摘要:

Marijuana, if rescheduled by the Drug Enforcement Agency, would be the only Food and Drug Administration (FDA)-approved drug to be administered by smoking. American physicians need timely, factual information about probable usage patterns and potential adverse effects of medical marijuana, and a factual complete review of the literature on the subject. We mailed a survey to 1,500 American clinical oncologists. Of particular interest was whether and how often in the past 24 months these physicians recommended smoked marijuana, synthetic tetrahydrocannabinol, or 5-HT3(serotonin) antagonists (ondansetron [Zofran], granisetron [Kytril]) for their patients. We also inquired whether and how often the oncologists would prescribe marijuana in the form of cigarettes, were it to be FDA-approved. Completed surveys were received from 1,122 (75%) of the oncologists. The percentages of oncologists who prescribed or recommended selected antiemetics more than five times between 1992 and 1994 were 98% for 5-HT3antagonists, 6% for dronabinol (Marinol), and 1% for smoked marijuana. We also found that 332 (30%) of the oncologistrespondents to this nationwide survey supported rescheduling of marijuana for medical purposes; however, two thirds (67%) of the 332 respondents who were in favor of rescheduling estimated that they would write less than one prescription per month for marijuana cigarettes. A comprehensive literature review failed to provide persuasive evidence to recommend marijuana as a needed antiemetic medicine.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The inhaled β2-adrenergic agonists form the mainstay of therapy for mild to moderate asthma. They are also highly effective for the management of exercise-induced asthma and nocturnal symptoms of the disease. Mounting evidence suggests that these agents may have the potential for the development of tolerance, particularly to their bronchodilating effects, and this tolerance may be associated with increases in asthma-related morbidity and mortality, though this link remains controversial. However, experience to date indicates that the β-agonists do not share the same propensity to cause tolerance. Instead, tolerance appears to be more closely associated with the regular use of these drugs rather than their PRN use. Furthermore, clinically relevant tolerance is more likely in patients who are treated regularly with high doses of a bronchodilator for long periods. Current therapeutic recommendations suggest that inhaled β-agonists should be used on a PRN basis when possible and that the lowest effective doses should be administered.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Integration of mental illness and substance abuse treatments is important for patients with “dual diagnosis,” the coexistence of an emotional ailment and a chemical dependency. Such comorbidity is usually associated with a poor prognosis. Both disorders require appropriate therapy so that remission of psychiatric symptoms and maintenance of sobriety become reachable goals for these individuals. A joint therapeutic approach improves outcome, functional expectation, and community adjustment.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Because it is capable of producing both congenital and acquired infections, the cytomegalovirus (CMV) has become an extremely important pathogen, and review of its history is pertinent. Inclusion-bearing cells were first shown by Ribbert in 1881. Goodpasture and Talbert in 1921 were the first to suggest that the “cytomegalia” could be due to a viral agent. In 1950, Smith and Vellios showed that infection may occur in utero. The introduction of exfoliative cytology methods allowed identification of characteristic cells in the urine of infected infants. Smith in 1956, Rowe and coworkers in 1956, and Weller et al in 1957 independently isolated human CMV strains. In 1960, Weller and coworkers proposed the term “cytomegalovirus” and subsequently isolated CMV from the urine of infants with generalized disease. CMV has now become one of the most common opportunistic pathogens encountered hi patients immunocompromised from congenital or acquired causes such as AIDS or transplantation procedures.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Geographic variations in adverse health outcomes have long been recognized in the United States, with specific focus on the southeastern region of the country. Cerebrovascular disease mortality rates have identified the Southeast as the “stroke belt” for decades, though rates are also high for other hypertension-related diseases including ischemic heart disease, diabetes, and end-stage renal disease. The increased cerebrovascular disease mortality in the Southeast has prompted intervention and research efforts. This paper provides a descriptive profile of the hypertensive end-organ diseases in this area to guide research efforts and to gauge changes in health outcomes and risks. In addition to mortality from stroke, this assessment identified excessive risks from diabetes, ischemic heart disease, and end-stage renal disease for some states in the Southeast. Trend variations in health outcomes were also detected.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Mesothelioma is a rare, asbestos-associated tumor that infrequently metastasizes. We reviewed 22 autopsies (from February 1989 through July 1994) showing mesothelioma. We determined distribution of metastases and staining characteristics of primary mesotheliomas compared to tissue involved by metastases and/or direct extension. Mean patient age was 68 years (range, 38 to 88 years); black:white patient ratio, 4:18; and male:female patient ratio, 2:1. All patients had a history of asbestos exposure. Fifteen autopsies were complete and 7 were limited to the thoracic cavity. Multiple sites were involved by direct extension. Metastases were in multiple sites, including omentum, stomach, intestine, mesentery, adrenal glands, ovary, pancreas, kidneys, liver, spleen, and vertebrae. Results of immunohistochemical staining of primary mesotheliomas and metastases were similar; both were positive for low-molecular-weight keratin and negative for carcinoembryonic antigen, Leu-M1, Ber-EP4, and periodic acid-Schiff reagent with diastase. Results of testing for high-molecular-weight keratin were variable.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The efficacy of condoms in preventing contamination of the transvaginal ultrasound transducer head and possible transmission of blood-borne pathogens is unknown. Our objective was to determine the rate of contamination of the transvaginal ultrasound probe after use in the emergency department. After indicated transvaginal ultrasound scans, the latex condom was removed and the transducer head was inspected for contamination. The presence of vaginal bleeding and the duration of the ultrasound scan were noted. Ten milliliters of hydrogen peroxide (H2O2) was placed in the condom. Bubbling, which occurs in the presence of blood or cervicovaginal secretions, was considered a positive test. Exposure of a clean condom or coupling gel to H2O2did not cause bubbling. Two-tailed Fisher's Exact and Student's t tests were used for statistical analysis. Of 173 cases, 8 (5%) had a positive H2O2test for contamination. In only 3 of these 8 cases was gross contamination seen. Latex condoms are ineffective in preventing contamination of the transvaginal ultrasound transducer head. Visual inspection of the transducer head often fails to identify the presence of blood or body fluids. This suggests that additional measures should be taken to prevent transmission of blood-borne pathogens.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Drooping of the big toe is found in a host of neurologic diseases. If found in isolation in a patient who has low back pain, with or without clear sensory deficit, this finding can be a useful, objective aid in localizing the lesion to the L-5 nerve root.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

This paper describes an “epidemic” of foreign body ingestion in six consecutive prisoners from the same jail. The resulting esophageal perforations won all patients “temporary vacations” from prison. The nature of the ingested foreign body (hypodermic needles fashioned into a “star”) guaranteed perforation of the esophagus. All six patients had emergency esophagotomy for foreign body removal. In the only case of significant morbidity, suture line disruption with mediastinitis and empyema led to esophagectomy, cervical esophagostomy, and tube gastrostomy. This patient survived and subsequently had uncomplicated esophagocoloplasty. Foreign objects of this type have not been described in the literature. Because of their specific design, they necessitate immediate and aggressive surgical management.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

A 3-year retrospective study (1992 to 1995) was done to identify all cases of Greenfield filter use in pregnant patients cared for by the Maternal-Fetal Medicine Service of our institution. The patient selection criteria included placement of a Greenfield filter in the index pregnancy or placement of a Greenfield filter before conception and in a patient who subsequently became pregnant. A series of eight pregnant patients with Greenfield filters was identified, the largest to date in a single institution. Management of the pregnant patient at risk for pulmonary embolism or its recurrence is problematic. Hypercoagulability occurs during pregnancy and predisposes the at-risk patient to thromboembolic phenomena such as deep venous thrombosis and pulmonary embolism. This study, though limited, indicates that Greenfield filters may be used safely in pregnant women and are effective in preventing pulmonary embolism or its recurrence.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID