摘要:

Patients with sickle cell disease appear to have a high incidence of cerebral aneurysm. These aneurysms are not associated with the usual risk factors of hypertension, renal disease, or connective tissue disease. We present two recent cases of patients with sickle cell disease and multiple cerebral aneurysms, review the literature on the association between sickle cell disease and cerebral aneurysms, and discuss a mechanism by which sickle cell disease may lead to the formation of cerebral aneurysms.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The positive effect of family support on the outcome from serious illness that requires intensive care has been recognized by clinicians for decades. We have all seen that family visitation and an intensive care environment more similar to that of a general ward (sunlight, radio, television) can benefit patients with psychosis related to intensive care. The severity of illness of the individual patient exerts a powerful stress on the family unit, but it has been difficult to measure this effect. We used a 40-question family needs survey with a degree of importance scale to compare the intensive care unit (ICU) with the general ward in terms of impact on the family. Five needs were found to discriminate these two environments. The family members of patients in an ICU considered it very important (1) for staff to give directions on what to do at the bedside, (2) to receive more support from their own family unit, (3) to have a place to be alone as a family unit in the hospital, (4) to be informed in advance of any transfer plan, and (5) to have flexibility in the time allowed for visitation. Family members are willing to accept decreased visitation time if the physicians and nurses can equate this decrease with the complexity of care in the ICU. The results of this survey have helped us modify and individualize our approach based on family expectations especially when patients are transferred from the general ward to the ICU or from the ICU to the ward.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The 1987 Texas Breast Screening Project was designed to educate women about the benefits and safety of mammographic screening. During the 2-week promotion, 109,339 women called toll-free telephone numbers to inquire about the program, and 64,459 (65%) of 99,650 eligible callers had $50 mammograms at 306 participating community radiology centers. Biopsies were obtained for 1,122 women (1.7% of those screened), and the ratio of benign to malignant biopsy results was 4.2:1. Among the women having biopsies, 214 cancers were found (3.3 cancers per 1,000 women screened). Forty-seven percent of the tumors were not palpable, 80% were smaller than 2 cm, and 72% were clinicopathologic stage 0 or I. These results show that women will respond to an invitation to attend mammographic screening, and that community radiology centers can detect large numbers of early, curable breast cancers.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

More than 36,000 of the 64,459 women who had $50 mammograms after a media campaign in 1987 completed a demographic and risk factor questionnaire. The screened women were young and well educated with high annual incomes. Only. 32% had had mammograms before 1987. Most women reported that high cost and lack of referral for mammography by their physicians were their reasons for not being screened previously. Publicity promoting the project and the lower cost for mammography were the features of the project that attracted participants. Population-based telephone surveys before and after the project showed a change in attitudes about breast cancer screening. The model used for recruitment in this project can improve compliance with recommendations for regular mammographic screening if charges for screening are reduced. Additional efforts are needed to attract minorities and poor or elderly women to regular breast screening.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Patients with sickle cell anemia often express myriad clinical signs and symptoms that affect their life-style and academic performance. Certain psychoeducational and psychosocial factors have been shown to influence the academic achievement of older patients with sickle cell anemia. However, studies evaluating the school readiness skills of younger children have not been published. To determine whether sickle cell anemia delays preschool development in children aged 4 to 6 years, we studied 10 affected children and 10 normal subjects matched for age, sex, and race. School readiness was evaluated by the Pediatric Examination of Educational Readiness (PEER), which assesses a child's performance in areas of developmental attainment such as visual input, verbal output, and short-term memory. The presence of associated movements (minor neurologic signs) and other areas of behavior such as selective attention, activity level, adaptive behavior, and processing efficiency are also observed. The children with sickle cell anemia scored significantly lower than their normal counterparts in several parameters of the PEER. The McCarthy Scales of Children's Abilities, a standardized psychometric test, showed that these children with sickle cell anemia were within the normal range of intelligence. Magnetic resonance imaging done on three children with sickle cell anemia who scored lowest on the PEER revealed no cerebrovascular infarcts. These preliminary studies demonstrate significant differences in school readiness skills between children with sickle cell anemia and normal subjects.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

We asked primary care physicians in South Carolina about their knowledge, attitudes, and beliefs regarding patients with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) and the services they provide for these patients. In support of an effort to develop more effective state policies regarding HIV/AIDS, the survey focused on conditions under which physicians would provide additional services for such patients; 597 of 900 physicians (66%) responded. Among responding physicians, 40% had not seen a patient with HIV infection/AIDS during the past year and 50% had seen only one to nine. Respondents identified lack of specialty backup support, insufficient clinical knowledge, and lack of available community services as the major barriers to providing care for these patients. Gaps in their knowledge included state and federal policies, available community resources, and clinical issues. Respondents said they would provide additional services if they had specialty backup (54%), better community and social support services (50%), additional training (46%), and limited liability (44%). We concluded that policy changes in these areas could expand access to care for HIV/AIDS patients in South Carolina.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The majority of patients with adenocarcinoma of the rectum are treated with radical surgical procedures. Lesions located in the distal third of the rectum are usually treated by abdominoperineal resection, and those situated in the proximal portion of the rectum are treated by low-anterior resection. Relatively small, moderately or well differentiated lesions have a low risk of lymph node metastasis, and are therefore amenable to conservative (ie, rectum-sparing) procedures. Conservative management options consist of transrectal excision, transrectal excision and preoperative or postoperative radiotherapy, endocavitary contact radiotherapy, and interstitial therapy. Discussion of these options, the experience at the University of Florida with two of these options, and review of the literature follow.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

We present a descriptive analysis of experience with pregnant women in the intensive care units at a tertiary hospital. During the period from 1983 through 1990, 38 women were admitted to our intensive care units during their pregnancy or within 2 weeks postpartum. This was a rate of 1 per 400 pregnant patients. The mean age of these 38 women was 25 years; 68% of them were white and 32% were primigravidas. Nineteen of the 38 women were mechanically ventilated. Twelve women were admitted for hypertensive disease and 10 for adult respiratory distress syndrome. Maternal mortality was 18% (7/38). Follow-up was available for 33 women. The fetal and neonatal loss rate in this group was 4 of 33 pregnancies. In this case series of 38 very ill women, it was apparent that a team approach of obstetricians, anesthesiologists, and intensive care workers provided optimal management for the mother and child.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Ninety-two gravid women had Doppler insonation of the umbilical cord after diagnosis of various pregnancy complications. Calculations of the systolic-diastolic (S/D) ratio were plotted against a nomogram of values developed at the Hospital of the University of Pennsylvania. An S/D ratio greater than the 95th percentile for gestational age correctly predicted 58% of women who became preeclamptic and 61% of infants who were small for gestational age (SGA). Of those fetuses with an elevated S/D ratio, 42% suffered fetal distress as defined by an abnormal fetal heart rate tracing, a 1- or 5-minute Apgar score less than 5 or 7, respectively, or a cord blood pH determination less than 7.20; 60% required operative delivery; and 49% stayed in the hospital longer than 5 days or were admitted to the Neonatal Intensive Care Unit (NICU). All these values are significantly greater than those obtained in a control group of uncomplicated pregnancies or a group of women with similar pregnancies, but with normal measurements of the umbilical artery S/D ratio. Moreover, 69% of abnormally elevated umbilical artery S/D ratios were detected at or before 30 weeks' gestation. Calculation of an S/D ratio of the umbilical cord greater than the 95th percentile for gestational age is an early and sensitive predictor of poor perinatal outcome.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

We retrospectively reviewed the cases of 51 patients with borderline ovarian tumors seen over a 9-year period. Half of these tumors were manifested by abdominal distention and pain; the remainder were found incidentally at the time of surgery planned for other reasons. Overall survival is excellent, but proper surgical staging reveals that approximately 15% of patients have metastasis beyond the ovaries, most commonly to the omentum, peritoneum, and retroperitoneal lymph nodes.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID