ISSN:0038-4348    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

ABSTRACT:Purified protein derivatives (PPDs) prepared from M tuberculosis (PPD-S), Mkansasii(PPD-Y), M scrolulaceum (PPD-G), Mavium(PPD-A), Mintracellulare(PPD-B), and Mfortuitum(PPD-F) were used simultaneously as skin tests to elicit profiles of reactivity in patients with clinical pulmonary disease roentgenologically suggestive of mycobacteriosis. These profiles were useful in delineating the specific cause of mycobacterial disease weeks before bacteriologic confirmation by culture, and they provided a basis for early treatment. When bacteriologic confirmation was attained, the diagnosis suggested by skin testing was correct. Treatment regimens for non-M tuberculosis (atypical) mycobacterial disease varied: a two- to three-drug regimen in the treatment of Maviumor Mintracellularedisease was ineffective and inappropriate, whereas a five-drug regimen without surgical excision of residual disease produced good results. Combining surgical resection with the five-drug regimen before and after operation produced the best results, however, with all patients showing apparent cure.

ISSN:0038-4348    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Three patients had diffuse reticulonodular shadowing on chest roentgenogram, dyspnea, cough, purulent sputum, airways obstruction, variable fever, and leukocytosis. Lung tissue from two showed inflammatory exudate in bronchioles and peribronchiolar alveoli; all had multiple isolates of eitherHaemophilus influenzaeorStreptococcus pneumoniaefrom sputum or lung tissue. When examined in the context of similar syndromes reported by others under different labels in the past, these observations suggest that this is a specific clinical entity, which is both uncommon and serious. Despite initial misdiagnosis in all three cases, the two patients in whom the true nature of the disease was promptly recognized had complete recovery after the institution of appropriate antibacterial therapy. The most accurate and appropriate term for this entity is diffuse bacterial bronchiolitis with bronchiolar pneumonia.

ISSN:0038-4348    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Sleep loss impairs ventilatory responsiveness to hypercapnia and hypoxia, and also interferes with performance on spirometry. To test the hypothesis that the decline in hypercapnic drive due to sleep loss is mediated by endorphin production, we measured loaded and unloaded CO2response after injection of placebo and naloxone in 11 normal subjects who were alternately rested and sleep-deprived. Blood for β-endorphin and epinephrine assay was drawn before testing each day. Unloaded CO2response was lower after sleep loss than after sleep restoration; naloxone had no effect on this difference. Likewise, there was no difference between CO2response after naloxone administration and CO2response in control subjects. β-Endorphin activity did not rise after sleep loss. Loaded CO2response was reduced compared to unloaded response and was not affected by sleep loss or by naloxone. The serum epinephrine level rose significantly with sleep loss. We conclude that naloxone is not a respiratory stimulant in normal people, and that it does not reverse the fall in CO2response that follows sleep loss.

ISSN:0038-4348    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

To determine the factors that allow early recognition of injuries to the intrathoracic and intra-abdominal organs in patients with penetrating wounds to the lower thorax and abdomen with site of entrance located in the back or flanks, we retrospectively analyzed the cases of 77 such patients. There were 65 stab wounds (85%) and 12 gunshot wounds (15%). The injuries were confined to the abdomen in 46 (60%); 39 were stab wounds and seven were gunshot wounds. The wounds were confined to the chest in 24 patients (31%) and involved both the chest and abdomen in seven cases (9%). Of the 53 abdominal wounds, 21 necessitated celiotomy; in 20 of them, an intra-abdominal organ was found injured, and one patient died (1.9%). Of the 24 injuries confined to the chest, only one patient required emergency thoracotomy due to massive hemorrhage; all 24 patients survived. All of the seven thoracoabdominal injuries, two produced by gunshot and five by stabbing, necessitated celiotomy. Most patients with gunshot wounds to the back and flanks require celiotomy, but a selective therapy can be safely used in patients with stab wounds. The rate of negative exploratory celiotomy was less than 5%; the mortality was 1.3%.

ISSN:0038-4348    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Although many authors have stated that surgical exploration should be mandatory for all neck wounds that penetrate the platysma, recent reports from many centers now claim that selective exploration is both safe and reasonable. A policy of selective exploration based on clinical presentation, anatomic location, and results of diagnostic studies has been followed at The Cooper Green Hospital in Birmingham, Alabama, for the past 13 years. We report a study of penetrating neck wounds in 136 consecutive patients admitted to The Cooper Green Hospital from 1972 to 1984. Seventy-seven patients (57%) had exploration immediately, with one death, while the remaining 59 (43%) were admitted and observed. Of these 59 patients, ten had arch aortography and nine had esophagography, all of which yielded normal results. The remainder of the patients observed had no clinical signs or symptoms to suggest a major injury. There were no deaths or complications related to the neck wounds in the 59 patients observed. Results of 27 explorations (35%) were negative. We conclude that selective exploration of penetrating neck wounds is both safe and reasonable.

ISSN:0038-4348    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Over a 3½-year period, we did 121 needle-localized breast biopsies for nonpalpable, mammographically suggestive lesions. The presence of a mass lesion on mammography with or without microcalcifications was associated with malignancy more frequently than microcalcifications alone. In 15 cases (12.4%), biopsy showed malignancy; 13 patients had modified radical mastectomy, with 11 (85%) having no histologic evidence of axillary metastases. Evaluation of risk factors associated with breast cancer in those patients with positive biopsy results showed that advanced age and a past history of a breast cancer were present in a significant number of patients. Four patients (3.5%) had complications; a hematoma developed in one (0.8%), and three (2.7%) required a second biopsy to remove the suggestive mammographic lesion. We conclude that needlelocalized breast biopsy is a reliable tool in detecting early breast carcinoma. The procedure causes only minimal morbidity and we believe it should be done in all patients with mammographically suggestive, nonpalpable breast lesions.

ISSN:0038-4348    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Over a four-month period, we did roentgenographic examinations of the cervical spine on 35 individuals with Down's syndrome, most of whom planned to participate in the Special Olympics. There were abnormalities in 40%, the most frequent being atlantoaxial subluxation. The presentations, risks, and recognition of this abnormality are discussed, as well as the pathomechanics. Many parents and some physicians may still be unaware of the possible hazards involving these spinal abnormalities, and of the recommendations and screening procedures that should be followed before individuals with Down's syndrome engage in strenuous activities.

ISSN:0038-4348    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Lower arm reconstruction of soft tissue defects and after ablation for cancer leaves the reconstructive surgeon few alternatives. We have used latissimus dorsi muscle (n = 1) and musculocutaneous flaps (n = 3) with good functional and cosmetic results. Defects in one patient with traumatic amputation, another with extravasation of doxorubicin, and two with cancer were closed without complications to donor site, recipient site, or flap. Skin paddle size averaged 182 sq cm in the three musculocutaneous flaps. Mean follow-up was six months.

ISSN:0038-4348    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Transsphincteric posterior resection of villous adenomas and small carcinomas restored gastrointestinal continuity and preserved continence in 25 of 26 patients in this study. No patient had local recurrence. This procedure is suitable for villous tumors that are too high for transanal or too low for transabdominal resection, and for small mobile malignancies of the lower 5 cm of the rectum.

ISSN:0038-4348    

出版商:OVID    

年代:1987

数据来源: OVID