摘要:

Amnesia is a common clinical problem characterized by four features: (1) normal immediate recall, (2) impaired ability to learn, (3) relatively spared ability to retrieve previously learned material, and (4) preserved cognitive and personality characteristics. Amnesia occurs as a distinct mental disorder, and nine variations seen clinically are described here: Korsakoff's psychosis, posttraumatic amnesia, amnesic stroke, postoperative amnesia, postinfectious amnesia, anoxic amnesia, transient global amnesia, amnesia following ECT, and psychogenic amnesia. The clinical findings which characterize and differentiate these disorders are presented, along with suggestions for management and a discussion of the outcome of anmesia.

ISSN:0038-4348    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Palliation of unresectable head and neck cancer remains a difficult problem. Because of excellent results reported by others with infusion of vinblastine, methotrexate, and 5-fluorouracil into the external carotid artery followed by irradiation before curative surgery, we applied this technic to 22 patients with advanced head and neck cancer. Fifteen patients from this group who had chemotherapy infusion followed by radiation therapy are compared with 21 patients who received radiation therapy alone. Both groups were similar in distribution of primary site, histology, and TNM stage. Of 15 patients, 14 (93%) bad partial or complete tumor regression after both arterial chemotherapy infusion and irradiation, while 14 of 17 patients (82%) receiving primary irradiation had partial or complete response. Drug toxicity and complications related to infusion occurred in all patients. Most patients in both groups had short survivals (mean of 14.1 months in infusion chemotherapy and radiation vs 9.1 months in primary irradiation). One patient remains alive in the infusion group and two in the control group; however, all have recurrent disease. Results indicate a slight increase in survival time with the addition of infusion chemotherapy to irradiation in palliative treatment of head and neck cancer.

ISSN:0038-4348    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

It is common practice in many cardiovascular surgical centers to withdraw 10% to 15% of a patient's blood volume before instituting cardiopulmonary bypass, for later transfusion. The autologous blood units are stored in the operating room at an ambient temperature of 20 to 22 C for periods of up to five hours. Currently accepted blood banking standards require immediate refrigeration of donated blood units. This requirement is based on the assumption that during the procedure of obtaining the blood it is likely that bacterial contamination may have occurred and large colonies of bacteria might result at warmer storage temperature. One hundred units of autologous blood were cultured (89 units from jugular lines and 11 units from radial artery lines). The mean storage time at ambient temperature was 2.9 hours (range 1.5 to 4.8 hours). All units except two were negative for growth of microorganisms at 15 days. These two units cultured a diphtheroid,Corynebacterium acnes(a common skin contaminant), on the ninth day of culture. Both units had been drawn from the same patient via an external jugular neck line prepared with 70% alcohol and had been stored at ambient temperature for 4.8 hours. (This patient had had coronary artery bypass and had remained afebrile throughout an uneventful postoperative course, with no signs of sepsis at four months' follow-up.) The results of this study indicate that bacterial growth in autologous blood units stored at ambient temperature is indeed possible. Strict aseptic technic must be observed in placing the lines through which the blood is collected. The potential benefits (eg, platelet viability) versus hazards of storage at ambient temperature are reevaluated.

ISSN:0038-4348    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

A prospective series of 200 patients with persistent hypercalcemia had an abbreviated diagnostic work-up consisting of parathormone radioimmunoassay, chest roentgenogram, intravenous pyelography, and serum protein electrophoresis. All patients with hypercalcemia and hyperparathormonism had neck exploration if roentgenograms failed to reveal evidence of ectopic hyperparathyroidism. Serum iPTH proved to be at least 96% accurate in predicting parathyroid disease while at the same time resulting in considerable diagnostic economy. An elevated iPTH was particularly helpful in distinguishing between hypercalcemia due to destruction of bone by malignancy and primary hyperparathyroidism with a coexisting malignancy. Further, measurement of parathormone was useful in evaluation of postoperative hypercalcemia.

ISSN:0038-4348    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Prostaglandin E1(PGE1) has been used for successful palliation in nine infants with congenital heart disease. Seven patients had pulmonary atresia with ductal-dependent pulmonary blood flow. In this group, systemic O2saturation increased from a mean value of 45% to 79% after infusion of PGE1, and surgical palliation was successfully done with the infants in stable condition, without hypoxemia or acidemia. An additional patient with coarctation of the aorta had marked ductal dilatation after PGE1infusion, as indicated by umbilical artery pulse pressure. The coarctation was repaired, with the infant in stable condition. The final patient had neonatal tricuspid insufficiency with right-to-left atrial shunting. Systemic O2saturation was improved after PGE1infusion, though the ductus was closed. The improved oxygenation was believed to be due to a reduction in pulmonary vascular resistance by PGE1. Prostaglandin E1provides a powerful new tool for palliation of critical congenital heart disease in infants whose ductal constriction can markedly influence their clinical status.

ISSN:0038-4348    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Nine patients with disabling pneumoconiosis were selected over a three-year period for study because of a work history of kaolin exposure. All had worked in the Missouri firebrick industry. Chest roentgenograms from all nine and lung tissue from two were consistent with silicosis. Worksite analysis of airborne dust at several Missouri firebrick factories revealed that some current workers are exposed to both free silica (up to 4.5%) and cristobalite (up to 8.9%) at levels exceeding the threshold limit value (TLV). Analysis of airborne dust from several kaolin processing plants in South Carolina and Georgia revealed that a few workers are exposed to about 1% free silica at levels occasionally exceeding the TLV. We conclude that silicosis is a serious risk for Missouri kaolin workers and a potential risk for workers in South Carolina and Georgia. A prevalence survey is needed in Missouri to assess the problem.

ISSN:0038-4348    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Organic, physiologic, and psychologic causes of dysmenorrhea are presented. Signs and symptoms include pelvic fullness, nausea, vomiting, diarrhea, urinary frequency, nervousness, and headaches. Primary dysmenorrhea has been treated with analgesics, diuretics, and antispasmodics. Androgen therapy was also found to be effective, but it cannot be used for women who have acne or hirsutism. Surgery is rarely indicated for primary dysmenorrhea.

ISSN:0038-4348    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

The ubiquity of dizziness in clinical practice and the complexity of diagnosis and treatment has necessitated the development of a home monitoring procedure which assists the patient in collecting information concerning the course of his condition and his response to therapy. A case report of a patient with refractory, long-term, posttraumatic vertigo is presented to demonstrate the feasibility and utility of this procedure. It was found that (1) the patient was able to monitor his progress continuously for 118 days; (2) the information generated appeared to be valid; and (3) this information was integrally associated with a functional improvement in the patient's condition.

ISSN:0038-4348    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Extensive evaluation of a small series of potential renal donors has revealed an alarming rate of previously unsuspected disease precluding acceptability for renal donation. Of 19 patients considered for donation at the Medical University of South Carolina, 15 were unsuitable for medical reasons (diabetes mellitus, multiple sclerosis, sickle cell trait, hypertension, polycystic kidneys, duodenal ulcer, pulmonary disease), psychologic reasons, or changes on renal arteriography consistent with nephrosclerosis. The importance of a thorough donor evaluation including total patient awareness of the risks involved for both himself and the recipient and extensive psychologic testing is stressed. Even with strict criteria for renal donation, this high rejection rate is surprising.

ISSN:0038-4348    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

The non-Hodgkin's lymphomas represent an area of rapid medical progress. Recent studies of staging have suggested that with respect to therapy disease is either limited (stage I or II) or advanced (stage III or IV). Bone marrow biopsy is important as an initial staging tool, and retroperitoneal evaluation (lymphangiography, ultrasound) is important when marrow involvement is not present and also as a means of establishing a baseline for clinical evaluation. For patients with nodular lymphoma, combination chemotherapy can produce high rates of complete remission, but relapses occur and survival has not been shown to be improved as compared to patients receiving single-agent therapy; the value of therapy in asymptomatic patients is not established. In contrast, advanced histiocytic lymphoma, which is rapidly fatal when single-agent therapy is used, is cured in half of patients receiving new combination chemotherapy regimens. While clinical discussions must use the Rappaport system of pathologic classification, because most data have been expressed using this terminology, it should be recognized that immunologic approaches to the classification of lymphoma exist, and that their clinical utility is undergoing evaluation.

ISSN:0038-4348    

出版商:OVID    

年代:1978

数据来源: OVID