摘要:

Factors associated with orthostatic blood pressure change in elderly outpatients were determined by surveying 398 medical clinical outpatients aged 65 years and older. Blood pressure was measured with random-zero sphygmomanometers after patients were 5 minutes in a supine and 5 minutes in a standing position. Orthostatic blood pressure changes were at normally distributed levels with systolic and diastolic pressures dropping an average of 4 mm Hg (standard deviation [SD] = 15 mm Hg) and 2 mm Hg (SD = 11 mm Hg), respectively. Orthostatic blood pressure changes were unassociated with age, race, sex, body mass, time since eating, symptoms, or other factors. According to multiple linear regression analysis, supine systolic pressure, chronic obstructive pulmonary disease (COPD), and diabetes mellitus were associated with a decrease in systolic pressure on standing. Hypertension, antiarthritic drugs, and abnormal heartbeat were associated with an increase in systolic pressure on standing. For orthostatic diastolic pressure changes, supine diastolic pressure and COPD were associated with a decrease in diastolic pressure on standing. Congestive heart failure was associated with an increase in standing diastolic pressure. Using logistic regression analysis, only supine systolic pressure was associated with a greater than 20-mm Hg drop in systolic pressure (n = 53, prevalence = 13%). Supine diastolic pressure and COPD were the only variables associated with a greater than 20-mm Hg drop in diastolic pressure (n = 16, prevalence = 4%). These factors may help physicians in identifying older persons at risk for having orthostatic hypotension.

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Background:The factors affecting patient compliance with peak flow monitoring in advanced chronic obstructive pulmonary disease (COPD) were examined using a prospective, blinded study.Methods:Twenty-eight male veterans were instructed in the use of an electronic, hand-held peak flow meter and the modified Medical Research Council dyspnea scale. They then entered a 6-month monitoring phase in which they recorded a dyspnea score once daily and peak expiratory flow rates twice daily, before and after bronchodilator use. The meter displays were disabled so that the patients were blinded to their values. Medical care was provided in the customary manner. Compliance was defined as the ratio of recorded values to all values specified by the protocol, exclusive of those missing due to circumstances beyond the patient's control.Results:Of 40 patients who met the entry criteria for this study, 8 refused to participate and 4 could not master the technique. The remaining 28 patients were enrolled. Overall, 25 (63% of those eligible) adhered to the protocol until its conclusion or until they became unable to comply because of medical or social problems. Compliance was 89.8 ± 15.0%. Of those followed for longer than 150 days, linear regression showed that only one patient had a decline in compliance over time (r = 0.84, P = 0.04). Compliance was lower in the afternoons (P < 0.001) and on days with higher dyspnea scores (P < 0.001). No other clinical factors had an effect on patient measurements.Conclusions:A substantial proportion of patients with advanced COPD can be trained in the technique of peak flow monitoring. Compliance is high if patients are enrolled in a longterm, structured program of supervision and periodic retraining.

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The authors sought to investigate the role of medical appropriateness as a potential explanatory factor in previously observed interracial cardiac procedure rate differences. A retrospective cohort study using RAND appropriateness criteria was conducted at a Veterans Affairs medical center among a sample of patients who were evaluated for cardiovascular disease during 1993 (n = 200). All participants were men and 50% were black (mean age= 61.8 years). Blacks were less likely than whites to undergo cardiac catheterizations (CC) (odds ratio [OR] = 0.23,P< 0.01). When RAND criteria were applied, blacks were found to have fewer indications that made them appropriate candidates for CC and more indications making them inappropriate candidates for CC (chi-square test,P< 0.05). No CC procedure underuse was found among blacks, whereas 10% of CC overuse was found among whites. Interracial CC procedure use differences were not due to procedure underuse among blacks but were in part due to overuse among whites.

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Complement component C9 is required for rapid complement-mediated killing ofEscherichia coli. In this report, the influence of supplemental C9 on the bactericidal and protective effects of beta-lactam antibiotics in neonates was assessed. By rocket immunoelectrophoresis, the intrinsic C9 concentrations of pooled serum from both human and rat neonates was less than 20% of adult levels. Supplemental C9 purified from human plasma enhanced the capacity of ampicillin-treated serum from human neonates to impair the survival ofE coliO7:K1:NM (P < 0.02). Similarly, supplemental C9 enhanced the capacity of cefotaxime-treated neonatal rat serum to impair the survival ofE coliO1:K1:NM (P < 0.05). Moreover, the intraperitoneal administration of C9 enhanced the survival of cefotaxine-treated neonatal rats that were septic withE coli(P< 0.05). These observations may contribute to the development of new strategies, such as augmentation of complement component serum concentrations, to reduce the morbidity and mortality of neonatalE colisepsis.

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The genusCitrobacterincludes three species of organisms that are uncommonly associated with human infection. When they are pathogenic, there are usually one or more associated respiratory, urinary, skin-soft tissue, and central nervous system infections and neonatal sepsis. These infections occur in the wake of significant systemic illness or complicate antibiotic usage. Rarely, infection has been associated with active tuberculosis. The authors report a case ofCitrobacter freundiiempyema in a patient with occult pulmonary histoplasmosis.

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Colonic volvulus is a rare complication of celiac disease. A case is reported of a 46-year-old man with a long-standing history of diarrhea and abdominal distention with a diagnosis of irritable bowel syndrome. After an elective inguinal hernia repair, a cecal volvulus and an ulcerative jejunoileitis developed in the patient that required an extensive intestinal resection. Short bowel syndrome developed and was treated with total parenteral and enteral nutrition. The patient had a poor course after reinitiation of oral diet. Subsequently, celiac sprue was diagnosed and the patient improved with a gluten-free diet.

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

A case of sulfinpyrazone-associated acute renal failure is reported. Sulfinpyrazone can cause reversible acute renal failure from acute tubular necrosis in patients with volume depletion. Brown tubular casts on urine microscopy and a fractional excretion of sodium greater than 1 are helpful in the diagnosis. Uric acid nephropathy and allergic interstitial nephritis should be included in the differential diagnosis of sulfinpyrazone-associated acute renal failure. Acute reduction of renal blood flow due to inhibition of renal prostaglandin synthesis and kallikrein activity by the drug is a possible mechanism. Treatment of sulfinpyrazone-induced acute tubular necrosis consists of intravascular hydration, supportive care, and withholding sulfinpyrazone. The patients at risk for acute renal failure due to sulfinpyrazone are those who have intravascular volume depletion as sensed by the kidneys.

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Hypertension in blacks differs in a quantitative sense from hypertension in whites; it occurs in blacks with greater frequency and severity and at a younger age when compared with whites. In addition, elevated blood pressure at any level is associated with increased cardiovascular morbidity and mortality in black patients. Several mechanisms have been suggested to account for this form of hypertension, implying that hypertension in black patients is intrinsically different from that in whites. Although these mechanisms remain unproven, it has generally been accepted that correctable renovascular disease and renovascular hypertension (RVH) occur infrequently in blacks; the authors, however, will review preliminary population-based data which suggest that the presence of renal artery diseaseis notdetermined by race or ethnicity. In addition, the prevalence of renovascular disease in a large group of consecutive hypertensive subjects will be presented. Finally, the blood pressure and renal function response after surgical renal artery repair in blacks will be compared with whites treated at the authors' institution. Taken collectively, these data and clinical experience support the search for and treatment of renal artery disease in properly selected hypertensive blacks.

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID