摘要:

Psoas abscess is a rare condition with vague clinical presentation. In this article, its epidemiology, etiology, bacteriology, diagnosis, and treatment are discussed. Common diseases that may be erroneously diagnosed in patients with psoas abscess are presented.

ISSN:0038-4348    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

We critically examined the literature regarding tamoxifen and raloxifene for breast cancer chemoprevention, a controversial topic of interest to all providers of health care services for women. The National Surgical Adjuvant Breast and Bowel Project showed that tamoxifen decreased the incidence of breast cancer in women at increased risk. Two European studies did not confirm this benefit. Although well-tolerated, tamoxifen chemoprevention continues to be associated with an increased risk of endometrial cancer. Raloxifene is a promising agent that has not been established to reduce the incidence of breast cancer in women at increased risk and currently should not be considered an alternative to tamoxifen outside of clinical trials. Tamoxifen results in a decreased risk of causing breast cancer in women at increased risk for having the disease. Women at increased risk are encouraged to participate in the ongoing clinical trial comparing tamoxifen and raloxifene for breast cancer prevention.

ISSN:0038-4348    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The methodology and criteria for bioequivalence testing have been firmly established by the Food and Drug Administration (FDA). For certain drugs with a narrow therapeutic index (eg, digoxin, levothyroxine, warfarin), generic substitution may not be advisable or even allowable, depending on the substitution laws of individual states. Digoxin and levothyroxine tablets are examples of drugs for which no New Drug Applications (NDAs) currently exist. However, commercially available generic products for both of these drugs have not been determined by the FDA to be therapeutically equivalent to the innovator products. Generic versions of warfarin have been approved by the FDA as being therapeutically equivalent to the innovator products, as have generic versions of the rescue inhaler albuterol. Yet, misinformation and myths persist regarding the adequacy and proven reliability of the FDA's determination of bioequivalence for these products.

ISSN:0038-4348    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background.A great deal of health information has become available on the Internet over the past several years. Some of this information is inaccurate or misleading to patients. We attempted to determine the accuracy of information on the Internet concerning age-related macular degeneration (ARMD).Methods.The term “macular degeneration” was entered in each of seven Internet search engines, and the subsequent links were followed and categorized. The number of sites that discussed treatment inconsistent with the peer-reviewed standard of care for ARMD was tabulated.Results.Of the 80 unique sites regarding ARMD that we identified, 17 (21%) featured nonconventional information.Conclusions.Many Internet sites feature unproven and costly nonconventional information about ARMD. Each physician should be prepared to address these sites and to suggest reliable sites concerning health information on the Internet.

ISSN:0038-4348    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

A new discipline in the medical field, called Darwinian (or evolutionary) Medicine, has arisen to study how natural selection could shape a machine as complex as the human body without eliminating its vulnerability to diseases. It asserts that systems and organs that form our bodies result from millions of years of evolutionary advances and are designed to survive in order to reproduce. According to this principle, Nature does not strive for complexity or perfection—it is blind and random. Using the scientific knowledge that has revolutionized biology, Darwinian Medicine seeks to provide an explanation for diseases based on the evolutionary process. This new discipline, in short, can undoubtedly help physicians in their medical practice, though further research is necessary to improve understanding of the range of its clinical application.

ISSN:0038-4348    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background.This study was done to determine the safety, efficacy, dosing requirements, and spontaneous recovery profiles of prolonged infusions of rocuronium bromide in the critically ill.Methods.This multicenter, prospective, nonrandomized, open label trial enrolled 32 patients at two university-based medical centers. Patients who were determined to require neuromuscular blockade for at least 24 hours received a bolus of 0.6 mg/kg of rocuronium. After subsequent recovery of two responses (T2) to the TOF stimulation, an infusion of rocuronium was begun at 10 &mgr;g/kg/min and continued for 24 to 120 hours as required by the patients' clinical status.Results.Patients were divided into multiple organ failure (MOF) and non–multiple organ failure (non-MOF) groups on enrollment. The mean infusion rates for the MOF and non-MOF groups were 0.2 and 0.5 mg/kg/hour, respectively.Conclusion.The mean infusion rate of rocuronium that provides approximately 90% blockade is less for critically ill patients with MOF. Spontaneous recovery was prolonged in patients with MOF.

ISSN:0038-4348    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background.Gastroesophageal reflux (GERD) affects a significant portion of the population, and refractory or untreated disease can have serious long-term complications. Antireflux procedures are now done more frequently because of advances in laparoscopic technique. It has been reported in the literature that the quality of care is better in larger urban hospitals than in smaller facilities. We report our experience with laparoscopic antireflux surgery in a 35-bed rural county hospital.Methods.We reviewed the charts of 26 patients who had a laparoscopic antireflux procedure in our facility during a 2-year period. Data from the preoperative evaluation, the operative procedure, and the postoperative period were recorded. The patients had office follow-up after the procedure and also were contacted at the time of the study to evaluate their outcome.Results.Ninety-five percent of the patients had excellent symptomatic relief from heartburn and required no medication at follow-up. There was no mortality. Our complication rate was 7%, and the conversion rate to laparotomy was 7%. Most patients were discharged on the day after the procedure.Conclusion.Laparoscopic antireflux procedures can effectively relieve symptoms of GERD with minimal morbidity and mortality. The outcome of our initial experience in a small rural facility is analogous to results previously published in the literature.

ISSN:0038-4348    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background.Sexually transmitted diseases (STD) during pregnancy are associated with adverse outcomes. We conducted a prenatal care provider survey to determine STD screening, diagnosis, and treatment practices.Methods.Standard questionnaires were mailed to Georgia-licensed obstetrician/gynecologists, family practitioners, and nurse-midwives (N = 3,082) in 1998.Results.Of the 1,300 care providers who returned the survey, 565 (44%) provided prenatal care, 390 (57%) were male, and 396 (70%) were obstetrician/ gynecologists. Overall, 553 prenatal care providers (98%) reported screening all pregnant patients for syphilis, 551 (98%) for hepatitis B, 501 (89%) for trichomonas, 474 (84%) for human immunodeficiency virus (HIV), 401 (71%) for gonorrhea, 403 (71%) for chlamydia, 475 (84%) for group B streptococci, and 130 (23%) for bacterial vaginosis (BV) (high risk). Less than 10% used amplification tests for chlamydia or gonorrhea. Most providers used appropriate regimens to treat STD in pregnant women. A written office policy on testing for BV or HIV was associated with increased screening.Conclusions.Provider education is needed about diagnosis and treatment of STD during pregnancy.

ISSN:0038-4348    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background.The objective of this study was to compare the sensitivity and specificity of 5 abdominal views for detecting free intraperitoneal fluid in trauma patients later diagnosed with hepatic or splenic injuries.Methods.This retrospective study conducted over a 17-month period enrolled patients with trauma. A Focused Abdominal Sonogram for Trauma (FAST) examination was done using 5 abdominal views. Exploratory laparotomy or computed tomography (CT) confirmed the presence of intraperitoneal fluid and associated injuries. The sensitivity and specificity were determined.Results.Of the 245 study patients, 29 had injuries to the liver or spleen or both. The 5-view FAST examination's sensitivity for detecting free intraperitoneal fluid associated with hepatic, splenic, or combined injuries was 77%, 90%, and 100%, respectively. The sensitivity of the single Morison's pouch view in detecting free intraperitoneal fluid associated with hepatic, splenic, or combined injuries was 38%, 20%, and 67%, respectively.Conclusion.For identifying free intraperitoneal fluid associated with hepatic or splenic injuries, no single view of the FAST examination could match the sensitivity provided by the 5-view technique.

ISSN:0038-4348    

出版商:OVID    

年代:2001

数据来源: OVID