ISSN:0038-4348    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

All occupations are associated with stress, but certain occupations are significantly more stressful than others. Stress is not always harmful. It is the individual's reaction to stress that determines the outcome, ie, whether the individual will adapt or become maladaptive. Individuals who feel they can control events or are in control of their lives are better able to handle stress than individuals who believe they are the victims of fate or chance and who feel powerless and helpless. For those individuals who feel powerless or helpless, suicide may be a means of taking control over their helplessness. Police officers, who are subject to extraordinary stress, present a paradigm for the study and treatment of stress in other occupations.

ISSN:0038-4348    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Hex death is one that follows a ritualized pronouncement of death by a powerful authority, a phenomenon not widely accepted by the Western medical community, despite scattered accounts witnessed by reputable observers. Case histories of two patients are presented. The first patient, a poorly educated man near death after a hex pronounced by a local voodoo priest, rapidly recovered after ingenious words and actions by his family physician. The second, who had a diagnosis of metastatic carcinoma of the esophagus, died believing he was dying of widespread cancer, as did his family and his physicians. At autopsy, only a 2 cm nodule of cancer in his liver was found. The cases raise several intriguing questions. Is death from hexing limited to ignorant and superstitious tribes, or is it part of some general phenomenon basic to many forms of human communication? Is hex death only a form of human persuasion? If we can cause death by what we say or do, then what lesser behavior do we induce in our patients? Can diagnostic labels of serious or life-threatening diseases, whether correct or not, be part of this general phenomenon?

ISSN:0038-4348    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Colorectal cancer is the second most common form of cancer in the United States, but controversy exists over the feasibility, benefits, and methods of screening. We conducted a large-scale, community-based screening program to determine the cost of screening for colorectal cancer. Based on detailed cost analysis, we arrived at a cost of $15233 per case of colon cancer diagnosed through mass screening, and $7611 per polyp discovered. These figures are much higher than those previously reported in less detailed studies. Other studies currently under way will determine whether morbidity and mortality are decreased by screening. Our data add the information necessary to determine the cost-effectiveness of mass screening for colon cancer, and will be useful in designing future strategies for the secondary prevention of colorectal cancer.

ISSN:0038-4348    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

To assess the usefulness of a continuous subcutaneous pump infusion of terbutaline for long-term tocolysis, we used this modality in 13 patients in whom other tocolytic regimens had failed. The mean ( $$ standard deviation) maternal age was 29.9 $$ 3.8 years. The study population included 10 singleton gestations, two sets of triplets, and one twin pregnancy. In three cases, the terbutaline pump was thought to have been successful (duration of pump therapy, 52.7 $$ 20.9 days; gestational age at delivery, 37.1 $$ 1.3 weeks), whereas in six cases marginal success was achieved (duration, 42.2 $$ 27.7 days; gestational age at delivery, 33.8 $$ 2.6 weeks). In the remaining four patients, pump therapy was discontinued after 2 to 23 days because of maternal complications. In contrast to previous reports, we achieved only limited success with the subcutaneous terbutaline pump in the small number of patients studied.

ISSN:0038-4348    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

This study was done to ascertain whether there was an increased incidence of acute rheumatic fever (ARF) in west Alabama, similar to that reported elsewhere within the United States. Hospital records for the previous 10 years were reviewed and 5-year intervals were compared (1980 through 1984 vs 1985 through 1989). A sevenfold increase was noted in the later period. Possible explanations for this increase are discussed. Close surveillance, appropriate testing, and adequate complete treatment must be continued to eradicate streptococcal disease leading to acute rheumatic fever.

ISSN:0038-4348    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Sixteen patients with spinal epidural compression by metastatic small-cell lung cancer were given radiotherapy for palliation. Lower limb motor deficit was the most prominent clinical manifestation. Neurologic dysfunction was commonly present for more than 48 hours before the diagnosis of compression. Median interval between diagnosis of lung cancer and epidural tumor was 8.5 months. Twelve percent of the patients survived for 1 year after diagnosis of epidural compression. Radiotherapy gave significant pain relief to eight (89%) of the symptomatic individuals. Among those whose status could be assessed, one third of the initially nonambulatory patients (n = 9) were able to walk again. Anal or bladder sphincter or sensory disturbance did not improve in four persons. Radiotherapy for spinal epidural compression in small-cell lung cancer, though not curative, is highly effective in the relief of pain and may ameliorate limb motor dysfunction in some patients.

ISSN:0038-4348    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Thirty-nine postmenopausal women were randomized to treatment with either percutaneous estradiol or a placebo. Those taking the estradiol had an increase in serum estradiol to follicular phase levels and a concomitant fall in serum follicle-stimulating hormone (FSH) levels. Atrophic vaginal epithelium became well estrogenized, and the frequency and severity of hot flushes decreased significantly. No significant benefits accrued to those using the placebo. Side effects were mild and similar in both groups. Percutaneous estradiol delivered in an alcohol-water gel is effective in treating climacteric symptoms and is an attractive alternative to both oral and transdermal patch administration of estrogen.

ISSN:0038-4348    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Analysis of all published cases and Food and Drug Administration (FDA) reports of retinopathy attributed to hydroxychloroquine sulfate (Plaquenil) does not reveal any evidence of permanent visual field scotoma occurring when the daily dose is related to body weight and does not exceed 6.5 mg/kg for maintenance therapy. Risk factors of unknown degree may appear at this dosage level only when the duration of treatment exceeds 10 years or when chronic renal insufficiency is present. In the absence of risk factors, annual ophthalmologic examinations and central field testing are recommended because non-drug-related macular diseases commonly occur in the older age group. When risk factors are present, more frequent examinations are indicated. A modified Amsler grid screening test for the central 10$$ of visual field is described and the participation of the treating physician in the testing program is encouraged to provide maximal medicolegal protection.

ISSN:0038-4348    

出版商:OVID    

年代:1992

数据来源: OVID