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Management of Peyronie disease by implantation of inflatable penile prosthesis.
Sixty-seven patients with advanced Peyronie disease were treated by implantation of an inflatable penile prosthesis (IPP).
Twenty-eight of the 67 patients had documented total erectile failure.
The remaining 39 patients had significant penile curvature causing "mechanical impotence" due to inability to achieve adequate vaginal penetration and chose implantation of an inflatable penile prosthesis (in some cases, combined with a straightening procedure) rather than one of the standard penile straightening procedures.
Currently, 63 of the 67 patients have functioning prosthetic devices; in 3 other patients the device was removed because of infection, and 1 patient was dissatisfied and had the device removed.
For impotent patients with severe Peyronie disease for whom other medical or surgical treatment is neither desirable nor suitable, we recommend implantation of an inflatable penile prosthesis combined with a possible straightening procedure.
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601
| 6,415
|
Antenatal microbiologic and maternal risk factors associated with prematurity.
In a prospective study of 202 women (gestational age 24 +/- 4 weeks), we evaluated possible influences of lower genital tract infection or bacterial conditions on obstetric outcomes, including preterm labor, preterm premature rupture of membranes, and preterm birth.
The presence of bacterial vaginosis (18.7%) was associated with an increased risk of preterm labor (relative risk, 2.6; 95% confidence interval, 1.08 to 6.46).
For women with bacterial vaginosis who also had Mobiluncus species morphotypes identified on Gram stain, the relative risk of preterm labor was 3.8 (95% confidence interval, 1.32 to 11.5).
Presence of vaginal Mycoplasma hominis (10.8% of patients) was associated with both preterm labor (relative risk, 1.8; 95% confidence interval, 0.77 to 4.4) and preterm birth (relative risk, 5.1; 95% confidence interval, 1.45 to 17.9).
Recovery of Staphylococcus aureus (3.0%) was associated with preterm labor (relative risk, 3.1; 95% confidence interval 1.12 to 8.7).
Identification of two or more bacterial-linked abnormalities was also associated with preterm labor (relative risk, 3.3; 95% confidence interval, 1.44 to 7.58).
An increased level of vaginal wash protease (greater than or equal to 10 trypsin units) (16%) was associated with preterm labor and was noted in 50% of women with preterm premature rupture of membranes.
A history of prior preterm birth was the single best historical predictor of both preterm labor (relative risk, 3.6; 95% confidence interval, 1.92 to 6.83) and preterm birth (relative risk, 6.7; 95% confidence interval, 2.2 to 20.4).
History of three or more abortions, antenatal urinary tract infection, and occurrence of medical complications during pregnancy also correlated with increased risk of preterm labor.
These findings affirm and refine associations of various maternal reproductive tract infections with preterm labor, premature rupture of membranes, and birth, allowing for controlled treatment trials aimed at prevention of preterm birth.
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602
| 2,804
|
Manual ventilation bags as a source for bacterial colonization of intubated patients.
A group of 14 intensive care unit (ICU) patients were studied to determine if manual ventilation bags (MVB) could serve as a source of bacterial or fungal pathogens that could colonize the respiratory tract of intubated patients.
A total of 51 cultures were simultaneously obtained of patient's sputum, the exterior MVB surface, MVB port, and MVB interior (postexhalation valve).
Pathogens colonizing or infecting the respiratory tract of intubated ICU patients were frequently simultaneously present on the exterior surface of the MVB and inside the MVB port used to connect the MVB with the endotracheal tube.
In addition, coagulase-negative staphylococci and yeast were frequently present on the exterior surface of the MVB.
The interior of the MVB was usually sterile.
In three instances pathogens were isolated from the MVB before isolation from the patient's sputum.
MVB may serve as a source for colonizing the respiratory tract of intubated ICU patients and/or the hands of medical personnel.
The exterior surface and port of MVB should be cleaned of visible debris and disinfected at least once a day.
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603
| 9,922
|
Prevention of a false diagnosis of sexually acquired reactive arthritis by synovial lymphocyte responses.
Three cases are reported in which a diagnosis of sexually acquired reactive arthritis might have been made erroneously from the history, but the enteric origin of the reactive arthritis was evident from synovial lymphocyte responses.
The importance of making the correct diagnosis and the avoidance of unwarranted spousal dysharmony is stressed.
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604
| 6,679
|
Tetanus immunization status and immunologic response to a booster in an emergency department geriatric population.
STUDY OBJECTIVES: Although effective procedures for the prevention of tetanus have long been available, serosurveys done since 1977 demonstrate that 49% to 66% of the elderly population lacks a protective antitoxin level (more than 0.01 IU/mL).
This study was undertaken to assess the tetanus immunization status of patients presenting to an emergency department and to evaluate their immunologic response to a tetanus booster.
SETTING: The study was conducted in a tertiary care ED.
TYPE OF PARTICIPANTS: The patients enrolled were 65 or more years old and had breaks in their skin barriers.
DESIGN: At each patient's initial presentation, pertinent demographic data and tetanus immunization history were recorded.
The patient was then followed for 21 days.
INTERVENTIONS: Each patient's antitoxin titer was determined on a serum sample by ELISA, and, if required by the Advisory Committee on Immunization Practices criteria, a booster was administered at the first visit.
MEASUREMENTS AND MAIN RESULTS: Serum antitoxin assays were repeated on days 7, 14, and 21 after the initial visit until seroconversion (titer more than 0.01 IU/mL).
Forty-four patients (55%) had protective levels at initial presentation, and in 36 (45%) the levels were not protective.
Age and sex were not predictive of protection.
Past military service and a definite history of three or more previous immunizations were good predictors of protection.
Of 34 patients who were followed serially for inadequate initial titers, only 19 (56%) seroconverted by day 14.
Patients who did not seroconvert were more likely to be older (P less than .05).
CONCLUSIONS: This study demonstrated that a significant number of elderly patients lacked an initial protective level of tetanus antitoxin.
Of these, 44% failed to seroconvert within 14 days and carried a potential risk of developing tetanus.
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605
| 4,187
|
Amputation or limb-lengthening for partial or total absence of the fibula.
Thirty-two patients who had ablation of the foot by the Syme or Boyd technique for partial or total absence of the fibula, with subsequent fitting of a prosthesis, were compared with eleven patients who had lengthening of the lower limb by the Wagner method, to assess the long-term results of each procedure.
The final results were evaluated on the basis of pain, limp, limb-length discrepancy, level of physical activity, and satisfaction of the patient.
Of the thirty-two patients who had an amputation, twenty-eight (88 per cent) had a satisfactory result, compared with only six (55 per cent) of the eleven patients who had limb-lengthening.
The amount of inequality between the lower limbs was classified as follows: Group I--the foot of the shorter extremity was at the distal third of the contralateral, normal limb, and the percentage of shortening was 15 per cent or less; Group II--the foot of the shorter extremity was at the level of the middle third of the contralateral, normal limb, and the percentage of shortening was between 16 and 25 per cent; and Group III--the foot of the shorter extremity was at the level of the proximal third of the contralateral, normal limb, and the percentage of shortening was greater than 26 per cent.
Lengthening was best suited for patients in Group I who had stable hips, knees, and ankles and a plantigrade foot.
Patients in Groups II and III were best served by ablation of the foot and fitting of a prosthesis.
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606
| 2,717
|
hemofiltration reverses left ventricular dysfunction during sepsis in dogs.
Depressed left ventricular (LV) contractility in sepsis has been ascribed to the presence of circulating cardiodepressant substance (filterable cardiodepressant factor in sepsis [FCS]); however, this finding is controversial.
The authors hypothesized that if a decrease in LV contractility indeed occurred due to a circulating depressant substance, then removal of this substance by hemofiltration would reverse by dysfunction.
In this study, LV mechanics were examined before and after hemofiltration in anesthetized dogs during continuous intravenous infusion of live Escherichia coli.
Left ventricular anterior-posterior and apex-base dimensions were measured by subendocardial ultrasonic crystal transducers implanted 4 weeks before the experiments.
Left ventricular contractility was determined from the end-systolic pressure-dimension relationship.
The slope of this relationship (Emax) is an index of contractility.
After 4 h of sepsis, Emax was reduced by one half.
Hemofiltration resulted in a return of Emax to control values.
The FCS activity in the plasma was also assessed by the percent reduction in isometric contraction of electrically stimulated, isolated right ventricular trabeculae obtained from nonseptic dogs.
The FCS activity reached a peak 4 h after sepsis and was reduced after 2 h of hemofiltration.
The results show that during experimental sepsis, a circulating substance of less than 30,000 d produces a decrease in LV contractility and that this LV dysfunction may be improved by hemofiltration.
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607
| 7,744
|
Eustachian valve endocarditis.
M mode and cross sectional echocardiography showed a highly mobile globular pedunculated mass(3.0 cm long with a maximum diameter of i.5 cm) attached to the eustachian valve in a heroin addict with staphylococcal endocarditis.
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608
| 858
|
The many faces and phases of borreliosis II.
Borrelia burgdorferi, the etiologic agent of Lyme disease, has also been associated with other cutaneous conditions.
Acrodermatitis chronica atrophicans and lymphadenosis benigna cutis are also caused by B.
burgdorferi.
Recent evidence links some cases of progressive facial hemiatrophy of Parry-Romberg, benign lymphocytic infiltrate of the skin (Jessner-Kanof), lichen sclerosus et atrophicus, morphea, and Shulman syndrome with borreliae.
This article reviews the manifestations of the diseases definitely linked to borreliosis and the evidence linking borreliae to progressive facial hemiatrophy, benign lymphocytic infiltrate, lichen sclerosus et atrophicus, morphea, and Shulman syndrome.
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C01
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609
| 8,201
|
Mycobacterium leprae-specific T cells from a tuberculoid leprosy patient suppress HLA-DR3-restricted T cell responses to an immunodominant epitope on 65-kDa hsp of mycobacteria.
The polar tuberculoid type (TT) of leprosy, characterized by high T cell reactivity to Mycobacterium leprae, is associated with HLA-DR3.
Surprisingly, DR3-restricted low T cell responsiveness to M.
leprae was found in HLA-DR3-positive TT leprosy patients.
This low responsiveness was specifically induced by M.
leprae but not by M.
tuberculosis and was seen only in patients and not in healthy controls.
We studied this patient-specific, M.
leprae-induced, DR3-restricted low T cell responsiveness in depth in one representative HLA-DR3-positive TT leprosy patient by using T cell clones.
From this patient two types of T cell clones were obtained: one type was cross-reactive with M.
tuberculosis and recognized an immunodominant epitope (amino acids 3 to 13) on the 65-kDa heat shock protein (hsp) the other type was M.
leprae specific and reacted to a protein other than the 65-kDa one.
To examine whether these M.
leprae-specific T cell clones were responsible for the DR3-restricted low responsiveness to M.
leprae, we tested them for the ability to suppress the proliferation of the DR3-restricted, 65-kDa, hsp-reactive clones.
The DR3-restricted, M.
leprae-specific T cells completely suppressed the proliferative responses of DR3-restricted, cross-reactive T cell clones to the 65-kDa hsp from the same patient as well as from other individuals.
Also, DR3-restricted responses to an irrelevant Ag were suppressed by the M.
leprae-specific T cell clones.
However, no suppression of non-DR3-restricted T cell responses was seen.
Although the mechanism must still be elucidated, this M.
leprae-induced, DR3-restricted immunosuppression may at least partly explain the observed DR3-associated low T cell responsiveness in TT leprosy patients.
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C01
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610
| 5,997
|
Syphilis, human immunodeficiency virus infection, and targeting prevention.
To examine the interaction between syphilis and human immunodeficiency virus-type 1 (HIV-1) infection in Oklahoma, we conducted an unlinked HIV seroprevalence survey using serum specimens submitted to the Oklahoma State Department of Health for serologic test for syphilis.
Of specimens with positive results from fluorescent treponemal antibody absorption test (FTA-ABS), 6.3% were HIV-1 seropositive compared to 0.8% of those that had negative results from FTA-ABS.
Among specimens positive for syphilis, HIV-1 seropositivity was found almost exclusively among those from persons 20 to 39 years of age and more often among those from men than those from women (9.9% vs 1.3%).
Of syphilis-positive specimens from 20- to 39-year-old men, 17.6% were HIV-1 seropositive.
In Oklahoma, an area with a relatively low overall prevalence of HIV-1 infection, targeting prevention efforts to young adults who test positive for syphilis should be an efficient way to reach some persons at high risk for HIV-1 infection.
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C01
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611
| 7,081
|
Levels of serum granulocyte colony-stimulating factor in patients with infections.
To clarify the physiologic roles of granulocyte colony-stimulating factor (G-CSF) in infectious states in vivo, we examined the serum levels of G-CSF in patients with infection.
Serum samples from 24 patients in the acute stage of infection (14 men and 10 women, age 65 to 101, without hematologic disorders), as well as samples from 32 age-matched normal elderly volunteers were investigated.
Sixteen of the initial 24 patients were reexamined after the recovery phase.
G-CSF levels were examined by quantitative enzyme immunoassay.
The G-CSF level in normal elderly controls, 25.3 +/- 19.7 pg/mL, was not different from that reported in other findings.
There was no statistically significant relationship between their G-CSF level and peripheral white blood cell count or neutrophilic granulocyte count.
The G-CSF level in the acute stage of infection was 731.8 +/- 895.0 pg/mL, with a range of 30 to 3,199 pg/mL.
There was no significant difference in G-CSF levels between patients with respiratory tract infection and those with urinary tract infection.
In all 16 cases examined, the serum G-CSF level in the acute stage of infection was significantly higher than that after recovery phase, the latter being the same as the level in normal elderly controls.
G-CSF must therefore play a significant role in human infectious states in vivo.
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612
| 6,532
|
Evidence for gonococcal transmission within a correctional system.
In a study to examine sexually transmissible disease occurring within a large correctional system where sexual activity is prohibited, 27 male inmates acquired culture-proven gonorrhea from in-jail sexual activity during a three-month period.
These results provide evidence to encourage inmate education about the acquired immunodeficiency syndrome (AIDS) and to support condom distribution programs in correctional facilities.
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613
| 6,975
|
Aerobic and anaerobic bacteriology of wounds and cutaneous abscesses.
The aerobic and anaerobic microbiologic characteristics of 584 wounds and 676 skin or soft-tissue abscesses were studied and correlated with the infection site.
In wounds, aerobic or facultative bacteria only were present in 223 specimens (38%), anaerobes only in 177 specimens (30%), and mixed flora in 184 specimens (32%).
In total there were 1470 isolates, 558 aerobic and 912 anaerobic, an average of 2.5 isolates per wound (1.6 anaerobic and 0.9 aerobic isolates).
In abscesses, aerobic or facultative bacteria were recovered in 177 specimens (26%), anaerobes only in 243 specimens (36%), and mixed flora in 256 specimens (38%).
In total there were 1702 isolates, 602 aerobic and 1100 anaerobic, an average of 2.5 isolates per abscess.
The highest rates of anaerobes in wounds were in the inguinal, buttocks, and trunk areas and in abscesses in the perirectal, external genitalia, neck, and inguinal areas.
The predominant aerobic organisms were Staphylococcus aureus (363 isolates), group A streptococci (98 isolates), and Escherichia coli (97 isolates).
The predominant anaerobic organisms were Bacteroides species (986 isolates), Peptostreptococcus species (559 isolates), Clostridium species (153 isolates), and Fusobacterium species (109 isolates).
The predominance of certain isolates in certain anatomical sites was correlated with their distribution in the normal flora adjacent to the infected site.
These data highlight the polymicrobial nature of wounds and cutaneous abscesses.
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C01
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614
| 3,118
|
Buccal cellulitis.
Buccal cellulitis (BC) is an innocuous appearing infection of the cheek that is found in children and has a high incidence of concomitant bacteremia.
Typically, the child is younger than 12 months and has a 2 to 8 hour prodrome of coryza and fever before developing the cellulitis on the cheek.
A purplish hue on the cellulitic region is highly suggestive of Hemophilus influenzae bacteremia.
The differential diagnosis is reviewed.
A complete blood count, blood culture, and cellulitis aspirate culture, should be obtained on all patients with BC.
Meningitis may be present despite the lack of meningeal signs.
A lumbar puncture should be performed on all children at risk for bacteremic BC.
The vast majority of these children are bacteremic and require parenteral antibiotics.
A typical case of BC is presented and its management is reviewed.
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615
| 5,922
|
Visceral protothecosis mimicking sclerosing cholangitis in an immunocompetent host: successful antifungal therapy.
A healthy 39-year-old man who had clinical findings consistent with sclerosing cholangitis was found to have systemic protothecosis at surgery.
Severe granulomatous inflammation and palpable nodules were found in the gallbladder, on the surface of the liver, and in the duodenum.
Prototheca wickerhamii was detected in biopsied specimens and stool; the titer of indirect fluorescent antibody to this organism was 1:2,000.
The patient recovered after a short course of treatment with amphotericin B and 3 months of oral therapy with ketoconazole.
He had no other concurrent illness and had no abnormality in his immune system.
This is the second reported human case of systemic protothecosis.
An elevated IgG level, an elevated erythrocyte sedimentation rate, eosinophilia, and abnormal levels of enzymes in the liver were found in both cases.
Protothecosis should be considered in the differential diagnosis of hepatic and biliary inflammatory diseases of uncertain etiology.
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C01
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616
| 6,505
|
Garlic-in-oil associated botulism: episode leads to product modification.
In February 1989, three cases of botulism occurred in persons who consumed garlic bread made from a garlic-in-oil product.
Testing of leftover garlic-in-oil showed it to have a pH of 5.7 and to contain high concentrations of Clostridium botulinum organisms and toxin.
This was the second episode of botulism associated with a low acid garlic-in-oil product which needs constant refrigeration.
In response, the Food and Drug Administration has taken steps to prevent a recurrence by requiring that microbial inhibitors or acidifying agents be added to such products.
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C01
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617
| 7,588
|
Concomitant neurocysticercosis and brucellosis.
A young Mexican woman had headache and left arm weakness develop shortly after immigrating to the United States.
A solitary cerebral cysticercus was found at surgery, but, instead of the expected finding of clear fluid, the cyst contained pus from which Brucella melitensis was cultured.
Although the patient had no signs or symptoms suggestive of brucellosis, agglutination studies revealed IgM and IgG antibodies consistent with active brucellosis.
Clinicians should be alert to the possibility of multiple infections in immigrants from countries where parasites and bacteria that are uncommon in the United States are endemic.
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C01
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618
| 52
|
Replacement of an aortic valve cusp after neonatal endocarditis.
Septic arthritis developed in a neonate after an infection of her hand.
Despite medical and surgical treatment endocarditis of her aortic valve developed and the resultant regurgitation required emergency surgery.
At operation a new valve cusp was fashioned from preserved calf pericardium.
Nine years later she was well and had full exercise tolerance with minimal aortic regurgitation.
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619
| 8,833
|
Metabolic regulation of renal gluconeogenesis in response to sepsis in the rat.
1.
The regulation of renal gluconeogenesis was studied in rats made septic by a caecal ligation and puncture technique.
2.
Blood glucose concentrations were not markedly different in septic rats, but lactate, pyruvate and alanine concentrations were markedly increased, compared with sham-operated rats.
Conversely, blood ketone body concentrations were significantly decreased in septic rats.
Both plasma insulin and glucagon concentrations were markedly elevated in response to sepsis.
3.
The maximal activities of glucose-6-phosphatase (EC 3.1.3.9), fructose-1,6-bisphosphatase (EC 3.1.3.11), pyruvate carboxylase (EC 6.4.1.1) and phosphoenolpyruvate carboxykinase (EC 4.1.1.49) were markedly decreased in kidneys obtained from septic rats, suggesting diminished renal gluconeogenesis.
4.
Renal concentrations of lactate, pyruvate and other gluconeogenetic intermediates were markedly elevated in septic rats, whereas those of acetyl-CoA and fructose 2,6-bisphosphate were decreased and unchanged, respectively.
5.
The rate of gluconeogenesis from added lactate, pyruvate and glycerol was decreased in isolated incubated renal tubules from septic rats.
6.
Sepsis decreased the arteriovenous concentration difference for glucose, lactate, and alanine.
Septic rats showed decreased net rates of glucose production and net rates of removal of lactate and alanine as compared with sham-operated controls.
7.
It is concluded that the diminished capacity for renal gluconeogenesis in septic rats could be the result of changes in the maximal activities or regulation of key non-equilibrium gluconeogenic enzymes or both, but the effect of other factors (e.g.
toxins) has not been excluded.
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C01
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620
| 6,810
|
Recurrent seizures in children with Shigella-associated convulsions.
Fifty-five children with Shigella-associated convulsions were followed prospectively to investigate their risk of subsequent febrile or nonfebrile seizures.
The duration of the follow-up period was between 6.9 and 14.1 years (9.7 +/- 3.1 years).
No case of nonfebrile seizures and only 2 cases (3%) of subsequent febrile seizures were observed during this period.
We conclude that although febrile and Shigella-associated convulsions share many clinical features, the natural history of these two conditions seems to be distinctly different.
Shigella-related convulsions are not associated with an increased incidence of subsequent febrile or nonfebrile convulsions.
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621
| 6,066
|
Hyperbaric oxygen therapy for necrotizing fasciitis reduces mortality and the need for debridements.
Twenty-nine patients with necrotizing fasciitis were treated from 1980 to 1988.
This study evaluates how the addition of hyperbaric oxygen (HBO) therapy to surgical treatment has affected mortality and the number of debridements required to achieve wound control in these patients.
Two groups of patients were viewed: group 1 (n = 12) received surgical debridement and antibiotics only; group 2 (n = 17) received HBO (90 minutes at 2.5 atm, average 7.4 treatments) in addition to surgery and antibiotics.
Both groups were similar in age, race, sex, wound bacteriology, and antimicrobial therapy.
Body surface area affected was similar, however, perineal involvement was more common in group 2 (53%) than in group 1 (12%).
The admitting conditions of patients in group 1 (non-HBO) were diabetic, 33%; white blood cell count more than 12,000, 50%; and shock, 8%.
The admitting conditions of patients in group 2 (HBO) were diabetic, 47%; white blood cell count more than 12,000, 59%; and shock, 29%.
Although group 2 patients receiving HBO were more seriously ill on admission, mortality was significantly lower (23%) compared to group 1 (66%) (p less than 0.02).
In addition, only 1.2 debridements per group 2 patient were required to achieve wound control versus 3.3 debridements per group 1 patient (p less than 0.03).
The addition of HBO therapy to the surgical and antimicrobial treatment of necrotizing fasciitis significantly reduced mortality and wound morbidity (number of debridements) in this study, especially among nonclostridial infections.
We conclude that HBO should be used routinely in the treatment of necrotizing fasciitis.
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622
| 6,771
|
Effect of human immunodeficiency virus (HIV) infection on the course of syphilis and on the response to treatment.
PURPOSE: To evaluate evidence that concurrent infection with human immunodeficiency virus (HIV) alters both the natural history of syphilis (by increasing the frequency of early neurosyphilis) and the response to penicillin.
DATA IDENTIFICATION: Review of major works on syphilis in the English language and files maintained since 1971, supplemented by a systematic search using Index Medicus and MEDLARS.
DATA EXTRACTION: The works mentioned above were critically reviewed for information on early neurosyphilis and, where relevant, HIV infection.
RESULTS OF DATA ANALYSIS: The central nervous system is regularly involved in early syphilis.
Standard recommended doses of benzathine penicillin provide cerebrospinal fluid levels that are probably at the borderline of efficacy, and cure relies on treatment and an adequate host immune response.
Early neurosyphilis, appearing within 2 years of onset of infection with Treponema pallidum, was uncommon in the prepenicillin era and usually occurred after inadequate therapy.
This complication was exceedingly rare in the first three decades of penicillin use.
In contrast, in the past decade, 40 patients with HIV infection have been reported to have asymptomatic neurosyphilis, or syphilitic meningitis, cranial nerve abnormalities (predominantly in cranial nerves II and VIII), or cerebrovascular accidents, singly or together.
In 40% of cases, HIV infection was first diagnosed when neurologic symptoms appeared.
Of the 38 patients for whom information was available, 18 had the acquired immunodeficiency syndrome (AIDS), 7 had AIDS-related complex, and 13 had antibody to HIV.
Sixteen had previously been treated for syphilis, of whom 5 (31%) had received benzathine penicillin within the previous 6 months.
Preliminary data also suggest that skin lesions and VDRL (Venereal Disease Research Laboratory) antibody in HIV-infected patients with secondary syphilis respond more slowly to conventional penicillin therapy.
CONCLUSION: Intensive therapy and follow-up observation is indicated for early syphilis in HIV-infected subjects.
Novel approaches to treatment deserve systematic evaluation.
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623
| 6,921
|
Seroprevalence of Helicobacter pylori in Seventh-Day Adventists and other groups in Maryland. Lack of association with diet.
To evaluate the possible role of diet in the transmission of Helicobacter pylori, we compared H pylori seroprevalence among Seventh-Day Adventists (who are vegetarian and abstain from alcohol, caffeine, and meat; n = 94) and two non-Seventh-Day Adventist control groups (n = 168).
With the use of an enzyme-linked immunosorbent assay H pylori antigen prepared in a French pressure cell, we found no difference in seroprevalence among these groups; however, seropositivity strongly correlated with age and black race.
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C01
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624
| 9,120
|
Chancroid: results from an outbreak in Houston, Texas.
A recent (and continuing) epidemic of chancroid in Houston has included morphologic variation in the disease, including so-called dwarf, classic, giant, transient, follicular, phagedenic, and pseudogranuloma inguinale types.
Most cases were clearly acquired by unprotected sexual encounters with local prostitutes.
The strain of Haemophilus ducreyi responsible for this outbreak was relatively easily cultured on routine media; unexpected sensitivity of this strain to vancomycin rendered the recommended "selective" growth medium much less optimal for isolation.
Therapeutic success uniformly followed the use of intramuscular ceftriaxone sodium; one case responded to oral ciprofloxacin hydrochloride.
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C01
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625
| 9,958
|
Aberrations in post-trauma monocyte (MO) subpopulation: role in septic shock syndrome.
Appearance of increased proportions of monocytes bearing the 72kd(FcRI) receptor for IgG correlated to aberrant monocyte (MO) functions, depressed immune functions, and poor clinical outcome.
The trauma patients' FcRI+ MO subpopulation produced the majority of their elevated IL-6, TNF alpha, TGF beta, and PGE2.
IgG stimulation of patients' MO through FcRI not only stimulated TNF alpha, IL-6, and PGE2 levels, but also greatly augmented the levels of these monokines produced after subsequent bacterial challenge.
Post-trauma increased IL-6 levels can lead to polyclonal B-cell activation and high levels of circulating, nonspecific IgG as seen in trauma patients.
This nonspecific IgG triggers the FcRI on the increased numbers of FcRI+ MO leading to ever-increasing monokine levels.
IL-4 was found to downregulate patients' FcRI+ MO production of mediators.
The cycle of altered cytokine levels, increased FcRI+ MO numbers, elevated IgG, and augmented triggering of FcRI+ MO may be broken by addition of IL-4.
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C01
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626
| 7,906
|
Septic pulmonary embolism complicating a central venous catheter.
Bacteremia is a recognized complication in patients with indwelling central venous catheters.
More recently pulmonary embolism in such patients has also been described.
Despite abundant clinical experience with these devices, to our knowledge, septic pulmonary embolism has not been reported in adult patients.
This case illustrates such a complication.
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627
| 6,649
|
Infection during chronic epidural catheterization: diagnosis and treatment.
A potentially serious complication of long-term epidural catheterization in cancer patients is infection.
The early signs of infection were studied in 350 patients in whom long-term epidural catheters were inserted.
Three areas of the catheter track were found to be involved; exit site and superficial catheter track infection, and epidural space infection.
The authors identified the early signs of infection in each area and the progress of the infection from the deep track to include the epidural space in four of these patients.
All 19 patients who developed deep track or epidural infections were successfully treated with antibiotics and catheter removal.
None of the patients required surgery for spinal cord decompression.
Catheters were replaced in 15 of the 19 treated patients who requested them after treatment with no recurrent infections.
It was concluded that use of long-term epidural catheterization is associated with a definable epidural infection rate.
The use of epidural opioid analgesia is an effective and safe means of obtaining pain relief for terminally ill patients when patients are monitored for possible infection and receive prompt treatment when the diagnosis is established.
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628
| 6,440
|
Cervicovaginal microflora and pregnancy outcome: results of a double-blind, placebo-controlled trial of erythromycin treatment.
Available information suggests that some instances of preterm birth or premature rupture of membranes are associated with clinically unrecognized infection and inflammation of the lower uterine segment, decidua, and fetal membranes.
Various cervicovaginal microorganisms have been recovered from these sites.
Many of these microorganisms produce factors that may lead to weakening of the fetal membranes, release of prostaglandins, or both.
This study evaluated the presence of various lower genital tract microflora and bacterial conditions in 229 women enrolled in a double-blind, placebo-controlled trial of short-course erythromycin treatment at 26 to 30 weeks' gestation to prevent preterm birth.
Demographic, obstetric, and microbiologic parameters were prospectively evaluated.
Premature rupture of membranes occurred less frequently (p less than 0.01) among women who received erythromycin (6%) versus placebo (16%).
Preterm premature rupture of membranes also occurred less frequently, although not significantly (p = 0.3) in patients who received erythromycin (2%) versus placebo (5%).
Erythromycin treatment significantly decreased the occurrence of premature rupture of membranes among women who were initially positive for Chlamydia trachomatis infection.
Logistic regression analysis demonstrated that C.
trachomatis (p = 0.05; odds ratio, 9), vaginal wash phospholipase C (p = 0.08; odds ratio, 6) and prior preterm birth (p = 0.007; odds ratio 17) were associated with increased risk of preterm birth.
Bacterial vaginosis, Mycoplasma hominis, Ureaplasma urealyticum were not significantly associated with increased risk of preterm birth or preterm rupture of membranes.
These findings support a role for selected lower genital tract microflora in preterm birth and premature rupture.
Large controlled treatment trials of specific infections or conditions associated with preterm birth and premature rupture of membranes are required to confirm the value of antimicrobial treatments in prevention of microbial-associated preterm birth.
|
C01
|
629
| 5,911
|
Hypercalcitoninemia, hypocalcemia, and toxic shock syndrome.
Toxic shock syndrome is a multisystem illness frequently complicated by hypocalcemia.
The etiology of the hypocalcemia, which may be severe, is not well understood.
We report two cases of fatal toxic shock syndrome accompanied by severe hypocalcemia; each patient also had an inappropriately elevated serum calcitonin level, which in one case was as high as 179,000 pg/mL.
Hypercalcitoninemia may be a cause of the low serum calcium levels as well as of certain clinical manifestations of toxic shock syndrome.
|
C01
|
630
| 5,348
|
Soleus-specific myopathy induced by passive stretching under local tetanus.
Twenty-four adult albino rats were injected with tetanus toxin into the right gastrocnemius muscle and then subjected to sustained dorsiflexion of the right ankle joint for 2 to 14 days.
Histologic examinations of the soleus after this procedure showed myopathic changes, characterized by variations in fiber diameters, myonecrosis with opaque fibers, interstitial fibrosis, and small groups of regenerated fibers.
Electron microscopy revealed derangement of T-tubules immediately adjacent to the sarcolemma in the early degenerative stage.
The size and wet weight of soleus increased compared to that of the control side between 2 and 5 days post-tetanus.
Serum GOT, LDH, and creatine kinase (CK) levels were elevated especially in the early degenerative stages.
Peri- and endomysial fibrosis developed gradually from about 3 days post-tetanus.
Pathomechanisms inducing these changes were discussed.
|
C01
|
631
| 882
|
Individualizing treatment of vaginal candidiasis.
Clinicians have a vast array of effective antimycotics for the treatment of vaginal candidiasis.
Multiple topical formulations are available, yet there is little evidence to suggest that formulation per se influences outcome.
A growing number of highly effective oral systemic antimycotic agents provide the practitioner with additional options.
Treatment regimens have also changed with the introduction of shorter, often single-day/single-dose courses of therapy.
Not all therapeutic agents have the same activity against vaginal fungal pathogens in that topical azoles tend to be more active than nystatin.
Differences in patient characteristics, however, are more important than the differences between antimycotic agents and therapeutic regimens in determining selection of the appropriate antimycotic.
Patients with vaginal candidiasis vary with regard to duration and severity of symptoms and past frequency of attacks, distribution of inflammation, and pregnancy status.
The clinician should consider all these variables both in selecting the appropriate antimycotic agent and the route of administration and in planning the duration of therapy.
Individualized therapy offers additional benefits to patients, who may then enjoy the maximum advantages of antimycotics now available.
|
C01
|
632
| 8,377
|
Human immunodeficiency virus infection in pregnancy.
Among an estimated 1 million to 1.5 million Americans infected with HIV, about 10 per cent are women.
Moreover, almost 30 per cent of HIV infection among women is acquired through heterosexual activity.
Therefore, the average obstetrician/gynecologist is not sheltered from dealing with HIV.
This article offers guidelines for caring for HIV-infected pregnant women during antepartum, intepartum, and postpartum phases.
|
C01
|
633
| 750
|
Neonatal osteomyelitis.
Thirty-four neonates with osteomyelitis were reviewed.
The hip (19) was the most common site involved.
Swelling and pseudoparalysis were the most significant local signs.
Radiographic abnormalities, such as metaphyseal rarefaction and/or joint subluxation were found on the initial radiographs in 18 of the 19 hips involved.
All patients were treated with antibiotics and all infections involving joints were drained surgically.
Good results were achieved in 75% of all sites and in 68% of hips.
|
C01
|
634
| 4,661
|
Quantitation of Tamm-Horsfall protein binding to uropathogenic Escherichia coli and lectins.
In quantitative experiments using ELISA, binding of Tamm-Horsfall protein (THP) to uropathogenic Escherichia coli was studied with monoclonal antibody to THP.
Adherence to E.
coli bearing type 1 fimbriae was proportional to THP concentration and size of the bacterial inoculum.
Type 1 fimbriae-bearing E.
coli bound 50 times more THP than did non-type 1-fimbriated or P-fimbriated strains.
Concanavalin A and wheat germ agglutinin bound THP in a dose-dependent fashion, whereas pokeweed mitogen and Vicia villosa B4 isolectin did not.
Addition of mannose and N-acetylglucosamine reduced adherence of THP to concanavalin A and wheat germ agglutinin by 50%-80%.
Sugar inhibition studies suggested that the fimbrial receptor site for THP has lectin-like properties and that THP binds to fimbriae via its mannose side chains.
This quantitative assay is useful for studying the interaction between THP, uroepithelial cells, and bacteria in vitro.
|
C01
|
635
| 636
|
Reduction of gastric ulcer recurrence after suppression of Helicobacter pylori by cefixime.
The effect on the recurrence of gastric ulcers after suppression of Helicobacter pylori by combined treatment with cimetidine and the antimicrobial drug cefixime was investigated.
Twenty one of 43 patients with endoscopically proved gastric ulcer and H pylori infection were randomly assigned to receive cimetidine 800 mg daily for 12 weeks; the remaining 22 patients received cimetidine 800 mg daily for 12 weeks plus cefixime 100 mg daily for the last two weeks.
After treatment, 88% of 17 patients on cimetidine only remained H pylori positive, whereas combined administration of cimetidine and cefixime had suppressed H pylori in 78% of 18 patients (p less than 0.05).
Seventeen patients in the former group whose ulcers healed but who remained H pylori positive and 18 patients in the latter group whose ulcers healed and who were no longer infected with H pylori continued to be followed after treatment.
These patients underwent endoscopy to detect ulcer recurrence if symptomatic, or at 12 and 24 weeks if asymptomatic.
At 12 weeks, recurrence was observed in seven of 15 (47%) patients in whom H pylori persisted, but in only one of 14 (7%) patients in whom H pylori had been suppressed (p less than 0.05).
At 24 weeks, however, recurrence rates were similar between the two groups.
These findings indicate that H pylori infection may be closely related to early ulcer recurrence.
|
C01
|
636
| 7,646
|
Endophthalmitis due to Sporothrix schenckii after penetrating ocular injury.
A 13-year-old boy developed endophthalmitis from traumatic inoculation of vegetable material penetrating his right eye.
Sporothrix schenckii was morphologically identified from the intraocular fluids.
However, repeated attempts to culture the organism proved negative.
Seventeen sporotrical endophthalmitis cases have so far been reported, and before this report, only one of them was secondary to trauma.
This is the sole eye to our knowledge not only to have escaped enucleation after sporotrical endophthalmitis but to have achieved useful (20/50) vision.
|
C01
|
637
| 9,938
|
Yersinia enterocolitica tenosynovitis. The first case.
We describe a case of tenosynovitis of tibialis posterior due to Yersinia enterocolitica occurring after injury by a plant thorn in a 55-year-old man.
The illness was chronic with 2 recurrences in spite of antibiotic treatment.
Full recovery was obtained only after surgical intervention.
Our patient's chronic course was fostered by the persistence of thorn fragments in the infected area and the exceptionally pathogenic character of the isolated colony of Yersinia.
|
C01
|
638
| 9,647
|
New isotopic technique for detecting prosthetic arterial graft infection: 99mTc-hexametazime-labelled leucocyte imaging.
Early and accurate detection of prosthetic arterial graft infection is important because this serious complication of vascular surgery carries high morbidity and mortality rates.
This report describes the use of a new method of isotopic imaging to detect graft infection using 99mTc-hexametazime-labelled leucocytes.
Seventeen patients with potentially infected arterial grafts were imaged in addition to routine investigations but were managed according to our normal surgical practice.
99mTc-imaging was positive in eight patients with proven graft infection and falsely positive in one patient with a groin haematoma (89 per cent specificity).
There were no false negatives (100 per cent sensitivity) after an average follow-up of 6 months (range 3-9 months).
This technique has proved a reliable and rapid method of confirming graft infection.
|
C01
|
639
| 957
|
An external urine collection device for incontinent women. Evaluation of long-term use.
Urinary incontinence is common in aged women, may precipitate nursing home admission, and may prompt use of a urine collection device, usually an indwelling urethral catheter.
The safety and efficacy of a new external urine collection device for women that is affixed to the perineum by an adhesive developed for ostomy bags was evaluated.
Applied to 26 aged women, 78% of 2,264 devices were leak-free for 24 hours and 49% for 48 hours.
The incidence of new bacteriuria was less than half that found in our earlier studies of long-term urethral catheters in the same institution.
Perineal erythema was infrequent and preexisting decubitus ulcers improved or did not change.
Four patients were withdrawn, one each because of periurethral itching, diminished urine output, recurrent wetness, and fracture of the proximal femur associated with severe osteoporosis.
This device may offer an alternative to urethral catheters for management of urinary incontinence but should not be used on women with urine retention and should be used with care on women with severe osteoporosis.
Controlled trials must determine effects upon bacteriologic complications and health-care costs.
|
C01
|
640
| 4,185
|
The patellofemoral joint after total knee arthroplasty without patellar resurfacing.
One hundred total knee replacements with a total condylar prosthesis and without patellar resurfacing were followed for a minimum of two years.
Eighty-four per cent of the knees were affected by osteoarthrosis.
Graded according to the knee-rating system of the Hospital for Special Surgery, there were eighteen excellent, fifty-three good, eighteen fair, and eleven poor results.
At the most recent follow-up, twenty-nine knees (29 per cent), nine of which were affected by rheumatoid arthritis, were still painful in the patellofemoral area.
The height and weight of the patient definitely influenced the amount of patellofemoral pain postoperatively.
Small patients who had osteoarthrosis were exceptionally free of pain, regardless of sex, age, or level of activity.
It seems that the best approach to patellofemoral replacement includes resurfacing of the patella in all patients who have rheumatoid arthritis and in patients who have osteoarthrosis if they have preoperative patellofemoral pain, are more than 160 centimeters tall, weigh more than sixty kilograms, and have advanced changes in the patella at the time of the operation.
|
C01
|
641
| 5,926
|
Listerial myocarditis in cardiac transplantation.
Clinical signs of heart failure developed in two cardiac transplant recipients and were interpreted initially as graft rejection.
Morphologic examination of explanted hearts revealed myocarditis with abscess formation and necrosis consistent with a bacterial process; Listeria monocytogenes was isolated from myocardial tissue in the first case and from blood in both.
The first patient also developed signs of meningoencephalitis, but the second had no signs of infection outside the heart.
Antimicrobial therapy and retransplantation were successful in eradicating listeriosis.
The differential diagnosis of heart failure in cardiac transplant recipients includes infectious myocarditis due to L.
monocytogenes.
|
C01
|
642
| 794
|
Possible role of bacterial siderophores in inflammation. Iron bound to the Pseudomonas siderophore pyochelin can function as a hydroxyl radical catalyst.
Tissue injury has been linked to neutrophil associated hydroxyl radical (.OH) generation, a process that requires an exogenous transition metal catalyst such as iron.
In vivo most iron is bound in a noncatalytic form.
To obtain iron required for growth, many bacteria secrete iron chelators (siderophores).
Since Pseudomonas aeruginosa infections are associated with considerable tissue destruction, we examined whether iron bound to the Pseudomonas siderophores pyochelin (PCH) and pyoverdin (PVD) could act as .OH catalysts.
Purified PCH and PVD were iron loaded (Fe-PCH, Fe-PVD) and added to a hypoxanthine/xanthine oxidase superoxide- (.O2-) and hydrogen peroxide (H2O2)-generating system.
Evidence for .OH generation was then sought using two different spin-trapping agents (5.5 dimethyl-pyrroline-1-oxide or N-t-butyl-alpha-phenylnitrone), as well as the deoxyribose oxidation assay.
Regardless of methodology, .OH generation was detected in the presence of Fe-PCH but not Fe-PVD.
Inhibition of the process by catalase and/or SOD suggested .OH formation with Fe-PCH occurred via the Haber-Weiss reaction.
Similar results were obtained when stimulated neutrophils were used as the source of .O2- and H2O2.
Addition of Fe-PCH but not Fe-PVD to stimulated neutrophils yielded .OH as detected by the above assay systems.
Since PCH and PVD bind ferric (Fe3+) but not ferrous (Fe2+) iron, .OH catalysis with Fe-PCH would likely involve .O2(-)-mediated reduction of Fe3+ to Fe2+ with subsequent release of "free" Fe2+.
This was confirmed by measuring formation of the Fe2(+)-ferrozine complex after exposure of Fe-PCH, but not Fe-PVD, to enzymatically generated .O2-.
These data show that Fe-PCH, but not Fe-PVD, is capable of catalyzing generation of .OH.
Such a process could represent as yet another mechanism of tissue injury at sites of infection with P.
aeruginosa.
|
C01
|
643
| 7,401
|
The national immunization program of The Netherlands.
After a brief explanation of the immunization policy in the Netherlands, the national immunization program is described, with special attention given to coupling of the municipal population records with a computerized database of individual immunization records at the provincial level.
The Dutch program achieves coverage rates greater than 90% for all routine immunizations.
Participation in the program is free of charge to every child living in the country up to the age of 13 years, but there is no obligation or requirement to be immunized.
Financing of the program is also discussed.
|
C01
|
644
| 8,481
|
Calcitonin gene-related peptide levels are elevated in patients with sepsis.
Calcitonin gene-related peptide (CGRP), an endogenous vasoactive peptide encoded by the calcitonin gene in nerve cells, is distributed throughout the cardiovascular system and is a potent vasodilator.
Plasma levels of CGRP have been elevated in animal models with sepsis.
This study was designed to determine whether plasma CGRP levels are elevated in patients with sepsis and perhaps contribute to the hyperdynamic cardiovascular state in sepsis.
Plasma CGRP levels were obtained from normal healthy volunteers and from patients with sepsis.
Volunteers were afebrile and had normal pulse and blood pressure.
Patients with sepsis were selected according to the following criteria: (1) temperature higher than 38.5 degrees C, (2) white blood count greater than 14,000/ml, (3) positive blood culture of bacterial organisms, (4) hemodynamic parameters consistent with hyperdynamic sepsis, and (5) negative history of thyroid or other endocrine abnormalities.
CGRP was extracted and assayed by radioimmunoassay for iodine 125-labeled human CGRP.
In patients with sepsis, the cardiac index was 5.4 +/- 0.5 L/min/m2 (normal, 3.0); systemic vascular resistance was 7.1 +/- 0.5 mm Hg/L/min (normal, 16); oxygen delivery was 1496 +/- 137 ml/min (normal, 1000).
Plasma CGRP levels were significantly elevated in the patients with sepsis, 14.9 +/- 3.2 pg/ml, compared to plasma CGRP levels in control volunteers, 2.0 +/- 0.3 pg/ml (p less than 0.0005).
These elevated levels of CGRP may contribute to the decreased vascular resistance and increased cardiac output in the hyperdynamic septic state.
|
C01
|
645
| 7,539
|
Botulism among Alaska Natives. The role of changing food preparation and consumption practices.
Alaska Natives have one of the highest rates of food-borne botulism worldwide.
All outbreaks have been associated with the consumption of native foods, but in recent years outbreaks have occurred in previously unaffected areas and have involved new food items.
Five botulism outbreaks occurred between 1975 and 1985 in an area of southwestern Alaska without previous confirmed outbreaks and among one ethnic group, the Yupik Eskimo.
Of the 5 outbreaks, 3 were associated with fermented beaver tail, a nontraditional native food recently introduced into the region.
Preparation techniques vary widely within villages and among ethnic groups.
Traditional fermentation techniques have changed over the past 50 years; current preparation methods used by some families and ethnic groups may be more favorable for Clostridium botulinum growth.
Prevention efforts should be targeted at high-risk subgroups of Alaska Natives who appear to have modified traditional practices and increased their risk of food-borne botulism.
|
C01
|
646
| 3,766
|
Occult fatal pulmonary embolism with disseminated intravascular coagulation. An unusual case masquerading as miliary tuberculosis.
We report a fatal case of occult pulmonary embolism complicating bronchogenic carcinoma which presented with rapidly progressive pulmonary miliary shadows and respiratory failure.
A clotting profile abnormality compatible with disseminated intravascular coagulation was noted.
Postmortem examination showed extensive clots occluding the major pulmonary vessels and areas of pulmonary infarcts.
Histologic examination revealed fibrin deposition in the microvasculature compatible with DIC.
Cases of pulmonary embolism with DIC have previously been reported, but this is the first case with pathologic confirmation.
Thus, unusual presentation with diffuse lung shadow and DIC should not deter the clinician from correct diagnosis so that appropriate treatment can be promptly started.
|
C01
|
647
| 8,146
|
Absence of significant bacteremia during urinary catheter manipulation in patients with chronic indwelling catheters.
The objective of this study was to quantify the microorganisms present in blood at urinary catheter removal and at reinsertion in patients with chronic indwelling urinary catheters.
This was a prospective study during a 4-month period at a university-affiliated geriatric medical center.
Our subjects were 33 patients with chronic indwelling urinary catheters and positive urinary cultures; the urinary catheter was usually changed once a month.
A peripheral vein line was used for blood withdrawal and urinary cultures and quantitative blood cultures (Isolator) were performed during and shortly after urinary catheter removal and insertion.
All patients had significant bacteriuria (greater than 10(5) cfu/mL) with an average of 2.3 microorganisms.
Among the 46 sequential quantitative blood cultures performed, only two patients had bacteremia from the urinary source and at a very low concentration; one patient had 0.13 cfu/mL Str.
faecalis in blood 5 minutes after removal of the urinary catheter, and the other 0.1 cfu/mL Proteus mirabilis 5 minutes after reinsertion of a new urinary catheter.
None of the patients had any subjective or objective clinical problem during the 36 hours after the urinary manipulation.
Clinical symptoms and bacteremia are rare events, and prophylactic antibiotics do not appear necessary during urinary catheter removal and reinsertion in elderly institutionalized patients.
Further studies are necessary to identify risk factors in the rare instances of patients with bacteremia.
|
C01
|
648
| 8,523
|
Tetracyclines in urology: current concepts
Tetracyclines have an unusually broad spectrum of antimicrobial activity.
They are generally well tolerated, with relatively few side effects compared with alternative antibiotic choices.
Tetracyclines also compare favorably with newer antimicrobials, i.e., oral quinolones, with respect to cost and microbial resistance.
Doxycycline's and minocycline's spectrum of antibacterial activity, pharmacokinetic profile, and safety profile make them preferred drugs when tetracyclines are indicated in urologic infections.
|
C01
|
649
| 4,627
|
Fucosylated oligosaccharides of human milk protect suckling mice from heat-stabile enterotoxin of Escherichia coli.
Human milk protects suckling mice from the diarrheagenic effects of heat-stabile enterotoxin of Escherichia coli (ST).
To identify the human milk fraction responsible for this protection, pooled skimmed, deproteinated milk was passed through charcoal, whereupon lactose was separated from the oligosaccharides.
The oligosaccharides contained ST-protective activity; the lactose did not.
The neutral, but not the acidic, fraction exhibited protective activity against ST (22% vs.
57% mortality, respectively; P less than .001).
The fucosylated, but not the nonfucosylated, subfractions of the neutral fraction contained the factor protective against ST (35% vs.
50% mortality, respectively; P less than .05).
An oligosaccharide isolation scheme based on different principles produced confirmatory results.
The commercially available neutral fucosylated oligosaccharides of human milk did not significantly protect the mice from the effects of ST.
Thus, the protective factor against ST seems to be a minor neutral fucosyloligosaccharide of human milk.
|
C01
|
650
| 5,914
|
Tuberculous psoas muscle abscess following chemoprophylaxis with isoniazid in a patient with human immunodeficiency virus infection.
A 34-year-old man with human immunodeficiency virus infection and disseminated Mycobacterium avium and Mycobacterium intracellulare infection developed a right psoas muscle abscess due to Mycobacterium tuberculosis.
The abscess occurred 18 months after completion of a 12-month course of chemoprophylaxis with isoniazid that was given because of a positive reaction with purified protein derivative of tuberculin.
The adjacent vertebrae did not appear to be involved.
The abscess was drained with a percutaneously inserted catheter, and he received standard antituberculous chemotherapy.
Three weeks into therapy, a second drainage with a catheter was required.
The isolation of two mycobacteria in this patient and the apparent failure of chemoprophylaxis with isoniazid are noted.
|
C01
|
651
| 7,861
|
Incidence of colonization, nosocomial pneumonia, and mortality in critically ill patients using a Trach Care closed-suction system versus an open-suction system: prospective, randomized study.
Eighty-four intubated, mechanically ventilated patients were prospectively evaluated for incidences of colonization and nosocomial pneumonias dependent on whether they received endotracheal suctioning by an "open" suction method vs.
"closed" suction (Trach Care Closed Suction System) method.
Results show that closed suctioning is associated with a significant (67% vs.
39% p less than .02) increase in colonization compared with open suctioning.
However, difference in the incidence of nosocomial pneumonia was not significantly (26% vs.
29%) different between closed and open suctioning.
Differences in severity of illness (Acute Physiology and Chronic Health Evaluation II and Therapeutic Intervention Scoring System), age, sex, presence of NG tubes, use of H2 antagonists or antacids, use of antibiotics, and history of smoking were all nonsignificant.
Survival analysis demonstrated that the probability of survival without developing nosocomial pneumonia was greater among closed-suctioning patients vs.
open-suctioned patients (p less than .03).
This study shows that suctioning performed via the Trach Care closed-suction system increases the incidence of colonization but not the incidence of nosocomial pneumonia, and may actually decrease mortality when compared with open-suction systems.
|
C01
|
652
| 5,605
|
Oral histoplasmosis as a presenting disease in acquired immunodeficiency syndrome [published erratum appears in Oral Surg Oral Med Oral Pathol 1991 Jan;71(1):76]
A 43-year-old homosexual man visited his dentist with painful, nodular, ulcerated lesions on the soft palate, right buccal mucosa, and right posterior maxillary gingiva.
Serologic studies for exposure to human immunodeficiency virus, performed before biopsy, were positive.
Biopsy of the maxillary gingiva demonstrated sheets of histiocytes containing small intracellular yeasts, which on culture were identified as Histoplasma capsulatum.
Bilateral leukoplakic lesions with some vertical furrowing involving the lateral borders of the tongue were also noted.
Histologically, hyperkeratosis and fungal hyphae were identified.
The patient was treated for histoplasmosis with amphotericin B, which resulted in significant improvement of the oral lesions.
He was subsequently hospitalized for fatigue and dyspnea and was found to have Pneumocystis carinii pneumonia.
Pulmonary status deteriorated within a 3-week period, and the patient died.
Autopsy findings were negative for histoplasmosis but positive for necrotizing and cavitary P.
carinii pneumonia, pulmonary and hepatic herpes simplex infections, and pulmonary and intestinal cytomegalovirus infection.
|
C01
|
653
| 9,509
|
Prevention of infection in a porous tracheal prosthesis by omental wrapping.
The ideal tracheal prosthesis has to permit complete incorporation by epithelialization of the luminal surface.
This is not possible with the currently available impermeable solid silicone tube.
The authors developed a reinforced, porous polyurethane tubular prosthesis which has the potential for complete incorporation.
However, because these prostheses are implanted in a contamined area such as the airway, they all become infected.
In order to prevent infection, the authors evaluated the effect of omental wrapping in guinea pigs.
The authors' tubular prosthesis was implanted subcutaneously in the abdominal area with the ends open to the air.
Ten prostheses were wrapped with omentum and 10 prostheses were not.
In 4 weeks, all control prostheses were infected and marsupialized.
All the wrapped prostheses remained in place and were macroscopically not infected.
Microscopically, all wrapped prostheses were well vascularized and were incorporated by granulation tissue, which did not occur in the prostheses of the control group.
From these results the authors conclude that omental wrapping would be an effective way to prevent infection of porous tracheal prostheses in an open-to-the-air situation, and allow rapid tissue ingrowth and incorporation in the host.
|
C01
|
654
| 833
|
Antigen specific serum antibody response to Chlamydia trachomatis in patients with acute pelvic inflammatory disease.
Sera from 35 patients with acute pelvic inflammatory disease (PID) with and without Chlamydia trachomatis confirmed by culture and sera from 19 control patients with neither evidence of pelvic infection nor C trachomatis infection were studied for the presence of serum IgG, IgA, and IgM antibodies to C trachomatis using enzyme immunoassay (EIA) and immunoblotting techniques.
There was no correlation between the antibody concentrations in the EIA and the spread of chlamydial infection, as determined by cervical, endometrial, and laparoscopic sampling for chlamydia.
The immunoblot analysis showed antibodies to the major outer membrane protein (MOMP) of C trachomatis elementary bodies in all patients who had had C trachomatis isolated.
Reactivity was also frequently observed against the 68, 62, 60, 45, and 31 kilodalton antigens.
About 20 antigenic polypeptides were identified.
Differences in antibody prevalence to specific chlamydial antigens, however, were not related to the site of chlamydial isolation or serum antibody concentrations observed with the EIA.
The results indicate that patients with PID with and without upper genital tract infection with C trachomatis cannot be differentiated by reactivity of sera to specific chlamydial polypeptide antigens.
The determination of a specific serum IgA antibody response by EIA was the most effective single test to discriminate between patients with and without acute chlamydial infection.
|
C01
|
655
| 2,434
|
Percutaneous transhepatic cholecystostomy for acute complicated cholecystitis in elderly patients.
We report our experience with percutaneous transhepatic cholecystostomy in 10 elderly patients with acute cholecystitis, complicated by empyema formation.
Most of these patients has severe underlying disease, rendering them at high risk for surgical intervention.
In all patients, the percutaneous procedure was followed by a rapid regression of clinical symptoms and of radiologic abnormalities.
Six were considered inoperable.
Three of these remain free of biliary symptoms, respectively 22, 10, and 7 months after percutaneous cholecystostomy.
Three others died of nonbiliary disease 1-4 months after cholecystostomy.
Three patients underwent successful elective cholecystostomy 1-5 wk after percutaneous cholecystostomy.
In one patient, cholecystectomy had to be performed because of recurrence of hydrops, 1 wk after catheter removal.
In our opinion, percutaneous transhepatic cholecystostomy is a safe and effective procedure in the treatment of elderly patients with acute complicated cholecystitis.
It can be followed by elective cholecystectomy in good surgical candidates, or by an expectant conservative management in high surgical risk patients.
|
C01
|
656
| 2,821
|
Effects of method of hemostasis on wound-infection rate.
Adequate hemostasis is important in preventing postoperative wound infection.
This study compared four methods of hemostasis: specific pinpoint vessel electrocautery (SPC), specific vessel ligation with 4-0 vicryl (SVL), nonspecific electrocautery of vessel plus excessive surrounding tissue (NSC), and nonspecific ligation of vessel and excessive surrounding tissue with 4-0 vicryl (NSL), on the rate of wound infection in rabbits that were contaminated with 10(6) Staphylococcus aureus.
There was no statistical significant increase in the rate of wound sepsis when electrocautery was used in a fashion producing minimal nonviable tissue compared to specific vessel ligation.
Electrocautery use for specific vessel hemostasis does not result in a higher wound infection rate in contaminated wounds.
|
C01
|
657
| 7,407
|
Postneonatal mortality in Norway: a study of recent trends and comparison with other mortality rates in Norwegian children.
Postneonatal mortality in Norway decreased rapidly from 1956 to 1980 but subsequently remained stable.
In recent years the postneonatal death rate appears to be increasing, primarily due to greater numbers of deaths attributed to the Sudden Infant Death Syndrome.
During the same period, mortality among older children has also decreased, with the decline evident in all leading causes.
Only among people aged 15 to 19 years have recent trends been less than encouraging, with the number of fatal traffic accidents in particular remaining stable or increasing.
Although there is room for continued improvement, the widely held belief that the health status of Norwegian children is good is supported by the trends in mortality.
|
C01
|
658
| 7,020
|
Nontropical pyomyositis as a cause of subacute, multifocal myalgia in the acquired immunodeficiency syndrome.
We report a case of nontropical pyomyositis in a patient with acquired immunodeficiency syndrome and disseminated Mycobacterium avium infection, in which severe myalgia was the presenting symptom over several weeks.
Multifocal muscle lesions were identified by gallium scanning and magnetic resonance imaging techniques.
The epidemiology, possible pathogenesis, clinical features, diagnostic imaging, and therapy are reviewed.
Early suspicion of nontropical pyomyositis in severely immunocompromised patients with "cryptic" myalgia is recommended.
|
C01
|
659
| 4,643
|
Detection of interleukin-3 in the serum of mice infected with Mycobacterium lepraemurium.
Infection of mice by Mycobacterium lepraemurium is accompanied by ablation of erythropoiesis in the bone marrow and gross enlargement of the spleen.
This, together with increased monocytopoiesis and the earlier demonstration of macrophage colony-stimulating factor in the serum of infected mice, suggested the activity of additional cytokines.
Eight weeks after infection of mice by M.
lepraemurium, interleukin-3 (IL-3) activity was demonstrated in the serum (titer, 1:3200).
The serum titer of IL-3 activity was maximal after 13 weeks (greater than 1:6400) and was slightly reduced after 18 weeks (1:6400).
That the IL-3 activity detected in the serum of the M.
lepraemurium-infected mice reflected the presence of IL-3 itself was confirmed by a neutralization assay using anti-murine IL-3 antibodies; IL-3 activity in the serum of mice 13 weeks after infection was completely abolished by the anti-IL-3 antibodies.
Finally, a 1-kb signal of IL-3 RNA was detected in the spleens of M.
lepraemurium-infected mice 13 weeks after infection.
|
C01
|
660
| 8,320
|
The interrelationship between human immunodeficiency virus infection and other sexually transmitted diseases.
The epidemiology of HIV infection in the United States is changing, with a dramatic reduction in the incidence of new HIV infection in homosexual men over the past decade because of altered sexual practices.
In contrast, heterosexual transmission of HIV is increasing and is disproportionately occurring in inner city racial minorities in association with drug use, populations that are currently experiencing epidemics of previously controlled STDs.
Sexually transmitted diseases, especially genital ulcerative diseases and perhaps C.
trachomatis and T.
vaginalis, facilitate sexual transmission of HIV.
In addition, HIV infection itself appears to increase the severity of certain STDs once they are acquired.
The control of STDs, particularly in those populations that are at high risk for HIV infection, should be of high priority and should be an integral component of AIDS control programs.
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C01
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661
| 4,528
|
Tuberculous peritonitis: a study comparing cirrhotic and noncirrhotic patients.
Tuberculous peritonitis is a rare disease, which often goes unrecognized because of the subtle clinical clues and its insidous onset.
We retrospectively analyzed the records of 37 cases of tuberculous peritonitis diagnosed over a 15-year period, and compared the clinical and diagnostic features of cirrhotic and noncirrhotic patients.
In cirrhotic patients, tuberculous peritonitis can simulate ascites from liver disease or spontaneous bacterial peritonitis.
The diagnosis is difficult in these patients because the ascitic fluid may not be of the exudative type as a result of the low albumin level in serum, and lymphocytes do not predominate in all cases.
Adenosine deaminase (ADA) activity in ascitic fluid was elevated (higher than 40 U/L) in all 11 patients (four patients with hepatic cirrhosis).
The time required to achieve a correct diagnosis was significantly longer in cirrhotic than in noncirrhotic patients.
The overall mortality was 13%, with deaths occurring exclusively among cirrhotic patients.
We emphasize that tuberculous peritonitis in cirrhotic patients can present an atypical picture.
A considerable element of suspicion is necessary.
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C01
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662
| 2,889
|
In vitro susceptibility of Xanthomonas (Pseudomonas) maltophilia to newer antimicrobial agents.
The susceptibilities of 45 clinical and 3 environmental isolates of Xanthomonas maltophilia to 14 antimicrobial agents was determined by broth microdilution.
The newer quinolones PD117596, PD117558, PD127391, A-56620, amifloxacin, and fleroxacin were the most active agents tested, with 70 to 99% of isolates being susceptible to these agents.
All isolates were resistant to trospectomycin.
The new aminoglycosides SCH24120 and SCH22591 were active against 12 and 1% of isolates, respectively.
|
C01
|
663
| 5,638
|
Immunogenicity of Haemophilus b conjugate vaccine (meningococcal protein conjugate) in children with prior invasive Haemophilus influenzae type b disease.
Children younger than 2 years of age with previous invasive Haemophilus influenzae (Hib) type b disease may not develop protective antibodies to antigens of Hib and may be at risk of developing a second episode of Hib disease.
Twenty-three children with prior Hib disease were immunized with Haemophilus b conjugate vaccine (meningococcal protein conjugate).
Children 12 to 24 months of age were given one dose of vaccine and children younger than 12 months of age were given 2 doses 2 months apart.
Antibody to the polysaccharide capsule of Hib (PRP) was measured by radioimmunoassay.
Eighteen children had preimmunization serum antibody concentrations less than 0.150 micrograms/ml.
All 18 children responded with greater than 0.150 micrograms/ml of antibody after a single dose of vaccine.
Only 1 of the 23 children had a preimmunization serum antibody concentration greater than 1.000 micrograms/ml.
Seventeen children ultimately responded with greater than 1.000 micrograms/ml of antibody (P less than 0.0001), concentrations of antibody thought to correlate with protection.
Haemophilus b conjugate vaccine (meningococcal protein conjugate) is immunogenic in children with invasive Hib disease.
Children younger than 2 years of age with invasive Hib disease should be subsequently immunized with a Hib conjugate vaccine.
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C01
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664
| 5,934
|
Infectious diseases as a Canadian subspecialty, with projections to the year 2000.
Infectious diseases is a relatively new subspecialty in Canada.
During the past decade, however, important advances have been made.
These include the formation of the Canadian Infectious Diseases Society and the development of the first Royal College of Physicians and Surgeons examinations in the subspecialty of infectious diseases.
The majority of Canadians training for practice in the field of infectious diseases are now enrolled in programs in Canada.
Despite predictions in the United States of an excess of physicians who specialize in infectious diseases, such a situation has not occurred in Canada.
More physicians with training in infectious diseases will be required in Canada in the next decade to fill positions in patient care, microbiology (for individuals with both clinical and laboratory training), research, epidemiology and infection control, programs related to human immunodeficiency virus infections, geographic and international medicine, the pharmaceutical industry, and education and administration.
In Canada, the extent to which infectious diseases physicians are involved in these areas varies from that in the United States.
This review suggests a continued need for physicians with appropriate training in infectious diseases.
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C01
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665
| 738
|
The Hastings bipolar hemiarthroplasty for subcapital fractures of the femoral neck. A 10-year prospective study.
In a 10-year prospective study, 561 displaced subcapital fractures of the femoral neck in 546 patients were treated with the Hastings bipolar hemiarthroplasty.
Within six months of their operations, 148 patients had died.
In 322 hips followed up, 243 with adequate serial radiographs separated by more than one year, only 14 (5.6%) showed acetabular erosion.
A group of 91 had been reviewed for between three and nine years (mean, 4 years 10 months) and of these, 95% had no pain or slight pain only.
Comparison with an earlier series of conventional hemiarthroplasties reported from this institution showed that the clinical results were similar, but that the erosion rate had been halved.
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C01
|
666
| 9,284
|
Risk factors for Staphylococcus aureus nosocomial pneumonia in critically ill patients.
Staphylococcus aureus nosocomial pneumonia has become an important infection not only because of an apparently increasing incidence but also because of its high mortality rate.
A total of 50 episodes of nosocomial pneumonia in critically ill patients in which etiologic diagnosis was well established were prospectively followed in a medical-surgical intensive care unit (ICU).
S.
aureus was isolated in a total of 13 episodes.
In the univariate analysis the variables significantly associated with S.
aureus nosocomial pneumonia were below 25 yr of age, coma, nonuse of corticosteroids, and antecedent trauma.
A step-forward logistic regression analysis defined only coma as significantly influencing the risk of developing S.
aureus nosocomial pneumonia.
We suggest that antimicrobial drugs active against S.
aureus must be included in the initial empirical antimicrobial regimen for treating nosocomial pneumonia in patients with coma.
The identification of factors influencing the etiology and the possibility of earlier effective antimicrobial treatment may represent a further step in the control of nosocomial pneumonia in critically ill patients by improving its prognosis.
|
C01
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667
| 2,515
|
Streptococcus mitis sepsis in bone marrow transplant patients receiving oral antimicrobial prophylaxis.
PURPOSE: Streptococcal infection has increasingly become a problem in neutropenic patients.
We report on an outbreak of Streptococcus mitis sepsis in six bone marrow transplant patients receiving oral antimicrobial prophylaxis.
PATIENTS AND METHODS: We performed an epidemiologic study of all patients in our bone marrow transplant program from 1986 to 1988.
The hospital and microbiology records for all patients were reviewed.
All bone marrow patients were treated according to specified protocols, including an oral prophylactic antimicrobial regimen that was changed in late 1987 from vancomycin/polymyxin/tobramycin to norfloxacin.
Identification, susceptibility testing, and whole cell protein analysis of streptococcal isolates were performed at the Reference and Antimicrobial Investigations Laboratories at the Centers for Disease Control.
RESULTS: We detected six cases of S.
mitis sepsis among 21 patients undergoing bone marrow transplantation.
No other concurrent pathogen was isolated from any patient at the time of the S.
mitis bacteremia.
Bacteremia developed within 72 hours of transplant in five of six patients and was associated with severe mucositis in four patients.
An environmental study failed to reveal any common source for the outbreak, and whole cell protein analysis of all six S.
mitis isolates revealed each to be distinct.
Of 12 patients receiving oral vancomycin/polymyxin/tobramycin, one developed S.
mitis bacteremia, versus five of nine patients receiving norfloxacin (p less than 0.03).
CONCLUSION: We believe S.
mitis bacteremia is a potential complication of bone marrow transplantation and is associated with antimicrobial prophylaxis with norfloxacin, especially in the setting of mucositis.
|
C01
|
668
| 8,368
|
Acute axonal polyneuropathy associated with anti-GM1 antibodies following Campylobacter enteritis.
We report 2 patients with Guillain-Barre syndrome (GBS) following Campylobacter jejuni enteritis.
Electrophysiologic studies indicated that the predominant process was axonal degeneration of motor nerves, and clinical recovery was poor.
Serum testing by thin-layer chromatography and enzyme-linked immunosorbent assay revealed that the sera from both patients contained high titers of IgG antibody against GM1 ganglioside.
These cases may represent a subgroup of GBS as acute axonal polyneuropathy following C jejuni enteritis associated with anti-GM1 antibodies.
|
C01
|
669
| 4,659
|
A large outbreak of antibiotic-resistant shigellosis at a mass gathering.
In July 1987, a large outbreak of shigellosis occurred among attendees at a mass gathering in a national forest, the annual Rainbow Family Gathering.
Sanitation in the campsite was poor, allowing widespread transmission of disease, probably by food, water, and person-to-person spread.
The attack rate may have been greater than 50% among the estimated 12,700 attendees.
The outbreak was caused by Shigella sonnei, resistant to ampicillin, tetracycline, and trimethoprim-sulfamethoxazole; the organism was of colicin type 9 and contained a 90-kilobase plasmid not found in non-outbreak-related strains.
The dispersal of the group resulted in nationwide dissemination of the organism, and outbreaks in three states were linked to transmission from attendees at the Gathering.
This outbreak demonstrates the potential for rapid dissemination of disease in such a setting and the necessity for careful planning of mass gatherings.
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670
| 2,516
|
Pleuritis as a manifestation of reactivation tuberculosis.
PURPOSE: The purpose of this study was to determine the frequency with which tuberculous pleuritis is a manifestation of reactivation tuberculosis and to compare the clinical manifestations of reactivation tuberculous pleuritis with "classic" tuberculous pleuritis, in which chest roentgenograms reveal no parenchymal infiltrates.
PATIENTS AND METHODS: We evaluated the medical records of 59 patients in whom tuberculous pleuritis was confirmed by histologic findings or mycobacterial culture.
Twenty-seven patients (46%) had typical chest roentgenographic findings of reactivation tuberculosis, whereas 32 (54%) had classic tuberculous pleuritis.
The clinical and laboratory features of these two groups were compared.
RESULTS: Symptoms were more prolonged and pleural fluid glucose and lactate dehydrogenase concentrations were more markedly abnormal in patients with reactivation pleuritis than in those with classic pleuritis, suggesting a more chronic inflammatory process in the former group.
Compared with patients with classic tuberculous pleuritis, those with reactivation pleuritis had a lower frequency of reactive tuberculin skin tests (61% versus 88%) and granulomatous pleural inflammation (25% versus 72%), but a higher bacillary burden, manifest by a higher frequency of positive sputum smears for acid-fast bacilli (50% versus 0%) and positive mycobacterial cultures from sputum (60% versus 23%) and pleural fluid (91% versus 66%).
CONCLUSIONS: In contrast to previous reports, tuberculous pleuritis was a manifestation of reactivation tuberculosis in 46% (27 of 59) of patients.
Tuberculous pleuritis is a more chronic process in patients with reactivation disease than in those with classic pleuritis.
The lower frequency of reactive tuberculin skin tests and granuloma formation, combined with the higher bacillary burden in patients with reactivation pleuritis, suggest that these patients mount a less effective immune response to Mycobacterium tuberculosis infection than do patients with the classic form of tuberculous pleuritis.
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C01
|
671
| 4,089
|
Transfusion risks.
Hepatitis remains the most serious transfusion risk, in terms of incidence and severity.
Transfusion-associated AIDS, hemolytic reactions, TRALI, and anaphylaxis are severe problems that occur relatively rarely, while febrile reactions and mild allergic reactions are common but not serious.
The key to avoiding all these complications is autotransfusion (see the article "Autologous Transfusion" in this issue).
Although intraoperative scavenging became available in many centers in the United States in the 1980s, it is hoped that pre-deposit autotransfusion will also become widely utilized in the next decade.
|
C01
|
672
| 4,657
|
Partial characterization of Chlamydia trachomatis isolates resistant to multiple antibiotics.
In vitro susceptibility testing was done on urogenital isolates of Chlamydia trachomatis from five patients, four of whom were suspected treatment failures.
At least one isolate from each patient was resistant to tetracycline at concentrations greater than or equal to micrograms/ml, although less than 1% of a population of organisms showed high-level resistance.
Fully resistant populations selected by passage through 8 micrograms/ml tetracycline either died or lost their resistance on further passage in antibiotic-free medium.
Relatively large inocula were required to demonstrate resistance, and morphology of inclusions was altered at high tetracycline concentrations.
The observed resistance may be a new characteristic of the organism or merely newly recognized.
Isolates resistant to tetracycline were resistant to doxycycline, erythromycin, sulfamethoxazole, and clindamycin but sensitive to rifampin, ciprofloxacin, and ofloxacin.
Thus, resistance to tetracycline, erythromycin, and clindamycin occurs in C.
trachomatis and may be a factor in some treatment failures.
|
C01
|
673
| 5,571
|
Retinal sensitivity in acute hypoglycemia.
We measured retinal threshold sensitivity via automated computerized static perimetry in predetermined meridians in euglycemic diabetic subjects and in the same subjects during insulin-induced hypoglycemia.
During periods of reduced blood glucose levels, decreased retinal sensitivity, most marked in temporal meridians, was observed.
|
C18
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674
| 4,680
|
Conjugated catecholamines in human plasma: where are they coming from?
The origins of conjugated catecholamines remain poorly known.
The aim of the present study was to see whether a major contribution comes from the sympathetic nervous system.
We have assumed some kind of parallelism between the activity of the sympathetic nervous system, the amount of catecholamines released and taken up, and the amount of conjugated catecholamines circulating in plasma.
Accordingly, an increase in sympathetic activity should be followed by an increase in the plasma level of conjugated catecholamines.
The plasma levels of sulfoconjugated and glucuroconjugated catecholamines were measured in 10 patients with mental disease resistant to drug treatment, before and after electroconvulsive therapy.
As expected, blood pressure, norepinephrine concentration, and epinephrine concentration in plasma were transiently increased.
Neither sulfoconjugated nor glucuroconjugated catecholamines were significantly changed.
Conjugated catecholamines were measured in 10 volunteers before and at the nadir of insulin-induced hypoglycemia.
As expected, plasma levels of norepinephrine and epinephrine were drastically increased.
Plasma levels of sulfoconjugates were decreased and glucuroconjugates increased; these were narrow but statistically significant variations.
Data reported in the present article do not support a major role for the activity of the sympathetic system in fixing the level of conjugated catecholamines in human plasma.
This is a negative, but nonetheless important, observation.
In human subjects, currently available information suggests an important role for the intestinal wall and renal function in determining the level of circulating sulfoconjugates.
|
C18
|
675
| 9,516
|
Benefit of bicarbonate dialysis during CAVHD.
The effect of bicarbonate dialysate (BD) on acid-base status in six pediatric CAVHD patients was examined during seven episodes of metabolic acidosis.
When metabolic acidosis was not corrected with CAVHD, a sterile BD was substituted for either acetate- or lactate-based dialysate.
Pre- and post-BD substitution levels of lactate, HCO3, PCO2, anion gap, and pH were recorded, as well as dose of intravenous (i.v.) bicarbonate.
Improvements in pH and serum HCO3 were seen in all seven cases.
Anion gap decreased in all but one of the patients who were switched from lactate to bicarbonate dialysate, with improvement most marked in those patients with marked elevation of the anion gap.
No adverse effect on PCO2 was noted.
Lactate dialysate may be less effective when serum lactate levels are high, and may contribute to further elevation of lactate levels and anion gap.
These data suggest that bicarbonate dialysate may be preferable to lactate or acetate dialysate in CAVHD patients with persistent metabolic acidosis.
|
C18
|
676
| 9,502
|
Detailed examination of complete bioprosthetic heart valves.
Six (3 control and 3 explanted) bioprostheses were examined histologically after embedding the complete valve in "plastic" and sectioning across the valve at 90 degree to the horizontal plane, and then horizontally across a stent post, with a low speed saw.
The prostheses, porcine or pericardial, had been in place 52 to 121 months.
In addition to cusp changes of degeneration and calcification that have been previously reported, the authors found extensive pannus deposition on the cloth covering the inflow surface of the prostheses, with some extension onto the biologic components; evidence of insudation of tissue fluid and ingrowth of fibroblasts; deposition of collagen; and infiltration of mononuclear cells in the interstices and interfaces.
Non-biologic components showed changes which may have affected prosthesis function.
The synthetic material covering the metal/plastic frame showed interstitial mononuclear cells.
Two of the three explanted valves showed changes in the polymeric plastic, and one in the metal components, including accentuated notching along the surfaces when compared to unimplanted prostheses.
A larger number of prostheses must be examined before definite conclusions can be drawn.
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C18
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677
| 3,065
|
Assessment of vitamin A status by a disk applicator for conjunctival impression cytology.
Conjunctival impression cytology was performed on 236 Indonesian preschool children, half of whom had mild xerophthalmia and half of whom were age-matched controls.
We devised an applicator that applies a paper disk of fixed area to the conjunctiva with even pressure.
The disk applicator was used to collect impression cytology specimens from the temporal bulbar conjunctiva of one eye while the original strip technique was used on the other eye.
Mean (+/- SD) serum retinol values for children with normal and abnormal discs were 22.0 +/- 8.6 micrograms/dL and 18.0 +/- 7.2 micrograms/dL P less than .0001).
Mean serum values for normal and abnormal strips were 21.7 +/- 8.6 micrograms/dL and 19.0 +/- 7.7 micrograms/dL (P less than .03).
Specimens obtained with the new disk applicator corresponded more closely with serum vitamin A levels and therefore vitamin A status than those obtained with the traditional strip technique.
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678
| 6,774
|
Slow glucose removal rate and hyperinsulinemia precede the development of type II diabetes in the offspring of diabetic parents.
OBJECTIVE: To determine whether insulin resistance or insulin deficiency is primary in the pathogenesis of type II diabetes.
DESIGN: Cohort analytic study of persons with normal glucose tolerance but with a high risk for developing type II diabetes (average follow-up time, 13 years).
SETTING: Outpatients had an intravenous glucose tolerance test and were contacted periodically to ascertain diagnoses of diabetes.
PARTICIPANTS: One hundred and fifty-five normal offspring, ranging in age from 16 to 60 years, of two parents with type II diabetes and 186 normal control subjects in the same age range who had no family history of diabetes.
MEASUREMENTS AND MAIN RESULTS: Two phenotypic characteristics distinguished the offspring of diabetic parents from control subjects.
They had slower glucose removal rates (Kg) (P less than 0.01) and higher insulin levels (fasting and during the second phase of insulin response to intravenous glucose; P less than 0.0001) than did control subjects, even after adjustment for differences in obesity.
Sixteen percent of the offspring developed type II diabetes.
Mean Kg at baseline was 1.7%/min among offspring who subsequently developed diabetes, 2.2%/min among offspring who remained nondiabetic, and 2.3%/min among control subjects.
Corresponding means for first-phase insulin were 498, 354, and 373 pM, respectively, whereas second-phase insulin means were 329, 117, and 87 pM, respectively.
In multivariate analysis, low Kg and high serum insulin levels independently increased the risk for developing diabetes among the offspring of diabetic parents.
CONCLUSIONS: One to two decades before type II diabetes is diagnosed, reduced glucose clearance is already present.
This reduced clearance is accompanied by compensatory hyperinsulinemia, not hypoinsulinemia, suggesting that the primary defect is in peripheral tissue response to insulin and glucose, not in the pancreatic beta cell.
|
C18
|
679
| 8,527
|
Screening 1140 fifth graders for hypercholesterolemia: family history inadequate to predict results
Cholesterol screening was performed on 1140 fifth-grade students in Scottsdale, AZ, as part of a school-affiliated, health-education program.
The goals were to determine whether family history of heart disease or high cholesterol can predict which children have high cholesterol levels and to examine the feasibility of screening large numbers of elementary school students.
Among the children studied, the mean cholesterol level was 168.3 mg/dL (4.35 mmol/L), and 13 percent had cholesterol levels above 200 mg/dL (5.20 mmol/L).
Fifty-four percent had a family member with high cholesterol or a heart attack before age 60 years, but 36 percent of the students with cholesterol levels greater than 200 mg/dL (5.20 mmol/L) had a negative family history.
Family history was neither sensitive nor specific as a predictor of elevated cholesterol levels (sensitivity 0.64, specificity 0.47, and positive predictive value 0.16 for predicting cholesterol levels greater than 200 mg/dL [5.20 mmol/L]).
Large numbers of children were screened safely and efficiently with good student and parental cooperation.
Results of this study do not support the current recommendations to screen children for hypercholesterolemia based upon their family histories.
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680
| 461
|
WHO Multinational Project for Childhood Diabetes. WHO Diamond Project Group.
Insulin-dependent diabetes mellitus (IDDM) is one of the most important chronic diseases of children worldwide.
IDDM leads to an 8- to 10-fold excess risk of mortality in developed countries, whereas in developing countries, most cases die within a few years.
A 60-fold international gradient in IDDM incidence has been reported, and epidemic periods have been identified.
A new World Health Organization program, Multinational Project for Childhood Diabetes (Diabetes Mondiale or DIAMOND), has been developed to investigate and characterize global incidence, mortality, and health care.
Over 10 yr (1990-1999), this study will collect population-based data concerning IDDM in greater than 90 centers in 50 countries worldwide.
The goals of DIAMOND are to collect standard information on incidence, risk factors, and mortality associated with IDDM; evaluate the efficiency and effectiveness of health care and the economics of diabetes; and establish national and international training programs in diabetes epidemiology.
It is hoped that the DIAMOND project will be instrumental for the prevention of this serious disease and its sequelae.
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681
| 3,842
|
Involvement of epidermal growth factor deficiency in pathogenesis of oligozoospermia in streptozotocin-induced diabetic mice.
Based on previous findings that epidermal growth factor (EGF), which plays an important role in maintenance of spermatogenesis, is deficient in diabetic mice, the significance of EGF deficiency in the pathogenesis of oligozoospermia in streptozotocin-induced diabetic mice was studied.
EGF levels in the submandibular glands and plasma of diabetic mice were 0.61 +/- 0.07 micrograms/mg tissue and 0.25 +/- 0.02 ng/ml (mean +/- SE), respectively, whereas those of normal mice were 1.63 +/- 0.08 micrograms/mg tissue and 0.54 +/- 0.04 ng/ml, respectively.
The epididymal sperm counts of diabetic mice, 4.7 +/- 0.14 x 10(5)/mg tissue, were significantly lower (P less than 0.01) than those of normal mice, 6.0 +/- 0.10 x 10(5)/mg tissue.
Administration of EGF (5 micrograms/mouse/day) to diabetic mice significantly (P less than 0.01) increased their sperm counts to 5.5 +/- 0.16 x 10(5)/mg tissue without affecting plasma levels of testosterone and glucose.
Furthermore, insulin treatment (1 U/mouse/day) of diabetic mice restored the submandibular gland, plasma EGF concentrations, and sperm counts to normal levels.
The restorative effects of insulin on sperm production appeared to be mediated, at least in part, by EGF, because its effect was significantly (P less than 0.01) reduced by the concomitant administration of EGF antiserum.
In addition, the plasma testosterone levels of diabetic mice, 67 +/- 14.3 ng/ml, were lower that those of normal mice, 122 +/- 19.1 ng/ml.
Administration of testosterone (1 mg/mouse/day) normalized the submandibular gland and plasma EGF levels and significantly increased sperm counts in the epididymis.
These results suggest that EGF deficiency is a possible cause for the pathogenesis of oligozoospermia in diabetic mice.
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682
| 4,271
|
Adrenal medullitis in type I diabetes.
To investigate whether cell-mediated immunity against the adrenal medulla occurs in type I diabetes (IDDM), we conducted a retrospective autopsy study of adrenal glands from IDDM and nondiabetic subjects using formalin-fixed tissue.
Forty-four IDDM subjects, aged 4-67 yrs (mean +/- SD, 44.8 +/- 15.4) with a duration of IDDM from 0-55 yr (28.6 +/- 14.2), and 29 nondiabetic controls, aged 8-82 yr (51.8 +/- 18.6), were evaluated for a lymphocytic infiltrate using UCHL1, which recognizes a subpopulation of resting T-lymphocytes and most activated T-lymphocytes.
Immunohistochemistry using antihuman B-cell antibody (L26) was also performed.
Sections were scored for both lymphocytic infiltrates and fibrosis [none (0), small (1), moderate (2), or large (3)].
Blinded scoring was performed.
A moderate to severe UCHL1 infiltrate was present in 9 of 44 (20%) IDDM, compared with 1 of 29 (3%) control subjects (P less than 0.04).
Mild to severe fibrosis (score 1, 2, or 3) was present in 22 of 42 (52%) IDDM subjects compared with 4 of 25 (16%) control subjects (P = 0.003).
Eight of 42 (19%) IDDM subjects had moderate to severe fibrosis (score 2 or 3) compared with 1 of 25 (4%) control subjects.
Seventeen of 44 (39%) IDDM subjects had either a moderate to large cellular infiltrate or moderate to severe adrenal medullary fibrosis compared with 2 of 29 (7%) control subjects (P = 0.003).
Staining of the adrenal medulla with L26 revealed a large cellular infiltrate in only one subject who was UCHL1 negative.
Adrenal medullitis was observed in 20% of IDDM subjects, suggesting that the adrenal medulla may be another immunological target in IDDM.
|
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|
683
| 5,919
|
A case of group B streptococcal pyomyositis
The group B streptococcus is an opportunistic pathogen that causes a variety of serious infections including bacteremias, puerperal sepsis, and neonatal meningitis.
Group B streptococcal infections of muscle are rare.
We report here an unusual case of group B streptococcal pyomyositis.
Pyomyositis arises predominantly from infections caused by Staphylococcus aureus and, occasionally, Streptococcus pyogenes.
Because of the rarity of pyomyositis in temperate climates, the common lack of localizing signs or symptoms, and the frequently negative blood cultures, considerable delay often precedes the diagnosis of pyomyositis; in fact, the infection has been initially misdiagnosed as muscle hematoma, cellulitis, thrombophlebitis, osteomyelitis, or neoplasm.
Diagnosis may be greatly aided by radiologic techniques that can demonstrate the sites of muscle enlargement and the presence of fluid collections.
The response to antibiotics is usually rapid, but resolution of the infection may require aspiration of deeply situated muscle abscesses.
This report describes a diabetic patient with an unusual presentation of pyomyositis that mimicked an acute abdomen.
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C18
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684
| 3,931
|
Reduced insulinotropic effects of glucagonlike peptide I-(7-36)-amide and gastric inhibitory polypeptide in isolated perfused diabetic rat pancreas.
The pathophysiological role of incretin in diabetes mellitus has not been established.
We therefore examined the effects of glucagonlike peptide I-(7-36)-amide (truncated GLP-I) and gastric inhibitory polypeptide (GIP) on insulin and glucagon release from isolated perfused pancreases of diabetic rats (12-14 wk of age, mean +/- SE fasting plasma glucose 8.9 +/- 0.6 mM, n = 25) after an injection of 90 mg/kg streptozocin on the 2nd day after birth and compared the results with those of nondiabetic control rats.
In diabetic rats, the infusion of 1 nM GLP-I or GIP in perfusates with varying glucose concentrations (2.8, 5.6, 8.3, 11.1, or 22.2 mM) caused a nearly equal degree of insulin stimulation from a similar basal insulin level.
Meanwhile, basal and GLP-I- or GIP-stimulated insulin release increased in correlation with the ambient glucose concentration in nondiabetic rats.
The degree of stimulation of insulin release at glucose concentrations of 5.6 mM in diabetic rats was approximately 33% that of nondiabetic rats.
The stimulation potency was the same between GLP-I and GIP.
The insulin treatment for diabetic rats (5 U/kg NPH insulin at 0900 and 2100 for 6 days) brought only a slight improvement in the glucose dependency of GLP-I-stimulated insulin release.
The effects of GLP-I and GIP on glucagon release were completely opposite.
GLP-I suppressed release; GIP stimulated it.
In diabetic rats, the degree of suppression by GLP-I and stimulation by GIP were almost the same with similar basal glucagon levels in the perfusate with varying glucose concentrations.
|
C18
|
685
| 3,259
|
Biometry of the crystalline lens in early-onset diabetes
Lenticular biometry on non-cataractous lenses has been studied by means of Scheimpflug photography and digital image analysis in 153 patients with early-onset insulin-dependent diabetes and 153 non-diabetic controls.
Anteroposterior axial lens thickness, cortical thickness, nuclear thickness, anterior and posterior lenticular curvatures, and anterior chamber depth were assessed.
Highly significant differences between the lenses of the diabetic subjects and non-diabetic controls were found.
After the effect of age had been accounted for within the diabetic subgroup, diabetic duration was found to be a highly significant determinant of lens dimensions, such that age-related dimensional changes for various biometric parameters were accelerated by between 52% and 121% after the onset of diabetes.
Because the diabetic duration of the early-onset diabetic subjects studied in this work was accurately known, this report is the first in which a precise assessment of the effect of 'true' diabetic duration on lens biometry has been possible.
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686
| 5,253
|
Effect of short-term intermittent antibiotic treatment on growth of Burmese (Myanmar) village children.
To test the hypothesis that subclinical enteric infection (such as bacterial overgrowth), rice malabsorption, and growth faltering are causally linked, a field trial of low-dose, short-term, intermittent antibiotic treatment was carried out in 142 hydrogen-producing (by lactulose breath hydrogen test) Burmese village children aged 6-59 months.
The children were randomly allocated treatment with metronidazole (20 mg/kg or 5 mg/kg daily), amoxycillin (25 mg/kg daily), or placebo given 1 week per month for 6 months.
A cooked rice meal breath hydrogen test was done to classify the children as rice absorbers (RA) or rice malabsorbers (RM) before treatment and monthly on the day before each cycle of treatment.
There were no differences between the treatment groups, so they were considered together.
Factorial analysis showed that antibiotic treatment did not significantly affect the proportion of RM children.
The only significant difference between antibiotic-treated and placebo-treated children's growth was in the subgroup of RM children aged 36-47 months; the antibiotic-treated children had significantly greater linear growth.
In other age groups antibiotic treatment had no effect on growth.
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C18
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687
| 460
|
Comparison of quantitative sensory-threshold measures for their association with foot ulceration in diabetic patients.
We compared the accuracy of cutaneous pressure perception-threshold measurements with that of other sensory-threshold measurements for detecting diabetic foot ulcer patients.
Three hundred fourteen non-insulin-dependent diabetic patients were studied, of whom 91 had either a current foot ulcer or a history of foot ulceration.
Foot ulcer patients had much higher pressure perception thresholds at the hallux than those without foot ulcers (mean +/- SE 4.63 +/- 0.05 vs.
3.54 +/- 0.04 U, P less than 0.001).
The magnitude of association was higher than that for vibration thresholds and markedly greater than those for cool and warm thresholds.
Pressure thresholds were highly accurate for identifying foot ulcer patients.
At a threshold level of 4.21 U, the sensitivity was 0.84, with a specificity of 0.96.
At similar sensitivities for vibration and thermal thresholds, specificities were lower.
Foot ulceration and cutaneous pressure perception threshold are strongly associated.
Pressure-threshold measurements are extremely accurate and perform at least as well as other quantitative sensory tests in identifying foot ulcer patients.
Assessment of the foot pressure threshold may have promise as a simple and inexpensive method for detecting diabetic patients at risk for foot ulcers.
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C18
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688
| 2,499
|
Deletion mapping of Aland Island eye disease to Xp21 between DXS67 (B24) and Duchenne muscular dystrophy.
Aland Island Eye Disease (AIED) is an X-linked form of ocular hypopigmentation--also known as Forsius-Eriksson, or type 2, ocular albinism--in which affected males demonstrate subnormal visual acuity, protanomalous red-green colorblindness, axial myopia, astigmatism, hypoplasia of the fovea, and hypopigmentation of the fundus.
A patient has previously been described who, in addition to AIED, manifested a contiguous gene syndrome which included congenital adrenal hypoplasia (AHC), glycerol kinase deficiency (GKD), and Duchenne muscular dystrophy (DMD).
In the present paper report we report the molecular genetic analysis of his deletion.
Initially, multiplex polymerase-chain-reaction amplification was used to screen for a DMD-locus deletion which was then further characterized, using DMD cDNA and genomic probes, via Southern blot analysis.
The deletion includes the region encompassed by probes C7 (DXS28) and DMD cDNA 8.
Probes B24 (DXS67) and DMD cDNA 5b-7 show normal hybridization patterns and appear to flank the deletion, while the DMD cDNA 8 detects a junction fragment.
Molecular genetic techniques have mapped the deletion in this patient to the subbands Xp21.3-21.2, between DXS67 and DMD.
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C18
|
689
| 6,934
|
Lovastatin. Warfarin interaction.
Two patients who developed hypoprothrombinemia and bleeding due to lovastatin-warfarin drug interaction are described.
Because of the wider use of lovastatin and warfarin, heightened clinical awareness of this potentially serious interaction must be publicized.
Therefore, prothrombin time should be monitored diligently when warfarin is prescribed to patients receiving lovastatin.
|
C18
|
690
| 3,965
|
Induction of insulin resistance in vivo by amylin and calcitonin gene-related peptide.
During hyperinsulinemic glucose-clamp studies, intravenous infusion of calcitonin gene-related peptide (CGRP) in rats antagonized the ability of insulin to stimulate peripheral glucose disposal by 52% (196 +/- 7.2 vs.
105 +/- 10.5 mumol.kg-1.min-1, P less than 0.05) and to inhibit hepatic glucose output by 54% (P less than 0.01).
CGRP also inhibited the in vitro effects of insulin to stimulate hexose uptake in cultured BC3H1 myocytes at all insulin concentrations studied.
Amylin is a peptide isolated from amyloid deposits in pancreatic islets of type II (non-insulin-dependent) diabetic subjects, is present in normal beta-cells, and bears a striking homology to CGRP.
When synthetic human amylin was infused during clamp studies, it inhibited the ability of insulin to stimulate glucose disposal by 56% (96.9 +/- 9.4 vs.
42.4 +/- 5.0 mumol.kg-1.min-1, P less than 0.05) and to suppress hepatic glucose output by 64%.
Therefore, amylin and CGRP can cause insulin resistance in vivo and may be implicated in insulin-resistant states such as type II diabetes mellitus.
|
C18
|
691
| 5,160
|
Primary hypertriglyceridemia with borderline high cholesterol and elevated apolipoprotein B concentrations. Comparison of gemfibrozil vs lovastatin therapy
A common pattern of dyslipidemia is elevated levels of plasma triglyceride, borderline high total cholesterol, reduced high-density lipoprotein, and increased apolipoprotein B.
This pattern of dyslipidemia frequently is associated with premature coronary heart disease.
Nicotinic acid is the drug of first choice for this pattern.
In this study, gemfibrozil and lovastatin were compared for their effects on the overall lipoprotein profile in 13 men with this type of dyslipidemia.
Both drugs significantly reduced very-low-density lipoprotein and intermediate-density lipoprotein cholesterol levels, and both modestly raised high-density lipoprotein cholesterol levels.
Gemfibrozil therapy, however, failed to reduce total cholesterol or total apolipoprotein B levels, whereas lovastatin therapy lowered levels of total cholesterol by 28%, low-density lipoprotein cholesterol by 33%, and total apolipoprotein B by 32%.
Moreover, lovastatin therapy caused greater declines in lipoprotein cholesterol ratios than gemfibrozil therapy.
Lovastatin thus seems to have certain advantages over gemfibrozil for treatment of elevated plasma triglyceride levels accompanied by borderline high total cholesterol and raised apolipoprotein B levels; therefore, lovastatin therapy should be considered as one approach for management of this condition.
|
C18
|
692
| 6,266
|
Dietary predictors of symptom-associated gallstones in middle-aged women.
In 1980, 88,837 women aged 34-59 y completed a semiquantitative food frequency questionnaire and were followed for 4 y.
Four hundred thirty-three women reported a cholecystectomy for recent cholecystitis, and 179 reported unremoved, newly symptomatic gallstones diagnosed by ultrasound or x ray.
Among the 59,306 women with Quetelet's index of relative weight less than 25 kg/m2, inverse associations were observed between intakes of vegetable fat and vegetable protein and the risk of reportedly symptomatic gallastones, after adjusting for age, Quetelet's index in 1980, weight change between 1976 and 1980, energy intake, and alcohol intake.
The relative risk in the highest quintile of vegetable fat intake, as compared with the lowest quintile, was 0.6 [95% confidence interval (CI), 0.4-0.9], and the corresponding relative risk for vegetable protein intake was 0.7 (95% CI, 0.6-0.9).
No significant associations were found with energy-adjusted intakes of cholesterol, animal fat, animal protein, carbohydrate, or sucrose.
|
C18
|
693
| 6,079
|
Severe primary hyperparathyroidism in a neonate having a parent with hypercalcemia: treatment by total parathyroidectomy and simultaneous heterotopic autotransplantation.
Neonatal primary hyperparathyroidism is a life-threatening disease because of marked hypercalcemia and severe respiratory distress caused by the hypoplastic thorax and occasional rib fractures.
We report a 29-day-old girl treated by total parathyroidectomy and simultaneous autotransplantation of parathyroid tissue (one fifth of each of the two glands) in the femoral quadriceps muscle near the groin.
At the time of operation, all four of the parathyroid glands were markedly enlarged, and their total weight was 900 mg.
Part of the resected parathyroid tissue was cryopreserved for further autotransplantation should hypoparathyroidism develop.
Two years six months after surgery, the infant was well and had normal levels of serum calcium and immunoreactive parathyroid hormone in the absence of any supplementary treatment.
Asymptomatic hypercalcemia in the presence of abnormally low fractional excretion of calcium was found in the father.
Based on our experience and review of the literature, we recommend total parathyroidectomy, autotransplantation, and cryopreservation for the neonate with primary hyperparathyroidism.
|
C18
|
694
| 539
|
A unified hypothesis for the complex genetics of HLA associations with IDDM.
Our understanding of the role of HLA genes associated with insulin-dependent diabetes mellitus (IDDM) is in disarray, despite recent improvements in the definition of specific alleles and haplotypes.
Some genes are highly associated with IDDM, other genes are associated with resistance to IDDM, and some highly associated susceptibility genes are markedly influenced by trans-associated synergistic effects (DR3/4 heterozygotes) or protective effects (DR2/4 heterozygotes).
This plethora of genetic associations has spawned the notion that there are many contributing susceptibility genes, which, in turn, has led to the search for shared structural features among different genes on IDDM-associated haplotypes.
From a more mechanistic point of view, however, the wide range of variable IDDM associations, with both cis- and trans-encoded protective and/or synergistic effects, suggests a different approach.
This article proposes a hypothesis in which the different HLA associations with IDDM can be simply explained by a single unifying concept: a hierarchy of affinities determines the interaction between a diabetogenic peptide and different class II molecules, and an individual is susceptible to IDDM if the class II molecule in that individual with the highest affinity for such a peptide is a DQ beta susceptibility gene.
The explicit formulation of this proposal and its genetic implications provide an explanation for HLA-encoded dominant "protection" and for some of the more subtle genetic observations related to cis and trans influences in IDDM susceptibility.
|
C18
|
695
| 9,036
|
Response to diet and cholestyramine in a patient with sitosterolemia.
In this report, an 11-year-old boy with diffuse tendinous and tuberous xanthomatosis and a plasma sterol concentration of 555 mg/dL, consisting primarily of cholesterol, is described.
Three months after changing from an unrestricted diet to a cholesterol-lowering diet, his plasma sterol concentration decreased to 221 mg/dL.
Because of the degree and rapidity of his response to diet, sitosterolemia was suspected.
According to results of capillary gas-liquid chromatography of his plasma sterols, there was a sitosterol concentration of 31.3 mg/dL (normal less than 1.0 mg/dL), establishing the diagnosis of sitosterolemia.
Addition of cholestyramine therapy (8 g/d) to a low sterol diet further lowered his plasma sterol concentration to 173 mg/dL and led to complete regression of all tuberous xanthomata.
Tendinous xanthomata regressed at a slower rate.
These findings show that the diagnosis of sitosterolemia should be suspected in severely hypercholesterolemic children (total cholesterol greater than 400 mg/dL) whose plasma cholesterol level is highly responsive to dietary manipulation.
The rapid and sustained lowering of plasma cholesterol and regression of xanthomata after treatment with diet and cholestyramine suggest that sitosterolemia is a treatable cause of premature atherosclerosis.
|
C18
|
696
| 215
|
Radiographic microcalcification and parenchymal patterns as indicators of histologic "high-risk" benign breast disease.
Breast tissue from a forensic autopsy series of 486 women (15 to 98 years of age) was studied radiographically and by histologic sampling.
Prevalence of Wolfe P2/Dy parenchymal patterns decreased with age.
Radiographic nonvascular microcalcification and histologic presence of marked ductal epithelial hyperplasia and lobular microcalcification increased with age.
Both of these histologic parameters of increased risk for breast cancer correlated with the presence of radiographic microcalcification and Wolfe P2/Dy parenchymal pattern.
The predictive value of the radiographic parameters for presence of "high-risk" proliferative fibrocystic change increased with age.
|
C18
|
697
| 9,875
|
Bartter's syndrome and diabetes mellitus.
We here report a case of Bartter's syndrome occurring in association with diabetes mellitus.
The patient, an insulin-dependent diabetic, presented with hypokalaemia, inappropriate kaliuresis and metabolic alkalosis.
He had high plasma renin activity, relatively low plasma aldosterone, and resistance to infused angiotensin II.
A high potassium diet raised total body potassium and serum potassium, did not affect plasma renin activity, but raised plasma aldosterone significantly and did not alter the resistance to angiotensin II.
Indomethacin administered acutely reduced urinary potassium and kallikrein excretion and, on chronic administration, lowered plasma renin activity, urinary chloride excretion, and raised serum potassium.
Salt restriction resulted in a prompt and significant reduction in urinary sodium and chloride excretion.
Urinary kallikrein excretion was very high throughout, increased with sodium restriction, and decreased with sodium loading.
Oral potassium supplementation partially corrected the hypokalaemia, but did not affect blood sugar control.
In this patient the primary defect appears to have been primary urinary potassium wasting, rather than sodium or chloride wasting.
The striking effects of indomethacin suggest that prostaglandins may play a fundamental role in the genesis of the syndrome.
|
C18
|
698
| 463
|
Lack of effect of clonidine and pentoxifylline in short-term therapy of diabetic peripheral neuropathy.
The goal of this study was to confirm or rule out anecdotal reports of beneficial effects of clonidine and pentoxifylline in the treatment of painful diabetic peripheral neuropathy.
Clonidine was administered to 16 subjects at two dosage levels (0.1 and 0.2 mg/day) and was compared to placebo in a crossover design, with each phase lasting 4 wk.
Either pentoxifylline (400 mg 3 times/day) or placebo was given to 21 subjects in a 12-wk trial.
Discomfort was characterized and rated with a subjective pain score (range 0-20).
There was a significant decrease in pain score from baseline with both active drugs (P less than 0.05), but this was no better than the response to placebo (P less than 0.30 for clonidine and P less than 0.95 for pentoxifylline).
This study does not demonstrate a short-term benefit of either clonidine or pentoxifylline in the treatment of peripheral neuropathy.
|
C18
|
699
| 456
|
Is menarche associated with diabetic retinopathy?
The goal of this study was to evaluate the association between menarchal status and diabetic retinopathy.
Diabetic retinopathy was present in 51 of 129 females; 7 were premenarchal, and 44 were postmenarchal.
The range of severity of retinopathy was greater in the postmenarchal group.
In multivariate analyses, duration of diabetes, menarchal status, and diastolic blood pressure were associated with the prevalence of diabetic retinopathy.
After partitioning the duration of diabetes into years before and years after menarche, both were significant, but the number of years of diabetes after menarche was more strongly associated.
At a 4-yr follow-up examination, more postmenarchal than premenarchal females had progression of their retinopathy (P = 0.06).
These data suggest that stage of sexual development, as reflected by menarchal status, is associated with the presence and possibly the risk of progression of diabetic retinopathy.
|
C18
|
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