摘要:

Traumatic injury frequently follows alcohol abuse. Between October 1, 1988 and January 31, 1992, 2,219 patients were admitted to the Trauma Service at the University Medical Center of Eastern Carolina-Pitt County. Of the 1,602 who were tested for serum ethanol, 685 (43%) were found to have measurable levels. Thirty-seven patients had alcohol withdrawal and were treated with intravenous ethanol; 34 were male (21 black, 13 white) and 3 female (1 black, 2 white), with an average age of 46 years. Those who had withdrawal had an average serum ethanol level, on presentation, of 239 mg/dL (N=34). Fourteen patients were involved in motor vehicle crashes, seven were pedestrians struck by cars, and the remaining 16 had various traumatic mechanisms of injury. The most common injuries were long-bone fractures and blunt abdominal trauma. The length of ethanol therapy averaged 4 days. A majority of patients had a favorable response to treatment. Relative contraindications to IV ethanol therapy were CNS trauma, liver disease, and pancreatitis. IV ethanol is a safe and effective method of alcohol detoxification in the trauma patient.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Twenty-four consecutively hospitalized patients with clinical evidence of lower extremity deep vein thrombosis (DVT) had blinded ipsilateral ultrasonographic duplex imaging (US), contrast venography (VG), and a one-time bilateral impedance plethysmography (IPG) examination. The cases of eight (33%) of the study patients were thought to be complicated due to a prior history of DVT or the presence of ipsilateral inguinal adenopathy. Interpretable test results were obtained for 100% of the US examinations, 88% of the VG studies, and 75% of the IPGs. One additional subject, included in our study for statistical analysis, had an unblinded false-negative US examination; in this case DVT was shown by VG but could not be seen on US despite the radiologist's prior knowledge. The sensitivities, specificities, and 95% confidence intervals for the three studies were as follows: US, 92% (81% to 103%) sensitivity, 100% (99% to 101%) specificity; VG, 100% (99% to 101%) sensitivity, 75% (58% to 96%) specificity; IPG, 50% (30% to 70%) sensitivity, 83% (68% to 98%) specificity. Of the six indeterminate IPG studies, four (67%) occurred in complicated cases. These data suggest that US should be the first-line noninvasive screening study done for evaluation of suspected DVT, especially in complicated cases.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

We reviewed the operative complications in 333 living related donor nephrectomies done at our institution over the past 12 years. The overall complication rate was 17.1%; only three patients (0.9%) had major complications, and none died. The major complications were a delayed splenectomy because of bleeding, an adrenalectomy, and acute renal failure in one patient in the immediate postoperative period. We concluded that donor nephrectomy done through a flank incision results in minimal morbidity.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The relationship between serum concentration of certain electrolytes and the pathogenesis of ventricular arrhythmia in myocardial infarction has been the subject of frequent review. The role of hypophosphatemia in the pathogenesis of arrhythmia in patients with acute myocardial infarction has not been as well studied. In our study group of 325 consecutive patients admitted to the coronary care unit of a community hospital, 111 were confirmed to have had a myocardial infarction. Patients were continuously monitored for ventricular arrhythmia during the first 24 hours, and the electrocardiographic records were reviewed for documentation of arrhythmia. From an admission blood sample, measurement of electrolytes included serum phosphate, calcium, bicarbonate, potassium, and magnesium. Associations between ventricular tachycardia and serum electrolyte abnormalities including magnesium, potassium, phosphate, calcium, and bicarbonate were studied. Low phosphate (less than 2.6 mg/dL) was a significant predictor of ventricular tachycardia in the myocardial infarction group. In the entire group of 325 patients prior to the confirmation of myocardial infarction, both low bicarbonate and low phosphate were significant predictors of ventricular tachycardia during the first 24 hours of hpspitalization. Although management of acidosis is considered early in the hospital course, phosphate replacement therapy is usually not as often considered. We recommend further study on the effectiveness of replacement therapy in hypophosphatemic patients with chest pain to reduce the risk of ventricular tachycardia.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

I tested the hypothesis that the most frequently used textbooks of internal medicine are inadequate in their coverage of the evaluation and management of common complaints and management problems of primary care. Fourteen common complaints (symptoms) and nine common management problems (diseases) representing 20% to 40% of primary care patient visits were identified, and seven major textbooks of internal medicine were reviewed to assess the amount and extent of coverage of these topics. The average number of pages devoted to all 14 major problems was about 30, or 1.5% of the total. About 40 (2%) of the pages addressed the nine management problems. The minimal amount of coverage devoted to these topics could be taken as evidence of the lack of respect, importance, and emphasis ascribed to them. The lack of instruction in these areas may enhance malaise in primary car medicine due to inadequate instruction in the needed data base and skills and the resultant patient dissatisfaction.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Varicella is an infrequent but potentially severe infection in adult HIV-infected patients. We reviewed five cases of varicella in HIV-seropositive men; two were complicated by severe headache and meningismus, and one of these patients also had hepatitis and thrombocytopenia. All five patients responded well to acyclovir therapy, but one patient had dermatomal zoster 2 years later, and another failed to have detectable antibody after infection. We also performed a serosurvey on 181 consecutive HIV-infected patients presenting themselves for evaluation. A total of 95% of these patients had demonstrable antibody to varicella-zoster virus. Immune status to varicella did not correlate with the declining CD4 count, which was well preserved even in patients with fewer than 200 CD4 cells/mm3.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

A 50-year-old man with an 8 x 4 cm mass on the posterior chest was found to have a large retroperitoneal abscess due toKlebsiella pneumoniae. The abscess dissected through the right lower lobe of the lung and the posterior chest wall to produce a subcutaneous mass. The source of the posterior chest wall mass appeared to be a perinephric abscess. A dome-shaped lesion above the right hemidiaphragm on chest radiograph resolved immediately with surgical drainage, suggesting that an abscess should be a prime consideration when one observes such a lesion on a chest film.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

We report the 10th known case of Crohn's disease associated with cystic fibrosis. Because the symptoms of Crohn's disease may easily be confused with those of cystic fibrosis, this association probably exceeds that predicted by existing prevalence data.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

A patient with an acute ischemic stroke had an interatrial septal aneurysm shown by transesophageal echocardiography. Interatrial shunting, compatible with a patent foramen ovale, was observed on a follow-up study after a second stroke. This was seen in association with a right atrial thrombus. This case illustrates that an interatrial septal aneurysm serves as a marker for potential interatrial shunting, which can lead to paradoxical cerebral embolism.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

TIA is an important risk factor for ischemic stroke. Early diagnosis and management can result in a significant reduction in the risk of subsequent stroke. We report the case of a 54-year-old man who developed a 5-second episode of leg weakness and in whom a tight stenosis of the appropriate carotid artery was found. TIAs can sometimes be brief and have an atypical presentation, requiring a high level of suspicion for early diagnosis.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID