JAMA : the journal of the American Medical Association
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Case Reports
Hyperosmolality induced by propylene glycol. A complication of silver sulfadiazine therapy.
An 8-month-old male infant was treated with topical silver sulfadiazine for a burn and complicating toxic epidermal necrolysis involving 78% of his total body surface area. Transdermal absorption of propylene glycol from the silver sulfadiazine produced hyperosmolality with an increased osmolal gap. ⋯ Elevated concentrations of propylene glycol may have contributed to the patient's cardiorespiratory arrest. The osmolal gap may be used as a screen for suspected propylene glycol intoxication in selected clinical settings.
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Coffee intake from three-day diet records was studied in association with plasma lipoprotein concentrations in a cross-sectional sample of 77 middle-aged American men to determine the significance and form of their interrelationships. The number of cups consumed per day correlated positively with levels of apolipoprotein B (r = .27, P less than or equal to .01) and became more strongly correlated when adjusted for age, cigarette use, adiposity, aerobic capacity, nutrient intake, and stress. ⋯ Graphic analyses revealed that plasma concentrations of apolipoprotein B and LDL-cholesterol were unrelated to intake of up to 2 cups of coffee per day and positively associated with intake exceeding 2 to 3 cups. These results suggest that male heavy coffee drinkers have lipoprotein profiles suggestive of increased cardiovascular disease risk, although the causality remains to be determined.
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Although the cesarean section rate has increased steadily for the past 12 years, further increase seems unlikely since the indications for performing the operation are already broadly defined. Most of the earlier indications will remain unchanged (eg, the presence of placenta previa and cephalopelvic disproportion). The trend toward vaginal delivery in perhaps 30% to 40% of breech births will probably have no material effect on the number of cesarean sections performed, and the present use of cesarean section for multiple pregnancy will probably continue. ⋯ Cesarean section mortality is much lower than it was in former years, but one may expect from one to two deaths per 1,000 operations. Overall, the maternal mortality from cesarean section per se is probably from three to five times higher than that of vaginal delivery (in one series, 11.5 times higher than vaginal delivery). The incidence of mild, transient respiratory signs in the newborn is higher after cesarean than after vaginal delivery, and the incidence of respiratory distress syndrome is also slightly higher.(ABSTRACT TRUNCATED AT 400 WORDS)
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Scurvy is a disease that can mimic other more serious disorders such as deep vein thrombosis, vasculitis, and systemic bleeding disorders. Because the clinical features of scurvy are no longer well appreciated, scorbutic patients are often extensively evaluated for other disorders. Familiarity with the risk factors for and clinical manifestation of scurvy can facilitate earlier diagnosis. We report three patients who highlight the epidemiology, clinical features, and differential diagnosis of scurvy.