By I. Samuel. Fuller Theological Seminary.
The symptoms include postprandial nausea and vomiting deltasone 20 mg visa, abdomi- nal pain deltasone 20 mg otc, diarrhea, and, occasionally, steatorrhea. Young infants have failure to thrive, and adults have weight loss. There appears to be a subset of patients with allergic eosinophilic gastroenteritis who have symptoms secondary to food. These patients generally have the mucosal form of this disease, with IgE-staining cells in jejunal tissue, elevated IgE in duo- denal fluids, atopic disease, elevated serum IgE concentrations, positive prick skin tests to a variety of foods and inhalants, peripheral blood eosinophilia, iron deficiency anemia, and hypoalbuminemia. The diagnosis of eosinophilic gastroenteropathy is based on an appropriate history and a GI biopsy demonstrating a characteristic eosinophilic infiltra- tion. The oral allergy syndrome is a form of contact urticaria that is confined almost ex- clusively to the oropharynx and rarely involves other target organs. Patients with imme- diate GI hypersensitivity present with GI symptoms after the ingestion of a specific food. Churg-Strauss syndrome is a form of small-vessel vasculitis; patients present with asthma, sinusitis, and eosinophilia. A 3-year-old boy is brought to your office by his mother, who relates that her son was diagnosed as hav- ing peanut hypersensitivity 1 year ago. He developed urticaria and nasal congestion after ingestion of peanuts. Since then, he has had two more episodes of hypersensitivity, with similar symptoms. Which of the following is the most appropriate treatment for this patient? Ketotifen Key Concept/Objective: To understand the management of food allergy The only proven therapy for food allergy is the strict elimination of that food from the patient’s diet.
Current vital signs are unremarkable buy deltasone 20mg on line, with the exception of his blood pressure trusted 40mg deltasone, which is 190/105 mm Hg. His pain does not respond to sublingual nitroglycerin and intravenous beta blockade. There is no difference in pulse or blood pressure between the upper extremities. Cardiac examination is normal, with the exception of a loud fourth heart sound. Electrocardiography reveals nonspecific ST-T wave changes, along with findings consistent with left ventricular hypertrophy. A chest x-ray reveals a widening of the mediastinum and a large cardiac silhouette without pleural effusions. Which of the following is the most appropriate step to take next in the workup of this patient? Initiate anticoagulation therapy immediately and activate the heart catheterization laboratory ❏ B. Order a stat spiral CT to rule out thoracic aortic dissection ❏ C. Order stat aortography to rule out thoracic aortic dissection ❏ D. Admit the patient for serial cardiac enzyme assays and ECGs to rule out myocardial infarction 1 CARDIOVASCULAR MEDICINE 33 Key Concept/Objective: To understand the importance of rapid diagnosis of thoracic aortic dis- section The most typical presentation of type B dissection is onset of severe interscapular pain, which may radiate down the back toward the legs. Type B dissection is frequently accom- panied by hypertension, whereas type A dissection more often occurs in the presence of normal or low blood pressure. Although myocardial infarction remains a possibility, this patient’s history and examination are consistent with aortic dissection. In lieu of the con- siderable pretest likelihood of aortic dissection, anticoagulation should be withheld until dissection is ruled out by spiral CT or another acceptable imaging modality. Although aor- tography is still used in some hospitals, it is seldom the initial test for aortic dissection.
The heart valves were tested in 5-month mitral valve sheep implants purchase deltasone 20 mg visa. The albumin-binding coating clearly improved the hemocompatibility of the heart valve buy deltasone 40mg on-line. Conclusions The data generated from these experiments demonstrate that these non-heparin-based coatings can provide substantial improvements in the blood compatibility of medical devices. The results also validate the scientific principles behind these alternative approaches targeted at preventing thrombus formation and enhancing the function of blood-contacting medical device materials. Medical device manufacturers now have the option to choose from either heparin-based surface modification or a variety of nonheparin, non-biological surface modification approaches to create hemocompatible surfaces on medical devices. Future Developments The inherent flexibility of these photochemical coupling methodologies makes possible the immobilization of a broad variety of molecules with the potential to improve the compatibility of blood-contacting materials. Current efforts at SurModics in this area include immobilization of extracellular matrix proteins and peptides (see Section VII), hydrogels, plasminogen binding reagents, and cell membrane components. ANTIMICROBIAL COATINGS Medical devices are essential tools in modern patient care. Unfortunately, these useful imple- ments can often lead to serious complications, such as device-related infection, if not managed properly. Nearly every medical device is prone to infection by a wide variety of pathogens. Implant devices account for about 45% of all nosocomial infections, with catheter-related Surface Modification of Biomaterials 115 urinary tract infections being the most common form. Ninety percent of bloodstream infec- tions are related to the use of an intravascular medical device. Device-related infection occurs less frequently in other devices, such as penile implants, but if an infection is evident, the morbidity is dramatic [28,29]. In addition to those devices listed above, infection of fracture fixation devices, dental implants, joint prostheses, vascular grafts, cardiac pacemakers and leads, hip prostheses, artificial voice prostheses, intrauterine devices, mammary implants, mechanical heart valves, and heart assist devices are associated with millions of infections at rates between 1–50% [30,31]. The pathogenesis of device-related infection is not well understood.
Other results of his physical examination are as follows: blood pressure buy deltasone 20 mg, 130/70 mm Hg trusted 10 mg deltasone; pulse, 84 beats/min; respiratory rate, 14 breaths/min. His neck veins are elevated, and the elevation increases upon inspiration. His cardiovascular examination is remarkable for an extra sound in early diastole, and he has no paradoxical pulse. His hematocrit is normal, and the results of pulmonary function studies and electrocardiography are unremarkable. What would be the definitive diagnostic workup for this patient? A and C Key Concept/Objective: To be able to recognize constrictive pericarditis Given this patient’s symptoms and his history of dialysis, he most likely has constrictive pericarditis. Definitive diagnosis requires demonstration of a thickened pericardium and equalization of right and left heart pressures. Findings of elevated central pressures in the absence of other signs of congestive heart failure are very helpful. In contrast to cardiac tamponade, paradoxical pulse is present, and the Kussmaul sign can occasionally be seen. A 26-year-old woman is being evaluated for dyspnea, which she experiences when she engages in phys- ical activity. She has been having these symptoms for the past 4 months. She denies having chest pain, orthopnea, or paroxysmal nocturnal dyspnea. The patient’s medical history is significant for her having one episode of atrial fibrillation 1 month ago. Her physical examination shows fixed splitting of S2 and a 2/6 systolic murmur in the pulmonic area. An electrocardiogram shows mild right axis deviation and an rSR’ pattern in V1. A chest x-ray reveals an enlarged right atrium and main pulmonary artery.