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1/10. Reactive airways dysfunction and systemic complaints after mass exposure to bromine.

    Occasionally children are the victims of mass poisoning from an environmental contaminant that occurs due to an unexpected common point source of exposure. In many cases the contaminant is a widely used chemical generally considered to be safe. In the following case, members of a sports team visiting a community for an athletic event were exposed to chemicals while staying at a local motel. bromine-based sanitizing agents and other chemicals such as hydrochloric acid, which were used in excess in the motel's swimming pool, may have accounted for symptoms experienced by the boy reported here and at least 16 other adolescents. Samples of pool water contained excess bromine (8.2 microg/mL; ideal pool bromine concentration is 2-4 microg/mL). Symptoms and signs attributable to bromine toxicity included irritative skin rashes; eye, nose, and throat irritation; bronchospasm; reduced exercise tolerance; fatigue; headache; gastrointestinal disturbances; and myalgias. While most of the victims recovered within a few days, the index case and several other adolescents had persistent or recurrent symptoms lasting weeks to months after the exposure.
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ranking = 1
keywords = hydrochloric acid, acid
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2/10. Supraesophageal complications of gastroesophageal reflux.

    Supraesophageal complications of GERD have become more commonly recognized or suspected by physicians. However, the direct association between these complications and GERD has often been difficult, if not impossible, to establish. Furthermore, the majority of patients with suspected supraesophageal complications of GERD do not have either the characteristic symptoms of heartburn and regurgitation or the definitive findings of esophageal inflammation, which would help reinforce the suspicion of a connection between the supraesophageal complications and GERD. Frequent acid reflux has been shown in patients with various bron-chopulmonary, laryngopharyngeal, or oral cavity disorders. GERD is one of the most common gastrointestinal complaints in the population. It is possible that the supraesophageal problems and acid reflux are mutually independent disorders that occur in the same person. The suspected mechanisms of GERD-related supraesophageal complications appear to be directed through two pathways: by a vagal reflex between the esophagus and tracheobronchial tree triggered by acid reflux or by microaspiration that causes contact damage to mucosal surfaces. The most useful diagnostic modality available to the clinician to aid in the diagnosis of supraesophageal GERD complications is the ambulatory pH recording technique. However, the sensitivity and specificity of this test for recording esophageal or pharyngeal acid reflux events has been critically challenged. Despite the many clinical studies that support the theory that GER has a role in suspected supraesophageal complications, only 1 long-term prospective controlled study of a large group of patients with asthma has shown the positive effects of the elimination of acid reflux. With the focus now on "outcomes medicine," there is a serious need for appropriately designed, controlled studies to answer the many questions surrounding a cause-and-effect association between acid reflux and supraesophageal disorders. Because of the lack of convincing proof between acid reflux and suspected supraesophageal complications, the physician must resort to an intent-to-treat strategy as both a primary therapy and a diagnostic trial. High-dose PPI therapy for prolonged periods is the recognized conservative therapy. Operative therapy (i.e., fundoplication operation) is the procedure of choice when overt regurgitation occurs or when medical therapy, although successful, is not practical for long periods. Controlled, well-designed clinical trials and more sophisticated techniques to measure and quantify acid reflux are crucial in the future to help determine which patients with suspected supraesophageal complications actually have acid reflux as a primary cause. The medical community needs to be alerted to the possibility of an association between GERD and supra-esophageal complications so that patients with a GERD-related complication will be recognized and effectively treated.
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ranking = 0.00012873670307561
keywords = acid
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3/10. Short-term lorazepam infusion and concern for propylene glycol toxicity: case report and review.

    A 34-year-old woman with a history of renal insufficiency induced by long-term cocaine use was admitted with acute shortness of breath remarkable for submandibular and anterior throat swelling. She required intubation, mechanical ventilation, and sedation. Sedation was administered with daily infusions of intravenous lorazepam 65, 313, and 305 mg for 3 days, respectively. Forty-eight hours into the infusion the patient experienced anion gap metabolic acidosis with hyperlactatemia, hyperosmolality, and increased osmolal gap. propylene glycol (PG), a component of lorazepam intravenous formulation, was considered the potential source of the metabolic abnormality. The patient received greater than 40 times the acceptable recommended amount of PG over 72 hours. Cessation of lorazepam produced major improvements in lactic acid, serum osmolality, and anion and osmolal gaps. The large PG exposure associated with long-term cocaine-induced renal insufficiency produced a toxic metabolic state. Agents containing PG should be avoided in patients with compromised renal function (creatinine clearance < or = 30 ml/min) induced by cocaine use.
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ranking = 2.8608156239024E-5
keywords = acid
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4/10. A novel CFTR mutation found in a Chinese patient with cystic fibrosis.

    BACKGROUND: Cystic fibrosis (CF) is rare in Chinese. We investigated the mutations in the gene of cystic fibrosis transmembrane conductance regulator (CFTR) in a Chinese CF patient and reviewed the clinical features, gene mutations in Chinese CF cases. methods: blood samples were collected from a previously reported CF girl and her parents. The 24 coding exons of CFTR of the proband were amplified and sequenced. RESULTS: A Chinese girl of 16 years old was diagnosed as CF at the age of 14. She had recurrent productive cough with bronchiectasis in bilateral upper lobes, parasinusitis and otitis media, but without pancreatic involvement. Her sweat chloride was (108.9 /- 3.3) mmol/L. A heterozygous novel missense mutation of 699 C --> A which results in the amino acid change of N189K was identified in exon 5. In addition, a heterozygous 3821 - 3823 delT mutation in exon 19 was found in CFTR. The mutation 699C --> A was inherited from her father, and the 3821 - 3823 delT mutation was from her mother. Twenty patients with CF in Chinese reported from 1974 to 2004 were also reviewed. DelF508 mutation was not found in the nine cases whose CFTR mutations were analyzed. CONCLUSIONS: The CF proband carries two heterozygous mutations (699C --> A and 3821 - 3823 delT) in CFTR. 699C --> A mutation is a novel mutation which is not reported previously. review of reported Chinese cases suggests that the genotype of Chinese CF may be different from those of white cases. More studies are needed to understand the spectra of CFTR and clinical CF features in Chinese.
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ranking = 1.4304078119512E-5
keywords = acid
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5/10. Respiratory cryptosporidiosis in a patient with malignant lymphoma. Report of a case and review of the literature.

    Respiratory cryptosporidiosis is a rare complication of intestinal infection by cryptosporidia, with only six cases reported (to our knowledge) since its first description in 1983. We report the first case of respiratory cryptosporidiosis recognized at the National Institutes of health, Bethesda, Md. An antemortem diagnosis was made based on recognition of acid-fast cryptosporidia in an induced sputum specimen obtained from a 64-year-old woman with malignant lymphoma and an associated profound immunodeficiency. autopsy confirmed the presence of cryptosporidia along the apical aspect of the respiratory epithelium lining the trachea, bronchi, and bronchioles. Cryptosporidia were also identified in the duodenum and gallbladder. Immunohistochemical staining of the paraffin-embedded autopsy lung sections using a monoclonal antibody verified the diagnosis of cryptosporidiosis. review of our case and the literature suggests that respiratory cryptosporidiosis is characterized by a chronic tracheitis, bronchitis, and bronchiolitis but generally does not cause severe pulmonary dysfunction.
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ranking = 1.4304078119512E-5
keywords = acid
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6/10. Increases in airway responsiveness following acute exposure to respiratory irritants. Reactive airway dysfunction syndrome or occupational asthma?

    We describe a persistent increase in nonspecific bronchial responsiveness following acute exposure to strong respiratory irritants in four subjects with no past history of asthma or atopy and in a subject with mild asthma. They were exposed either to a bleaching agent, sulfuric acid, hydrochloric acid, perchloroethylene, or toluene diisocyanate fumes. In all cases the inhalation of high concentrations of irritant fumes was brief (less than one hour) and induced acute symptoms of cough and dyspnea. The asthmatic subject developed a severe bronchospasm which required mechanical ventilation. In all subjects the exposure led to prolonged (more than one year) symptoms of variable airflow obstruction induced on contact with common respiratory irritants. In the previously normal subjects, a mild hyperresponsiveness to methacholine could be observed. The asthmatic subject became dependent on steroids. No change in the forced expiratory volume in one second was observed when the subject exposed to sulfuric acid was rechallenged in the laboratory, but her nonspecific bronchial responsiveness was then back to normal at this time. When those exposed to perchloroethylene or toluene diisocyanate fumes were reexposed to these agents, a late asthmatic response occurred, suggesting that the subjects developed occupational asthma after an intense short-term exposure to perchloroethylene or toluene diisocyanate. We conclude that airway hyperresponsiveness can develop or increase after the inhalation of high concentrations of irritants and that these changes may be prolonged. Occupational asthma following intense short-term exposure to sensitizing agents should be differentiated from airway hyperresponsiveness which results from a nonsensitizing mechanism, as in the reactive airway dysfunction syndrome.
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ranking = 1.0000286081562
keywords = hydrochloric acid, acid
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7/10. Respiratory disease in a photographer.

    Reversible airways obstruction occurred in a photographer after long-term exposure (over many years) to sulfuric and acetic acid fixers. air-exchange recommendations for darkrooms by the Building Officials Code Administration [1981] differ markedly from those recommended by the American Society of heating, Refrigerating, and Airconditioning Engineers [1977] and the fixer manufacturer (Eastman Kodak). Use of fume hoods or rates of air-exchange higher than are required by law may be necessary to prevent symptoms and disease in certain workers.
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ranking = 1.4304078119512E-5
keywords = acid
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8/10. Gastro-oesophageal reflux and adverse respiratory events in children under anaesthesia.

    The incidence of gastro-oesophageal reflux in children undergoing general anaesthesia has not previously been studied. One-hundred-and-twenty children (ASA Class 1-2) were studied intraoperatively using continuous oesophageal pH monitoring. The incidence of reflux was 2.5% (3 of 120). None of these three patients had an adverse respiratory event. There was no correlation between reflux and adverse respiratory events. Thirteen patients had minor respiratory events without evidence of acid reflux. Gastro-oesophageal reflux does occur in healthy paediatric patients having minor surgery, but was not a significant cause of the adverse respiratory events that occurred in our study.
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ranking = 1.4304078119512E-5
keywords = acid
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9/10. hydrochloric acid inhalation: who needs admission?

    Nine pharmaceutical workers were exposed to hydrochloric acid (HCl) fumes. Four were discharged with no symptoms after a 4 h observation period in the accident and emergency (A&E) department. The remaining five were admitted to the medical unit because of severe symptoms, reduced peak expiratory flow rate (PEFR), or hypoxaemia. Treatment was symptomatic and discharge followed 24 h later. Only one patient, discharged from the medical unit, developed long term airway hyper-reactivity, superimposed on a background of chronic obstructive airways disease. Thus patients who are minimally symptomatic with normal PEFR and oxygen saturation values can be safely discharged from the A&E department after a short observation period of 4 h with advice to return if dyspnoea occurs. Caution should be employed in severely symptomatic patients, those with pre-existing lung pathology or reduced PEFR, and hypoxaemic patients, where observation for at least 24 h is recommended.
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ranking = 1.0000572163125
keywords = hydrochloric acid, acid
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10/10. Spectrum of supraesophageal complications of gastroesophageal reflux disease.

    There is a growing body of clinical and research evidence to support the role of gastroesophageal reflux in the etiology of certain disorders occurring in structures located above the body of the esophagus. These supraesophageal complications have only recently been identified but substantiation of the role of gastroesophageal reflux has been difficult and sometimes impossible with the technology currently available. This introductory article to the clinical issues involved in supraesophageal complications of GERD presents several index cases and asks far more questions than it gives answers about these patients. Clinical evidence supporting the role of GERD is discussed and the results of therapy reviewed. education of the practicing physician to the role of supraesophageal complications of GERD is urged to help recognize the likelihood of such clinical conditions. There is a real need for additional clinical use and evaluation of multi site intraesophageal and pharyngeal pH probes in patients with suspected supraesophageal complications of GERD. More importantly, development of new techniques for measuring micro reflux events and sophisticated methods for determining the duration of acid exposure in tissues above the esophagus is essential. Finally, more prospective controlled outcome studies of patients with supraesophageal complications of GERD are needed utilizing specific treatment algorithms.
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ranking = 1.4304078119512E-5
keywords = acid
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