PAIN MEDICINE, Issue 2 2002
Article first published online: 4 JUL 200
Forest Tennant, MD, Dr PH; Laura Herman RN BSN FNP Veract Intractable Pain Centers, 338 S. Glendora Ave., West Covina, CA 91790 It is recognized that biologic markers of severe, intractable pain (SIP) can help distinguish degrees of pain and assist in monitoring treatment effectiveness. Fifty (50.0%) adult ambulatory SIP patients, at the time of referral described their pain as constant, excruciating, produced a bed or house-bound state, and was uncontrolled by non-opioid medications and low dosages of the weak opioids, hydrocodone or codeine. Patients were treated with a long-acting opioid preparation consisting of methadone, oxycodone, morphine, or transdermal fentanyl in addition to a short-acting opioid for breakthrough pain. These patients were screened before treatment and after three months of opioid treatment by: (1) blood pressure; (2) pulse rate; (3) morning cortisol and pregnenolone serum concentrations; and (4) erythrocyte sedimentation rate (ESR). The percentage of patients with physiologic abnormalities before and after three months of treatment were as follows: (1) hypertension above 140/90 mm/Hg; 28 (56.0%) vrs 14 (28.0%); (2) tachycardia above 84/minute; 21 (42.0%) vrs 9 (18.0%); (3) elevated serum cortisol concentration; 12 (24.0%) vrs 2 (4.0%); (4) low serum cortisol serum concentration; 7 (14.0% vrs 1 (2.0%); (5) low pregnenolone serum concentration; 18 (36.0%) vrs 3 (6.0%); and (6) elevated ESR; 10 (20.0%) vrs 3 (6.0%) (p<.05). Mean blood pressure, pulse rate, ESR, and serum concentrations of cortisol and pregnenolone in patients who demonstrated a physiologic abnormality all positively and significantly (p<.05) altered these markers toward normal. This study indicates that some physiologic abnormalities, particularly those related to pituitary-adrenal over-stimulation with excess output of catecholamines and glucocorticoids, may serve as biologic markers which can help to identify SIP and monitor treatment effectiveness. [source]

Reliability of a new ultrasonic cardiac output monitor in recipients of living donor liver transplantation,,§¶

LIVER TRANSPLANTATION, Issue 7 2008
Bai-Chuan Su
The ultrasonic cardiac output monitor (USCOM) is a new Doppler device for noninvasive hemodynamic monitoring. The aim of this prospective nonrandomized study was to test the feasibility, perioperative reliability, and clinical applicability of using USCOM as an alternative to pulmonary artery catheterization in recipients of living donor liver transplantation. Thirteen patients scheduled to receive living donor liver transplants were initially recruited. Three were subsequently excluded prior to the commencement of surgery because of technical difficulties in obtaining diagnostic-quality images with USCOM. Ten patients proceeded to be studied. Cardiac output measurements by thermodilution and USCOM were compared at 30-minute intervals throughout the procedure and at 10 specific procedural reference points during the surgery when hemodynamic changes were most likely to be observed. The data were analyzed with Lin's concordance coefficient and Bland-Altman analysis. Two hundred ninety paired cardiac output values were obtained from the 10 patients. The concordance between both methods was excellent in 8 patients and satisfactory in 2. Bland-Altman analysis of all data produced a mean bias of , 0.02 L/minute for USCOM, and the 95% limits of agreement were ,1.06 to +1.10 L/minute. Further analysis of the 10 reference time points showed minimal bias and high levels of agreement between the methods. We conclude that USCOM provides an accurate and noninvasive method for cardiac output measurement during liver transplantation. It may therefore represent an alternative to pulmonary artery catheter placement with consequent reduction in patient's risk and morbidity associated with catheterization. Liver Transpl 14:1029,1037, 2008. © 2008 AASLD. [source]

Comparison of the USCOM ultrasound cardiac output monitor with pulmonary artery catheter thermodilution in patients undergoing liver transplantation,

LIVER TRANSPLANTATION, Issue 7 2008
Lai-Sze Grace Wong
The aim of the study was to compare the standard technique of cardiac output determination by pulmonary artery catheter thermodilution (PAC-TD) with a noninvasive ultrasound Doppler monitor (USCOM Pty., Ltd., Coffs Harbour, Australia) in surgery for liver transplantation. We wished to determine if the degree of accuracy would allow the ultrasound cardiac output monitor (USCOM) to be used as an alternative monitor in a clinical setting in which wide fluctuations in cardiac output could be expected. This was a prospective method comparison study, with 71 paired measurements obtained in 12 patients undergoing liver transplantation in a university teaching hospital. Bland-Altman analysis of the 2 techniques showed a bias of 0.39 L/minute, with the USCOM cardiac output lower compared with that of PAC-TD. The bias was small and did not vary with the magnitude of the cardiac output. The 95% limits of agreement were ,1.47 and 2.25 L/minute. There was good repeatability for USCOM measurements, with a repeatability coefficient of 0.43 for USCOM versus 0.77 for PAC-TD. We conclude that USCOM is acceptable for the clinical determination of noninvasive cardiac output, particularly in situations in which tracking changes over time is more important than knowing the precise value. However, the utility of USCOM is limited by its inability to measure pulmonary artery pressure. Liver Transpl 14:1038,1043, 2008. © 2008 AASLD. [source]

RE: RESUSCITATION BEYOND 10 MINUTES OF TERM BABIES BORN WITHOUT SIGNS OF LIFE

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 8 2004
JR Tompkins Dr
No abstract is available for this article. [source]

Suppression of the mouse double minute 4 gene causes changes in cell cycle control in a human mesothelial cell line responsive to ultraviolet radiation exposure

ENVIRONMENTAL AND MOLECULAR MUTAGENESIS, Issue 9 2009
Melisa Bunderson-Schelvan
Abstract The TP53 tumor suppressor gene is the most frequently inactivated gene in human cancer identified to date. However, TP53 mutations are rare in human mesotheliomas, as well as in many other types of cancer, suggesting that aberrant TP53 function may be due to alterations in its regulatory pathways. Mouse double minute 4 (MDM4) has been shown to be a key regulator of TP53 activity, both independently as well as in concert with its structural homolog, Mouse Double Minute 2 (MDM2). The purpose of this study was to characterize the effects of MDM4 suppression on TP53 and other proteins involved in cell cycle control before and after ultraviolet (UV) exposure in MeT5a cells, a nonmalignant human mesothelial line. Short hairpin RNA (shRNA) was used to investigate the impact of MDM4 on TP53 function and cellular transcription. Suppression of MDM4 was confirmed by Western blot. MDM4 suppressed cells were analyzed for cell cycle changes with and without exposure to UV. Changes in cell growth as well as differences in the regulation of direct transcriptional targets of TP53, CDKN1A (cyclin-dependent kinase 1,, p21) and BAX, suggest a shift from cell cycle arrest to apoptosis upon increasing UV exposure. These results demonstrate the importance of MDM4in cell cycle regulation as well as a possible role inthe pathogenesis of mesothelioma-type cancers. Environ. Mol. Mutagen. 2009. © 2009 Wiley-Liss, Inc. [source]

The Effect of Denture Cleansing Solutions on the Retention of Yellow Hader Clips: An In Vitro Study

JOURNAL OF PROSTHODONTICS, Issue 3 2007
Reena M. Varghese DMD
Purpose: To evaluate the retention of yellow Hader clips after exposure to various denture cleansers. Methods: Seven groups of 18 yellow Hader clips each were soaked for the equivalent of 6 months of clinical use in the following denture cleansing solutions: Polident Regular, Polident Overnight, Efferdent, 5.25% Sodium Hypochlorite (NaOCl, 1:10 dilution) 15 min/day, NaOCl (1:10 dilution) 8 hours/day, water and dry (control) group. A Universal Testing Machine, set at a crosshead speed of 2 in/min, pulled each clip once, and the peak load-to-dislodgement was recorded and used as a measure to reflect changes in the retention of the Hader clips. Data were analyzed by a one-way analysis of variance followed by Tukey's HSD test. A p value , 0.05 was considered significant. Results: Denture cleansing solutions affected the retentive values of yellow Hader clips (F= 6.102, p, .0001). Sodium hypochlorite solution, 15 min/day for 6 months, caused an increase in the retentive values of the clips tested with a mean peak load-to-dislodgement of 22.63 ± 1.29 N. In addition, clips soaked in water showed no difference in retentive values when compared with all other groups. Furthermore, Polident Regular, Polident Overnight, Efferdent, and NaOCl (8 hours/day) had no effect on the retentive values of yellow Hader clips. Conclusion: This in vitro study demonstrated that the retention of yellow Hader clips used in implant overdentures is unaffected when soaked in commercial effervescent denture cleansers (Polident 5 Minute, Polident Overnight, and Efferdent) for six simulated months. Sodium hypochlorite statistically increased the single-pull retentive values of the clips, an effect that may not be beneficial. Increased retentive values may be associated with reduced durability of clips; further research is needed to address this issue. [source]

Minute on UNFCCC Conference of the Parties , COP 15 in Copenhagen

THE ECUMENICAL REVIEW, Issue 2 2010
Article first published online: 15 JUN 2010
No abstract is available for this article. [source]

One Minute to Midnight: Kennedy, Khrushchev, and Castro on the Brink of Nuclear War , By Michael Dobbs

THE HISTORIAN, Issue 3 2010
Jaclyn Stanke
No abstract is available for this article. [source]

Last Minute: Emergency Medicine

ACADEMIC EMERGENCY MEDICINE, Issue 8 2009
Harvey Castro MD
No abstract is available for this article. [source]

Hydraulische Reaktionen des Zements in Mörtel bei verschiedenen Parametern

BETON- UND STAHLBETONBAU, Issue 8 2010
Analytische Betrachtungen mittels Kryotransfer-Rasterelektronenmikroskopie
Allgemeines; Baustoffe Abstract Die Kryotransfer-Rasterelektronenmikroskopie wird mittlerweile sehr häufig zur Erforschung von Abbindereaktionen in Zementen und anderen Baustoffen eingesetzt und kann heute als Standardverfahren angesehen werden. Ein wesentliches Interesse für industrielle Anwendungen besteht unter anderem darin, Untersuchungen des Zementleims in-situ bereits ab der Wasserzugabe bzw. ab der ersten Minute der Hydratation in so genannten "Zeitschnitten" durchzuführen. In der vorliegenden Arbeit wird der Einsatz eines Kryotransfer-Systems bei der Untersuchung der Abbindereaktionen des Zements in einem herkömmlichen Beton aufgezeigt. Als unterschiedliche Parameter wurden modellhaft Abbindezeiten von 1 Minute, 5 und 60 Minuten bei Abbindetemperaturen von 4 °C, 22 °C und 40 °C gewählt. Hydraulic Reactions of Cement in Mortar at Different Parameters Analytical Observations by Means of Cryo-Transfer-Scanning-Electron-Microscopy For the investigation of hydraulic reactions of cements and other building materials the cryo-transfer scanning-electron-microscopy is frequently used by now. Today the cryo-transfer technique is considered as a reference procedure. An essential concern in industrial applications is , amongst others , the insitu investigation of the cement paste at the very early state of hydration , just after the addition of water, respectively during the first minutes within so-called "time-cuts". The present work illustrates the application of a cryo-transfer system for the investigations on hydraulic reactions of conventional concrete. Exemplary parameters were curing times of 1 minute, 5 and 60 minutes at curing temperatures of 4 °C, 22 °C and 40 °C. [source]

Famous for One Minute

BUSINESS STRATEGY REVIEW, Issue 1 2004
Stuart Crainer
No abstract is available for this article. [source]

The Abraham Lincoln Presidential Library and Museum The Civil War in Four Minutes

CURATOR THE MUSEUM JOURNAL, Issue 1 2006
Beverly Serrell
First page of article [source]

Minutes of the Advisory Committee

EUROPEAN JOURNAL OF SOIL SCIENCE, Issue 1 2001
O. K. Borggaard
No abstract is available for this article. [source]

Minutes of the 77th Annual General Meeting of the Agricultural Economics Society held on Monday 31 March 2008 at the Royal Agricultural College, Cirencester,

JOURNAL OF AGRICULTURAL ECONOMICS, Issue 3 2008
Article first published online: 5 AUG 200
First page of article [source]

Maximum Daily 6 Minutes of Activity: An Index of Functional Capacity Derived from Actigraphy and Its Application to Older Adults with Heart Failure

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2010
Jason Howell BA
OBJECTIVES: To compare the correlation between the maximum 6 minutes of daily activity (M6min) and standard measures of functional capacity in older adults with heart failure (HF) with that in younger subjects and its prognostic utility. DESIGN: Prospective, cohort study. SETTING: Tertiary care, academic HF center. PARTICIPANTS: Sixty, ambulatory, adults, New York Heart Association (NYHA) Class I to III, stratified into young (50.9 ± 9.4) and older cohorts (76.8 ± 8.0). MEASUREMENTS: Correlation between M6min and measures of functional capacity (6-minute walk test; 6MWT) and peak oxygen consumption (VO2) according to cardiopulmonary exercise testing in a subset of subjects. Survival analysis was employed to evaluate the association between M6min and adverse events. RESULTS: Adherence to actigraphy was high (90%) and did not differ according to age. The correlation between M6min and 6MWT was higher in subjects aged 65 and older than in those younger than 65 (correlation coefficient (r=0.702, P<.001 vs r=0.490, P=.002). M6min was also significantly associated with peak VO2 (r=0.612, P=.006). During the study, 26 events occurred (2 deaths, 10 hospitalizations, 8 emergency department visits, and 6 intercurrent illnesses). The M6min was significantly associated with subsequent events (hazard ratio=2.728, 95% confidence interval=1.10,6.77, P=.03), independent of age, sex, ejection fraction, NYHA class, brain natriuretic peptide, and 6MWT. CONCLUSION: The high adherence to actigraphy and association with standard measures of functional capacity and independent association with subsequent morbid events suggest that it may be useful for monitoring older adults with HF. [source]

Deterioration of Organization in the First Minutes of Atrial Fibrillation: A Beat-to-Beat Analysis of Cycle Length and Wave Similarity

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 1 2007
FLAVIA RAVELLI Ph.D.
Introduction: It has been recently suggested that many episodes of atrial fibrillation (AF) may be partially organized at the onset and thus more suitable for antitachycardia pacing therapy. Nevertheless, the time course of organization in the first minutes of AF has not been quantified yet. Methods and Results: Twenty episodes of paroxysmal AF were studied. Electrograms were recorded from the right atrium (RA), distal (CSd), and proximal coronary sinus (CSp). The time course of AF cycle length (AFCL) and the regularity of wave morphology (similarity index S) were beat-to-beat measured at each recording site during the first 7 minutes of AF. AFCL and S showed a decreasing trend after the onset of AF. AFCL decreased from 208 ± 31 to 171 ± 21 msec (P < 0.001), from 206 ± 40 to 169 ± 23 msec (P < 0.001) and from 190 ± 42 to 152 ± 18 msec (P < 0.05), respectively, in RA, CSd, and CSp. Similarly, the similarity index decreased in CSd from 0.37 ± 0.27 to 0.12 ± 0.09 (P < 0.01) and in RA from 0.40 ± 0.18 to 0.17 ± 0.16 (P < 0.001). The 80% of the decrease occurred during the first 3 minutes of the arrhythmia, while after this time both cycle length and similarity index did not change significantly anymore. Conversely, the electrical activity in CSp was highly disorganized (S = 0.05 ± 0.03) even in the first minute of AF, and no decreasing temporal trend was observed. Conclusion: Higher levels of organization and longer fibrillation intervals exist at the onset of AF. The degree of organization of the electrical activity decays within less than 3 minutes. Since antitachycardia pacing success rate increases with high levels of organization, these results suggest an early delivery of pacing treatment. [source]

Idiographically Determined Versus Standard Absorption Periods in Alcohol Administration Studies

ALCOHOLISM, Issue 5 2010
Rebecca L. Schacht
Background:, Effects of alcohol vary depending on blood alcohol level and limb. Some researchers use standard absorption periods (SAPs) to determine when postdrinking experimental protocols should begin. Others use an idiographically determined absorption period (IDAP) based on criterion breath alcohol concentration (BrAC). We investigated and compared the characteristics of each method. Methods:, Sixty-eight social drinkers (47% women) consumed a bolus dose of alcohol intended to raise BrAC to 0.08%. BrACs were recorded every 3 minutes until beginning to descend. Minutes to reach criterion BrAC (0.06%) and between-subjects postdrinking BrAC variability were analyzed. Results:, Mean time to reach 0.06% BrAC was 22.9 ± 14.6 minutes. Standard deviations in BrAC were 4 times greater using SAPs compared to IDAPs. Ten percent of participants' BrAC readings were on the descending limb 30 minutes postdrinking, and 25% were descending at 45 minutes postdrinking. Conclusions:, IDAPs result in less BrAC variability and may reduce experimental noise relative to SAPs. Experimental control in future alcohol administration studies may be enhanced by the use of IDAPs instead of SAPs. [source]

ASTDD Annual Business Meeting Minutes

JOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 2003
Article first published online: 6 AUG 200
No abstract is available for this article. [source]

PBPK Modeling as a Basis for Achieving a Steady BrAC of 60 ± 5 mg% Within Ten Minutes

ALCOHOLISM, Issue 4 2000
S. O'Connor
No abstract is available for this article. [source]

What We Think About Donne: A History of Donne Criticism in Twenty Minutes

LITERATURE COMPASS (ELECTRONIC), Issue 4 2008
Paul A. Parrish
This paper is part of the second Literature Compass panel cluster arising from The Texas A&M John Donne Collection: A Symposium and Exhibition. [Correction added after online publication 24 October 2008: ,This paper introduces the second Literature Compass panel cluster' changed to ,This paper is part of the second Literature Compass panel cluster'.] Comprising an introduction by Gary Stringer and three of the papers presented at the symposium, this cluster seeks to examine the current state of Donne Studies and aims to provide a snapshot of the field. The symposium was held April 6,7, 2006. The cluster is made up of the following articles: ,Introduction to the Second Donne Cluster: Three Papers from The Texas A&M John Donne Collection: A Symposium and Exhibition', Gary A. Stringer, Literature Compass 5 (2008), DOI: 10.1111/j.1741-4113.2008.00551.x. ,Donne into Print: The Seventeenth-Century Collected Editions of Donne's Poetry', Ted-Larry Pebworth, Literature Compass 5 (2008), DOI: 10.1111/j.1741-4113.2008.00552.x. ,"a mixed Parenthesis": John Donne's Letters to Severall Persons of Honour', M. Thomas Hester, Literature Compass 5 (2008), DOI: 10.1111/j.1741-4113.2008.00553.x. ,What We Think About Donne: A History of Donne Criticism in Twenty Minutes', Paul A. Parrish, Literature Compass 5 (2008), DOI: 10.1111/j.1741-4113.2008.00554.x. *** The standard paradigm of critical responses to John Donne from the seventeenth century to the present is not seriously contested: during his own day Donne was reasonably well known, albeit a somewhat controversial poet. As the century progressed, Donne became increasingly out of fashion, and throughout the eighteenth century and into the nineteenth century, Donne had largely disappeared from the public and critical eye. The ,rescue' of Donne in the late nineteenth and early twentieth centuries has led to an interest that has continued largely unabated to the present, though often without the unbridled enthusiasm that characterizes some responses early in the twentieth century. In the past few decades, Donne's work has been viewed through the lenses of virtually every critical and theoretical approach one could identify. More recent efforts, particularly as exemplified by the Variorum Edition of the Poetry of John Donne, have not so much challenged the standard paradigm regarding Donne criticism as to add to our knowledge and understanding by filling in gaps and shading in historical transitions, the better to provide a more comprehensive understanding of what we have thought about Donne for more than four centuries. [source]

Minutes of the Annual ASNE Business Meeting and Joint Council Meeting , March 24, 2003

NAVAL ENGINEERS JOURNAL, Issue 3 2003
Article first published online: 29 OCT 200
First page of article [source]

Minutes of the ISPAD Annual General Assembly , Business Meeting

PEDIATRIC DIABETES, Issue 6 2006
Thomas Danne
First page of article [source]

Minutes of the Annual Membership Meeting

THE JOURNAL OF FINANCE, Issue 4 2003
Article first published online: 15 JUL 200
No abstract is available for this article. [source]

Unparalleled Rates for the Activation of Aryl Chlorides and Bromides: Coupling with Amines and Boronic Acids in Minutes at Room Temperature.

CHEMINFORM, Issue 19 2003
James P. Stambuli
Abstract For Abstract see ChemInform Abstract in Full Text. [source]

What We Think About Donne: A History of Donne Criticism in Twenty Minutes

The effect of diabetes on heart rate and other determinants of myocardial oxygen demand in acute coronary syndromes

DIABETIC MEDICINE, Issue 9 2004
K. Foo
Abstract Aims To compare major determinants of myocardial oxygen demand (heart rate, blood pressure and rate pressure product) in patients with and without diabetes admitted with acute coronary syndromes. Methods A cross-sectional study of the relation between diabetes and haemodynamic indices of myocardial oxygen demand in 2542 patients with acute coronary syndromes, of whom 1041 (41.0%) had acute myocardial infarction and 1501 (59.0%) unstable angina. Results Of the 2542 patients, 701 (27.6%) had diabetes. Major haemodynamic determinants of myocardial oxygen demand were higher in patients with than without diabetes: heart rate 80.0 ± 20.4 vs. 75.2 ± 19.2 beats/minute (P < 0.0001); systolic blood pressure 147.3 ± 30.3 vs. 143.2 ± 28.5 mmHg (P = 0.002); rate-pressure product 11533 ± 4198 vs. 10541 ± 3689 beats/minute × mmHg (P < 0.0001). Multiple regression analysis confirmed diabetes as a significant determinant of presenting heart rate [multiplicative coefficient (MC) 1.05; 95% confidence interval (CI) 1.03,1.07; P < 0.0001], rate pressure product (MC 1.09; CI 1.05,1.12; P < 0.0001) and systolic blood pressure, which was estimated to be 3.9 mmHg higher than in patients without diabetes (P = 0.003). These effects of diabetes were independent of a range of baseline variables including acute left ventricular failure and mode of presentation (unstable angina or myocardial infarction). Conclusions In acute coronary syndromes, heart rarte and other determinants of myocardial oxygen demand are higher in patients with than without diabetes, providing a potential contributory mechanism of exaggerated regional ischaemia in this high-risk group. [source]

Heart Rate Changes and ECG Abnormalities During Epileptic Seizures: Prevalence and Definition of an Objective Clinical Sign

EPILEPSIA, Issue 8 2002
Maeike Zijlmans
Summary: ,Purpose: To determine the prevalence of heart rate changes and ECG abnormalities during epileptic seizures and to determine the timing of heart rate changes compared to the first electrographic and clinical signs. To assess the risk factors for the occurrence of ECG abnormalities. Methods: We analyzed retrospectively 281 seizures in 81 patients with intractable epilepsy who had prolonged video-EEG and two-channel ECG. The nature and timing of heart rate changes compared to the electrographic and clinical seizure onset was determined. The ictal period (including one minute preictally and three minutes postictally) was analyzed for cardiac arrhythmias, conduction and repolarization abnormalities. Risk factors for cardiac abnormalities were investigated using parametric and non-parametric statistics. Results: There was an increase in heart rate of at least 10 beats/minute in 73% of seizures (93% of patients) and this occurred most often around seizure onset. In 23% of seizures (49% of patients) the rate increase preceded both the electrographic and the clinical onset. ECG abnormalities were found in 26% of seizures (44% of patients). One patient had an asystole for 30 seconds. Long seizure duration increased the occurrence of ECG abnormalities. No other risk factor was found. Conclusions: Heart rate changes occur frequently and occur around the time or even before the earliest electrographic or clinical change. The change can clarify the timing of seizure onset and the specific rate pattern may be useful for seizure diagnosis and for automatic seizure detection. ECG abnormalities occur often and repeatedly in several seizures of the same patient. [source]

ORIGINAL RESEARCH,PHARMACOTHERAPY: Hemodynamic Effects of Sildenafil Citrate and Isosorbide Mononitrate in Men with Coronary Artery Disease and Erectile Dysfunction

THE JOURNAL OF SEXUAL MEDICINE, Issue 3 2005
Graham Jackson
ABSTRACT Introduction., Mild hemodynamic effects have been reported with sildenafil citrate therapy. Aim., To compare the hemodynamic effects of sildenafil and isosorbide mononitrate (ISMN) in men with coronary artery disease and erectile dysfunction. Methods., A total of 31 men aged 35 years or older with coronary artery disease (at least 50% narrowing of the left main stem or at least 70% narrowing of any other coronary artery) and erectile dysfunction (receiving medication for erectile dysfunction or scoring less than 26 out of a maximum score of 30 on the erectile function domain questions of International Index of Erectile Function) were randomized to sildenafil 100 mg (n = 10), ISMN 40 mg (n = 11), or placebo (n = 10) in this single-dose multicenter study. Main Outcome Measures., Hemodynamic parameters were measured at baseline, 1, 2, 4, and 6 hours post dose. Results., Compared with baseline, cardiac index increased slightly with sildenafil (0.29 L/min/m2 at 1 hour) and decreased slightly with placebo (,0.12 L/min/m2 at 4 hours) and ISMN (,0.14 L/min/m2 at 1 hour). The stroke volume index increased from baseline at each time point post dose with sildenafil (4.4 mL/m2 at 2 hours), but decreased with ISMN (,5.8 mL/m2 at 1 hour) and placebo (,2.8 mL/m2 at 4 hours). ISMN reduced mean arterial pressure more than sildenafil did (,22 vs. ,10 mm Hg at 2 hours, respectively). Both sildenafil and ISMN increased heart rate (4 vs. 7 beats/minute at 1 hour, respectively) and decreased systemic vascular resistance, but sildenafil produced greater reductions in pulmonary vascular resistance. There were no serious adverse events in the sildenafil group. Conclusions., Sildenafil 100 mg was well tolerated and induced smaller changes in central and peripheral hemodynamic pressures compared with ISMN 40 mg. Moreover, sildenafil selectively reduced pulmonary resistance, which may have clinical importance in pulmonary hypertension. [source]

Derivation of a Triage Algorithm for Chest Radiography of Community-acquired Pneumonia Patients in the Emergency Department

ACADEMIC EMERGENCY MEDICINE, Issue 1 2008
Demetrios N. Kyriacou MD
Abstract Background:, Community-acquired pneumonia (CAP) accounts for 1.5 million emergency department (ED) patient visits in the United States each year. Objectives:, To derive an algorithm for the ED triage setting that facilitates rapid and accurate ordering of chest radiography (CXR) for CAP. Methods:, The authors conducted an ED-based retrospective matched case,control study using 100 radiographic confirmed CAP cases and 100 radiographic confirmed influenzalike illness (ILI) controls. Sensitivities and specificities of characteristics assessed in the triage setting were measured to discriminate CAP from ILI. The authors then used classification tree analysis to derive an algorithm that maximizes sensitivity and specificity for detecting patients with CAP in the ED triage setting. Results:, Temperature greater than 100.4°F (likelihood ratio = 4.39, 95% confidence interval [CI] = 2.04 to 9.45), heart rate greater than 110 beats/minute (likelihood ratio = 3.59, 95% CI = 1.82 to 7.10), and pulse oximetry less than 96% (likelihood ratio = 2.36, 95% CI = 1.32 to 4.20) were the strongest predictors of CAP. However, no single characteristic was adequately sensitive and specific to accurately discriminate CAP from ILI. A three-step algorithm (using optimum cut points for elevated temperature, tachycardia, and hypoxemia on room air pulse oximetry) was derived that is 70.8% sensitive (95% CI = 60.7% to 79.7%) and 79.1% specific (95% CI = 69.3% to 86.9%). Conclusions:, No single characteristic adequately discriminates CAP from ILI, but a derived clinical algorithm may detect most radiographic confirmed CAP patients in the triage setting. Prospective assessment of this algorithm will be needed to determine its effects on the care of ED patients with suspected pneumonia. [source]

Influenza A in Young Children with Suspected Respiratory Syncytial Virus Infection

ACADEMIC EMERGENCY MEDICINE, Issue 12 2003
Marla J. Friedman DO
Objectives: To determine the prevalence of influenza A in young children suspected of having respiratory syncytial virus (RSV) infection and to compare the clinical presentation of these patients with those who have proven RSV infection. Methods: Children younger than or at 36 months of age who presented to a pediatric emergency department (ED) with suspected RSV infection during the influenza A season of 2001,2002 were eligible. Eligible children had an RSV antigen test ordered as part of their initial clinical management. A consecutive sample of children was enrolled for prospective observational analysis. The main outcome measure was the prevalence of influenza A in young children with suspected RSV infection. The secondary outcome measure was a comparison of the clinical presentations, of the two groups. Results: During the study period, 420 patients presented for evaluation of respiratory illness. RSV tests were ordered on 251 patients. Of 197 eligible patients, 124 (63%) tested positive for RSV and 33 (17%) for influenza A. Influenza A patients were more likely to have temperatures at or above 39°C than RSV patients (36% vs. 15%; p = 0.01). RSV patients were more tachypneic (54 vs. 43 breaths/minute; p < 0.0001) and more often had wheezing (90% vs. 8%; p < 0.0001). Twenty influenza patients (61%) were hospitalized. Conclusions: This study found a high prevalence of influenza A in young children suspected of having RSV infection. Clinicians should consider influenza A in young febrile children presenting with respiratory illnesses. [source]