摘要:

Although clinical benefits for aminoglycoside dosing services have been suggested, this has not been clearly documented in a prospective fashion. Therefore, we randomly assigned patients to be dosed (1) by their physician (Physician dosing method), (2) by predicting an initial dosage (Predictive dosing method), or (3) by calculating an initial dosing regimen by measuring the pharmacokinetics for the individual patients after a loading dose (Individual dosing method). The patients' clinical response and nephrotoxicity were then evaluated. The individual dosing method resulted in erratic aminoglycoside levels, necessitating its elimination from the study. This group was not included in the final analysis. Of the 164 patients entering the study, 41 had a documented gram-negative infection, received aminoglycosides for more than 2 days, and had serum aminoglycoside levels measured. The predictive dosing method in these 41 patients produced statistically significant higher peak and lower trough levels, but there was no difference in the incidence of nephrotoxicity or clinical response. The 95% confidence intervals precluded any major clinical benefit in these patients with documented gram-negative infections. We question the previous findings of increased efficacy and decreased nephrotoxicity with the use of an aminoglycoside dosing service and suggest that larger studies be done.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Using continuous wave Doppler ultrasonography to measure umbilical artery-flow velocity waveforms (FVWs) is a safe, noninvasive means of quantifying placental resistance to blood flow. Detection of abnormally elevated resistance to umbilical perfusion may identify pregnancies complicated by uteroplacental insufficiency. Use of this technique to identify high-risk pregnancies requires ready access to standard tables of normal FVW values obtained from well-defined populations under usual clinical conditions. We report measurements of the systolic-diastolic (S-D) ratio of the umbilical artery obtained between 16 and 43 weeks in 122 normal pregnancies. A gestational-age-adjusted table of normal values is presented.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The hand is a commonly injured part of the body that frequently becomes infected. Improperly treated hand infections can lead to severe disability including stiffness, contracture, and amputation. This article describes the current concepts of diagnosis and treatment of common hand infections.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Amiodarone, a benzofuran derivative, has proven useful in the control of serious cardiac arrhythmias. We reviewed the English language medical literature to characterize clinical, radiographic, scintigraphic, pathologic, diagnostic, and prognostic data concerning amiodarone pulmonary toxicity. Our review showed that features consistent with amiodarone pulmonary toxicity include exertional dyspnea, fever, and high sedimentation rates, usually in patients taking larger maintenance doses. Positive findings on gallium scan, foamy alveolar macrophages on lung biopsy or bronchoalveolar lavage, and resolution of abnormal chest roentgenogram upon withdrawal of amiodarone and/or institution of corticosteroid therapy support a diagnosis of amiodarone pulmonary toxicity. Conversely, maintenance doses of 400 mg or less daily, normal lung diffusing capacity and bronchoalveolar lavage or lung biopsy specimens without foamy alveolar macrophages are features that make amiodarone pulmonary toxicity unlikely. Amiodarone pulmonary toxicity should be considered in any patient who has new or clinical worsening of respiratory symptoms and/or abnormalities on chest roentgenogram. Congestive heart failure is often present in these patients and must be excluded before a diagnosis of amiodarone pulmonary toxicity can be considered. Amiodarone pulmonary toxicity also needs to be distinguished from pulmonary infection. Therefore, amiodarone pulmonary toxicity remains a clinical diagnosis relying upon a composite of clinical, radiographic, and histopathologic findings.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Certain phrases in the medical language have lost their meaning and in some cases now suggest the exact opposite of the facts. These are “anemia of chronic disease,” “liver function tests,” “the prevalence,” “S1 was present,” “S1 is normal,” “neurologic syncope,” “orthostatic hypotension,” “the neck veins were distended,” “hospital-acquired pneumonia,” and “right-sided backward failure.” I suggest a different and more clinically useful way of looking at these phrases.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID