ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Thirty-six patients were studied for the presence of the lupus anticoagulant and its possible clinical and laboratory associations. Seven patients were found to have the anticoagulant. These patients had a significantly increased incidence of both thromboembolic complications (5/7 vs. 2/29) and thrombocytopenia (4/7 vs. 4/29). None of them had a bleeding tendency. Except for these associations, patients with the anticoagulant did not differ from those without the anticoagulant by any demographic, clinical, or laboratory parameter. The present study confirms observations that SLE patients with the lupus anticoagulant have an increased risk of thrombosis.

ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Selenium deficiency has been implicated as contributing to the development of cardiovascular disease, skeletal muscle myopathy, anemia, increased cancer risk, and deranged immune function. Since these problems may also be associated with renal failure, and the kidney plays an important role in selenium homeostasis, we measured selenium and compared it with nutritional status in 24 stable hemodialysis patients, 12 chronic intermittent peritoneal dialysis patients, and 29 healthy controls. Whole blood and plasma selenium was determined by a spectrofluorometric method. For whole blood the mean (±SD) selenium levels were 0.11 ± 0.02 ug/ml in controls vs. 0.071 ± 0.01 ug/ml in hemodialysis cases and 0.052 ± 0.006 ug/ml in peritoneal dialysis (p < 0.005). Significant decreases were seen also for plasma and red blood cell selenium in all groups respectively. Pre- and postdialysis plasma and whole blood selenium levels showed no significant changes in both dialysis groups. However, predialysis residual peritoneal fluid did contain selenium (0.029 ± 0.005 ug/ml).Some evidence of protein-energy undernutrition was noted in both dialysis groups compared with controls. However, no significant differences in nutritional parameters were noted between hemodialysis and peritoneal dialysis patients. When all groups were combined, significant correlations were found between whole blood selenium and serum albumin (r = 0.61; p < 0.001), triceps skin fold in females (r = 0.62; p < 0.001), and midarm muscle circumference in males (r = 0.71; p < 0.001).We conclude that low blood selenium is present in renal failure patients undergoing hemodialysis. This abnormality is even greater in peritoneal dialysis cases. Although pre- and postdialysis selenium levels do not change appreciably, peritoneal fluid contained selenium and represents a source of loss. Poor proteincalorie nutritional status was also evident in both dialysis groups and probably contributed to this abnormality.

ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Although metastatic involvement of the thyroid is not commonly considered in the differential diagnosis of a patient with a thyroid mass, such involvement may be more frequent than has been previously appreciated. To evaluate the prevalence of this disorder, all patients with thyroid nodules referred in a 12-month period underwent fine-needle aspiration, regardless of history or scan results. Seventy patients were studied, six of whom had a previous history of malignant disease. Two of the latter had coincidental thyroid disease, but four (5.7% of the total series) had carcinoma metastatic to the thyroid gland. Two of these patients had had no evidence of malignancy for years prior to the appearance of the thyroid metastases. In one case, the metastasis was functioning nodule. Fine-needle aspiration cytology provided prompt and accurate diagnosis in all patients. We conclude that (1) metastatic carcinoma to the thyroid is not rare, (2) its presentation may be confused with primary thyroid disease, and (3) fine-needle aspiration cytology is the procedure of choice in such cases, and should be done early in the evaluation of all patients with thyroid nodules, regardless of the presumed etiology or function by scan.

ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Anticholinesterase medications (anti-ChEs) play a significant role in the diagnosis and treatment of myasthenia gravis (MG). The primary effect on the heart produced by a surfeit of ACh is bradyarrhythmias with consequent fall in cardiac output and hypotension; yet, adverse cardiac reactions to these agents have been reported relatively infrequently. The authors describe 12 patients with MG from a pool of more than 1,000 who suffered hypotensive episodes related to use of anti-ChEs. The 12 patients (seven male, five female) had a mean age of 62.6 years; of these, eight adverse reactions occurred after edrophonium, two after neostigmine, and two after pyridostigmine. Seven patients had a recent increase in anti-ChEs and none had a decrease in dosage. Nine patients suffered either from severe sinus bradycardia (20 beats/min), junctional bradycardia, or complete AV dissociation. Two patients had paradoxic sinus tachycardia and all had syncopal or near-syncopal episodes. Evidence for cholinergic stimulation of other organs was generally lacking. No recurrence appeared with reduction of the dose of anti-ChEs or discontinuation of the drug.The authors believe that these agents should be given with caution to patients with inflammatory, infiltrative, or degenerative disease of the conduction systems, patients being treated with digitals, calcium-channel antagonists or beta blockers, patients with myocardial ischemia, and elderly patients. Appropriate resuscitative equipment should be readily available.

ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Severe hyperlipidemia was nearly completely corrected in 16 diabetic patients who were treated with regular insulin at breakfast and supper. Serum cholesterol levels fell from 572 ± 52 mg/dl to 247 ± 10 mg/dl and serum triglycerides fell from 6,330 ± 820 mg/dl to 354 ± 40 mg/dl over a 4-month period of treatment. Establishment of comparable degrees of control of the fasting blood glucose and hemoglobin A1clevels by NPH insulin did not correct the hyperlipidemia. Regular insulin timed to act for the disposal of ingested substrates appears to provide physiologic actions important in the treatment of diabetic hyperlipidemia.

ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

To test the hypothesis that family function differs in patients acording to their level of diabetes control, family function was assessed using the Family APGAR questionnaire in low-income patients with adult-onset diabetes who were under comprehensive care in five community health centers. From 3,000 active patients, a group of 385 with the following characteristics were randomly selected: mean age, 59.1 (range 25–93); M:F ratio, 1:4; and ethnic distribution (blacks: Hispanics: whites, 48%: 31%:21%). Categorizing patients by their extent of diabetes control, good family function was found in 92% of patients in good control of their diabetes mellitus, in 66% of those in fair control, and only in 50% of those in poor control (p <0.005, X2=44.1, df=2). Since these data point to the association between levels of family functioning and control of diabetes, further studies are needed to ascertain if an improvement in family functioning will lead to better diabetic control.

ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The development of cisplatin and the use of intensive combination chemotherapy have resulted in significant therapeutic advances in medical oncology, as well as the need for intensive supportive care aimed at ameliorating enhanced toxicity. From the patient's perspective, the most prominent adverse effects of chemotherapy are nausea and vomiting. Inadequate control of these symptoms leads to physiologic debilitation and psychologic distress, sequelae that result in either the patient being medically unable to continue therapy or noncompliant. Recent antiemetic research has created a voluminous data base from which the appropriate management of many aspects of chemotherapy-induced emesis can be gleaned. Despite these advances, at least 30% of patients continue to experience some degree of acute emesis with chemotherapy, and the problems of delayed and anticipatory nausea and vomiting have just begun to be addressed. Effective management of chemotherapy-induced emesis is an important aspect of the total care of oncologic patients, improving patient compliance and enhancing the therapeutic index of chemotherapy regimens resulting in a decrease in the overall morbidity and mortality of cancer therapy.

ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Reports of electrocardiographic abnormalities in association with myoglobinuria have been sparse and have included conduction disturbances, ST segment shifts, and T-wave changes. In many instances, these changes were noted in patients with underlying heart disease. We report a case of a 34-year-old woman with ST segment depression and T-wave inversion in the inferolateral leads during the acute episode of myoglobinuria. There was no demonstrable underlying heart disease, and there was parallel resolution of these ECG changes with myoglobinuria. We conclude that these ECG changes were produced by cardiac muscle involvement in a manner similar to that observed in skeletal muscle in myoglobinuria.

ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Heart transplantation is an effective means of treating patients with severe congestive heart failure. Following heart transplantation, the 1-year survival rate is now greater than 80%, and the 5-year survival rater is more than 60% at major medical centers. More than 1,200 heart transplants were performed in more than nine countries worldwide in 1985. The failure of medicare to pay for this procedure is no longer defensible on medical grounds. The argument in favor of medicare funding for heart transplantation is at least as compelling as that for kidney dialysis, the treatment of cancer, or AIDS. The limited availability of donor organs (at most, 1300–2000/year) is likely to place a finite constraint on the number of heart transplants that can and will be performed. Although combined heart-lung transplantation is feasible therapy for certain patients with severe pulmonary hypertension, the availability of suitable donors poses an even greater restriction on this procedure. Totally implantable ventricular assist devices are on the horizon. These devices have the potential for helping 17,000 to 35,000 patients annually at an estimated cost to society of $2.5 to $5 billion per annum. The development and use of such extremely expensive technology poses major socioeconomic and ethical questions for society.

ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID