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Objectives: Musculoskeletal pain is a common emergency department (ED) presentation, and patient-centered care may improve quality of life, treatment satisfaction, and outcomes. Our objective was to investigate the expectations, definitions of success, and priorities of ED patients with musculoskeletal pain., Methods: We conducted a cross-sectional survey of the demographic, clinical, and psychosocial characteristics of adult ED patients (n = 210) with musculoskeletal pain. Patients completed the Patient-Centered Outcomes Questionnaire to quantify usual, desired, expected, and successful levels of pain and interference with daily activities, fatigue, and emotion from 0 (none) to 100 (worst imaginable). They also reported the importance of improvement in each domain. Cluster analysis identified subgroups by importance ratings. Patients were asked their willingness to try various pharmacologic and nonpharmacologic treatments. Fully completed surveys were analyzed (n = 174)., Results: Most patients desired 100% resolution in each domain and defined treatment success as substantial (median = 63.2%-76.5%) reductions but expected only moderate (median = 45%-53.7%) improvements across all domains. Patients with previous pain episodes had similar desired levels but less stringent definitions of success and expectations for improvement. Cluster analysis identified three patient subgroups by importance ratings of each domain: (1) multiple domains important (n = 118) with high importance attached to all four domains, (2) pain and function important (n = 34) with high importance primarily for pain and interference with daily activities, and (3) only pain important (n = 22). Regardless of subgroup, there was a high willingness to use a variety of pharmacologic and nonpharmacologic treatments., Discussion: ED patients with musculoskeletal pain have expectations and goals that include addressing impairments in function, improving quality of life, and reducing pain., Conclusions: Our findings indicate that: (1) patient subgroups by outcome priorities may exist that could inform multimodal, personalized approaches from the ED and (2) patients are flexible in which treatments they are willing to try to meet their individual goals., (© 2021 by the Society for Academic Emergency Medicine.)

A case of orbital metastasis of cervical keratinizing squamous cell carcinoma is presented. The patient, in remission from primary cervical and ovarian cancers, presented with complaints of left eye ptosis and pain. Examination revealed the presence of a moderately tender mass along the left supra-temporal orbital rim and downward displacement of the left globe. Computed tomography revealed a poorly circumscribed mass with superior lateral wall bone loss. Excised tissue contained invasive, poorly differentiated nests of pan keratin and epithelial membrane antigen-positive squamous cells with numerous pleomorphic multinucleated giant cells. Multiple treatment regimes were unsuccessful, and the patient expired due to disease complications after 3 months.

Purpose: To document reversible corneal edema caused by amantadine in a pediatric patient., Methods: A 14-year-old boy with a neurologic tremor was referred for bilateral visual loss. Our examination disclosed bilateral corneal edema without ocular inflammation. Pachymetry confirmed significantly increased corneal thickness above 900 microm., Results: Review of the patient's medical information revealed recent institution of amantadine as a means to control the patient's tremor. On cessation of this agent, rapid resolution of corneal edema and recovery of visual acuity occurred. Repeat pachymetry measurement revealed normal corneal thickness., Conclusion: In cases of corneal edema and in the absence of any identifiable ocular causes, a review of toxic effects of systemic medication should be undertaken. Amantadine can cause corneal decompensation and needs to be considered as part of the differential diagnosis of corneal edema.

A 29-year-old African American man presented to the emergency department at the University of Arkansas for Medical Sciences with a fishhook perforating the cornea of the left eye (OS) extending into the anterior chamber. The fishhook was removed via its entrance wound and was subsequently repaired. Fishhook injuries to the eye can result in profound visual impairment. Management of these injuries is dependent on the involved ocular structures and location of the hook. Visual prognosis can be profoundly affected by the initial management. Surgical management options are reviewed.

A man with advanced malignant disease presented complaining of vision changes in the left eye. Examination revealed an afferent pupillary defect and visual field defect in that eye. Imaging indicated carcinomatous disease of the left optic nerve, and a diagnosis of carcinomatous optic neuropathy was made.

The perception of affordances for the actions of other people (actors) was examined. Observers judged the maximum and preferred sitting heights of tall and short actors. Judgments were scaled in centimeters, as a proportion of the observer's leg length, and as a proportion of each actor's leg length. In Experiment 1 observers viewed live actors standing next to a chair. When judgments were scaled by actor leg length, they reflected the actual ordinal relation between the capabilities of the actors. The perception of affordances from kinematic displays was then evaluated. Observers differentiated tall and short actors, but only when the displays contained direct information about relations between the actors and the chair. It is concluded that observers can perceive affordances for the actions of actors and that kinematic displays can be enough to support such percepts if they preserve actor-environment relations that define affordances.

Research indicates that people can accurately judge the relative mass of colliding objects, i.e., which is heavier, if the collisions viewed involve actual physical objects. This study explored whether such judgements are affected by the image velocity of the colliding objects. Videotaped collisions involving different screen velocities were shown to observers. The accuracy of judgments of collision decreased significantly at slower velocities. A velocity-threshold hypothesis is offered as a possible account for this finding.

Adults without mental retardation commonly fail to notice nominally obvious aspects of naturalistic scenes (Becklen & Cervone, 1983). We replicated and extended this effect to adults with mild mental retardation. Adults with and without retardation viewed a 60-second videotape of an amateur basketball game. They were instructed to press a button whenever the ball was passed. At one point, a woman carrying an open umbrella walked bodily through the ongoing action. Becklen and Cervone found that only 35% of adults without retardation noticed this unexpected event and that noticing was not predicted by task performance prior to the woman's appearance. In the present study noticing rates for subjects without retardation were similar to those reported by Becklen and Cervone and noticing by subjects with mental retardation was at least as high. Task performance for subjects with mental retardation was significantly lower than that of subjects without retardation, but noticing was not predicted by task performance (prior to the unexpected event) for either group. Results were interpreted in the context of an ecological approach to attention.

A number of agents that mimic the ability of the thyroid hormone, T3, to decrease plasma cholesterol levels are described; one is as effective as T3 at reducing cholesterol levels and stimulating liver function, but has very little effect on cardiac function and is thus less likely to be toxic. The agent may be useful in the treatment of atherosclerosis.

Intra-arterial fusions of histamine cause vasodilation of resistance vessels, extravasation of albumin and oedema in cat skeletal muscle. Treatment with either mepyramine or metiamide significantly reduced the extravasation of albumin and rate of oedema formation. The doses of mepyramine and metiamide used did not modify the vascular responses to bradykinin.

1 Differentiation of the roles of histamine H1- and H2-receptors in the mediation of the effects of histamine on the isolated working heart of the guinea-pig was achieved through the use of histamine and selective histamine receptor agonists and antagonists. 2 Histamine over the dose range 10(-9) mol to 10(-6) mol produced dose-related increases in sinus rate, left intraventricular pressure (LVP)max, LVdP/dtmax, coronary flow, aortic flow, total cardiac output and external pressure-volume work. 3 Dimaprit, a selective histamine H2-receptor agonist, produced very similar responses to histamine. 4 2-Pyridylethylamine, a selective histamine H1-receptor agonist, had little effect on cardiac function unless large doses were administered. Such doses produced increases in all measured parameters. 5 Cimetidine, a selective histamine H2-receptor antagonist, antagonized the effects of histamine and dimaprit and some but not all effects of 2-pyridylethylamine. In the presence of cimetidine a decrease in all parameters with the exception of sinus rate was observed with both histamine and 2-pyridylethylamine. 6 The selective histamine H1-receptor antagonist, mepyramine, had little effect on responses to all three agonists. However, the depressant effects observed with histamine and 2-pyridylethylamine in the presence of cimetidine were antagonized by mepyramine. 7 The results indicate the important role of the histamine H2-receptor in the mediation of the gross cardiac effects of histamine and also indicate that histamine H1-receptors can mediate cardiac depression.

1. The vasodilator activity of histamine has been studied in anaesthetized cats. 2. Histamine causes dose-dependent vasodilatation in the vasculature of the hind-limb and mesentery, perfused with blood at constant flow. 3. Experiments using the selective antagonists mepyramine and metiamide indicate the involvement of both H1- and H2-receptors in the vasodilator responses to histamine. Mepyramine (2.5 X 10(-6) mol/kg), causes displacement of the histamine dose-response curve. This displacement is maximum with a dose-ratio of about 10. Further dose-dependent displacement of the dose-response curve occurred after metiamide (4 X 10(-7) mol kg-1 min-1 and 2 X 10(-6) mol kg-1 min-1), although these doses of metiamide had no effect on histamine responses in the absence of mepyramine. 4. Vasodilator responses could also be elicited by the selective H1-receptor agonists, 2-methylhistamine, 2-(2-aminoethyl)pyridine and 2-(2-aminoethyl)thiazole and the selective H2-receptor agonist, 4-methylhistamine. 5. The selectivity of mepyramine and metiamide as histamine receptor antagonists was confirmed by their failure to reduce the vasodilator responses to acetylcholine, isoprenaline and bradykinin.

1. Experiments have been made to determine the vascular effects of histamine and the mechanism of histamine-induced oedema formation in cat skeletal muscle. 2. Histamine caused dose-dependent dilatation of resistance vessels and increased intravascular volume over the dose range 1 X 10(-10)-1 X 10(-8) mol/kg min. The dilatation of resistance vessels resulted in dose-dependent increases in capillary hydrostatic pressure. 3. Histamine increased vascular permeability, as measured by accumulation of [131I]human serum albumin in the tissue, during infusions at 1 X 10(-8) mol/kg min but no albumin accumulation could be detected at lower infusion rates. 4. Oedema formation during histamine infusion of 1 X 10(-10) and 1 X 10(-9) mol/kg min seemed to be due to increases in capillary hydrostatic pressure and independent of increased vascular permeability. During infusions of histamine 1 X 10(-8) mol/kg min oedema was due predominantly to increased vascular permeability and to a lesser extent, the increase in capillary hydrostatic pressure.

1 The cardiovascular responses to dimaprit (S-(3-dimethylaminopropyl) isothiourea) a selective histamine H2-receptor agonist have been studied in anaesthetized cats, dogs, rats and rabbits. 2 Dimaprit lowered systemic arterial blood pressure in all species whether given by intravenous injection or by continous infusion. Intra-arterial injections or infusions caused vasodilatation in the femoral vascular bed. 3 In the cat, continuous intravenous infusions of dimaprit lowered blood pressure without any significant change in heart rate or cardiac output. The fall in blood pressure was thus due to a decrease in peripheral vascular resistance. 4 Dimaprit, given intravenously, increased coronary and gastric blood flows and there were associated marked reductions in vascular resistance. Small reductions in vascular resistance occurred in skeletal muscle, in the intestine and the kidneys. 5 The histamine H2-receptor antagonists, metiamide and cimetidine, antagonized the depressor and vasodilator responses to dimaprit.

We investigated the changes in cardiac function following alterations in thyroid state of rats, using the isolated working heart preparation. This technique allows heart rate, contractility, and pump function to be studied under controlled conditions. Surgical thyroidectomy resulted in significant impairment of cardiac function. Single doses of 3,5,3'-triiodo-L-thyronine (T3) or L-thyroxine (T4) were given to thyroidectomised rats. Cardiac function was restored to normal within 48 h of administration of 0.5 mg/kg T3 or 2.5 mg/kg T4 without significant changes in heart weight. The dose-response relationships between T3 and T4 and cardiac function showed that significant changes occurred after single doses of T3, 0.02 mg/kg, or T4, 0.5 mg/kg. An increase in contractility was seen within 12 h of administration of T3, before other physiological effects of T3 are reported to occur. This indicates that the change in contractility is the result of a direct effect of thyroid hormones on the heart and is not secondary to changed loading conditions of the heart. Changes in heart rate occurred between 18 and 48 h. The maximum heart rate achieved did not exceed that in hearts from euthyroid rats, although contractility could be increased above euthyroid levels.