摘要:

To assess the hypothesis that beta blocker use and hypertension are associated with high lipoprotein(a) [Lp(a)] or with reduced basal fibrinolytic activity, the authors studied relationships of hypertension and beta blockers to Lp(a), lipids, lipoproteins, apolipoproteins, and basal fibrinolytic activity in 385 patients consecutively referred for diagnosis and therapy of hyperlipidemia. A second aim was to determine possible gender differences in fibrinolytic activity among patients with hypertension. Ninety-nine patients (58 women [88% post-menopausal] and 41 men) had drug-treated hypertension. In women, hypertension was a positive, independent predictor of the major inhibitors of fibrinolysis, plasminogen activator inhibitor antigen (p = 0.017), and plasminogen activator inhibitor activity (p = 0.004). In men and women, major risk factors for atherosclerosis were significant, independent predictors of reduced basal fibrinolysis. Median Lp(a) in the 99 patients with hypertension (16 mg/dL) did not differ from Lp(a) (18 mg/dL) in normotensive patients (p > 0.1). Of the 385 patients, the 39 beta blocker users had higher plasminogen activator inhibitor activity (p = 0.01), higher triglyceride (p = 0.02) levels, and higher Quetelet Indices (p = 0.01) than non-users (n = 346). After covariance adjusting for age, Quetelet Indices, sex, and tri-glycerides, plasminogen activator inhibitor activity was not higher in beta blocker users than in non-users (p > 0.1). Median Lp(a) did not differ in beta blocker users (16 mg/dL) and in non-users (17 mg/dL), p greater than 0.1. Hypertensive, predominantly post-menopausal women are likely to have high plasminogen activator inhibitor activity and plasminogen activator inhibitor antigen with concurrent reduced fibrinolytic activity, as well as high fibrinogen levels. These independent coronary heart disease risk factors, along with their hypertension, may put hypertensive, post-menopausal women at increased risk for coronary heart disease.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The authors assessed the long-term efficacy of a weight-loss program combining the use of a very low-calorie diet and behavior modification. This program involved medical supervision as well as group behavior modification classes, which emphasized long-term lifestyle changes, along with nutrition education. A study was conducted in 1984 and again in 1991, of un-selected consecutive patients who had completed this hospital-based, weight-control program 12 to 18 months earlier. Patients were asked to return to the medical center to be weighed and complete a questionnaire regarding biobehavioral factors. The results of both the 1984 and 1991 follow-up studies were very similar. The patients' initial body mass index was 34.6 kg/m2± 0.57 kg/m2(mean ± standard error of the mean, n = 109) and average weight loss was 23.2 kg ± 1.1 kg, resulting in a body mass index of 26.2 kg/m2± 0.42 kg/m2upon completion of the program. At 12 to 18 months of follow-up, mean body mass index was 29.6 kg/m2± 0.54 kg/m2. There was a wide spectrum of long-term compliance and recidivism. On average, 61% of patients kept off at least 50% of the weight they had originally lost. In addition, medication usage for hypertension, hyperlipidemia, and diabetes was reduced among the patients with reduced obesity. A retrospective analysis of patient characteristics and habits did not accurately predict which patients would be successful long-term. In conclusion, the combined use of a very low-calorie diet plus behavior modification was successful in the majority of patients who completed the program. Because there was a significant improvement in a number of medical problems, this approach continues to warrant consideration for the treatment of obesity.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Detection of nonrandom variation in outcomes with statistical control charts is at the heart of quality improvement techniques. The authors examined the charts ability to detect variations in outcome of pneumonia. They surveyed Medicare claims data for DRG 89, pneumonia with complications or co-morbidities, from November 1988 through October 1991 at 20 Illinois hospitals with the most Medicare discharges for DRG 89. Control charts were constructed on five outcomes—mean length of stay, range of length of stay, mortality, readmissions, and complications. Standard techniques from industrial statistics were used to construct the historical means and control limits derived from 2 years of data, to plot the monthly samples from the 3rd year of data and to score the control charts for nonrandom variation at less than 1% probability. The observed number of control charts with nonrandom variation was 33 of 100; the expected number was 9.18 (p < 0.0001). Nineteen hospitals had 1 to 3 control charts with nonrandom variation on the five outcomes, whereas only one hospital had none. The number of control charts with nonrandom variation per hospital did not correlate with hospital size, occupancy, teaching status, location, or payer-mix. Statistical control charts provide simple tools for identification of nonrandom variation in outcomes. To the extent that these variations can be related to quality issues, the charts will be useful for quality management.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Pigeon and dove eggwhite exhibit high level P1antigenic activity and are potent and specific inhibitors of adherence mediated by P fimbriae of uropathogenicEscherichia coli.To evaluate pigeon and dove eggwhite as P fimbrial receptor analogues in the prevention of ascending renal infection, mice were challenged with a P fimbriatedE. coliurosepsis isolate suspended in saline alone or in saline plus various inhibitors of adherence, including D-mannose, globoside, and chicken, dove, and pigeon eggwhite. D-mannose inhibited mannose-sensitive adherence but not P fimbrial adherence, and failed to prevent renal infection. Globoside and chicken eggwhite also failed to inhibit P fimbrial adherence; chicken eggwhite had little and globoside had no impact on renal infection. In contrast, dove and pigeon eggwhite eliminated P fimbrial adherence and significantly reduced the incidence and intensity of renal infection. These findings suggest that pigeon and dove eggwhite provide P1-antigen-specific protection against ascending renal infection in mice due to P fimbriated uropathogenicE. coli.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Bacterial sepsis is a rare and potentially fatal complication of platelet transfusions. Bacterial contamination is estimated to occur in 2% to 6% of platelet concentrates, but clinically apparent septicemia occurs in less than 1% of multi-donor platelet transfusions. The incidence of bacterial sepsis from single-donor platelet transfusions is significantly lower, possibly because of shorter storage time of apharesis platelets. The authors report a case of fatalStaphylococcus aureussepsis from a single-donor platelet transfusion obtained through a closed system. They conclude that as the demand for platelet transfusion increases, recognition of bacterial sepsis from transfusions and continued reassessment of procedures for collection and storage of platelet concentrates is warranted.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Beta cell hypersecretion is associated with the syndrome of hyperandrogenism, insulin resistance, and acanthosis nigricans. It is unknown whether concomitant alpha cell secretory dysfunction occurs in patients with this syndrome. The authors evaluated the gastroenteropancreatic hormones in four family members with varying degrees of the hyperandrogenism, insulin resistance, and acanthosis nigricans syndrome. Gastroenteropancreatic hormones were measured during oral glucose tolerance test with and without subcutaneous octreotide injection. The study revealed that the administration of subcutaneous octreotide resulted in suppression of beta cell function (insulin and c-peptide) but had no effect or a delayed effect on alpha cell secretion (glucagon). Furthermore, the severity of glucagon abnormalities paralleled that of beta cell hypersecretion and the clinical and phenotypic manifestations of acanthosis nigricans in our four patients. We speculate that this alpha cell aberration could potentially be involved in the altered glucose homeostasis and perhaps the skin manifestations of this syndrome. Therefore, glucagon levels should be evaluated in the hormonal studies in patients with hyperandrogenism, insulin resistance, and acanthosis nigricans syndrome.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The lupus anticoagulant is a well-described in vitro phenomenon that may be associated with arterial and venous thrombotic episodes. The lupus anticoagulant is never accompanied by a hemorrhagic diathesis unless it is associated with a second coagulation abnormality such as thrombocytopenia or hypoprothrombinemia. The lupus anticoagulant-hypoprothrombinemia syndrome is now a well-defined entity that may cause a severe, life-threatening hemorrhagic diathesis. The hypoprothrombinemia in this syndrome is the result of rapid clearance of prothrombin-antiprothrombin antibody complexes by the reticulo-endothelial system. The cause of antiprothrombin antibody formation is unknown. The authors describe a recent experience with a patient with this syndrome who initially had recurrent, life-threatening gastrointestinal bleeding. They were able to demonstrate hypoprothrombinemia and the presence of prothrombin-antiprothrombin antibody immune complexes. The patient was treated with prednisone, with correction of the bleeding disorder; however, the patient had resultant death from thrombosis. A literature review of the past 30 years as it relates to the discovery and treatment of this phenomenon is included.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Hypercalcemia is a relatively common problem seen in the presence of malignancy, and is the most common life-threatening metabolic disorder in patients with cancer. In the hospitalized patient, malignancy is the most common cause of hypercalcemia. It is estimated that hypercalcemia occurs in 10% to 20% of patients with cancer. Usually, it is a sign of advanced disease. Approximately 85% of patients with cancer and hypercalcemia will have disease metastatic to bone. The remaining 15%, however, will have some other etiology for their hypercalcemia, typically squamous carcinomas of the head and neck, esophagus, and lung. This type of hypercalcemia has been termed humoral hypercalcemia of malignancy and has been associated with the secretion of various cytokines, including parathyroid hormone-related protein. In this case report, the authors document the production of parathyroid hormone-related protein by an adenocarcinoma—cholangiocarcinoma. This is documented both by measurement of the protein in the patient's serum and staining of the protein within the tumor by a monoclonal antibody. A general discussion of hypercalcemia and malignancy also is provided.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The anemia of chronic disease may be viewed simply as the anemia that accompanies chronic inflammatory, infectious, or neoplastic disorders. Because these conditions are very common, the anemia of chronic disease is one of the most frequent anemias encountered, and is only second in incidence to iron-deficiency anemia. The anemia of chronic disease is primarily an anemia due to underproduction of red cells, with low reticulocyte production, and is most often a normochromic, normocytic anemia. However, in 30% to 50% of patients, the red cells are hypochromic and microcytic and, most often, the serum iron, total iron-binding capacity, and transferrin saturation are reduced in the presence of adequate iron stores. Although the differential diagnosis includes other underproduction anemias, such as those caused by vitamin and mineral deficiencies, renal failure, endocrinopathies, and myelodysplasia, it generally is easily distinguished from these conditions. Nevertheless, an understanding of the pathogenesis of this condition, as well as a means of alleviating the anemia when the chronic disorder persists, has remained elusive. Recently, major advances have occurred toward understanding the pathogenesis of the anemia of chronic disease and its treatment, and these advances are reviewed.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID