摘要:

Every physician’s office should be a melanoma detection station. Identification and surgical excision of early melanoma is today’s best answer to reducing the death rate from this treacherous disease. Public awareness of melanoma is gaining momentum. Melanoma education for physicians is vital if the battle against melanoma is to be successful. This presentation is a challenge to all physicians and students of medicine to identify patients at risk for melanoma and to follow up with a skin scan to search for suspicious spots on all patients with risk factors for melanoma as a part of their physical examination. We need to teach individuals at risk to do self-examination, to report immediately any recent growth changes in an existing mole or any recently acquired pigmented lesion, and to practice the rules of safe sun exposure. Because securing a suitable specimen of tissue for biopsy and proper interpretation of sections are paramount in patient management and understanding prognosis, we present guidelines for performing a proper biopsy.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Drug abuse during pregnancy has attracted national attention, but most studies are from large cities. This study is concerned with the indigent pregnant patients in a midsized city in the southeastern United States. In a 23-month study, 2,442 patients were delivered of neonates. Using specific criteria, 511 patients were tested for drug abuse. A positive test was identified in 156 (31%), cocaine being the most common agent. During 2 months of random testing, 15 patients (16%) had positive drug screens. Comparison of drug-positive pregnant patients with general obstetric patients identified many adverse obstetric and perinatal outcome data. Drug-positive patients weighed less, were older, were prone to not seek prenatal care, and were more likely to deliver prematurely and have a growth-retarded infant. Drug abuse in this population had significant impact on the health of the patient and her unborn infant.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

As of 1986, all 50 states had implemented mandatory child restraint laws. When used correctly, restraint systems have been proven to reduce the number of fatalities, hospitalizations, and injuries. To date, there is little information regarding compliance with restraint systems for disabled children. There are no data available on fatalities of or injuries to disabled children. This study assessed the restraint system (if any) used in the transportation of disabled children with special restraint needs. We conducted a survey to determine the restraint practices used in transporting these children to school, to our outpatient clinic, and around home. Our survey found that two thirds of the handicapped children reviewed were transported unsafely in at least one mode of transportation. We recommend that health care providers review the transportation needs of their handicapped patients in order to ensure safe transportation.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Needs assessments are essential for policy formulation and the appropriate design of intervention programs. Recent nationwide data show that among large metropolitan areas of the United States, Baltimore has one of the highest infant mortality rates and ranks in the worst top 10 for blacks and the top 5 for whites for most indicators of poor pregnancy outcome. In this paper, we present the methods and results of a needs assessment that used multiple sources of routinely collected data and was conducted for the purpose of identifying intervention factors contributing to infant mortality in Baltimore City. This needs assessment was used by the Baltimore City Health Department to successfully secure funding for the federal Healthy Start Infant Mortality Prevention Initiative. We present the results of the analyses, along with some of the proposed interventions that resulted from the needs assessment. We also discuss the limitations of this type of needs assessment as well as suggestions for future needs assessments for the design of interventions to improve perinatal health.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Recent investigations of outbreaks ofSalmonella enteritidisgastroenteritis among humans, especially in the northeastern United States, implicate grade A shell chicken eggs as the likely vehicle of transmission. In April 1991 we investigated an outbreak ofS enteritidisinfections after a wedding anniversary celebration in Beaufort, South Carolina. Sixty-eight percent of persons who ate a macaroni and cheese dish, but none of the 16 attendees who did not, became ill (P<.001). The chef used six grade A eggs in the macaroni and cheese and may have undercooked it. The egg supplier processed eggs exclusively from farms in South Carolina and North Carolina. This outbreak suggests that the epidemic ofS enteritidisin flocks of laying hens and the consequent threat of human infection has spread to the Carolinas.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

A prospective study of infection due toHelicobacter pyloriin 104 Southern Appalachian veterans with upper gastrointestinal symptoms revealed a prevalence of 67%. There was no age difference observed between those with and withoutH pylori. The organism was shown to be present in 12 of 13 patients with duodenal ulcer (92%), 6 of 10 with gastric ulcer (60%), and 52 of 81 with nonulcer dyspepsia (64%). Using culture as standard, the urease test showed a sensitivity of 76% and specificity of 100%, while the biopsy stain had a sensitivity of 97%. The presence of acute inflammation in the antrum and body of the stomach closely correlated with the presence of the organism. Somewhat at variance with previous studies, our study indicated thatH pyloriin the body mucosa was strongly associated with chronic superficial gastritis with and without acute inflammation. Such a finding may reflect the natural history of infection due toH pyloriand the advanced age of our patients.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

This retrospective study consisted of 148 patients who were consecutively discharged during 1991 from a geriatric VA Hospital population. Seventy-six were 65 years of age or older, and all were male. Data included admission serum albumin level, age, length of stay, diagnosis, and disposition. Albumin level was negatively associated with length of stay and with outcome disposition. Albumin level was not associated with diagnosis. Age alone was not associated with albumin level, length of stay, diagnosis, or disposition. We conclude that a low albumin level is an independent predictor of a worse disposition. Age did not predict nutritional status, length of stay, diagnosis, or disposition.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Necrotizing fasciitis (NF) is a rapidly progressive disease characterized by extensive necrosis of the skin, fascia, and subcutaneous tissue, with sparing of the underlying muscle. Diabetes mellitus, Bartholin’s gland abscess, and recent surgical procedures (including episiotomy) are factors often found in obstetric and gynecologic patients. Mortality in this group of patients is higher than in the general surgical population. Death is usually due to overwhelming sepsis, renal and respiratory failure, and multiple organ failure. The infections are usually polymicrobial, with α-hemolytic streptococci, gram-negative coliforms, and anaerobic bacteria. Lower survival has been reported in large series when the groin is involved or when the general nutritional state is poor. From October 1988 to August 1990, we treated five patients with necrotizing fasciitis. Certain important characteristics of such patients have not been discussed in the obstetric and gynecologic literature. Nutritional status, with special emphasis on total protein, albumin, and the effects of alcoholism, has a significant impact on mortality. Nutritional support of these patients may improve survival. To limit the impact of secondary infections, surgical approaches should be modified by the anatomic location of the initial lesions. More frequent debriding in the operating room and early fecal diversion are recommended.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Disseminated candidemia is a common nosocomial infection in the neonatal intensive care unit, though only a few studies have reported the outcome of amphotericin B therapy in neonatal candidiasis. Our treatment regimen consisted of an initial daily amphotericin B dose of 0.5 mg/kg. (For infants weighing >1 kg, the second dose was increased to 1 mg/kg.) At 3 to 5 days, if the blood culture was negative, amphotericin B therapy was changed to every other day and continued for a total of 10 doses. Records of 36 patients given this regimen were reviewed for signs of toxicity or treatment failure. The mean birth weight was 988 ± 510 g, and the gestational age was 28 ± 3.9 weeks. The patients were ventilated for 13 ± 15 days and had central lines for 6.7 ± 9.3 days before development of candidemia. The mean age at onset of candidemia was 29.1 ± 19.8 days. The interval from culture to treatment was 2.9 days. Six of 36 patients died, 2 of candidal meningitis and 4 of complications unrelated to candidal infection. Thirteen (36%) of the patients had candidal pustules during the course of their disease; 1 had osteomyelitis. There was no evidence of toxicity from this drug regimen and no apparent treatment failures. There were no changes in BUN and creatinine before or during therapy and no change in total urinary output. Blood cultures became sterile except in one patient who died on the first day of therapy. Most of the patients in this study had candidemia in the absence of a central indwelling catheter. Further prospective pharmacokinetic and therapeutic studies are warranted for this regimen of amphotericin B, which carries a low risk for toxicity.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Bacteriuria is a common clinical problem among children with neurogenic bladder due to meningomyelocele or traumatic spinal cord injury. To determine the frequency of bacteriuria among affected children at our institution, we obtained 257 urine specimens from 105 children being seen as outpatients for routine care over a 2-year study period. Specimens were obtained via catneterization. Almost half of these specimens (110/257 or 43%) yielded positive results when tested for urinary pathogens. To assess whether any characteristics of these children were related to the likelihood of bacteriuria, we analyzed further a subgroup of 46 children with normal renal ultrasonography from whom two to five specimens were obtained. There were no statistically significant associations between the likelihood of bacteriuria and the following characteristics: age, gender, socioeconomic status, level of spinal cord lesion, voiding technique, and use of prophylactic antibiotics. Children with neurogenic bladder are at high risk for bacteriuria. The pathogenesis of this bacteriuria, its part in deterioration of the urinary tract, and the possible means of its prevention in this special population all deserve further study.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID