ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Glutamine (Gln) is an important nutrient substrate for lymphocytes and macrophages in vitro. This pilot study evaluated effects of Gln supplementation on circulating lymphocytes and lymphocyte subsets after allogeneic bone marrow transplantation (BMT). Adult patients received either parenteral nutrition supplemented by L-Gln (Gln-PN) or standard Gln-free PN after BMT. Leukocyte and total lymphocyte counts were determined during hospitalization, and flow cytometry studies of peripheral mononuclear cells were performed 1 to 2 weeks after hospital discharge. The Gln-PN group demonstrated a higher percentage of blood lymphocytes during hospitalization. At flow cytometry, patients who received Gln-PN had an increased total lymphocyte count (332 ± 50 versus 590 ± 71 cells/µL, P = 0.010); greater numbers of total T lymphocytes (54 ± 19 versus 229 ± 70 cells/µL, P = 0.030); and higher CD4+ and CD8+ T-lymphocyte counts in peripheral blood compared with controls. Gln-PN may support lymphocyte recovery after BMT.

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

We evaluated the willingness of clients at a large urban sexually transmitted diseases (STD) clinic in the southeastern United States to participate in future trials of preventive vaccines for HIV type 1 (HIV-1). A single trained interviewer administered an oral survey instrument to STD clinic clients over a 4-week enrollment period. The participants were 167 randomly selected clients (90 men and 77 women), most of whom were young, African-American heterosexuals. Risk behaviors for HIV-1 infection were highly prevalent. Overall, 67% of clients expressed willingness to consider participation in an HIV-1 vaccine trial. By univariate analysis, prior HIV-1 testing was significantly associated with willingness to participate (P = 0.04). Multivariate analysis revealed that female gender (P = 0.05) and prior HIV-1 testing (P = 0.03) were significant predictors of willingness to participate.

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The occurrence of autoimmune phenomena in 28 patients with thromboangiitis obliterans (Buerger's disease) was determined. The following were sought: antineutrophil cytoplasmic antibodies against proteinase 3 (cANCA) and myeloperoxidase (pANCA), antinuclear antibodies, anti-Ro antibodies, anticardiolipin antibodies, and antiendothelial cell antibodies (AECA). For the last, an enzyme-linked immunosorbent assay was developed which verified the presence of the AECA phenomenon with immunofluorescence and confocal microscopy. Seven patients with active disease had AECA titers of 1,857± 450 arbitrary units (AU) compared with 126 ± 15 AU in 30 normal control subjects (P < 0.001) and 461 ± 41 AU in 21 patients in remission (P < 0.01). Antibodies from the sera of patients with active disease reacted not only with surface epitopes but also with sites within the cytoplasm of human endothelial cells. AECA may be useful in following disease activity and may play a role in the pathogenesis of thromboangiitis obliterans.

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Twenty patients with acute myocardial infarction (AMI) treated with streptokinase (SK) and 11 patients with AMI not treated with SK were clinically and echocardiographically evaluated in the intensive coronary care unit (ICCU). Blood samples, in which complement components C4d, C5b-9, and Bb were measured, were taken immediately after arrival of the patient at the ICCU, 1 hour after SK infusion, and 24 hours later from the SK group, and similar time-matched samples were taken from the control group. The classic, alternative, and common complement pathways were found to be activated in AMI, but this activation was statistically significant only in the SK-treated group. Activation was not related to the site of the AMI nor to the extent of its damage, as assessed by Killip class and ejection fraction. However, in the SK-treated group and even more so in non-SK group, the C5b-9 increment was significantly higher in patients diagnosed with reperfusion, based on ST-segment recovery of ⩾50% reduction from the peak ST-segment level. There was little change in complement levels when reperfusion did not occur. Detection of reperfusion without coronary angiography would have important practical clinical implications, and complement activation may predict its occurrence. However, more studies of this phenomenon are needed.

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Patient care is shifting from an inpatient setting to an ambulatory setting. Despite this shift, most internal medicine clerkships provide the majority of medical student training in inpatient settings or in university tertiary care clinics, which are not representative of patient care in a community setting. We created a separate ambulatory clerkship that used volunteer community faculty at local and distant sites. The steps involved are described here, including finding time within the clerkship, reaching consensus within the department, defining the curriculum, identifying sites, and developing preceptors. Various parameters were measured to ensure quality in educational design. Comparisons of the 1-year pilot program, the full implementation program, and the inpatient program revealed that use of community sites does not affect cognitive knowledge acquisition but does influence students' satisfaction level.

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

To gain a better understanding of senior medical students who perceive high-technology medicine as the desirable form of medical practice, we developed and evaluated a structural equation model. Intolerance to clinical uncertainty, Machiavellianism, and authoritarianism characterized students who scored higher on reliance on high-technology medicine. High scorers also tended to have a negative orientation toward patients' pyschological problems and were unlikely to choose careers in primary care medicine. Students who perceive high technology as a panacea in clinical medicine share personal traits and attitudes toward patients that are not conducive to achieving the national goal of a 50:50 ratio between primary and non-primary care physicians.

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Rapidly growing mycobacteria, an infrequent cause of human disease, are increasingly being recognized as human pathogens rather than mere colonizers. Rapidly growing mycobacteria infrequently cause disease in patients with acquired immunodeficiency syndrome (AIDS). It is unclear whether patients with AIDS are more predisposed than others to infection by these organisms. The optimal regimen and duration of treatment is similarly uncertain.Mycobacterium fortuitumis a rare cause of lymphadenitis or neck abscess. We report two cases ofM fortuitumneck abscesses in patients with AIDS which were successfully treated with antibiotics after initial drainage. In one of these patients,M fortuitumneck abscess was the AIDS-defining illness. We also present a review of the cases reported in literature. It appears that such infections may be treated with a combination of ciprofloxacin and clarithromycin after incision and drainage of the abscess.

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The case history is presented of a patient with recurrent massive hemoptysis caused by necrotizing bronchial aspergillosis associated with sarcoidosis. The involved segments (right IX and X) were resected for treatment of the life-threatening hemoptysis. Histologic examination of the resected specimen confirmed the diagnosis. Necrotizing bronchial aspergillosis is a rare variant form of invasive pulmonary aspergillosis and has not been described previously as a cause of hemoptysis in sarcoidosis.

ISSN:0002-9629    

出版商:OVID    

年代:1998

数据来源: OVID