摘要:

A number of treatment options are currently available for the medical management of epilepsy. Conventional antiepileptic drugs (AEDs) include phenytoin, carbamazepine, valproic acid, ethosuximide, barbiturates, and benzodiazepines. Although these drugs control seizures, they may also cause blood dyscrasias, sedation, and cognitive impairment. Felbamate, gabapentin, lamotrigine, and vigabatrin are new AEDs believed to cause fewer side effects than conventional medications. Felbamate, however, has been linked with substantially increased incidence of aplastic anemia, and the other new AEDs have been studied for relatively short periods of time. Ketogenic diets, comprised of foods high in fat and low in protein and carbohydrate content, have been reported to improve seizure control. However, these diets are widely acknowledged to be unpalatable, making sustained compliance with dietary restrictions difficult. To promote long-term control of seizures, physicians must consider the side effects of therapeutic interventions for epilepsy, as well as their anticonvulsant efficacy.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Polyps of the gallbladder are often incidentally identified during radiographic evaluation of abdominal pain. Once identified, they pose a dilemma with respect to their proper long-term management. Herein, polyps of the gallbladder are reviewed with specific attention to their management in light of their malignant potential. The available data suggest that polyps larger than 10 mm or that show rapid growth should be considered suggestive of malignancy, prompting cholecystectomy.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

This report updates previous reports regarding the tolerance and efficacy of periodic vagus nerve stimulation in a group of 19 children with medically and surgically intractable epilepsy. After vagal stimulator implantation, follow-up continued from 2 months to 30 months, with the study period ending in October 1995. Of the 19 patients, 6 (32%) had more than a 90% reduction in the number of monthly seizures, and 10 (53%) had more than a 50% reduction. Global evaluation scores indicated that only 1 patient had deterioration from baseline, 5 had no change, and the remainder had modest to remarkable improvement. All 3 children with unsuccessful corpuscallosotomy had improvement after implantation of the stimulator, and 5 of 6 children with Lennox-Gastaut syndrome had a 90% reduction of seizures. Five patients required fewer antiepileptic medications, and 1 patient had an increase in medication. Adversities included 2 possible wound infections, 1 instance of generator failure, and hoarseness during stimulation in all patients. Changing stimulation parameters to increase the rate of stimulation and reduce the interval between stimulations resulted in improved seizure control in 4 of 5 patients. Periodic VNS was well tolerated by these children and may have a role in the management of refractory epilepsy.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Children at summer camp are at risk of injury and illness. The American Academy of Pediatrics and the American Camping Association have specific guidelines for the medical care of children in summer residential camps. This report describes the types of illnesses and injuries seen in 730 children attending camp for 2 weeks, use of the infirmary, and difference in the onset of infectious diseases compared with injuries during the camp session. During the month studied, there were 921 infirmary visits. The most common diagnoses were injuries and infectious disease. Girls and boys were equally likely to be seen in the infirmary and had the same distribution of diagnoses. Infectious disease (gastroenteritis) had a later mean day of onset during the camp session than did injuries and was increasing in frequency at the end of each session. Potential common camp medical problems (sunburn, otitis externa) were prevented by simple medical preventive care.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The proportion of the Medicare-eligible population living in health professional shortage areas (HPSAs), their demographics, and three health status indicators were examined in relationship to market-based reform proposals. Medicare-eligible residents of Georgia and Kentucky were classified as living in an HPSA (n = 154,812) or non-HPSA (n = 556,602). Chi-squares were computed for demographic variables and health status indicators. A Mantel-Haenszel summary chi-square was computed after stratification of health status indicators by poverty level. Elderly residents of HPSAs accounted for 22% of the study population. Significant differences in all demographic variables except sex were detected. HPSA residents were more likely to have a mobility limitation, self-care limitation, or both a mobility and self-care limitation. Elderly residents in HPSAs are significantly more likely to have poorer health status and mobility limitations. Physician supply in HPSAs may be inadequate to support market-based reforms.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Medication use during pregnancy has changed over time because of various factors: new products have been marketed, concerns have arisen regarding safety and efficacy, public education has increased, and some prescription medications have been granted nonprescription status by the Food and Drug Administration. The purpose of this investigation was to determine overall medication and substance use by prenatal patients whose infants were delivered at our tertiary university hospital. Within 96 hours after delivery, 100 women were evaluated by a personal interview and medical record review. The medications most commonly used during pregnancy were vitamins, analgesics, calcium and iron preparations, and antibiotics. The mean numbers of medications consumed during the second and third trimesters (3.32 ± 1.87 and 4.13 ± 2.46) were significantly higher than the mean number taken before pregnancy (2.65 ± 1.95). Over-the-counter medications accounted for 54% of the total products taken during pregnancy. Percentages of women using caffeine, tobacco, alcohol, and illicit drugs decreased during pregnancy.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

We did a retrospective study of the prevalence of nocturnal and diurnal enuresis in patients with attention-deficit hyperactivity disorder (ADHD). Patients with ADHD were identified at a referral center for developmental pediatrics. Control patients were identified at a general pediatric and pediatric allergy clinic. Adjusting for differences in sex and current age, ADHD children at age 6 were 2.7 times more likely than controls to have nocturnal enuresis and 4.5 times more likely to have diurnal enuresis. Results at children's current age were consistent with results at age 6; however, these differences were not statistically significant. Nocturnal and diurnal enuresis was found to be significantly more common in children with ADHD than in control subjects. Physicians who treat patients with ADHD should routinely inquire about the presence of enuresis.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Systemic radionuclide therapy with strontium chloride Sr 89 is a rediscovered alternative to relieve pain from bony metastases. Although numerous advances have been made in the diagnosis and treatment of cancer, pain remains a serious and debilitating disease complication. An increasing number of clinical trials are reporting satisfactory results with89Sr-chloride therapy, now available for widespread clinical use. We have treated 11 patients with this radionuclide; of these patients, 8 had excellent to dramatic pain relief and 3 had mild to moderate improvement. Clinical response was based on subjective pain relief, increased mobility, decreased analgesic uptake, and/or improvement in daily activities, including work habits.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

In this report, we assess the safety of terazosin in the treatment of patients with symptomatic benign prostatic hyperplasia. We analyzed seven prospectively designed placebo-controlled trials involving 3,080 patients, 1,689 of whom received the study drug in doses ranging from 1 mg to 20 mg daily for a total of 1,282 patient-years of exposure. The most common side effects seen in treated patients were dizziness (10.7%), asthenia (7.5%), and peripheral edema (4.0%). These side effects were generally reported as mild and improved after cessation of therapy. The incidence of withdrawal from the study due to side effects was 14.5% in the treatment arm versus 11.4% in the placebo control arm. Also noted was a statistically significant decreased risk of urinary tract infection and myocardial infarction in the terazosin-treated group. This updated report confirms that terazosin can be administered safely to a population of men with symptomatic benign prostatic hyperplasia with minimal clinically significant side effects.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Hearing and/or balance disorders are symptoms that may be associated with tumors of the cerebelloporitine angle (CPA). Between March 1988 and May 1995, 22 patients had diagnosis or evaluation of CPA tumors at Cleveland Clinic Florida. The most common presenting signs or symptoms included unilateral low-frequency tinnitus, unsteadiness, and/or asymmetric hearing loss. On the basis of our experience, we have constructed an algorithm to help identify and manage acoustic nerve dysfunction. We compare our findings with national epidemiologic data and current medical reports.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID