The American journal of medicine
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To investigate the effects of chronic marijuana smoking on lung function, pulmonary function tests including single-breath carbon monoxide diffusing capacities were performed in 15 healthy women who smoked 1.7 +/- 1.4 (mean +/- SD) marijuana cigarettes per day for 235 +/- 135 days per year for a mean of 10.5 +/- 3.7 years. Control groups included 27 nonsmoking and 26 tobacco-smoking women. ⋯ The subset of subjects who smoked marijuana and tobacco had a further reduction of the single-breath carbon monoxide diffusing capacity to 65 +/- 17 percent, which was significantly different from that in both nonsmoking and smoking control subjects (80 +/- 7 percent). These results suggest that heavy marijuana smoking when added to tobacco smoking may damage the gas exchange surface of the lung.
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Historically, diabetic ketoacidosis has been attributed exclusively to the accumulation of ketoacids resulting in wide anion gap metabolic acidosis. An unusual patient with non-insulin-dependent diabetes mellitus who presented with mild hyperglycemia, ketonemia, and acidosis with a normal anion gap is described. No other known causes of hyperchloremic metabolic acidosis were present, and resolution of acidosis followed administration of intravenous insulin. This case illustrates that the finding of a normal anion gap, per se, may not exclude the presence of diabetic ketoacidosis.
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Randomized Controlled Trial Comparative Study Clinical Trial
Flurbiprofen, aspirin, codeine, and placebo for postpartum uterine pain.
Flurbiprofen (Ansaid, Upjohn), a substituted phenyl propionic acid, is a new analgesic/anti-inflammatory agent. To evaluate its relative efficacy in noninflammatory pain, 159 hospitalized women with moderate or severe postpartum uterine cramps were given single oral doses of 50 mg of flurbiprofen, 650 mg of aspirin, 60 or 120 mg of codeine sulfate, or placebo in a parallel, stratified, randomized block, placebo-controlled, double-blind trial. Patients rated pain intensity, pain relief, and side effects in uniform interviews for six hours after treatment. ⋯ Results of codeine treatment were equivocal with no evidence of a positive dose response. Side effects were unremarkable except for dizziness and drowsiness after the 120-mg codeine dose. These findings suggest that flurbiprofen as an analgesic for patients with postpartum uterine pain is equivalent to aspirin and superior to codeine.
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Isolated dissecting hematoma (aneurysm) of a coronary artery is a rare occurrence that often results in myocardial infarction and sudden death. A case of dissecting hematoma involving the left main, left anterior descending, and left circumflex coronary arteries is described in a patient who had received vigorous closed-chest cardiac resuscitation. This is believed to be the first reported case of coronary artery dissection caused by epicardial trauma from closed-chest cardiac resuscitation. This case demonstrates that dissecting hematoma of the coronary artery can be a complication of cardiac resuscitation.
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In order to assess the frequency and severity of lactic acidosis and 3-hydroxybutyric acidosis in ethanol abusers, 29 patients who presented to an emergency room with acute intoxication were tested. Most were also chronic ethanol abusers but were not otherwise seriously ill. Their serum ethanol concentrations averaged 226.5 +/- 94.8 mg/dl (range 98 to 426 mg/dl). ⋯ Only two patients had even trivially elevated plasma levels of 3-hydroxybutyrate, 1.0 and 1.2 mmol/liter. Thus, these patients did not have unrecognized "alcoholic ketosis" manifested mainly as 3-hydroxybutyric acidosis. An unexpected and unexplained finding was the presence of hyperchloremia in 10 of the 29 patients, with serum chloride levels of more than 110 mmol/liter.