in patients treated with ticarcillin, clavulanic acid, and tobramycin, 10 (43.5%) developed positive direct antiglobulin tests versus 2 of 26 (7.7%) patients treated with piperacillin and tobramycin (P = 0.0044). In vitro immunohematological studies showed that clavulanic acid caused a nonimmunologic adsorption of plasma proteins onto the erythrocyte surface. Hemolysis was not associated with such nonimmunologic adsorption. However, the resulting positive antiglobulin test might delay cross matching of blood products for transfusions or interfere with the evaluation of true immune-mediated hemolytic anemia.     

Symptoms of irritable bowel syndrome in ulcerative colitis in remission

The prevalence of symptoms suggestive of a motility disturbance similar to the irritable bowel syndrome was investigated in 98 patients with ulcerative colitis in remission, and a similar number of age- and sex-matched healthy controls. Thirty-three per cent of patients compared with 7% of controls fulfilled the criteria for such a syndrome (p<0·01). Contrary to expectations these symptoms were not confined to patients with distal disease. Other symptoms such as constipation were also very common in the colitic group (31%).     

Chronic 17β‐estradiol or cholesterol prevents stress‐induced hippocampal CA3 dendritic retraction in ovariectomized female rats: Possible correspondence between CA1 spine properties and spatial acquisition

Chronic stress may have different effects on hippocampal CA3 and CA1 neuronal morphology and function depending upon hormonal status, but rarely are manipulations of stress and gonadal steroids combined. Experiment 1 investigated the effects of chronic restraint and 17β‐estradiol replacement on CA3 and CA1 dendritic morphology and spatial learning in ovariectomized (OVX) female Sprague–Dawley rats. OVX rats were implanted with 25% 17β‐estradiol, 100% cholesterol, or blank silastic capsules and then chronically restrained (6h/d/21d) or kept in home cages. 17β‐Estradiol or cholesterol prevented stress‐induced CA3 dendritic retraction, increased CA1 apical spine density, and altered CA1 spine shape. The combination of chronic stress and 17β‐estradiol facilitated water maze acquisition compared to chronic stress + blank implants and nonstressed controls + 17β‐estradiol. To further investigate the interaction between 17β‐estradiol and stress on hippocampal morphology, experiment 2 was conducted on gonadally intact, cycling female rats that were chronically restrained (6h/d/21d), and then euthanized at proestrus (high ovarian hormones) or estrus (low ovarian hormones). Cycling female rats failed to show chronic stress‐induced CA3 dendritic retraction at either estrous phase. Chronic stress enhanced the ratio of CA1 basal spine heads to headless spines as found in experiment 1. In addition, proestrous rats displayed increased CA1 spine density regardless of stress history. These results show that 17β‐estradiol or cholesterol protect against chronic stress‐induced CA3 dendritic retraction in females. These stress‐ and 17β‐estradiol‐induced morphological changes may provide insight into how dendritic complexity and spine properties contribute to spatial ability. © 2009 Wiley‐Liss, Inc.     

FDG SPECT in patients with lung masses

STUDY OBJECTIVES: To determine whether 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG) single-photon emission CT (SPECT) is useful in characterizing pulmonary masses. DESIGN: Scans were prospectively acquired and interpreted. Interpretations were performed with CT or chest radiograph but interpreters were blinded to eventual diagnosis. SETTING: University hospital practice and affiliated Veterans Administration medical center. PATIENTS OR PARTICIPANTS: Forty patients participated as part of an institutional review board-approved research protocol, and informed consent was obtained in all. Eight additional patient scans were acquired as part of their clinical evaluation for pulmonary mass. MEASUREMENTS AND RESULTS: There were 26 malignant lesions (12 were 1 to 2 cm in size, the rest were larger) and 17 benign lesions (3 were < 1 cm in size, 9 were 1 to 2 cm in size, and 5 were larger). Averaged sensitivity, specificity, positive predictive value, and negative predictive value were, respectively, 50% (12 of 24), 94% (17 of 18), 92% (12 of 13), and 59% (17 of 29) for lesions 1 to 2 cm in size, 100% (28 of 28), 90% (9 of 10), 97% (28 of 29), and 100% (9 of 9) for lesions > 2 cm in size. There was good correlation between readers (p < 0.0001). CONCLUSION: FDG SPECT is useful in characterizing pulmonary masses > 2 cm in size and appears to be equivalent to positron emission tomography for these lesions. Although currently clinically suboptimal for characterizing lesions < or = 2 cm in size, FDG SPECT appears to be better than current anatomic imaging methods. In addition, the positive predictive value of FDG SPECT for small lesions is also high (92%), and this technique appears potentially useful in the subset of patients in whom a positive result would alter clinical diagnostic pathways or care.     

Perforated ileal diverticulitis: CT findings

Diverticulosis of the ileum is very uncommon. The differential diagnosis for any inflammatory process in the right lower quadrant of the abdomen includes appendicitis, Crohn's disease, and other infectious and inflammatory conditions of the terminal ileum and cecum. Diagnosis of small bowel diverticulitis is based on radiological findings, and computed tomography is the method of choice to demonstrate mural changes and the mesenteric extent of the inflammation. Preoperative knowledge of this condition may influence surgical and medical management.     

Medication safety in community pharmacy: a qualitative study of the sociotechnical context

Background  

While much research has been conducted on medication safety, few of these studies have addressed primary care, despite the high volume of prescribing and dispensing of medicines that occurs in this setting. Those studies that have examined primary care dispensing emphasised the need to understand the role of sociotechnical factors (that is, the interactions between people, tasks, equipment and organisational structures) in promoting or preventing medication incidents. The aim of this study was to identify sociotechnical factors that community pharmacy staff encounter in practice, and suggest how these factors might impact on medication safety.