ISSN:0002-9629    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background:Multiple reports have described associations between occupational inhalant exposure and lung disease. Previous occupational lung disease investigations have studied populations consisting of both smokers and nonsmokers. Smoking complicates interpretation of toxicant exposure-response relationships. The objective of this study was to determine whether, among never-smokers, occupational exposure to gases, dusts, or fumes is associated with a history of respiratory disorders and pulmonary function test defined obstructive lung disease.Methods:We performed a retrospective analysis of 517 never-smoker patients who underwent pulmonary function testing in our clinical laboratory between 1986 and 1999. We calculated the relative risks of developing adverse respiratory health outcomes given a history of exposure to occupational inhalants.Results:Compared with persons with a negative occupational exposure history, exposed persons had an increased risk of reporting a history of bronchitis [relative risk (RR), 1.59; 95% confidence interval (CI), 1.20–2.12], recurrent lung infections (RR, 2.09; 95% CI, 1.14–3.82), and bronchodilator use (RR, 1.61; 95% CI, 1.26–2.06). There was also a statistically significant association between a history of inhalant exposure and the finding of an obstructive ventilatory defect on pulmonary function testing (RR, 1.79; 95% CI, 1.12–2.85). A history of inhalant exposure was not associated with self-reported asthma (RR, 1.08; 95% CI, 0.83–1.41). The population attributable risk estimates for respiratory disorders due to inhalant exposure were: bronchitis, 23.6%; recurrent lung infection, 36.3%; bronchodilator use, 24.3%; and obstructive lung disease, 29.6%.Conclusions:Occupational inhalant exposure is a strong risk factor for lung disease in this population of never smokers. A significant burden of respiratory disease in this population may be attributable to occupational inhalant exposure.

ISSN:0002-9629    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background:Pulmonary complications of diabetes mellitus have been poorly characterized. Although some authors have reported normal pulmonary function, others found abnormalities in lung volumes, pulmonary mechanics, and diffusing capacity.Subjects and Methods:We studied pulmonary function in a group of patients with diabetes using a combined cardiopulmonary exercise test. Twenty-seven patients with diabetes aged 48 ± 13 years participated in the study.Results:Overall, forced vital capacity, forced expiratory volume in 1 second, and forced expiratory flow, midexpiratory phase, were within the predicted values, but the residual volume/total lung capacity ratio was slightly elevated. Comparison by diabetes type showed nonsignificant differences in forced expiratory volume in 1 second and forced expiratory flow, midexpiratory phase. Residual volume/total lung capacity ratio was significantly elevated in type 1 patients compared with type 2. Carbon monoxide diffusion capacity (Dlco) was normal in both groups. There was no correlation between the results on pulmonary function test and duration of disease, presence of microangiopathy, or glycemic control. The Dlco was significantly lower in patients with microangiopathic changes, but not when Dlco was corrected for alveolar volume. On the cardiopulmonary exercise test, maximal workload, maximum oxygen uptake, and maximal heart rate were less than predicted, whereas anaerobic threshold and ventilatory reserve were normal. No significant differences were noted in diabetes type, and there was no correlation between parameters of cardiopulmonary exercise test and the other variables.Conclusion:Spirometric values are preserved in patients with diabetes mellitus, and there are no defects in diffusing capacity. Cardiovascular factors may account for impaired physical performance. There is no need for routine screening of pulmonary function among diabetic patients.

ISSN:0002-9629    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background:The population of hospitalized older patients is increasing. We investigated whether clinicians accurately detected renal insufficiency in older patients and chose correct doses of commonly prescribed antibiotics.Methods:We conducted a retrospective chart review of 1044 patients >80 years admitted to the University of California Davis Medical Center between January and December 1997 with a diagnosis of infection. Inclusion criteria included data necessary to calculate creatinine clearance using the Cockroft-Gault equation and administration of any of the study antibiotics. Patients with unstable renal function, defined as an increase in creatinine of ≥1.0 mg/dL/day were excluded. Administered dosages of each study drug were compared with the appropriate adjusted doses. We examined the variables of age, weight, serum creatinine, and sex to determine whether any were individually predictive of dosing errors.Results:Dosing errors were identified in all of the antibiotics studied, and the overall dosing error rate was 34%. The factors that were predictive of dosage errors were advanced age and low body weight. Serum creatinine and sex were not statistically significant factors.Conclusions:Widespread errors in medication dosing are made in elderly hospitalized patients. The Cockroft-Gault equation reveals significant renal insufficiency requiring dose adjustments in most elderly patients studied, especially those > 85 years of age and with low body weight. Estimation of glomerular filtration rate should be performed routinely on all admitted patients older than 80 and in any patient with low lean body mass.

ISSN:0002-9629    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Objective:To report a syndrome in 30 patients characterized by headache, myoclonic tremors of the eyelids (blepharoclonus), action tremors of the hands on flexion-extension movements at the wrists simulating asterixis (pseudoasterixis) and habitual diurnal movements of the feet. Ten patients are described in detail.Methods:Clinical history, neurologic examination, computed tomography of the head, magnetic resonance imaging of the brain, electroencephalogram, electromyogram, and nerve conduction velocities. Headaches were diagnosed according to the International Headache Society classification. A retrospective uncontrolled review of the cases collected by the author was completed.Results:Seven patients had migraine with aura and 8 without aura; 3 had both migraine and tension headache, 11 had tension headache, 2 had cluster headache, and 1 had idiopathic stabbing headache. None of the patients had tumoral lesions or vascular malformations of the brain. Eight of the subjects had history of somnambulism and 9 had family history of somnambulism. Restless legs syndrome was present in 8 patients in addition to restless feet. Some evidence of axonal peripheral neuropathy was present in 13 patients.Conclusion:This report supports the notion that in certain cases, an association exists between headache, involuntary movement disorders, and peripheral neuropathy. Additional studies are needed to elucidate the pathogenesis of this syndrome.

ISSN:0002-9629    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background:Human intravenous IgG (IVIG) containing specific antibodies protects neonatal rats from septic death. However, IVIG has immunosuppressive properties and clinical trials of IVIG in neonates at risk for sepsis have yielded conflicting results.Hypothesis:This study was designed to test the hypothesis that nonspecific antibodies in IVIG reduce survival in neonatal rats infected withEscherichia coli.Methods:Specific antibodies were adsorbed from IVIG withE colito produce IVIG/anti-E coli−. After transthoracic administration ofE coli, survival was determined in neonatal rats injected intraperitoneally with phosphate-buffered saline, IVIG/anti-E coli− (500 mg/kg) or IVIG containing anti-E coliantibodies (IVIG/anti-E coli+). Complement-mediated hemolytic activity of neonatal rat serum was quantified using sensitized sheep erythrocytes.Results:Compared with placebo, intraperitoneal IVIG/anti-E coli− reduced neonatal survival afterE coliinfection. In contrast, IVIG/anti-E coli+ protected infected animals. Both IVIG/anti-E coli− and IVIG/anti-E coli+ impaired the complement-mediated hemolytic activity of neonatal rat serum.Conclusions:IVIG contained (1) nonspecific antibodies that reduced survival in neonatal rats infected withE coliand (2) protective anti-E coliantibodies that enhanced survival in neonatal rats infected withE coli. We speculate that in clinical trials of IVIG to treat or prevent neonatal sepsis, inconsistent results may be caused, in part, by lot-to-lot variations in the ratio of immunosuppressive, nonspecific antibodies to protective, specific antibodies.

ISSN:0002-9629    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The allocation of medical resources is often a great concern in the United States. This article discusses a case concerning utility of resources in a patient with a terminal disease. We assert that the goals of treatment tailored to an individual patient should be made at the bedside by a fiduciary (physician) in conjunction with the patient’s preferences and values. There is great responsibility in making these decisions and it is critical that they be made at the bedside with the patient and family clearly aware of the goals of treatments and informed of treatment limitations.

ISSN:0002-9629    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The implantable cardioverter-defibrillator (ICD) represents an important advance in the treatment of ventricular arrhythmias, but infection has remained a serious complication of device implantation. Fungal infections associated with these devices are uncommon, with only 4 cases previously reported. We describe a case of ICD-associated endocarditis caused byCandida albicansthat was successfully treated with complete device explantation and prolonged antifungal therapy, and we review the features of ICD-related fungal infections.

ISSN:0002-9629    

出版商:OVID    

年代:2001

数据来源: OVID