摘要:

Incidental prostate cancer is an indolent disease typically characterized by a benign clinical course. This is not clearly established, however, as recent reports suggest that up to 27% of cases progress with long-term follow-up. The indolent history of this disease led initially to the hypothesis that mutations of the p53 gene would be an infrequent event in this patient population. Archival specimens from 24 patients with Stage A1carcinomas were evaluated for abnormal p53 expression. In 23 patients the disease was diagnosed after transurethral resection for bladder outlet obstructive symptoms, and in one patient after a radical prostatectomy. Using a monoclonal antibody (P Ab 240) and an immunohistochemical technique, a total of 36 microfoci of tumor were evaluated. Thirteen (36%) microfoci were positive with an intense nuclear staining pattern (2+), and eight (22%) microfoci had an intermediate staining pattern. Four areas of prostatic intraepithelial neoplasia also stained positively with a 2+ staining pattern. These results suggest that abnormal p53 expression is a feature of a significant number of incidental prostatic carcinomas and that this occurrence is an early event in the development of the malignant phenotype.

ISSN:0002-9629    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Serum angiotensin converting enzyme (ACE) levels are higher in patients with diabetes mellitus than in many others. Techniques are available to grade different degrees of diabetic retinopathy, which can demonstrate a relationship between ACE and diabetic retinopathy. In this study, patients with diabetic retinopathy had higher serum ACE levels (6.3 ± 0.2) than nondiabetic patients (4.3 ± 0.5) (p > 0.001). In addition, the mean serum ACE level in diabetic patients with nonproliferative retinopathy (5.55 ± 0.4) was less than that in diabetic patients with proliferative retinopathy (6.63 ± 0.25) (p = 0.02). Due to the variability in individual serum ACE levels and the frequent use of ACE inhibitors by hypertensive diabetics, these techniques are not suitable for retinopathy screening programs. However, the graded relationship demonstrated by these data may have relevance for the pathophysiology of diabetic retinopathy.

ISSN:0002-9629    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

To be more responsive to the nation's health needs, medical educators should identify those personal qualities associated with effective primary medical care. For this research Machiavellianism was chosen as a tracer character trait opposed to the characteristics embodied in an ideal family physician. A survey was conducted of 167 freshmen from one medical school and 823 seniors from four medical schools, with Machiavellianism scores used to predict their professional role characteristics, attributional style toward patients, and choice of a career specialty. Results showed that 15% of all students scored positively on the Machiavellianism scale. Mean Machiavellianism scores for seniors did not differ from those for freshmen. Men had higher Machiavellianism scores than women. Those students with high Machiavellianism scores relied excessively on high-tech medicine and were externally controlled, intolerant of ambiguity, and authoritarian. Seniors' high Machiavellianism scores predicted a negative attributional style toward geriatric and hypochondriac patients, thereby validating the use of Machiavellianism to measure medical students' indifference to patients and their problems.

ISSN:0002-9629    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

In eight healthy volunteers, basal and arginine-stimulated plasma glucose and growth hormone levels were determined during administration of a placebo and after 3 days of ibuprofen (800 mg four times daily). Ibuprofen had no significant effect on basal or stimulated plasma glucose or growth hormone levels. As is not the case with indomethacin, ibuprofen fails to increase basal and arginine-stimulated plasma growth hormone levels. This suggests that the effect of indomethacin on growth hormone secretion is due to a mechanism unrelated to inhibition of prostaglandin synthesis.

ISSN:0002-9629    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Symptomatic congenital cytomegalovirus (CMV) disease occurs almost exclusively in infants born to seronegative mothers who acquire the virus during pregnancy. This study sought to determine patterns of CMV immunity in women of childbearing age at one center participating in a national study. Cord blood specimens from 100 consecutive deliveries at each of three hospitals were tested for CMV-specific IgG. Mean age of women in this sample was 25.7 years; 76% were white, 60% were from middle and upper socioeconomic status, 64% were married, and 57% had other living children. Overall seroprevalence rate was 62%. Univariate analysis showed strong associations between sero-positivity and lower socioeconomic status, non-white race, and age younger than 25 years (odds ratios, 4.4, 3.9, and 2.5, respectively). Stratification by socioeconomic status and race eliminated the effect of age. Stratification by socioeconomic status markedly reduced the effect of race, whereas stratification by race only moderately reduced the effect of lower socioeconomic status, which was the strongest predictor of seropositivity (odds ratio, 3.4). Seroprevalence was lowest among older white women of middle and upper socioeconomic status (47% seropositive). Development of longitudinal regional seroprevalence data will facilitate interpretation of data generated by the National CMV Registry.

ISSN:0002-9629    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

To determine the risk factors, clinical presentation, and long-term outcome of primary spontaneous pneumothorax (PSP), all available cases of PSP in the Israeli Defense Forces (IDF) were retrospectively reviewed. Using the computerized IDF database, all men who had pneumothorax were identified and a telephone interview obtained with 343 individuals, 286 of whom had PSP and agreed to participate in this study. These 286 persons experienced 498 episodes of PSP, with 314 medical records available for review. Average length of follow-up from the first episode of PSP was 107.2 months. Of the study population, 11.5% had a positive family history for PSP. The height-to-weight ratio was significantly and positively correlated with the number of PSP episodes per person, with the regression coefficient being 0.49. The age distribution of those with PSP had a monophasic pattern, with the average age being 25.3 years on first episode. More than one episode of PSP occurred in 41.3% of patients. No ipsilateral recurrences were observed after surgery. Treatment with a sclerosing agent seemed to be more effective in preventing ipsilateral recurrences of PSP than chest tube insertion alone (26.5% vs. 38.3%). Primary spontaneous pneumothorax is an important medical problem, especially in men of military age. It has a significant inherited component in its etiology, with asthenic body build being an additional risk factor. Based on a literature review and the data obtained from this study, it was concluded that chest tube insertion with intrapleural instillation of a sclerosing agent is the preferred nonsurgical invasive treatment modality in PSP.

ISSN:0002-9629    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

A case of silent thyroiditis after unilateral adrenalectomy for treatment of Cushing's syndrome is reported. The left adrenocortical adenoma was resected. Glucocorticoid was replaced after the operation and was gradually tapered. Thyrotoxic symptoms with painless goiter occurred 9 months after the adrenalectomy when a replacement dose of prednisolone was tapered to 5 mg/d. Plasma-free thyroid hormones increased and thyrotropin was suppressed. Thyroidal uptake of radioactive iodine was extremely low. Both titers of antimicrosomal and antithyroglobulin antibodies stayed at high levels throughout the observation period from the preoperative stage. Normalization of thyroid functions was obtained 3 months after the onset of thyrotoxicosis with β-adrenergic blocker alone. It was speculated that exposure to a large amount of endogenous and supplementary exogenous glucocorticoid protected the patient's immune system from autoimmune attack of thyroid antigens and that tapering of the supplementary glucocorticoid caused exacerbation of immune responses, resulting in overt thyroid dysfunction even 9 months after adrenalectomy.

ISSN:0002-9629    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The case of a 7-month-old Nigerian child who presented with anemia and microcytosis is described. Hemoglobin electrophoresis studies revealed a band with pronounced cathodic mobility. This represented a heterohybrid hemoglobin tetramer composed of an α-globin mutant, G-Philadelphia (αGPhil), and two variant β-globin chains, βC and βO-Arab. The absolute amounts of αGPhil found in the propositus were less than expected for an α2-globin gene product. It has not been established whether αGPhiladelphia interacting with βO-Arab and βC globin chains is the cause of the microcytosis.

ISSN:0002-9629    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Hemoglobin A2levels in members of an African American family with −88 C→T β+-thalassemia were measured, and two patients in whom iron deficiency anemia developed were evaluated during treatment. Iron deficiency may diminish the level of HbA2in healthy control subjects and in patients with heterozygous β-thalassemia; in addition, it may reduce the amount of variant hemoglobin in certain hemoglobinopathies. Although iron deficiency appeared to be associated with a reduction in HbA2quantity in the patient with heterozygous β-thalassemia, the level of HbA2did not fall below the range characteristic of β-thalassemia. It had been proposed that mutations in the β-globin gene promoter may be associated with higher-than-expected levels of HbA2However, this “mild” β-globin gene promoter mutation did not seem to result in HbA2concentrations higher than anticipated in the heterozygous β-thalassemias.

ISSN:0002-9629    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Recent attempts to reduce weight by patients with anorexia nervosa have sometimes led to life-threatening hematologic complications. This report describes an instance in which a patient with anorexia nervosa and pancytopenia drastically improved with treatment that included administration of granulocyte colony-stimulating factor. The patient had lost 27 kg of body weight within 8 months. Even after admission, the blood cell count continued to decrease rapidly as follows: platelet, from 244 × 103/μl to 44 × 103/μl; erythrocyte, from 4.04 × 106/μl to 2.58 × 106/μl; and leukocyte, from 4.8 × 103/μl to 1.6 × 103/μl (granulocyte, 0.8 × 103/μl). Complications included pneumomediastinum, pneumothorax, purpura, petechiae, hepatomegaly, fever, gangrenous stomatitis, and somnolence. Bone marrow aspiration disclosed absence of fat cells, marrow hypoplasia, and infiltration of the mature lymphocytes. Intravenous hyperalimentation, blood transfusion, γ-globulin, and antibiotics were administered, but leukopenia and fever remained. However, administration of recombinant human granulocyte colony-stimulating factor dramatically reversed the leukopenia and fever. With careful nutrition therapy, the patient's blood cell count and bone marrow normalized by the time of discharge. It was concluded that severe hematologic disorders may occur in patients with anorexia nervosa, and advanced treatment may be required to save the patient's life.

ISSN:0002-9629    

出版商:OVID    

年代:1993

数据来源: OVID