摘要:

BackgroundInformation is limited regarding the most effective methods of recruitment in internal medicine residency programs. To address this deficiency, we conducted a 4-year survey of students who interviewed at our program addressing aspects of the application and interview process to maximize recruitment.MethodsA 25-item questionnaire was mailed after the match to all students who interviewed but did not match with our program from 1994 to 1997.ResultsThe response rate varied from 35% in 1994 to 70% in 1997. Variables that showed significant improvement after intervention included brochure mailings, resident greeting, resident luncheon, and perceived resident satisfaction. There was a 50% increase in program applications and the percent of applicants rating our program in their first 3 choices rose from 21% in 1995 to 51% in 1997.ConclusionsThe major factors influencing our applicant’s decisions regarding our program included resident involvement and brochure development/mailings. We have focused our efforts on those components to make the greatest impact on increasing the attractiveness of our program for internal medicine training.

ISSN:0002-9629    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

We have cloned the platelet receptor for type I collagen, but the structure-function of the receptor has not been completely established. The purpose of this investigation was to identify a collagen binding site(s) of the platelet receptor. Three peptides were synthesized chemically. Each peptide serves as an inhibitor of type I collagen-induced platelet aggregation, ATP release, platelet protein phosphorylation, and platelet adhesion to artificial matrices and aortic segments. We show that a nonapeptide specifically inhibits type I collagen-induced platelet aggregation and the release of ATP in a dose-dependent fashion. The peptide also inhibits the binding of radiolabeled &agr;1(I) chain to washed platelets, the adhesion of radiolabeled platelets to type I collagen-coated petri dishes, rabbit aortic segments, and platelet protein phosphorylation. Deletion of this peptide region of the cloned cDNA abolishes the inhibitory effect of the recombinant protein on type I collagen-induced platelet aggregation. These findings support the likelihood that the nonapeptide forms part of the binding site of the platelet receptor for type I collagen.

ISSN:0002-9629    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Respiratory failure in myxedema is a complex medical emergency and may require prolonged ventilatory assistance. Appropriate management of this medical problem requires an understanding of its effects on the central nervous system and peripheral neuromusculoskeletal system. Weaning of these patients can be very protracted and requires a diligent multidisciplinary approach. Because of its infrequency, ventilatory management of severe hypothyroidism has not been studied in a controlled fashion. The first part of this review discusses the mechanisms of respiratory failure in myxedema. The second part explores strategies in mechanical ventilation and weaning of myxedematous patients.

ISSN:0002-9629    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Decisions regarding health care of the severely mentally retarded can be difficult. We present 2 cases of patients with severe mental retardation who lived in long-term care facilities. Both patients had progressive loss of renal function and eventually reached end-stage renal disease. In each case, the decision was made not to initiate dialysis. We discuss issues of dialysis and medical care of the severely mentally retarded and advocate using the principles of “best respect” and “best interest” in making medical decisions in this population.

ISSN:0002-9629    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Persons infected with HIV display a variety of vascular abnormalities and harbor particularly striking alterations in endothelial morphology and function. We review the effects of the virus and viral products on the endothelium and emphasize their effects on altering the clinical expression of HIV-associated diseases.

ISSN:0002-9629    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

BackgroundThe 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitors lovastatin and simvastatin have been associated with rhabdomyolysis in cardiac transplant recipients. Herein, we report a case of a 52-year-old male recipient of a cardiac transplant who developed rhabdomyolysis and acute renal failure caused by simvastatin precipitated by multiple drug interactions.MethodsThe patient had a history of cardiac transplantation (5 years before) and presented with a 2-day history of dark urine preceded by 2 weeks of diffuse myalgias. He had been maintained on cyclosporine throughout the entire post-transplant period. Simvastatin was added and pravastatin was discontinued 2 months before admission. Two weeks before the onset of muscle symptoms, digoxin and verapamil were started for new-onset atrial fibrillation. Creatinine phosphokinase levels peaked at 950,000 IU with serum creatinine of 3.3 mg/dL (baseline, 1.8 mg/dL).ResultsReview of the medication history indicates a temporal association between the addition of 3 drugs (simvastatin, verapamil, and digoxin) to the medication regimen already containing cyclosporine and the episode of rhabdomyolysis. All of these drugs are cytochrome P450 3A4 and/or P-glycoprotein substrates that are known from previous pharmacokinetic studies to individually produce substantial increases in levels of simvastatin.ConclusionWe believe this case illustrates that avoiding the use of drugs that are cytochrome P450 3A4 and/or P-glycoprotein substrates reduces the risk of rhabdomyolysis caused by 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitors.

ISSN:0002-9629    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

We present 3 cases of anti-myeloperoxidase, anti-neutrophil cytoplasmic antibody (MPO-ANCA)-positive rapidly progressive glomerulonephritis developed during the treatment with d-penicillamine (d-PC) for rheumatoid arthritis. Rheumatoid arthritis was diagnosed in these patients, and d-PC was administered to them at doses of 100, 200, and 300 mg per day for 32, 42, and 39 months, respectively. They developed proteinuria, hematuria, renal insufficiency, and anemia, and d-PC was stopped. On admission, MPO-ANCA was strongly positive in their sera. Renal biopsy showed glomerulonephritis with cellular crescents. Immunofluorescence examination revealed deposits of granular IgG, IgM, IgA, C1q, and C3 in the mesangium. The 3 patients were treated with steroid pulse therapy along with administration of anticoagulants, and cyclophosphamide was also used in 2 patients. Their renal function improved gradually and MPO-ANCA disappeared after immunosuppressive treatment.

ISSN:0002-9629    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The resurgence of tuberculosis has been of increasing concern to public health. Laryngeal and cutaneous tuberculosis have long been regarded as two of the most infectious forms of the disease. In this article, we re-emphasize the public health consequences of a case of laryngeal TB, which must be considered in the differential diagnosis of a patient with persistent fever, cough, weight loss, and hoarseness.

ISSN:0002-9629    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Our patient presented with abdominal pain, weight loss, and fever with evidence of oral thrush and pelvic inflammatory disease on exam. Radiographs demonstrated a small bowel obstruction with free air. An exploratory laparotomy demonstrated 2 perforations of the distal ileum. Pathologic exam revealed features consistent with histoplasmosis. We discuss gastrointestinal involvement of histoplasmosis in AIDS and its treatment.

ISSN:0002-9629    

出版商:OVID    

年代:2000

数据来源: OVID