Dyspepsia in pregnancy.

Dyspepsia with or without nausea is common during pregnancy. Known ulcer disease, gastritis, and GERD may improve during pregnancy. Many women have a stoic and long-suffering posture during pregnancy owing to an unrealistic expectation concerning the teratogenicity of commonly used drugs. It is appropriate in medicine to alleviate pain and suffering when possible, and many drugs can be used safely and effectively to control upper gastrointestinal tract symptoms. When symptoms are persistent into the late second trimester, refractory to pharmacologic treatment, or severe, H. pylori infection, complications of ulcer disease, and underlying cancer should be suspected and sequentially ruled out. More timely treatment and work-up of nonobstetric disease during pregnancy is expected to lower perinatal complications.

Foreign body ingestions in the Emergency Department: case reports and review of treatment.

We report a series of alleged ingestions of razor blades and other metal objects by prisoners presenting to an inner city Emergency Department. Fourteen claims of ingestions of razor blades or other metal objects involving eight prisoners occurred in a 5-week period. The motives behind the ingestions varied. Auditory hallucination was the most common reason given for the ingestions. Other motives included efforts to leave prison, depression, and accidental razor blade swallowing. Attempts were made in all patients to verify ingestions by radiograph. Some ingestions could not be confirmed by radiograph and were considered to be factitious. Only 1 of the 14 incidents resulted in hospital admission. All others were either treated in the Emergency Department or the patient was returned to jail with no treatment. No patient had a poor clinical outcome as a result of the ingestion, indicating that diagnostic radiographs and invasive procedures may not always be necessary. A review of treatment of foreign body ingestions is given as well as a summary of the treatment and outcome of these cases.

Impact of antiseizure medication level on the incidence of sudden unexplained death from epilepsy in patients from an inner city emergency department.

Sudden unexplained death from seizures (SUDS) accounts for death in approximately 10% of the epileptic population. SUDS usually occurs in young males with a history of seizure disorders who are in otherwise good health. No definitive anatomical lesions are found at autopsy that explain death. There is however, a correlation between SUDS and subtherapeutic levels of antiseizure medications. The purpose of this study was to retrospectively review and compare drug levels from a seizure patient that presented to an inner city emergency department to those from the medical examiners office. This study was prompted by a wrongful death claim for substandard care in a known seizure disorder patient. The claim alleged that the death was directly attributed to subtherapeutic seizure medication levels. We report the results from 150 seizure patients that presented to the emergency department with a chief complaint of a recent seizure and of 163 patients that were examined post mortem. 58% of the emergency department patients who were taking phenytoin, 79% taking carbamazapine and 82% of the patients taking phenobarbital had subtherapeutic levels. No patient in this population died and only 13% required hospital admission. These levels were comparable to the post mortem population.

Effect of deferoxamine on late deaths following CPR in rats.

The iron-chelating agent deferoxamine was studied in an animal model as postresuscitation therapy to prevent late deaths and brain damage following total circulatory arrest and resuscitation. Cardiorespiratory arrest was induced by injection of cold, 1% KCl into the left ventricles of ketamine-anesthetized rats pretreated with succinylcholine, and by discontinuation of positive pressure ventilation. CPR was begun after six minutes, and animals with return of spontaneous circulation were entered into the study. Within five minutes after return of spontaneous circulation, treated animals received deferoxamine (50 mg/kg, IV). At ten days, 16 of 25 (64%) of treated animals had survived without neurologic deficit, compared to nine of 25 (36%) of controls (chi square = 3.92, P less than .05). Chelation of intracellular iron by deferoxamine may have prevented free-radical-mediated reactions that led to late deaths in control animals.