摘要:

Alzheimer's disease (AD) is a common problem with complex challenges in assessment and management for the primary care physician. We present a practical, six-step strategy for physicians to use in AD care, summarized by the acronym ACROSS: assessment of AD, communication of the diagnosis, referral to appropriate community resources, ongoing evaluation, providing solutions to patient and caregiver problems, and maintaining sensitivity to family caregiver issues. The family caregiver of the patient with AD provides the physician with essential diagnostic information and implements physician recommendations for AD care. Advice and support from the physician are essential for the family caregiver to withstand the relentless strain of caring for a loved one with a progressive dementia. We provide practical suggestions for management of common patient and caregiver problems across the stages of AD

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

We evaluated 20 patients with pulmonary strongyloidiasis for risk factors, clinical and imaging manifestations, complications, treatment, and outcome. Eighteen (90%) had risk factors for strongyloidiasis including steroid use, age greater than 65, chronic lung disease, use of histamine blockers, or chronic debilitating illness. Pulmonary signs and symptoms, including cough, shortness of breath, wheezing, and hemoptysis, were present in 19 (95%); adult respiratory distress syndrome (ARDS) developed in 9 (45%). Pulmonary infiltrates occurred in 18 (90%). Gastrointestinal signs and symptoms were also common. Peripheral blood eosinophilia occurred in 15 (75%). Twelve (60%) had secondary infection, and 3(15%) had bacterial lung abscesses. All were treated with thiabendazole, 25 mg/kg twice daily; on average, patients without ARDS were treated for 3 days, versus 7 days for those with ARDS. Seventy percent responded to therapy; 30% died. Preexisting chronic lung disease and ARDS were statistically significant predictors of a poor prognosis

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Diagnostic methods for pulmonary embolism and deep vein thrombosis of the lower extremity are intertwined, since the latter nearly always precedes the former. Recent prospective studies show that an independent clinical estimate of disease probability helps to refine probability estimates of ventilation-perfusion lung scans and of ultrasonography with compression, reducing the need for pulmonary angiography and contrast venography. Repeated ultrasonography with compression can also be used to stratify patients into groups that are at high or low risk for subsequent pulmonary embolic events. I give algorithms and guidelines for the clinical use of these findings. Effective treatment of acute venous thromboembolism depends on achieving an antithrombotic state with heparin and warfarin. I give recommendations for dosing and monitoring heparin and warfarin that are based on knowledge of heparin blood levels and on use of the international normalized ratio with warfarin therapy. Use of low-molecular-weight heparin to prevent deep vein thrombosis is briefly described

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Pancreatic cancer usually requires palliative rather than curative therapy. Palliative procedures should have low morbidity and mortality, provide a good quality of life, and necessitate minimal hospitalization. The surgeon, endoscopist, and radiologist all play a role in delivering effective palliation to properly selected patients

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Of 292 patients (210 males and 82 females) receiving medication for attentiondeficit hyperactivity disorder (ADHD), 272 (93%) responded well to sustained-release dextroamphetamine (D-Amp) and 21 patients (7%) to sustained-release methylphenidate (MPD). The dose of D-Amp ranged from 0.2 to 3.6 mg/kg/day and the dose of MPD from 1.4 to 7.7 mg/kg/day, without side effects requiring cessation of therapy. This suggests that the clinical improvement rate can be increased to nearly 100% in appropriate situations

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Demonstration of clonality is supportive of a diagnosis of malignancy in cases of lymphoproliferative disorders. Determination of clonality at the molecular level is currently accomplished by Southern analysis; however, the polymerase chain reaction offers a potential alternative that is rapid, simple, and less expensive. To test its feasibility as a diagnostic test, we amplified the DNA from 121 suspected lymphoproliferative disorders submitted for gene rearrangement studies. In comparison to Southern analyses, a sensitivity of 70% and specificity of 96% were obtained. To test the effect of primer variability in the joining region of the heavy-chain gene, we substituted a more degenerate primer but found no changes in sensitivity or specificity. We conclude that the polymerase chain reaction has current application with minute or fixed specimens and may generally serve as a rapid, initial evaluation for B-cell clonality, followed by Southern analysis in negative cases. However, higher overall sensitivity must be achieved before this technique can replace Southern analysis as the method of choice in determining clonal gene rearrangements

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

We surveyed 136 physicians, nurses, dentists, physician assistants, and other medical professionals who were residents of the United States and had volunteered their professional services for 6 months or less from October 1992 through January 1994 at St. Jude Hospital, a rural hospital on the island of St. Lucia in the southern Caribbean. This hospital has relied almost entirely on volunteer staffing over the past 27 years. The survey explored motivations for volunteering, opinions on medical care, and personal background. Of those who returned the questionnaire (a 68% response rate), 98% considered overall care to be adequate or better than adequate despite limited hospital facilities and frequent changes of personnel. Seventy-seven percent cited unavailability of opportunities, limited backup medical coverage in locales where they might want to volunteer, and concerns about licensing and insurance as reasons for not doing volunteer work in the United States

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The effects of intravenous fluids on hematocrit are debated. We sought to determine whether maintenance or bolus fluid therapy causes a significant change in the hematocrit and other hematologic parameters included in the complete blood count. Nine subjects completed a randomized three-period crossover designed trial in which they were given no fluid, maintenance fluid, or a bolus of fluid followed by maintenance fluid. We measured complete blood counts at baseline, 1 hour, 4 hours, and 8 hours. In the bolus fluid trial, the hemoglobin and hematocrit values (mean ± SEM) decreased by a maximum of 1.5 ± 0.1 g/dL and 4.1 ± 0.3% at 1 hour. There was no difference in hemoglobin or hematocrit during the no fluid or maintenance fluid treatments. No significant changes occurred in white blood cell or platelet counts. We demonstrated that maintenance fluid infusions do not significantly alter the complete blood count. Saline bolus is associated with a significant decrease in hemoglobin and hematocrit, but these parameters trend toward baseline over time

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

To determine whether laparoscopy presents any significant risks for tubal sterilization in obese women, we retrospectively reviewed the records of 248 consecutive patients who had laparoscopic tubal sterilization between January and December 1991 at our institution. The 147 obese women were compared with the 101 nonobese women as controls for the study parameters. Two methods of closed laparoscopy were used as interval procedures, with similar proportions in obese and nonobese women. We observed no complications in any patient, and there were no significant differences in the mean operating time and estimated blood loss between the two groups of women. We conclude that laparoscopy should be considered safe and laparoscopic tubal sterilization can be performed in obese women with the same efficiency, morbidity rate, and length of hospitalization as in nonobese women

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

To determine the technical feasibility and success of laparoscopic fundoplication in the treatment of severe gastroesophageal reflux disease (GERD), 18 consecutive adult patients were enrolled in a prospective study. All patients had received unsuccessful conservative treatment, were refractory to medical management, or had recurrence of symptoms of esophagitis after omeprazole therapy. All patients had severe acid reflux on 24-hour esophageal pH monitoring, endoscopic evidence of previous or ongoing esophagitis, and a defective lower esophageal sphincter on manometry. Complete (Nissen) fundoplication was done in 11 and partial (Toupet) fundoplication in 7 patients; the mean operative time was 183 minutes (range, 120 to 357 minutes). Feedings were initiated on the first postoperative day, and the average length of stay was 2.6 days (range, 1 to 6). There were no deaths or conversions to laparotomy. Postoperative morbidity consisted of transient bloating in three patients and dysphagia requiring dilatation in four patients. Return to work or normal activity averaged 19 days (range, 3 to 28), and 17 patients (94%) reported good to excellent results, with a median follow-up of 7 months. Laparoscopic fundoplication is technically feasible and offers a sound surgical alternative to patients with refractory GERD, but longitudinal follow-up is required to confirm long-term results

ISSN:0038-4348    

出版商:OVID    

年代:1996

数据来源: OVID