摘要:

In December 1988 an indigenous case of cutaneous anthrax was identified in Texas. The patient, a 63-year-old male Hispanic from southwest Texas, was a sheep shearer and had a recent history of dissecting sheep that had died suddenly. He experienced an illness characterized by left arm pain and edema. A necrotic lesion developed on his left forearm, with cellulitis and lymphadenopathy. After treatment with oral and intravenous penicillins, the patient fully recovered. Western blot testing revealed a fourfold or greater rise in antibody titer toBacillus anthracisprotective antigen and lethal factor. This represents the first case of indigenous anthrax in Texas in more than 20 years.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Remarkable advances have been made in the field of neuro-otologic and skull base surgery within the past decade. Each component of the “disease model”—prevention, diagnosis, therapy, and rehabilitation—is undergoing rapid progress. The purpose of this paper is to highlight only a few of these achievements. Each topic chosen has witnessed recent advancement in one aspect of the disease model. Neurofibromatosis (prevention) has been subjected to chromosomal mapping, allowing for genetic counseling. Intraoperative facial nerve monitoring (diagnosis) has allowed improved anatomic and functional preservation of this nerve during surgery. Embolization of glomus tumors (therapy) has rendered these difficult lesions more surgically manageable, and cochlear implantation (rehabilitation) has allowed the profoundly deaf to play a more active role in society. Each of these topics is briefly discussed as it relates to the temporal bone surgeon.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Most lumbar disk displacements occur through the lateral fibers of the posterior longitudinal ligament, whereas only a small percentage occur through the strong midline fibers. The midline disk herniation is identified as a focal midline dural sac compression and is better seen on the lateral myelogram and computed tomography scan. Of the 22 patients in this study, 14 had midline lumbar disk herniations at L4–5. Their presenting symptoms including back pain with sciatica, were similar to those of lateral disk herniations. On physical examination, however, patients commonly had only positive root tension signs with few nerve root deficits. The incidence of cauda equina syndrome was 27%. The results of treatment were much poorer in these patients than results reported with lateral herniations; 41% were good, 27% fair, and 32% poor. Surgical decompression yielded the best results. A wide exposure is usually needed to provide adequate decompression.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The use of functional endoscopic sinus surgery has been limited typically to management of chronic sinusitis, nasal polyposis, and recurrent acute sinusitis. Antrochoanal polyps (ACPs) traditionally have been resected using a Caldwell-Luc sinusotomy. We used the endoscopic approach, however, in the treatment of five cases of ACP. There was recurrence in one case, but the polyp was successfully removed endoscopically. In the other four cases there has been no evidence of recurrence at a maximum follow-up of 24 months. We believe that transnasal endoscopic antrochoanal polypectomy is an excellent surgical option; there is significantly less postoperative morbidity than with the transantral approach, and rates of complete cure are similar.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

We reviewed the charts of 106 patients treated with carbamazepine. Age, sex, race, seizure type, seizure focus, age at onset, duration of epileptic illness, reasons for discontinuing treatment, other medications, and response to treatment of seizures, psychiatric symptoms, and behavioral symptoms were recorded. Statistical analysis was done to determine clinical factors influencing response to carbamazepine. Increasing duration, of epileptic illness leads to a decreased response to carbamazepine, which controls both seizure and behavioral symptoms effectively; concurrent medication decreases behavioral symptom control without affecting the control of the seizures. We found a strongly negative correlation between duration of seizures and improvement of psychiatric symptoms with carbamazepine therapy. We provide a clinical profile of the carbamazepine responder to guide clinicians in their use of this drug.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Patients are unhappy with the way physicians treat them, not so much medically, as personally. If public opinion is correct, recent medical graduates are less able to win the favor of their patients than previous ones. This article outlines a series of practical strategies for improving doctor-patient relationships. Sooner or later, most physicians learn these strategies by role-reversal. Perhaps a discussion of these with physicians in training (and others) will save some time, generate some goodwill, and improve outcomes for patients and physicians alike.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

When the American Society of Anesthesiologists published itsGuidelines for Regional Anesthesia in Obstetrics, I did a survey to determine what impact a broadly implemented strict interpretation of those guidelines might have on obstetric anesthesia care in small rural Alabama hospitals. Thirty-six rural Alabama hospitals with fewer than 200 beds were included in the survey, with a response rate of 50%. Data included total deliveries, cesarean section rates, utilization rates of anesthesia services, personnel‘ providing anesthesia care, and identification of physician personnel available during labor and cesarean section. Results showed that anesthesia care is provided for approximately 52% of births in the responding hospitals. Of these, approximately 60% of cesarean sections and 90% of vaginal deliveries are not routinely attended by anesthesiologists. If these data also reflect the nonrespondent hospitals, statewide access could be limited for approximately 6000 parturients annually. TheGuidelinesshould be interpreted with caution. Rather than conform to related policies, interpretation should allow implementation consistent with the capabilities of the individual institutions, while ensuring quality anesthesia care for the parturients.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

From 1979 to 1982, 163 patients with colorectal cancer were found to have distant metastases. Of these, 112 (69%) had metastatic disease at the time of initial diagnosis (synchronous metastases [SM]); in the remaining 51 (31%) metastases developed during the course of the disease (metachronous metastases [MM]). The liver was the most common site of metastasis in both groups (72% and 65%, respectively); with the exception of brain metastasis, liver metastasis had the worst prognosis (median survival time [MST], 9 months). The MST for other sites of metastasis were: lung, 10.5 months; bone, 10 months; multiple sites, 10 months; and brain, 5.5 months. Of the 81 patients with SM in the liver, 38% were treated with single modality therapy and 62% with combined modality therapy. Thirty-three patients had MM in the liver. The median time for development of liver metastases (metastasis-free interval [MFI]) was 17.5 months; only lung metastases developed faster (12 months). MFIs for other sites were 20, 20.5, and 33 months for bone, multiple sites, and brain, respectively.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

We reviewed genetics charts of 2235 patients seen from 1985 to 1990 at Vanderbilt University Medical Center, Nashville, Tennessee, and summarized the 20 most common reasons for referral (occurring in 1138 of the patients) and the diagnoses or conditions among patients receiving genetic services in one of four clinical settings (prenatal counseling clinics, general genetics clinics, outreach genetics clinics, and ward consultations). The five most common reasons for referral were advanced maternal age (≥35 years) (203/1138, or 18% of patients), followed by dysmorphic features/multiple congenital anomalies (MCA) (185/1138; 16%), developmental delay/mental retardation (MR) (168/1138; 15%), Down's syndrome (103/1138; 9%), and abnormal maternal serum α-fetoprotein (MSAFP) (74/1138; 7%). The five most common diagnoses or conditions identified for all genetics patients were advanced maternal age (≥35 years) (195/906; 22%), developmental delay/MR (111/906; 12%), dysmorphic features/MCA (107/906; 12%), Down's syndrome (88/906; 10%), and multiple fetal losses (57/906; 6%). Of the 20 most common diagnoses or conditions categorized in 602 of the 906 patients, a multifactorial cause was observed in 25% of those patients; a chromosomal cause was observed in 26% of cases of Down's syndrome, accounting for 55% of the chromosomal disorders; a single gene disorder was observed in 17% of patients; an environmental cause was seen in 4%; and an unknown cause was noted in 28%. We hope this study will help physicians in middle Tennessee and surrounding areas by increasing their awareness of the types and frequencies of genetic diseases so that misdiagnoses and delayed referrals can be avoided.

ISSN:0038-4348    

出版商:OVID    

年代:1993

数据来源: OVID