摘要:

&NA;Renal tubular acidosis is a constellation of syndromes arising from different derangements of tubular acid transport. Recent advances in the biology of urinary acidification have allowed us to discern various molecular mechanisms responsible for these syndromes. This report relates clinical disorders of acidification to the underlying defective mechanisms responsible for them. A clinical classification of these disorders is presented, integrating each disorder with the prevailing serum potassium concentration. That renal tubular acidosis can be associated with low, normal, or high serum potassium concentration is now explainable by identifying the specific defect in transport causing each syndrome.

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Germ cell tumors (GCTs) in male patients are particularly important in oncology because the impact of a cure in the young patient population is significant. Patients with poor‐risk tumors by the international classification system have about a 50% likelihood of long‐term survival. No randomized trial has proved a chemotherapy regimen to be superior to that of four courses of combination bleomycin, etoposide, and cisplatin. Ongoing research is evaluating the role of high‐dose chemotherapy and hematopoietic stem cell transplantation as initial therapy in patients with intermediate‐risk and poor‐risk GCT. Newer agents such as gemcitabine and paclitaxel have shown promise and may be incorporated in future chemotherapeutic regimens. We review the major prognostication systems, areas of research directed at improving treatment outcome, and approaches that will improve understanding and management of these neoplasms in the future.

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Lumbar hernias occur infrequently; however, after trauma, they can present challenging problems in management. Unlike congenital or primary acquired lumbar hernias, posttraumatic lumbar hernias result from a disruption in normal anatomic boundaries and may require extensive reconstruction. We describe a case of lumbar hernia in a patient who had been crushed between two train cars, review the anatomy of the lumbar region, and identify treatment options.

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.Earlier diagnosis and treatment of diabetes mellitus is desirable. We studied the prevalence of newly identified diabetes among hospital inpatients.Methods.We did a prospective observational study in a community teaching hospital.Results.Thirty‐six patients had hyperglycemia on at least 2 days and were considered to have newly identified diabetes mellitus. They represented approximately 1% of the inpatient population. Sixteen (44%) were receiving corticosteroid treatment. Five of the patients (14%) died during the hospitalization. Twenty‐four (67%) received insulin treatment during hospitalization. Of the 31 surviving patients, only 15 (48%) had documentation of discharge plans for diabetes‐related treatment, 7 (23%) received instruction by a dietitian, and 5 (16%) received education about diabetes self‐management from a diabetes nurse educator.Conclusion.Hospitalized patients with newly identified hyperglycemia represent an opportunity for early diagnosis, education, and treatment of a substantial proportion of patients with undiagnosed diabetes.

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.Venous thrombosis followed by pulmonary embolism is one of the most common causes of sudden death among middle‐aged adults. Several inherited polymorphisms are associated with heightened risk of venous thrombosis, including mutation at position 20210 of the prothrombin gene and mutation at codon 506 of the factor V gene.Methods.We studied mutation prevalence in 67 individuals who died of pulmonary embolism and were autopsied in a medical examiner's facility over a 5‐year period. Mutations were identified by polymerase chain reaction followed by allele‐specific endonuclease digestion.Results.Traditional risk factors for pulmonary embolism (eg, immobility, oral contraceptive use, cancer) were identified in 75%. Heterozygous mutation of the prothrombin gene was found in 3/67 (4%), and heterozygous mutation of the factor V gene was identified in 3/66 (4%). No homozygotes or compound heterozygotes were identified. The prevalence of mutation was not significantly different from that of the general population.Conclusions.Individuals who die suddenly from pulmonary embolism are not often affected by prothrombin or factor V gene mutations. Therefore, medical examiners need not routinely test for these mutations in individuals who die of pulmonary embolism.

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.Although the first reports of infection due to penicillin‐nonsusceptibleStreptococcus pneumoniaein the United States were in children, these strains have circulated widely in recent years, with the prevalence increasing dramatically among the elderly. Regional surveillance of pneumococcal susceptibility profiles may assist clinicians in management decisions, increase awareness of this microbial threat, and target potential areas of intervention.Methods.As part of ongoing surveillance, we surveyed single‐patient pneumococcal blood isolates in our 440‐bed Staten Island community teaching hospital from June 1, 1996, through May 31, 1998.Results.Overall, of 47 single‐patient isolates, 16 (35%) were penicillin nonsusceptible. Of 35 isolates from adults, 15 (44%) were nonsusceptible, compared with 1 of 12 (8%) from children. Seven of the nonsusceptible isolates (44%) were from persons ≥65 years old and represented 47% of the isolates from this age group.Conclusions.Community‐acquired penicillin‐nonsusceptible pneumococcal bacteremia is not simply a pediatric problem, but also a threat to the elderly.

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.In an effort to prevent falls of pediatric surgical patients from the operating table, a set of portable cushioned operating table siderails was developed.Methods.A set of portable cushioned operating table siderails was used in the operating room over a 5‐year period in more than 2,550 cases.Results.The portable cushioned siderails provided an effective, easily placed barrier to falling. No falls were recorded.Conclusions.Portable cushioned siderails provide an effective barrier to prevent pediatric surgical patients from falling from the operating table.

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.We studied the nature of associated ocular trauma during the 1998 and 1999 New Orleans parade seasons and whether trends were observable from previous surveys.Methods.A prospective survey and retrospective analysis included 18 emergency rooms (ERs) in the New Orleans area.Results.Sixteen surveys representing eight ERs were completed between February 19 and 24, 1998, and 32 surveys representing five ERs were completed between February 5 and 17, 1999. In both years, the most common ocular complaints were pain, blur, foreign body sensation, tearing, and photophobia. The most common slit lamp findings in 1998 were within normal limits, corneal abrasion, and conjunctival hyperemia. In 1999, the most common findings were subconjunctival hemorrhage, corneal abrasion, cell and flare, and lid laceration.Conclusions.Projectile injuries of the eyes are common during Mardi Gras due to the nature of interaction between paradegoers and float riders. We found no identifiable trend in the number or type of injuries reported in 1986, 1987, and 1998 Mardi Gras surveys.

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.This study was done to analyze the economic effect of clarithromycin on the daily dosing of cyclosporine in lung transplantation.Methods.Nine consecutive patients (mean age ± SEM, 34.6 ± 5.2 years) had transplantation from June 1995 to June 1996. Median follow‐up time was 649 days (range, 431 to 799 days). Preoperative diagnoses were cystic fibrosis (n = 4), idiopathic pulmonary fibrosis (n = 2), emphysema, bronchiectasis, and obliterative bronchiolitis. Median time from transplantation to addition of clarithromycin to a standard immunosuppressive regimen was 86 days (range, 14 to 181 days).Results.Baseline cyclosporine dose (9.9 ± 2.2 mg/kg/day) was reduced to 5.8 ± 1.0 mg/kg/day and 4.1 ± 0.8 mg/kg/day at 1 month and 1 year, respectively, after initiation of clarithromycin therapy. Estimated annual savings were $3,400 per patient. There was no increase in infection or rejection episodes.Conclusions.Clarithromycin safely reduced the dose and cost of cyclosporine in this series.

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID