摘要:

The bleeding time is prolonged in anemic patients independent of their platelet count and is shortened by elevating the hematocrit. It is theorized that an increase in circulating red blood cells increases platelet radial movement and interaction with endothelium. Platelet dysfunction in uremia is well known but poorly understood. Anemia is one contributory factor; others may involve storage pool deficiency, increased vessel wall prostaglandin production, and abnormal platelet arachidonic acid metabolism. Ameliorating anemia with red blood cell transfusions has been shown to shorten the bleeding time without affecting other platelet function values. Recently, recombinant human erythropoietin has been shown to shorten the bleeding time, with a parallel rise in hematocrit level to 30%. Clinicians should be aware that a diminished hematocrit may contribute to the bleeding tendency already present in patients with thrombocytopenia.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Attention deficit hyperactivity disorder (ADHD) is a common, disabling disease in adults. Newly developed diagnostic measures are available to screen for and support the diagnosis. ADHD typically causes complaints of disturbances of attention, impulsivity, and hyperactivity, although a subgroup of patients have only problems with attention. The disorder may be subtle or it may be obscured by secondary problems; the boundaries of the syndrome often blur with those of other disease entities. Once the diagnosis is confirmed, effective pharmacologic treatments are available. Psychologic treatment serves an important adjunctive role for associated problems and concurrent psychologic disorders. Marked improvement in quality of life often occurs after diagnosis and appropriate treatment.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Obsessive-compulsive disorder (OCD) is an intriguing, difficult problem characterized by anxiety-producing intrusive thoughts and performance of anxiety-reducing rituals. Current evidence suggests that OCD may be associated with dysregulation of serotonin and dopamine neurotransmission. Numerous early studies involving the serotonin-specific reuptake inhibitor clomipramine led to the formulation of this hypothesis. Positive results with clomipramine initiated further research with other serotonin-specific reuptake inhibitors, such as fluoxetine, fluvoxamine, sertraline, and serotonergic agents such as buspirone and trazodone. Findings from a number of clinical trials suggest that drugs that inhibit serotonin reuptake or affect serotonergic transmission in other ways are of clear benefit in the treatment of OCD. These drugs may be more effective for obsessive thoughts than for compulsive rituals. Effective pharmacotherapy can dramatically decrease obsessive-compulsive symptoms and improve the patient's quality of life.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

ABSTRACT:There is little information on the long-term consequences for employees when no-smoking policies are established in the workplace. Our study was designed to assess changes in employee health and smoking behavior. Of the original 60 subjects, 40 employees (18 smokers, 22 nonsmokers) completed this study, which was conducted in a major medical institution. Nonsmokers were recruited as part of the study to determine whether they showed evidence of workplace carbon monoxide associated with passive smoke, potentially inhaled at the work site. Baseline measurements of smoking frequency, carbon monoxide, and weight were obtained during the month preceding the smoking restrictions and at 6 and 18 months afterward. Smokers made significant reductions in daily smoking during the first 6 months but gradually returned to prepolicy levels over the following year. Smokers, in particular, showed increases in weight. Smokers gained 4.93 lb after 18 months, whereas nonsmokers gained 2.25 lb in the same period. Nonsmoker employees showed no evidence of workplace carbon monoxide exposure associated with passive smoke. We discuss the implications of the findings for no-smoking policies in the workplace.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Carpal tunnel syndrome (CTS) has been linked to repetitive motion only in the past 15 years or so. Often the studies supporting this proposed link have not used strict clinical criteria and have rarely had electrodiagnostic confirmation of the diagnosis. In order to better assess the actual incidence of CTS in patients in a repetitive-motion job who had pain, numbness, tingling, or all three in the hand, wrist, or forearm, we examined 112 consecutive charts of such patients referred to a consulting neurologist for a possible diagnosis of carpal tunnel syndrome. Thirty-five percent of those patients had either classic clinical symptoms or positive electrodiagnostic results, but only half of these (17% of the total) actually had both. It is thus suggested that the incidence of CTS in patients doing repetitive motion may have been overestimated in the literature, and very strict clinical and electrodiagnostic criteria should be used before a diagnosis of carpal tunnel syndrome is made or surgery is contemplated in these patients.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Tracheoesophageal (TE) speech is now the most common method of voice rehabilitation after total laryngectomy. The speech intelligibility of laryngectomees who use TE speech as their primary mode of communication was evaluated by 20 “naive” listeners. Two speech intelligibility tests were administered using phonetically balanced rhyming words or lists of spondee words. The overall intelligibility for the group of laryngectomees was 76 %, with a wide range of variability among the individual TE speakers. We concluded that TE speech is significantly less intelligible to naive listeners than normal laryngeal speech; further refinement of voice rehabilitation for laryngectomees is needed.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The imaging methods currently used to localize the parathyroid gland in patients with hyperparathyroidism have been criticized as unreliable and even misleading. We evaluated a new imaging technique that uses technetium Tc 99m sestamibi and iodine 123. We studied 21 patients having a diagnosis of primary hyperparathyroidism and no previous parathyroid surgery. Scintigraphy to localize the abnormal parathyroid was done before operation. A solitary adenoma was localized in 14 patients. Six patients had images consistent with diffuse hyperplasia, and one patient had a dual adenoma. The surgical and histologic findings confirmed the preoperative data. The sensitivity of this method is 87.5%, the specificity is 100%, and the predictive value is 100%. This new method of preoperative localization of abnormal parathyroid glands is useful in patients having initial neck exploration for primary hyperparathyroidism.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Magnetic resonance imaging (MRI) has provided a clear view of the sella turcica and the pituitary gland, even on “routine” procedures that invariably include the sagittal T1-weighted sequence. A pituitary gland that does not fully occupy the sella is a common observation, even in normal individuals. Terms such as “empty sella” and “partially empty sella” have become more commonly used, occasionally giving rise to some confusion regarding their clinical significance. In a prospective study of 50 “near-normal” patients, based exclusively on the midsagittal T1-weighted image, we have found a statistically significant increase in sellar emptiness with age, a phenomenon that is more prominent in women. The finding of an empty or partially empty sella on routine MRI of the brain is therefore usually of no clinical significance.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

We assessed the magnitude, demographics, seroprevalence, and reasons for site selection among South Carolina residents who chose to be tested in bordering states offering anonymous testing for human immunodeficiency virus (HIV). Residents tested from July 1990 through July 1991 at selected HIV testing sites in bordering states were surveyed and HIV test results were recorded. Of the 75 residents tested at these sites, 66 (88%) were white, 44 (59%) were male, and 9 (12.3%) of the 73 whose test results were recorded were HIV infected. During the same period, 57,137 individuals were HIV tested in-state by the state health department, of which 1,752 (3.1%) were positive. Residents tested outside the state were more likely to be HIV infected, male, and white than individuals tested within the state. Our findings suggest that although large numbers of South Carolinians are not HIV tested anonymously in other states, those tested anonymously out of state have a different demographic and risk profile than those tested confidentially in state.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Cyclo(His-Pro) (CHP) is a gut-neuropeptide that influences both appetite and carbohydrate metabolism. This study was undertaken to determine whether concentrations of CHP correlated with various clinical markers of nutritional status and progression of HIV infection. Serum concentrations of CHP were analyzed in a clinical sample of 100 HIV-positive patients whose HIV clinical status ranged from asymptomatic to advanced disease with weight loss. We found a relationship between CHP concentrations and serum albumin and hemoglobin levels, markers of chronic nutrition and disease. However, no correlation was seen between CHP and cortisol concentrations, a marker of acute stress. To analyze the relationship of HIV clinical stage and CHP, patients were divided into three subgroups: asymptomatic, mildly symptomatic, and clearcut AIDS. CHP concentrations were significantly correlated with HIV clinical stage. These data lead to the hypothesis that CHP is a marker of disease progression and that it potentially plays a role in modulating the nutrition of HIV-infected patients.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID