Chronic urticaria in a 17-year-old patient with a past history of bowel disease.
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Adolescent↗
Biomedical subjects
B A Muller
Publications and source records attributed to B A Muller.
Sinusitis and its relationship to asthma. Can treating one airway disease ameliorate another?
In a large percentage of patients with upper airway disease, asthma and sinusitis occur concomitantly. As many as 88% of patients with asthma exhibit the symptoms of rhinitis, and half of rhinitic patients have asthma. In this article, Dr Muller explores the interrelationship of sinusitis and asthma, including characteristics, mechanisms of action, and diagnosis, and provides suggestions for optimal treatment of both.
Asthma↗
Fluvoxamine for somatoform disorders: an open trial.
Although the pharmacologic treatment of somatoform disorders has scarcely been investigated, there is reason to believe that antidepressants might be useful. We examined the response of 29 patients with somatoform disorders from a general medicine clinic to a selective serotonin reuptake inhibitor, fluvoxamine. The drug was administered in doses of up to 300 mg daily for 8 weeks. Sixty-one percent of the patients who took medication for at least 2 weeks were at least moderately improved. In addition to antidepressant effects, fluvoxamine had other beneficial effects and was well-tolerated. The benefits of drug therapy were modest but appear to warrant a placebo-controlled trial.
Adult↗
Severe neuromuscular complications possibly associated with amlodipine.
OBJECTIVE: To document a case of severe, progressive myopathy, myalgias, arthralgias, and weakness possibly caused by amlodipine in a patient with benign essential hypertension. CASE SUMMARY: A 52-year-old white woman with asthma and newly diagnosed hypertension was initiated on zafirlukast therapy for asthma and amlodipine therapy for hypertension. Two months later, the patient reported severe, generalized muscle and joint pain, muscle stiffness, and weakness. The zafirlukast was discontinued without resolution of symptoms. Laboratory tests revealed an elevated C-reactive protein. The amlodipine dosage was increased. Her symptoms persisted and further laboratory tests revealed a positive anti-nuclear antibody screen, and negative single- and double-stranded DNA antibody tests. After another amlodipine dosage increase, the patient experienced a sudden onset of left-sided facial numbness, facial weakness, and a severe headache.The patient was admitted to rule out a possible cerebrovascular event or a metabolic neurologic process. Magnetic resonance imaging showed no abnormalities. The patient discontinued the amlodipine and reported complete resolution of the neurologic symptoms after 4 days. One month later, zafirlukast was reinitiated without a return of symptoms. CONCLUSIONS: Amlodipine was not initially suspected as a cause of these symptoms because these effects are not commonly associated with amlodipine therapy. However, due to the temporal relationship and progression of symptoms with increasing amlodipine dosage, drug-related causes were eventually explored. Review of the medical literature suggests myalgias and arthralgias may be adverse effects common to dihydropyridine calcium-channel antagonists.
Amlodipine↗
Prognostic value of methacholine challenge in patients with respiratory symptoms.
BACKGROUND: The objective was to study the current clinical status of 78 adults with respiratory symptoms, who were referred 3 to 10 years ago for diagnostic methacholine challenge. We tested the hypothesis that methacholine hyperresponsiveness would be associated on follow-up with increased symptoms of chest tightness, dyspnea, wheezing, cough, and more frequent use of selected treatment modalities. METHODS: Current symptoms were evaluated by means of interview questionnaire, and methacholine challenge was repeated during follow-up examination. Comparisons were made between patients who were and those who were not hyperresponsive to methacholine at initial and follow-up challenges by using specific symptoms and calculated symptom and treatment scores. RESULTS: We found that subjects who had positive methacholine challenge results on initial challenge (n = 37) were significantly more likely than those with negative results (n = 41) to have nonexertional chest tightness, wheezing, and dyspnea, but not cough. A high proportion of both groups had current symptoms. Two thirds of the patients continued to have positive (n = 25) or negative (n = 27) methacholine challenge results, and one third had a change in status (n = 26). Significant correlations were also found between follow-up methacholine responsiveness and concurrent symptoms, again with the exception of cough. CONCLUSIONS: Methacholine challenge warrants cautious interpretation in the individual patient as an aid to diagnosis and prognosis in the evaluation of respiratory symptoms, especially cough.
Adult↗
Comparisons of specific and nonspecific bronchoprovocation in subjects with asthma, rhinitis, and healthy subjects.
BACKGROUND: We studied subjects with atopic asthma, atopic rhinitis, and nonatopic healthy subjects to evaluate responsiveness to bronchoprovocation with both methacholine and allergen. METHODS: Subjects with a demonstrable FEV1 PD20 to methacholine or allergen (responders) were further analyzed for putative sensitivity (PD20 FEV1) and reactivity (dose-response slopes) to determine whether any characteristics could distinguish individuals with asthma from other responders. Subjects were recruited without sex restrictions and were between the ages of 18 and 45 years old. They were nonsmokers, had no other medical problems, and were free of upper respiratory infection for at least 6 weeks before challenge. All had a history taken, physical examination, limited laboratory screening, chest radiography, pulmonary function testing, and intradermal skin testing before admission to the study. RESULTS: Although the groups were significantly different in both sensitivity and reactivity to methacholine, responses to allergen bronchoprovocation were sufficiently similar between responders with asthma and those with rhinitis to prevent separation on the basis of either sensitivity or reactivity. The fall in FEV1 at the nadir of the late response, which was greater in the asthma group, was significantly correlated with sensitivity and reactivity of the immediate response to allergen but not to methacholine. Regression analysis demonstrated a stronger association between allergen and methacholine responsiveness in subjects with rhinitis than in subjects with asthma. CONCLUSION: We concluded that (1) nonspecific bronchial hyperresponsiveness fails to explain why patients with allergic asthma have clinical asthma as a result of allergen exposure and patients with allergic rhinitis do not; (2) hyperresponsiveness to allergen does not simply reflect quantitative or qualitative airway nonspecific hyperresponsiveness; and (3) clinical asthma may involve mechanisms difficult to elucidate by laboratory bronchoprovocation techniques.
Adolescent↗
Health Attitude Survey. A scale for assessing somatizing patients.
The authors designed an instrument, the Health Attitude Survey, to assess somatization, and administered it to over 1,000 patients attending a general medicine clinic. Within this population, a series of somatizing patients and control patients were identified for purposes of developing and testing the instrument. The 27-item scale was rapidly administered and acceptable to the patients. Based on comparisons with other measures of somatization, the instrument appeared to be a valid measure of the attitudes and perceptions of somatizing patients, and it distinguished these patients from the control subjects. The measure showed acceptable predictive value and may prove useful in clinical settings, where rapid screening is desired.
Adult↗
Personality dysfunction among somatizing patients.
To examine the nature and extent of personality dysfunction related to somatization, the authors administered the Structured Interview for DSM-IV Personality and the NEO Five-Factor Inventory to a series of somatizing and nonsomatizing patients in a general medicine clinic. A greater percentage of somatizers met criteria for one or more DSM-IV personality disorders, especially obsessive-compulsive disorder, than did control patients. Somatizers also differed from control patients with respect to self-defeating, depressive, and negativistic personality traits and scored higher on the dimension of neuroticism and lower on the dimension of agreeableness. In addition, initial and facultative somatizers showed more personality pathology than true somatizers. These findings suggest that certain personality disorders and traits contribute to somatization by way of increased symptom reporting and care-seeking behavior.
Adult↗