摘要:

We designed a study to assess the personal gun ownership and safety practices of trauma center workers in Birmingham, Alabama. Survey questionnaires administered to nurses, physicians, and other workers in pediatric and adult trauma centers showed that two thirds (65%) owned a gun and 56% owned a handgun. Gun owners with children were less likely to have loaded, unlocked guns in their homes than those without children (33% vs 56%). Loaded guns were carried in cars by 48% of workers. Worker title and attitude regarding handgun restrictions were the strongest predictors of unsafe gun ownership in a logistic regression model. Workers with loaded, unlocked guns in their home considered themselves and their family at no greater risk of gun injury from family-owned guns than workers without guns. We conclude that many trauma workers had unsafely stored guns and failed to recognize the associated risks.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The Patient Self-Determination Act became effective in December 1991 and mandates that patients be given information about legal rights regarding living wills and durable powers of attorney for health care. We investigated the impact this law has had on hospitals, medical personnel, and patients. We conducted a survey of all hospitals in the state of Georgia, collecting data regarding implementation and knowledge of the law, as well as effects of the law and beliefs about it. The data indicated that hospitals relied primarily on the Georgia Hospital Association for implementation policy, that “minimalist” implementation of the law occurs in most hospitals, and that the biggest perceived problem with the law was the inappropriateness of presenting this information at hospital admission and problems patients had in comprehending the materials presented. Despite these concerns, most respondents did not want the law repealed.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Eleven patients, aged 36 to 55 years, with silicone breast implants had episodes of severe chest pain similar to heart attacks 6 weeks to 7 years after breast implantation; one patient had a severe attack 1 month after explantation. The chest pain, which was not related to physical exertion, lasted from 15 minutes to 4 days, and descriptions of it varied from a “pressing” type of pain to “stabbing” pain with radiation to the shoulders, left arm, and jaw. The associated symptoms were diaphoresis, nausea, vomiting, dyspnea, and palpitations. All of the patients had a normal electrocardiogram (ECG) with the exception of one, whose ECG showed nonspecific ST changes. Ten had cardiac evaluations, all of which yielded normal results. All had implant removal, and five were found to have at least one ruptured implant. Nine had an implant capsule biopsy; all had chronic inflammatory rinds, and five had free silicone in tissue whether or not the implants were ruptured. All eight who had a pectoralis major muscle biopsy had abnormal results: (neurogenic atrophy [six], fasciitis [three], myositis [one], chronic inflammation [one], free silicone [one], and neuroma [one]). We concluded that silicone breast implants may cause an atypical chest pain syndrome, probably due to local inflammatory reactions and neuroma formation.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

In this study of 503 consecutive cases of amebic liver abscess documented during a 21-year period, 110 (22%) were complicated by perforation. Perforation sites included pleuropulmonary structures (79 cases, 72%) subphrenic space (15 cases, 14%); and peritoneal cavity (11 cases, 10%). The less common sites were the thoracic and abdominal wall, pericardial sac, bile duct, kidney, mediastinum, colon, and right flank. Trophozoites were recovered in 29% of cases. For the rest of the cases, diagnosis was based on the clinical manifestations and the dramatic response to a therapeutic trial of amebicides. Open surgical drainage was done in 10 of 11 patients who had peritoneal perforation; 6 of them were cured and 5 died. Of 97 patients with perforation sites other than the peritoneal cavity, 64 were treated with metronidazole in addition to needle aspiration and/or percutaneous catheter drainage, and all achieved complete remission without relapse during subsequent follow-up. Of the 36 cases treated with metronidazole alone, 22 (61%) were cured. The mortality rate in the group with perforated abscess was 17% (19/110), compared with 5% (25/503) in the whole series. The results suggested that (1) amebic liver abscess can be difficult to diagnose, especially when the pathogen is not isolated; and (2) metronidazole combined with needle aspiration and/or percutaneous catheter drainage is the treatment of choice for amebic liver abscess with perforation.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Interleukin-1β(IL-1β) a proinflammatory cytokine associated with adult lung diseases, may play a role in the development of bronchopulmonary dysplasia (BPD). Concentrations of IL-1βwere measured in bronchoalveolar lavage fluid from 17 infants on day 1 of life and in 18 infants intubated until day 14. IL-1βwas detected in 31 of 35 samples. Day 14 concentrations were significantly higher than those obtained on day 1. The four infants who had BPD had significantly higher IL-1βlevels than those who received oxygen for less than a week or for 1 to 4 weeks. Day 1 IL-1βconcentration was related to the neutrophil count and inversely to gestational age. IL-1βis present in the majority of newborn infants intubated on day 1 or at 2 weeks of life and is elevated during the first 24 hours in infants who will subsequently require longer ventilatory support. It is also elevated in infants who have a stronger pulmonary inflammatory response.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Isolated central nervous system (CNS) mucormycosis is a rare but life-threatening infection. We report a case of bilateral frontal lobe mucormycosis in a previously healthy woman. Intravenous drug use was the most likely route of infection. After treatment with surgical drainage and amphotericin B, she survived but suffered permanent neurologic deficits. We identified 29 previous reports of isolated CNS mucormycosis in the medical literature. Including our case, the patients averaged 32 years of age and most were male. Intravenous drug use appears to be the most important risk factor, present in 20 patients (67%). Treatment with amphotericin B was the only predictor of survival, reducing mortality from 92% to 41%. Isolated CNS mucormycosis should be considered in the differential diagnosis of brain abscesses, especially in intravenous drug users. Prompt initiation of therapy with amphotericin B may be life-saving.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Uterine rupture occurs in less than 1% of pregnancies. The literature over the past several years confirms the safety of the low transverse uterine scar. We report a case of spontaneous rupture of a low transverse cesarean scar at 36 weeks' gestation, resulting in fetal death.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Zenker's diverticulum is an unusual site of origin for clinically significant upper gastrointestinal hemorrhage. Only three such cases have been previously documented. We report a case of massive upper gastrointestinal bleeding from a Zenker's diverticulum seen as hemoptysis and associated with chronic ingestion of one aspirin tablet every other day. Because of the propensity for ingested tablets to lodge in the diverticulum, caution is urged when prescribing ulcerogenic agents in pill form to a patient with a known Zenker's diverticulum.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Continent reconstruction of the lower urinary tract using the appendicovesicostomy (Mitrofanoff principle) is an excellent means of managing many patients with altered bladder function, especially those with good bladder volume and low pressure. Motivated patients unable to perform urethral catheterization because of paresis or other reasons now have a method of urinary diversion free of an appliance, though additional procedures may be necessary if bladder volume is low and/or bladder pressure is high. We no longer routinely perform appendectomy during bladder substitution or bladder augmentation procedures. By removing the appendix, we may be discarding an appendage that might prove useful should future urinary reconstruction procedures be required.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Intrathoracic desmoid tumors are extremely rare, only 12 cases having been reported in the literature. In the 14-year-old girl we describe, a desmoid tumor manifested as an intrathoracic mass. Computed tomography of the chest after administration of intravenous contrast medium showed a large intrathoracic heterogeneous mass and lysis of multiple adjacent vertebral bodies. After incomplete resection of the tumor, T1-weighted magnetic resonance imaging showed residual tumor that produced signal intensity equal to that of skeletal muscle. Intense enhancement after intravenous administration of gadolinium allowed improved delineation of adjacent tissue involvement.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID