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:

With the epidemic of cholera in South and Central America and reports of cholera in the Northern Hemisphere in Mexico, increasing concern focuses on sanitation problems along the border between the United States and Mexico, It is feared that binationally shared water supplies are threatened or contaminated by sewage and other wastes. Although much anecdotal information exists, surprisingly few hard data are available in the United States (or in Mexico, for that matter) regarding water quality on the Mexican side of the border. This shortage of data is felt most acutely in the semiarid portions of the border, where water is extraordinarily scarce. In 1987, researchers at the University of Texas School of Public Health (UTSPH) began gathering data on the availability, accessibility, and bacteriologic and chemical safety of raw and finished drinking water in Mexico its border with Texas. In view of their timely significance, we wish to share pertinent data. This particular study was carried out in Ciudad Juarez, a city of more than 1 million people, situated just across the Rio Grande from the Texas city of El Paso. The investigation was conducted at the invitation and with the assistance of municipal authorities of Cd. Juarez. As far as we know, this was the first time the water in Cd. Juarez had been tested for indicator fecal bactera and other selected contaminants.

ISSN:0038-4348    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Rotor wing aircraft used in transport of the trauma victim have not been subject to objective means of evaluating their contribution to patient care. A retrospective evaluation of a Bell 206 L-1 and an Aerospatiale 365 N-1 using the Revised Trauma Score Triage (RTS) as an indicator of status in 98 patients transported from the scene of injury was conducted. Ground (GT), flight (FT), and total mission (TMT) times, as well as initial RTS, final RTS, and the difference between them (DRTS) were determined for all patients. Statistical analysis was done using two-way ANOVA. GT, FT, and TMT were significantly lower in patients transported by the 365 N-1. In more severely injured patients (RTS ≥ 10), DRTS and final RTS were significantly higher in the 365 N-1; FT was significantly less. The contributions of various aeromedical aircraft to the care of the trauma victim may be assessed using objective indices of patient status.

ISSN:0038-4348    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

We report the results of a clinical study of female patients sustaining gunshot wounds to a breast. Thirteen homicides were reviewed by the Fulton County Medical Examiner. A prospective series of patients treated by the Grady Memorial Hospital Trauma Service included eight additional cases. Ten (48%) of the combined series of 21 patients had significant intra-abdominal injury; of these, five (24%) had injuries confined to the abdomen as a result of a missile striking a breast. A wound pattern consisting of a superior breast entrance wound, an inferior breast exit wound, and an inframammary thoracoabdominal reentry wound was noted in five patients, four of whom had intra-abdominal injuries and three only intra-abdominal injuries. Careful examination for this wound pattern should alert the clinician to the possibility of intraabdominal injury. One should anticipate a 50% incidence of intra-abdominal injury in female patients sustaining gunshot wounds to a breast.

ISSN:0038-4348    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Bacterial vaginosis is common among patients seen by gynecologists. Several types of therapy have been proposed. The purpose of this prospective, randomized, double-blind clinical trial was to examine the efficacy of clindamycin vaginal cream for the treatment of bacterial vaginosis. Sixty patients with symptoms of bacterial vaginosis were randomized into the study, and 46 completed the protocol. Twenty-three patients received 2% clindamycin vaginal cream (5 g applied intravaginally at bedtime for 7 days), with placebo oral tablets twice daily for 7 days. The other 23 patients received oral metronidazole tablets (500 mg twice a day for 7 days) and placebo vaginal cream (5 g intravaginally for 7 days). The cure rates for the two regimens were comparable. Twenty-two (97%) of the patients treated with clindamycin vaginal cream had improvement or cure at the first follow-up visit versus 19 (83%) of those taking metronidazole. There was no statistically significant difference between the two results. Side effects for both regimens were comparable. We conclude that 2% clindamycin vaginal cream offers similar efficacy and safety to standard oral metronidazole therapy for bacterial vaginosis.

ISSN:0038-4348    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

At the Veterans Administration Medical Center in Washington, DC, 73 patients with bronchogeic carcinoma had pulmonary wedge resection from February 1967 to March 1988, with a 1.4% perioperative mortality and a 4.1% morbidity. Mean age of the patients was 63 years. Patients were considered poor risk with a mean Goldman index of 9 \pm 4 (class II), mean ASA physical status classification II, mean 1-second forced expiratory volume (FEV1) of 1.25 liters (42% predicted), ratio of FEV, to forced vital capacity 30% predicted, and maximum voluntary ventilation 24% predicted. Staging of the bronchogenic carcinomas indicated 68% stage I, 15% stage II, and 17% stage III, and histology showed 41% epidermoid, 40% adenocarcinoma, 12% bronchoalveolar, 3% large cell, and 4% small cell type. For the 72 patients eligible for follow-up, data were available on 62 for a period ranging from 4 months to 35 years. Survival was 94% at 1 year 55% at 3 years, 29% at 5 years, 5% at 10 years, and 2% at 15 years. Within 5 years, 21% of the patients had died of causes other than bronchogenic carcinoma. The rate of recurrence was 16%. Analysis by each stage of lung cancer showed local recurrence in 4% of patients with stage I disease, in 9% of those with stage II disease, and in 59% of those with stage III disease. We conclude that wedge resection provided acceptable surgical treatment in a group of high-risk surgical patients.

ISSN:0038-4348    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Hereditary angioedema is a rare disease resulting from a lack of functional C1 esterase inhibitor (C1 INH). Several genetic defects can cause decreased production of the protein or the synthesis of a biologically inactive form. A similar, acquired condition is occasionally seen, associated with malignancies or as an autoimmune process. Disease severity varies greatly among affected individuals. Most patients have cutaneous, laryngeal, or gastrointestinal edema, often in combinations. The symptoms may appear spontaneously or result from a stimulus, usually trauma. When clinical suspicion exists, measurement of the C4 level screens for the disease. An assay showing low serum C1 INH function confirms the diagnosis. When disease severity warrants, symptoms can be controlled with anabolic steroids or antifibrinolytics. Doses should be increased before symptom-provoking events. Emergencies are treated with plasma infusions, fluids, and pain control. Where available, C1 INH concentrate is the treatment of choice. Therapy can usually be monitored by control of symptoms. With appropriate therapy, most cases remain well controlled.

ISSN:0038-4348    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The recommendations of the expert panel of he National Cholesterol Education Program (NCEP) have been endorsed by national medical organizations as standards for the detection and treatment of hypercholesterolemia, yet information on how these recommendations are being followed in primary care settings is limited. This study was done to determine bow family physicians in four primary care clinics associated with a teaching hospital in a large southern city follow the NCEP guidelines. Of the total patient sample (N-817). about 60% had at least one total serum cholesterol measurement. Patients in the younger age groups were Jess Likely to have a cholesterol determination than older patients. Of those in the “self-pay” category only 33% had a cholesterol determination. Variability by clinic and provider type was also noted, with physician assistants showing the highest compliance witih screening guidelines (75%), whereas only 43% of patients seen by family practice residents had a cholesterol measurement. Of patients who should have had a lipoprotein analysis, based on total serum cholesterol and risk factors, only 23% actually had a lipid profile. Our study and Other similar ones point out that case finding varies considerbly and that efforts to improve case finding need to continue.

ISSN:0038-4348    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ABSTEACT: The purpose of this study was to determine whether providing respite care to persons with Alzheimer's disease and other dementias decreased stress and mood disturbances in caregivers. Caregivers of persons receiving respite care (n = 7), and not receiving respite care (n =8) were tested at entry into the study and at 5 weeks and 10 weeks, using the Profile of Mood States and the Relative's Stress Scale. Using repeated measures analysis of variance, a downward trend for study subjects and an upward trend for controls was found for Relative's Stress Scores. Similar trends were found on the Personal Distress Subscale of the Relative's Stress Scale. No difference occurred in rates of institutionalization between those receiving and not receiving day care. Our study suggests that respite care for demented persons living at home significantly reduces the stress among caregivers.

ISSN:0038-4348    

出版商:OVID    

年代:1992

数据来源: OVID