摘要:

Abnormalities of oxygen use occur in obstructive sleep apnea, as do impaired cerebral perfusion and alterations of cerebral function. In this case study, the authors quantitated the local cerebral glucose metabolic rate in two patients with obstructive sleep apnea (one with and one without oxygen supply dependency) and assessed cerebral glucose use by increasing oxygen delivery through passive leg elevation.Obstructive sleep apnea was confirmed by visual analysis of nocturnal pulse oximetry traces in two patients and its severity assessed from the respiratory disturbance index and minimum oxygen saturation. Awake local cerebral glucose metabolic rate (pM/min/lOO g) was determined by positron-emission tomography using [ 18F]-2-Fluoro-2-Deoxy-D-Glucose at baseline and on the following day during passive leg elevation.Conditions otherwise were unchanged. The patient with global oxygen supply dependency exhibited a significant increase in the local cerebral glucose metabolic rate. In contrast, the patient without global supply dependency had no change in the local cerebral glucose metabolic rate.These case studies demonstrate the first evidence of improvement in regional metabolic consumption in response to increased oxygen delivery and in the presence of global oxygen supplydependency.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

To participate effectively in their health care, older patients often are expected to read a wide variety of materials, including written instructions, brochures, and consent forms. This study quantitates the reading ability of older patients and compares it to that of younger patients. Two hundred seventy-two patients 30 and older were selected from five outpatient clinics at a public teaching hospital and tested for objective reading ability using the Peabody Individual Achievement Test—Revised. The 76 patients 60 and older read significantly worse (grade level 2.9) than the 196 patients younger than 60 (grade level 5.8) (P< 0.0001). Older patients also completed significantly fewer years of school than younger patients (7.3 years versus 10.6 years). Analysis of variance for age categories 30–44, 45–59, 60–74, and 75 and older confirmed declining reading ability and educational status with advancing age. Multiple regression analysis helped show that an equation could be derived to predict reading ability from age, educational status, race, and sex, but the coefficient of determination was so low (r2= 0.39) that it cannot be considered clinically useful for individual patients. In this study, older patients read significantly worse than younger patients, and a formula that combines age, race, sex, and educational status cannot reliably predict reading ability for individual patients. Most older patients read on a level so low that they cannot be expected to read most commonly used written materials. Routine testing of reading ability may allow more appropriate design and use of written materials.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The relative role that humoral immunity plays in protection against infection with the intracellular bacterium,Francisella tularensis, remains controversial. Cellular immunity is thought to play the major and perhaps only role. The authors, in this article, investigate the immunologic and protective properties of immune serum collected from human recipients of the live tularemia vaccine (LVS). Sera of recipients of the vaccine demonstrated reactivity with the vaccine strain by enzyme-linked immunosorbent assay and Western blot analysis. This reactivity appeared to be directed primarily against the lipopolysaccharide of LVS and demonstrated complete cross-reactivity with fully virulentF. tularensis(Schu4). Pooled immune sera protected mice fully against a 10,000 LD50 challenge with the LVS strain relative to non-immune sera. The protection was abrogated by dilution or preadsorption with the LVS strain but not by preadsorption withEscherichia coli, which suggests specificity of protection. The authors conclude that antibodies to the LVS strain ofF. tularensisare generated by live vaccination in humans and play a significant role in protection of mice against lethal challenge with the same organism. These antibodies crossreact completely with fully virulentF. tularensis, but whether they play a role in protection against fully virulent human tularemia strains requires further experimentation.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Injury is the leading cause of death for every year but the first of a child's life and, additionally, generates enormous costs in health care, disability, pain, and suffering. Research and programatic efforts for injury control continue to have low priority relative to their modest costs and potential to reduce health-care and other costs to society. Modest improvements in data systems would lead to more effective targeting of injury control efforts that are useful in preventing injuries. Analytic studies of changeable risk factors and effectiveness of interventions would widen the range of available interventions and their cost-effectiveness.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Dose responses for ultraviolet B light (UVB)-induced suppression of contact sensitivity were studied in mice, with and without cyclophosphamide (Cy) pretreatment, to investigate the role of Cy-sensitive suppression. Mice were irradiated on the back, sensitized on the abdomen, and challenged on the ears. Half of the mice were injected intraperitoneally with 200 mg/kg of Cy 3 days before being sensitized. Ultraviolet B light radiation reduced the ear swelling reactions in a linear relation to the log10 of the dose. Fifty percent suppression was shown by the computer-generated regression line at approximately 4.8 kJ/m2of UVB radiation, with complete suppression at approximately 65 kJ/m2. In mice pretreated with Cy, ear swelling was increased, showing inhibition of a Cy-sensitive suppressive component of the contact sensitivity reaction. This Cy-sensitive component also was seen in mice treated with UVB, but with higher doses of UVB, there still was a UVB-dose-dependent decline in ear swelling in Cy pretreated mice, and there was complete suppression of reactions with the highest doses of UVB in the Cy-treated mice. Therefore, there is a second mechanism, not sensitive to Cy, that causes UVB-induced immune suppression.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Blastocystis hominisis an enteric protozoan associated with clinical illness. To determine the prevalence of intestinal injury in patients withB. hominisinfection, the authors prospectively evaluated 18 patients withB. hominisinfection by endoscopy and a test of intestinal permeability. Seventeen patients had gastrointestinal symptoms. Colonic mucosa appeared normal by lower endoscopy in 12 of 13 patients, and was friable slightly in 1. Duodenal mucosa was normal by upper endoscopy in nine patients. Pathologic examination of mucosal biopsy specimens did not demonstrate evidence of mucosal invasion. 51Cr-edetic acid (51Cr-EDTA) was given to the 18 patients with stools positive forB. hominisand to 32 healthy control subjects. Approximately 100 uCi of 51Cr-EDTA was given orally after an overnight fast, and urine was collected for the following 24 hours. Mean 24-hour urinary excretion of 51Cr-EDTA, calculated as a percent of the administered dose, was 1.31% (0.34–2.76%) in patients withB. hominisinfection and 1.99% (0.59–3.48%) in the control subjects. The intestinal permeability to 51Cr-EDTA in blastocystis-infected individuals was not increased, but was decreased significantly compared with healthy subjects (p < 0.005). Therefore, in a group of symptomatic patients withB. hominisinfection, endoscopy typically did not show evidence of significant intestinal inflammation, and results of intestinal permeability testing with 51Cr-EDTA did not suggest impaired barrier function of the intestinal mucosa. The clinical literature onB. hominisinfection and intestinal injury is reviewed.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Anti-neutrophil antibodies of the immunoglobulin G (IgG) class have been implicated in the pathogenesis of autoimmune neutropenia, but few reports have described immunoglobulin M (IgM) anti-neutrophil antibodies. To investigate the prevalence of IgM anti-neutrophil antibodies, sera from 130 patients with possible autoimmune neutropenia were studied for IgG and IgM anti-neutrophil antibodies using an immunofluorescence flow cytometric assay. Twenty-five patients (19%) had IgG anti-neutrophil antibodies exclusively, 21 patients (16%) had both IgG and IgM anti-neutrophil antibodies, and 11 patients (8%) had IgM anti-neutrophil antibodies exclusively. Immunoglobulin M anti-neutrophil antibodies were found in adults and children with isolated chronic neutropenia and in patients with Felty's syndrome, systemic lupus erythematosus, immune thrombocytopenic purpura, and human immunodeficiency virus. Patients with neutropenia with only IgM anti-neutrophil antibodies comprised almost 20% of antibody-positive patients in this study.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The authors describe a young man with hemophilia complicated by chronic hepatic dysfunction, hypodysfibrinogenemia, and immune thrombocytopenia that resulted in a complex coagulopathy. The patient had a ruptured occipital arteriovenous malformation. The malformation was managed by temporary correction of the coagulopathy using cryoprecipitate, platelet transfusions, and plasmapheresis with fresh frozen plasma replacement. The patient underwent staged preoperative embolization followed by surgical excision of the lesion. Hemostasis was acceptable during the neurointerventional and subsequent surgical management, and no complications of coagulopathy occurred. Plasmapheresis may provide effective preparation for patients with hemophilia and complex coagulation abnormalities who require neurosurgical intervention.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Toxic shock syndrome is a febrile, multiorgan illness related to toxins elaborated by staphylococcal or streptococcal infections. In the 1980s, most cases were associated with menstruation. More recently, many cases now are unrelated to menses. In this article, the authors describe a case of a nonmenstruating woman with toxic shock syndrome, associated with cellulitis of her arm. Cultures of the arm grewStaphylococcal aureus, which produced enterotoxin B.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Wegener's granulomatosis is a well-defined systemic vasculitic syndrome that primarily affects the upper and lower respiratory tracts and the kidney. Hashimoto's thyroiditis is another autoimmune syndrome with the thyroid as its primary target organ. The relation between Hashimoto's thyroiditis and Wegener's granulomatosis is not reported in the English literature. In this article, the authors describe a patient with Hashimoto's thyroiditis in whom fulminant Wegener's granulomatosis subsequently developed. The immunologic similarities between these two diseases leads to the consideration that Wegener's granulomatosis possibly may be another immunologic disorder associated with Hashimoto's thyroiditis.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID