ISSN:0038-4348    

出版商:OVID    

年代:1983

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

We evaluated clinical features of five cases ofToxoplasmaencephalitis (TE) occurring in recent Haitian entrants into the United States. None of the patients had any underlying malignancy or known immunosuppressive therapy. Histopathologic findings of TE at autopsy were confirmed by peroxidase-antiperoxidase method. Four patients had an antecedent episode of disseminated tuberculosis and all five were receiving antituberculous therapy when neurologic manifestations of lethargy, seizures, and motor weakness first developed. These symptoms progressed into coma and death within 15 days. Peripheral lymphocytopenia was noted in all patients; three were anergic. Parenchymal lesions were identified by CT brain scans and total proteins were elevated in spinal fluid in all cases. TE appears to be a manifestation of the acquired immune deficiency syndrome in Haitians; it should be suspected in those with a febrile illness and multiple focal lesions of the central nervous system.

ISSN:0038-4348    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

We describe a new technique for the surgical treatment of exogenous morbid obesity. The stomach is partitioned from the angle of His toward the lesser curvature, and a Roux-en-Y proximal jejunal limb drains the proximal gastric pouch, which is 25 to 35 ml in capacity. By use of the enteroanastomosis (EEA) or the intraluminal (ILS) stapling instrument for the gastrojejunostomy from the lesser curvature of the stomach, the functional reliability, vascular integrity, and ease of construction of the stoma have been improved. We performed the gastric bypass operation on 300 consecutive patients, 268 women and 32 men, over a two-year period beginning in June 1979. The patients' average admission weight was 126 kg. Diseases associated with obesity were observed in 57% of the patients, and concomitant operations were performed in 29%. The average weight loss at 6, 12, 18, and 24 months was 37.0, 48.5, 51.5, and 52.0 kg, respectively. Early and late complications occurred in 37 patients (12%), requiring 40 reoperations. Two deaths (0.6%) occurred within the 30 months' of observation.

ISSN:0038-4348    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

We studied 67 patients who had operation for perforated peptic ulcer. Operative treatment included plication with omentum (Graham closure) in 27 patients, vagotomy and pyloroplasty in 32 patients, or vagotomy and antrectomy in eight patients, depending on antecedent ulcer history, degree of contamination, and general patient condition. Mortality was high with simple closure in patients with long-standing perforation or associated disease. Early complications associated with Graham closure included rebleeding, perforation, and obstruction. There were no deaths or major complications related to vagotomy and pyloroplasty. In selected patients, definitive operation is safe and produces excellent long-term results.

ISSN:0038-4348    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

This report describes the use of exercise testing in handicapped subjects to determine work capacity and the safety of exercise. Arm crank, bicycle, and wheelchair exercise studies are described by means of a few selected cases.

ISSN:0038-4348    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Occasionally Hirschsprung's disease is misdiagnosed until the patient reaches adolescence. The disease of these young people may present technical problems not encountered in the neonate. I describe three such patients, ages 10, 13, and 19 years, who were managed successfully by slightly different surgical methods.

ISSN:0038-4348    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Eleven cases of fracture of the thoracic and lumbar spine were treated with segmental spinal instrumentation (Luque rods). The majority of these injuries occurred in motor vehicular accidents or falls from a height and were usually associated with multisystem trauma. This method of instrumentation provided immediate rigid internal fixation, which obviated the need for postoperative orthoses, allowed easier nursing care and early ambulation, and facilitated rehabilitation of patients with spinal cord injury. At 13 months' average follow-up, there have been no instances of wire breakage, rod deformation, or deterioration of neurologic status. This favorable experience suggests that segmental spinal instrumentation should be considered as an alternative mode of spinal instrumentation in fractures of the thoracic and lumbar spine.

ISSN:0038-4348    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Through the use of gait analysis, this study attempts to characterize gait after total knee arthroplasty as a function of postoperative time to quantify the effectiveness of the surgery and to evaluate prostheses of several different designs. Gait analysis on 32 preoperative and 50 postoperative patients included measurement of velocity, cadence, stride length, and gait cycle. Postoperative data were collected at various intervals from 0.7 to 111 months after knee surgery (average postoperative time, 45.3 months). Linear regression analysis of velocity, cadence, stride length, gait cycle, and the ratio of contralateral to pathologic single limb support time as a function of postoperative time are reported with statistical error limits. Extrapolation of these results to zero postoperative time indicates that the patients who had had total knee arthroplasty had a slight improvement in all gait parameters compared to the preoperative control group. This was not statistically significant, however, except for cadence (P< .05). Although velocity and stride length increased slightly toward more normal values with increased postoperative time, gait parameters at no time approached normal values.

ISSN:0038-4348    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

In a ten-year retrospective study of 233 patients who sustained a vascular injury to an extremity, eight (3.4%) extremities were amputated. Factors that affect the incidence of amputation after peripheral vascular trauma include early operation, fasciotomy, preoperative antibiotics, appropriate vascular reconstruction with adequate tissue coverage, use of arteriography during and after reconstruction, and early reoperation for postoperative complications. Some patients benefit psychologically and physically from early definitive amputation.

ISSN:0038-4348    

出版商:OVID    

年代:1983

数据来源: OVID