Terson's syndrome presenting as an ophthalmic emergency

PURPOSE: To report an unusual case of Terson's syndrome caused by a ruptured intracranial aneurysm presenting as an ophthalmic emergency with visual loss, without any neurological features at the time of presentation. METHODS: Case report. A 38-year-old man was referred to the eye emergency department with sudden loss of vision in both eyes. Vitreous haemorrhage was noted in both eyes. There was no history of loss of consciousness or headaches and no signs of meningeal irritation at presentation. The patient subsequently developed progressive neck stiffness and headache. RESULTS: Neuro-imaging studies revealed a subarachnoid haemorrhage resulting from a ruptured carotid-ophthalmic artery aneurysm. CONCLUSIONS: It is important to consider Terson's syndrome, a potentially life-threatening condition, in any patient presenting with bilateral vitreous haemorrhage. Some patients may not show any headache, neurological deficits or signs of meningeal irritation at presentation but may develop them later on.     

Onset of symptom relief with rabeprazole: a community-based, open-label assessment of patients with erosive oesophagitis

BACKGROUND: In numerous clinical trials, proton pump inhibitors have demonstrated potent acid suppression and healing of erosive oesophagitis, as well as successful symptom relief for the entire spectrum of gastro-oesophageal reflux disease. AIM: The 'Future of Acid Suppression Therapy' (FAST) trial evaluated, in actual clinical practice, the timing of symptom relief, changes in symptom severity, health-related quality of life and safety in endoscopically confirmed erosive gastro-oesophageal reflux disease treated with rabeprazole. METHODS: This open-label, multicentre study enrolled 2579 patients to receive rabeprazole treatment using 20 mg once daily for 8 weeks. Between two clinical visits (at enrollment and week 8), patients used an interactive voice response system to rate gastro-oesophageal reflux disease symptoms. Subgroup analyses of efficacy were conducted for gender, age, Hetzel-Dent grade, presence of Barrett's oesophagus and for patients reporting previously ineffective symptom relief with omeprazole or lansoprazole. RESULTS: On day 1, rabeprazole significantly decreased daytime and night-time heartburn severity, regurgitation and belching. Complete relief of daytime and night-time heartburn was achieved in 64.0% and 69.2% of symptomatic patients, respectively, on day 1, and in 81.1% and 85.7% of patients, respectively, on day 7. Patients with moderate or severe heartburn symptoms at baseline achieved an even greater degree of satisfactory symptom relief (none or mild) from day 1 onwards. The median time to satisfactory heartburn relief was 2 days. Subgroup analyses showed no consistent differences in efficacy compared to the overall population treated. Health-related quality of life in patients was significantly lower than that of the US general population and improved significantly after 8 weeks of rabeprazole therapy. Rabeprazole was well tolerated, with headache as the most common adverse event, reported by less than 2% of the study population. CONCLUSIONS: In this large, open-label trial, rabeprazole rapidly and effectively relieved gastro-oesophageal reflux disease symptoms in most patients with erosive oesophagitis. Substantial symptom relief was noted on day 1; improvement continued over the first week and at week 4. By week 8, the health-related quality of life had also improved vs. baseline.     

Combined air pollution particle and ozone exposure increases airway responsiveness in mice

We investigated whether coexposure to inhaled ambient particles and ozone affects airway responsiveness (AR, measured as enhanced pause, Penh) and allergic inflammation (AI) in a murine model of asthma. Ovalbumin-sensitized mice were challenged with either ovalbumin ("asthmatic") or phosphate-buffered saline (PBS) aerosols for 3 successive days. Immediately after daily challenge, mice were exposed for 5 h to concentrated ambient particles (CAPs), or 0.3 ppm ozone, or both, or neither (n > or = 61/group, 12 experiments). Exposure to CAPs alone or coexposure to CAPs + O(3) caused an increase in Penh in both normal and "asthmatic" mice. These responses were transient and small, increasing approximately 0.9% per 100-microg/m(3) increase in CAPs. Analysis of the effects of particle composition on AR revealed an association between the AlSi particle fraction and increased AR in "asthmatic" mice exposed to ozone and particles. No effects of pollutants on AI were noted. We conclude that (1) particle exposure causes an immediate, short-lived (<24 h) increase in AR in mice; (2) these responses are small; and (3) changes in AR may be correlated with specific elements within the particle mixture.     

Effect of pharmacological treatments for diabetes on homocysteine

Hyperhomocysteinemia is a well-established risk factor for cardiovascular disease. The association of hyperhomocysteinemia with diabetes mellitus is complex and may explain some of the risk of CVD in diabetics not explained by traditional risk factors. Both modifiable and non-modifiable factors interact with homocysteine metabolism and determine the plasma homocysteine concentrations. These include genetic abnormalities, age, sex, and various nutritional and hormonal determinants, all of which play a role in atherosclerosis and accelerated peripheral and cardio-vascular disease (CVD). Several medications modulate homocysteine metabolism and hence may play a role in the pathogenesis of CVD. Changes in renal function and interference with the homocysteine metabolism account for some of these drug effects. While a few of these drugs raise plasma homocysteine concentrations, others are beneficial and may counter some of the deleterious effects of hyperhomocysteinemia. Treatment of hyperhomocysteinemia with vitamins lowers plasma homocysteine concentrations and also reverses many of these drug effects. Little data is available on the effect of this intervention on cardiovascular outcomes. This review briefly outlines the effect of various medications used in the management of type 2 diabetes mellitus and metabolic syndrome.     

Alcohol-associated admissions to an adult intensive care unit: an audit

BACKGROUND AND OBJECTIVE: Excessive alcohol consumption is a major cause for premature death and preventable ill health in the whole population. We set out to audit admissions to the intensive care unit (ICU) of our large teaching hospital with respect to alcohol-related admissions. METHODS: A prospective audit was conducted into alcohol-associated admissions to our university hospital adult ICU over 12 months. The following data were collected for each patient admitted: age, gender, diagnosis and amount of alcohol consumption, APACHE II score, and the probability of death. RESULTS: Patients with definite alcohol consumption constituted 39.1% (124 patients) of all admissions (317 patients) to the ICU. In Group 1 (89 patients), the admission was directly associated with alcohol consumption, which included heavy alcohol consumption. Group 2 (35 patients) consisted of 'social drinkers'; and Group 3 was composed of patients who denied any alcohol intake. Group 1 had a high median APACHE II score of 19 (range 4-35) and a significantly higher mortality rate (41.6%) than Group 3 (18.4%, P < 0.001) or the entire sample studied (23.7%, P < 0.001). The results also demonstrated an incidence of pneumonia of 29.2% (26 patients) in alcohol-associated admissions compared with 22.8% (eight patients) in Group 2 and 21.8% (19 patients) in Group 3. Trauma admissions amounted to 11.4% of the patients studied (24/211 patients), 17 (70.8%) of whom were directly associated with alcohol and it included 11 pedestrians. CONCLUSIONS: Alcohol may play a major role in the admission and mortality of ICU patients. Further investigations are warranted because our sample size is so small.     

Totally implanted venous access device removal in interventional radiology

PURPOSE: To demonstrate that totally implanted venous access device (TIVAD) removal in the out-patient interventional radiology (IR) recovery room is safe and effective. MATERIALS AND METHODS: Fifty-seven TIVADs were removed in 56 patients using a standard cut-down technique. Forty-one devices (72%) in 40 patients without signs of pocket infection were closed with primary intention with sub-cuticular absorbable or simple non-absorbable sutures, depending on operator preference. All patients were followed up to assess for bleeding or infection. Sixteen devices (28%) in 16 patients with suspected pocket infection were allowed to heal by secondary intention. These patients were managed with antibiotics and dressing changes until healing was complete. Catheter tips were sent for culture and sensitivity. RESULTS: TIVADs were removed intact in all 57 cases. There were no cases of air embolism, uncontrolled hemorrhage, retained foreign body or catheter fragmentation. No bleeding or infectious complications were noted in those patients who were allowed to heal with primary intention. Wound closure was accomplished in all patients who were allowed to heal with primary or secondary intention. CONCLUSION: TIVAD removal in an out-patient recovery room by an interventional radiology team is safe and feasible, providing a possible alternative venue for this procedure.     

Technology as a 'major driver' of health care costs: a cointegration analysis of the Newhouse conjecture

Per capita real income on the demand-side and technological change, proxied by total R&D and health R&D spending, on the supply-side are hypothesized as major drivers of per capita real health care expenditure in the US during the 1960-1997 period. The findings are robust to a battery of unit root and cointegration tests. They support the Newhouse [Journal of Economic Perspectives 6 (1992) 3] conjecture that technological change is a major escalator of health care expenditure and confirm a significant and stable long-run relationship among per capita real health care expenditure, per capita real income and broad-based R&D expenditures. Policy implications are noted.