ISSN:0038-4348    

出版商:OVID    

年代:1985

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The morphology of ventricular premature complexes (VPCs) is useful in detecting old or recent myocardial infarction. Rarely, however, have VPCs provided the first objective evidence of transmural myocardial infarction. In two patients with chest pain, VPCs early in the hospital course revealed myocardial infarction, while normally conducted sinus beats showed no evidence of acute transmural infarction. Transmural infarction with total occlusion of a large coronary artery was confirmed angiographically. We conclude that acute transmural myocardial infarction may be diagnosed early and accurately from VPC morphology before the appearance of other evidence of infarction.

ISSN:0038-4348    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Fifteen patients with left ventricular heart failure (LVF) without known breathing disorders during sleep had full-night recordings of sleep and breathing to study the incidence and impact of the apnea of Cheyne-Stokes breathing. This group showed a marked degree of sleep-related breathing abnormalities, 40% demonstrating Cheyne-Stokes breathing with five or more central apneas per hour of sleep. Cheyrne-Stokes breathing during sleep in patients with LVF predicted an increased short-term mortality rate. All six patients with LVF and Cheyne-Stokes breathing with more than five apneas per hour of sleep were dead within six months, while only three of nine patients without recurrent apnea died within six months, a significant difference (P< .05) even in this small group. Among seven patients with LVF studied with the polysomnogram, there were statistically significant differences between the Cheyne-Stokes and non-apnea groups in total sleep time, awakenings per hour, and the number of arterial desaturations. Although sleep disturbances have been anecdotally described in patients with LVF, no previous investigation has determined the incidence and impact of Cheyne-Stokes breathing during sleep in LVF. Our findings that Cheyne-Stokes breathing predicts an adverse short-term mortality rate confirm the clinical impression that Cheyne-Stokes breathing is a poor prognostic sign in LVF.

ISSN:0038-4348    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Research advancements in the use of laboratory testing to diagnose psychiatric conditions have recently led to certain misconceptions about the diagnostic accuracy of these tests. One such test, the dexamethasone suppression test (DST), was introduced as a laboratory test for melancholia (or “endogenous” depression). Because depressed patients are frequently first seen as outpatients by primary care physicians, there has been interest in using the DST as a screening test for depression. This paper lists the variables that contribute to abnormal (false-positive?) DST results and points out the diagnostic limitations of this laboratory test in outpatients. Several guidelines are proposed for diagnosing depression without the DST.

ISSN:0038-4348    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

We reviewed the clinical and laboratory characteristics of 34 patients who had classical heatstroke during the Kansas City heat wave of 1980. The patients were elderly, predominantly black, and of low socioeconomic class. Overall mortality was 18%, with 9% of patients exhibiting severe residual neurologic deficit; 73% had full recovery. Patients with coma, temperature greater than or equal to 108 F (42.2 C), severe hypotension, coagulopathy, and need for respiratory assistance were at highest risk of death. Associated disease was common (67%), with hypertension (32%), diabetes (21%), and alcoholism (21%) being most frequent. Medications known to predispose to heatstroke were used by 56% of patients. Hematologic abnormalities were nonspecific, and clinical evidence of renal or hepatic failure was rare. Hyponatremia, hypokalemia, hypocalcemia, hypomagnesemia, hypophosphatemia, and elevated levels of creatine phosphokinase and glucose were frequent but did not correlate with outcome. The predominant arterial blood gas abnormality was metabolic acidosis or a combined metabolic acidosis and respiratory alkalosis.

ISSN:0038-4348    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Infectious diarrhea (ID) caused 242 infant deaths in South Carolina between 1970 and 1978, and is still a significant cause of death in the southeastern United States. Therefore, using South Carolina death certificates from 1970 to 1978 and the state’s linked birth/death certificate file, we sought prenatal and postnatal characteristics that might predict death from gastroenteritis in the first year of life. Accuracy of diagnoses was verified from the original death certificates and in a sample of hospital charts. Most deaths caused by ID occurred after the first 28 days of life and were significantly concentrated in the winter. Low birth weight (odds ratio 7.09), nonwhite race (7.00), inadequate prenatal care (4.35), small size of hospital (0.31), and illegitimate birth (2.35) were all significantly associated with postneonatal death. Infants with all of the three strongest predictor characteristics were 14 times as likely to die of ID, but the “predictive value” of this combination for ID death was only 0.54%. Although mothers of these high-risk infants should be given special education about prevention of dehydration, and the families would be logical candidates for a rotavirus vaccine trial, more expensive interventions should not be instituted without a cost-benefit analysis.

ISSN:0038-4348    

出版商:OVID    

年代:1985

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

From 1967-1980, 488 infertile women underwent induction of ovulation with clomiphene citrate at the University of Virginia Hospital. Conception occurred during treatment cycles in 209 women (group 1), but 279 women (group 2) failed to conceive. The outcome of pregnancy was defined in group 1, and the pregnancies that occurred in both groups after treatment was discontinued were analyzed. Early pregnancy wastage (spontaneous abortion and ectopic pregnancy) in these groups was compared with the accepted incidence in the general population. Although the rates of adverse pregnancy outcome were higher in our study populations, there was no statistical difference when compared to the general population.

ISSN:0038-4348    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Phantom sensation and phantom limb pain are two recognized sequelae of limb amputation. In most previous surveys, amputations were done for arteriosclerotic or trauma related conditions. We studied 25 patients who had lower extremity amputation for neoplasia. In studying the features of pain before and after amputation, we found phantom limb pain in cancer patients similar in presentation and description to that in noncancer amputees. There appeared to be no correlation between the severity of each episode of phantom pain and the overall effect of the pain on the patient's life. The quality and location of the phantom pain did not resemble the preamputation pain. We recommend a multidisciplinary approach to treatment.

ISSN:0038-4348    

出版商:OVID    

年代:1985

数据来源: OVID