摘要:

We report on the experience of a 500-bed, long-term care facility in Miami, Fla, which provides housing and nursing care units for patients—ranging from those who are independendy ambulatory to those who are acutely ill and feeble—in preparing for, during, and in the immediate aftermath of Hurricane Andrew, which struck on August 24, 1992. The problems encountered included a massive influx of evacuated elderly to the facility, facility isolation, loss of electrical power, loss of running water, special dietary needs, and limited professional staffing due to personal property losses or loss of transportation. Overwhelmed county emergency medical services, limited access to hospitals and patient care, and difficulty in procuring supplies exacerbated the already complicated situation resulting from the storm. As a result of these catastrophic conditions, a number of challenges specific to the care of the elderly were identified. In conjunction with the Florida Department of Elder Affairs, we drafted a comprehensive blueprint that could serve as a disaster plan for other long-term care facilities facing a similar threat during the hurricane season.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Medical devices have become an important component of our professional armamentarium. This paper exposes the practitioner to the Food and Drug Administration and its control over medical devices. Specifically, the 1976 amendment to the Food and Drug Administration Acts is described, along with the subsequent federal laws. Because of all the new technology available, physicians should be aware of the applicable laws and regulations. In addition, a review of the penile prosthesis includes its history and evolution, as well as the entire product line available for use. Attention is directed to the problems that have arisen from malfunctioning components.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

To determine the extent and types of injuries and illnesses in Louisiana associated with or related to Hurricane Andrew, we gathered data from hospital emergency departments and coroner's offices on demographic variables, institution, nature and cause of the injury or illness, body part affected, location, and date and time of the event. A hurricanerelated injury or illness was defined as one that occurred from noon on August 24,1992, through midnight on September 21,1992, as a direct or indirect result of the preparation for (preimpact), the impact of, or the clean-up after the hurricane (postimpact). Nineteen parishes in south-central Louisiana that were most affected by Hurricane Andrew provided data from patients seen in emergency departments and reports from coroner's offices. Active, advance surveillance of this type promotes and facilitates the reporting of disasterrelated health outcomes. Future planning for hurricanes should take into account the high rate of cuts, lacerations, and puncture wounds, particularly during the postimpact phase.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

In the United States, 10,000 to 20,000 patients have epilepsy uncontrolled by medication. The addition of a second-line drug to the primary regimen has a 2% to 11% chance of controlling the seizures. We present a series of 35 patients with intractable epilepsy who had surgical resection of their seizure focus. Seventy-five percent of the patients with temporal lobe epilepsy were made seizure free, with an additional 14% sustaining a greater than 90% reduction in seizures (decrease in number and frequency). Seventy-one percent of the patients with extratemporal lobe epilepsy (seizures originating outside the temporal lobe) had a worthwhile reduction (>90%) in their seizures. Two patients sustained permanent clinically significant deficits as a result of their presurgical evaluation or resection. There were no deaths. Epilepsy surgery offers a cure for the “incurable” patient with a morbidity of 5% to 6%.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

We endoscopically evaluated odynophagia and/or dysphagia in 23 patients with acquired immunodeficiency syndrome (AIDS). Eleven patients (48%) were found to have esophageal ulcers. Seven of them had deep, sharply demarcated, well-circumscribed ulcer craters with raised edges; in two the ulcer extended to the muscularis propria. Ulcers were single in four patients, multiple in six, and unspecified in one. Biopsies were nondiagnostic. In eight patients, mycobacterial, viral, and fungal cultures were negative. Specific infections diagnosed in three patients were treated with appropriate agents. Ulcers were treated symptomatically, and seven patients received therapy for suspected viral etiology. Symptoms remained unchanged in five patients, improved in three, and resolved in two. Fifty-five percent of patients died within 3.6 months (mean) of diagnosis. Large solitary and multiple esophageal ulcers are common in AIDS patients with odynophagia and dysphagia.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

This investigation was designed to determine whether the narcotic alfentanil, a relatively new fentanyl derivative with rapid onset of action and offset of activity, alone or in combination with midazolam has advantages over the traditional meperidine and midazolam regimen for conscious sedation. Thirty-five subjects were randomized to receive an initial dose of narcotic and sedative with additional narcotics or sedatives administered as needed. Subjects receiving no midazolam sedative (alfentanil and placebo group, n=13) had less desaturation and had the need for supplemental oxygen less often than those receiving alfentanil and midazolam (n=11) or meperidine and midazolam (n=11). There were no differences as assessed by patient and colonoscopist for tolerance and discomfort, procedure ease, recovery time, complications, electrocardiogram, and blood pressure. Baseline evaluation did not predict the need for supplemental oxygen. We concluded that alfentanil, with or without a sedative, has no advantage over the commonly used meperidine and midazolam regimen.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Adrenal myelolipomas are rare benign neoplasms composed of mature fat and bone marrow elements. Most are asymptomatic tumors found incidentally at postmortem examinations. We report the natural history of an adrenal myelolipoma in a middle-aged man over a 6-year interval.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Myelolipomas are benign tumors composed of an admixture of mature adipose tissue and normal hematopoietic cells. The vast majority occur within the adrenal glands, but several extra-adrenal myelolipomas (EAMLs) have been reported. The typical EAML is a solitary, well-defined mass within the abdomen, most commonly in the retroperitoneal presacral area. EAMLs may produce symptoms related to their mass effect, but they are occasionally incidental findings. Most commonly, the patient is older than 40 years and has no hematologic abnormalities. It is important to distinguish EAMLs from other soft tissue tumors, in particular liposarcomas, myxoid malignant fibrous histiocytomas, and extramedullary hematopoietic tumors. We discuss two cases of EAML. The first was in the retroperitoneum of a 76-year-old woman. It is the largest EAML ever reported, measuring 26 cm × 15 cm × 11 cm. The second, a presacral mass in a 68-year-old man, was diagnosed preoperatively by percutaneous computed tomography-guided fine needle aspiration biopsy. Preoperative diagnosis facilitated surgical management in this case. We discuss the clinical, radiologic, and pathologic characteristics and the differential diagnosis of this rare entity.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

We report a case of gold pulmonary toxicity in a patient with adult-onset Still's disease with dyspnea on exertion and a normal chest radiograph. Withdrawal of gold therapy resulted in complete resolution of pulmonary toxicity in our patient without the need for additional steroid therapy.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

We report a case of intramural gastric actinomycosis and review the features of the additional 16 cases of this uncommon infection reported in the literature. The patient had gastrointestinal symptoms, weight loss, and fever after gastric operation. At laparotomy, an infiltrating gastric tumor-like lesion was found. Histology revealed actinomycosis, and the patient was successfully treated with oral penicillin. Because of its rarity, intramural actinomycosis is an entity overlooked by most surgeons. Reporting of such cases may help increase the awareness of this important and curable disease.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID