摘要:

BackgroundPertussis is a potentially serious vaccine-preventable disease. Many clinicians are unaware that pertussis is common in adults, and that adults are a major reservoir of the disease in the United States.MethodsA MEDLINE search was conducted of all English-language articles pertinent to pertussis infections in adults. Results of relevant articles were compiled into a narrative review.ResultsStudies have shown that sporadic cases of pertussis in adults are common in a variety of clinical settings. Patients typicall+pressnt with a prolonged cough illness preceded by upper respiratory symptoms. Widespread outbreaks of pertussis occasionally occur in high schools, college campuses, and healthcare settings. The diagnosis and treatment of adults with pertussis are reviewed.ConclusionsPertussis infection, because of waning immunity, is common i n adults. Routine bqoster immunization of adults with the newer acellular vaccine may lead to the elimination of the disease in both children and adults.

ISSN:0038-4348    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ContextObesity is increasing at an alarming rate. During the past decade, the overall prevalence of obesity in the United States increased over 30%, with more than one third of the adult population meeting the definition of being overweight.ObjectiveWe review current and emerging therapies, present outcome data from a large clinical practice, and discuss challenges for physicians and researchers involved in obesity treatment.SummaryBecause obesity is a risk factor for numerous medical disorders and excess mortality, it is imperative that effective treatments be developed. While the current conservative therapies produce short-term weight losses, they are ineffective in the long term. Some obesity treatments are controversial, most notably the increasing use of anorexiant medications. For example, the Food and Drug Administration (FDA) recently requested the withdrawal of two widely used medications because of concerns about side effects. Currently, therapies that combine psychosocial interventions, drugs, and extended maintenance appear to have the most promising long-term benefits.ConclusionsLong-term treatment, including extended pharmacotherapy, may be necessary for many obese patients. Broader definitions of treatment outcome and success, including improvements in comorbid conditions, physical activity, and quality of life are needed.

ISSN:0038-4348    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundThis study was done to determine the prevalence of folate deficiency and macrocytosis in patients admitted to the hospital medicine service with alcohol and nonalcohol-related illnesses.MethodsTwo groups of patients, with and without alcohol-related illnesses, were included. Patients were excluded if they received folate therapy, medications known to alter folate concentrations, or if they had an uncertain diagnosis. Complete blood count and erythrocyte folate concentrations were determined from each patient. A Fisher's Exact Test and odds ratio were used to determine the prevalence of macrocytosis and correlation between folate deficiency and macrocytosis in the alcoholic group, respectively.ResultsOf the 36 alcoholic patients, 11.1% were folate deficient, and 33.3% had macrocytosis. Only 2 of 12 patients with macrocytosis were folate deficient. No control patient had macrocytosis or folate deficiency.ConclusionThe prevalence of folate deficiency among patients with alcohol-related illness is low. There is no correlation detected between macrocytosis and folate deficiency. Our findings suggest that it may be inappropriate to routinely supplement all alcoholics with folic acid, but certainly a small minority may benefit from it.

ISSN:0038-4348    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundCarisoprodol is a skeletal muscle relaxant with the potential for abuse. A carisoprodol overdose is rarely considered fatal. Nevertheless, we encountered carisoprodol in several cases, prompting review of our experience.MethodsWe did a retrospective study of cases examined at the Jefferson County Coroner/Medical Examiner Office from January 1,1986, to October 31, 1997, reviewing investigative reports and autopsy findings.ResultsCarisoprodol was present in 24 cases. Seventeen decedents died of acute drug intoxication. Carisoprodol was never the sole drug detected at autopsy, nor was it ever the sole cause of death. Propoxyphene was a co-intoxicant in 8 of the 24 cases.ConclusionsCarisoprodol causes respiratory depression. Since the mechanism of death was respiratory depression in 82% of the decedents who died of acute intoxication, we consider that carisoprodol was probably responsible, in part, for those deaths. The simultaneous use of propoxyphene and carisoprodol seems to be especially dangerous.

ISSN:0038-4348    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundWe wanted to determine the relationship between weather/seasonal conditions and the incidence/severity of HELLP syndrome.MethodsWe retrospectively reviewed medical records of all patients with class 1 (platelet nadir ≤50,000/μL), class 2 (platelet nadir >50,000/μL but ≤100,000/μL), and class 3 (platelet nadir >100,000/μL but ≤150,000/μL) HELLP syndrome, who had been treated at the University of Mississippi Medical Center between January 1, 1980, and December 31, 1992.ResultsNo seasonal differences were observed in the incidence or severity of pregnancies complicated by HELLP syndrome.ConclusionHELLP syndrome appears to occur throughout the year without any seasonal variation.

ISSN:0038-4348    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundAfter developing a synthetic composite material (TMS-1) made from a porous polypropylene mesh (placed in apposition to fascia) coated on the “visceral” side with solid polyurethane, we compared its efficacy with that of porous polytetrafluoroethylene, polypropylene, and primary fascial closure when the repairs were left exposed to the environment.MethodsWe created 1 cm2abdominal wall defects in each of the four abdominal quadrants of rats (n = 12). We used porous polytetrafluoroethylene, polypropylene, and TMS-1 to repair three defects; the fourth we primarily closed. The skin was left open in all cases, leaving the fascial closures exposed. A second group of rats (n = 24) had the same operation, except that peritonitis was induced using a standard fecal inoculation technique. When the rats were killed 2 weeks later, a “blinded” observer using a standard scale assessed the surface area and severity of adhesions formed.ResultsWhen compared with the other synthetic materials, the surface area of adhesions formed was significantly less after primary closure in clean conditions; in contaminated conditions, it was less than porous polytetrafluoroethylene, polypropylene, and the same as TMS-1. Furthermore, in contaminated conditions, the severity of adhesions beneath TMS-1 was the same as primary closure and significantly less than those beneath the polypropylene.ConclusionThe overall superiority of TMS-1 over porous polytetrafluoroethylene and polypropylene in septic conditions justifies further experiments to define its long-term efficacy in the repair of large defects.

ISSN:0038-4348    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundSeveral anticonvulsant agents, including carbamazepine, phenytoin, and valproate, are effective in some patients for the treatment of pain and tremor. This study reports on a trial of the newly introduced anticonvulsant, gabapentin, for pain and tremor control.MethodsA large case series of patients with centrally mediated pain, peripherally mediated pain, migraine, and tremor were treated in an open-label study with gabapentin (maximum of 2,700 mg/day).ResultsThirty-nine patients (65%) had moderate-to-excellent improvement in symptoms, with the best responses occurring in patients with peripherally mediated neuropathic pain. The other conditions treated that showed some improvement were benign essential/familial tremor, restless legs syndrome, centrally mediated pain, and periodic nighttime leg movements.ConclusionsGabapentin offers an effective, safe alternative therapy or co-therapy for the listed painful conditions and tremor; it does not affect the metabolism of other medications and is well tolerated.

ISSN:0038-4348    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundSurveys in recent years show that office emergencies are likely to occur in pediatric offices and that most offices are not equipped to deal with these situations.MethodsTo determine the pediatrician's preparedness to manage emergencies, we surveyed a randomly selected sample of 240 office-based pediatricians in Louisiana. We asked for information about basic and advanced cardiac life support training of the physicians and staff, availability of office equipment and medications, prearranged emergency plans, and staff preparedness.ResultsOnly 73% of pediatricians were trained in pediatric advanced life support (PALS). Of all support staff, only 48% were trained in basic life support, and 30% were trained in PALS. The most common deficiencies in equipment included intraosseous needles (62%), endotracheal tubes (54%), oxygen tanks (39%), intravenous catheters (29%), and nebulizers (22%). Availability of medications ranged from 75% for epinephrine 1:1,000 to 22% for calcium chloride. Although two thirds of the pediatricians had designed emergency plans for their offices, only 20% were conducting mock drills.ConclusionsDeficiencies exist among pediatricians and office staff regarding appropriate levels of preparedness to handle pediatric emergencies. Recommendations are made to attain appropriate levels of preparedness.

ISSN:0038-4348    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundA retrospective study was done to assess the correlation between endometrial cells on routine cervical cytology and carcinoma of the endometrium.MethodsIn a 4-year period, endometrial cells of some type were identified on the Papanicolaou (Pap.) smears of 61 women, of whom 52 had further diagnostic evaluation of the endometrium. Data were analyzed with a multivariate stepwise logistic regression.ResultsThe results indicated an association of endometrial cells in Pap smears with carcinoma of the endometrium in seven patients (13.5%). In 45 patients (86.5%), the final diagnosis was benign. Factors that impacted the diagnosis of carcinoma were the findings of atypical or cancerous endometrial cells on Pap smear and abnormal vaginal bleeding.ConclusionsThese data indicate the importance of further diagnostic evaluation with endometrial sampling in postmenopausal patients with endometrial cells seen in Pap smears, especially those with abnormal bleeding.

ISSN:0038-4348    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Although Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal (GI) tract, complications in adults are rare, especially in the elderly. Intestinal obstruction is the most common complication in the adult, and inflammation mimicking acute appendicitis may also occur. Lower GI bleeding as a result of Meckel's diverticulum with ectopic gastric mucosa is distinctly unusual among the elderly, with most previous case reports involving patients under the age of 40. The case we report involved a 91-year-old man with massive lower GI hemorrhage found to be due to a Meckel's diverticulum with ectopic gastric mucosa.

ISSN:0038-4348    

出版商:OVID    

年代:1998

数据来源: OVID