摘要:

Between 15 and 30 million Americans have allergic rhinitis. Costs of diminished job and school performance extend beyond the financial burden of treatment, taking their toll in worker productivity and school absences. Therapeutic approaches include allergen avoidance, pharmaceuticals, and allergy immunotherapy. Among the pharmaceutical agents, decongestants, anti-inflammatory drugs, and antihistamines relieve allergic rhinitis symptoms. Often, decongestants are prescribed along with antihistamines to provide maximum relief. Anti-inflammatory agents such as cromolyn sodium and topical corticosteroids are efficacious despite their delayed effect. However, allergic rhinitis is most frequently treated with antihistamines. Today's antihistamines have minimal sedative effects and cholinergic actions, are safe to use, and do not impair performance.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

When mental retardation is complicated by mental illness, the clinical result is “dual diagnosis.” Though recognized as such only since the 1970s, these patients have long been the subset of the developmentally disabled most resistant to integration into the community. The maladaptive behavior or mental illness often prevents training for the retardation or other developmental disability. Because these patients are no longer placed in the back wards of state institutions, the modern expectation is that even this most difficult group can be influenced by positive behavior support directed by a psychologist and medication treatment programs prescribed by a psychiatrist. In addition, program specialists structure the work, play, and learning environment of the patients. These activities, living conditions, and peer relationships will form a dynamic interaction with the behavior therapy and the medication. The challenge of adapting to this interaction is met by an interdisciplinary team. Subject to bizarre behavior and difficult to diagnose and treat, patients with both mental retardation and mental illness are best directed to providers trained for these patients.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Because Armed Forces Reserve members, especially combat support units, were rapidly mobilized during Operation Desert Shield/Desert Storm, they were at higher risk for anxiety and stress-related disorders. Personnel in reserve units in the military force structure are at greater risk for psychologic stress due to rapid mobilization and demobilization, which allows minimal time to process adverse experiences or fears. The unexpected disruption of families and careers and resulting financial pressures are magnified in older age groups who have increased personal and family commitments. Personnel in combat support units are at greatest risk when they lack necessary training, cohesion, and leadership. Prevention efforts in reserve units should involve education regarding the potential for activation and associated disruption of family and career plans. Support networks for reserve families should be encouraged. Additional training in an appropriate context regarding risks of biologic and chemical exposure, with the goal of developing confidence in training and equipment, should be stressed. Finally, group processing before demobilization and recall within 90 days of return to emphasize unit cohesion and readjustment to civilian life may be of benefit.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The purpose of the study was to determine whether the incidence of periventricular-intraventricular hemorrhage (PV-IVH) is significantly different between the firstborn and secondborn of very low birth weight twins. The firstborn and secondborn of 102 sets of twins were compared by incidence of PV-IVH, mode of delivery, birth weight, 5-minute Apgar score, pH, duration of oxygen therapy, duration of ventilator support, and occurrence of patent ductus arteriosus, air leak, bronchopulmonary dysplasia, or hyaline membrane disease. PV-IVH was graded by the Papile classification. Statistical data were analyzed by either the pairedttest or McNemar's test. Major PV-IVH (grades III and IV) occurred in 11 firstborn and 14 secondborn infants. Minor PV-IVH (grades I and II) occurred in 11 firstborn and 8 secondborn twins. Neither these findings nor those from other measured variables showed a statistically significant difference.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Multicentric Castleman's disease is an unusual lymphoproliferative lesion typically associated with systemic manifestations and specific histopathology. We describe two cases of pathologically proven multicentric Castleman's disease along with radiographic and ultrasonographic findings.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

We examined health care utilization by subjects with symptoms of borderline personality disorder. The study included 194 female subjects between the ages of 17 and 52 who were consecutively seen for nonemergency medical care in a health maintenance organization. Each subject completed the borderline personality scale of the Personality Diagnostic Questionnaire-Revised (PDQ-R), as well as the Self-Harm Inventory, which correlates with the diagnosis of borderline personality. For each instrument, subjects with scores suggestive of borderline personality were compared with subjects without this disorder in regard to their utilization of health care resources (eg, number of combined telephone contacts and physician visits, number of physicians seen, number of prescriptions obtained) during the preceding 12 months. Subjects with more severe borderline personality disorder (according to the PDQ-R) made significantly more contacts with the health care facility (ie, telephone calls and physician visits) and received more prescriptions.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The use of stress echocardiography (SE) in an elderly population was retrospectively evaluated and compared with myocardial perfusion scintigraphy (MPS) in a similar group. Patients ≥80 years of age were evaluated by treadmill or pharmacologic SE (group 1; n=65) to determine its predictive value for cardiac events. A second group had MPS (group 2; n=68). We identified 11 patients in group I and 25 in group 2 who had a cardiac event, with no statistical significance between the positive predictive value of SE and MPS (55% vs 49%) and the negative predictive value of SE and MPS (89% vs 73%). The actuarial event-free survival was better for patients with negative SE than for patients with positive SE or negative or positive MPS. This study suggests that SE is comparable to MPS as a prognosticator of cardiac events in octogenarians. The retrospective design and the small population studied are major limitations. A larger, prospective trial should be launched to analyze this group and compare various stress tests.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Lewy bodies have historically been considered a histopathologic hallmark of idiopathic Parkinson's disease. Recently, it has become clear that Lewy bodies play a role in neurodegenerative processes other than idiopathic Parkinson's disease, including diffuse Lewy body disease and diffuse Lewy bodies with concomitant Alzheimer's disease changes. It is likely that these processes represent a spectrum of neurodegenerative change in which Lewy bodies play a pivotal role. Although much is known and has been written regarding the histopathology and pathophysiology of Lewy body diseases, specific criteria for their diagnosis remain problematic. Within the spectrum of Lewy body disease, overlap in clinical presentation and histopathologic findings has caused some to dismiss attempts at subcategorizing Lewy body disease as artificial. We present, in brief, current information and theories concerning the pathology and pathogenesis of Lewy body disease.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Passive smoking is the involuntary inhalation of tobacco smoke by nonsmokers. The purpose of this study was to estimate the degree of passive smoking exposure sustained by smokers and nonsmokers in a nonventilated submarine through the measurement of end-expiratory carbon monoxide (EECO) levels. The initial and final EECO levels were compared for both smokers and nonsmokers. A simple linear regression equation was then used to compare the initial EECO levels in smokers (and their daily cigarette use) with the postsubmergence EECO levels in nonsmokers. Our results showed the postsubmergence EECO levels in the nonsmoking crew members approximated the initial EECO levels in crew members who smoked 21 cigarettes per day. Nonsmokers in a submerged submarine are exposed to significant levels of CO. Future studies are needed to determine the health consequences of this significantly increased level of exposure in nonsmokers.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

We studied the effectiveness of EMLA cream (2.5% lidocaine, 2.5% prilocaine)in reducing distress, anxiety, and pain associated with phlebotomy in pediatric outpatients. This was a randomized, double-blind, placebo-controlled study using EMLA cream or placebo 1 hour before phlebotomy. Distress, anticipatory anxiety, pain, and adverse reactions were measured. Measurements of distress and ease of procedure, as well as changes in heart rate, showed significant improvement with EMLA cream as compared with placebo. Pain was decreased with use of EMLA cream. Anticipatory anxiety levels were equal within both groups. Ratings of cream efficacy by parent/observer scales were in favor of EMLA cream.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID