摘要:

Background.Systolic blood pressure (SBP) is even more important than diastolic blood pressure (DBP) with regard to the risk of cardiovascular complications.Methods and Results.Pitfalls in the diagnosis of systolic hypertension include the auscultatory gap, use of the proper size cuff (obese adult size for mid-arm circumference >33 cm and child's cuff for mid-arm circumference <23 cm), a “white coat” effect of about 17 mm Hg, regression toward the mean, and a tendency to focus only on hypertension rather than all of the cardiovascular risk factors. Pitfalls in the pharmacologic management of systolic hypertension include being too aggressive with “acute” therapy, too fast in up-titration, too complacent about adverse effects, too unaware of important drug or food interactions, and too content with the achieved level of SBP.Conclusion.In treated hypertensives, SBP is typically less well controlled than DBP. Clinicians must not generally be content with partial control of SBP.

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Early recognition and prompt intervention are the most crucial steps in the management of gallstone-induced biliary disease. Many conditions can mimic the presentation of gallstone-induced complications. Therefore, participation of a clinically astute physician is essential in evaluating symptoms and interpreting diagnostic data in patients with symptomatic gallstones.

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Scalp lacerations are often present in patients requiring emergency care for blunt trauma. These injuries are most commonly seen in unrestrained drivers or occupants involved in motor vehicle crashes in which the victim is partially or totally ejected. Patients with scalp lacerations often have associated injuries that redirect the clinician's attention to other injury sites. Some scalp lacerations are severe enough to cause hypovolemic shock and acute anemia. If the patient arrives in shock, the perfusion pressure may be low, and there may be minimal active scalp bleeding. Under such circumstances, the scalp wound may be initially dismissed as trivial and attention appropriately turned to assuring an adequate airway, establishing intravenous lines, initiating volume resuscitation, and searching for more “occult” sources of blood loss. However, as the blood pressure returns toward normal, bleeding from the scalp wound becomes more profuse and presents a hemostatic challenge to the clinician. A case presentation illustrates some of these issues and confirms the effectiveness of an often overlooked but simple technique to control scalp hemorrhage—Raney clip application.

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Pellagra was in existence for nearly two centuries in Europe before being recognized in the United States, where it was first reported in 1902. Over the next two decades, pellagra occurred in epidemic proportions in the American South. Poverty and consumption of corn were the most frequently observed risk factors. Since the exact cause and cure of pellagra was not known, a culture of “pellagraphobia” formed among the public. Patients were shunned and ostracized. The medical community implicated spoiled corn as the cause of pellagra, which had economic repercussions for agriculturists. Joseph Goldberger, MD, of the United States Public Health Service eventually solved the secret of the malady: faulty diet. Goldberger was able to prevent and induce pellagra by dietary modification, a landmark event in the annals of medicine, nutrition, and epidemiology. His work and the social history of that period are reviewed.

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.Childhood obesity has been associated with elevated serum levels of total cholesterol, triglycerides, and low-density lipoproteins (LDLs). We observed the lipid profiles of obese female subjects versus obese male subjects before and after significant weight loss.Methods.We studied 29 girls and 21 boys enrolled in a multidisciplinary weight reduction program.Results.Measures were taken at enrollment and at 10 weeks. Significant improvements were observed for changes in percentage of ideal body weight and total cholesterol and triglyceride levels. In addition, LDL decreased significantly in girls but not in boys.Conclusions.A combination of diet, behavior modification, and exercise, is an effective instrument for lowering total cholesterol and triglyceride levels in obese children. In addition, girls tend to be more susceptible to a decrease in LDL level, which might result in an increased cardiovascular protective effect.

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.The main study objective was to investigate cholesterol treatment practices of primary care physicians in a managed care setting.Methods.The study was a retrospective review of data with a quasiexperimental design. The National Cholesterol Education Program–Adult Treatment Panel II (NCEP-ATP II) guidelines were used as the reference for conducting a measurement model in the study. Data were randomly selected via a systematic probability sampling method from a health maintenance organization (HMO) capitated risk-based contracting medical clinic in southern Florida.Results.Of the 348 patients selected for the study, 224 (65%) needed either dietary therapy (n = 106) or drug therapy (n =118). However, only 16 patients (13.6%) had ever had cholesterol-lowering drug regimens prescribed during the 5-year study period.Conclusions.Our findings indicate that (1) primary care physicians have poorly adopted the cholesterol management practice recommended by NCEP guidelines and need to improve their recognition and treatment of hypercholesterolemia; and (2) the problem of underutilizing prescription medications may be associated with risk-sharing capitation arrangements between physicians and third-party insurers.

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.Isradipine is a calcium channel blocker of the dihydropyridine class. It has limited effects on myocardial contractility; is available in a powder-filled capsule and has a half-life of 6 to 8 hours.Methods.Pharmacy records were reviewed to identify pediatric patients who had received isradipine. The following demographic data were obtained: age, weight, sex, underlying medical problems, and initial blood pressure values. Information concerning isradipine included the initial dose and its interval, subsequent dose escalations, blood pressure response to the medication, and duration of therapy.Results.The study population comprised 12 patients, ranging in age from 10 days to 11 years. The etiology of the hypertension was renal in 9 cases and nonrenal in 3. Initial dosing with isradipine was 0.1 mg/kg/dose. Six patients had emergent hypertension, and their blood pressure had been controlled with intravenous nicardipine before oral isradipine. Six patients received initial therapy with oral isradipine. Isradipine was monotherapy in 7 patients and in combination with other agents in 5 patients. The dose of isradipine required for blood pressure control was 0.6 ± 0.3 mg/kg/day (range, 0.3 to 1.2 mg/kg/day). Isradipine failed to provide effective blood pressure control in 2 patients. In 1 of these patients, isradipine was effective after peritoneal dialysis.Conclusions.Isradipine is an effective, orally administered agent for control of hypertension in children.

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.The xanthines have been shown to be effective in the treatment of apnea of prematurity. Limited reports are available in the literature concerning the use of these agents with apnea related to respiratory syncytial virus (RSV) infections.Methods.A retrospective review was done to identify infants who received caffeine therapy for RSV-associated apnea. The number of apneic episodes during the 2 hours before the use of caffeine and the number of apneic episodes after the administration of caffeine were compared using a Wilcoxon nonparametric test.Results.The 7 infants ranged in age from 14 to 64 days and in weight from 2.8 to 4.4 kg. The number of apneic episodes per hour for the 2 to 3 hours before the administration of caffeine ranged from 7 to 12, and the number of episodes during the 3 hours after the administration of the first dose of caffeine ranged from 0 to 2. The apneic episodes after caffeine responded to external stimulation. Apnea recurred in 3 infants, 18 to 24 hours after the first dose of caffeine. These infants received a second dose of caffeine (5 mg/kg).Conclusions.Caffeine should be considered in the treatment of apnea related to RSV infections in neonates and infants.

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.Health care professionals often use written material or video recordings to teach their patients without knowing which is more effective for comprehension of the information.Methods.Patients watched either an instructional videotape about sleep apnea or read a newly designed brochure, then responded to a structured questionnaire containing 11 knowledge-based questions and 1 open-ended question (requesting suggestions for improvement of the brochure or videotape).Results.Mean reported educational level was grade 12, and mean reading level was between grade 7 and 8. Using video significantly improved only two areas of knowledge for low-level (below grade 8) readers: defining sleep apnea (66% vs 43%) and identifying what continuous positive airway pressure (CPAP) does for the patient (94% vs 78%). Patients requested material with more diverse cultural representation, more information on treatment and outcomes, and fewer polysyllabic words.Conclusions.Emphasis on diagnosis and treatment, explained using simple words, should be reflected in the content of patient education brochures or videos. Providing information by video alone may have limited benefits.

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID