摘要:

Pain is often the first symptom of cancer. Pain and fear of pain are concerns of most cancer patients and their families. The therapeutic options available to control pain are numerous, allowing practitioners to better individualize treatment. We present an overview of the pathophysiology of cancer pain, the current theories of pharmacologic opioid management, advantages of adjuvant drugs, and the range of invasive and noninvasive procedures that practitioners can offer their patients who have cancer–related pain.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Although ubiquitous, migraine remains incompletely understood and thus often ineffectively managed. Fortunately, new advances in our understanding of migraine's origins have led to identification and application of therapeutic intervention that is unparalleled in its specificity and clinical efficacy. We present a unified model of migraine genesis and explain how application of the model to clinical practice may improve therapeutic management of this common disorder.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Patients were interviewed immediately after discharge outside the emergency department to determine whether they could read their discharge instructions and recall their diagnosis and treatment plan. The association between frequency of correct responses and various characteristics of the patients was assessed. Of the patients completing the interview, 72% could read the discharge instructions. The illiteracy rate was higher for patients with less than 9 years of education and for patients aged 50 to 59 years. There was no association between patient race, sex, or literacy. The correct diagnosis was given by 79% of patients, correct treatment information by 49%, and correct follow–up information by 82%. Overall, 37% of patients answered all questions correctly and 8% answered all questions incorrectly. No association was found between frequency of correct responses and variables examined. Miscommunication of discharge information occurs frequently; illiteracy does not completely account for the observed low rates of recall.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

In small preliminary trials, ciprofloxacin has failed to eradicateHelicobacter pylori. Since fluoroquinolones have a marked reduction in bactericidal activity at acidic pH, we altered the gastric pH using omeprazole and investigated the efficacy of ciprofloxacin in eradicatingH pylori. Forty–four consecutive patients infected withH pyloriwere prospectively studied in a randomized, double–blind, controlled trial comparing ciprofloxacin with a placebo for 2 weeks. Both treatment groups received bismuth and omeprazole. In 36 patients, follow–up endoscopy was done 4 weeks after the cessation of all study drugs. TheH pyloriinfection cleared in 13 of 17 patients (76%) in the ciprofloxacin group versus 5 of 19 (26%) in the placebo group. Concurrent administration of omeprazole with ciprofloxacin resulted in increased bactericidal activity againstH pylori. Ciprofloxacin when combined with omeprazole and bismuth is efficacious for eradication ofH pylori.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

A retrospective review was done to determine the efficacy and hemodynamic effects of slow intravenous amiodarone administration on invasively monitored patients with acute onset of atrial fibrillation or atrial flutter and left ventricular ejection fractions <15%. Eight patients met predefined inclusion criteria. All received 300 mg amiodarone intravenously over 1 hour. Seven reverted to sinus rhythm within 1 hour, with return of most hemodynamic variables to baseline. Before reversion, each patient experienced a beneficial slowing of heart rate (mean, 28%) resulting in significant improvement of stroke volume index (mean, 49%) and left ventricular stroke work index (mean, 61%). No patient had hemodynamic deterioration attributable to amiodarone infusion. Slow intravenous infusion of amiodarone appears to be an effective and hemodynamically well–tolerated therapy for atrial fibrillation and atrial flutter in critically ill patients with marked depression of left ventricular systolic function.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

To assess the effects of high doses of shock waves to organs in the right upper quadrant of the abdomen, 36 adolescent swine were given one treatment of either 2,000 (2k), 6,000 (6k), or 10,000 (10k) shock waves at 24 kV peak pressure using a spark–gap lithotriptor. Shock waves were sonographically focused on the lumen of the gallbladder. Blood and tissue were examined for each group at 48 hours, at 35 days, and at 6 months. This study showed that administration of up to five times the accepted upper limit of shock waves produced no permanent damage. Transient injury, most commonly hematoma, was encountered. No posttreatment intra–abdominal catastrophes occurred. Although no renal injury was seen, it should be noted that the focus of maximum energy was 5 cm cephalad to the right kidney. This study suggests that an increased number of shock waves may be administered safely to this area of the abdomen.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Inadequate immunization has been a major cause of epidemic measles, but risk factors for inadequate immunization are poorly characterized. By using measles data bases and computerized birth certificate files, we identified a retrospective cohort of 1,070 Texas–born children who were aged 15 months to 10 years when they had measles during the 1988 to 1991 epidemics. We used measles and birth certificate data, including prenatal care and demographic information, to determine immunization status and risk factors for inadequate measles immunization. Risk factors predicting lack of immunization in children with measles in stepwise logistic regression were black ethnicity, urban residence, poor prenatal care, preschool age, and an unknown father. Birth certificates contain information that can predict inadequate measles vaccination and should be evaluated prospectively.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

We present the case of a woman who had an Accufix atrial “J” pacemaker lead implanted in 1990. Subsequently, Telectronics Pacing Systems recalled two models of the atrial leads after problems with fracture and malfunction were reported. One of these models was used in our case. Fifty–two months after implantation, following recommended fluoroscopic screening, our patient was found to have a complete fracture of the “J” retention wire with one fragment protruding from the sheath in the right atrium and another fragment of the wire lodged in the right ventricle. The pacemaker had continued to function normally and there was no clinical evidence to suggest such a potentially disastrous fracture. Our report emphasizes the importance of fluoroscopic screening of all patients with atrial leads involved in the recall.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Pulmonary alveolar proteinosis is a nonspecific alveolar response to various forms of injuries. Many cases have been associated with hematologic malignancies. The most commonly reported complication of pulmonary alveolar proteinosis is superinfection with fungal, bacterial, and viral infections. We report a case of a 33–year–old man with alveolar proteinosis complicated byMycobacterium avium–intracellularecomplex infection. The additional presence of diffuse lymphocytic interstitial pneumonitis is an association that has not been previously reported.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

An enzyme–linked immunosorbent assay was used to measure the levels of therapeutic antivenin (Antivenin [Crotalidae] Polyvalent, Wyeth–Ayerst) in serum and the levels of venom in the urine of a patient bitten by a western diamondback rattlesnake (Crotalus atrox). Serum and urine samples were taken on admission, during hospitalization, and during follow–up until 5 months after the bite. Photographs were taken of the bite site on admission to the hospital and during follow–up. Serum levels of therapeutic antivenin were highest between 1 and 3 days after the bite but were still detectable 46 days as well as 4 months after the bite.Crotalus atroxvenom was detectable in the urine 4 days after the bite and was still measurable 6 days after the bite.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID