ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Osteoporosis is an important health problem in the United States affecting approximately 24 million Americans, 15 to 20 million of whom are women over 45 years of age. Bone fractures are the major cause of morbidity and mortality associated with osteoporosis. The most common fractures are those of the forearm, hip, and vertebral body, as well as the humerus, tibia, pelvis, and ribs. Osteoporosis-related injuries result in complications leading to prolonged hospitalization, decreased independence, increased incidence of depression, and a reduced quality of life. The disease takes an enormous personal and economic toll, with estimated costs in excess of $13.8 billion annually for direct medical treatment. The incidence of osteoporosis-related fractures is increasing and constitutes a major public health problem in the United States. With a few preventive measures such as identification of risk factors, careful examination, and a few simple diagnostic tests, prevention of osteoporosis during the teen and early adult years is far superior to any treatment for older individuals. Osteoporosis can be identified and an appropriate treatment strategy can be determined.

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Automatic implantable cardioverter-defibrillators (ICDs) are becoming increasingly common, as is refusal of resuscitative efforts at the end of life, both by patients and surrogate decision-makers. While it is clear that a terminally ill patient who lacks decisional capacity may, through a surrogate, refuse cardiopulmonary resuscitation (CPR), is it appropriate for physicians to infer from such a refusal that the patient's ICD should be deactivated? A proper answer to this question requires consideration of the nature of consent to a do-not-resuscitate (DNR) order, the context in which permission is given for the writing of the DNR order, and the ontologic status of implantable devices in general and ICDs in particular. We introduce the concept of “biofixtures” and suggest that a biofixture analysis is a novel way of approaching the difficult ethical issues that may confound the care of patients with implantable devices.

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.Remodeling of the endocrine pancreas, caused by the deleterious effects of amylin as it is co-synthesized, co-packaged, and co-secreted with insulin, gives clinicians and researchers cause to ponder.Methods.A literature search was done, and relevant publications and texts on amylin and islet amyloid polypeptide (IAPP) were reviewed.Results.The mechanisms and clinical consequences attributed to the remodeling of the endocrine pancreas, along with proposals for reevaluating the methods of treating patients who have type 2 diabetes are illustrated and discussed.Conclusions.In addition to controlling the devastating effects of glucotoxicity, lipotoxicity, and hypertension, we should consider the newer hypoglycemic agents with regard to their effects on the remodeling of the endocrine pancreas. This remodeling results in structural and subsequent functional changes, causing continued elevations of hemoglobin A1C. Studies are indicated to determine whether amylin (IAPP) may be implicated in the remodeling of the arterial vessel wall, the glomerulus of the kidney, and the cardiac interstitium.

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The presence of extra nipples and breasts, polythelia and polymastia respectively, is not uncommon. Such supernumerary breast tissue usually is found within the milk line extending from the axilla to pubic region. It was once thought that this condition was a symbol of increased fertility and femininity. Anne Boleyn was said to have a third breast. Ancient goddesses of fertility had row upon row of breasts on their chests. Polythelia is seen congenitally. Ectopic breast tissue and polymastia may not appear until enhanced by sex hormones during puberty or early pregnancy. The same pathology that can affect normally positioned breasts, including carcinoma, can occur in supernumerary breast tissue. Renal and other organ system anomalies are associated with supernumerary breast tissue. Further research is needed to establish the clinical significance of supernumerary breast tissue in light of its reported associated conditions. Appropriate treatment is yet to be refined.

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Blunt rupture of the colon follows a direct blow to the abdomen. Physical findings suggesting peritoneal irritation are usually present early in the postinjury period and lead to further evaluation and operation. In unresponsive patients, physical findings may be masked, diagnosis delayed, and outcome compromised. Perioperative antibiotics and early celiotomy with complete intra-abdominal exploration and primary repair of the colon injury usually provide excellent results.

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.Too little is understood about the spread of the acquired immunodeficiency syndrome (AIDS) in rural America. This study focuses on changes over 5 years in two low prevalence and two high prevalence human immunodeficiency virus (HIV) rural service areas.Methods.An initial study conducted in 1993 provided a base line for the study. Each site was revisited in the summer of 1998. Data were analyzed by degree of rurality of the site, prevalence levels, and risk categories.Results.Changes in the number of AIDS cases ranged from slow steady growth to increases of an epidemic magnitude. Some settings were characterized primarily by white homosexual men, and others had a more diverse population living in poverty.Conclusions.Populations receiving priority for national AIDS funding should be expanded to include rural America as a target group, and funding should provide the latitude for communities to match their local needs.

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.The diagnosis of Kawasaki disease (KD) is made by fulfillment of clinical criteria. The dramatic effectiveness of intravenous immune globulin in this disease might lead to treatment of cases that do not meet those criteria.Methods.A retrospective review was conducted of all cases of KD treated at Kosair Children's Hospital between January 1993 and July 1997.Results.Fifty-six patients were identified. Demographic features were similar to reports from other regions of the country. Forty-eight children fulfilled criteria for typical or atypical KD and 8 (14%) did not. The latter children were not distinguished from those meeting criteria by standard laboratory test results. Echocardiographic abnormalities were found in 17 cases, including 3 with coronary artery aneurysms, but all abnormalities eventually resolved.Conclusions.The treatment of 14% of patients despite incomplete diagnostic criteria illustrates the tendency to be liberal in treatment decisions regarding KD. Whether this proportion of patients has a forme fruste of the illness that warrants treatment will await definitive biological markers for the syndrome.

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.Because HIV-infected and HIV-exposed children are at risk of acquiring infectious diseases, they should be immunized.Methods.We abstracted charts at pediatric HIV clinics in Dallas and San Antonio, matched the children to birth certificates and assessed up-to-date immunization status.Results.Of the 178 children, 108 (61%) were up to date for the diphtheria-tetanus-pertussis (DTP), polio, and measles-mumps-rubella (MMR) series. In multivariate analysis, predictors of delayed immunization included maternal high-risk sexual partners and infant antiretroviral therapy.Conclusion.In this population of children born to HIV-infected mothers, immunizations were up to date in 61%, a figure that exceeds or equals immunization levels for other Texas children. Texas falls short of the recommended goal of 90% immunization for children of HIV-infected mothers and healthy children.

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background.Although the occurrence of iron deficiency anemia and hemoglobinopathies in Vietnamese immigrants has been reported, folate and vitamin B12deficiencies have not. Proper diagnosis and effective treatment is necessary to achieve a complete correction of anemia.Methods.We retrospectively analyzed the records of Vietnamese immigrants seen in our medical clinic from 1991 to 1993. Fifty-nine anemic patients (48 females and 11 males) had low levels of red blood cell (RBC) folate and/or serum vitamin B12.Results.The patients' mean age was 37.7 ± 17 years. Mean hemoglobin and hematocrit values were 11.4 ± 0.7 g/dL and 34.4% ± 2.2%, respectively. Mean corpuscular volume (MCV) was normal in 40 patients (68%) (mean, 89.1 ± 5 fL) and low in 19 patients (32%) (mean, 69.7 ± 6 fL). Forty-four patients had low RBC folate levels (mean, 157.7 ± 41.7 ng/mL). Twenty patients had low serum vitamin B12levels (mean, 165.6 ± 47 pg/mL). Fourteen patients had ferritin levels of <20%.Conclusions.Concomitant folate, vitamin B12, and iron deficiencies or hemoglobinopathies might have been responsible for either normal or low MCV in some of our anemic patients. In this ethnic group, RBC folate and serum vitamin B12levels should be determined in all anemic patients.

ISSN:0038-4348    

出版商:OVID    

年代:2000

数据来源: OVID