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PubMed1976

[Pulmonary reactions to non-infective antigenic contaminants].

There are different categories of non-infectious antigenic contaminants capable of provoking pulmonary reactions: thermophilic actinomycetales, fungi, vegetable particles, protein antigens, arthropods, drugs; their identification is based on their isolation, culture, and the study of their biochemical composition. The pulmonary reactions depend on the size and number of antigenic particles inhaled and by the underlying background. The immunological mechanisms brought into play a complex Arthus's phenomenon: in addition to the IgGs, the IgEs and the different factors of complement intervene; the recent acquisitions of immunomorphology enable better comprehension of the histogenesis of the pulmonary granuloma. The diagnosis of extrinsic allergic alveolitis is founded on well defined criteria of clinical, radiological, respiratory functional, immunological and histophthological order. These conditions are met with in agricultural, industrial and urban environments or are related to iatrogenic diseases. Many problems still remain obscure with regards to the pathogenesis and integration within the framework of immunological pneumonia of various conditions, and especially certain sarcoidosis.

Antibodies↗
PubMed2003

[Orthostatic hypotension and its treatment in the elderly].

DEFINITION CRITERIA: Orthostatic hypotension (OH) is a frequent pathology in the elderly, defined, since the consensus meeting in 1996, as a drop in systolic blood pressure of > or = 20 mmHg and/or diastolic blood pressure of > or =10 mmHg, 1, 2 or 3 minutes after orthostatism. SEVERAL RISKS: Orthostatic hypotension is associated with the risk of falls and is a limiting factor in the patients' autonomy and quality of life. However, it is also an independent predictive factor of mortality, which should justify its fairly systematic research in the elderly. MULTIPLE CAUSES: Its multi-factor origin is enhanced by certain modifications related to age (autonomous nervous system, arterial wall), but above all by the numerous pathological situations and predominantly the iatrogenic disease, hypertension, or frequent situations in geriatrics such as anaemia and dehydration that must be systematically explored. THERAPEUTIC MEASURES: Its treatment relies on the elimination of the enhancing element, the patient's education, the wearing of elastic stockings and, at a later stage, administration of treatments such as midodrine.

Aged↗
PubMed2003

A prospective analysis of inpatient consultations to a gastroenterology service.

The provision of a formal consultation service for inpatients between subspecialists is little studied. We prospectively surveyed the pattern of inpatient consultations from hospital-based generalists and surgeons to the gastroenterology (GI) service for inpatients in a large urban teaching hospital over a 5 month period. There are two GI consultants/attendings and five GI registrars/fellows on the service. A formal consultation is made by the requesting team to the GI service using the hospital computer network. All referrals over a 5 month period were prospectively analysed. 242 consecutive inpatient referrals were sent to the GI service over 5 months. Average age was 56 years, 48.8% males. 32 consultants/attendings from other disciplines sent referrals. Most patients were seen within one working day. Urgent referrals were seen without delay. The commonest reasons for referral were abdominal pain (15.8%), percutaneous endoscopic gastrostomy (PEG) tube insertion (13.6%), diarrhoea (12.8%), abnormal liver blood tests (10%), nausea and vomiting (8.2%), anaemia (6.2%), and melaena (4.9%). Iatrogenic diseases accounted for 6.2% of consultations. Ongoing patient care was assumed by the GI team in 9.5% of referrals. 15.3% required a second consultation visit before discharge. 22.7% of referrals were followed in the GI outpatients' clinic after discharge. 51.2% underwent an endoscopic procedure. 13.6% of referrals were for PEG tube insertion. A quarter of these were considered unsuitable for immediate PEG tube insertion. Subspecialty consultation provides an expert opinion, encourages discussion and learning, and improves patient care. In our experience, the provision of specialist advice and reassurance often speeded up a patient's work-up and expedited discharge. However, evaluating referral patients and subsequently providing ongoing inpatient and outpatient care and provision of endoscopy for these referrals contributes significantly to the workload of the GI service.

Adolescent↗
PubMed1978

Adverse effects from topical steroids.

The introduction of topical corticosteroids greatly expanded the practitioner's dermatologic armamentarium and at the same time augmented the list of local and systemic iatrogenic diseases with which he must deal. A recent review of the literature was undertaken to determine the adverse effects seen with topically administered corticosteroids. These were found to be arbitrarily assignable to eight categories: pilosebaceous, atrophic, therapeutic, immunologic, cosmetic, endocrinologic, oculonasal, and allergic. A brief discussion of the individual entities seen in each category as well as the etiology, when known, and treatment, if any, are included in this discussion.

Administration, Topical↗