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1.
BMJ Mil Health ; 168(5): 359-361, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32753538

RESUMO

INTRODUCTION: Ketamine is a vital component for acute pain management in emergency trauma care for both civilian and military hospitals. This preliminary analysis examined whether combat-injured US service members sustaining traumatic brain injuries (TBI) experienced increased odds of ketamine side effects compared with those without TBI. METHODS: This preliminary analysis included combat-injured service members, ages ≥18 years with documented pain scores during the 24 hours before and 48 hours after receiving an intravenous ketamine infusion at Walter Reed National Military Medical Center (WRNMMC) between 2007 and 2014. Logistic regression modeling examined the association between TBI and ketamine side effects (eg, hallucinations, nightmares, dysphoria, nausea, decreased oxygen saturation) during hospitalisation. RESULTS: Of the 77 patients, 62% presented with a documented TBI. Side effects were documented for 18.8% of those without TBI and 24.4% of those with TBI. Analyses were unable to find evidence against the null hypothesis with the current sample size, even when adjusting for injury characteristics and preinfusion opioid doses (adjusted OR=0.90 (95% CI 0.26 to 3.34), p=0.87). CONCLUSION: In this small sample of combat-injured service members, we were unable to detect a difference in ketamine-related side effects by documented TBI status. These hypothesis-generating findings support the need for future studies to examine the use of intravenous ketamine infusions for pain management, and subsequent care outcomes in patients who experience polytraumatic trauma inclusive of TBI.


Assuntos
Lesões Encefálicas Traumáticas , Ketamina , Militares , Adolescente , Analgésicos Opioides , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/tratamento farmacológico , Hospitais Militares , Humanos , Ketamina/efeitos adversos , Estados Unidos
2.
ACR Open Rheumatol ; 1(7): 403-411, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31777820

RESUMO

OBJECTIVE: Interstitial lung disease (ILD) is a frequent complication of systemic sclerosis (SSc) (scleroderma) and the leading cause of scleroderma-related deaths. There exists an unmet need for a new drug therapy for ILD-complicated SSc. Substantial evidence supports an important role for thrombin in the pathogenesis of SSc-associated ILD (hereafter SSc-ILD), and targeting thrombin with a direct thrombin inhibitor could prove to be a novel and effective treatment strategy. As a first step toward designing a clinical trial to test the efficacy of thrombin inhibition in SSc-ILD, we conducted this study to test the safety and tolerability of dabigatran in patients with SSc-ILD. METHODS: We performed a prospective, single-center, open-label treatment trial with the direct thrombin inhibitor, dabigatran, in patients with SSc-ILD. Any patient with a history of gastrointestinal hemorrhage or gastric antral vascular ectasia was excluded. Blood monitoring was performed monthly, and patient-reported outcomes, pulmonary function tests, and skin scores were obtained at baseline and at 3- and 6-month visits. Bronchoscopy with bronchoalveolar lavage (BAL) was performed at baseline and at 6 months for measurement of lung thrombin activity. RESULTS: Of 15 patients with SSc-ILD, 14 completed 6 months of treatment with dabigatran at 75 mg taken orally twice daily. Adverse events were uncommon and usually mild or unrelated to the study medication. No serious adverse event was observed. Dabigatran was well tolerated, and we observed no significant gastrointestinal, pulmonary, or other safety issues or intolerability. BAL fluid thrombin activity decreased or remained stable in 13 of 14 (92.8%) subjects. CONCLUSION: Dabigatran appears to be safe and well tolerated in patients with SSc-ILD. A larger randomized controlled trial to test the efficacy of direct thrombin inhibition with dabigatran can be considered.

3.
Sarcoidosis Vasc Diffuse Lung Dis ; 28(2): 139-45, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22117505

RESUMO

BACKGROUND: Sarcoidosis associated pulmonary hypertension (SAPH) is associated with significant morbidity and mortality. There is a paucity of information concerning therapy for this condition. METHODS: We performed a prospective, open-label, proof of concept trial of ambrisentan for SAPH. 21 subjects with SAPH received 5 mg/day of ambrisentan for 4 weeks and then 10/mg day for 20 subsequent weeks. RESULTS: No significant change was noted in the 6-minute walk distance over the course of the study (mean change between week 0 and 24: 9.8 +/- 54.6 meters, p: NS). There were also no significant differences between weeks 0 and 24 in terms of dyspnea as measured by the modified Borg scale, serum brain naturetic peptide, diffusing capacity, and quality of life as measured by the Short Form-36. There was a high dropout rate: overall: 11/21, 52%; social reasons: 3/21, 14%; medical reasons: 8/21, 38% because of dyspnea: 6/21, 29% and/or edema: 4/21, 19%. Of those who completed the 24 week study (10/21, 48%), there was an improvement in their WHO functional class and a marked improvement in their health related quality of life as measured by the St. George Respiratory questionnaire (-15.3 +/- 25.0). However both these improvments did not reach statistical significance possibly because of the small sample size. CONCLUSION: Although ambrisentan was not well tolerated by many of these subjects with SAPH, in those who remained in this 24-week trial, improvements in WHO functional class and in health related quality of life suggested a possible benefit of this drug in selected patients.


Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão Pulmonar/tratamento farmacológico , Fenilpropionatos/uso terapêutico , Piridazinas/uso terapêutico , Sarcoidose/complicações , Adulto , Anti-Hipertensivos/efeitos adversos , Teste de Esforço , Tolerância ao Exercício/efeitos dos fármacos , Feminino , Humanos , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/fisiopatologia , Pulmão/efeitos dos fármacos , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , North Carolina , Fenilpropionatos/efeitos adversos , Estudos Prospectivos , Piridazinas/efeitos adversos , Qualidade de Vida , Recuperação de Função Fisiológica , Testes de Função Respiratória , South Carolina , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento
4.
Sarcoidosis Vasc Diffuse Lung Dis ; 26(2): 110-20, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20560291

RESUMO

RATIONALE: Patients with sarcoidosis associated pulmonary hypertension (SAPH) have responded to systemic prostacyclin therapy. OBJECTIVES: To determine the rate of response to inhaled prostacyclin, iloprost, in SAPH. METHODS: Sarcoidosis patients with pulmonary hypertension and no evidence for left ventricular dysfunction were enrolled in an open label, prospective study. Patients underwent right heart catheterization and six minute walk (6MW) test. Quality of life was evaluated using several instruments, including the Saint George Respiratory Questionnaire (SGRQ). Patients received 5 mcg of inhaled iloprost every 2-3 hours while awake. After four months of therapy, patients underwent repeat cardiac catheterization, 6 MW test, and completed quality of life questionnaires. MEASUREMENTS AND MAIN RESULTS: Of the 22 patients enrolled, 15 completed all 16 weeks of therapy. The most common reasons for study discontinuation included drug associated cough (3 patients) and compliance with the prescribed number of treatments per day (2 patients). Six patients experienced a 20% or greater decrease in pulmonary vascular resistance (PVR) from baseline with five of these six patients also showing > or = 5 mm Hg reduction in PA mean. Although three patients improved the 6MW distance by at least 30 meters, only one had a decrease in PVR. At 16 weeks a significant decrease was reported in the SGRQ activity score (p = 0.0273), with seven patients having a 4 point or greater decrease. CONCLUSION: Inhaled iloprost as monotherapy was associated with an improvement in pulmonary hemodynamics and quality of life as assessed by the SGRQ activity score in some sarcoidosis patients with SAPH.


Assuntos
Hipertensão Pulmonar/induzido quimicamente , Iloprosta/efeitos adversos , Pressão Propulsora Pulmonar/efeitos dos fármacos , Sarcoidose Pulmonar/tratamento farmacológico , Vasodilatadores/efeitos adversos , Administração por Inalação , Adulto , Idoso , Feminino , Seguimentos , Humanos , Hipertensão Pulmonar/fisiopatologia , Iloprosta/administração & dosagem , Masculino , Pessoa de Meia-Idade , Prognóstico , Qualidade de Vida , Sarcoidose Pulmonar/fisiopatologia , Inquéritos e Questionários , Vasodilatadores/administração & dosagem
5.
Thorax ; 60(6): 521-3, 2005 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15923255

RESUMO

The symptoms of extra-oesophageal gastro-oesophageal reflux disease (GORD) (such as chronic cough and hoarseness) are traditionally more difficult to treat than typical GORD symptoms (heartburn and regurgitation). Patients with extra-oesophageal manifestations may require longer and higher doses of acid suppressive therapy. In patients not responding to acid suppressive therapy the physician faces a dilemma as to whether the symptoms are due to ongoing acid reflux, non-acid reflux, or not associated with reflux. We report the case of a 45 year old woman with a history of a chronic cough referred for fundoplication after documenting her symptoms were associated with non-acid reflux using multichannel intraluminal impedance and pH (MII-pH).


Assuntos
Tosse/terapia , Fundoplicatura/métodos , Refluxo Gastroesofágico/terapia , Doença Crônica , Tosse/etiologia , Impedância Elétrica , Feminino , Refluxo Gastroesofágico/complicações , Humanos , Concentração de Íons de Hidrogênio , Pessoa de Meia-Idade
8.
South Med J ; 90(9): 911-4, 1997 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-9305302

RESUMO

BACKGROUND: Chest pain (CP), its cause unknown, is a common and often prominent symptom of sarcoidosis. METHODS: We determined the frequency and character of CP in patients with pulmonary sarcoidosis and examined its relationship with (1) length of time since diagnosis, (2) roentgenograhic stage, and (3) radiographic abnormalities on spiral chest computed tomography (CT). RESULTS: Twenty-two patients were studied: 14 of 22 patients (64%) had CP, with 4 of 14 (29%) identifying pain as their primary symptom. Eleven of 14 (79%) had pleuritic CP; 12 of 22 (54.5%) described CP as substernal; and 5 of 22 (22.7%) described CP between the scapula. There was not a significant correlation between CP and the presence or degree of lymphadenopathy. There was no significant correlation between CP and the presence or location of pleural disease. Abnormalities of other thoracic structures also had no significant correlation with the presence of CP. CONCLUSIONS: We conclude that there is no "anatomic reason" for CP in patients with pulmonary sarcoidosis that is evident on chest CT.


Assuntos
Dor no Peito/etiologia , Pneumopatias/patologia , Sarcoidose/patologia , Adulto , Tosse/etiologia , Dispneia/etiologia , Feminino , Humanos , Pneumopatias/complicações , Pneumopatias/diagnóstico por imagem , Doenças Linfáticas/diagnóstico por imagem , Doenças Linfáticas/patologia , Masculino , Pessoa de Meia-Idade , Doenças Pleurais/diagnóstico por imagem , Doenças Pleurais/patologia , Pleurisia/etiologia , Intensificação de Imagem Radiográfica , Sarcoidose/complicações , Sarcoidose/diagnóstico por imagem , Escápula , Esterno , Fatores de Tempo , Tomografia Computadorizada por Raios X
10.
Acta Cytol ; 37(1): 3-9, 1993.
Artigo em Inglês | MEDLINE | ID: mdl-7679536

RESUMO

Collagenous spherulosis (CS) is a benign breast lesion usually seen in association with other benign proliferative processes in the breast. To the best of our knowledge, this is the second fine needle aspiration (FNA) cytologic report of CS and the first with corresponding immunocytochemical and ultrastructural studies performed on the subsequent biopsy material. Cytologically, the aspirate consisted of scattered, metachromatically staining hyaline globules seen best with Diff-Quik stain in intimate association with numerous groups of benign ductal cells some of which had a papillary configuration. The globules exhibited periodic acid-Schiff positivity. A subsequent excisional biopsy confirmed the cytologic impression and revealed a multifocal process of ductal papillomas and papillomatosis containing numerous eosinophilic spherules with morphologic features and histochemical staining reactions typical of CS. Electron microscopic and immunoperoxidase studies suggest the spherules to be composed predominantly of basement membrane proteins, specifically type IV collagen, laminin and fibronectin, and to be derived principally from myoepithelial cells. Although CS has been found primarily in benign breast lesions, it can be found in other organs and in association with both benign and malignant processes. The differential diagnosis of other breast lesions that can be confused with CS on FNA biopsy is presented.


Assuntos
Mama/patologia , Colágeno/análise , Adulto , Biópsia , Mama/cirurgia , Mama/ultraestrutura , Feminino , Fibronectinas/análise , Humanos , Imuno-Histoquímica , Queratinas/análise , Laminina/análise , Proteínas S100/análise
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