Annals of allergy
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Case Reports
Myocardial infarction induced by coronary vasospasm after self-administration of epinephrine.
A case of a 30-year-old man who developed a myocardial infarction after self-administering an Epi-Pen for an episode of idiopathic anaphylaxis is reported. The patient had numerous risk factors for coronary artery disease, and it was suspected that epinephrine-induced coronary spasm caused the infarct. The Epi-Pen Junior may be indicated in such adults with numerous risk factors for coronary artery disease who are at risk for recurrent anaphylaxis.
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Charts of all children with severe acute asthma admitted to the Pediatric Intensive Care unit (PICU) of this hospital between January 1987 and December 1990 were reviewed retrospectively. There were 47 admissions for life threatening asthma to the PICU over this period, representing about 2% of all acute asthma admissions to our hospital. The mean duration of symptoms in these patients before admission was 54 hours. ⋯ Only two patients developed pneumothorax, neither of whom had been mechanically ventilated, but they did not require surgical intervention for drainage. There was only one death in a patient who was known to have sickle cell anemia and developed sagittal sinus thrombosis. We conclude from our series that the mortality for children with life threatening asthma admitted to PICU is very low if bronchodilators and steroids are used optimally in their management, along with judicious selection of those requiring mechanical ventilation.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Comparison of cetirizine and terfenadine in the treatment of chronic idiopathic urticaria.
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We analyzed forced expiration maneuver-induced bronchoconstriction in 14 asthmatic patients and in seven normal subjects by breaking down the forced expiration maneuver of spirometry (the FVC maneuver) into two phases: a slow, deep inspiration to the total lung capacity (TLC) (the DI maneuver) and a forced expiration to the residual volume (RV) (the PFV maneuver). Specific airway conductance (sGaw) was measured at functional residual capacity (FRC) after each of the three maneuvers. All of the maneuvers caused the greatest bronchoconstriction immediately after completion of the maneuver. ⋯ The normal subjects did not show any changes in the sGaw by any of the maneuvers. The inhalation of albuterol almost abolished the response of bronchoconstriction to any of the three maneuvers, but inhalation of an anticholinergic agent, ipratropium bromide, did blunt the response. This study suggests that forced expiration maneuver-induced bronchoconstriction in asthmatics can be caused not only by deep inspiration to the TLC but also by forced expiration to the RV, and that the bronchoconstriction may be brought about mainly by an increase in parasympathetic activity.