摘要:

To determine the clinical significance of finding occult blood in a stool sample obtained during digital rectal examination of patients with no gastrointestinal complaints, we reviewed the records of patients who had colonoscopy for this indication. Of the 185 patients (average age, 59.4 years) who met study criteria, 48 were inpatients when the Hemoccult-positive rectal examination was recorded. Neoplastic lesions were found in 28% of the patients (51/185). Thirteen of the lesions were adenocarcinomas and 38 were adenomatous polyps. Seventy-five patients (41%) had normal findings on colonoscopy. Nonneoplastic lesions were found in the remaining 32%. Comparison of patients with neoplastic lesions and patients with nonneoplastic lesions showed no significant difference with respect to the presence of anemia (43% vs 48%), inpatient status at the time of positive rectal examination (23% vs 29%), or sex. Although the mean age was similar in patients with and without neoplastic lesions (60.5 and 56.8 years, respectively), no neoplastic lesions were found in patients less than 45 years old. We conclude that testing stool obtained during rectal examination for occult blood does not increase the rate of false-positive results, and positive tests should prompt a structural evaluation of the colon to detect neoplasia in patients with an age-related risk for colon carcinoma.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

A multicenter randomized comparative trial was done to assess the safety and efficacy of oral ofloxacin (400 mg twice daily for 10 days) versus cefoxitin (2 g intramuscularly) followed by doxycycline (100 mg twice daily orally for 10 days) for the outpatient treatment of uncomplicated pelvic inflammatory disease (PID).Neisseria gonorrhoeae(GC) grew on pretreatment endocervical cultures from 43 of 268 women (16%), and in 30 of 247 women (12%) cultures were positive forChlamydia trachomatis(Ct). Ninety-five percent (122/128) of the women treated with the ofloxacin regimen and 93% (112/121) of those treated with the cefoxitin/doxycycline regimen had cure or improvement on examination at a minimum of one follow-up visit. All GC species were eradicated by both ofloxacin and cefoxitin. Among women who returned for follow-up, the eradication ofC trachomatiswas 88% (15/17) for the cefoxitin/ doxycycline group and 100% (18/18) for ofloxacin. Side effects were more prevalent in the cefoxitin/ doxycycline group (15%) than in the ofloxacin group (7%), nausea/vomiting being the most frequent adverse effect. In this study, it appears that ofloxacin and cefoxitin/doxycycline have similar clinical effectiveness for the outpatient treatment of uncomplicated pelvic inflammatory disease.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The purpose of this investigation was to determine the incidence of cervicitis due toChlamydia trachomatisin rural pregnant women, urban pregnant women, and urban nonpregnant women in Georgia. Evaluation of endocervical chlamydial cultures from 447 women showed prevalence rates forC trachomatiscervicitis of 12% in the urban pregnant group, 7% in urban nonpregnant women, and 21% in rural pregnant women. Fewer rural pregnant women (2%) reported a previous history ofC trachomatiscervicitis than urban pregnant women (9%) and urban nonpregnant women (19%). Data from this study imply that screening forC trachomatismay be done less frequently in rural women than in urban women. The high prevalence ofC trachomatisinfection observed in rural pregnant women emphasizes the importance of routinely screening this group as currently recommended. Laboratory testing forC trachomatismay be overlooked because of insufficient funds and an emphasis on other sexually transmitted diseases.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

We reviewed microbiology and infection control records at a Memphis children's hospital from 1982 to 1990 to obtain epidemiologic, clinical, and microbiologic data on group A streptococcal (GAS) bacteremia. Varicella was the underlying condition in 8 of 37 (22%) patients identified and was often associated with severe GAS disease, including toxic shock-like syndrome. Twenty-one of 31 (68%) available blood isolates made GAS pyrogenic exotoxin (SPE) B by Ouchterlony immunodiffusion; gene probes identifiedspeCandspeAin 18 (58%) and 8 (26%) isolates, respectively. The B/C toxin profile, identified in 11 (35%) isolates, was the most common profile in this population, and the overall rate forspeCwas higher than rates recently reported from other areas. Although the clinical significance of the toxin profiles in our population is unclear, these data emphasize the geographic and temporal variability in the microbiologic properties of GAS disease.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The range of procedures now routinely done through the laparoscope has continued to expand due to improved equipment for insufflation, hemostasis, and tissue manipulation, and to imaginative approaches to otherwise “routine” gynecologic problems traditionally treated by laparotomy. As with all new technologies, advocates predict that the methodology will prove to have an almost unlimited potential, while established skeptics predict that it will have a narrow applicability. With time and further clinical application, a consensus somewhere between the two positions will be reached. But while this technology develops and experience begins to accumulate, it is necessary to train residents in the technique. We discuss our experience with introducing laparoscopic management of ectopic pregnancy into a residency training program. Our results indicate a rapid learning curve, with minimal patient morbidity, brief hospitalization, and rapid convalescence.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Acute upper airway obstruction is usually associated with inflammatory processes such as epiglottitis, and with laryngeal trauma and laryngeal tumors. Not uncommonly, systemic diseases such as Wegener's granulomatosis and sarcoidosis may manifest initially as upper airway obstruction requiring intubation or tracheostomy. We describe our experience in the diagnosis and management of cases of airway obstruction due to previously undiagnosed systemic diseases. We believe that physicians should be familiar with the airway manifestations of these systemic diseases when treating patients with airway distress of apparently unknown cause.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

An end-to-end anastomosis was done in the center of a 5-cm devascularized jejunal segment in 5 control laboratory rabbits and 14 experimental rabbits. A second group consisted of 5 control animals and 11 experimental animals having end-to-end jejunojejunostomy in the center of a 10-cm devascularized jejunal segment. In the experimental animals, the anastomosis was wrapped circumferentially by a vascularized omental pedicle. Anastomotic leaks or fistulas developed in five 10-cm controls (100%), five 5-cm controls (100%), nine 10-cm omental wraps (82%), and four 5-cm omental wraps (29%). The remaining animals had strictures of various degrees. Injection of methylene blue into the omental vessels showed perfusion to the mucosa from the omentum. The difference between the 10-cm segment and the 5-cm segment indicates some limitation to the available blood flow from the omentum. The anastomotic stricturing was due to ischemic injury before reperfusion by ingrowth of omental vessels. A vascularized omental pedicle wrap can augment blood flow; however, the time required for neovascular ingrowth allows ischemic mucosal injury if there is no other available blood supply.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Beta irradiation with strontium 90 has been associated with significant iatrogenic disease, causing such complications as ptosis, symblepharon, iridic and scleral atrophy, cataracts, and endophthalmitis. We studied 171 eyes in 140 patients treated and followed up during a 17-year period from 1973 to 1990. We sought to show that a single small dose of radiation administered immediately after surgical excision not only prevents decrease recurrence, but also avoids significant complication. Pterygia recurred in 14 (8%) of the 171 eyes treated. Six of these recurrences were corneal and eight were conjunctival. Complications were seen in five (3%) of the 171 eyes treated. All were minor except for one case of scleral thinning in a diabetic patient. Optimal radiation dosage to avoid significant recurrence in this adult population is a single dose of 2,000 rads using a bare sclera technique that vaults the limbus.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Infections due to nontuberculous mycobacteria (NTM) are especially common in patients with AIDS. Meningitis due to NTM, however, is rare. A search for CSF cultures positive for NTM over the past 11 years at our hospital yielded 16 cases. Of these, 15 were caused byMycobacterium avium-intracellulare(MAI), and one was caused byM fortuitum. All patients with MAI infection had widespread dissemination and at least one risk factor for AIDS. Clinical features included weight loss, altered mentation, and seizures. Analysis of cerebrospinal fluid revealed a mildly elevated leukocyte count with lymphocyte predominance and normal protein and glucose values. All direct smears were negative for acid-fast bacilli. In-hospital mortality was 67%. The patient with infection due toM fortuitumhad a preexisting diagnosis of AIDS and had a right upper lobe pneumonia and headaches. Cranial CT showed an enlarged infundibulum of the pituitary gland. Results of CSF analysis were essentially normal, and direct smears were negative. He left the hospital against medical advice. Our study indicates that the finding of MAI in the CSF in patients with AIDS is associated with an in-house mortality of 67% indicating a very poor prognosis.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Studies of dyspepsia show a 1% to 2% prevalence in adults, and 25% to 40% of these patients do not have a physical reason for their symptoms. These findings prompted us to do a retrospective follow-up study of 390 patients having motility studies for chest pain and gastrointestinal (GI) symptoms; 278 (71%) responded. Patients were asked to complete a self-rating symptom questionnaire regarding current GI symptoms and current symptoms of anxiety, panic, and depression; they were also asked to complete the Brief Symptom Inventory. Two groups were compared—those with known heart disease and those without heart disease. Substantial numbers of patients in both groups satisfied criteria for generalized anxiety disorders (>70%), panic disorder (>30%), and major depression (>35%). GI symptoms compatible with nonulcer dyspepsia were strongly associated with a psychiatric diagnosis. Our data suggest that anxiety and depressive states are strongly associated with dyspepsia and other GI symptoms not caused by ulcer disease.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID