摘要:

Herpes zoster (HZ) often occurs concomitantly with various internal malignancies, most commonly hematologic in origin. Authors in the past proposed that HZ was a marker for internal malignancy, since it is often found in association with a malignancy. A critical review of the literature revealed that when HZ and malignancy occur in the same individual, rarely does HZ precede the malignancy, but usually follows it. Many studies have evaluated HZ in cancer patients, but only three studies have evaluated the occurrence of malignancy after the diagnosis of HZ, and all found no increased incidence of internal malignancy in patients with HZ. Since HZ is a poor marker for internal malignancy, extensive workups to find occult malignancy are not indicated. In rare cases, however, HZ precedes a malignancy. We therefore recommend a baseline history and physical examination, with further directed workup only if there are abnormal findings.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Every health care worker should be aware of the quality and deficiencies of gloves in the health care setting. Since the introduction of the human immunodeficiency virus into the health care setting, the medical community's compliance with universal precautions and the standards mandated by the Food and Drug Administration have worked in a mutual effort to enhance the quality of medical gloves considerably. Despite these improvements in protecting health care workers, recent studies on glove integrity before and after use warn against taking die protective aspect of gloves for granted. According to studies, latex gloves provide die best available protection from biohazardous substances, but stricter regulation of glove production and a continual observance of recommendations and regulations by health care regulators are necessary to improve glove quality. This report is designed to reveal the fact regarding the true safety integrity of two main glove types, latex and polyvinyl chloride, through permeability testing with various biomaterials and substances.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Academic tenure is the guarantee that a faculty member cannot be arbitrarily dismissed. The tenure system developed to maintain academics free of external pressure and coercion, and in dramatic instances tenure has been used to defend academic freedom. With the development of the research-oriented medical school staffed by full-time faculty, the reward system of tenure and promotion was grafted on to academic medicine. The changing face of academic clinical medicine places significant stresses on the traditional tenure system and raises the question of whether it is fundamentally irrelevant. Tenure has been defended as the protector of free inquiry, insurer of academic excellence, contributor to research and its benefits to society, and a means of selecting the best and brightest for our faculties. Tenure has been criticized as a contributor to academic sloth, codifier of gender and racial discrimination, and as a system unable to deal with the economic realities of high-priced referral specialties. As academic medical centers increase their efforts at clinical outreach, it is unclear whether traditional promotion and tenure will be of interest to clinicians employed solely to deliver primary care. In this special report, I review the history of tenure, arguments for and against its use for clinicians, and proposals for reform.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Data from asbestos workers were used to devise a cutpoint classifier to identify subjects as Nonuser (non-tobacco user), Smokeless (exclusive smokeless tobacco user), and Smoker (ignited tobacco user). In some clinical trials and smoking cessation programs, Smokeless should be separated from Smoker. One therefore needs a marker for smoke exposure, such as thiocyanate, since nicotine levels, as measured by cotinine, could be similar in both groups. Levels of cotinine (ng/mL) and thiocyanate (μmol/L) levels (mean ± SD) were, respectively: 320.9 ± 201.1 and 145.9 ± 63.7 for the Smoker group; 339.1 ±327.5 and 32.0 ± 16.9 for the Smokeless group; and 0.6 ± 2.6 and 58.2 ± 33.2 for the Nonuser group. For Nonuser, Smokeless, and Smoker, respectively, the self-reported status was 45.1%, 10.8%, and 44.1%, which was adjusted to 42.2%, 11.6%, and 46.2%; the classifier yielded sensitivities of 100%, 76.1%, and 92.2%; specificities of 96.1%, 97.6%, and 96.4%; and predictive values of 94.9%, 80.6%, and 95.6%. The classifier successfully identified Nonusers, separated Smokeless from Smoker, and determined the prevalence of false reports in our cohort.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Our purpose was to determine the discovery method and stage of newly discovered breast cancers at two different medical centers. To do this, we conducted a retrospective chart review at our urban and suburban teaching hospitals during 1991 through 1992 and 1992, respectively. Only 29 (26%) of 112 cancers at our urban hospital were discovered mammographically; 38 (38%) of 100 neoplasms were discovered using mammography at our suburban hospital. At both institutions, the mammographically discovered cancers had a lower stage than those detected clinically. Despite proven benefits and the efforts of organizations such as the American College of Radiology and the American Cancer Society, screening mammography remains underused in the patient populations that we studied.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Mid-ileal conduit stenosis is an unusual yet morbid complication following ileal conduit urinary diversion. We report the cases of four patients who developed mid-ileal stenosis at an average interval of 19.5 years after urinary diversion, with the longest interval being 25 years. This series emphasizes the importance of life-long follow-up of patients who have had urinary-intestinal diversion.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

To facilitate access to care for HIV-infected women, a maternal-child program was started at an HIV outpatient clinic in New Orleans. The program consisted of free child care and transportation, separate waiting and examination rooms, female care providers, merged visits for mother and child, and on-site colposcopy services. This study evaluates the efficacy of the program on improving attendance at the clinic by follow-up of 143 women and 557 men (serving as controls). Multivariate models were adjusted for history of intravenous drug abuse, race, age, CD4 cell count, staging of disease, and time in the clinic. Half of the clients achieved high attendance rates. Women were as likely as men to achieve high attendance rates before the interventions, but more likely to do so at both 6 months and 1 year postintervention (after adjustment for the other variables). These results suggest that responding to special gender-related needs can improve women's attendance for clinic visits.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Previous publications have described thrombotic events with unclear causes in individuals infected with the human immunodeficiency virus (HIV). We stratified the cases of 52 individuals infected with HIV by degree of immunosuppression and the presence of complicating illnesses. Plasma from these individuals was screened for abnormalities that might predispose to thromboses. We found statistically significant differences between patients with CD4 counts < 200/mm3> and those whose CD4 counts were > 400/mm3in the following: d-dimers, functional protein C, antigenic protein C, total protein S antigen, free protein S antigen, C4b-binding protein (C4b-BP), and von Willebrand antigen (vWD). Free protein S correlated inversely with C4b-BP; vWD directly with total protein S; and protein C inversely with d-dimers. D-dimers were significantly elevated only in immunosuppressed patients with complicating neoplastic/inflammatory disease. We propose that low-grade disseminated intravascular coagulopathy in severely immunosuppressed individuals with HIV and infectious, inflammatory, or neoplastic complications is responsible for depressed protein C, which, together with elevations in total protein S and vWD (markers of endothelial injury), indicates a thrombotic predisposition.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

We reviewed the medical records of 17 patients with sickle hemoglobinopathy-associated cholelithiasis who were candidates for laparoscopic cholecystectomy (LG) between 1991 and 1994. Eight patients with suspected choledocholithiasis (CDL) were identified, all of whom had preoperative endoscopic retrograde cholangiopancreatography (ERCP), which revealed CDL in 3 patients (18%), all of whom had endoscopic ductal clearance. Choledocholithiasis was suspected because of hyperbilirubinemia or serum liver enzyme abnormalities. Incremental hyperbilirubinemia exceeding “baseline” values by > 5 mg/dL was the best predictor of CDL. Subsequent LC was successful with discharge within 2 days of LC in all but one patient, who was converted to open cholecystectomy. This small series suggests that in sickle hemoglobinopathy patients with cholelithiasis (1) CDL is relatively common among patients with an increase above baseline hyperbilirubinemia, (2) bile duct dilatation, alkaline phosphatase, and serum aminotransferase levels are poor predictors of CDL, and (3) sequential endoscopic/laparoscopic management of cholelithiasis and suspected CDL is successful.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

We compared the efficacy of very-low-intensity oral anticoagulation (OA) with that of the recommended standard low-intensity oral anticoagulation, using international normalized ratios (INRs). We enrolled 101 patients into a pilot study—51 patients in the very-low-intensity anticoagulation arm (INR 1.4 to 2.0) and 50 in the standard low-intensity anticoagulation arm (INR 2.0 to 3.0). They were monitored for thrombotic/embolic and hemorrhagic complications for an average follow-up of 1.5 years. Two thrombotic/embolic events occurred in the very-low-intensity group; no thrombotic/embolic events occurred in the standard low-intensity group. No major bleeding occurred in the very-low-intensity group; one major hemorrhagic event occurred in the standard low-intensity group. These findings did not achieve a statistically significant difference in major complications between the two groups. It appears that very-low-intensity OA (INR 1.4 to 2.0) is as effective in preventing thromboses as standard low-intensity OA (INR 2.0 to 3.0).

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID