摘要:

BackgroundFindings indicative of a problem with circulation have been reported in patients with chronic fatigue syndrome (CFS). We examined this possibility by measuring the patient’s cardiac output and assessing its relation to presenting symptoms.MethodsImpedance cardiography and symptom data were collected from 38 patients with CFS grouped into cases with severe (n = 18) and less severe (n = 20) illness and compared with those from 27 matched, sedentary control subjects.ResultsThe patients with severe CFS had significantly lower stroke volume and cardiac output than the controls and less ill patients. Postexertional fatigue and flu-like symptoms of infection differentiated the patients with severe CFS from those with less severe CFS (88.5% concordance) and were predictive (R2= 0.46,P< 0.0002) of lower cardiac output. In contrast, neuropsychiatric symptoms showed no specific association with cardiac output.ConclusionsThese results provide a preliminary indication of reduced circulation in patients with severe CFS. Further research is needed to confirm this finding and to define its clinical implications and pathogenetic mechanisms.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundA new meaning of the word “trend” is appearing in reports of clinical trials.MethodsAbstracts of all clinical trials in PubMed with English abstracts that contained the word “trend” for each decade from 1971 to 2001 were reviewed.Results“Trend” was used 36 times in 1981, 170 times in 1991, to 375 times in 2001, most often to refer to a judgment about statistical significance. When the expression “significant trend” was accompanied by aPvalue, thePvalue was always less than 0.05; when the expression “nonsignificant trend” was accompanied by aPvalue, allPvalues were greater than 0.05; 25% of the time,Pvalues were greater than 0.19, and 5% of the time, they were greater than 0.45. When the unmodified word “trend” was accompanied by aPvalue, mostPvalues were greater than 0.05. However, on 16 occasions, thePvalue was less than 0.05, and 5% of the time,Pvalues were greater than 0.20; on 1 occasion it was used with aPvalue of 0.6. About 30% of the time, the exact meaning of the word could not be determined from the abstract.ConclusionA novel use of the word “trend” has developed in the medical literature over the last several decades. This novel use should be documented in technical dictionaries, and further discussion should occur about the implications of this new connotation. In the meantime, clinical trials reporting can be improved by accompanying the word “trend” with associatedPvalues or point estimates and 95% confidence intervals.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Despite some improvements in the health status of the world during the last few decades, major obstacles remain. Improvements in health outcomes have not been shared equally among countries and poverty is clearly the main reason. Infectious diseases, which remain the major cause of death worldwide, are an incalculable source of human misery and economic loss. In fact, 25% of all deaths and 30% of the global burden of disease are attributed to infectious diseases. Unfortunately, more than 95% of these deaths, most of which are preventable, occur in the developing world, where poverty is widespread. The 3 major infectious disease killers in these countries are HIV/AIDS, tuberculosis, and malaria. The principles of social justice and health as a human right in the developing world have been advocated as the main justification for health assistance from rich to poor countries. Although we do not disagree with this, we argue that a strategy that emphasizes the shared benefit to rich and poor countries would facilitate this process. We propose that the accomplishment of these challenging tasks should be viewed from the perspective of game theory, where the interests of the parties (in this case rich and poor countries) overlap. As the world becomes increasingly integrated, economic development in resource-poor countries will increase the opportunities for richer countries to profit from investment in the developing world. Global health has political and international security implications for the developed world, as well. In view of the current health status of the developing world, we are not playing a game but facing a matter of life and death. “When health is absent, wisdom cannot reveal itself, art cannot becomes manifest, strength cannot fight, wealth becomes useless, and intelligence cannot be applied” Herophilus, 325 bce (Physician to Alexander the Great)The purpose of this article is to address the relationship between health, poverty, and development in the context of game theory. We will focus on the link between economic inequalities and health outcomes, exclusively concentrating our analysis on the impact of infectious diseases. Subsequently, we will outline the game, the players, and the potential win-win outcomes that may potentially result.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

A general medicine consult service can be difficult to manage because house staff are unaccustomed to the consultant role, the required knowledge is new and diverse, and the curriculum may be poorly defined. Within the last 3 decades, perioperative consultation has been more rigorously studied and a more evidence-based method has emerged. The consultative service at the University of Tennessee has developed a systematic approach to medical consultation that provides efficient, evidence-based patient care along with resident education. The curricular model, which reflects the newly required competencies of the American Board of Internal Medicine and the Residency Review Committee, is transferable to most training settings.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Rhabdomyolysis is the clinical and laboratory syndrome resulting from skeletal muscle injury and release of potentially toxic substances into the circulation. The severity of rhabdomyolysis varies widely from asymptomatic elevation of muscle enzymes to the life-threatening complications of acute renal failure and severe electrolyte abnormalities. The etiology of rhabdomyolysis may be considered under 4 categories: (1) trauma or direct injury, (2) excessive muscle activity, (3) hereditary muscle enzyme defects, and (4) other less obvious medical causes. The latter medical causes may be subdivided into the following: (1) drugs and toxins, (2) muscle hypoxia, (3) metabolic and endocrine disorders, (4) infections, (5) temperature alterations, and (6) miscellaneous causes. The diagnosis of rhabdomyolysis depends on recognizing the symptoms of muscle pain and weakness, detecting the presence of or history of red-to-brown urine (myoglobinuria), and finding short-term elevations of creatine kinase that are not attributable to myocardial infarction or inflammatory myopathies. The major therapeutic goal is to recognize and treat complications as soon as possible, particularly electrolyte abnormalities and acute renal failure. Knowledge of the other medical causes of rhabdomyolysis allows one to identify and treat this potentially serious condition in otherwise occult cases.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

We present a case of acute, symptomatic hyponatremia in a young woman that developed after use of 3,4-methylenedioxymethylamphetamine (MDMA), more commonly known as “ecstasy.” The patient was treated with 5% saline and had complete recovery. The pathogenesis of MDMA-associated hyponatremia involves excessive water intake and inappropriately elevated antidiuretic hormone (ADH) levels. It seems that young, premenopausal women are at particularly high risk for the development of severe, symptomatic hyponatremia after use of this drug. Review of the literature revealed 4 fatal outcomes from MDMA-associated hyponatremia. All were women and all died from cerebellar tonsillar herniation. We suggest that acute hyponatremia that develops after MDMA use may be a life-threatening condition. Recent recommendation that MDMA users should drink large volumes of water may not be appropriate.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Angioedema with hypereosinophilia syndrome has a dramatic clinical presentation that may result from T-cell dysregulation and/or eosinophil dysfunction. Symptoms may be either episodic or persistent and are usually responsive to systemic glucocorticosteroid therapy. This diabetic patient had a dramatically severe presentation, responsive to high-dose steroids but relapsing when prednisone was tapered. To decrease his risks from long-term steroids, a therapeutic trial of intravenous immunoglobulin (IVIG) was tried, and a slow taper off of glucocorticosteroids achieved a prolonged remission. A brief recurrence and subsequent remission of eosinophilia and symptoms were associated with changes in the IVIG preparation lot and source. We conclude that some cases of angioedema with hypereosinophilia syndrome may be highly responsive to IVIG therapy and, furthermore, that specific sources and/or lots of IVIG may have significantly different immunoregulatory properties.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

A case of a 58-year-old female patient who presented with significant blood eosinophilia and thromboembolic events is described. The patient was eventually diagnosed as suffering from a disseminated malignancy of gastrointestinal origin. Immunohistochemical studies of the tumor are presented. These studies show that tumor cells produce interleukin-3 and −5 and granulocyte macrophage-colony stimulating factor. These cytokines are known to support differentiation, proliferation, and survival of eosinophils. Their secretion is the probable explanation for the appearance of high blood eosinophilia in this patient. To the best of our knowledge, combined blood eosinophilia and thromboembolism as presenting manifestations of a solid tumor have never been reported.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

A woman was admitted to the hospital with joint pain. She was also found to have pericardial effusion, renal dysfunction, pancytopenia, and positive antinuclear antibody; a diagnosis of systemic lupus erythematosus (SLE) was made. Although she had neither neurological symptoms nor fever, laboratory tests showed microangiopathic hemolytic anemia, thrombocytopenia, and renal dysfunction. Therefore, we diagnosed her illness as SLE complicated by thrombotic microangiopathy (TMA). Plasmapheresis was performed in addition to immunosuppressive therapy. TMA improved rapidly and renal function improved gradually. The number of patients with SLE complicated by TMA is relatively small and the mortality rate is extremely high. A diagnosis of TMA is difficult to determine in patients with SLE because of the overlapping clinical symptoms. The data suggest that prompt induction of plasmapheresis in addition to immunosuppressive therapy is necessary in SLE patients having symptoms suspicious of TMA even before they fulfill the 5 symptoms typical of TMA.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

A 56-year-old woman with diabetes who had undergone a coronary artery bypass surgery for triple-vessel coronary artery disease presented 2 weeks after discharge with classic features of cholesterol embolization, blue toes, renal insufficiency, and intractable abdominal pain. Despite a multitude of investigations, the cause of her abdominal pain was elusive. Laparoscopic cholecystectomy revealed the cause: acute cholecystitis secondary to cholesterol crystal embolization. Although rare, cholecystitis as a manifestation of cholesterol embolization can occur, and prompt recognition will prevent unnecessary investigations and ensure immediate treatment.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID