ISSN:0038-4348    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

There are men and classes of men that stand above the common herd: the soldier, the sailor, and the shepherd not infrequently; the artist rarely; rarlier still, the clergyman; the physician almost as a rule. He is the flower (such as it is) of our civilization....

ISSN:0038-4348    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The spongiform encephalopathies encompass several diseases affecting humans and animals. In the United States, the most common of these disorders in humans is Creutzfeldt-Jakob disease. The most frequent manifestations include dementia, pyramidal tract signs, and extrapyramidal movement disorder. Several clinically distinct syndromes can be identified. Often the diagnosis is confused with other forms of dementia, and the only definitive method for establishing the diagnosis is autopsy evaluation of brain tissue. Unfortunately, since the recognition of the infectious etiology of Creutzfeldt-Jakob disease, fear has often unreasonably interfered with clinical care and autopsy evaluation of affected patients. In actuality, because of the low and restricted infectivity of the responsible agent, affected individuals present minimal risks to clinical caretakers, and handling of patient specimens is not dangerous if appropriate precautions are taken. These precautions are well established, and physicians and other health care workers should not refuse care or appropriate evaluation (including autopsy) to individuals with suspected Creutzfeldt-Jakob disease.

ISSN:0038-4348    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

We describe a case of group A β-hemolytic streptococcal bacteremia in an individual infected with the human immunodeficiency virus (HIV). The organism was also recovered from the stool, but not from the throat. A review of 19 cases of group A β-hemolytic streptococcal bacteremia shows an association between an underlying immunologic defect and the occurrence of serious group A β-hemolytic streptococcal infection in adults. We review evidence in the literature suggesting that there is a predisposition to infection caused by pyogenic bacteria in HIV-infected individuals.

ISSN:0038-4348    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Using continuous wave Doppler ultrasound, we studied the umbilical and uterine flow velocity waveforms in 68 pregnant women who had chronic hypertension and/or preeclampsia. The systolic-diastolic (S/D) ratio was considered an expression of vascular resistance peripheral to the point of insonation. Abnormal umbilical artery S/D ratio (>95th percentile) alone or with abnormal uterine artery S/D ratio was associated with poor pregnancy outcome as judged by incidence of intrauterine growth retardation (IUGR), cesarean section rate, birth weight, perinatal morbidity and mortality, and prematurity. In patients with preeclampsia and abnormal Doppler values, pregnancy outcome was poor, whereas in those with normal Doppler values, pregnancy outcome approached normal. The same relationship was also found in patients with chronic hypertension. The sensitivity and specificity for the prediction of IUGR by the umbilical artery S/D ratio alone was 71% and 93%, respectively. The uterine artery S/D ratio alone yielded a 66% sensitivity and 64% specificity, and when both tests were taken into account, the sensitivity increased to 75% and the specificity to 100%. Abnormal umbilical and uterine artery S/D ratios were associated with 100% IUGR and 25% perinatal mortality. We conclude that in pregnant women with hypertensive disorders there is a significant difference in pregnancy outcome between those with normal and those with abnormal Doppler values. Umbilical artery S/D ratio alone is a better predictor of IUGR and poor pregnancy outcome than the uterine artery S/D ratio.

ISSN:0038-4348    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

It is currently recommended that every pregnant woman have a blood glucose screening test for gestational diabetes at 24 to 28 weeks' gestation. Random urine samples are also tested for glucose at each prenatal visit. In 500 consecutive pregnant women, random urine glucose screening values from each prenatal visit were compared with a serum glucose test done at 28 weeks' gestation after ingestion of a 50 gm glucose-containing beverage. Twenty-two patients (4.4%) subsequently were identified as having gestational diabetes. Eighty-five (17%) had some degree of glycosuria, and 19 (3.8%) had severe glycosuria. Only six (27%) of the 22 women with gestational diabetes had any glycosuria. As a screening test for gestational diabetes, glycosuria had a 27% sensitivity and a positive predictive value of only 7.1%. Severe glycosuria, although increased in women with gestational diabetes (P= .0071), occurred in only 18% of cases. Detection of severe glycosuria before 24 weeks' gestation is an indication to do earlier blood glucose screening. After blood glucose screening is done, routinely screening the urine for glycosuria at each prenatal visit does not appear to be clinically useful.

ISSN:0038-4348    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

We retrospectively reviewed 76 cerclage procedures done in 62 patients from January 1980 through October 1987 at the Louisiana State University Medical Center, Shreveport. The study showed a significant increase in fetal salvage after cerclage—from 23% to 72%. Emergency cerclage resulted in a fetal salvage rate of only 12%, in contrast to elective cerclage, which yielded a fetal salvage of 81%. Furthermore, fetal salvage was lower when the cerclage was done at less than 12 weeks' estimated gestational age (65%). The McDonald cerclage was done in 69 procedures, using a single suture in 49 patients and a double suture in 20. The fetal salvage rate was the same regardless of the number of sutures placed.

ISSN:0038-4348    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The Cotrel-Dubousset instrumentation (CDI) system developed between 1982 and 1984 is now being used extensively for the posterior correction of idiopathic scoliosis. In this study we compared the lateral and rotational correction obtained with CDI to that obtained with Harrington rod instrumentation and Drummond wiring. We matched 14 patients who had had CDI by age and sex with 14 patients who had had either Harrington rod instrumentation (n = 5) or Drummond wiring (n = 9). Average lateral curve correction was significantly better with CDI than with the combination of the other systems (71.9% and 56.4%, respectively;P< .01). Average rotational correction was studied using the methods of Mehta, and Nash and Moe; all patients having CDI showed a median rotational improvement of 30°; 57% of the comparison group had minimal improvement (P< .01). These results suggest that CDI may offer a significant alternative to the Harrington and Drummond spinal instrumentation systems in the surgical management of adolescent idiopathic scoliosis.

ISSN:0038-4348    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Incidental splenectomy during exploratory laparotomy significantly increases morbidity and mortality. These rates, elevated in the morbidly obese, prompted a splenic preservation policy for any splenic injury during bariatric surgery. This review was needed to assess how this policy affected this population's intrinsically high perioperative risks. Six of 200 patients having primary or revisional vertical banded gastroplasty for morbid obesity or failure of previous bariatric surgery had splenic injury. In one case, splenectomy was necessary; in the other five, splenic repair was relatively easy and was not followed by problems related specifically to splenic surgery. Risks for splenic injury include previous operation, rigid retractors, adhesions in the left upper quadrant, and traction on adjacent viscera. We conclude that splenic injury during bariatric surgery should be repaired by the simplest hemostatic method(s). Splenectomy should be reserved for the irreparably injured organ or when instability of the patient's condition demands promptness.

ISSN:0038-4348    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Severity of injury, patient age and preexisting medical conditions, time from injury to treatment, and quality of care rendered are generally recognized as major determinants of outcome after trauma. In a retrospective review, we compared 456 elderly patients (age ≥65 years) with traumatic injuries to 985 younger patients (age <65). We compared cause of injury, injury severity score (ISS), seven risk factors indicating preexisting disease, complications, length of stay, and mortality. Overall mortality was 6.0% for patients aged less than 65 years and 8.6% for those older than 65. The injury severity score at which the probability of death was 10% was 17.3 in the older group and 24.9 in the younger group. Factors associated with outcome included cause of trauma (P< .001), ISS (P< .001), and number of complication factors (P< .01) Preexisting risk factors were not significantly associated with outcome. We conclude that trauma in the elderly causes higher mortality with less severe injury, and that the mortality is related to the cause and severity of the trauma and the number of complications, and not to pre-existing disease. Length of stay increases with the severity of injury, except in the severely injured, who die.

ISSN:0038-4348    

出版商:OVID    

年代:1990

数据来源: OVID