Anaphylactic reactions to a vaccine or to a vaccine constituent are an absolute contraindication to the use of that vaccine or to vaccines containing that constituent. A problem which is encountered frequently is allergy to eggs. Hypersensitivity to egg is a contraindication to influenza vaccine, and an anaphylactic reaction to egg contraindicates influenza and yellow fever vaccines. There is increasing evidence that MMR vaccine can be given safely to children even if they had previously had an anaphylactic reaction after eating food containing egg, but strict caution is advised and day admission to a hospital for the procedure is recommended.
When the asthmatic response is triggered by an external allergen such as pollen, a major part of the primary immune response consists of the release of histamine from mast cells, a process termed 'degranulation'. Histamine has a wide range of actions in tissues, but in the bronchial tissues it causes constriction of smooth muscle via the H, receptors. This action can be prevented by sodium cromoglycate, which inhibits mast cell degranulation. As a result it has a powerful prophylactic action in asthma, but is of little use for relief of an acute attack. It is valuable for the management of extrinsic asthma and exercise-induced asthma. Cromoglycate is now thought to have an additional actions such as inhibition of pulmonary sensory C-fibre discharge38 39. Anew drug in the category of anti-allergies is nedocromil sodium, which is equipotent with sodium cromoglycate40.
Allergies and anaphylaxis are potentially severe, life-threatening problems for the traveller. Allergies to egg protein and some antibiotics are contraindications to some vaccines, such as yellow fever. Severe food allergy, in a country where travellers can hardly make themselves understood, is a life-threatening condition. Carrying pictures of the ingredients or food to be avoided could help, but will not guarantee the safety of meals. In such circumstances, it is advisable to carry adrenaline (epinephrine) and a Medic-Alert bracelet or card.
Summarized briefly using our psychoanalytic concepts the memory of infantile object relations with a depressed, unempathetic, and helpless mother (who doubts whether she will be able to feed her baby, takes 3 months to find out that her baby is suffering from a severe allergy, etc.) were evoked in the transference situation. The sudden change in bodily state due to the allergic reaction was remembered by Mr. X unconsciously after the summer break. Relevant transference patterns from the traumatic early object relations and central unconscious fantasies were suddenly unfolded-a process (determined by projections and projective identifications, etc.) which the analyst did not yet consciously understand, but to which she responded by intensive countertransference feelings of insufficiency, depression, and strange psychosomatic reactions. After supervision she was able to regain interest in the psychodynamics new, analogous situation. In this sense recategorizations in later interactional...
Granulomatous inflammation may accompany fungal or mycobacterial infections of the prostate (24,60). Nonspecific granulomatous prostatitis is a rare self-limiting condition of unknown etiology that is not associated with known infectious agents. It often contains severe inflammatory infiltrates consisting of loosely formed granulomata with associated foamy macrophages, neutrophils, plasma cells, and eosinophils (24). Allergic granulomatous prostatitis is an exceedingly rare condition associated with systemic generalized allergic conditions in which the granulomas are associated with abundant eosinophils (24).
The need for and type of prophylaxis will depend on the anticipated duration and intensity of exposure to malaria, as well as the pattern of drug resistance in the areas of travel. It is necessary to ascertain whether the traveller will have ready access to competent medical care, whether there will be travel in a drug-resistant P. falciparum area (see map) and whether there are any contraindications to the use of a particular antimalarial drug. Any allergies or illnesses that may increase the risk of travel must also be taken into consideration. Individuals who have had splenectomy or who have cardiac, neurological or psychiatric conditions may present special problems. The final decision about the need for and type of chemoprophylaxis should be individualised and should take into account the risk of acquiring infection vs. the potential risks of the drugs.
As well as how it must be manufactured. Binders are used to hold the various components together, and include starches and polyvinylpyrrolidine (to which many dogs exhibit a species-specific allergy). Bulking agents (sometimes called dilutants, or, con-fusingly for a solid formulation, diluents) include lactose and cellulose, and increase tablet weight, which may improve production uniformity. Coatings are often sugar- or cellulose-based and may be employed when a drug tastes foul, or to create a particular color scheme. Silica and starch may also be used to improve the flow of powder in mass production, when it is known as a pro-glidant, and stearic acid salts are used to enable tablets to escape the press when finished, this being an unusual use of the term lubricant.
Penicillin is very safe (apart from occasional, possibly severe, allergies). It is almost without pharmacological effects in humans. But it is a prescription-only medicine almost worldwide. The conditions that are to be treated with penicillin almost always need medical attention. There would be no reliable means to limit the OTC sale of penicillin in the United States to those few indications that patients can manage for themselves.
Intravenous contrast used in CT is an iodine-based contrast similar to that used for IVPs and numerous other radiological procedures. The iodine in the contrast causes X-ray absorption so that vascular structures and organs taking up the contrast medium appear more dense during the examination. This improves the contrast resolution between vascular and non-vascular structures. Contraindications to intravenous contrast include known contrast allergy, renal impairment and diabetic patients taking Metformin. 217
Streptococcus pyogenes, group A haemolytic streptococci can invade various tissues of human skin and subcutaneous tissues, mucous membranes, blood and some deep tissues. The common clinical manifestations of streptococcal infection include streptococcal sore throat, erysipelas, scarlet fever and puerperal fever. Some strains produce an erythro-genic toxin which is responsible for the characteristic erythematous rash of scarlet fever. Rheumatic fever (see below) and acute glomerulonephritis result from allergic reactions to streptococcal infections.
Most of the infections caused by enterococci in non-immunocom-promised patients, such as UTIs, soft-tissue infections and intraabdominal abscesses, do not require therapy using a regimen with bactericidal activity. Single-drug treatment with ampicillin, penicillin or vancomycin (in case of allergy to P-lactams) is usually sufficient. Ureidopenicillins, such as piperacillin and mezlocillin, with broader spectrum might also be used, especially when mixed infection is suspected. Ticarcillin and carbenicillin are not regarded as active anti-enterococcal agents and should not be prescribed for that purpose. Fluoroquinolones and nitrofurantoin alone are only marginally active against enterococci and have been successfully used only in lower UTIs (Lefort etal., 2000). Erythromycin and rifampin have had little clinical use against enterococci, whereas tetracyclines and chloramphenicol had some use for VRE before the approval of quinupristin-dalfopristin and linezolid. Despite the fact that...
The Polish experience also demonstrated the relative safety of population-wide treatment with KI. Very mild and transient changes in thyroid function were seen in 0.37 of newborn babies, with no apparent long-term consequences. A small proportion of children and adults developed nausea and vomiting, and a few individuals developed respiratory distress due to a presumed allergic reaction to the iodine preparation.
I was in basically good health for a man of my age. My cholesterol count was under 180 blood pressure level was normal, I did not and do not have any cardiovascular problems, no allergies, no respiratory problems, etc. Like most men who were active athletically in their young adult years, I knew I was in good health and did not get a regular physical each year, as I felt I did not need a physical each year, as we all should do after age 40, and especially if there is a history of cancer or other diseases in your family history.
Personal laser lancing devices for obtaining capillary blood samples became available in 1999. Since a beam of light, rather than a lancet, penetrates the skin, sharps disposal is eliminated and pain is reduced. Skin patch systems for glucose monitoring on the forearm are also under development. Monitors that read the patch test results and can store months' worth of data, by time and date, will be paired with such patch monitoring systems. A new formulation of glucagon, based upon recombinant DNA technology, eliminates dependency on animal pancreas glands for manufacture. Generalized allergic reactions and nausea vomiting, which occurred using previ
Which have physiological relevance beyond purely nutritional properties 41 . These factors are implicated in growth and development, protective defense mechanisms, energy metabolism and immune homeostasis in multiple tissues. Despite the improvement in infant formula development, differences in response to infection and the development of allergy and atopic disease have been reported for FF and BF infants 42 . Although some of these bioactive proteins are also present in bovine milk 41 , it has generally been assumed that they do not survive the technological processing used in the manufacture of infant formulas. As such, infant formulas are considered to lack some of the protective factors which human milk inherently provides.
Drugs that are used to treat common conditions such as hypertension and allergic conditions can also influence tear film dynamics. If a patient presents with a complaint involving the tear film, it is important to rule out whether this is a side effect of other medication. Antihypertensives administered systemically (e.g. reserpine, diazoxide) stimulate tear flow whilst antihistamines reduce tear flow.
The dermis consists of two layers of fibroblasts embedded in ECM, the papillary layer next to the basal layer of the epidermis and the deeper reticular layer (Ham and Cormack, 1979). The papillary layer derives its name from the fact that it is thrown into papillae that project up into the epidermis. This layer is pervaded by a capillary network that provides nourishment to the epidermis and acts as a heat exchanger. The ECM of the papillary layer contains a network of thin collagen and elastic fibers. Mast cells, immune cells that release histamine in allergic reactions, are present in the dermis, as well as in other connective tissue compart
Barium suspension is the most frequently used contrast medium. Children above 6 months of age who are reluctant to drink barium may be encouraged by adding additional flavoring to the barium. Any commercially available chocolate syrup or instant drinking chocolate powder renders the barium more palatable without altering its radiographic characteristics. It is advisable to check for allergies and to be aware that some commercial flavoring preparations contain allergenic products.
Nasal Allergy. 2nd edition. Blackwell Scientific Publication, Oxford 1979. 36. Norman PS, Naclerio RM, Creticos PM, Togas A Lichtenstein LM, Mediator relase after allergic and physical nasal challenge. Int. Arch. Allergy Appl. Immunol. 1985 77 57-63. 64. Berg OH, Lie K, Steinsvag SK. The effects of topical nasal steroids on rat respiratory mucosa in vivo, with special reference to benzalkonium chloride. Allergy 1997 52 627632. 66. Braat JPM, Ainge G, Bowles JAK. The lack of effect of benzalkonium chloride on the cilia of the nasal mucosa in patients with perennial allergic rhinitis a combined functional, light scanning and transmission electron microscopy study. Clin. Exp. Allergy 1995 25 957-965.
Therefore, one in six (3 x 2) inserts will fuse in the correct reading frame and orientation. In addition, for shotgun cloning of genomic fragments, the size of the insert is less critical because the presence of a naturally occurring stop codon at the end of an ORF does not affect expression of the fusion as it does with the direct fusions to gene III or gene VIII. The pJuFo system has been used to fuse the expression products of a cDNA library from Aspergillus fumigatus on the surface of phages and screen for phages that bind human serum IgE to identify and clone allergenic proteins produced from A. fumigatus (Crameri et al., 1994). In addition, a phage cDNA expression library from human lymphocytes has been used to identify fl-actin as a cellular protein that binds to HIV-1 reverse transcriptase (Hottiger et al., 1995). Finally, a genomic library ofE. coli has been constructed in pJuFo and used to clone genes based on binding affinity to a target...
The ADA suggests each physician provide two documents for traveling diabetics. One is a letter listing supplies, medications, and any drug allergies. The second is a prescription for emergency use in case medications are lost. The traveler and health provider should write for a list of International Diabetes Federation groups at the IDF, 40 Washington St, B-1050, Brussels, Belgium. An identity bracelet is important for identifying the traveler as diabetic in an emergency, and the ADA affiliates have Diabetes Identity Cards available in several languages.
A wide range of possible presentations and clinical signs and symptoms may make it difficult to diagnose anaphylaxis. It is important to undertake a full history and examination as soon as possible. A history of previous allergies as well as the recent incident is vital. Special attention should be given to skin condition (colour, presence of rashes), pulse rate, blood pressure, respiratory rate and auscultation of the chest. A peak flow should also be measured and recorded if possible (Resuscitation Council UK 2002). All patients who have suffered a severe reaction should be referred to a specialist allergy clinic for further investigation and assessment.
Medications are prescribed, distributed, and consumed under the assumption that the therapeutic plan will work as intended to provide the expected outcome. It is clear from previous chapters that there are many biological system issues that will influence success of the plan. Other organizational and societal system issues also influence success of the therapeutic plan as profoundly as do the biological systems issues. A prescriber writes an order for a medication based on the best available information, the likely diagnosis, and the expected outcome. A pharmacist reviews the requested medication order (prescription), clarifies it based upon additional information about the patient or medication (allergies, drug interactions, etc.), prepares the medication for use, counsels the patient about the drug, and gives it to the patient. The patient is responsible for understanding the therapeutic objective, knowing about the drug, creating a daily compliance plan (deciding when to take the...
When I eventually saw the ENT specialist, he suggested that I was suffering from a virus and advised me to rest he thought the lump would eventually go away. When Charlie Schreiber called in a few days later he asked how I got on. I told him the advice I had been given by the specialist was to rest and casually added I don't know if that comes in tablet form or it's a liquid I remember Charlie was very quiet at first, and kept looking at the floor. Then he said, I don't like to say this kind of thing Mrs P, but I feel you should seek a second opinion. It so happened I already had an appointment with Professor Newman-Taylor in London at the Royal Brompton Hospital in December to discuss a long-standing allergy problem. He said he
Biolistically with marker genes is capable of transient expression of these genes after storage for 6 weeks in honey. The quantities of pollen likely to be ingested with honey are so low that they pose allergenic rather than toxic risks to humans. However the risks may be greater for people consuming quantities of pollen, especially if it has been collected exclusively from transgenic crop plants.
Medication ordering or execution represented 61 of the serious errors. Slips and lapses rather than rule-based or knowledge errors were most common. Lesar et al. (22) describe the results of a review of 2103 clinically significant medication errors in an academic medical center. It was determined that 0.4 of medication orders were in error 42 of the errors were overdosage, and 13 were the result of drug allergies that were not accounted for prior to prescribing. This work showed that medication errors result most frequently from failure to alter dose or drug after changes in renal or hepatic status, missed allergies, wrong drug name, wrong dosage form (e.g., IV for IM), use of abbreviations, or incorrect calculation of a drug dose. They concluded that an improved organizational focus on technological risk management and training should reduce errors and patient risk of ADEs.
As far back as the 19th century, Hillier (1865), in working with eczema, implicated mental excitement, nervous debility and anxiety as the cause of these skin diseases. In 1982, Teshima and colleagues found that emotional stress had the capacity to influence the immune system to a great extent and that this would often manifest in cutaneous illness. They found that the tension in patients could lead to an enhancement of allergic reactions and these allergic patients were shown to improve with relaxation and autogenic training. There were also speculative implications for skin disease with the finding that the function of T-cells and the phagocytosis of macrophages were suppressed by induced stress. Furthermore, evidence of the strong relationship between the skin and the central nervous system (CNS) has been demonstrated by Ortonne and colleagues (1983) who noted that innervation of the CNS often produced blushing, perspiration and pallor.
Characteristics of immunemediated responses do have common features which can be considered together
Thus, foreign proteins such as those associated with bee stings, pollen grains or present in rat urine are potential antigens and are examples of substances known to cause allergies by immune mechanisms. Clearly, however, many foreign compounds which are known to induce immune responses, are too small to be antigens. Such compounds, known as haptens, must be covalently linked to a larger carrier molecule in order to stimulate an immune response. Reversible binding to proteins such as plasma proteins is not sufficient to stimulate an immune response. Therefore small, foreign molecules which act as haptens are often chemically reactive and so are able to react with proteins or other macromolecules. The hapten may be the foreign compound to which the animal is exposed, or it may be a reactive metabolite. Although several different antigens might be produced, possibly only one with a particular tertiary structure or number of haptens (epitopes) attached to the carrier molecule, will...
Malaria prophylaxis needs to be optimal, and standby treatment should be available in case of an unexpected breakthrough. Travel to multiresistant malaria fal-ciparum areas without adequate medical facilities should be discouraged. Antimosquito measures are self-evident. In case of fever with or without signs of respiratory tract infection, penicillin treatment (or a macrolide in the case of penicillin allergy) should be started promptly. A thick blood film to exclude malaria should be done without delay at the same time. After bites by dogs or cats immediate prophylactic antibiotic treatment must be initiated, with co-amoxiclav (7 days) or, in case of penicillin allergy, clindamycin (300 mg thrice daily for 7 days).
Additionally, a number of non-thyroidal side effects of iodine have to be mentioned. These may be gastrointestinal (stomach pain, nausea, vomiting, and diarrhea), allergy related (angioedema, arthralgia, eosinophilia, lym-phadenopathy, urticaria), or skin rashes. However, such non-thyroidal side effects are very rare. Extremely rare disorders reported to be caused by excess iodine ingestion include dermatitis herpetiformis (Duhring's disease), iodo-derma tuberosum, and hypocomplementemic vasculitis and myotonia congenita 1 .
Charpin D, Birnbaum J, Haddi H, Genard G, Lanteaume A, Toumi M, Farai F, Van der Brembt X, Vervolet D. (1991). Altitude and allergy to house dust mite. Am. Rev. Respir. Dis. 143 983-986. 60. Wardlaw AJ. (1993). The role of air pollution in asthma. Clin Exp Allergy 23 81-96.
Diabetic patients should be prepared for travel like most other travellers. They can be given all the vaccines indicated. Special attention should be taken to ensure that influenza and pneumococcal immunisations are up to date. Hepatitis B vaccination is strongly recommended as diabetics are at greatest risk of receiving health care and injections abroad. They should carry their own needles, even if they are not taking insulin. For all travellers carrying needles and syringes, a letter on official stationary and signed by the attending physician, should be provided. An example of such letter is shown in Figure 3.1. A Medic-Alert bracelet (engraved with the wearer's allergies or other medical conditions) is also recommended. Malaria prophylaxis should be used when recommended.
Side-effects include oesophagitis, gastritis, vaginal candidiasis and photosensitivity (which may be severe). Allergic reactions, oesophageal ulceration, hepatic and renal toxicity, and blood dyscrasias are rare. It is contraindicated in pregnant and lactating women and in children younger than 8 years, as it may result in bone deposition and discoloration of the teeth. It should be taken with food or liquid to decrease the likelihood of gastrointestinal disturbances. It is believed that doxycycline can be used for prolonged periods at a dose of 100mg day, although safety has yet to be established. It is reassuring that doxycycline has apparently been
P.G.R. and A.C. are supported in part by grants from FIRB 2001 (grant no. RBNE01KJHT), by the European Community, contract no. 12793, project Allergy Card and by Fondazione Cariplo (Milan). We thank J. Rappsilber, L. Sennels, D. Cecconi and A. Castagna for their valuable help in urine and sera analyses and L. Guerrier and F. Fortis for providing data on protein-depletion methods.
The absorptive capacity of the nasal mucosa has been known for centuries. Even if unexploited by pharmaceutical scientists, the abuse of cocaine (including by primitive peoples), and nicotine (snuff) has routinely used this route of administration for systemic delivery. Vast annual tonnages of anti-allergy and decongestant drugs are now administered to the noses of the developed world. These are intended to treat local symptoms, and avoidance of systemic absorption is a favourable feature. a-Adrenergic agonists, antihistamines, and steroids probably lead the list for this topical route of administration.
Dextran19 of low molecular weight (40.000 MW) in 10 solution has been used in microsurgery as a pharmacologic adjunct because it is a volume expander, increases blood flow, interferes with platelet attachment to vessel wall and it has antifibrin function. It may be dangerous however, because of allergic reactions and tissue edema, including cerebral and pulmonary edema.
Identical or very similar strains of the influenza virus circulate in the different hemispheres, and travellers at high risk should be vaccinated with the current strain specific vaccine for that year. Although different strains of the influenza virus may circulate in tropical countries, the same advice applies to travellers as mentioned previously. Influenza vaccines are administered intramuscularly and are licensed for use for paediatrics and adults. Children under the age of 13 years should receive two doses of vaccine administered 4-6 weeks apart for the primary course. Adults require a single dose as the primary course and, as with children, a booster dose is administered annually. Influenza vaccine is a well-tolerated vaccine, occasionally associated with fever and general malaise which resolves within 48 h. Use of the vaccine is contrain-dicated in those with a severe egg allergy. It may also be advisable for travellers at high risk of the complications of influenza infection...
Yellow fever vaccine, a live attenuated vaccine, is administered subcutaneously as a single 0.5 ml dose for children aged 9 months and over and adults. The risk of encephalitis following administration of yellow fever vaccine is greatest for those under 4 months old if absolutely necessary, infants aged 4-9 months old who may be exposed to a high risk of infection can be vaccinated. Although a highly immunogenic vaccine which probably confers life-long immunity, a booster dose is required every 10 years for those at continued risk of exposure. As a live vaccine, its use is contraindicated in the im-munosupressed, pregnancy and for those with a serious egg allergy or hypersensitivity to polymyxin and neo-mycin. It may be administered simultaneously with human normal immunoglobulin and the same guidance applies to the administration with other live vaccines.
Expression of the Brazil nut albumins has resulted in significant increases in the methionine content of seeds of oilseed rape, tobacco (by up to 30 ) (50,51), Arabidopsis (by 20 ) (52), narbon bean (Vicia narbonen-sis) (by up to threefold) (53), and soybean (R. Jung, personal communication). However, it is now known that the Brazil nut protein is allergenic to humans (54,55) and the commercial development of seeds expressing this protein has therefore been suspended. Although a number of other (i.e., methionine-poor) 2S albumins are also allergenic (e.g., from mustards, castor bean, cotton), there is no evidence that this applies to the methionine-rich albumin (SFA8) of sunflower, which contains 16 Met out of 103 total residues (but see note added in proof). Molvig et al. (56) reported that the expression of this protein in seeds of lupin resulted in an increase in methionine by 94 , although there was no effect on total seed sulfur, the increase being at the expense of cysteine...
Patients for laser resurfacing should be carefully selected and understand the aims and limitations of laser treatment. A thorough history with particular emphasis upon the use of topical skin preparations, allergies and sensitivities and previous herpetic infections is taken. Fair skinned patients (Fitzpatrick grades 1 and 2) are ideal for resurfacing whereas darker skinned individuals (Fitzpatrick grades 3 and 4) run a risk of post laser hyperpigmentation and should be approached cautiously. Laser resurfacing is contra-indicated in patients with deeply pigmented skin (Fitzpatrick grades 5 and 6). Pre-operative photographs with detailed diagrams and sketches are mandatory.
Besides providing milk that is more easily digested by vulnerable preterm infants, breastfeeding facilitates attachment by ensuring that the mother has a primary role in her baby's recovery (Kavanaugh et al., 1997 Meier, 2001). Preterm infants fed breast milk have lower risks of infection and NEC, learn to nipple feed better, have higher cognitive scores, and may have a lower risk of chronic gastrointestinal diseases and allergies (AAP, 2006 Mizuno et al., 2002 Mortensen et al., 2002). Women who breast-feed have less postpartum blood loss, enhanced bone mineralization, and a reduced risk of ovarian and breast cancer (AAP, 2006).
Immunotoxicity involves either the effect of a chemical on the immune system (immunosuppression) or stimulation of the immune system which leads to the toxic response (allergy). Immunosuppression may be caused by a variety of chemicals which damage or interfere with lymphoid organs such as thymus or bone marrow. The stimulation of the immune system leading to allergy requires either a larger molecule or the addition of the chemical (hapten) to a larger molecule such as a protein (hapten hypothesis). The resulting antigen must then be recognized as 'non-self' by the immune system in order for there to be a response. The response does not necessarily depend on the nature of the hapten and may involve more tissues than the site of exposure.
Despite good parental intentions and efforts, injuries happen and health problems occur. Families should consider traveling with a medical kit to allow prompt response to health problems incurred during their trip. A medical kit could include important health information about the child (name, birth date, weight, medical allergies, immunization history, doses of current medications, and blood type) as well as medicines and supplies. Routine first-aid supplies (bandages, tape, gauze, splints, disinfecting solutions) could be part of a traveling medical kit. Usual medications would be carried, often with two separate supplies in case the traveler is separated from part of the luggage during the trip. Antibacterial skin ointment, steroid creams, antihistamines, analgesics, and antipyretics could also be useful. Families should know the size-appropriate dosing for common medications (acetaminophen paracetamol 10-15mgkg-1 per dose every 4h, ibuprofen 10mgkg i per dose every 6h as needed)....
Because of the importance of drug interactions (see Chapter 15), a detailed medication history should be recorded that identifies all prescription, nonpre-scription, and alternative or complementary medications used by the patient. In addition to medication dosage, other factors that may contribute to the development of adverse reactions include medication administration route, method, site, schedule, rate, and duration. A history of allergies, intolerances, and other medication reactions should be fully investigated. The potential for cross-allergenicity or cross-reactivity should not be overlooked. The possibility of drug-induced laboratory test interference (analytical or physiological) and drug-drug or drug-nutrient interactions should also be explored.
Typically, serum chemistries and renal, hepatic, hematologic, electrolyte, and mineral panels are included. A complete medical history (including a review of all body systems) and physical examination and a complete medication history (including allergies and intolerances) should be included. Use of prescription, nonprescription, and alternative and complementary medications by study participants should be specifically documented.
A summary of any significant past medical problems, including known allergies, should be carried by the traveler. A recent electrocardiogram for those with cardiac disease is advisable, especially recordings with and without pacing for travelers who have pacemakers. The make, model, and lot number of implanted devices (e.g. pacemakers, defibrillators, and prosthetic cardiac valves or joints) and date of insertion should be recorded. Copies of other significant and relevant laboratory results should also be carried. For serious medical conditions, especially those that may result in an altered level of consciousness, a medical bracelet can allow rapid identification of these problems and could be life saving.
For the time being, lymphangioscintigraphy and conventional oil contrast lymphography are the most suitable investigations of lymphatic and chylous edemas. Lymphangioscintigraphy1 is the most popular method used for the screening of lymphedemas. Since it is a noninvasive method, it can be easily repeated in the patient follow-up, especially after microsurgery. A small tracer dose (Tc99m) adsorbed in colloid spherules (colloid sulphide, rhenium, dextran) is injected in the dermis-hypodermis, in the interdigital spaces. The lymphotropic nature of these substances permits display of the preferential lymphatic pathways with a gamma-camera and allows measurement of the flow rate and lymph node uptake. A tracer clearance measurement is a very useful parameter from a lymphodynamic point of view. Direct lymphangiography is better indicated in the study of gravitational reflux lymphatic and chylous edema of the lower limb and external genitalia when requiring a surgical treatment. In this...
Left-sided native valve S. aureus endocarditis requires 4 weeks of parenteral antibiotic therapy. MSSA infection is treated with a P-lactamase-resistant penicillin such as flucloxacillin. Vancomycin is the treatment of choice for patients with MRSA native valve endocarditis or for those with an anaphylactic penicillin allergy, although this is associated with a higher rate of treatment failure (Small and Chambers 1990 Levine, Fromm and Reddy 1991). Evidence for the benefit of combination therapy with gentamicin is limited. One study demonstrated that patients receiving nafcillin plus gentamicin had a more rapid rate of bacteraemia clearance, a higher rate of nephrotoxicity but no difference in mortality compared with those treated with nafcillin alone (Korzeniowski and Sande 1982). Gentamicin is currently added for the first 3-5 or 7 days (the duration of gentamicin differing between US and UK guidelines, respectively). The benefit of adding rifampicin to a penicillinase-resistant...
Preoperative, routine computed tomography (CT) scan evaluation is useful in determining the presence of ascites, varices, and other signs of portal hypertension, liver volume, and focal or diffuse lesions. CT arterial portography has aided in detecting liver neoplasms, especially metastases. However, its usefulness in liver transplantation has been limited due to altered hepatic hemodynamics secondary to cirrhosis, and it requires placement of a selective catheter in the splenic or superior mesenteric arteries. Three-dimensional, helical CT angiography (CTA) is a noninvasive technique that is useful to evaluate the normal and variant arterial supply of the liver. The need for intravenous (IV) conventional radiographic contrast may limit the use of CT scan techniques in patients with renal insufficiency or contrast allergies. Visceral angiography is usually reserved as a problem-solving tool in pre-transplant liver evaluation. It is useful in delineating the arterial anatomy, and...
Penicillin and its derivatives are very widely used antibiotics which cause more allergic reactions than any other class of drug. The incidence of allergic reactions to such drugs occurs in 1-10 of recipients. All four types of hypersensitivity reaction have been observed with penicillin. Thus high doses may cause haemolytic anaemia and immune complex disease, cell-mediated immunity may give rise to skin rashes and eruptions, and the most common reactions are urticaria, skin eruptions and arthralgia. Antipenicillin IgE antibodies have been detected consistent with an anaphylactic reaction. The anaphylactic reactions (Type 1 see Chapter 6) which occur in 0.004-0.015 of patients may be life threatening. Pencillin is a reactive molecule both in vitro and in vivo where it undergoes a slow transformation to a variety of products. Some of these products are more reactive than the parent drug and can bind covalently to protein, reacting with nucleophilic amino, hydroxyl, mercapto and...
This exciting study was followed by several other recent studies which examined both in vitro and clinical effects of PC-SPES. At UCSF,62 33 patients with androgen-dependent prostate cancer (ADPCa) and 37 patients with androgen-independent prostate cancer (AIPCa) were treated with PC-SPES (nine capsules daily). All ADPCa patients experienced a PSA decline of 80 , with a median duration of 57+ weeks. No patient developed PSA progression. Almost all of these patients had declines of testosterone to the anorchid range. Nineteen (54 ) of 35 AIPCa patients had a PSA decline of 50 , a commonly used surrogate index for a robust response in these clinical situations.62 Median time to PSA progression was 4 months. Of 25 patients with positive bone scans, two had improvement, seven had stable disease, 11 had progressive disease and five did not have a repeat bone scan because of PSA progression. Severe toxicities included thrombo-embolic events and allergic reactions. Other frequent toxicities...
Schistosomiasis is the most common cause of eosinophilia in travellers from Africa seen in our clinic or in London. The next most common systemic cause is filarial infections. Onchocerciasis is still a major problem in West Africa, the Yemen and in Central and South America (Chapter 8). Patients are often asymptomatic or present years after exposure with itchy skin. Occasionally nodules containing adult worms can be found, and fun-doscopy should always be performed to detect choroidoretinitis, which leads to blindness. Diagnosis is usually confirmed by examining skin snips for motile larvae. Treatment with diethylcarbamazine (DEC) is invariably followed by an allergic reaction (the Mazzotti reaction) which can be severe enough to cause hypoten-sive collapse in heavily infected patients. It can be used to confirm the diagnosis in skin-snip negative patients by giving a small dose of DEC. This reaction is much less common following the current treatment of choice which
Pentamidine is another alternative that has been widely used. It is effective but quite toxic (Thakur et al., 1991). It can result in hypotension if infused too rapidly. It is also associated with bone marrow suppression, nausea, vomiting, reversible azotemia and damage to pancreatic B cells, resulting in the release of insulin and life-threatening hypoglycemia. Those affected may later develop insulin-dependent diabetes mellitus, a potential fatal complication for someone living in an area without electricity, refrigeration or access to insulin. Less frequent side-effects are acute pancreatitis, rash and allergic reactions, including anaphylaxis.
In this definition, achievable simply requires the objective to be possible. It excludes (a) unpredictable and undetectable errors, (b) unpredictable idiosyncratic circumstances such as allergic reactions that develop so suddenly that they could not be interrupted, and (c) uncorrectable random interference, such as, for example, a treatment that does not succeed because a patient was injured by an agency entirely outside of the medications use process (e.g., an accident unrelated to medications use). (1) Drug toxicity where levels could have been checked or were available but ignored (2) use of CI drugs (3) failure to detect adverse effects that were present long before admission excluded immunologic or idiosyncratic reactions predictable but unavoidable side effects, e.g., chemotherapy-induced neutropenia rapidly developing effects Inappropriate prescribing (as defined) (1) Patient did not take a drug known to reduce prevent symptoms according to prescribed directions (2) patient had...
The last order of the eurosid II clade is Sapindales (nine families), which are nearly all woody species, whereas Brassicales and to a lesser degree Malvales have many herbaceous species. The largest family of the order is that of the maple and litchi (Sapindaceae), which is a largely tropical group the well-known north temperate maples and horse chestnuts (buckeyes) are two exceptions to this distribution. Another important family of tropical forest trees is the mahogany family (Meliaceae), from which also comes an important insecticide, neem. The citrus or rue family (Rutaceae) is also an important woody group, but there are some herbaceous species, such as rue itself, which is a temperate genus. Grapefruit, lemons, limes and oranges, as well as a number of minor fruits, are important commercially. The poison ivy and cashew family (Anacardiaceae) is another largely tropical group the family is well known for its highly allergenic oils, which cause severe and sometimes fatal...
Eosinophils also increase in number during allergic reactions in which there is stimulation of IgE production, but their function in allergic hypersensitivity is not clear. Like neutrophils, eosinophils can exit through blood vessel walls into the tissues. Fig. 8-8. The structure and function of the major antibody groups, or isotypes. A mnemonic for the various isotypes is GAMED immunoglobulins G, A, M, E, and D, or IgG, IgA, IgM, IgE, and IgD. The particular isotype is determined by the constant, Fc (Fraction c ) portion. IgG is the main, classic immunoglobulin. IgA is the main antibody in secretions and plays a significant role in first-line defense at the mucosal level. IgM is the main antibody in the initial primary immune response and shows good complement activation in view of its large ( Magnum ) size, consisting of five IgG-like subunits. IgE is found in allergy and worm infestation. Its Fc region binds to eosinophils, basophils and mast...
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