ISSN:0002-9629    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

This study was designed to determine the impact of noncritical (less than 70% narrowing of the luminal diameter) coronary stenoses on the long-term survival rate of patients with coronary artery disease. The survival rate of 3,342 patients with normal coronary arteries (Group 1A) was compared with that of 2,184 patients with only noncritical stenoses (Group IB). Similarly, the survival rate of 1,128 patients with one or more critical lesions (Group 2A) was compared with that of 5,944 cases with noncritical plus critical lesions (Group 2B). Patients with noncritical lesions had significantly lower 10-year survival rates (85.8%) than did those with normal coronary arteries (90.1%). However, the difference in survival rate was attributable to older age, male sex, and higher prevalence of cigarette smoking, diabetes mellitus, and hypertension in Group IB than in Group 1A; presence of noncritical stenoses was not a statistically significant independent determinant of survival. Long-term survival rates of the patients with one or more critical lesions (Group 2A) were equivalent to that of patients with critical stenoses plus one or more noncritical lesions (Group 2B). Therefore, 1) patients with only noncritical stenoses have more risk factors for coronary artery disease than do those with normal coronary arteries; 2) these patients have a reduced long-term survival rate that reflects these risk factors rather than the presence of noncritical lesions; and 3) in patients with critical lesions, the presence of additional non-critical stenoses does not affect the long-term survival rate.

ISSN:0002-9629    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Interferons exert antiviral, antiproliferative, and immunomodulatory effects on target cells. The effectiveness of interferon treatment can be followed by measuring parameters involved in interferon action. The clinical effectiveness of interferons has been proved in the human papillomavirus (HPV)-associated disease condyloma acuminatum. Because one of the most important goals in the treatment of this condition is the elimination of recurrences, it was asked whether clinically effective interferon therapy was associated with elimination of HPV DNA. The authors used a polymerase chain reaction-based method to detect the HPV from minute amounts of clinical biopsies. Human papillomavirus-transformed cell lines or cloned HPV genomes served as different copy number controls. The intensity ratio of L1 HPV and the human βglobin (which served as an internal control) fragments was determined and used for estimation of HPV copy number in different biopsies. A direct effect of interferon treatment on HPV viral genome copies was observed in a group of responder patients, but not in the clinically resistant group. With these data, a correlation was found between virologic data and clinical findings. This method also can be used in other lesions to determine the HPV copy number and HPV type and may have value in determining the antiviral activities of other agents used in the treatment of HPV-related lesions.

ISSN:0002-9629    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The authors attempted to measure the influence of a physical diagnosis course and its preceptors on the career decisions of second-year medical students. They designed pre- and post-course questionnaires for 204 second-year medical students in a University of Texas Health Science Center at San Antonio Advanced Physical Diagnosis course. They found that 48% of students changed their career choice during the study period, 75% believed their preceptor was a very good role model, and 39% thought their preceptor influenced their career choice. Students who believed their preceptor was a good role model were 31 times more likely to consider their preceptors' career (confidence interval [CI] 95, 4.1–236). In results from students precepted by primary care physicians, there was a nonsignificant trend toward choosing a primary care career (Odds Ratio [OR]) 1.6 [CI95, 0.7–3.3]). Factors associated with a final career choice of primary care were a primary care career choice at baseline (OR 8.5 [CI95, 3.8–19.0]) and a belief that physical diagnosis skills would be important to a future career (OR 4.7 [CI95, 1.1–20.0]). By multivariable analysis, only a primary care career choice at baseline remained significant (OR 8.7 [CI95, 3.5–21.3]). The authors concluded that good role models can influence students to consider alternative career choices, but this effect is still overshadowed by a student's baseline career choice. This reinforces the importance of selecting medical school applicants already inclined toward a primary care career.

ISSN:0002-9629    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

In a landmark study, the Diabetes Control and Complications Trial proved that intensive insulin therapy (IIT) reduced the incidence and severity of the microvascular complications of insulin-dependent diabetes mellitus. Retinopathy, nephropathy, and neuropathy were all improved by IIT. The trial was conducted by endocrinologists experienced in the management of IIT. However, only a small minority of patients with diabetes are cared for by endocrinologists; the vast majority receive their care from primary care physicians. In this article, the authors describe the practical aspects of IIT for those physicians unfamiliar with IIT but who want to offer the benefits of this therapy to patients with diabetes. The authors define suitable candidates for IIT, describe the initiation and management of IIT, and emphasize the potential complications of this therapy. Severe hypoglycemia is the major risk of IIT, and caution must be used to reduce the incidence of this dangerous complication.

ISSN:0002-9629    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Most patients withRhodococcus equiinfection are immunocompromised by either HIV infection, malignancy, or medication. Diagnosis is frequently missed or delayed because the organisms, resembling diphtheroids on smears, may be regarded as contaminants. Their clinical, pathologic, histochemical, and micro-biologic resemblance to mycobacteria can result in misdiagnosis. Two cases were seen recently in our institution.R. equipericarditis developed in a 29-year-old woman with failed renal transplant andR. equiaxillary lymphadenitis developed in an asymptomatic 27-year-old man. These patients are important because the former is the first reported case ofR. equipericarditis, and the second case was unusual because of the absence of immunocompromise.

ISSN:0002-9629    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Progressive shortness of breath developed in an elderly woman with a 25-year history of recurrent superficial phlebitis and hemoptysis. Extensive mural thrombosis and ectasia of the large and medium-sized pulmonary arteries and aorta were revealed on echocardiography and computerized tomography. The patient died 2 months later. On autopsy, the gross morphologic findings were similar with those observed by imaging. Histologically, there was mild inflammation in the intima and media of the aorta and the large pulmonary arteries, consistent with nonspecific arteritis. The extensive thrombosis and ectasia of the pulmonary arteries and aorta differ from previously published cases and cannot be assigned to a known nosologic entity. Two alternative explanations are proposed. First, an endothelial disorder was responsible for a diffuse vasculopathy that involved veins, pulmonary arteries, and aorta. Second, a vasculopathy of the Hugh-Stovin type, characterized by phlebitis and pulmonary thromboembolism, caused pulmonary hypertension and low cardiac output. The low flow state favorized aortic thrombosis and, at the site of interaction between the clot and the arterial wall, arteritis developed as an epiphenomenon, which induced arterial dilatation. Combined idiopathic pulmonary artery and aortic thrombosis and ectasia is rare and calls for corroboration of sporadic observations such as the current one.

ISSN:0002-9629    

出版商:OVID    

年代:1995

数据来源: OVID