摘要:

Background.The use of nondepolarizing neuromuscular blocking drugs (NDNMBDs) via continuous infusion in the intensive care unit (ICU) is gaining in popularity. Several new NDNMBDs have been developed recently; these drugs vary in their elimination, metabolism, and half-lives.Methods.A review of the recent English language literature was done, with those articles relevant to the ICU being incorporated into this paper.Results.The six most frequently used NDNMBDs, consisting of atracurium, cisatracurium, doxacurium, pancuronium, rocuronium, and vecuronium, were reviewed. The neuromuscular junction and impulse transmission, clinical monitoring, clinical pharmacology, the elimination and metabolism, the adverse reactions, and the drug interactions of these NDNMBDs are reviewed.Conclusions.The use of NDNMBDs is progressively increasing in ICUs. Proper understanding of normal neuromuscular physiology, clinical pharmacology, and drug interactions is essential to optimize patient care and to minimize the risk of adverse reactions.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background.Within the past 5 years, several factors have altered our view of the diagnosis, prognosis, treatment, and genetics of bipolar illness.Methods.Significant advances in these areas are reviewed.Results.Diagnostic changes include establishment of symptom duration requirements that limit confusion with affective instability. Prognostic insights include the realization that illness likely begets illness and, conversely, that adequate control is probably instrumental in improving long-term prognosis. Therapeutic advances are marked by the Food and Drug Administration approval of divalproex for acute mania.Conclusions.Genetic and family studies suggest that (1) bipolar illness is a discrete condition, not related to unipolar depression; and (2) bipolar illness may manifest a phenomenon known as anticipation (worsening of the disease with succession generations), which may be related to a specific nucleic acid abnormality.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The timing of surgery during the menstrual cycle of premenopausal breast cancer patients was correlated with their disease-free survival (DFS) and overall survival (OS). The study included 150 premenopausal patients treated for breast cancer between 1977 and 1992. The data were analyzed using three different menstrual cycle phase categorization schemes: (1) days 0 to 6 and 21 to 32 vs 7 to 20; (2) days 0 to 2 and 13 to 32 vs 3 to 12; and (3) days 0 to 14 vs 14 to 32. Two different surgery dates used for analysis were biopsy date and definitive surgery date. There was no association of the timing of surgery with OS. Only one categorization scheme correlated with DFS (scheme No. 2), and this correlation was significant using either surgery or biopsy dates. Thus, premenopausal breast cancer patients who have biopsy and/or definitive surgery during their perimenstrual phase (days 0 to 2 or after day 13) of the menstrual cycle may have a longer DFS than patients operated on during their midcycle phase (days 3 to 13); however, this may not affect overall survival.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Back pain in children has long been considered a serious condition with an organic cause. The staff of the Shriner's Hospital had been informally noting that diagnoses among children with back pain had been changing. We conducted a retrospective study of 648 patients with spinal disorders treated at the Shriner's Hospital for Crippled Children, Spokane Unit, between January 1991 and June 1993. The patients were divided into two groups: those with pain and those without pain. It was found that back pain with no organic cause was the primary diagnosis in 57% of the group having pain. Only one child had a diagnosis of malignancy, and there were no cases of active infection. In the group with pain, three interesting associations were found concerning psychosocial problems, disability, and litigation. It was found that the diagnoses in children with back pain treated at this referral center during the study period parallel those in the adult population with back pain.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Solitary fibrous tumor (SFT) is a rare neoplasm that, in addition to its classic presentation as a pleural-based mass, can also be encountered in unusual sites. The main difficulty in making the diagnosis of SFTs results from the unfamiliarity with its diverse clinical and pathologic features. This series of SFTs, some with unusual clinicopathologic presentation, included nine women and two men, ranging in age from 28 years to 74 years (five in pleura, one in lung parenchyma, one in breast, and four in mediastinum). The tumors were locally excised in eight cases and were resected along with portions of lung parenchyma in three. A panel of immunohistochemical stains was used to characterize these tumors. They were all vimentin-positive and, with the exception of one case, CD34-positive. Tumors were negative with antibodies directed against cytokeratin, factor VIII-related antigen, S-100 protein, muscle-specific actin, and smooth-muscle actin. Various diagnoses were initially rendered for these clinically and pathologically diverse lesions by the examining pathologists. Awareness of the various gross and microscopic patterns of these tumors, the possibility of occurring in unusual sites, and the use of immunohistochemical stains, particularly CD34, should eliminate most of the difficulties in arriving at a correct diagnosis. One patient died of metastatic breast cancer; all other patients were alive and well with a median follow-up of 17 months.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The objective of our study was to verify a suspected increased incidence of non-transitional cell carcinoma (TCC) of the bladder in female patients treated at our institution. The study included 169 patients, 83% of whom resided in the Texas Gulf Coast region. Tumors were considered TCC or non-TCC on the basis of their predominant histologic pattern. The incidence of non-TCC among men (8.1%) was comparable with data from American tumor registries and European studies. In contrast, our female patients exhibited a marked increased incidence of non-TCC (42.3%), which is approximately five times higher than that in other series. All male and female patients with non-TCC had invasive disease. History of urinary tract infections was strongly associated with non-TCC. Our results suggest that our sample of the female population in the Texas Gulf Coast region has a significantly high incidence of non-TCC. This unusual trend merits further investigation.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The objectives of this study were to estimate the prevalence of obesity in school-aged children in Jefferson County, Alabama; to learn when school-aged children become obese; to determine the susceptible groups; and to study the association between obesity and blood pressure. During the school year, 5,953 children, ranging in age from 5 years to 11 years, were screened for weight, height, and blood pressure, using standardized techniques. We found that obesity, defined as ≥120% of ideal body weight for height, is prevalent in 5-year-old to 11-year-old children. The prevalence of obesity in girls at age 5 was 23% in blacks and 10% in whites, rising to 47% in blacks and 27% in whites by age 11. In boys, the prevalence of obesity at age 5 was 13% in blacks and 6% in whites, rising to 29% in blacks and 22% in whites by age 11. The prevalence of obesity is significantly greater in black than in white children and is also significantly greater in girls than boys. The systolic and diastolic blood pressures were significantly higher in obese than in non-obese children. We conclude that the significant prevalence of childhood obesity and an associated complication, increased blood pressure, emerge in school-aged children. Thus, we recommend investigations of prevention and intervention programs to be used in the school setting.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background.Coronary heart disease (CHD) remains the most common cause of death among blacks, and the difference in CHD mortality between blacks and whites is growing. This trend may be due in part to higher rates of CHD risk factors among blacks. This study was done to determine the prevalence of CHD risk factors among a population-based sample of 403 rural blacks in Virginia.Methods.Community-based screening evaluations included the determination of exercise and smoking habits, blood pressure, height, weight, total and high-density lipoprotein (HDL) cholesterol, and glycosylated hemoglobin.Results.The prevalences of smoking (32.5% of men, 20.0% of women), high cholesterol (16.6% of men, 18.9% of women) and sedentary lifestyle (37.5% of men, 66.7% of women) were similar to prevalences reported for other black populations. However, the prevalences of diabetes (13.6% of men, 15.6% of women), hypertension (30.9% of men, 43.1% of women), and obesity (38.7% of men, 64.7% of women) were higher than those reported elsewhere. Increased body mass index was significantly associated with higher prevalences of hypertension, diabetes, and low HDL cholesterol.Conclusions.Innovative methods are needed to decrease the high risk factor prevalences among this population.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background.Midazolam is used frequently to sedate children for gastrointestinal endoscopy. The sedative dosage of intravenous midazolam commonly reported in children is up to 0.3 mg/kg. We hypothesized that larger doses of midazolam could be used for pediatric endoscopy.Methods.We retrospectively reviewed the medical records of 116 pediatric patients (aged 1 year to 18 years) who had endoscopy. The efficacy and side effects of sedation in 45 patients who received midazolam doses of ≥0.3 mg/kg were compared with the same effects in 71 children who received <0.3 mg/kg.Results.All patients received = 1 mg/kg meperidine (up to 50 mg) intravenously. The blood pressure, pulse rate, respiratory rate, oxygen saturation, degree and duration of sedation, and incidence of side effects such as hypotension, hypoxia, or vomiting were similar in both groups.Conclusions.Intravenous doses of midazolam >0.3 mg/kg can be used for conscious sedation in children.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Tramadol (Ultram) is a new analgesic agent with a dual mechanism of action that includes weak agonistic effects at the µ-opioid receptor as well as inhibition of neurotransmitter (serotonin, norepinephrine) re-uptake. Although it has proven to be a safe and effective agent for the control of pain, adverse effects can occur with its use. I report the occurrence of seizure activity after the inadvertent administration of 4 mg/kg of tramadol to a child. Previous reports of seizure activity after tramadol administration are reviewed and the treatment of this problem is discussed.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID