摘要:

Physicians in the United States may encounter Hansen’s disease in immigrants and in patients from endemic areas such as Texas, Louisiana, Hawaii, and California. Exposure to infected armadillos may be one means of acquiring the disease. TheMycobacterium lepraebacillus has a predilection for nerves and skin in the cooler areas of the body. The limited tuberculoid form of the disease is characterized by one or a few hypoesthetic skin lesions and palpably enlarged nerves. The more extensive lepromatous form of the disease appears as multiple nodular skin lesions, sometimes with involvement of the nasal structures and eye. Current recommended regimens for treatment of Hansen’s disease are based on combinations of dapsone, rifampin, and clofazimine. Recent advances in treatment have resulted in a significant decline in the worldwide prevalence of the disease.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Modern diagnostic imaging techniques and new methods for anterior and posterior decompression and reconstruction of the bony spinal column have dramatically improved the surgeon’s ability to treat malignant tumors of the adult bony spine. The day of the laminectomy and Harrington rod reconstruction has passed, and an aggressive surgical approach is now justified for many primary and secondary malignant lesions of the spine. This article addresses the diagnosis and therapy of malignant tumors of the bony spine, emphasizing the common primary tumors of the spine and even more common metastatic lesions. Specific tumor types and therapeutic approaches at different levels of the spine are addressed, and newer techniques available to the treating clinician are reviewed. Current specific approaches to myeloma/plasmacytoma, breast carcinoma, prostate carcinoma, lung carcinoma, renal cell carcinoma, and chordoma and primary rectal carcinoma of the sacrum are reviewed in detail.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Conventional rate limits for sinus rhythm—100/min as the tachycardia threshold and 60/min as the bradycardia threshold—were established by consensus and never formally examined. Because clinical experience indicated that both figures were too high, we investigated this formally in 500 normal individuals. Results were consistent with normal data from the Framingham Study 5,000-subject cohort and the EPICORE Center cohort of more than 18,000 normal persons. Therefore, rounded tachycardia and bradycardia thresholds of 90/min and 50/min for normal sinus rhydim should improve the sensitivity of tachycardia detection and the specificity of bradycardia detection. The appropriate rate range (rounded) for sinus rhythm is 50/min to 90/min.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

This prospective clinical study was done because our initial retrospective review suggested that laparoscopic appendectomy (LA) offers no significant advantages over open appendectomy (OA) yet is significantly more expensive. From July 1992 to August 1993, 57 patients were approached preoperatively for randomization to either LA (n=19) or OA (n=18). There were no statistically significant differences between the LA and OA groups in operative risk: mean age, 28 ± 2 vs 26 ± 2 years; percent female, 26% vs 22%; body mass index, 24 ± 0.8 vs 26 ± 1.2 kg/m2. All patients were either ASA class I or class II, 78% in each group being class II. The differences between the LA and OA groups in mean operating time required (93 ± 12 vs 87 ± 8 minutes), postoperative intramuscular narcotic analgesic usage (24 ± 6 vs 26 ± 6 hours), postoperative hospital stay (57 ± 12 vs 66 ± 10 hours), and return to normal activity (20 ± 6 vs 14 ± 3 days) were also not significant. However, LA was much more expensive because of higher operating room charges. The mean total hospital bill was $4,600 ± $160 for the LA group and $1,700 ± $70 for the OA group. This prospective study corroborated our previous analysis. Laparoscopic appendectomy is safe, effective, and expensive and overall has no greatly significant advantages over open appendectomy.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Laparoscopic cholecystectomy (LC) has been widely used in recent years because of short postoperative hospital stays and low morbidity. In this study, 24 patients were prospectively evaluated with preoperative and postoperative spirometry, arterial blood gas determinations, and chest radiographs to quantitate the magnitude of postoperative pulmonary changes after LC. Statistically significant reductions were noted in forced vital capacity (FVC) (mean decrease, 810 mL) and forced expired volume in 1 second (FEV1) (mean decrease, 420 mL). Clinically important changes in arterial blood gas values did not occur. Of 20 postoperative chest films, 7 showed the development of atelectasis or effusion and 9 showed persistence of subdiaphragmatic free air 24 hours after LC. In summary, LC caused mean decreases of 23% in FVC and 16% in FEV124 hours after surgery. The physiologic derangements that follow LC are sufficiently small that all but the most severely impaired patients with pulmonary disease should be able to tolerate this operation.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

We analyzed the outcome of 63 consecutive, adequate interventions for atherosclerotic renal artery stenosis and hypertension: 34 patients had percutaneous transluminal renal angioplasty, and 29 had surgical correction. Hypertension was cured in 21% of patients and improved in 47%, but 32% failed to respond. We analyzed clinical variables predictive of cure. Duration of hypertension, level of diastolic blood pressure, and sex were found to be predictive of cure. The highest probability of cure was found in men with a duration of hypertension of less than 10 years and an initial diastolic blood pressure of greater than 80 mm Hg. Use of these clinical variables in a tree-based model correctly classified 80% of cases, with a sensitivity of 92% and a specificity of 77%. We conclude that a tree-based clinical algorithm based on only three clinical criteria correctly predicted cure of hypertension in most patients with renal artery stenosis and may be useful in decision making. A prospective analysis will be required to evaluate the clinical validity of the algorithm.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

A 15-minute, 6-page questionnaire on breast-feeding was administered to the obstetric residents in four metropolitan academic training programs in Korea to assess their attitudes toward and knowledge about breast-feeding and their confidence in managing breast-feeding problems. The questionnaires were self-administered and confidential, and the participation rate was 84% (n=76). Overall, the study participants indicated a neutral attitude toward breast-feeding (2.9 on a 6-point scale, where 1 equals the most positive attitude and 6 equals the most negative attitude). Their self-confidence was inappropriately high, with 49% of the total sample describing themselves as “confident” or “very confident” to manage common breast-feeding problems. Female residents had a higher confidence level than male residents. Although high in self-confidence about breast-feeding, the residents in this study were not knowledgeable about breast-feeding management, answering only 38% of the questions correctly. To be truly supportive of breast-feeding, obstetricians should receive didactic and clinical training in breast-feeding management.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Seventeen patients with biopsy-confirmed hepatic cirrhosis and tense ascites performed reproducible pulmonary functions and had arterial blood gas analysis before and after having a therapeutic large volume paracentesis. Each patient showed significant improvement in the static lung volumes as determined by helium dilution techniques. Dynamic airflow also improved as expressed by the FVC and the FEV1. The FEV1/FVC ratio remained unchanged. Each patient snowed a significant improvement in oxygenation 120 minutes after LVP. Alveolar ventilation as expressed by Paco2did not change. The pathophysiology that explains the improvement in oxygenation remains speculative. Large volume paracentesis appears to have a salutary effect on oxygenation, as well as on pulmonary function.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Two train conductors had chest tightness, painful breathing, muscle cramps, and nausea after fighting a fire in a battery box under a passenger coach. Shortly thereafter, they became anosmic and had excessive fatigue, persistent headaches, sleep disturbances, irritability, unstable moods, and hypertension. Urinary cadmium and nickel levels were elevated. Neurobehavioral testing showed, in comparison to referents, prolonged reaction times, abnormal balance, prolonged blink reflex latency, severely constricted visual fields, and decreased vibration sense. Test scores showed that immediate verbal and visual recall were normal but delayed recall was reduced. Scores on overlearned information were normal. Tests measuring dexterity, coordination, decision making, and peripheral sensation and discrimination revealed abnormalities. Repeat testing 6 and 12 months after exposure showed persistent abnormalities. Cadmium and vinyl chloride are the most plausible causes of the neurotoxicity, but fumes from the fire may have contained other neurotoxic chemicals.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

How do restrictive smoking policies affect the smoking behavior of employees? At two federal hospitals, 2,700 employees completed written surveys after implementation of restrictive smoking policies. At one hospital, smokers reported less smoking at work (down 2.0 cigarettes a day at 6 months, 1.7 at 12) without compensatory smoking. At the other, no significant changes in smoking behavior were reported. However, at both hospitals, some baseline smokers quit smoking. At 6 months, 9% had quit at one hospital and 8% at the other. Analyses were done using these two studies and 17 published studies. In 11 of 11 studies, consumption at work decreased, and in 12 of 14, total daily consumption decreased. Regression analysis indicated that the number of smokers who quit smoking after policy implementation increases over time at rates exceeding those normally expected in the population. Smoking policies appear to effect a reduction in total cigarette consumption and an increase in the number of smokers who quit.

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID