摘要:

&NA;Pulmonary signs and symptoms may provide important differential clues to the diagnosis of tick‐borne illness incurred in the southern United States.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

&NA;Cerebrovascular accidents are one of the most serious causes of morbidity in patients sustaining an acute myocardial infarction. In patients who do not receive thrombolytic therapy, the most common form of stroke is thromboembolic, occurring in up to 2.4% of patients, predominantly in those sustaining large anterior infarctions. In patients receiving thrombolytic therapy, intracranial hemorrhage is the most common form of stroke, occurring in 0.1% to 1.4%. Predisposing conditions for intracranial bleeding include low body weight, female sex, advanced age, use of oral anticoagulant medication before the administration of lytic therapy, diastolic blood pressure greater than 110 mm Hg, and the specific thrombolytic agent administered. Hematologic management of the patient sustaining a hemorrhagic cerebrovascular accident should include (1) discontinuance of thrombolytic therapy, anticoagulants, and antiplatelet agents and (2) infusion of cryoprecipitate to replenish fibrinogen. In certain cases, administration of fresh frozen plasma, protamine sulfate, and exogenous platelets may be required. Finally, evacuation of the hematoma may provide the most definitive form of treatment in selected cases.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

&NA;We discuss the assessment of testamentary capacity (ability to execute a valid will) in elderly people. Such assessment should include evaluation of the person's knowledge regarding the purpose of the will, the extent of the property involved, the legal heirs, and how the property is distributed according to the will. Some conditions may invalidate a will, including insane delusions and undue influence; however, the mere presence of severe mental illness, such as schizophrenia or dementia, does not automatically render elderly people incompetent to execute a valid will.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

&NA;Serious morbidity and mortality are associated with postoperative wound infections in peripheral vascular surgery. The use of prophylactic antibiotics is considered the standard of care, with attention focused on the most efficacious agent. A prospective, randomized study was conducted to evaluate the efficacy of ceftriaxone versus cefazolin in prevention of postoperative wound infections in a group of patients who had peripheral arterial operations between October 1991 and February 1993. Patient characteristics associated with an increased risk of postoperative wound infection were evaluated. Prophylaxis was provided for 105 operations with cefazolin and 103 operations with ceftriaxone. The overall wound infection rate was 3.85%. Six operations (5.7%) in the cefazolin group were complicated by wound infection versus 2 operations (1.9%) in the ceftriaxone group. Diabetes (6 infections/64 operations; infection rate, 9%) and a personal history of previous aortocoronary bypass (5 infections/49 operations; infection rate, 10%) were characteristics associated with an increased chance for postoperative wound infection. Ceftriaxone is therapeutically equivalent to cefazolin in the prevention of postoperative wound infections in peripheral vascular surgery.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

&NA;We present two cases that support an infectious cause of inflammatory pseudotumor of the liver. Each patient had sepsis due to chronic abdominal abscesses, along with a liver mass. Both patients had exploratory celiotomy, and histologic examination of the liver mass revealed inflammatory pseudotumor of the liver. Evidence of a mixed bacterial/Actinomycesinfection was noted in hepatic tissue sections in one patient, andBacteroides caccaewas cultured directly from the liver biopsy in the other patient. This is the first known report of bacteria being cultured from biopsy specimens of a hepatic pseudotumor and the only reported case ofActinomyceswithin a hepatic pseudotumor. Clinical and pathologic findings in these two cases indicate that an extrahepatic infectious source should be explored as a potential cause of inflammatory pseudotumor of the liver.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

&NA;Appendiceal spirochetosis is rarely described in the literature. We assessed the incidence of spirochetosis in a series of 109 appendectomies (76 adult and 33 pediatric cases) done for either suspected acute appendicitis or as a concurrent procedure. Appendiceal spirochetosis was identified on hematoxylin‐eosin sections and confirmed by Steiner and Steiner stain and ultrastructural study in two women and two men. One of these four patients was found to have HIV infection. The HIV status of the other three patients was unknown. We observed appendiceal spirochetosis to be an uncommon phenomenon that affects both sexes, occurring with or without symptoms of acute appendicitis. None of our four positive cases occurred in the pediatric age group.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

&NA;We retrospectively reviewed medical records and computerized critical care data for 40 consecutive critically ill surgical patients receiving “standard” doses (1.5 to 2.0 mg/kg loading dose and 3 to 5 mg/kg/day) of gentamicin or tobramycin for gram‐negative infections. End points measured were serum drug levels and clearance of infection. Therapeutic serum aminoglycoside levels were achieved within 48 hours of therapy by only 7 patients (17.5%). Among the remaining 33 patients, significantly fewer septic than nonseptic patients had clearance of their infection (11% vs 92%). Specific physiologic criteria of sepsis may be used to identify critically ill patients who will most likely benefit from aggressive initial aminoglycoside dosing when these drugs are used to treat gram‐negative infections.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

&NA;A central venous access service (CVAS) was created in a 600‐bed teaching hospital to do elective percutaneous central venous catheterization (PCVC) in a safe and expeditious manner. A vascular surgeon, physician assistants, and registered nurses specializing in intravenous therapy comprise the service. From November 1990 through June 1995, the CVAS was consulted for 1,008 PCVC procedures—853 primary insertion attempts and 155 guidewire exchanges. Various types of catheters were inserted for hemodialysis, fluid and medication administration, chemotherapy, and total parenteral nutrition. The primary insertion failure rate was 4% (31/853) and the major complication rate was 1% (8/853); major complications consisted of four pneumothoraces and four lymphocutaneous fistulae. Success and complication rates were superior to those previously reported for less experienced operators. The favorable results of this study support the efficacy of a CVAS.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

&NA;A computerized medical record search of 61,406 live births from January 1, 1990, through December 31, 1994, identified 14 cases of pathologic uterine rings. This yielded an incidence of pathologic uterine rings of 0.02% of all live births. In a retrospective, matched study design, three control subjects having vaginal delivery and three having cesarean delivery were matched with each case of pathologic uterine ring for age, race, parity, estimated gestational age, single or multiple gestation, primary or repeat cesarean section, and indication for the cesarean delivery. Comparison with controls who had cesarean section showed no significant differences in duration of labor, rupture of membranes, use of oxytocin, or fetal head position. Pathologic uterine rings continue to occur in modern obstetrics, but their reported incidence has decreased. These data suggest that the characteristics of parturition have no clear association with the formation of a pathologic uterine ring.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

&NA;Previous studies have indicated the benefits of cardiac rehabilitation programs after major coronary artery disease (CAD) events. We studied 591 consecutive patients from two academic institutions before and after completion of a cardiac rehabilitation and exercise training program to determine the effects of this therapy on exercise capacity, indices of obesity, plasma lipid values, behavioral characteristics, and quality of life parameters. After cardiac rehabilitation, statistically significant improvements occurred in exercise capacity (+33%), percent body fat (−6%), body mass index (−1%), HDL‐C (+5%), triglycerides (−9%), LDL‐C/HDL‐C (−6%), anxiety score (−39%), depression score (−35%), somatization score (−37%), and in all parameters of quality of life studied (total +14%). These data further support the ability of cardiac rehabilitation and exercise training programs to improve exercise capacity, plasma lipid values, obesity indices, behavioral characteristics, and quality of life parameters in a large cohort of patients who have had major CAD events.

ISSN:0038-4348    

出版商:OVID    

年代:1997

数据来源: OVID