摘要:

This review summarizes results of hormonal management in patients with metastatic prostate cancer in terms of both timing and amount of androgen blockade. The standard of delayed hormonal therapy resulted from data of the Veterans Administration Cooperative Urologic Research Group showing high toxicity in patients treated with estrogen therapy. Reanalysis of those data using cancer-specific deaths showed improved cancer-specific survival with early hormonal therapy. A large and growing body of clinical data also suggests a superior benefit to early hormonal therapy. The concept of total androgen (adrenal and testicular) ablation was supported by reports that show a survival advantage using a combined blockade over luteinizing hormone-releasing hormone agonist alone. A National Cancer Institute study showed particularly impressive disease-free and overall survival in a subset of patients with low volume disease and good performance status. However, caution should be exercised in view of differing Canadian and European data. This review provides guidelines for treatment, but ultimately the timing and amount of androgen deprivation must be tailored to the individual patient. Ongoing and future prospective studies hold the promise of answers to these difficult and unresolved questions.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Several recent reports suggest that emergency physicians do not use adequate analgesia for patients with acutely painful conditions in the emergency department (ED). To quantify the extent of this problem, we retrospectively studied 401 patients who were treated for acute fracture over a 17-day period in eight area-wide emergency departments. Patient age, fracture site, and ED setting (urban or suburban, teaching or nonteaching) were noted. Only 121 patients (30%) received analgesics while in the ED; neither fracture site, ED setting, or patient age significantly altered analgesic dispensing practices. We conclude that inadequate use of analgesics in patients who come to the ED for treatment of acute fractures is widespread and that efforts aimed at improving the appropriate use of analgesics in the ED are warranted.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Trends of US suicide rates show great variations among demographic groups over time. Although more attention has been directed to the increasing suicide rate among adolescents, persons aged 65 years and older continue to commit suicide at a higher rate than for any other age group. To examine the recent trend of suicide rates and compare the suicide pattern with that at the national level, we conducted a study using suicide data in Alabama from 1980 to 1989. For all age groups in Alabama in the 1980s, male suicide rates exceeded female rates. Of the four major race-sex groups, nonwhite females are an especially low-risk group, experiencing a rate of about 1.5/100,000 at all ages.There have been remarkable increases in suicide rates in the 1980s for males, especially for nonwhite males in Alabama. The results suggest that high-risk groups to be targeted for interventions are men over age 45 (especially white men over age 65), and divorced and widowed men and women.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Progressive conductive deafness may be caused by otosclerosis, a bone fixation of the stapes that causes reduced transmission of sound from the eardrum to the inner ear. Since the late 1950s, stapes surgery has been considered the treatment of choice for alleviating hearing loss due to otosclerosis. Over the past 20 years, there has been a decline in the number of stapes operations done. As a result, there are concerns regarding results of the stapes surgery done today compared with the results of such surgery when it was done more frequently. In this paper, I retrospectively review 603 stapes operations that I did at the Farrior Ear Clinic between 1981 and 1991. There were 484 primary stapes operations. Hearing results using the small fenestra technique showed closure of the air-bone gap to 10 dB or less in 96% of cases. During the same period, 119 revision operations were also done. The surgical technique, operative findings, and hearing results are presented. In both primary and revision stapes surgery, the hearing results of this series are compatible with the results of earlier, larger series. My findings show that stapes surgery is still the treatment of choice for hearing loss due to otosclerosis.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

3 cm). All four direct defects occurred in male patients. We conclude that asymptomatic defects are surprisingly common in our surgical population (13%) and that laparoscopic examination of the pelvis is a sensitive technique for identifying these defects. To date, no patient with laparoscopically diagnosed hernia has had symptoms or complications related to the hernia. We recommend that the surgeon should note in the medical record the presence of a defect, but not proceed with prophylactic repair of asymptomatic defects.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Little is known about the epidemiology of Bartholin's duct abscess and cyst. We did an emergency department-based case-control study to examine demographic risk factors for this condition. We found that risk varied by age. After adjustment for pregnancy status, the relative odds (odds ratio [OR]) of occurrence of Bartholin's duct abscess for women 20 to 29 years old, compared to women younger than 20 years, was 2.3. The association was weaker among women in their 30s and 40s (OR=1.4 and 1.1, respectively). The majority of patients were Hispanic whites (66% of cases and 79% of control subjects). Risk of Bartholin's duct abscess was greater among non-Hispanic white women (OR=1.9) and black women (OR=2.4). At lowest risk of this condition were women with high parity (≥4) or high gravidity (≥5). These findings suggest that the risk factor profile of this condition is similar to that of most sexually transmitted diseases. The advisability of presumptive antibiotic treatment of these patients and examination and treatment of their sexual partners should be considered.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

We report four cases of niacin-induced hepatotoxicity. All four patients were using sustained-release niacin preparations. When they stopped taking niacin, symptoms and laboratory abnormalities resolved. Two of the patients had focal fatty infiltration of the liver on imaging studies, a presentation of niacin hepatotoxicity not previously described. One patient had a coagulopathy even though aminotransferase levels were only mildly elevated. We recommend that patients using sustained-release preparations of niacin have periodic monitoring of liver enzymes and that the preparation be discontinued if any abnormalities develop.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

To determine the incidence of arteriographically proven coronary artery disease in black men evaluated for chest pain, we retrospectively reviewed the charts of 208 black men, aged 20 to 60, who had coronary arteriography at the Medical Center of Central Georgia (MCCG) from 1985 through January 1990. Age, type of chest pain, and risk factors commonly accepted as associated with coronary disease (hypertension, family history, left ventricular hypertrophy, diabetes, smoking, and hypercholesterolemia) were identified for each patient. Patients were categorized by previous evidence of coronary disease: 145 were studied to evaluate suspected disease and 63 to evaluate previously proven (prior catheterization) or presumptive (prior myocardial infarction) disease. Chest pain groups (typical and atypical angina) were analyzed by Pearson chi-square goodness of fit using the Diamond and Forrester age and chest pain tables as a model. Risk factors were analyzed using a maximum likelihood chi-square test. Coronary artery disease was common in the study group (48.6% of all patients) but significantly less than predicted by the Diamond and Forrester tables. Risk factors were highly prevalent, but only age and smoking were associated with catheterization-proven coronary artery disease in this group. We conclude that coronary artery disease is common in black men evaluated for chest pain but less frequent than would be expected from comparison with findings in white men presenting similar clinical features. Risk factors other than age and smoking were not associated with increased incidence of disease. A prospective study is needed to delineate a more effective means of evaluating black male patients with chest pain.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The newly availableHaemophilus influenzaetype b (HIB) protein conjugate vaccines are efficacious among study populations in which a high proportion of infants and children are vaccinated. In this retrospective study, we show the impact of the availability of HIB conjugate vaccines on the incidence of HIB meningitis at Arkansas Children's Hospital (ACH) in Little Rock. The Arkansas State Health Department estimates that only 43% of children in the state younger than 2 years of age have received the appropriate vaccinations. From 1985 through 1987, 27.3 ± 4 HIB meningitis cases per year were treated at ACH. Although an HIB conjugate vaccine was licensed for 18-month-old children in December 1987, the incidence of HIB meningitis treated at ACH did not decrease significantly; there were 19.0 ± 2 cases per year from 1988 through 1990. In December 1990, an HIB conjugate vaccine was licensed for use in infants beginning at 2 months of age. From that time through August 1992, there were five cases of HIB meningitis treated at ACH, representing a significant decrease over previous years. Four of these cases occurred in unimmunized infants younger than 6 months of age. The availability of HIB conjugate vaccines for infants has resulted in a dramatic decrease in the number of cases of HIB meningitis treated at ACH, despite a relatively low proportion of infants and children who are receiving vaccination.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Hypokalemia occurs in 50% to 68% of trauma patients. To investigate the pathophysiology of these changes in serum potassium, we prospectively studied 133 trauma patients. Among the patients who had hypokalemia, the serum potassium usually decreased within 1 hour of trauma and returned to normal within 24 hours without significant potassium replacement. In bivariant analysis, age, admission systolic blood pressure, cardiac injury, and serum epinephrine level were associated with admission serum potassium value (Kl), whereas sex, mechanism of injury, number of organ systems injured, blood glucose, serum alcohol, arterial pH, Injury Severity Score, trauma score, estimated blood loss, and urine potassium were not significantly related to Kl. But in a multiple regression model, the only significant independent variables were age, arterial pH, and serum epinephrine level.

ISSN:0038-4348    

出版商:OVID    

年代:1994

数据来源: OVID