摘要:

The Diabetes Control and Complications Trial has conclusively established that intensive control of insulin-dependent diabetes mellitus in persons aged 19 to 26 years (almost exclusively white, normotensive, nondyslipidemic, of normal weight, and insulin sensitive) reduces by ± 50% the likelihood of retinopathy, nephropathy, and neuropathy. In contrast, persons with non-insulin-dependent diabetes mellitus (NIDDM) are older, overweight, hypertensive, dyslipidemic, and insulin resistant. Glycemia is only one of their risk factors, and they die of macrovascular disease. Review of studies supporting glycemic control versus risk factor reduction as management of NIDDM suggests a clear need to address risk factors besides glycemic control for successful prevention of complications of NIDDM. A new schematic proposal for intervention based upon risk factor reduction is presented.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

This study compares the rate of mental disorders in children and adolescents with sickle cell disease with the rate in a corresponding control population. Using the clinical interview, a diagnosis based on DSM-III-R criteria for the presence of 13 mental disorders common to childhood was considered in a sequential sample of 39 subjects with sickle cell disease and a convenience sample of 26 same-race control subjects. Thirty-one percent of the sickle cell group and 42% of the control group screened positive for one or more of the selected mental disorders. The difference was not significant. When subgroups of mental disorders were considered (anxiety disorders, depressive disorders, disruptive behavior disorders, psychotic disorders, and other selected disorders), the differences were still not significant. This study suggests that children and adolescents with sickle cell disease do not have a greater risk for clinically significant mental disorders than same-race outpatient clinic controls. This study supports other reports in the medical literature that suggest that children attending outpatient medical clinics are at a higher risk for mental disorder than is seen in epidemiologic studies of nonmedical populations.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Ipsilateral, concomitant femoral neck and shaft fracture is a rare fracture pattern encountered by orthopaedic surgeons. We review 11 cases of this fracture pattern. Treatment was by reduction and stabilization of the femoral neck fracture with one or more cannulated screws, followed by fixation of the femoral shaft using a Russell-Taylor reconstruction nail or a Russell-Taylor Delta reconstruction nail. When properly sequenced, this has proven to be a successful treatment method in these dual fractures, resulting in a low complication rate. No avascular necrosis of the femoral head or nonunion of either fracture site occurred. In our series, one patient with delayed union had varus angulation of 120° of the femoral neck. Good functional outcome based on patients' ability to perform activities of daily living was achieved.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Diagnosis of vertically acquired human immunodeficiency virus (HIV) infection is often difficult because of transplacentally acquired maternal antibodies. The polymerase chain reaction (PCR) test is commercially available and has high sensitivity and specificity. To evaluate the usefulness of PCR testing in the early diagnosis of perinatally acquired HIV infection, we reviewed records of 122 children having follow-up in the Northeast Florida Pediatric AIDS Program. Seventy-two children were excluded for various reasons. Of the remaining 50 children, 37 had PCR testing. In 5 children, the initial PCR test was done at >18 months of age. Results of PCR testing were positive in 8 of 13 (62%) at birth, 12 of 18 (67%) by 1 month of age, 18 of 23 (78%) by 2 months of age, and 20 of 24 (83%) by 3 months of age. In 24 of 27 (85%), results were positive by the time the children reached 4 months of age. Our data suggest that the PCR test is a useful tool for early diagnosis of vertically transmitted HIV infection.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Elderly patients with community-acquired pneumonia may not have a systemic inflammatory response characterized by fever and leukocytosis. We compared lack of fever and leukocytosis with mortality in elderly patients with community-acquired pneumonia. Patients with fever and leukocytosis (group A, 47 patients) were compared with those without fever and leukocytosis (group B, 17 patients). Comparison of the two groups by unpaired, twotailedttest showed that lack of fever and leukocytosis correlated with mortality. Hospitalized elderly patients who have community-acquired pneumonia without fever and leukocytosis are seven times more likely to die than those who have these symptoms. Future research in the adjunct use of immune modulators such as granulocyte colony-stimulating factor in these patients should be encouraged.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

To assay and profile chronic neurobehavioral impairment associated with chlordane exposure in symptomatic patients, consecutive evaluations of nine patients were done with sensitive neurophysiologic and neuropsychologic tests for neurobehavioral function. Their visual fields, balance, reaction time, blink, color discrimination, grip strength, cognitive function, recall, memory, and perceptual motor speed were tested, and mood states and frequencies of 35 symptoms were appraised. Prevalences of abnormality were compared test-by-test to predict values with confidence intervals, and mean values for the group were compared with reference values. Testing showed abnormal balance with eyes closed in 7, abnormal color discrimination in 6, verbal recall deficit in 5, and prolonged blink reflex latency, prolonged choice reaction time, and decreased Culture Fair scores in 4 each. Profile of Mood States score was elevated in 5. These observations suggest that chlordane causes protracted neurotoxicity.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

To define the role of ambulatory pH monitoring in evaluating chronic cough, we studied esophageal pH values of patients referred to a gastroenterology laboratory. Chronic cough was evaluated in 31 patients, who were grouped based on response to treatments; 11 patients (35.5%) had gastroesophageal reflux (GER)-related cough, 11 (35.5%) had pulmonary/otorhinolaryngologic-related cough (1 bronchitis, 6 asthma, 2 postnasal drip, 1 pneumonia), and 9 patients (29%) had cough of unknown etiology. Esophageal pH values of groups were compared. Excessive acid reflux distally (upright and supine) and proximally (upright) and cough symptom frequency related to acid reflux were significantly higher in patients with GER. Esophageal pH monitoring had good sensitivity (91%), specificity (82%), and positive (83%) and negative (90%) predictive values in identifying GER-related cough. In summary, ambulatory pH monitoring is an excellent test for identifying patients with GERrelated cough.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

During a period of 7 years at our institution, four girls and one boy with Down's syndrome, ages 9 to 16 years, were examined and treated for hyperthyroidism. Two patients had Graves' disease and they responded to propylthiouracil (PTU) with a predictable clinical course resulting in remission within 4 years. The remaining three patients included in this report had hyperthyroid profiles similar to those of the two with Graves' disease except for their antibody panels. These patients, in addition to the elevated thyroid-stimulating immunoglobulin (TSI) level observed in Graves' disease, also had significantly elevated antimicrosomal antibody (AMA) and antithyroglobulin antibody (ATGA) at the time of diagnosis. Elevated TSI level was again present in two patients who had a recurrence of hyperthyroidism after PTU therapy was discontinued. Treatment of these three patients was best done with the continuation of PTU therapy at a lower dose and the addition of thyroxine as soon as mild hypothyroidism developed. Treatment with PTU and thyroxine was continued until the TSI level was no longer elevated. Levels of AMA and ATGA remained elevated long after the TSI level became normal. All three patients eventually had hypothyroidism and continue to require thyroxine replacement.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

With increasing evidence of the effectiveness of mass screening in reducing mortality from both cervical and breast cancer, we began to study the rates of cervical cytology and mammography in 1994 for its impact on increased efforts to gain participation among its target population, the Sioux Indian women. Data were collected from 100 diabetic and 100 randomly selected patients aged 50 to 69 years. Patients with diabetes were selected to better evaluate the effects of patient acceptance of screening tests, since these patients are believed to be more motivated to have preventive care. However, this study showed no observable differences. Among the patients with diabetes, 33% had at least one cervical smear and 45% had a mammogram. For patients without diabetes, the rates were 32% and 42%, respectively. The number of patient visits to physicians during the 12-month study period averaged 7 for patients with diabetes and 4 for randomized patients. Thus, this paper contends that missed opportunity and limited access to cancer screening were the main reasons for such displeasing statistics.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID