Pharmacy Market Structure and the Opioid Epidemic

SSRN Electronic Journal · 2025-01-01

Local Factors and the Opioid Epidemic

8th Annual Conference of the American Society of Health Economists · 2019-06-26

Association Between Opioid Prescribing and Opioid Abuse and Mortality

7th Annual Conference of the American Society of Health Economists · 2018-06-13

Infantile Sialic Acid Storage Disease: A Rare Cause of Cytoplasmic Vacuolation in Pediatric Patients

Pediatric Pathology & Laboratory Medicine · 1995-01-01 · 18 citations

We report a case of infantile sialic acid storage disease (ISSD) in a black infant presenting in utero with nonimmune hydrops, ascites, and anemia requiring intrauterine transfusion. Upon birth, the patient had prominent edema, large anterior fontanelle, partial absence of the rectus abdominis, clubbing of the left foot, gingival hypertrophy, short first metatarsals, prominent scrotal raphe, right heart dilatation, and left ventricular dysfunction. Radiographs showed pulmonary hypoplasia and epiphyseal stippling. He died of respiratory failure at day 2. Autopsy demonstrated capillary hemangiomata, remote cerebral hemorrhages, and central nervous system periventricular leukomalacia, as well as severe cardio- and hepatosplenomegaly. Multiple single membrane-limited vacuoles consistent with enlarged lysosomes were present in virtually all cell types examined, with striking involvement of liver, myocardium, and placenta. Vacuolar contents were not identifiable by electron microscopy. Demonstration of elevated free sialic acid in urine, amniotic fluid, and cultured fibroblasts confirmed the diagnosis of ISSD. Characteristics of sialic acid storage diseases and their diagnosis are reviewed. ISSD should be considered in infants with empty cytoplasmic vacuoles in multiple tissue types.

Coexisting Endogenous and Exogenous Llpold Pneumonia and Pulmonary Alveolar Proteinosis in a Patient with Neurodevelopmental Disease

Pediatric Pathology · 1994-01-01 · 15 citations

We report a unique case of coexisting exogenous lipoid pneumonia, endogenous lipoid pneumonia (ELP), and pulmonary alveolar proteinosis (PAP) in a 5-year-old patient with severe neurodevelopmental disease. The patient presented with gastroesophageal reflux and presumed chronic lung disease resulting from recurrent aspiration pneumonias and succumbed to respiratory failure. The autopsy showed lipid-laden macrophages and periodic acid-Schiff-positive granular material in alveolar spaces and multilamellated structures within both alveolar macrophages and extracellular debris. These findings were similar to those in previous reports of coexisting ELP and PAP in the setting of gastroesophageal reflux. However, the present case differed by the presence of scattered large osmiophilic extracellular lipid vacuoles. Besides strengthening the association between ELP and PAP and their relationship to gastroesophageal reflux, this case suggests that they may arise together with exogenous lipoid pneumonia, through related mechanisms, in the setting of neurodevelopmental disease.

Rocky Mountain Spotted Fever: Hepatic Lesions in Childhood Cases

Pediatric Pathology · 1986-01-01 · 20 citations

We studied 16 fatal childhood cases of Rocky Mountain spotted fever (RMSF). Hepatic histologic lesions with statistically significant differences from age- and sex-matched controls were portal triaditis consisting of polymorphonuclear leukocytes and large mononuclear cells, portal vasculitis, sinusoidal leukocytosis, erythrophagocytosis by Kupffer cells, and gross hepatic weight. Hepatocellular necrosis, cholestasis, and congestion were not more frequent in RMSF than in controls. Using immunofluorescence microscopy, we were able to demonstrate rickettsial organisms in portal blood vessels and sinusoidal lining cells of 7 cases.

Case 6 Abnormal Facies and Mental Retardation in a Patient with Cystic Fibrosis of the Pancreas

Pediatric Pathology · 1986-01-01

Pulmonary Pathology of Rocky Mountain Spotted Fever (RMSF) in Children

Pediatric Pathology · 1985-01-01 · 14 citations

Despite infrequent respiratory symptoms, histopathologic changes were identified in the lungs of 15 of 16 children dying of Rocky Mountain spotted fever (RMSF). Gross examination demonstrated increased lung weight, edema, congestion, focal hemorrhage, and bronchopneumonia in a few cases. Paraffin sections were stained with hematoxylin and eosin and phosphotungstic acid-hematoxylin, and available blocks were examined by direct immunofluoresence for Rickettsia rickettsii. Cases and controls matched for age and sex were randomized and examined blindly for pathologic changes. In addition, morphometric measurements of mean alveolar septal thickness were made in each case. The histopathologic findings include (1) diffuse interstitial mononuclear (lymphocyte and macrophage) inflammatory infiltrate in 15/16 cases of RMSF (5/10 controls), (2) pulmonary edema and intraalveolar hemorrhage in 11/16 cases of RMSF (2/10 controls), and (3) vasculitis of small pulmonary venules and arterioles in 5/16 RMSF cases (0/10 controls). Rickettsia rickettsii were identified in 4/8 RMSF cases by direct fluorescent antibody technique. Although pulmonary disease is not always clinically apparent in children with RMSF, involvement of the pulmonary microcirculation is a frequent event in fatal cases and may contribute to the development of non-cardiogenic pulmonary edema.

Multiple Congenital Septal Atresias of the Intestine: Histomorphologic and Pathogenetic Implications

Pediatric Pathology · 1983-01-01 · 12 citations

Congenital atresias of the gastrointestinal tract are usually single and divided into three forms on a morphologic basis. The septal or diaphragmatic type (type I) is the least common. We report an infant with multiple type I atresias involving both the small and large intestine and describe the unique histologic features of the septa: fragmentation of muscularis mucosa, multiple septal cysts lined by columnar epithelium, circular and longitudinal muscular layers, and absence of inflammation. This infant had a sibling who died with multiple intestinal atresias of the septal type. The histologic features suggest that type I gastrointestinal atresias may be due to failure of complete recanalization rather than result from healing of vascular of inflammatory events.

Unusual Abdominal Involvement in Rickettsial Diseases-Reply

JAMA · 1983-04-01

<h3>In Reply.—</h3> Dr Mansueto and co-work-ers describe two unusual and in teresting patients with BF and intra-abdominal lesions. Although gastrointestinal (GI) symptoms are frequent in RMSF (63% of 131 patients described by Kaplowitz et al having nausea, vomiting, or diarrhea before treatment),¹our knowledge of intra-abdominal pathological lesions in RMSF is limited to usually mild hepatic involvement in fatal cases.²It is possible that GI symptoms are caused by rickettsial infection in the blood vessels of the intestine, peritoneum, or other abdominal viscera; on the other hand, nausea and vomiting might be caused by rickettsial encephalitis, probably the most important component of severe RMSF. The parallel rise of RMSF in the United States and BF in Italy is important knowledge. Ecologic changes, including those affecting tick populations in the United States and the Mediterranean basin, must be elucidated. Physicians must be aware that infection with<i>R conorii</i>may