摘要:

BackgroundIntracranial calcification is associated with chronic hypoparathyroidism. The relationship between intracranial calcification, neurological abnormalities and cognitive deficits in this disorder is unknown. The purpose of this study was to determine whether chronic hypoparathyroidism is associated with cognitive impairment.MethodsWe studied 11 hypoparathyroid patients and compared them with a sex-, age-, and education-matched control group. The hypoparathyroidism was postsurgical in nine and idiopathic in two. All patients underwent nonenhanced head computed tomography, detailed neurological examinations, and a battery of cognitive tests. These tests were performed separately and individual examiners were blinded to the results of the other components of the study.ResultsThe mean age of the patients was 55 years; the duration of hypoparathyroidism was at least 9 years. Neuropsychological testing revealed cognitive impairment in 65% of hypoparathyroid subjects, and the presence of significant differences between the hypoparathyroid and control groups. Computed tomography showed intracranial calcification in 6 of 10 hypoparathyroid subjects tested, and neurological (motor) examination revealed 5 of 11 with abnormal findings. There were positive correlations between the presence of cognitive deficits and cerebral calcification (r= 0.59,P= 0.07), between abnormal motor findings and cerebral calcification (r= 0.77,P< 0.01) and between abnormal motor findings and the degree of cognitive deficit (r= 0.83,P< 0.01).ConclusionsWe conclude that cognitive and neurological deficits commonly occur in patients with chronic hypoparathyroidism and may be pathophysiologically related to the presence of intracranical calcification.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundPatients hospitalized in the intensive care unit (ICU) tend to become agitated and confused, and many even develop temporary psychoses (the ICU syndrome). We wondered whether the regulation of sleep and the secretion of melatonin is abnormal in ICU patients. Therefore, we studied the association of sleep-wake pattern in patients hospitalized in the ICU, their melatonin secretion rates, and profile compared with a control group of patients in general medical wards.MethodsSleep was assessed by actigraphy. Urine was collected every 3 hours for 24 hours. Melatonin secretion was assessed by measuring the melatonin metabolite 6-sulphatoxymelatonin by enzyme-linked immunosorbent assay.ResultsActigraphy suggested that the ICU patients lacked normal sleep behavior for the entire study period, except for occasional short naps. Compared with controls, the nocturnal peak of melatonin secretion was absent, except in two patients in the nonventilated group, and showed a flat curve.ConclusionsOur results suggest that lack of sleep is indeed a severe problem in ICU patients and is accompanied by impairment of normal melatonin secretion. The possibility that melatonin administration may prove useful in improving sleep patterns in ICU patients deserves further study.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundObesity is a rapidly increasing health problem among US youth. Hyperinsulinemia is associated with obesity and has been found to be a contributory factor for the development of cardiovascular disease in the obese. It has been suggested that hyperinsulinemia of obesity is a result of increased insulin secretion caused by insulin resistance. However, it has been shown in adults that decreased hepatic insulin clearance (HIC) is the primary cause of hyperinsulinemia in this population.MethodsWe studied 15 obese children and adolescents (11 F, 4 M; 8.6 to 18.1 years) before and 10 weeks after their enrollment in a multidisciplinary weight reduction program, which included a protein-sparing modified fast, a moderate intensity progressive exercise program, and a behavior-modification intervention.ResultsAll patients lost weight (P< 0.05). Measurements of immunoreactive insulin (IRI) and C-peptide reactivity (CPR) were performed before the program and at 10 weeks. IRI levels dropped significantly, whereas CPR levels did not change. CPR/IRI molar ratios, considered an indirect estimation of HIC, rose significantly after weight loss.ConclusionsOur data suggest that hyperinsulinemia seen in obese children and adolescents is caused by decreased HIC. The cause for this decrease remains unknown, but it is reversible upon weight loss.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Little is known about the customary level of sodium intake by salt-sensitive people and the nature of obstacles they face in the adoption of a reduced-sodium diet. These issues were addressed with 12 salt-sensitive (SS) and 9 salt-insensitive (SI) normotensive adults. Information about sodium consumption, taste, and blood pressure and concerns about following a diet reduced in sodium were collected at baseline and monthly while participants followed a 100 mmol Na/day diet for 4 months. Mean sodium intakes of both groups were comparable at baseline and were reduced significantly during diet. The principal dietary concerns were reduced food availability, increased food costs, and reduced food palatability. There were no group differences. Ratings declined over time, but only the food palatability issue did so significantly because of a shift by the SI only. While the predictive value of SS classification remains uncertain, these data indicate that dietary change is feasible in SS subjects.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundAlthough physical exercise training is highly recommended, physical exercise causes oxidative stress, which is potentially injurious. This study evaluates this ‘exercise paradox’ by evaluating the effect of physical exercise on exercise-induced lipid peroxidation.MethodsMeasurement of lipid peroxidation (ie, expired ethane and pentane and plasma malondealdehyde) taken during cardiopulmonary exercise stress testing were compared between a group of 10 cardiac patients who underwent physical exercise training in a cardiac rehabilitation setting and a group of 10 nonexercising cardiac patients.ResultsOur findings indicate that physical exercise training increased physical work capacity without a concomitant increase in expired markers of lipid peroxidation (ethane and pentane) and decreased malondealdehyde levels.ConclusionsBecause physical exercise-trained people can perform more intense physical work with less oxidative stress, we conclude that physical exercise training can reduce potential chronic health effects associated with daily activities by contributing to an overall reduction in exercise-induced free radical production.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundTo examine the accuracy of noncontact tympanic (NCT) temperatures in outpatients, we conducted a prospective study comparing NCT temperature with temperatures obtained by oral mercury thermometers.Methods:\MThe study included 410 patients in whom oral and NCT temperatures were obtained.Results:—Mean oral temperature was 36.47 ± 0.44°C and mean NCT temperature was 36.36 ± 0.49°C. On paired-sample, two-sided t-testing, oral temperature differed significantly from NCT temperature, with aP-value < 0.0001. The difference between simultaneous oral and NCT temperatures was ≥ 1°F; in 63 cases, oral temperature was higher than NCT temperature.ConclusionWe conclude that NCT temperature measurement is not reliable in an internal medicine outpatient clinic setting.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Isoniazid inhibits the metabolism of several drugs, resulting in clinically significant interactions in some patients. Clinical trials and case reports have documented that isoniazid can cause increased phenytoin and carbamazepine serum concentrations and toxicity. In relatively high doses, isoniazid can also cause increased effect of theophylline and warfarin. Isoniazid inhibits metabolism of selected benzodiazepines and vitamin D. Inhibition of monoamine oxidase and histaminase by isoniazid can cause significant drug-food interactions. Food greatly decreases isoniazid bioavailability. Although probably best recognized as an inhibitor of drug metabolism, isoniazid has a biphasic effect of inhibition-induction on one cytochrome P450 isozyme, CYP2E1, which partially explains the interaction with acetaminophen and increased risk of hepatotoxicity. Continued investigations will likely result in discovery of new isoniazid interactions.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

A 60-year-old woman with multiple sclerosis and recurrent urinary tract infections (UTI) was evaluated for the recent onset of a dry cough, dyspnea on exertion, and jaundice. Investigation demonstrated interstitial lung disease with bilateral infiltrates and unilateral effusion, as well as a severe chronic active hepatitis with marked fibrosis. Other notable features were positive antinuclear antibodies and anti-smooth-muscle antibodies and the absence of any possible cause except for nitrofurantoin treatment (Macrodantin, 100 mg/day), which the patient had been taking for the previous 3 years as a prophylactic measure against UTI. The patient died of pneumococcal septicemia less than 30 days after presentation. Pulmonary or hepatic injury caused by nitrofurantoin treatment is rare; their combined occurrence is hardly ever described. Combined drug-induced pulmonary and hepatic toxicity is reviewed and should be considered early in the differential diagnosis to allow reversibility and avoid serious outcomes.

ISSN:0002-9629    

出版商:OVID    

年代:1999

数据来源: OVID