摘要:

Background.Low-molecular-weight heparin (LMWH), because of its efficacy and ease of use, is an attractive alternative to unfractionated heparin in treatment and prophylaxis of venous thromboembolismMethods.Using MEDLINE, I searched for relevant clinical trials using LMWH. I carefully reviewed these trials, allowing development of recommendations for use of LMWH in clinical practiceResults.A large amount of data is available for evaluating the use of LMWH in treatment of venous thromboembolism and in prophylaxis against venous thromboembolism. Less data are available concerning the utility of these agents in cardiovascular and cerebrovascular disordersConclusions.Based on available literature, LMWH should be strongly considered as therapy for acute deep venous thrombosis, though Food and Drug Administration (FDA) approval for this indication is currently pending. These agents are also excellent pharmacologic prophylactic agents in orthopedic surgery patients. Recent data suggest use in unstable angina in place of heparin. Other indications for use are not as well defined at this time

ISSN:0038-4348    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Background.Technologic advances have led to increased use of computers at home and in the workplace. It is estimated that more than 100 million workers in the United States and Canada will be using computers daily by the year 2000. Anecdotal reports have suggested a link between video display terminals (VDTs) and disease. This has generated much concern about whether electromagnetic radiation (EMR) emitted by VDTs cause illness among usersMethods.We reviewed pertinent articles in the literatureResults.Several studies have addressed the role of VDTs in disease causation, specifically whether EMR causes skin or ocular disease or obstetric complications. The data reviewed were inconsistent or methodically flawed. Therefore, a definitive conclusion cannot be drawn to support the hypothesis that EMR produced by VDTs causes diseaseConclusions.We believe continued research should be done to further define and elucidate the risk of EMR produced by VDTs

ISSN:0038-4348    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Background.Juvenile dermatomyositis/polymyositis (JDMS/PM) are childhood inflammatory myopathies that normally affect children between 2 and 15 years of age. The disease is manifested as severe proximal muscle weakness and, in JDMS, as a characteristic cutaneous eruption. It is difficult to predict the course of the disease. This study is aimed at objectively assessing the long-term morbidity of dermatomyositis/polymyositis in childrenMethods.Twelve cases of JDMS/PM identified through chart review were evaluated by physical and dermatologic examination, muscle testing, ultrasonography, and magnetic resonance imaging (MRI)Results.The patient population included 6 male and 6 female patients with a mean age of 18.8 years (standard deviation 12.4). The mean age at onset of JDMS/PM was 5.8 years (SD 2.8), and the mean time from onset of symptoms to beginning of the study was 10.1 years (SD 9.3). The mean duration of corticosteroid therapy was 53.1 months (SD 40.5), with patients reporting an average of 1.7 relapses (SD 1.5). Patients compared their own activity level with that of healthy control subjects, and on a scale of 1 to 5 with 5 being normal, their mean score was 3.9 (SD 0.9). Fifty-eight percent of the patients had at least one residual finding on physical examination, and 78% of those with JDMS had residual dermatologic sequelae. Despite these findings, the mean grade for the group was 4.6 (SD 0.6) for muscle strength, using a scale of 0 to 5 with 0 being no muscle resistance and 5 being normal. In 60% of patients examined by ultrasonography, increased echogenicity indicated possible residual fibrotic change in at least one muscle group. Although MRI showed no active disease process in four patients, scattered intramuscular calcification was found in one patientConclusions.Multiple physical and dermatologic sequelae are commonly present in patients with JDMS/PM on long-term follow-up, but these do not preclude a productive life. Ultrasonography and MRI provide additional noninvasive means of analysis, but because of the current high cost, MRI is not routinely recommended

ISSN:0038-4348    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Background.Malignant pleural effusions are classically exudative, though occasionally they can be transudative. We attempted to determine the prevalence of transudative malignant pleural effusions and to describe their clinical and radiographic characteristicsMethods.We studied the medical records of 215 patients with malignant pleural effusion, which contained complete data on pleural fluid analysis for 171 of themResults.Eight cases of transudative malignant effusion were found. Seven of these eight patients had a concomitant disorder known to cause transudative pleural effusion. One patient had fluid overload due to renal failure, and another had been admitted earlier with congestive heart failure. Two patients had definite evidence of deep venous thrombosis, allowing us to postulate pulmonary embolism as a factor contributing to transudation. Three patients had CT evidence of superior vena cava obstruction. Only one patient had no known associations with causes of transudative effusionConclusion.Malignant pleural effusions were transudative in 5% of our patients. In all except one patient, some evidence suggested the concomitant presence of a transudative state

ISSN:0038-4348    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Background.This study examined alcoholism identification and interventions by internal medicine residents, determined the prevalence of alcoholism among indigent inpatients, and examined some variables related to alcoholism in this populationMethods.The alcohol abuse and dependence section of the Diagnostic Interview Schedule was administered to 197 inpatients, and chart audits were doneResults.The obtained prevalence of alcoholism was 17%. Residents identified current alcohol abuse among 71% of current alcoholics, 17% of past alcoholics, and 3% of nonalcoholics. Sixty-two percent of alcoholics identified by the residents did not receive advice or referral, 13% received advice, 17% were referred to Alcoholics Anonymous, and 8% were referred to an inpatient facilityConclusions.Our results suggest that although residents' identification of alcoholism is satisfactory, it is necessary to improve their rates of intervention. The profile of the alcoholic inpatients in this study includes demographics, presence of chronic illnesses, and utilization of medical services as compared with nonalcoholics

ISSN:0038-4348    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Pregnancy-associated osteoporosis (PAO) is considered a rare complication of pregnancy and lactation, but the actual incidence is unknown. Pregnancy-associated osteoporosis is self-limited and usually does not recur during subsequent pregnancies, but little is known about its pathogenesis or the dynamics of bone density during the evolution and recovery phases of an acute episode. We report a case of idiopathic PAO. Follow-up included repeat measurements of bone density, which revealed a striking rate of improvement during the first 6 months after delivery (50% increase) and continuous improvement, at a diminished though still relatively high rate, during the successive year. This observation provides insight into the early stages of recovery from PAO

ISSN:0038-4348    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Rapidly growing mycobacteria have occasionally been reported to cause catheterrelated infections. We report a case of a central venous catheter-related bacteremia, caused byMycobacterium smegmatis, in a patient with cancer. Cultures of the catheter tip and blood cultures grewM smegmatisandEnterococcus faecalis. The patient responded to catheter removal and a 3-month course of antibiotics (doxycycline and ciprofloxacin). Based on our experience and the reported experience with other rapidly growing mycobacteria,M smegmatiscatheterrelated bacteremia should be treated with catheter removal and a course of appropriate antibiotics, based on in vitro susceptibility testing

ISSN:0038-4348    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1998

数据来源: OVID