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10,003,500 | Measured resting energy expenditure (REE) was compared to predicted basal energy expenditure (BEE) in 35 consecutive patients with nonseptic inflammatory bowel disease (IBD) and 20 healthy volunteers. Patients with IBD were groups greater or less than 90% ideal body weight (IBW). The BEE in kcal/day was found to be equivalent to the measured REE in both patient groups. It is suggested that the BEE be used to determine caloric requirements in nonseptic patients with inflammatory bowel disease. Patients less than 90% IBW had significantly higher measured energy expenditure (26.4 +/- 1.0) per kg body weight than either controls (21.2 +/- 0.7) or patients greater than or equal to 90% IBW (21.2 +/- 0.8), p less than 0.001. It is suggested that this increased expenditure is due to a combined effect of weight loss and intrinsic disease. | [
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10,003,501 | Accuracy of the first endoscopic procedure in the differential diagnosis of gastric lesions. | [
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10,003,502 | The accuracy of endoscopy and directed biopsy in the differential diagnosis of gastric lesions was evaluated by comparing the diagnoses of one endoscopic procedure (endoscopy and multiple directed biopsies) with the definitive diagnoses in 333 patients. The overall endoscopic and bioptic accuracy rate for all patients amounted to 98.8%. Separate accuracy rates of endoscopy alone and biopsy were 86.5% and 94.9%, respectively. The reliability of endoscopy was similar in the diagnosis of malignant and benign lesions (86% and 89%). Endoscopic biopsy was correct in 99.1+ of benign lesions and in 86% of malignancies. False negative rates were 3.9% for endoscopy and 4.0% for biopsy. It is concluded that one endoscopic procedure is a highly reliable method in the differential diagnosis of benign and malignant gastric lesions. | [
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] |
10,003,503 | A single dose tinidazole and doxycycline prophylaxis in elective surgery of colon and rectum. A prospective controlled clinical multicenter study. | [
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10,003,504 | Antimicrobial prophylaxis with agents active against aerobic and anaerobic micro-organisms leads to a significant reduction of infectious complications following colorectal surgery. A single dose (1600 mg) of tinidazole (a nitroimidazole derivate) and doxycycline (400 mg) will provide serum and tissue values well above minimum inhibitory concentration (MIC) values for more than 24 hours. To reduce the unwanted side effects and cost of prolonged antimicrobial prophylaxis, a prospective controlled clinical multicenter study comparing the effect of a single dose before operation of tinidazole and doxycycline to five days of prophylaxis before operation in 234 patients undergoing elective colorectal surgery was undertaken. Six patients given a single dose of prophylaxis before operation (n = 118) developed infectious complication (5.1%). Prolongation of prophylaxis before operation for four days after operation (n = 116) did not lead to any further reduction of infectious complications. A single dose of tinidazole and doxycycline before operation is a simple and effective prophylaxis against infectious complications following elective colorectal surgery. | [
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10,003,505 | Vascular injuries of the axilla. | [
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] |
10,003,506 | Between January 1970 and December 1980, 65 patients sustaining 85 vascular injuries of the axillary artery and/or vein were managed at the Ben Taub General Hospital in Houston, Texas. Concomitant injuries of the subclavian and/or brachial vessels were noted in 34 per cent of patients. A variety of exposure techniques was used in approaching the axillary vessels. Emphasis upon preservation of collateral vessels led to an increased use of substitute vascular conduits over end-to-end anastomosis. The ready availability of prosthetic conduits, absence of graft infection, and excellent short-term patency have made them a primary choice for axillary arterial reconstruction in our recent experience. Associated brachial plexus injury (35%) accounted for the most significant long-term morbidity. The operative mortality was 3.1%, and one patient required upper extremity amputation following failure of repeated revascularization attempts. | [
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10,003,507 | Diagnostic discrepancies: a reply to North and Cadoret. | [
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10,003,508 | Psychiatrists are also physicians. | [
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10,003,510 | One hundred two male inmates of county jail, randomly selected from those referred for psychiatric evaluation, were studied. Ninety percent had had psychiatric hospitalization; 92% had prior arrest records, 75% for felonies. Four fifths exhibited severe, overt psychopathology. More than three fourths met the criteria for involuntary hospitalization. When arrested, more than one third were transients and only 12% were employed. Thus, this population is characterized by extensive experience with both the criminal justice and mental health systems, severe acute and chronic mental illness, and poor functioning. More than half were currently charged with felonies and 39% with crimes of violence. We were also attempted to determine why inmates had been arrested rather than hospitalized and whether there has been "criminalization" of the mentally ill. There appears to be a need for more emphasis on ongoing involuntary treatment for this population. | [
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10,003,511 | Battery incidents and batterers in a maximum security hospital. | [
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10,003,512 | Of 638 reported assaultive and disruptive incidents in 1979 in a maximum security hospital, 221 (34.6%) were batteries. Whether an incident was a battery or not was a function of time and location. Preludes to battery were noted by staff in only 23.1% of cases and were high-frequency behaviors with low predictive value. Impact and injury to patients and officers occurred through both batteries themselves and efforts to subdue the batterer. With length of hospitalization controlled, the distributions of preadmission criminal charges were not significantly different between batterers and controls. Policies that alter patterns in the timing and location of interaction among patients and in the response of officers or other personnel to batteries in progress offer promise for reducing incident and injury rates. | [
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] |
10,003,513 | Epidemiology of affective disorders. | [
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] |
10,003,514 | Data from recent epidemiological studies involving psychosocial risk factors for affective disorders are reviewed. The results of these studies are divided into the categories of depressive symptoms, bipolar depressive disorder, and nonbipolar depressive disorder. When the data are examined using these categories, remarkable consistency in psychosocial risk factors for depressive symptoms and nonbipolar depressive disorder is observed, suggesting possible continuity between these conditions. Psychosocial risk factors for bipolar disorder differ substantially from those identified for depressive symptoms and nonbipolar depressive disorder and, therefore, provide further support for the bipolar-nonbipolar distinction. | [
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10,003,515 | An evaluation of the family history method for ascertaining psychiatric disorders. | [
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10,003,516 | This methodologic study assessed the accuracy of family history data in ascertaining psychiatric disorders in relatives. Comparison of diagnoses based on family history with diagnoses based on direct interview indicated that the specificity for the family history method is high, but that the sensitivity is generally low. Accuracy was better for affective disorders and alcoholism than for less severe disorders; spouses and offspring provided more accurate information than parents and siblings. The use of multiple information increased sensitivity somewhat, with little adverse effect on specificity. However, because errors were often correlated when more than one person provided information about a particular relative, the use of multiple informants generally did not improve accuracy substantially. Analysis of family-genetic studies should take account of the differential quality of data obtained by the family history method vs direct interview. | [
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10,003,517 | Are there borderlines in Britain? A cross-validation of US findings. | [
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10,003,518 | This study extends the series of investigations of the borderline concept to a British inpatient population. It compares patient's ratings and diagnoses according to DSM-III, the international Classification of Diseases, ninth version (ICD-9), Gunderson's Diagnostic Interview for Borderlines (DIB), and Minnesota Multiphasic Personality Inventory data. A subpopulation of British inpatients was identified by DIB and DSM-III borderline criteria. All were given ICD-9 personality disorder diagnoses by their British consulting psychiatrists. The date support the concept of borderline personality disorder in the sense that there is a significant level of agreement between the DIB and DSM-III diagnoses, but the clinical and psychometric differentiation of borderline from other types of personality disorders, as well as the interrelationship between the borderline personality disorder and a concomitant depressive state, remain to be demonstrated before the validity of the borderline concept is established. | [
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10,003,519 | DSM-III schizophreniform disorder. Comparisons with schizophrenia and affective disorder. | [
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10,003,520 | We compared blind ratings of outcome and familial psychopathology across four diagnostic groups to test the validity of DSM-III schizophreniform disorder. Outcome ratings for schizophreniform disorder fell between those for affective disorder and those for schizophrenia. Outcome differences between schizophreniform and schizophrenic groups were no longer significant when patients who received somatic therapy during their index admission were excluded. Furthermore, schizophreniform probands had patterns of familial psychopathology that resembled those for schizophrenic probands more than those for affective disorder probands. In the combined group of schizophrenic and schizophreniform patients, longer illness durations at index admission predicted lower recovery rates. Our data suggests that a shorter specified duration may be appropriate in the definition of schizophreniform disorder. | [
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10,003,521 | CSF levels of gamma-aminobutyric acid in schizophrenia. Low values in recently ill patients. | [
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10,003,522 | gamma-Aminobutyric acid (GABA) levels in CSF were not significantly different in 30 drug-free schizophrenic patients and in 39 normal control subjects, because the control subjects were significantly older. Schizophrenic women had significantly lower levels than age-matched normal control women (less than 30 years). The GABA levels increased with duration of illness, number of hospitalizations, and months of hospitalizations, as well as with age. They correlated nonsignificantly with psychosis levels. After short-term pimozide treatment, GABA levels in all patients were raised, albeit nonsignificantly. The date suggest that low GABA levels may be observed only in the early years of the illness, particularly in female schizophrenic patients, and that these levels increase with time and with long-term neuroleptic treatment. | [
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10,003,523 | Viability of physical medicine and rehabilitation in the 1980s. | [
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] |
10,003,524 | Body build and its relationship to pressure distribution in the seated wheelchair patient. | [
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10,003,525 | The clinical evaluation of wheelchair cushions used to relieve pressure of patients with severe physical disability has become a major concern for the rehabilitation team. This paper describes the effects of body build, based on height, weight, sex, and age of the subjects studied, on the location, magnitude and gradient of the pressure exerted by patients seated in wheelchairs. It was found that thin patients had higher pressures over bony prominences and greater frequency of the maximum pressure occurring in a bony location than did average-weight or obese subjects. | [
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10,003,526 | Shortwave diathermy effects on 35S-sulfate uptake and glycosaminoglycan concentration in rabbit knee tissue. | [
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] |
10,003,527 | The effect of shortwave diathermy on glycosaminoglycan metabolism in different connective tissues of rabbit knee was studied by both autoradiography and radioactivity measurements and quantification of the separated glycosaminoglycans. Of 30 rabbits used, 12 received 100W shortwave diathermy to the right knee 10 minutes a day for 5 days. Autoradiography clearly showed a higher uptake of 35S-sulfate by the capsular tissues of the knee treated with shortwave diathermy than in the contralateral knee. The most prominent feature of the biochemical analysis was the increase in the galactosamine (43%) and glucosamine (26%) concentrations of the collateral ligament glycosaminoglycans of the treated knee. | [
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10,003,528 | Physical activity and inactivity influences on 14C-leucine incorporation in reinnervated rat gastrocnemius. | [
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10,003,529 | The influence of activity and inactivity in reinnervated gastrocnemius muscles of adult rats was evaluated by measuring muscle mass, sarcoplasmic proteins (SP), myofibrillar proteins (MP), and 14C-leucine incorporation. Both sciatic nerves were crushed in 18 adult female Wistar rats, 6 of which were exercised daily on a 35% grade treadmill at a running speed of 27 m/min, 6 others underwent bilateral cast-immobilization of the ankle, knee, and hip joints at 90 degrees, and 6 were kept as sedentary controls between 2 and 6 weeks after denervation. During this period, all animals received daily an injection of 0.2 ml of 14C-leucine (sp. activity 51.4 muCi/mM). The exercised rats had similar muscle mass, but significantly increased in both MP and 14C-leucine incorporation, when compared to the sedentary rats. In contrast, the cast-immobilization group showed significant decreases in muscle weight and 14C-leucine incorporation in SP. These results suggest that activity enhances the apparent synthesis of MP in reinnervating muscles, but does not indicate that inactivity interferes with or limits the process of reinnervation by impeding the synthesis of SP or MP. | [
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10,003,530 | Rehabilitation medicine: follow-up study on teaching communication skills. | [
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10,003,531 | A communication skills training course was given to 22 rehabilitation professionals and the results were previously reported. The level of communication skills was also evaluated in 18 months after the course in 15 of the 22 trainees using written and videotape tests. Although scores were lower than those on previous postcourse testing, they were significantly higher than on precourse testing. Communications skills can be taught using the Human Resources Development Model and appear to result in a lasting improvement in communication. | [
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10,003,532 | Electromyographic evidence of inferior gluteal nerve compromise: an early representation of recurrent colorectal carcinoma. | [
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10,003,533 | Lumbosacral or primary buttock pain and cutaneous anesthesia in the distribution of the posterior femoral cutaneous nerve were the initial symptoms in 5 patients later proven to have extensions of previously resected colorectal malignancy. The initial electromyographic impression of an inferior gluteal nerve mononeuropathy associated with recurrent neoplasia was confirmed by a positive colon biopsy in 1 case and widespread pelvic metastasis demonstrated at laparotomy in the 4 remaining cases. Four of the 5 patients also had increased levels of carcinoembryonic antigen. Roentgenographs and other laboratory data were otherwise normal in all 5 cases. Entrapment of the inferior gluteal nerve and the accompanying posterior femoral cutaneous nerves is facilitated by its medial, intrapelvic fixation at its origin from the sciatic nerve and the crowding effect of the piriformis muscle above, the dorsal rim of the sciatic notch behind and the inferior gluteal vessels and nodes below. The demonstration of hypestesia over the inferior lateral buttock and a concomitant history of colorectal malignancy should alter the examiner to the possible presence of an inferior gluteal nerve neuropathy. | [
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10,003,534 | Physical and surgical examination of patient after 6-year coma. | [
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10,003,535 | A patient with head trauma who had been comatose for 6 years and residing in a nursing home, began to respond to her environment and subsequently underwent rehabilitation that resulted in significant recovery. Speech and psychologic functions that had been severely affected improved considerably after 9 months training. Surgical release of immobilization contractures that had prevented significant use of any extremity, resulted in healing of several decubitus ulcers and allowed the patient to regain some ADL skills in a wheelchair. Further urethral erosion was prevented by adequate hygiene and release of adductor spasticity. After 14 months of intensive rehabilitation and family teaching, the patient was able to live at home with her family. | [
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10,003,536 | Limb load monitor: evaluation of a sensory feedback device for controlled weight bearing. | [
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] |
10,003,537 | In order to evaluate usefulness of the Limb Load Monitor (LLM), an auditory feedback device, in a prescribed weight-bearing program, a clinical study was conducted. Results were divided into objective and subjective findings. Objective findings substantiated that both the study group and control group reached established goals, but the study group reached goals twice as fast. Subjective findings indicated that the device served to remind and assume the patient that weight bearing was being performed as prescribed. | [
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10,003,538 | Physiatry and the physiatrist: a personal experience. | [
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10,003,539 | Management of the appendix in young patients with Crohn's disease. | [
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10,003,540 | Sixty-six young patients (average age, 17.2 years) underwent intestinal operations for Crohn's disease during a 14-year period at the UCLA Hospital. Nine had undergone previous appendectomy for suspected appendicitis, and in seven subsequent enteric fistulae and/or obstruction involving the cecum developed. None of the appendices were acutely inflamed. During the same period, a total of 125 children with Crohn's disease underwent medical or surgical care, and in none did acute appendicitis develop. Of the 66 patients under 22 years old who required intestinal resection, 60 had removal of the cecum. In a child with ileal Crohn's disease, rarely should a normal appendix be removed because of the high likelihood of complications and the low incidence of subsequent appendicitis. | [
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10,003,541 | Traumatic diaphragmatic hernia. | [
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10,003,542 | The records of 36 patients with traumatic diaphragmatic hernia (TDH) were reviewed. In 14, acute hernias were diagnosed, but the diagnosis was made one month to 15 years after injury in 22 patients with chronic hernia. Seven acute TDHs were due to blunt and seven to penetrating trauma. Four chronic TDHs were due to blunt and 18 to penetrating trauma. Chest pain, abdominal pain, or dyspnea occurred in each acute case and in 18 of 22 chronic cases. Plain chest roentgenograms were abnormal in 33 of 36 cases. Pleural effusion or abnormal diaphragmatic contour were common abnormal findings. Supradiaphragmatic bowel, pathognomonic of TDH, was evident in seven acute and eight chronic hernias. Celiotomy was routinely employed in acute hernias, celiotomy or thoracotomy in chronic hernias. There were three deaths, two with associated CNS injury and one with chronic pulmonary disease. | [
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10,003,543 | Hepatic resection of metastatic colorectal carcinoma: a ten-year experience. | [
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10,003,544 | Nineteen patients have undergone partial hepatectomy for metastatic colorectal carcinoma at UCLA during the past ten years, including five trisegmentectomies (TS), eight lobectomies (L), and six segmentectomies (SG), with only one (5.3%) mortality. Twelve lesions were solitary (S) and seven multiple (M). Mean survival is 27.4 months, with three patients surviving over five years and one nearly eight years. Better mean survival exists for S (33.2 months) compared with M (15.8 months) lesions; for lesser resections: SG (44.7 months), compared with L (24.3 months) and TS (11.0 months); and for those with delayed appearance of hepatic metastases: beyond two years (40.5 months), less than one year (24.8 months), and synchronous (23.1 months). Survival figures should improve, as none of the 12 surviving patients have evidence of recurrent disease and many have short follow-up. This experience defends aggressive surgical treatment of resectable colorectal carcinoma metastatic to liver, because systemic therapy is markedly less effective. | [
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10,003,545 | Prothrombin and partial thromboplastin times as preoperative screening tests. | [
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10,003,546 | Preoperative tests of coagulation function have been suggested to detect patients who are likely to have abnormal bleeding during and after surgery. A study was designed to determine the yield of prothrombin time (PT) and partial thromboplastin time (PTT), both in discovering patients who are at risk for abnormal bleeding and in inducing changes in patient care or outcome. Of 750 patients on three surgical services, 611 (81%) patients had no indication of a bleeding disorder on history or physical examination. Of the 139 patients who had clinical indications, 25 (18.0%) patients had an abnormal PT or PTT. Of the 611 patients without clinical indications, 480 patients had the PT or PTT determined, and 13 (2.7%) patients had abnormal results. One (0.2%) of the 480 patients might have benefited from the test result (this patient required a second operation to control arterial bleeding). The prolonged PT or PTT was of no apparent clinical importance in the remaining 12 patients without indications of bleeding disorders preoperatively. The low yield of the PT and PTT in detecting unsuspected bleeding disorders preoperatively was further obscured by the larger number of apparently false-positive results. | [
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10,003,547 | Real-time Doppler spectrum analysis: predictive value in defining operable carotid artery disease. | [
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10,003,548 | A prospective study compared the sensitivity, specificity, and predictive value of indirect periorbital Doppler screening and direct carotid Doppler interrogation using real-time sound spectrum analysis to detect operable extracranial carotid occlusive disease. The results of noninvasive studies were compared with independently assessed contrast arteriograms of carotid arteries of patients studied for symptomatic cerebrovascular disease. Periorbital Doppler ultrasound was insensitive to carotid stenosis of less than 75% and did not distinguish operable stenosis from inoperable occlusion of the internal carotid artery. Carotid Doppler spectrum analysis was sensitive to 98% of hemodynamically significant disease and correctly discriminated 77% of carotid occlusions, 96% of stenoses larger than 50%, and 70% of stenoses of less than 50%. The predictive value for direct carotid interrogation in identifying carotid occlusion or operable stenosis was 94% and 86%, respectively. Real-time spectrum analysis of direct carotid Doppler signals substantially improves the diagnostic accuracy of noninvasive identification of operable carotid artery disease. | [
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10,003,549 | Evaluation of carotid bifurcation disease: the role of common carotid artery velocity patterns. | [
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] |
10,003,550 | We evaluated duplex ultrasonographic velocity patterns from the common carotid artery in 156 patients with arteriographically verified internal carotid artery disease. Flow to zero during diastole in the common carotid was found in three groups of patients: (1) those with flow to zero in both common carotids not related to disease of the carotid bulb; (2) those with a tight (90% to 99%) stenosis in the internal carotid; and (3) those with total occlusion of the internal carotid. Although such flow to zero is commonly observed with total occlusion of the internal carotid artery, it may also be seen with high-grade stenosis. Thus, when found, it is essential to ascertain if flow is indeed present in the internal carotid artery; understanding changes in velocity patterns of the common carotid has improved our overall accuracy in detecting extracranial carotid artery disease. | [
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10,003,551 | Preoperative roentgenographically guided percutaneous localization of occult breast lesions: three-year experience with 180 patients and description of a method. | [
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10,003,552 | The identification of a suspicious occult breast lesion with mammography should, in most instances, result in roentgenographically guided localization followed by surgical excision. Over a three-year period, we performed 180 roentgenographically guided preoperative localizations for occult breast lesions, 32% (57/180) of which were malignant. Of the total, there were 85 masses and 95 clustered microcalcifications. We prefer to use a modified hookwire for lesion localization. | [
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10,003,553 | Graded compression stockings: custom vs noncustom. | [
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10,003,554 | Graded compression stockings of the leg (high pressure at the ankle and low pressure at the thigh) seem to help the return of venous blood to the heart and reduce the incidence deep-vein thrombosis and pulmonary emboli in supine patients. Recent advances allow noncustom stockings to be chosen for mesomorphic patients by leg length and calf circumference yet deliver the desired level of graded compression. To test the hypothesis that custom-tailored and noncustom, low-modulus. circular-knit stockings are equally efficient, a Doppler instrument and recorder were used to continually monitor femoral-vein velocity both when the patient had the stocking on and after it was removed. The changes in venous velocity after removal of custom and noncustom stockings were similar (-19% and -27%, respectively). In the five patients with whom both types of stocking were evaluated, the changes were -24% for custom and -22% for noncustom stockings. Using Laplace's law and measuring the tension created by a given stretch (circumference), low-modulus stockings were shown to deliver a more uniform pressure over a greater range of leg circumference than did high-modulus stockings. These results justify the use of noncustom, low-modulus, circular-knit elastic stockings to increase femoral-vein velocity in supine, mesomorphic patients. | [
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] |
10,003,555 | Isolated atherosclerotic aneurysms of the internal iliac arteries: report of two cases and review of literature. | [
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10,003,556 | Isolated arteriosclerotic aneurysms of the internal iliac artery are uncommon, with an incidence approaching 0.4%. Although the symptoms invariably involve the genitourinary or gastrointestinal systems, the aneurysms may be found during abdominal, rectal, or vaginal examinations. The 75% mortality associated with the rupture of an internal iliac aneurysm mandates for early surgery for these aneurysms. Operation may consist of ligation of the internal iliac artery, excision of the aneurysm, or an obliterative endoaneurysmorrhaphy. While the operative mortality has average 33.3%, there were no operative deaths in this series. | [
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10,003,557 | Delayed wound infection. An 11-year survey. | [
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10,003,558 | A small number of patients manifest wound infections several months to several years after their operations. A study was undertaken to delineate the clinical characteristics of patients whose infections became apparent after a prolonged time interval from surgery. Twenty-six patients were admitted to the New York Hospital-Cornell University Medical Center, with wound infections that occurred more than six months postoperatively. There were three distinct groups. The first group consisted of patients with Staphylococcus aureus infections related to superficial stitch abscesses. The second group comprised patients with pacemaker infections; S epidermidis was the most frequently recovered organism. The third group consisted of patients with more clinically significant infections. These infectious complications followed genitourinary, gastrointestinal, and biliary surgery. The findings of this study suggest that most of these infections are caused by organisms introduced into the wound at the time of surgery; these organisms may become active because of alterations in the host's resistance. | [
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10,003,559 | Humoral-phagocyte axis of immune defense in burn patients. Chemoluminigenic probing. | [
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10,003,560 | Both serum opsonic capacity and granulocyte oxygenation activity were measured in 35 burn patients during their course of therapy. The microbicidal action of granulocytes is effected via the metabolic generation of oxygenating agents; introduction of chemoluminigenic substrates, such as luminol or dimethyl biacridinium dinitrate, allows ultrasensitive measurement of phagocyte oxygenation activity. Serum opsonic capacity can also be assayed by measuring the rate of activation of phagocyte oxygenation activity. Alterations in granulocyte oxygenation activity were observed in individuals patients in temporal association with changes in clinical condition, and sepsis was associated with a marked decrease in activity. An initial depression in opsonic capacity was noted at the time of admission of patients with major burns, more than 40% total body surface. Thereafter, depression of opsonic capacity was temporally associated with sepsis in individual patients. Chemoluminigenic probing provides a rapid, sensitive, and objective method for assessing the status of the humoral-phagocyte axis, and as a clinical laboratory technique is particularly applicable for monitoring patient populations in which sepsis is prevalent. | [
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10,003,561 | Altered hepatocellular active transport. An early change in peritonitis. | [
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10,003,562 | Multiple system failure is often the final result of severe infection that cannot be controlled. The changes that may occur in remote organs and cells in the early stages of sepsis and that may initiate this process have not been defined. To study this, indocyanine green (ICG) clearance, serum enzyme levels, and reticuloendothelial (RE) function were measured during various stages of sepsis, which was produced in rats by cecal ligation and puncture (CLP). The clearance of ICG decreased significantly during the early stages of sepsis (five hours after CLP) at a time when there was no change in the serum enzyme levels or RE function. Ten hours after CLP, RE function was depressed, and serum enzyme levels were elevated. Progressive changes in RE function and serum enzyme levels occurred in the late stages of sepsis (16 hours after CLP). Since unaltered hepatic adenosine triphosphate levels have been previously found, even ten hours after CLP, humoral factor(s) may be responsible for altered ICG clearance in the early stages of sepsis. Thus, hepatocellular dysfunction occurred early in the course of sepsis and was manifested by a deficit in a plasma membrane active transport process (ICG clearance). Indocyanine green clearance provided an extremely sensitive early indication of a hepatic abnormality. | [
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10,003,563 | Duration of preventive antibiotic administration for penetrating abdominal trauma. | [
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10,003,564 | Eighty-two patients with penetrating abdominal trauma and visceral injuries requiring laparotomy were prospectively randomized to receive either 12 hours or five days of penicillin G potassium and doxycycline hyclate beginning before operation. Distribution between groups was equivalent for all risk factors except shock, which was more prevalent in the 12-hour group. Antibiotics were first administered an average of 64 minutes following injury, and 90% of all patients had received antibiotics and were being operated on within 3 hours 15 minutes. Overall infection rates were 17% in patients with colon penetration, 14% in patients without colon penetration but with other intestinal penetration, and 0% in patients without intestinal penetration. Twelve-hour and five-day antibiotic regimens were comparable in the prevention of postoperative infectious complications following penetrating abdominal injuries. Intestinal penetration was the most important risk factor for developmental of infectious complications in this patient population. | [
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10,003,565 | Generalized peritonitis. To irrigate or not to irrigate the abdominal cavity. | [
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10,003,566 | The objectives of surgery for generalized peritonitis are to eliminate the source of continual bacterial contamination and to prevent septicemia and intra-abdominal abscess formation. A prospective randomized study of three different operative approaches of treating residual peritoneal contamination was undertaken: group 1, no peritoneal irrigation (14 patients); group 2, intraoperative peritoneal irrigation (15 patients); group 3, both intraoperative and postoperative peritoneal irrigation (15 patients). The mortality in groups 1, 2, and 3 was 28.5%, 26.6%, and 33%, respectively. The overall incidence of septicemia and intra-abdominal abscesses in groups 1, 2, and 3 was 23%, 22%, and 17%, respectively. In those patients who survived, the incidence of intra-abdominal abscesses, wound infection, and septicemia was 6%, 23%, and 13%, respectively. In this series, there was no detectable difference in the mortality and infectious complications between the three treatment groups. The only clinical factors that adversely affected mortality and morbidity were peritonitis originating from the colon and age greater than 60 years. Early surgical intervention with removal of the source of peritonitis, debridement of all necrotic tissue, and drainage of abscesses remain the cornerstones of successful therapy in generalized peritonitis. | [
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10,003,567 | Pathologic synergy in cardiovascular and respiratory compensation with cirrhosis and sepsis. A manifestation of a common metabolic defect? | [
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10,003,568 | Multivariable physiologic studies of cardiovascular, respiratory, and metabolic functions were performed in 341 patients (884 studies). Eighty patients had cirrhotic liver disease, 64 had sepsis, 87 had nonseptic cariogenic syndromes, and 110 had nonseptic general surgical or traumatic injury. The group with cirrhosis had the highest cardiac index and ejection fraction. When compared with the group with nonseptic surgery or trauma, vascular tone was reduced in the patients with cirrhosis or sepsis and was lowest in patients with both conditions. Ventricular function was good in the groups with cirrhosis or sepsis, due to the additive effect in reducing vascular tone that allowed ejection fraction to increase, but caused the ratio of alveolar ventilation to perfusion (VA/QT) to fall, resulting in a greater perfusion of a decreased pulmonary vascular bed. The falls in vascular tone and VA/QT in patients with cirrhosis or sepsis result from the reduced oxygen consumption that occurs due to metabolic imbalance (B state). This B state seems to reflect a hepatic inability to metabolize aromatic amino acids, so that levels of tyrosine, phenylalanine, and the false neurotransmitter octopamine increase. These mechanisms are pathologically synergistic when sepsis and cirrhosis occur together. | [
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10,003,569 | Amebic liver abscess. | [
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10,003,570 | Amebic liver abscess was seen in 35 patients over a ten-year period at Cook County and the University of Illinois hospitals, Chicago; 32 had immigrated from an area of endemic amebiasis, but three were natives of Chicago. Typically they had right upper-quadrant abdominal pain and fever of short duration (nine days); on physical examination, upper abdominal tenderness and hepatomegaly were usually present. The diagnosis was confirmed by liver scan, serologic studies, aspiration of "anchovy paste" from the abscess, and/or a favorable response to specific antiamebic therapy. Most were solitary abscesses in the right lobe of the liver. Metronidazole treatment alone was adequate in 24 of 29 patients (83%). Nine patients underwent percutaneous or surgical drainage of the abscess owing to incorrect diagnosis (three), persistent pain and fever after medical treatment (three), expanding left lobe abscess (two), and for diagnosis (one). Mortality was 5.7% (two patients). Owing to current immigration patterns amebic liver abscess should be considered in the differential diagnosis of patients with right upper-quadrant pain and fever. The diagnosis should be confirmed with a liver scan and serologic study for amebiasis. | [
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10,003,571 | Calcification of Meckel's diverticulum. | [
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10,003,572 | Ileocecal valve: misconceptions. | [
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10,003,574 | The incidence of radiation-induced parotid cancer. | [
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10,003,575 | Separation of en bloc cadaveric kidneys with a linear anastomosis stapler. | [
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] |
10,003,576 | Aphasia with nonhemorrhagic lesions in the basal ganglia and internal capsule. | [
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10,003,577 | Atypical aphasia syndromes were associated with circumscribed nonhemorrhagic infarctions of the anterior limb of the internal capsule and of the striatum, in the dominant hemisphere. None of the several cases could be classified in terms of the classic cortical aphasia syndromes, nor did they correspond to the description of aphasia produced by hemorrhage in the thalamus or putamen. Control subjects without aphasia had lesions in the same structures of the nondominant hemisphere, or they had comparably circumscribed damage, which was located lateral or caudal to the previously indicated locus. The findings raise the question of participation of the dominant striatum, and of the connectional systems that course in the anterior limb of the internal capsule, in language processing. | [
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10,003,578 | Guillain-Barré syndrome in the US Army. | [
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] |
10,003,579 | Using the US Army's operational reporting system, the medical records of soldiers with Guillain-Barré syndrome were retrieved and compared with reported incidence figures from the 1976 national influenza immunization program. Military personnel sustained an incidence of disease approximatley 50% higher than unvaccinated civilians but less than 25% of the rate attributed to civilian vaccinees. | [
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10,003,581 | The study of a patient with remarkable disorientation for place associated with an acute nondominant parietooccipital lesion raised the general question of a relationship between disorientation for place and topographical disorientation. The literature does not address this matter. The clinical findings of one case in particular are presented here in detail. Another six patients had been seen with a disproportionate disorientation for place; in each there was an acute insult to the nondominant hemisphere. Based on these cases, there is preliminary evidence of a possible relationship. | [
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10,003,582 | Lacunar infarcts: clinical and computed tomographic correlations. | [
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10,003,583 | The computed tomographic (CT) findings in 34 patients in whom 45 lacunae were observed were reviewed. Twenty-four patients had a recent stroke-like clinical picture, whereas in ten patients, symptoms developed gradually. Three patients had no abnormal neurologic findings. Twenty-two patients had evidence of systemic arterial hypertension. A round or ovoid, sharply marginated, nonenhancing hypodense lesion that was smaller than 20 mm in diameter and that was seen on only two scan sections was considered characteristic of a cerebral lacuna. With the use of "high resolution" CT, the frequency of the diagnosis of cerebral lacunae by CT has markedly increased. | [
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10,003,584 | On-site seizure clinic: impact on th welfare of mentally retarded, institutionalized patients. | [
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10,003,585 | Progressive hemifacial atrophy: report of three cases, including one observed over 43 years, and computed tomographic findings. | [
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10,003,586 | Three cases of progressive hemifacial atrophy were studied. In two patients, abnormalities were noted on the computed tomographic (CT) brain scan, whereas a third patient, with widespread cutaneous and neurologic involvement, had a normal CT scan. Patient 1, first described 44 years ago, had a neurologic disorder with features that have previously been associated with progressive hemifacial atrophy, but that have appeared years after the hemifacial atrophy ceased progression. | [
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10,003,587 | Polyamine levels in CSF from patients with pituitary tumors or nonneoplastic pituitary disease. | [
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10,003,588 | Cerebrospinal fluid polyamine determinations were performed in 21 patients harboring pituitary tumors and six patients with nonneoplastic pituitary disease. Although CSF putrescine levels were significantly elevated in some patients harboring tumors, other patients showed no elevation. Polyamine levels did not correlate with tumor size, as assessed by the presence or absence of suprasellar extension. Data on patients harboring nonneoplastic pituitary disease were variable. Compared with other findings from this laboratory on the use of polyamine levels for the diagnosis and management of other brain tumors, these findings suggest that CSF polyamine levels will not have a significant diagnostic role in the treatment of patients suspected to have pituitary disease. | [
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] |
10,003,589 | Botulism: a case with associated sensory abnormalities. | [
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10,003,590 | A 25-year-old man with type A botulism had prominent sensory symptoms and signs, which are findings that have not been previously reported to date. A sensory mononeuropathy multiplex was suspected. Sensory abnormalities do not exclude the diagnosis of botulism. | [
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10,003,591 | Chronic amebic meningoencephalitis. | [
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10,003,592 | A patient had a five-year history of sleep disturbance that culminated in a confusional illness with convulsions from which he made a partial recovery. On three separate occasions, the same ameba (Hartmannella rhysodes) was seen in and cultured from the patient's CSF. There was a rising serum titer of immobilizing antibody against the isolated strain of the ameba. The diagnosis of chronic amebic meningoencephalitis was considered in this patient. | [
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10,003,593 | Intracranial solitary extraskeletal plasmacytoma resembling meningioma. | [
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10,003,594 | A patient had an intracranial solitary extraskeletal plasmacytoma (SEP). To date, only 12 similar cases have been reported in the English literature. This report includes the first description of computed tomographic findings in a patient with intracranial SEP. There is a striking similarity between the features of intracranial SEP and meningiomas. A detailed comparative study of the features of these two neoplasms was done. The findings indicate that the age and sex distribution, clinical features, location of the tumors, roentgenographic findings, and even the gross pathologic nature of the two neoplasms are very similar. The course and prognosis, however, are probably different. Intracranial SEP, although rare, should be included in the differential diagnosis of brain tumors that arise in areas where meningiomas commonly arise. | [
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10,003,595 | The histologic effect of intraventricular injection of metrizamide. | [
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10,003,596 | A patient with sudden apoplexy and coma was found to have hydrocephalus on computed tomographic scan, and metrizamide was instilled into the ventricles. Subsequent autopsy disclosed a brainstem infarct secondary to a primary dissecting aneurysm of the basilar artery, and a histologic picture of encephalitis in the walls of the lateral and third ventricles. Metrizamide may cause pathologic changes that must be recognized for the correct interpretation by the pathologist of tissue sections previously exposed to metrizamide. In the present case, the changes were seen 11 days after exposure of the tissue to metrizamide, consonant with the time course of similar changes observed in animals. The localization of the cellular infiltrates to the Virchow-Robin spaces corroborates evidence from the literature that metrizamide enters brain parenchyma via these spaces. | [
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10,003,597 | Brain abscess caused by Strongyloides stercoralis. | [
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10,003,598 | Carbamazepine-induced ophthalmoplegia. | [
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] |
10,003,599 | Diagnosis of thrombotic giant basilar artery aneurysm on computed tomographic scan. | [
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] |
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