PGD12 Cost of Prescription Drugs and Cost of Treatment Failure for Sinusitis

A self-administered, disease-specific form of health status instrument for patients with COPD is not available in America. The St. George's Respiratory Questionnaire (SGRQ) is a successful measure in Great Britain and Europe that meets these requirements, but syntax and colloquial differences make an American version necessary.
OBJECTIVE: To test the validity and reliability of an American translation (ATSGRQ) of the SGRQ.
METHODS: Two bilingual health professionals independently translated the SGRQ based on summarized input from panels of American COPD patients and American respiratory professionals. Consensus was reached on the translated version and then back-translated by two other bilingual health professionals. To establish reliability, the ATSGRQ was given to COPD patients at the beginning of a pulmonary rehabilitation program (PRP) and repeated 1 week later. To establish validity, the ATSGRQ was used with pulmonary function tests, the Medical Research Council's dyspnea scale (DYS), 6-minute walk (6MW), and Short Form Health Status Profile-36 (SF-36) at the beginning and end of PRP for 24 COPD patients.
RESULTS: The patients were mean age 70 yr, 40% male, mean FEV1 = 0.95. The ATSGRQ Cronbach's alpha for overall scale and symptom, activity, and impact components was respectively .87, .65, .79, .80. Test-retest correlations were .70, .60, .72, .64, respectively. Baseline correlations between total ATSGRQ and FEV1, DYS, 6MW, and SF-36 physical and mental health component scores were −.43, 54, .56, −.76, −.62. From initial to post-PRP, the symptom ATSGRQ decreased 12.6% (p = .004); DYS decreased 10.6% (p = .043).
CONCLUSION: Based on these preliminary data, the ATSGRQ appears to be a valid, reliable health status instrument for use in an American COPD population.     

Routine CT screening of psychiatry inpatients

During a 3-year period, all inpatients in the psychiatry unit underwent routine screening computed tomography (CT) in an effort to detect clinically unsuspected intracranial abnormalities. Of 261 patients examined who had no focal neurologic deficits, 103 had schizophrenia, 71 had depression, 48 had bipolar disorders, and 39 had paranoid delusions. Findings on 230 (88.1%) of the CT scans were within normal limits, and 27 (10.4%) showed only cortical atrophy. The remaining four cases (1.5%) demonstrated basal ganglia calcification (n = 2), old lacunar infarction (n = 1), or osteoma arising from the inner table of the skull (n = 1), all of which were considered to be clinically unrelated to the patients' psychiatric conditions. In the absence of focal neurologic deficits or other findings suggesting an intracranial abnormality (eg, papilledema, seizures, persistent or increasing headaches), there is no justification for routine CT scanning in patients admitted to the hospital for psychiatric disorders.     

Prognostic significance of argyrophilic nucleolar organizer region (AgNOR) in resected non-small cell lung cancer (NSCLC)

The expression of the nucleolar organizer regions (NORs) was quantified in paraffin sections of tumors and lymph node metastasis, by means of digital image analysis, in 75 patients with resected non-small cell lung cancer (NSCLC). Patients were divided in two groups: early stage (stages I and II) and advanced stage (stages IIIa, IIIb and IV). The prognostic significance of AgNOR expression was tested by Cox regression analysis in models controlled for age, sex, vital status, stage and histological type. Tumors at early stages had a lower expression of AgNOR than those at more advanced diseases. The mean values obtained for NORs in advanced disease were almost the same as those in the primary tumors when compared with the corresponding lymph node metastasis (r = 0.90; p < 0.01; linear regression). The prognostic role of AgNOR was significant only for tumors at stages I and II and not for advanced neoplasms (stages IIIa, IIIb and IV). These results encourage the inclusion of AgNOR quantitation in routine material, especially in early lung cancer.      

Morphine pharmacokinetics in premature and mature newborn infants

The pharmacokinetics of a single dose of morphine was investigated in five term infants (gestational age 37–40 weeks) and eight preterm infants (gestational age 25–32 weeks). In the five term infants, median (range) volume of distribution at steady state (Vd_β) was 1758 (634–2700) ml/kg, plasma clearance (Cl) was 4.73 (1–75–6.61) ml/kg/min and terminal half-life (T1/2) was 224 (107–394) min. In the eight preterm infants, Vd_β was 2366 (1662–2876) ml/kg, Cl was 2.82 (1.88–6.60) ml/kg/min and T1/2 was 556 (248–834) min. No correlation was found between clearance and gestational age, but we found a significant negative correlation between T1/2 and gestational age. We conclude that there is considerable variation in the pharmacokinetic properties of morphine in both term and preterm newborn infants. Because of this variation, careful individual assessment of the clinical effect of therapy with morphine in newborn infants should be exercised.     

Systemic chemotherapy induces microsatellite instability in the peripheral blood mononuclear cells of breast cancer patients

Introduction  

Systemic chemotherapy is an important part of treatment for breast cancer. We conducted the present study to evaluate whether systemic chemotherapy could produce microsatellite instability (MSI) in the peripheral blood mononuclear cell fraction of breast cancer patients.     

The anticonvulsant hypersensitivity syndrome

BACKGROUND: The anticonvulsant hypersensitivity syndrome is a potentially fatal multisystemic reaction to anticonvulsant medications. OBJECTIVES: The purpose of this study was to investigate the clinical characteristics of anticonvulsant hypersensitivity syndrome. RESULTS: A total 32 subjects, aged from 6 to 72 years, diagnosed as having anticonvulsant hypersensitivity syndrome based on clinical and histopathological findings, were included in the study. In 22 of the 32 cases, the anticonvulsants had been administered prophylactically after craniotomy and in 10 cases for epilepsy. When the cases were assessed for skin lesions, maculopapular eruption was registered in 22, Stevens-Johnson syndrome in five, and toxic epidermal necrolysis (TEN) in five. Treatment included suspension of the offending drug and then, except for the cases with toxic epidermal necrolysis, administration of corticosteroids. The 22 cases that required anticonvulsant therapy were treated with valproic acid. In all cases, we observed rapid clinical improvement corroborated by laboratory findings. CONCLUSIONS: It is essential that due importance be given to the development of an eruption in individuals to whom anticonvulsants are administered after craniotomy because anticonvulsant hypersensitivity syndrome is likely to be life-threatening.     

Manifestation of cellulitis after saphenous venectomy for coronary bypass surgery

A few cases of onset of cellulitis after saphenous venectomy for coronary by-pass surgery were first reported by Baddour and Bisno in 1982. We reviewed the dinical characteristics of 31 subjects followed up in our department following onset of manifestations of cellulitis after saphenous venectomy for coronary by-pass surgery. In all the subjects the cellulitis originated at the scar of the saphenous venectomy, and most presented ill-defined, mildly erythematous, slightly oedematous lesions. Mycologically confirmed tinea pedis was found in 25 subjects. All the patients responded well to penicillins or cephalosporins. In this report we comment on the pathogenesis of this complication of saphenous venectomy based on the clinical features of the cases reviewed. We suggest that saphenous venectomy may destroy the lymphatics in the lower leg, that are located adjacent to the great saphenous vein, and thus microorganisms penetrating into the skin may easily cause cellulitis in areas with impaired lymphatic drainage.     

MEDIAL ORBITAL WALL BLOWOUT FRACTURE WITH MEDIAL RECTUS MUSCLE ENTRAPMENT

We report a case of left medial rectus palsy due to entrapment by a fracture of the lateral wall of the ethmoidal sinus following a road traffic accident and discuss the presentation and management of this unusual complication.