摘要:

Cardiac arrhythmias are disorders of impulse formation, impulse conduction, or both. Part I of this two-part review discusses clinically relevant cardiac electrophysiology, as well as the pathogenesis, recognition, and management of ventricular premature beats and ventricular tachyarrhythmias. Part II will review the pathogenesis, recognition, and management of supraventricular premature beats and supraventricular tachyarrhythmias.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

WDHA (watery diarrhea, hypokalemia, andachlorhydria) syndrome is an unusual paraneoplastic condition caused by excess vasoactive intestinal polypeptide (VIP) secreted by certain tumors. The onset of the syndrome is insidious, and diagnosis is usually delayed by months to years. Morbidity and mortality from untreated WDHA syndrome are related to long-standing dehydration and electrolyte and acid-base disturbances resulting in chronic renal failure. Diagnosis requires documentation of large volumes of secretory diarrhea, elevated serum VIP levels, and localization of the VIP-secreting tumor. Treatment includes correction of volume, electrolyte, and metabolic abnormalities, pharmacotherapy to decrease gastrointestinal secretion and increase absorption, and ultimately surgical resection or debullcing of the vipoma.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

As the American health care system struggles to provide universal access to quality care at an acceptable price, many planners focus on rationing as the only way to make available the necessary resources. I discuss some of the ethical, economic, and political issues that relate to health care rationing. The four important questions to consider when examining a rationing plan are: (1) Who acts as the gatekeeper? (2) What kinds of goods or services are rationed? (3) What happens to the money and resources that are saved by rationing? (4) Does the system provide a safety valve for the well-to-do? This article examines two prototypical rationing systems—the British system and the Oregon plan—and answers these four questions for both systems. Because of the absence of an efficient market economy in health care and the certainty of resource constraints, rationing is inevitable in American health care. The primary issues are whether rationing will be done implicitly or explicitly and whether it will be based primarily on ability to pay (as in the present system) or on comparative judgments about the costs and benefits of medical interventions.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Nitric oxide (NO) has recently been found to be the endothelium-derived factor that produces profound relaxation of the vascular smooth muscle. This discovery has led to the experimental use of inhaled NO as a selective pulmonary vasodilator without concomitant systemic vasodilation. Currently, clinical trials of inhaled NO in persistent pulmonary hypertension of the newborn (PPHN) are in progress. Inhaled NO has also been used in the adult respiratory distress syndrome (ARDS). The therapeutic role, if any, of inhaled NO in other diseases featuring pulmonary hypertension remains unknown. Further research is needed to determine potential toxic effects of NO, development of delivery systems, and monitoring techniques applicable to routine clinical care.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The purpose of this study was to examine the effects of aerobic exercise on resting systolic and diastolic blood pressure in normotensive adults. The results of nine studies published in journals (1963 to 1992) and representing a total of 438 subjects (289 exercise, 149 control) were statistically aggregated using the meta-analytic technique. Statistically significant reductions were found for both resting systolic and diastolic blood pressure (X ± SD, systolic, 3 ± 3, 95% confidence interval, 1.30 to 5.11; diastolic, 3 ± 4, 95% confidence interval, 0.05 to 4.82). None of the changes were significant for the control groups. Absolute reductions corresponded with decreases of approximately 2% in resting systolic pressure and 4% in diastolic blood pressure. Significant correlations were found between changes in resting blood pressure and duration of training (systolic,r= .66; diastolic,r= .80, both atP< .05). The results of this study suggest that aerobic exercise results in small reductions on resting systolic and diastolic blood pressure among normotensive adults. However, such small reductions may not be clinically important.In addition, more meticulous studies on this topic are needed.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

I present my experience with 180 inflatable penile prostheses inserted in 167 patients with organic sexual impotence of 4 months to 30 years in duration. Mean age was 59.3 years. Prostheses used were AMS 700 (9), Flexiflate (14), Mentor Mark II (99), and Mentor Alpha I (58). Mean follow-up was 43.5 months. Overall complication rate was 17.8% (32 cases). In 24 cases, the complications were major (infection, malfunction, and extrusion) and necessitated reoperation. The remaining complications (8 cases) were minor (partial deviation, autoinflation), and surgical intervention was not needed. Staphylococcus epidermidis was the offending microorganism in 7 of 9 infections. In general, my results with these penile prosthesis implants suggest that they are a valid form of treatment for organic impotence.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

This study was conducted to test the predictive validity of a new alcohol screening test, the Alcohol Use Disorders Identification Test (AUDIT), in a general medicine teaching clinic and to assess physician recognition and treatment of alcohol and drug disorders. The research procedures included completion of the AUDIT, a standardized diagnostic alcohol and drug assessment, an exit interview, and a chart review The random sample comprised 132 recruited subjects. The internal reliability of the AUDIT was .77. The optimal cutoff score for the AUDIT in this sample was 5, with a sensitivity of .61 and specificity of .84. The exit interviews revealed that physicians asked their patients about alcohol use and drug use with 20% (n = 26) and 17% (n = 23) of the sample, respectively. Five of the 28 patients who met DSM-IIIR criteria had a diagnosis recorded in the chart.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Drug resistant tuberculosis (DRTB) is a growing national health concern in both urban populations and rural areas and is exacerbated by the growing epidemic of human immunodeficiency virus (HIV) infection. Between 1989 and 1992, 7 cases of DRTB (5 with multidrug-resistance) were diagnosed in an eight-county region of East Tennessee. During 1990 and 1991 alone, 5 of 100 patients with tuberculosis had drug resistant strains (5%). All 7 patients with DRTB had 100% resistance to isoniazid; 5 also had resistance to streptomycin, 2 to rifampin, and 1 to pyrazinamide and ethambutol. All patients were white, U.S: born, and without evidence of HIV infection. Contact investigation revealed that more contacts of patients with DRTB (13 of 74, 18%) were infected than were contacts of patients with drug-sensitive tuberculosis (46 of 290, 16%). Our study demonstrates that DRTB is not confined to geographically distinct areas, but may be a subtle and easily missed diagnosis in presumably low-risk rural populations.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Valvular heart disease accounts for considerable morbidity and some mortality among patients with end-stage renal disease (ESRD ). To determine the prevalence and severity of valvular and perivalvular abnormalities, including valvular thickening, stenosis, calcification, regurgitation, and mitral annular calcification (MAC), and the impact of age and duration of dialysis on valvular disease in these patients, we reviewed Doppler echocardiograms in 75 consecutive patients requiring hemodialysis for ESRD. Our results showed that valvular sclerosis, calcification, and MAC were common in patients requiring hemodialysis; valvular regurgitation was both more prevalent and more severe in hemodialysis patients than in “normal subjects”; and age of the patient and duration of dialysis were related to the prevalence of valvular disease in ESRD. These findings suggest that Doppler echocardiography should be frequently used to assess possible valvular heart disease in patients receiving hemodialysis for ESRD, particularly older patients, those who have received dialysis for several years, and those with suspected valvular disease based on history and physical examinations.

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Gunshot injuries to the head and neck are frequently seen in patients brought to a level I trauma center. These injuries result in great morbidity and mortality and a significant expenditure of health care dollars. Missile injuries to the temporal bone, though less common, can likewise be devastating. Common sequelae include vertigo, deafness, facial nerve paralysis, and death. A series of missile injuries to the temporal bone treated at Tampa General Hospital during 1993 prompted a review of head and neck missile injuries in our trauma registry over the past 4 years (1989 to 1993). More than 100 patients were shot in the head or neck; 25 of them had injury to the temporal bone. Outcomes included facial nerve injury (8), deafness (9), vertigo (3), and death (13).

ISSN:0038-4348    

出版商:OVID    

年代:1995

数据来源: OVID