Allergic Reactions Ebook

51 Ways to Reduce Allergies

51 Ways to Reduce Allergies

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Allergy Relief

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Itching Rash Welts Or Hives Allergic Reactions In The Skin

Touching, eating, injecting, or breathing certain things can cause an itching rash or hives in allergic persons. For more details, see Allergic Reactions, p.' 166. If you get an itching rash, hives, or any other allergic reaction after taking or being injected with any medicine, stop using it and never use that medicine again in your life

Drug allergy

Drug allergy is uncommon and comprises only 6 of all adverse drug reactions, which overall are, of course, common. Importantly, drug allergy can occur with only small doses of drug. However, most drug reactions of a seemingly allergic nature are not in fact immune-mediated (i.e. true allergy) but due to other effects often of a chemical nature, e.g. mast cell release. Drug allergy is separate from The most common drug allergy is to penicillin. This occurs in 1 5 of recipients and is responsible for 90 of all cases of drug allergy and for 90 of cases of fatal anaphylaxis. Other important drug allergies are seen following Anaphylaxis is the potentially fatal manifestation of drug allergy with an onset within minutes. It usually follows parenteral drug administration but can follow oral dosage. Its clinical features include Drug allergy may be diagnosed when Gorevic P 1985 Drug allergy. In Kaplan AP (ed) Allergy. New York Churchill Livingstone. p. 473. Weiss ME 1992 Drug allergy. Med...

Allergic Reactions

An allergy is a disturbance or reaction that affects only certain persons when things they are sensitive or allergic to are . . . Allergic reactions, which can be mild or very serious, include An allergy is not an infection and cannot be passed from one person to another. However, children of allergic parents also tend to have allergies. Often allergic persons suffer more in certain seasons or whenever they come in touch with the substances that bother them. Common causes of allergic reactions are

CAllergic Reactions

(1) Allergic reactions following blood or plasma transfusions occur less frequently than leukocyte chill fever reactions and are usually relatively mild. Most consist of local erythema, hives, and itching which develop during transfusion and that can be easily treated with, or prevented by, administration of antihistamines. The American National Red Cross, Washington, D.C., AABB Rare Donor file, and Canadian Red Cross, Toronto, Ontario, maintain registries of lgA-deficient donors. While an antihistamine, for example, diphenhydramine (Benadryl), may be sufficient for some allergic reactions, use epinephrine for any anaphylactic reactions.

Chronic Allergic Eye Diseases

Chronic allergic ocular disease encompasses several disorders, such as seasonal atopic conjunctivitis, perennial atopic conjunctivitis, atopic keratoconjunctivitis (AKC) and vernal keratoconjunctivitis (VKC) 7 . Seasonal atopic conjunctivitis (SAC) is a time-limited disease and in most cases conjunctivitis is only one manifestation of additional allergic reactions (rhinitis, hay fever or a hay fever like symptomatology, and in severe cases conjunctivitis is associated with different forms of pulmonary affection). Atopic keratoconjunctivitis is a severe, bilateral, ocular allergic disease affecting adults. A familial history for atopy and an association with systemic atopic dermatitis are common. Symptoms commonly include itching, burning, and tearing. Signs include involvement of mainly upper conjunctiva in the form of a papillary conjunctivitis. The corneal epithelium reveals mild to moderate inflammatory changes that can result in scarring and neovasculariza-tion leading to...

Effector Cells and Cytokine Release

Mast cells (MCs) are bone-marrow-derived tissue cells containing prominent cytoplasmic granules. They have a clear and pivotal role in allergy, but also take part in wound healing and native immunity 11 . In type I hypersensitivity reactions, MCs elicit the early stages of the allergic inflammatory response. In fact the cross-linking of IgE antibodies bound to high-affinity IgE receptors by the antigen and the release of various preformed (histamine) and newly synthesized mediators causes immediate MC degranulation. In addition, the later release of chemiotactic factors, cytokines and chemo-kines, from activated MCs also induces the onset of the late-phase reaction, characterized by tissue infiltration and activation of various inflammatory cells and notably the eosinophils. The cytokines growth factors detected in situ in human MCs include interleukin (IL)-3, IL-4, IL-5, IL-6, IL-8, IL-10, IL-13, IL-16, tumor necrosis factor-a (TNF-a), vascular endothelial growth factor (VEGF),...

Neuropeptide and Growth Factor Involvement

Allergic inflammation might also follow the release of neuropeptides, mainly substance P, as observed in VKC 20 , which cause characteristic features of allergic inflammation, including vasodilatation, increased vascular permeability and a contribution to further release of hista-mine from MCs. Specifically, tryptase- and his-tamine-releasing factors might greatly contribute to SP release and to amplifying the chronic allergic reaction, triggering nerves to release neuropeptides by binding to protease-activated receptors. Fig. 1.1. A possible cross-talk between mast cells (MCs),eosinophils (EOS) and fibroblasts (FBs) during the early and late phase of allergic reactions. MCs and EOS effects exerted on FBs seem to be related to the release of either fibrogenic or fibrolytic mediators in Fig. 1.1. A possible cross-talk between mast cells (MCs),eosinophils (EOS) and fibroblasts (FBs) during the early and late phase of allergic reactions. MCs and EOS effects exerted on FBs seem to be...

And the Contribution of Fibroblasts

Tissue remodelling and formation of giant papillae are some of the consequences of chronic allergic disorders, including the eye 1,21 . Remodelling involves both production and deposition of extracellular matrix (ECM) components, as well as degradation and clearance of newly synthesized products 21 . Any inflammatory reaction can induce tissue damage and a resulting healing process, which is a very complex event involving interactions of both inflammatory and structural cells 1 . Three main overlapping phases have been identified in tissue response to injury, which can continue for months to years inflammation, granulation tissue formation - including fibroblast (FB) proliferation, migration, differentiation and remodelling. This process can be physiological and well balanced or can result in an exaggerated pathological process, which includes remodelling and or fibrosis 21 . FBs represent the main target and effector cells of these processes due to their ability to migrate to the...

Preprocedure Evaluation and Preparation

The indications for arteriography should be carefully evaluated and previous imaging studies should be reviewed. Medical history of the patient should also be complete, including history of allergic reactions and coagulation disorders. Proper management before arteriography requires the following steps

Anabolic Steroid Abuse

Steroids produce a lysosomal membrane stabilization, blocking leukotriene formation from arachidonic acid, blocking the action of phospholipase A, and inhibiting cyclooxygenase activity (decreased prostaglandin formation). Because of this, steroids are used in a number of settings, such as acute inflammation, anaphylaxis, allergy states, and immune suppression as well as for the treatment of Addison's disease.

Section Iv The Special Sense Of Smell Olfaction 19 General

The taste sensation is closely related to the sensation of smell. We often select food and enjoy particular dishes because of a pleasant odor or aroma. A person with a cold or allergies usually claims the food is tasteless. Actually, his sense of smell has been affected and disturbed his sense of taste. There have been many attempts to distinguish and classify the primary sensations of smells. One classification distinguishes seven classes of primary sensations camphoraceous, musky, floral, pepperminty, ethereal, pungent, and putrid. Later research suggests that there may be as many as fifty or more primary sensations of smell. Although animals have a more highly developed sense of smell than humans, humans can identify at least 4000 different odors. Olfactory receptors become tired easily with the result that humans cannot smell the same odor for very long, but they can pick up a new odor. Additionally, a particular odor in an area of many odors can be identified, and an odor smelled...

Chronic granulomatous disease

She has seen an allergy specialist for several years and has received desensitization shots for multiple allergies, including pollen, dust, and cat hair. The most common congenital immunodeficiency. Diarrhea is usually caused by Giardia lamblia recurrent sinopulmonary infections are caused by 5. pneumoniae, H. influenzae, or S. aureus associated with an increased incidence of allergies and autoimmune diseases. Selective IgA deficiency may be due to a specific defect in isotype switching. P-209

Scorpion Venom Poisoning

Scorpion venoms have received much research attention in recent years as efforts to isolate the various components proceed. The venoms of scorpions posing a serious threat to human life possess toxins with significant neurologic and cardiovascular effects. These venoms stimulate massive release of neurotransmitters from autonomic nerve terminals, neuromuscular junctions, and the adrenal medulla, resulting in sympathetic, parasympathetic, and paralytic signs and symptoms.105,120 Pain is a common immediate symptom and may be enhanced by the presence of serotonin in many venoms.120 Paresthesias may occur as well. Systemic findings are related to venom-induced release of acetylcholine and catecholamines. Such findings may include restlessness, anxiety, roving eye movements, hypersalivation, diaphoresis, nausea, vomiting, hypertension, bradycardia, tachycardia, dysrhythmias, hyperthermia, muscle fasciculations, alternating opisthotonos and emprosthotonos, weakness, paralysis, difficulty...

How People Use Alternative Therapies

I work part-time for a little store and a customer came in who I know and she was lamenting that her one son had just been diagnosed as having this wheat allergy and she said 'And he's got a birthday party on Saturday and I don't know what to do.' So I said 'Call me tonight and I'll give you some places to go to and some ideas.' She phoned me a few weeks later and she said 'Here's a recipe book that I've picked up that's really good.' So we've been swapping back and forth like that. Neighbour down the road was at work and somebody was lamenting her daughter is wheat sensitive now and this woman phoned me clear out of the blue. I think I've talked to maybe four people who have just called because somebody has been talking about a friend of a friend and so we've been networking.

Maturation Of Immune Responses And Antimicrobial Immunity

Activation of the Th2 pathway can lead to immediate hypersensitivity, an IgE-dependent form of allergy. The reaction is initiated when IgE antibodies that are bound via their Fc region to the IgE receptors, principally on mast cells, bind their specific antigens (allergens). Crosslinking of the IgE receptors on these cells stimulates the activation and release of mediators from these cells. IL-4 from Th2 lymphocytes strongly promotes the synthesis of IgE the Th2 cytokines IL-5 and GM-CSF stimulate eosinophil differentiation and activation and IL-4 acts on mast cells. IgE, eosinophils, and mast cells are involved in host defense against the extracellular helminthic parasites. On the other hand, a dysregulated Th2 response leads to chronic inflammation, asthma being a prime example.54

Vaccine Formulations and Delivery

The initial era of vaccine development was based on the use of killed or attenuated whole organisms as immunogens. Usually these produced reasonable immune responses because of their recruitment of innate immunity, but in some cases they are associated with adverse reactions. Examples of adverse reactions would include the encephalopathic responses to the older formulations of killed Bordetella pertussis vaccine and the allergy to contaminating egg protein of influenza vaccine, which is produced by growing the virus in chicken eggs. To avoid such issues, many newer vaccines use purified molecules as immunogens.

Recirculation to EALT

In EALT, there is only sparse information so far about homing mechanisms and regulating factors. The presence of high endothelial venules in the normal human conjunctiva has been shown (for review see 26 ). The intestinal vascular ad-dressin MAdACAM-1 is not observed on high endothelial venules but other adhesion molecules like VAP-1, ICAM-1, VCAM-1 and E-se-lectin have been found and showed a weak or sporadic staining. These addressins are thought to be possibly involved in extraintestinal homing but may also indicate an inflammatory response. The presence of ICAM-1 in the normal human conjunctiva was confirmed but ICAM-1, VCAM-1 and E-selectin were found to be inflammation dependent and strongly expressed only under inflammatory allergic conditions 1 .

Dangerous Reactions From Injecting Certain Medicines

The risk of a serious reaction is greater in a person who has previously been injected with one of these medicines or with another medicine of the same group. This risk is especially great if the medicine caused an allergic reaction (hives, rash, itching, swelling, or trouble breathing) a few hours or days after the injection was given. 4. In very serious cases, like tetanus or snakebite, if there is a good chance that the antitoxin might produce an allergic reaction (if the person suffers from allergies or asthma or has had horse serum before), inject promethazine or diphenhydramine 15 minutes before giving the antitoxin adults, 25 to 50 mg. children, 10 to 25 mg., depending on their size (see p. 387).

Activation of TLymphocytes by Cytokines

Production by plasma cells and may therefore be involved in the upregulation of IgE that is observed in allergy. This indicates that inflammatory reactions are not solely mediated by Thi-type lymphocytes and questions the Thi Th2 paradigm to some extent. The inflammatory events that occur in allergic eye disease are moderate in the acute seasonal and perennial allergic disease, SAC and PAC, and mainly lead to edema, redness and itching, whereas the immigration of inflammatory cells is limited. However, in the more chronic allergic diseases such as vernal and atopic keratoconjunctivitis (VKC and AKC) there is a more pronounced immigration of inflammatory cells. In chronic allergic eye disease but not, or only weakly, in acute ocular allergy, activated matrix metalloproteinases occur in the tissue and tear film and may explain the occurrence of corneal destruction in the chronic forms. There the inflammatory process can lead to scarring and can have sight threatening complications,...

J Unconsciousness 24 Treat A Casualty With Anaphylactic Shock

Ask the casualty if he is carrying medication for allergic reaction. If the casualty is carrying medication (usually an autoinjector containing 0.3 milliliter of 1 1000 epinephrine per injection), assist the casualty in administering the injection or administer the injection to him in accordance with the instructions in the kit.

Cellular Responses in EAU

Effector T cells are often characterized as either T-helper cell type i or type 2 (Thi or Th2) by their selective patterns of cytokine secretion. Classically, the Th2 phenotype is observed in allergy or in conferring protection from autoimmune diseases whereas the Thi phenotype has been linked to numerous autoimmune diseases

Examination Of Nosesinuses

Inspect the external nose and look for redness, edema, lumps, tumors, or poor alignment. A patient with red nostrils may blow the nose frequently because of allergies or infectious rhinitis. Dilated, engorged blood vessels of the nose may indicate either that the patient is outside in all kinds of weather much of the time or that he is an alcoholic. A person with a bulbous, discolored nose may have rosacea (a chronic inflammatory disorder similar to acne). (4) Check nasal discharge. If there is nasal discharge, assess its color, consistency, and odor. Also, check for blood in the discharge. The patient may have an allergy or a cold if the discharge is profuse and thin.

Identify Bee Hornet Yellow Jacket And Wasp Stings

There are over 100,000 species of hymenopterans (bees, hornets, yellow jackets, wasps, ants, and similar insects). They are especially dangerous because a casualty may be stung by many insects at the same time. The bee has a barbed stinger that remains in the casualty. (The bee flies away and dies.) The wasp, hornet, and yellow jacket retain their stingers and can sting repeatedly. Stings from hymenopterans result in more deaths than do snakebites. Approximately five percent of the population is allergic to the venom of bees, hornets, yellow jackets, and or wasps. These casualties may have allergic reactions that can develop into anaphylactic shock if preventive measures are not taken. The fire ant is discussed separately in paragraphs 2-13 and 2-14.

Recurrent Aphthous Ulcers

Recurrent aphthous ulcer (RAU) (figure 1-10) is a chronic inflammatory disease with repeated episodes of ulcerations. Recent investigations seem to indicate that the aphthous lesion is associated with an altered local immune response. This disease is characterized by small, whitish ulcers with red borders. The disease normally occurs as a single lesion or, infrequently, as multiple lesions on the wet mucous membranes of the lip, tongue, cheek, or floor of the mouth. Lesions appear as depressions on the mucous membrane and are covered by a grayish-white or light-yellow membrane. There is no vesicle formation before the ulcer appears, distinguishing this disease from viral diseases of the oral mucosa. Associated with the development of a recurrent aphthous ulcer is generally trauma, endocrine change, psychic factors, or allergy. The lesions are painful however, the condition is self-limiting with the lesions usually healing in 10 to 14 days without leaving scars. Recurrent aphthous...

Allergic Manifestations

The allergic condition called angioneurotic edema may be related to food allergy, hypersensitivity, local infection, and endocrine or emotional disturbances. The characteristic symptom is rapid swelling of the affected tissue in 5 to 30 minutes with itching and burning sensations present. The areas most commonly involved are the skin about the eyes and chin, the lips, and the tongue. A major concern is the potential for laryngeal edema and airway compromise. The symptoms are treated.

Transcribing And Checking

After the information has been transcribed from the DA Form 4256, the profile form is checked for medication errors, overdoses, drug interactions, contraindications, and possible allergic reactions. The pharmacy copy of the DA Form 4256 should also be checked against the completed patient profile to make sure there are no transcription errors. The specialist who performs this check should place his initials in the appropriate space. Ideally, these two steps, transcribing and checking, should be performed by different individuals. This reduces the chance for errors.

Anaphylaxis And Anaphylactic Shock 31 Introduction

When a foreign protein or other foreign substance is introduced into the body, the normal systemic reaction is to throw off the substance. Anaphylaxis is an unusual allergic reaction. It is caused by a hypersensitivity to a specific substance introduced into the body for the second or a subsequent time. Anaphylaxis is never apparent during the first contact with the foreign substance. During the time between the first and second experience with the foreign substance, the person develops antibodies. In a majority of cases, the antibody produced is immunoglobin IgE. When the foreign substance (antigen) makes later contact with the person, there is an antigen-antibody reaction. The body releases a toxic histamine-like substance that causes a mild to lethal reaction. When the reaction is severe, it is called anaphylactic shock. The shorter the time before symptoms appear, the greater the risk of a fatal reaction. Anaphylactic shock is always considered a serious medical emergency.

Substances Causing Anaphylactic Shock

Parenteral injections of penicillin are the most frequent cause of anaphylactic shock. If the drug is ingested, the reaction is less rapid than through injection, but will still occur. Tetanus antitoxin is another frequent cause. Some antitoxins and extracts of allergenic substances are formed by using animal serum. When these are used for testing or desensitizing an allergic patient, these can cause anaphylactic shock. Diagnostic medical procedures such as an angiogram or pyelogram use contrast media containing iodide. These media have been known to produce a serious allergic response. b. People with a history of allergies are more likely to develop anaphylactic problems than those who do not have such a history. The patient should be questioned carefully and any known allergies should be posted on the patient's chart in a manner that is easily visible to anyone who is concerned with patient care. When a serum such as horse, rabbit, or bovine is...

Myocardial Preservation Techniques

Aspirin has clearly been shown to be of benefit in acute MI and unstable angina, both of which cause functional defects in platelets by permanently inactivating prostaglandin G H synthase. Patients should chew a 325 mg aspirin tablet as soon as possible after the onset of symptoms. Its efficacy is such that aspirin should probably be used in every patient who presents with new-onset chest pain of possible ischemic etiology, assuming there is no history of ana-phylaxis or allergy to aspirin. Its antiplatelet action begins to work within 15 to 30 minutes. Ticlopidine (Ticlid), another antiplatelet agent, is used in patients with a history of allergy to aspirin or anaphylaxis. Ticlopidine has been shown to be effective in reducing cardiovascular mortality and acute MI in patients with unstable angina.19 However, it has a delayed onset of action compared with aspirin (24 to 48 hours), which makes it a clear second choice for platelet inhibition. Long-term use of...

Treatment And Prognosis

Available preparations of diphtheria antitoxin are of equine origin and, as with any heterologous serum, may produce immediate or delayed reactions. A history of prior horse serum exposure or allergy should be obtained and the patient tested for hypersensitivity by skin or eye testing prior to administration of the product. During hypersensitivity testing or infusion of diphtheria antitoxin, a 1 1000 solution of epinephrine should be available and ready for emergency use if needed. For skin testing, 0.1 mL of a 1 100 dilution of diphtheria antitoxin in physiologic saline is injected intracutaneously. A wheal 1 cm or more in diameter at 20 minutes indicates sensitivity. In persons with a history of allergy to equine serum, 0.05 mL of a 1 1000 dilution should be administered. A negative test does not preclude the occurrence of serum reactions.

Snaremediated Vesicle Fusion As A Therapeutic Agent

These studies also confirmed that the receptor used for targeting the conjugate to cells is not critical for conjugate function and that the HN domain is sufficiently promiscuous to facilitate LC transfer across the internal membranes of both neuronal and nonneuronal cells. Replacement of the receptor binding domains of clostridial neurotoxins with domains of the constant region of the IgE (FC) by chemical conjugation of the FC to LHN has been reported as an approach to producing hybrid proteins able to target mast cells and basophilic leukocytes and inhibit inflammatory mediator release from these cells in allergic reactions.43

Magnetic Resonance Imaging

Magnetic resonance imaging (MRI) for AAA offers comparable results to CT scanning in terms of assessment of aneurysm size, proximal extent, iliac extension, and etiology (e.g., inflammatory), and has the added advantage of being noninvasive and safe because no contrast administration is required. The procedure, however, is not well tolerated by claustrophobic patients, and its limited availability and expense have relegated its use to a second-line investigation for AAA, reserved for those patients for whom CT scanning is inappropriate (e.g., iodinated contrast allergy, chronic renal failure, or claustrophobia).

Patients who are at risk of sudden deterioration

Deterioration can be anticipated (due to the nature of a pre-existing condition or the type of surgery undergone) or unanticipated. It is important to remember that unanticipated deteriorations can be due to equipment failure, or idiosyncratic reactions to therapy (e.g. drug allergy) as well as unexpected conditions, such as heart attack, or pulmonary embolus. Proper attention to basic patient care and monitoring can prevent or allow early detection of some of these conditions.

Answers and Case Discussion

The patient's current hypertension provides a relative contraindication to thrombolytic agents, although one could still be administered if the projected benefit outweighed the risk or if treatment was administered and resulted in the BP falling below 180 110. Aspirin is, of course, absolutely con-traindicated because of the clear history of allergy, and in this case, one might want to use clopidogrel.

Antibiotics To Fight Infection

Do not give penicillin to a person who is allergic to it. Ask about the person's allergies before you give penicillin pills or injections. When you inject penicillin, always keep epinephrine (Adrenalin) ready to inject if the person shows signs of allergic shock. Stay with the person for 30 minutes. If you see these signs. . .

Reducing Facial Scars

Another method of elevating type III depressed scars is injection of a filler material. Bovine collagen is widely used for this purpose. I prefer injecting Fascian to provide filling. Fascian is composed mainly of human collagen derived from fascia obtained from tissue donors. Unlike bovine collagen, there is virtually no risk of an allergic reaction from human collagen. The human material also persists longer after injection generally six months, compared to three months for bovine collagen.

Oral Tolerance Induction

This mechanism of mucosal tolerance is usually effective for nutritional proteins, preventing adverse reactions that potentially lead to food allergies. This tolerance is mediated by suppressor cells specific for the respective antigen however, the exact mechanisms of this suppression are not yet fully elucidated. It is assumed that suppressor T cells recognize the respective antigen and secrete suppressive cytokines, such as TGF-b, IL-10 (Th3, Tr type) or cytokines belonging to the respective antagonistic Th type of the immune response 79 (Fig. 16.3). To date various antigens have been orally applied to uveitis patients 51,54,75 .

Phobias Reflections on Definitions

The issue of ''clinical significance'' as an essential criterion for diagnosis is still an open question for all mental disorders 1 there is a true problem in our mind in equating statistical normality with the absence of pathology in the field of phobias and in psychiatry in general. Phobias can be assimilated to allergies we do not need to be treated for all allergies we need to be treated for those allergies we most probably will be exposed to or that constitute great danger if we are ever exposed to them. Thus the issue of diagnosis needs to be dissociated in the minds of mental health workers (not only in the field of phobia) from that of necessity for treatment. This does not mean that the proneness to phobia could not by itself be regarded as a marker, even if it has not produced major distress in one's life, the same way most specialists would recognize genetic proneness to allergy even if no anaphylactic reaction has occurred so far in the life of an individual.

Section V Sensitization To Cold Injuries 515 Sensitization

Frequently in all degrees of cold injury, the affected individual becomes sensitized to further exposure to cold. With milder injuries, sensitization to cold may persist only days or weeks, but in more severe injuries, cold sensitivity of the injured part may be permanent. Consequently, additional precautions must be taken by a person once injured by cold to prevent further injuries. In certain cases, true cold sensitivity or allergy may exist. Such persons may demonstrate urticaria or hives with intense burning, itching, and swelling when exposed to cold. Generally, this happens to persons who have had a cold injury. Rarely, however, this reaction may be a family trait or happen to a person who has plasma cryoglobulin or cold agglutinins. In such persons, cold exposure may cause a systemic reaction of generalized urticaria, asthma, and even shock.

Phobias Facts or Fiction

On the question of comorbidity, it not easy even for experienced clinicians to elicit, in a reasonable amount of time, all of the phobic behaviours in different psychiatric conditions such as the fears of being seen in public in body dysmorphic disorder, avoidance of situations associated with obsessing, avoidance of complex stimuli in the autism spectrum disorders, difficulty in interacting with people and consequent avoidance in depression, fears of expressing some emotions, interoceptive fears, and the huge problem of avoidance ''ascribed to medical causes without adequate evidence'' 6 . A few examples of these are gastrointestinal symptoms, total allergy syndromes, fatigue and pain syndromes.

Relative Contraindications

Patients with metallic hip joint replacements will have significant artifacts in the pelvis with limited evaluation of colonic segments in this region. This is a relative contraindication depending on the clinical question asked. Intravenous iodinated contrast allergy is also a relative contraindication as any patient with a history of a mild contrast allergy can be premedicated for the exam or not receive the injection. Claustrophobia is also a relative contraindication to the study. Patients can take an oral sedative prior to the study. An incompetent ileocecal valve is another relative contra-indication for CTC as distention of the colon may be suboptimal.

Problems That Occur During Sleep

Inherited differences in the shape of the upper airways, and diminished elastic content of the tissues with age. Allergies, infection, respiratory irritants, and smoking can cause swelling of these tissues. Alcohol and some drugs can cause the muscles of the throat to relax. Lying on the back can cause the tongue and other throat tissue to be pulled back by gravity. Large tonsils and adenoids may constrict the size of the throat. Nasal congestion may force more mouth breathing. Even depression, stress, or anxiety can cause changes in blood flow to the nose, causing swelling.

Host defense mechanisms and pathogen survival strategies

From beneficial commensal bacteria, as well as antigens from pathogens. The details of how the human body regulates its intestinal immune response to distinguish between benign and harmful foreign antigens remain largely a mystery. However, the vast immune potential of the intestinal mucosa as well as the problems associated with its malfunction (such as food allergies and inflammatory bowel diseases) makes continued research on the intestinal immune system a priority.

Inflammatory Dermatoses Eczema

Vulvar Eczema

Allergic contact eczema is a Type IV cell-mediated allergic reaction that takes 48 to 72 hours to develop following exposure to the offending allergen. This type of allergy is uncommon on the vulvar skin alone and is likelier to be found if there is perianal eczema as well. The commonest allergens include topical antibiotics and preservatives in the ointments or creams that are being used. The topical steroid itself can on rare occasions be responsible. It is important to patch test the patient if the vulvar rash is worsening with treatment.

Gallbladder and Biliary System Radiography

How The Gallbladder Tested

Indications for the test include suspected gallstones, gallbladder inflammation, and cystic duct obstruction. Contraindications are allergies to iodine contrast media and diseases of the digestive tract that may interfere with the absorption of orally ingested contrast media. dinated contrast medium that is injected through the liver into an intrahepatic bile duct. Visualization of the intra- and extrahepatic bile ducts, and occasionally the gallbladder, is then accomplished. Suspected duct obstruction and unexplained jaundice are the major indications for this procedure. Contraindications include allergies to the contrast media.

Gastrointestinal Radiography

Exam are dehydration, renal insufficiency, and multiple myeloma. Contraindications include allergies to the contrast medium. Retrograde pyelography, which often confirms the findings of intravenous urography, is indicated when IVU IVP yields insufficient results. Patient allergy to the intravenous contrast medium also provides an indication for retrograde pyelography. The contrast medium for RP is not absorbed into the bloodstream.

Vocal Fold Augmentation with Calcium Hydroxylapatite

Synthetic calcium hydroxylapatite (CaHA Radiesse, BioForm, Franksville, Wis.) was approved for vocal fold augmentation by the United States Food and Drug Administration (FDA) Center for Devices and Radiological Health in January 2002. Calcium hydroxylapatite is the primary mineral constituent of bone and teeth. The substance has a proven track record of being highly biocompatible 1-6 . The laryngeal implant is created by suspending CaHA spherules in a gel carrier composed primarily of glycerin and water. The gel is reabsorbed and eventually replaced by soft tissue in-growth. The CaHA remains at the site of injection and has the potential for long-standing augmentation. Since its approval by the FDA, we have injected over 100 vocal folds with CaHA and have achieved excellent results 7 . Theoretical complications include implant migration, granuloma formation, vocal fold mucosal wave irregularities, allergic reaction, infection, and ectopic calcification. None of these complications...

Reactions To Contrast Media

Histamine, a substance found in all humans, has several functions, one of which is the release of blood plasma through capillary walls to body tissue. This release of fluids produces swelling of tissue called edema. Histamine is held in check by a histamine inhibitor and, in some people, the balance between the two is delicate and rather easily upset. These people are the unfortunate individuals who suffer from allergies such as hay fever. e. Allergy. If the patient indicates that he is allergic to iodine, that seafood makes him sick, or that he had problems during a previous examination, the probability of a reaction is increased. Regardless of the outcome of the questions, the specialist should report his findings to the injecting physicians, preferably outside the exposure room so that the patient cannot hear the conversation.

Atrophic Vaginitis And Serosanguineous Discharge

(Hoskins, 2 e, pp 385-386, 393-394, 628-630.) Cyclophosphamide is an alkylating agent that cross-links DNA and also inhibits DNA synthesis. Hemorrhagic cystitis and alopecia are common side effects. Cisplatin causes renal damage and neural toxicity. Patients must be well hydrated. Its mode of action does not fit a specific category Taxol can produce allergic reactions and bone marrow depression. Bleomycin and doxorubicin are antibiotics whose side effects are pulmonary fibrosis and cardiac toxicity, respectively Vincristine arrests cells in metaphase by binding microtubular proteins and preventing the formation of mitotic spindles. Peripheral neuropathy is a common side effect.

Subcourse Md0588 Environmental Diseasesinjuries I Introduction

The spiders that are identified can be as lethal as some types of snakes, but many of the insects are not. These insects are included because they are medically important, in terms of pain and the possibility of an allergic reaction. Many people can show an allergy that will progress to anaphylactic shock. Some types of marine life can emit a poison that is more lethal than that of any snake, and many military personnel are stationed at, or near the habitats of these animals. The lesson on hepatitis identifies the various types of this disease. The routes of person to person transmission, and disease precautions, will be of special interest.

BMechanisms of Erythrocyte Sensitization

(a) Unlike the previous group of drugs, the penicillins and cephalosporins (and possibly carbromal and methadone) bind firmly to the RBC membrane. Considerable experimental work has demonstrated that the immunogenicity is a result of its ability to react chemically with tissue proteins to form several different haptenic groups. The major haptenic determinant is the benzylpenicilloyl (BPO) group. Approximately three percent of patients receiving massive doses of intravenous penicillin will develop a positive direct antiglobulin test, and some of these will develop hemolytic anemia. The mechanism of the positive direct antiglobulin test and hemolytic anemia seems clear. The drug is absorbed to the RBCs. A immune antibody, for example, antipenicillin, is produced by the patient and will react with the penicillin on the RBCs. The end-product, therefore, is a RBC sensitized with lgG. Complement is not usually involved in this reaction, and, thus intravascular hemolysis does not usually...

Druginduced Tubulointerstitial Disease

Significant dehydration and electrolyte imbalance may occur in loop diuretic overdose. These compounds (furosemide, bumetanide, and ethacrynic acid) are potent diuretics that inhibit the Na K 2C1 transport system, which can result in hypokalemic metabolic alkalosis. Potassium replacement and correction of hypovolemia can reverse this toxicity. Additional adverse effects include ototoxicity, hyperuricemia, allergic reactions, and hypomagnesemia.

The Implications Of Alternative Health Beliefs

Research has shown that part of what lay people value about alternative therapies is that they are based on an ideology where health is understood as comprising more than just human biology (Furnham and Smith 1988 Pawluch et al.1994 Schneirov and Geczik 1996). Likewise, amongst the positive aspects attributed to these informants' alternative model of health is its emphasis on a holistic understanding of health and healing. A holistic approach to health care is something that the informants desire and something they feel is woefully lacking in allopathic medicine. However, for the individual who adopts such an alternative model of health, holism has its price. For example, one implication for the individual of the pursuit of this form of holistic health is that participation in alternative therapies can be, as McGuire (1988) points out, incredibly labour intensive. To illustrate, Pam's daughter was diagnosed by their naturopath as having several allergies and sensitivities, many of...


Individuals with a history of high sensitivity (such as severe systemic reactions or anaphylaxis to eating eggs) should be exempt from immunizing agents cultivated in eggs. Immunizing agents cultivated in eggs include those for influenza, yellow fever, measles, mumps, and rubella. Allergists should arrange for skin testing with dilutions of egg extract and vaccine product, plus positive and negative controls, under conditions with adequate precautions. Record severe individual reactions or significant proven allergy in the individual's immunization record. When soldiers must be immunized for a military mission, contact a board-certified allergist to make up the schedule for specific immunizations.


For patients with mild to moderately active OCP, we generally begin therapy with diamin-odiphenylsulfone (Dapsone), provided there are no contraindications (sulfa allergy, glucoses-phosphate deyhydrogenase deficiency). Dapsone is a synthetic sulfone with both antiinflammatory and antimicrobial activity. The drug interferes with neutrophil chemotaxis and prevents lysosomal enzyme release and phagocytosis. While Dapsone is highly effective when used short term, Fern and associates 8 have demonstrated this benefit to be temporary, with disease recurrence within weeks to months while on therapy. Patients who demonstrate a positive response can be maintained on a reduced dose. This drug should not be used in G6PD-defi-cient patients and not in those with sulfa allergies. We typically begin with 25 mg twice daily, and advance to no higher than 50 mg three times daily. Sulfapyridine is a possible alternative 7 .

Catheter Angiography

The most widely used contrast agents for catheter angiography are the water-soluble iodine-based agents. They can be divided into ionic and the newer nonionic agents. Nonionic agents have the advantage of considerably reducing the risk of adverse reactions to contrast, but are more expensive. In the United Kingdom the low-osmolar nonionic agents are used almost exclusively for intravascular procedures. These agents are denser than blood, and the commonly used strength for diagnostic and interventional work is 300 mg of iodine per milliliter of contrast. For hand injections, this strength of contrast is usually diluted 50 50 with saline. Patients with a previous history of adverse reactions to these contrast media, a strong history of allergic disease, or a hyper-sensitivity to iodine are at risk of developing a severe allergic reaction to these contrast agents. Other investigative modalities that do not require iodinated contrast media such as MRI or ultrasound should be considered,...


When a substance is put in the mouth, the substance is exposed to tiny receptors in the taste buds. Each person has about 10,000 taste buds. Most of the taste buds are on the surface of the tongue, but some are on the roof of the mouth and some are in the throat. We seem to taste many substances, but actually there are only four primary taste sensations sour, salt, bitter, and sweet. Other tastes such as chocolate, pepper, and coffee are combinations of these four tastes changed by olfactory sensations. If you have a cold or an allergy, you may feel that you cannot taste your food. What is happening is that your taste sensations are operating correctly, but your olfactory (smell) sensations are not. Much of what we think of as taste is actually smell. The odor from food passes upward into the nasopharynx and stimulates the olfactory system. If the sense of smell is greatly impaired, the quality of taste can change completely fresh onions can taste sweet and limburger cheese taste very...


A 2-year-old took his brother's allergy medication. He is brought to the hospital by ambulance because of tremors and hyperactivity. The medics report that the child had a seizure before arriving at the hospital. On physical examination the patient has fever, flushed skin, tachycardia, and fixed dilated pupils. Definition. Antihistamines are used as sedatives, for allergies, for antinausea, and for motion sickness. They are available over the counter and as prescription. They may be found in some cold medications such as liquid cough medication.

GTreat the Casualty

Evacuate the Casualty Return Casualty to Duty. Request evacuation if the casualty is showing signs and symptoms of respiratory distress and or anaphylactic shock, is not responding to initial treatment, or has bite or sting from an arthropod requiring evacuation (such as the brown recluse spider). If a casualty is not showing any abnormal reaction to the bite or sting and evacuation is not a normal part of treatment, return the soldier to duty. Tell him to return to you or seek other medical help if he begins having difficulty breathing or if other signs or symptoms of allergic reaction occur.


Angiography is still considered the gold standard for the assessment of vessel patency. Introduced in the intraoperative setting, this technique was able to accurately depict the anatomy of reconstruction and the outflow. However, it remains an invasive procedure, which requires direct injection of contrast dye into the vessel. Angiography requires two projections to obtain an appropriate vision of the vessel. Complications related to needle insertion (dissection and thrombosis) or the contrast dye (nephrotox-icity or allergic reaction) have been described. Their incidence is probably less frequent than commonly thought 7 , and the introduction of digital subtraction (available also on portable machinery) has further lowered this rate. Its disadvantages are the same as those encountered for preoperative diagnosis besides the cost of the machinery and the necessity for specifically trained personnel, its accuracy has been questioned. The presence of air inside the lumen, and an...

Mast Cells

Contain preformed bioactive agents, e. g. hista-mine and the enzymes tryptase and or chymase. According to the content of tryptase and or chy-mase, mast cells are divided into a connective tissue type containing tryptase and chymase (MTC) and a mucosal type that contains only tryptase (MT). In the normal human conjunctiva mast cells only occur in the lamina propria and their majority (95 ) are positive for tryptase and chymase. In allergic eye disease the number of Mt mast cells increases and they can occur inside the epithelium and tear film 39 . They produce further signalling molecules such as cytokines 10 of the Thi and Th2 type that act in an immune modulatory way on various cell types including leukocytes and epithelial cells and influence the course of ocular allergy.


The Canada Health Monitor (1993) found that 23 percent of the people they surveyed were directed to alternative therapies by an allopathic physician. Likewise, a similar proportion of the people who spoke with me found their way to alternative practitioners on the recommendation of an allopath. For example, Pam's doctor suggested she see a naturopath. She told me, We have a friend, a doctor, we wanted her opinion and she said 'have a paediatric assessment done and an allergy assessment.' That's where we went to him the naturopath he was recommended by my GP. Furthermore, almost as many informants accessed other alternative therapies and or practitioners through allopaths as through alternative practitioners. This is somewhat surprising, as people remain reluctant to disclose their use of alternative therapies to physicians (Eisenberg et al.1993 Montbriand and Laing 1991 Perlman et al. 1999 Ramsay et al. 1999). However, to the degree that the boundaries between allopathic and...


However, they do have different physical properties, and the surgeon needs to have a basic grasp of the underlying science (and art) of wound care. Enzymatic agents (e.g., streptokinase-streptodornase) undoubtedly digest the constituents of slough. However, they are relatively ineffective against deep necrosis or hard eschar. There is evidence that they speed up healing, and may damage the wound environment. Hydrocolloid dressings come in many forms, and are generally impermeable to gases, water vapor, and bacteria. They produce a moist, acidic, low-oxygen tension wound environment that has been shown experimentally to enhance wound healing. Patients like these dressings because they are easy to use, and patients can bathe with the dressing in situ. The dressings absorb exudate (reducing the frequency of dressing changes, smell, risks of cross-infection, and costs) and may provide superior pain relief. However, in randomized controlled trials where both treatment...


The role of sclerotherapy is controversial, with practitioner's views based largely on professional background and country of origin rather than on clinical comparative studies. Some scle-rotherapists believe they can treat all VVs, but most accept the superiority of surgery in the presence of main stem, SFJ, or SPJ incompetence. However, the advent of foam sclerosants may revolutionize the management of such disease. The aim is to place a small volume of sclerosant in the lumen of a vein empty of blood, and then appose the walls of that vein with appropriate compression. The vein then fibroses closed without the formation of clot. Some practitioners use magnifying loupes for smaller veins, and there is increasing interest in injecting larger veins under ultrasound guidance (echosclerotherapy). The vein must be kept empty of blood both during and after the injection to prevent thrombophlebitis. Adequate compression is difficult in the perineum, upper thigh, and popliteal fossa,...


This type of wound may be caused by a jellyfish, Portuguese man-of-war, anemones, corals or hydras. The treatment in this case is to inactivate the area with alcohol and sprinkle the wound with meat tenderizer (coalesce with powder) and scrape the area. The cause for the intense burning pain that occurs from the sting of the jellyfish is from nematocysts (stinging cells) found on the jellyfish's tentacles. For several days, these cells remain potent when the sea creature is washed up on shore. To prevent further stinging from the wound, apply 95 alcohol to neutralize the protein toxin of the nematocyst, apply the meat tenderizer. After the powder dries the area, the stings will stick together and you can remove the stings by scraping the area. The complications from this type of wound may be allergic reactions or respiratory arrest. (An alternate treatment is the use of hot water as explained in the following paragraph.) c. Puncture by Spines. Punctures may be...

Volume 1

Section E surveys the numerous trauma-associated conditions with important time-sensitive diagnostic and management considerations. This section includes discussions on the management of intoxication due to alcohol, drugs, poisoning, and envenomations. Anaphylaxis and allergy are discussed with specific implications for the trauma patient. Burn injuries are extensively reviewed, as are cold- and heat-related injuries, near-drowning, and weapons of mass destruction. In addition, the less frequently encountered trauma demographics (e.g., pediatrics, geriatrics, obstetrics) each have their own dedicated chapters. Finally, the pitfalls in trauma management and the elements constituting the tertiary survey are fully described.

Preventive Measures

Any time you are using a serum with an animal base, extracts which are known to cause allergic reactions, or contrast media containing iodide, you should have epinephrine hydrochloride (Adrenalin) available. An antihistamine, aminophylline, and levarterenol should also be available. The patient should be kept under observation for at least twenty minutes. If a reaction occurs within the first few minutes, there could be a medical emergency. Notify the doctor at the first sign of symptoms such as redness and itching at the injection site, itching eyes, nasal symptoms or a tight feeling in the chest. If there is a slight reaction, the doctor will order an antihistamine by mouth. In a more severe case, the antihistamine is given parenterally and a tourniquet should be applied above the injection site. Adrenalin is frequently injected into the site. Periodic injections of Adrenalin can be given until the reaction begins to reverse or tachycardia develops. Aminophylline may be given to...

Checking Drawers

After the cassette(s) for a nursing unit is (are) filled, the drawers should be checked by a registered pharmacist whenever possible. The pharmacist will check each medication drawer, compare it with the patient profile, and ensure that each medication listed on the patient profile has the corresponding medication and or a tag in the drawer. The correct medication, strength, and number of doses must be present. The pharmacist may also make one more check for overdoses, allergies, drug interactions, contraindications, and incompatibilities. This check becomes one more step in the quality assurance program to insure patient safety. After the drawers are filled and checked, the cassette is ready for delivery to the ward.


The X-Ray Requisition Form (SF 519-A or-B). The radiology department should enter an accurate and complete recording of the patient's exam on the x-ray requisition form (SF 579-A or-B). The x-ray technologist will need to review the clinical history, the history of treatment, and any allergic conditions before proceeding. If there is a request for a neck exam, the requisition form should specify which kind, soft tissue neck or cervical spine neck. By indicating what is wrong with the patient in the patient's history, e.g., penny lodged in the throat, the radiographer then knows that a soft tissue neck exam, and not a cervical spine exam, is required.

Thrombolytic Agents

The incidence of intracranial hemorrhage is < 1 with all agents. Slightly more than 25 of patients will have mild-to-moderate systemic bleeding complications.10'14'15 Streptokinase can produce allergic reactions (3.6 ) or hypotensive reactions (up to 10 ),but they are rarely severe.10 Antibodies to streptokinase limit its effectiveness on a second occasion, and a previous exposure to streptokinase is an indication for the utilization of one of the other agents.

EThe Adolescent

Anaphylaxis (anaphylactic shock) is an immediate, severe hypersensitivity. This allergic reaction may occur to a person who comes in contact with something to which he is extremely allergic. This type of shock is a true emergency, requiring medications to combat the allergic reaction. (1) Is there a family history of asthma or allergies (2) Does the child have known allergies If the answer is yes, he could have asthma.


In an address to the annual meeting of the Tennessee Society of Radiologic Technologists (1991), Michael R. Bloyd, R.T., R.N. expressed his concern about x-ray technologists who carry out procedures on a daily basis that are legally and ethically questionable.7 Bloyd maintains that technologists should question any order from a physician that they are skeptical about or that they don't understand.8 Some x-ray technologists don't feel a personal sense of responsibility for their actions because they rationalize that it is the radiologist who is ultimately responsible for what goes on in the radiology department. But, in fact, every x-ray technologist must, to some extent, assume personal responsibility for his or her own actions. Starting your own IV, injecting narcotics such as Valium, or injecting contrast agents are actions outside the scope of practice. Performing these tasks means that the x-ray technologist is actually practicing medicine or nursing and that is against the law,9...


Advantages and Disadvantages of Micronized Acellular Dermis for Clinical UseThe principal advantage of micronized acellular human dermis reflects its origin as human tissue. It is not believed to be allergenic and therefore requires no pre-testing prior to its use. This allows it to be used in nearly all clinical scenarios on short notice. This is in contrast to bovine collagen preparations, such as Zyplast Zyderm (Inamed, Santa Barbara, Calif.), which do require allergy testing. The testing process itself is not an obstacle, but it can delay the treatment process up to 4 weeks, which has been the recommended observation period following skin test prior to injection for bovine collagen. It is noteworthy that many practitioners, including the present author, choose to wait only lweek following skin testing for bovine collagen injection laryn-goplasty. The advantage remains with micronized acellular dermis, however, as the patient with aspiration or difficulties with travel cannot wait...

Items 458460

The foods most likely to cause allergic reactions include egg, milk, seafood, nuts, and soybeans d. The organ systems most frequently involved in allergic reactions to foods in adults are the respiratory and cardiovascular systems e. Immunotherapy is a proven therapy for food allergies

Antibiotic Selection

Peri-operative prophylaxis should target all pathogens that could be encountered in a possible infection of the surgical site and implant, including Staphylococcus aureus and various skin colonizers. For vascular surgery of the lower extremities and in the case of groin incision, addition of an agent with coverage for Gram-negative pathogens is advisable (usually an aminoglycoside). For intra-abdominal surgery coverage for anaerobes may also be added (usually metronidazole) 54, 94 . According to the recently published consensus positions of the Surgical Infection Prevention Guideline Writers Workgroup (SIP-GWW), taking part in the US Medicare National Surgical Infection Prevention Project, the recommended antimicrobials for cardiothoracic and vascular surgery include cefazolin and cefuroxime 2 . In patients with a history of serious -lactam allergy, vancomycin is recommended as the first alternative agent. Clindamycin may serve as a second alternative, if local antimicrobial...

Toxic Hepatitis

Toxic hepatitis is hepatitis caused by the direct action of poison on the liver cells. These chemicals may be taken into the system by inhalation, ingestion, skin absorption, or injection. The chemicals can cause liver poisoning, a hepatitis-like reaction, an allergic reaction that inhibits the flow of bile (hypersensitivity cholestasis) or bile flow inhibited by steroids (steroid cholestasis).


His pain had faded by the time of arrival in the emergency department, and an initial ECG and enzyme studies had been negative. Nonetheless, he had been admitted to the CCU by his family physician with a preliminary diagnosis of unstable angina. Your review of the admitting nursing notes had revealed that he is a one and one-half pack a day smoker, and leads a sedentary lifestyle. He is on no medications, and actually has not seen a physician in several years. His father had coronary artery bypass surgery when he was 70 years of age. He has no known allergies.


The dose of sulphasalazine ranges from 1,000 to 2,000 mg day, divided into two doses. Frequently occurring side effects include GI tract disturbances, nausea, vomiting, gastric distress and headache. Sulphasalazine can induce myelosuppression. Photosensitivity and allergic reactions may induce rash. Typically, sulphasalazine is indicated in patients with spondylarthropathies as a disease-modifying or steroid-sparing drug. For the treatment of uveitis, sulphasalazine is used as a preventive measure to maintain remissions of anterior uveitis. In a prospective 3-year follow-up of patients it was shown that sulphasalazine significantly reduced the number of relapses and the severity of anterior uveitis associated with ankylosing spondylitis 7 . Another retrospective study demonstrated that sulphasalazine

Laboratory Studies

Deet is the active ingredient of most commercially available skin repellents and is the most effective insect repellent available at this time (Fradin and Day, 2002). It should be the standard against which the effectiveness of alternative repellents is judged (WHO, 1996). It is always preferable to conduct tests on human volunteers for greatest accuracy, provided that laboratory-reared mosquitoes are used to eliminate the risk of disease transmission, and the volunteers selected show mild or no allergic reaction to mosquito bites. It is conventional to use Aedes aegypti mosquitoes for repellent testing, but people generally show milder reactions to Anopheles bites. Ae. aegypti are commonly used, as they are easy to rear under laboratory conditions and are avid biters. However, several other species also fulfill these criteria, including An. stephensi, Anopheles gambiae s.s., Anopheles arabiensis, and Anopheles albitarsis. The U.S. EPA (1999) recommends using Ae. aegypti along with a...


Selegiline is not a first-line agent for the treatment of AD. It is more costly and has a more malignant side effect profile than vitamin E. Selegiline may be offered to patients who are unable to take vitamin E because of allergy, sensitivity or coagulopathy risk, but they should be well informed that selegiline is not a standard of care for AD.


Complication rates for vasectomy and vasovasostomy are low, but include bleeding, secondary skin infection, and drug allergy due to the use of local anesthesia. The vasectomy offers a relatively safe outpatient procedure that may prove attractive, particularly in the partners of older women in whom the complication rate for tubal procedures may be markedly higher.

DA Form 4256

The information on the profile is obtained from the DA Form 4256, Clinical Record-Doctor's Orders (figure 2-3) and other documents found in the inpatient record (chart). DA Form 4256 is a set made up of three copies. The original copy stays in the patient's chart, the second copy goes to the pharmacy, and the third copy is placed in the nurse's book. The second copy is pink in color and is referred to in the pharmacy as the pink sheet. The form is perforated at four places so that as an order is written, that portion may be removed and sent to the pharmacy. When the profile is prepared, the specialist should transcribe the patient information data, allergies, diagnosis, and preexisting conditions as listed in the chart. He should transcribe the physician's order exactly as it is written on the DA Form 4256 and place his initials in the appropriate space.


This category includes lichen simplex chronicus and epithelial hyperplasia, and in the past was often called leukoplakia or hyperplastic dystrophy. Clinically, this typically presents with complaints of itching and burning, and often follows contact with a topical irritant, although the patient may not recall such an exposure. Any part of the vulva may be affected, and the skin may appear erythematous with fissuring and excoriation. Lichenification, or the accentuation of normal skin markings, which results in thickening and raised white plaques, is also commonly seen. The process may be localized or diffuse and can been seen in all of the reproductive stages. This condition frequently may be associated with long-term use of topical therapies such as antifungals or steroids for other conditions, and may be causally related. A history of atopy, allergies, or eczema is also a likely risk factor.


The answer is a. (Yudofsky, 3 e, pp 455-459.) The patient's perse-cutory delusions and disorganized thinking could suggest a psychotic disorder such as schizophrenia or brief reactive psychosis, but fluctuations in consciousness and disorientation are typically found in delirium. Disturbances in memory, language, and sleep-wake cycles are also typical of delirium. Delusions, hallucinations, illusions, and misperceptions are also common. The causes of delirium are many and include metabolic encephalopathies, such as the hyperglycemic encephalopathy experienced by the patient in the vignette intoxication with drugs and poisons withdrawal syndromes head trauma epilepsy neoplasms vascular disorders allergic reactions and injuries caused by physical agents (heat, cold, radiations).

Xomed Silastic Block

Arytenoid Adduction With Thyroplasty

Silicone elastomer, commonly referred to as Silastic, is a polymerized form of silicone gel. Silastic is inert material which is well tolerated when implanted into the human body. A long track record of Silastic use exists (mostly in the orthopedic literature), and approximately 25 years of experience have accumulated for its use in the larynx 1 . Silastic can be used successfully as a long-term material for glottic insufficiency in both immobile and mobile vocal folds. Type-I allergic reactions and granuloma formation long-term complications are almost non-existent 2 . 2. Hunsaker DH, Martin PJ (1995) Allergic reaction to solid silicone implant in medial thyroplasty. Otolaryngol HeadNeck Surg 113 782-784

Blocking infection

Another way probiotic microorganisms are known to protect against pathogens is via their ability to stimulate intestinal mucosal immunity (Blum and Schiffrin, 2003 Fioramonti et al., 2003). Probiotic microorganisms also help maintain intestinal homeostasis, but the mechanisms they use to do so are not clear (Blum and Schiffrin, 2003). In spite of our inadequate understanding of the mechanisms by which probiotic microorganisms exert their beneficial effects, evidence exists that supports their use in the treatment of various human health problems ranging from foodborne infections, diarrhea, cancer, food allergies, and inflammatory bowel disease (for reviews see Reid et al., 2003a,b Salminen, 1999). Despite their medical promise, many problems remain concerning the use of probiotics. Chief among these concerns is the general lack of large-scale trials to test the safety and efficacy of probiotic use (Tannock, 2003). Regarding the safety of probiotics, specific concerns have emerged...

Immune System

The answer is d. (Murray, 5 e, p 93.) IgE is found on the surface of mast cells and basophils. When antigen binds to the IgE, the mast cell releases various mediators involved in allergic reactions and antiparasitic defense. 21. The answer is a. (Fauci, 14 e, p 877.) A superantigen can activate T cells without binding to the T cell receptor in an antigen-specific manner. Therefore, the superantigen can stimulate a large number of T cells, which can result in massive cytokine release, causing shock and tissue damage. An antigen that can activate B cells without T cell help is called a T-independent antigen. Haptens, usually small molecules, can become antigenic when attached to carrier proteins. Adjuvants can help in maintaining antigen at a tissue site. It does not evoke IgE, which is found in allergic reactions. 24. The answer is c. (Murray, 5 e, p 114.) Delayed type hypersensitivity (DTH) responses are important in protection against intracellular bacteria. In this type of response,...

Zidovudine Toxicity

Discussion Significant dehydration and electrolyte imbalance may occur in loop diuretic overdose. These compounds (furosemide, bumetanide, and ethacrynic acid) are potent diuretics that inhibit the Na K 2C1 transport system, which can result in hypokalemic metabolic alkalosis. Potassium replacement and correction of hypovolemia can reverse this toxicity. Additional adverse effects include ototoxicity, hyperuricemia, allergic reactions (except for ethacrynic acid which is not sulfa-derived) and hypomagnesemia.


A 21-year-old woman comes to the office complaining of sore throat, rash, and fatigue. The sore throat and fatigue began roughly 8 days ago, accompanied by a subjective fever (temperature not recorded). Three days before this visit, the patient visited an urgent care center and was given amoxicillin for her symptoms. A rash subsequently developed- The patient denies any drug allergies and remembers taking some kind of penicillin several years ago without having a problem. Her sore throat and fatigue did not improve with the amoxicillin. Vital signs are as follows

Medical Histories

Patients may be allergic or hypersensitive to any of a number of drugs or materials used in dentistry. The dental officer must take a thorough history, so that he may avoid the use of drugs and materials to which the patient may have an unfavorable reaction.

Cosmetic camouflage

Camouflage creams differ from ordinary cosmetics in that they have a greater opacity, therefore greater covering power, and they are waterproof if treated with care. The creams contain some sunscreen, but sunblock can be worn under the camouflage creams as additional protection. There are very few recorded cases of patients having an allergic reaction to camouflage creams, although some of the brands do contain lanolin.

Failure to Thrive

Failure to thrive can result from malnutrition (starvation, deprivation, abuse), malabsorption (from infection, celiac disease, cystic fibrosis, disaccharidase deficiency, protein-losing enteropathy), allergies, immune deficiency states, and chronic disease.