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8041101 | [The problem of paramedicine and the therapy of urologic patients]. | A questionnaire study covering a large number of urological patients is carried out in an attempt to establish the extent to which the services of paramedical healers are sought, as well as the underlying motivation involved. It is demonstrated that 13.12 per cent of the inquired refer to alternative medicine specialists. Usually it is a matter of patients with chronic and incurable conditions, such as nephrolithiasis, adenoma of the prostate gland, oncourological diseases, chronic prostatitis and cystalgia. Of the vast variety of healers, herbalists and extrasensory perception therapists appear to be the most attractive. Nearly one-third of the patients appear to be the most attractive. Nearly one-third of the patients attain temporary effect of a varying degree, estimated subjectively. All patients with some improvement have undergone parallel treatment by urologist and healer. The problem is comprehensively discussed. |
8041099 | [Selective surgical treatment in hemorrhages from gastric and duodenal ulcers. The surgical procedure and methods]. | This is a study on 446 patients presenting bleeding gastric ulcers (95) and bleeding duodenal ulcers (351), 314 men and 132 women, covering the period 1985 through 1991. The length of hospitalization of those admitted as inpatients is comparatively assayed with the operative activity and lethality indicators, and on the ground of the obtained results the contingent at risk is identified. The symptoms of the disease are grouped in leading syndromes characteristic of the nosological entity. Based on the same criteria, the prognostic and risk factors are outlined, and accordingly patients admitted with bleeding ulcers are assigned under the heading risk groups which contributes to the early selection of patients. The latter in turn defines both the indications and terms of undertaking the operative intervention. Proceeding from personal experience to date, early selection and operative management using organ-preserving and organ-sparing methods are recommended. |
8041098 | [The clinical and microbiological study of the preparation perfloxacin in treating urologic infections]. | Experience with Pefloxacin treatment of thirty-nine patients presenting urinary tract infection, over the period 1992-1993, is shared. The drug is administered per os at dosage--800 mg, divided in two doses given at 12-hour intervals. As shown by the results of assaying the clinical symptoms, laboratory indicators and microbiological findings in the urine, the therapeutic effect is very good. A clinical cure is recorded in 76 cases (92 per cent), and healing of the bacteriological agent--in 92.31 per cent. Side effects are rarely observed and mildly manifested. The results of Pefloxacin treatment warrant the assumption that the drug synthesized is encouraging, suitable for both out- and inpatient treatment of urinary tract infections, and therefore it should be introduced in the daily routine practice. |
8041097 | [Oleogranuloma of the penis]. | Based on literature data and personal clinical experience with twenty patients presenting sex organ oleogranuloma, summed up inferences are reached about the choice of a rational therapeutic approach. The conservative treatment in both acute and chronic stage of the disease proves ineffective. Operative treatment is the basic one, and is aimed at radical removal of the granulation tissue and injected lipid material deposits. The resulting skin defect may be covered using diverse procedures, briefly outlined in the paper. |
8041096 | [Renal carcinoma with bilateral location and in the single kidney]. | Patients with renal carcinoma, admitted to the university urological clinic in Rostock, Germany, over a ten-year period (1980 through 1990), are analyzed retrospectively. In ninety-seven patients the histological diagnosis is confirmed during operation. Renal carcinoma with bilateral location is diagnosed in eight of them. Four patients present a single kidney because of previous neoplastic nephrectomy of the other one. Apart from that there are five patients with carcinoma of the only kidney due to other causes: aplasia of the first kidney (4 cases) and nephrectomy of a pyelonephrotic kidney (1 case). The total number of carcinomas involving the only kidney amount to nine, and in seven of them the organ salvaging operation performed is successful. In two patients, owing to involvement of the wall discovered during operation, this intervention proves impracticable. Here the operation terminates with radical nephrectomy, with the patients undergoing hemodialysis, and preparation for renal transplantation. The survival term exceeds five years in one patient alone. Two deaths occur during the operation, attributed to the advanced stage of the tumor: in 4 patients T4, and in the remainder (4)-T3a and T3b. |
8041095 | [The clinical and anesthesiological aspects of ambulatory pediatric urological operations]. | Over a five-year period, a total of 838 children, aged 0.5 to 15 years, undergo surgical treatment in the urological clinic, accounting for 16.49 per cent of all operations performed. Of the total number of children subjected to surgery, 772 (92.12 per cent) are operated on an outpatient basis which is 15.19 per cent of all operations. In case of correct assessment of the indications and contraindications, the postoperative anesthesiological and clinical complications prove to be rather low--less than 0.5 per cent, and what is more, they are of a mild nature and do not threaten the life and health of the patient. The combination ketalar+diazepam, administered intravenously at small doses, is recommended as the most suitable anesthesia for outpatient urological operations in pediatrics. It secures good anesthesia with a residual analgetic effect lasting 3-4 hours postoperatively. |
8041094 | [The effect of temporary skin substitutes on the area around the wound following an experimental thermal burn of the skin]. | The effect of temporary skin resurfacing on processes developing in the skin surrounding post-thermal-burn wounds is morphologically studied in experiment. The burned wound region and perilesional area are immediately covered by a fresh allograft, xenograft, Ampoxen, Pharmexplant and Deflamol ointment. Tissue specimens for histological evaluation are taken within 3, 7 and 14 days. The processes developing within the wound and in the perilesional area under a fresh allograft and Deflamol ointment appear to be the most beneficial. Here the inflammatory response is substantially milder, and regardless of the latter, the regeneration and even differentiation of cells in the course of healing are more clearcut, as compared to the other resurfacing methods used in the experiment. |
8041093 | [The experimental and clinical use of neprolizin in thermal burns of the skin]. | Morphological skin changes within the focus of lesion and in the perilesional area are studied against the background of local application of the Bulgarian enzyme preparation Neprolyzin. The experimentally induced injury includes thermal burn, mechanical crushing (conquassatio), and combination of the two. The drug is administered immediately after the trauma, or on the fourth post-injury day, with the studies performed after 4-day-long treatment. In the clinical trial Neprolyzin is applied within 3 to 4 days of a third-degree burn. In conclusion, it is stressed that Neprolyzin should be applied immediately after a thermal burn, it should not be used in handling a mechanical crush injury, whereas in the event of associated trauma it should be used on the fourth post-injury day. The clinical assessment points to the necessity of local anesthesia during application of the drug, or analgesics up to one hour after the dressing. |
8041092 | [The advantage of biological explants in covering donor areas]. | A new method of treating raw donor wounds by biological resurfacing in conjunction with fluid bed is described. The classical method of donor area treatment and the newly developed procedure are comparatively studied. Inferences are reached warranting recommendation of the new approach as a routine method for operative management of patients with extensive burns, and all cases where free skin grafting is used as well. |
8041091 | [The area around the wound in experimental chemical injuries to the skin]. | This is an experimental assessment of the morphological patterns of skin in the area surrounding wounds, produced by exposure to sodium base, sulfuric acid and hydrochloric acid. The changes are followed up from 6th hour to 28th post-injury day, and compared with those in the skin surrounding thermal burns using the same experimental setup. The differences in healing processes, both by comparison with the control group, and between the individual chemical agents, are insignificant. Following chemical injury as well, nonspecific tissue healing processes develop in the area around the wound. The diagnostic and therapeutic problems faced, and the potentials in the wound area after chemical lesions are similar to those following other types of skin damage. |
8041090 | [The treatment of extensive burns using a primary biological dressing in the Clinitron fluidized bed]. | The treatment of extensive burns using a method recently adopted in this country, namely application of primary biological dressing in patients undergoing treatment under conditions of "Clinitron" fluid bed, is discussed. The ten-year follow-up study covers 1100 patients with extensive burns, distributed in three groups according to the method of local treatment employed: 1) Patients treated by closed method in conventional conditions. 2) Patients treated by closed method under fluid bed conditions. 3) Patients treated on a fluid bed plus primary dressing with the newly obtained biopreparations for local application--Cypocol and skin collagen transplant. The approach outlined is consistent with the traditional treatment procedures. By combining the curative properties of biopreparations, used as primary biological dressing, with those of the fluid bed, a clinical effect considerably superior over the one thus far recorded is attained. Emphasis is laid on the advantages of the therapeutic approach proposed-suppressing endo-and exogenous infections, and substantial reduction of the hospitalization term. |
8041089 | [The CO2 laser is an effective method for treating condylomata acuminata]. | Twenty-six patients presenting condylomata acuminata are operated with CO2 laser (two in outpatient conditions), and 22 of them (84.61 per cent) estimate the pain as mild. Recurrence of the disease is registered in one case (3.85 per cent), but most likely it is a matter of minor vegetations, missed during the operation. In extensive condylomatous vegetations, CO2 laser is applied in conjunction with electrocautery in a fashion to obviate the side effects relating to electroresection. In five patients the laser radiation toxic effect on HPV is demonstrated for the first time by the filtered in situ hybridization method. It is worth noting that the therapeutic approach suggested combines radicality and efficiency of treatment, with the patients running an uneventful and painless postoperative course. |
8041088 | [Laser hemorrhoidectomy]. | Thirty-two patients are subjected to operation using CO2 laser. In nine of them laser submucous hemorrhoidectomy is performed--a procedure also developed in the Department of Abdominal Surgery. Most patients operated by the method of Milligan--Morgan and Whitehead with laser define the postoperative pain as medium severe. Eight of 9 patients, operated after the method of submucous hemorrhoidectomy using laser clamps, estimate the pain as mild, and one--as medium severe. The patients are followed up over periods ranging from six months to three years. Assessment of the late postoperative results show recurrence of the disease in one case (3.12 per cent), operated according to Milligan--Morgan. Stenosis of the anus as a complication of Whitehead's operation is recorded in one case, and sensory incontinence--similarly in one (totalling 6.25 per cent). |
8041087 | [Echinococcosis--the current surgical aspects]. | Over the period 1985 through 1992, forty-four patients presenting echinococcosis (echinococcus of the liver--33 cases, lung--nine, and spleen--two), aged 12 to 79 years, are operated in the emergency surgery clinic of the State Faculty Hospital "Queen Giovanna". The up-to-date methods of diagnosing are comprehensively described, followed by illustration and discussion of the operative procedures used in the treatment of echinococcosis. The early and long-term results are estimated as satisfactory. |
8041086 | [Postoperative complications in occlusive colonic ileus of tumor origin]. | Out of a total of 232 patients with obturation colonic ileus subjected to operation, in 79 cases (34.05 per cent) various types of complications are observed, distributed in four groups as follows: group one--on behalf of the organ operated on (colon and rectum), group two--peritoneal cavity and abdominal organs, group three--organs and systems outside the abdominal cavity, and group four--operative wound. In this respect bronchopulmonary complications, would infections and paralytic ileus play a major role. |
8041085 | [The structure of colorectal carcinoma morbidity complicated by occlusive ileus]. | A total of 232 patients with obturation neoplastic ileus of the colon are operated over a 12-year period (1979-1990). Colorectal carcinoma is the underlying cause of the development of obturation colonic impatency. Of the total of 654 patients with carcinoma of the colon and rectum operated on obturation colonic ileus is diagnosed in 232 cases (35.47 per cent). There is a tendency of the morbidity rate of obturation colonic ileus to increase during the observation period, rather markedly expressed in rectal carcinoma cases. In 160 patients (68.97 per cent) the neoplasm is located in the colon, and in seventy-two (31.03 per cent)--in the rectum. The morbidity rate recorded in men and among the urban population is higher. Obturation colonic impatency of a neoplastic origin is taken to be a pathological condition of advanced age. The mean age in men is 57.9 years, and in women--57.7 years. |
8041084 | [A retrospective survey study of diagnosis and surgical treatment in peptic ulcer]. | A total of 239 patients of which 183 operated over the period 1987 through 1992 are reviewed. Cases with duodenal location of the lesion predominate (84 per cent), next ranking gastric ulcers (14 per cent), and type II according to Johnson (2 per cent). Among the patients operated on resection methods, type Billroth II, with antecolic gastroenteroanastomosis and Braun's anastomosis, accounting for 84.1 per cent of the total of planned operations, are mainly used. Retrocolic gastroenteroanastomosis type Hoffmeister-Finsterer is performed in five, and Billroth I-in one patient. Three patients presenting gastric ulcer, free of malignization signs, are subjected to pylorus-preserving resection according to MacKee. Resection methods as a definitive therapeutic approach to ulcers, at that according to Billroth II, are predominant owing to the fact that most patients operated on present ulcers penetrating the pancreas, involving ligamentum hepatoduodenale and the descending portion of the duodenum, and pyloric stenosis, making impossible the restoration of passage by Billroth I or other operations. A lasting good result is attained in 92 per cent of cases, minor complaints are recorded in 6 per cent, and substantial complaints-in 2 per cent. The study results lead to the inference that standard resections with anterior gastroenteroanastomosis in complicated ulcers, ruling out other alternatives, yield a permanent therapeutic effect. The approach to individual patients should be by no means unified, and the most expedient operative procedure should be used. Owing to delayed operative treatment and numerous complications, the classical resection methods prove to be the method of choice in the surgical management of ulcers. |
8041083 | [Results of transduodenal papillosphincterotomy and double internal drainage of the common bile duct using the SPP-20 device]. | The authors discuss the immediate and late results of operations conducted with the [symbol: see text] suturing instrument of their design. It made possible one-stage transduodenal papillosphincteroplasty by application of two rows of tantalum staple sutures with division of the tissue between them--papillosphincterotomy. The authors conducted the operation on 242 patients for benign stenosis of the common bile duct by stones incarcerated in it. In 29 patients the intervention was complemented by the formation of supraduodenal choledochoduodenoanastomosis by means of the same suturing instrument, establishing in this was double internal drainage of the bile ducts. The suturing instrument made the operation easier and atraumatic and provided reliable hemostasis. Immediate postoperative mortality as 1.9%. Transduodenal papillosphincterotomy with the [symbol: see text] suturing instrument produced g od and satisfactory results in 95.2% and poor results in 4.8% of patients; poor late results of double drainage of the choledochus by the authors' method were not registered. |
8041079 | [A method of invaginated non-reflux esophago-intestinal anastomosis]. | A new method for the formation of an invagination areflux esophago-intestinal anastomosis is suggested. Incompetence of the anastomosis was not encountered in any of the 52 performed operations for gastrectomy. Five patients died, but the cause of death was not connected with the method of anastomosis formation. |
8041077 | [Classification of limited hyperkeratoses]. | A classification of limited hyperkeratoses (LH) was developed for practical use in out-patient surgical practice on the basis of literature data and personal studies and observations over 630 patients. Hyperkeratoses are classified according to the etiological sign (mechanical damage to the skin, diseases and deformities of the locomotor apparatus-neurotrophic, genetic, miscellaneous), clinical course (acute LH-soft corn, uncomplicated and infected and chronic LH-dry corn or callus, uncomplicated and complicated with suppuration, formation of fistula, malignization), according to shape (spherical, ellipsoid, cone-shaped), according to localization (hand and foot, unilateral, bilateral, combined, palm, finger, toe, interdigital), according to size (small, moderate, large), and according to number (solitary, multiple). The cause of the disease in 452 patients was the mechanical effect of poorly fitting shoes and trauma caused by various objects. In 19 patients LH occurred as the result of a pathological condition of the locomotor apparatus (exostosis, flexion contracture of the toes, amputation stump, etc.). In 70 cases LH was a consequence of diseases of the peripheral nervous system. There were rare causes in the remaining patients. Various methods of treatment are suggested, including the use of a laser scalpel, depending on the classification signs of the disease. Removal of the etiological factors is a very significant measure in the treatment and prevention of LH. |
8041076 | [Indirect electrochemical detoxication in the combined treatment of purulent diseases in surgical practice]. | The method of indirect electrochemical detoxification by means of sodium hypochlorite (NaClO) obtained by isotonic NaCl solution electrolysis on a [symbol: see text] device consists in modeling hepatic monooxygenase detoxifying function on cytochrome B-450. Indirect electrochemical detoxification was conducted in more than 200 patients with generalized abdominal pyo-inflammatory processes and marked intoxication syndrome. Sodium hypochlorite was used for intravenous treatment of endotoxicosis in concentrations of 600 mg/l and 300 mg/l in volumes of 1/10 and 1/6 CBV in patients with generalized fibrinopurulent peritonitis and pancreonecrosis and for local administration during programmed prophylactic treatment of the abdominal cavity. The detoxifying effect was best in patients with grade 2-3-intoxication (according to V. K. Gostishchev et al., 1989). Local use of NaClO was marked by a high necrolytic effect, antiseptic properties, capability for reducing the resistance of the microflora to antibiotics, etc. The work discusses the methods of hypochlorite application, indications, contraindications, possible complications and their prevention. |
8041075 | [Etiology and pathogenesis of inguinal hernias]. | The article deals with the most debatable problems of etiopathogenesis of inguinal hernias. The principal role of pathology of the vaginal process of the peritoneum in the etiology of oblique inguinal hernias is shown and the frequency of this pathological condition is determined. On the basis of the study the authors substantiate the need for the etiopathogenetic principle in the choice of the method of herniotomy. |
8041074 | [Diagnosis and treatment of intestinal tuberculosis]. | Primary tuberculosis of the intestines was revealed in four patients. The process was localized in the cecum in three and in the descending colon in one patient. The true diagnosis was suspected before the operation in one patient, determined during the operation in two patients and after pathohistological study in one patient. The course of the disease was complicated by intestinal obstruction in three cases by anemia in one case. The differential diagnosis was made with intestinal tumors. Three patients underwent right hemicolectomy and one patient left hemicolectomy. Specific therapy was prescribed after recognition of the tuberculous process. All patients recovered. |
8041073 | [Duodenal cancer]. | Primary duodenal carcinoma is a relatively rare oncological disease and accounts for 0.04-0.5% of all tumors of the gastrointestinal tract. The absence of pathognomonic symptoms and insufficient knowledge and watchfulness on the part of doctors in relation to this pathological condition are the main causes of the difficult diagnosis and early detection of the disease. Esophagogastroduodenoscopy with biopsy, radiological duodenography, ultrasonic examination, and computered tomography of the abdominal organs play the main role in timely diagnosis of primary duodenal carcinoma. Pancreatoduodenal resection is the optimal method of treatment. |
8041072 | [Effectiveness of preserving large intestinal segments in surgical treatment of proliferative diffuse polyposis]. | Among 390 patients who were operated on in the Research Institute of Proctology for the proliferative form of diffuse polyposis, 242 underwent various types of operations in which polyp-free segments of the large intestine were not resected. In the first 5 postoperative years all 242 patients were examined, in follow-up periods of 6 to 10 years 144 patients (59.5%), in periods of 11 to 15 years 88 patients (36.4%), in periods of 16 to 20 years 28 patients (11.6%), and after 21 years 8 patients (3.3%) were examined. Development of carcinoma in the preserved segments was encountered in 26 patients (10.7%), and intensive growth of polyps for which the preserved segment had to be removed was found in 5 patients (2.1%). There was no significant increase of the risk of carcinoma development in the preserved intestinal segments in patients who previously had a malignant tumor in the resected part of the large intestine. The development of carcinoma and intensive growth of polyps were encountered most frequently in patients in whom the distal parts of the large intestine were not removed during the operation. The obtained data are evidence of the validity of the choice of the volume of the operation based on the endeavor to preserve the polyp-free parts of the large intestine for rehabilitation of the patients. |
8041071 | [Surgical treatment of anal insufficiency]. | Organic defects in the lateral walls of the rectal obturative apparatus involving no more than one fourth of its circumference are repaired by end-to-end or side-to-side sphincteroplasty. Sphincterolevatoroplasty is indicated in anterior or posterior defects and sphincterogluteoplasty with short or long grafts of the greatest gluteus muscles in larger defects. For cases in which the gluteal muscles cannot be used, an operation has been developed for repair of the defects with the medial part of the great adductor muscle. A damaged internal sphincter muscle of the anus is reconstructed by means of a muscular cuff formed from the wall of a pulled down rectum. |
8041070 | [Lipid metabolism during hemosorption in experimental peritonitis]. | Increase of lipolytic hormones and cAMP was revealed in experimental peritonitis. The amount of free fatty acids and the total protein content in the blood increased on the average by 50 and 40%, respectively. The blood free fatty acid content reduced to control values after hemosorption, the triglyceride concentration was normalized simultaneously, and the cAMP level became stable. Thus, hemosorption caused a positive effect on the lipid metabolism in peritonitis because of diminished intensity of lipolysis which was activated in this disease. |
8041069 | [Treatment of generalized peritonitis with fenestration of the abdominal cavity]. | The authors suggest a new method for the treatment of generalized peritonitis. It is based on the use of a device of the authors' construction which allows the condition of the abdominal cavity to be visualized continuously and the cavity to be cleansed regularly with the aid of laparoscope. The method is called fenestration of the abdominal cavity. The authors had 395 patients with purulent peritonitis, 171 (43.3%) of them were treated by the semiopen method, 41 of these patients (10.4%) were subjected to fenestration of the abdominal cavity. The authors consider fenestration indicated in generalized peritonitis with signs of polyorganic insufficiency in the presence of a large amount of exudate and concurrent interintestinal, subdiaphragmatic, and pelvic abscesses or when there is a tendency towards their development. With the use of the device for fenestration the number of cleansing relaparotomies was reduced to minimum. Relaparotomy was conducted once in 35, twice in 4, and three times in 2 patients. In all patients the abdominal cavity was examined daily with a laparoscope, the exudate was aspired, and antibiotics were introduced. Phlegmon of the anterior abdominal wall was in early postoperative complication in 2 patients. Five (12.2%) patients died. |
8041068 | [Potential uses of plasma scalpel in liver and gallbladder surgery]. | The article deals with the results of experimental studies and clinical experience in the use of the plasma scalpel in 25 unbred dogs and 192 patients with diseases of the liver and gallbladder. Histological studies of the hepatic tissue after treatment with the laser scalpel allowed the conclusion that such manipulations are safe. The advantages of using the device for arresting bleeding and the flow of bile from the resected hepatic areas were revealed. The accumulated experience in operations on the liver and gallbladder with a plasma scalpel made it possible to develop optimal approaches to the use of the plasma flow in resections of the liver and to suggest three methods for removal of the gallbladder. Their introduction into practice improved the intraoperative possibilities of treatment of the gallbladder bed. |
8041067 | [Vagotomy for bleeding pyloroduodenal ulcer]. | In the choice of surgical tactics and operative method in bleeding pyloroduodenal ulcer the author suggests forming several uniform groups with concrete recommendations for the terms and types of organ-preserving operations with vagotomy. Tactical principles of treatment, elaborated from clinical material number of urgent and emergency operations to be reduced to 15% (74). Among 74 patients who underwent surgery for urgent and emergency indications the mortality rate was 8.1%. The late-term results were excellent and good in 88% and poor in 12% of patients. |
8041066 | [Surgical treatment of patients with ulcerative pyloroduodenal stenosis]. | The article discusses the results of surgical treatment of 342 patients with ulcerative pyloroduodenal stenosis. Selective proximal vagotomy (SPV) and truncal vagotomy (TV) with various operations were conducted in 202 patients, resection of the stomach--in 149 patients. To preserve the pylorus in the presence of anatomical conditions the authors combined SPV with duodenoplasty or pyloroduodenolysis (25 patients). The immediate results were best after vagotomy (0.4% fatal outcomes). Among 140 patients who underwent resection 5 (3.6%) died. Postoperative gastrostasis was encountered most frequently after vagotomy in patients with decompensated stenosis (17%). Bearing in mind marked and stable (up to 3 years) inhibition of gastric bioelectric activity occurring, according to the results of electrogastrography, after SPV, the authors consider decompensated stenosis too be a contraindication for any type of vagotomy. In the late-term period current peptic ulcers were revealed after SPV in 6.2%, after TV in 6.1%, and after resection in 2% of cases. Intraoperative pH measurement is recommended to improve the late-term results after vagotomy; it reduced the incidence of recurrences to 1.6%. |
8041065 | [Initial experience with laparoscopic appendectomy in children]. | The article generalizes the first experience in successful laparoscopic appendectomies in children carried out by the method suggested by F. Götz et al. which we modified and adapted to pediatric practice. In all cases of acute appendicitis the laparoscopic manipulation began with the diagnostic stageo by performing two abdominal punctures with small-diameter trocars. Laparoscopic appendectomy was undertaken only in recognized destructive appendicitis. It was conducted 205 times in children 2 to 14 years old in various localization of the vermiform process, including subhepatic and retroperineal. Complicated forms of appendicitis were encountered in 52 patients. Nineteen children had generalized purulent appendicitis, 18 had circumscribed peritonitis, and 11 children had a loose infiltrate and signs of circumscribed peritonitis. A peri-appendicular abscess was found in the remaining 4 children. All endoscopic operations were completed successfully. In 205 endoscopically removed vermiform processes the clinical and morphological signs were in full agreement, with the exception of one case in which secondary inflammatory changes were determined in the process when the clinical diagnosis was phlegmonous appendicitis. Six complications occurred in the postoperative period: abdominal infiltrate in two patients, which was cured by nonoperative measures, and an abdominal abscess in another two patients (one was treated by laparoscopic drainage and the other by laparotomy). Early adhesive obstruction developed in two cases and was removed laparoscopically. Fatal outcomes and complications connected with laparoscopy were not encountered. |
8041064 | [Initial experience with laparoscopic appendectomy]. | On the basis of analysis of their personal experience and the literature data, the authors claim that appendectomy under control of a laparoscope is an alternative to the traditional operation. Laparoscopic appendectomy was conducted in patients with acute and chronic appendicitis. The indication for appendectomy in chronic form of the disease is determined by the results of complete clinical examination and laparoscopic inspection of the region of the right iliac fossa, which is undertaken before each operative intervention. The authors performed laparoscopic appendectomy with the use of a monitor which made it possible for the operating team to watch the operation. The base of the process was ligated with an endoligature or compressed with clips, and then cutoff by means of high frequency current. The stump of the process was not buried in the cupula of the cecum. Laparoscopic appendectomy for chronic appendicitis was performed, as a rule, as a simultaneous intervention in laparoscopic cholecystectomy or operations undertaken for other diseases. The authors did not encounter in the postoperative period any complications associated with appendectomy. The postoperative period was somewhat easier than after the traditional intervention. The motor activity of the patients was completely restored as early as the second-third day. Experience shows competence of such operations. |
8041063 | [Traumatic injuries of the pancreas]. | Retrospective analysis of surgical treatment of 153 patients with traumatic damage to the pancreas is discussed. The injury was closed in 67.3% and open in 32.7% of cases. All cases were grouped in 4 degrees of severity: 1st degree--contusion of the gland without damage to the capsule (22.2%); 2nd degree--rupture of the gland without injury to the pancreatic duct (34.6%); 3rd degree--rupture of the gland with damage to the duct; 4th degree--combined pancreatoduodenal injury (15.7%). The therapeutic tactics was determined by the degree of injury inflicted to the pancreas. In 1st degree operation on the pancreas was not needed. In 2nd and 3rd degrees "abdominization" with drainage was the operation of choice. Distal resection was expedient only in crushing of the organ. The tactics in pancreatoduodenal injuries depended on the character of the duodenal wound. Thirty-nine (25.5%) patients died, 24 (61.5%) of them died in the first two postoperative days from shock. Pancreatitis was the prevailing postoperative complication, it occurred in 41 (31.8%) patients. All patients with injuries to the pancreas should be managed as cases of potential pancreatitis. |
8041062 | [Etiology, pathogenesis, clinical aspects, diagnosis and treatment of posttraumatic pancreatitis]. | The authors generalize their experience in the treatment of 41 patients with posttraumatic pancreatitis. This complication predominated in the early postoperative period in patients with various degree of injury to the pancreas. The main etiopathogenic factors of the development of posttraumatic pancreatitis are indicated. The therapeutic tactics was mainly nonoperative. The effect was positive in 24 cases. Seventeen (41.5%) patients had the pyodestructive form. The mortality rate was 29.3%. The leading principle of management was the initial attitude towards all patients with injury to the pancreas as if they were potential patients with posttraumatic pancreatitis, and the prescription of preventive treatment. |
8041061 | [Asymptomatic multiple intracranial tuberculous nodules detected in a case of miliary tuberculosis]. | A case of multiple intracranial tuberculous nodule following miliary tuberculosis was reported. The case was a 19-year-old woman visited a general practitioner, because of fever. Chest x-ray film on the first visit showed diffuse granular shadows in her both lungs with pleural effusion in the left side. The case was diagnosed as bacterial pneumonia, and was treated with antibiotics. She had been getting worse, and the doctor finally examined her sputum, and tubercle bacilli were seen in her sputum (Gaffky 4) by the Ziehl Neelsen's staining. She was introduced to our hospital. Chest x-ray film on admission showed diffuse granular shadows in her both lungs and she was diagnosed her as miliary tuberculosis, and anti-tuberculous therapy was quickly started. She didn't complain of any neurological disorders, but her brain CT showed several nodules in the left cerebral cortex enhanced with contrast medium. T1 weighted MRI enhanced by Gd-DTPA revealed abnormal enhancements in the cerebrum, the cerebellum, and the midbrain. She was treated with anti-epileptic drugs, but after 65 days, she started to suffer from epileptic stroke. Six months later, her brain lesions have improved by the use of anti-tuberculosis drugs and anti-epileptic drugs. The incidence of tuberculosis has decreased in Japan, and, many doctors did not show concern on, thus, a doctor's delay is a serious problem in Japan. Advocary should be made to doctors to detect tuberculous patients as early as possible. |
8041060 | [A case of pulmonary, pleural, and renal tuberculosis associated with DIC and a prolonged increase in D-dimer]. | A 26-year-old male who had been diagnosed as pulmonary tuberculosis three years ago with an antituberculous chemotherapy of only two months, complained of tiredness, exertional dyspnea and fever since a month ago. Bloody sputum, bloody stool and hematuria have developed three days before admission. Petechiae over the body trunk and lower extremities were observed on admission. Peripheral blood examination revealed lymphocytopenia (672/microliters), low hemoglobin content (6.2 g/dl), thrombocytopenia (3,000/microliters), elevated FDP (36.2 micrograms/ml) and D-dimer (25.0 micrograms/ml) values. Chest radiograph showed a massive pleural effusion in the right hemithorax, bilateral pulmonary infiltrates and a cavity on CT scan. Together with positive acid-fast bacilli in sputum, diagnoses of relapsed pulmonary tuberculosis, tuberculous pleurisy associated with DIC (disseminated intravascular coagulation) were made. Left hydronephrosis which was presumed to be a consequence of infundibulum stenosis due to renal tuberculosis, was detected by abdominal ultrasonography. Treatment with antituberculous drugs and protease inhibitors were started with thoracic tube drainage. DIC condition was improved by the 20th hospital day and sputum culture turned to be negative after the 4th week, however, fever up to 38 degrees C continued until the end of the 7th week and a D-dimer which is a representative marker for secondary fibrinolysis, continuously showed a high level up to the 10th week of hospitalization. The patient was uneventful during the three months follow up period after discharge. DIC is a well known complication of sepsis including miliary tuberculosis, whereas it is rarely associated with cavitary tuberculosis and no case of prolonged elevation of D-dimer have been reported.(ABSTRACT TRUNCATED AT 250 WORDS) |
8041059 | [The relationship between pulmonary hemodynamics and chest X-ray findings in patients with sequelae of pulmonary tuberculosis]. | For better understanding of pathophysiological aspects of tuberculosis sequelae, we investigated the relationship between pulmonary hemodynamics and chest X-ray findings. One hundred and seven patients with sequelae of pulmonary tuberculosis were examined by the right cardiac catheterization, and pulmonary hemodynamic values were measured and calculated. Chest X-ray findings were defined and classified into the following five items. The items were emphysematous change; fibrosis, bronchiectasis and/or cavity (hereafter abbreviated as "fibrosis"); pulmonary resection and/or atelectasis; pleural thickening; and thoracoplasty. The extent of each finding was defined. We tried to describe chest X-ray findings by applying and categorizing these classifications and the extent to each case. First, we tried to estimate the grade of pulmonary hypertension by categorized X-ray findings. Further, we analyzed what kinds of findings were most influential on the increase of pulmonary artery mean pressure (PPA) and pulmonary arteriolar resistance (PAR). Secondly, we investigated whether PPA, cardiac index (CI) and PAR changed before and after oxygen administration. Thirdly, we analyzed what kind of X-ray findings most affected pulmonary hemodynamics under 100% oxygen administration for 10 minutes. The results were as follows: (1) Out of 107 cases, it was possible to predict PPA by categorized chest X-ray findings in 75 cases by Hayashi's first method of quantification, one of multivariative analyses. "Pleural thickening" was the most influential finding on the increase of PPA. "Fibrosis" was the most influential on the increase of PAR. (2) The values of PPA, CI and PAR decreased more after 100% oxygen administration than under room air breathing. Therefore, PAR was used as the index to estimate pulmonary hemodynamics under the condition of oxygen administration. (3) It was possible to measure PAR under oxygen administration (PARO2) in 72 cases. "Emphysematous change" was the most influential X-ray finding on the increase of PARO2. From these results, it was thought that pulmonary circulatory disorder in patients with tuberculosis sequelae was caused by the combination of various chest X-ray findings with the different extent. It was possible to predict pulmonary hypertension to a certain degree from categorized chest X-ray findings. It was suggested that "emphysematous change" less related to hypoxic pulmonary vasoconstriction than "fibrosis" and "pleural thickening" from the results of comparison among the partial correlation coefficients, which were associated with the increase of PAR under room air breathing and oxygen administration.(ABSTRACT TRUNCATED AT 400 WORDS) |
8041058 | [Studies on the problems of resistance to antituberculous drugs. II--2. Clinically significant critical concentration of streptomycin, isoniazid, kanamycin and ethambutol]. | The proportion method demands an exact count of the colonies on the control and drug-containing media to calculate an exact percentage of resistant bacilli among bacilli-population. To realize this objective, the bacilli suspension must be fresh and homogeneous, susceptible and resistant bacilli must be equally distributed, each bacillus must be dispersed as a single cell when the bacilli suspension is diluted, colony count must be reduced at a rate parallel to the dilution. The critical concentration of each drug should essentially be determined in a clinical manner, however as the multi-drug combination therapy in the rule for the treatment of tuberculosis, it is very difficult to make an exact determination of the resistance to each of drugs. It may be better, as Canetti pointed out, to decide using the pure bacteriological method and later compare findings with clinical studies, making changes in the future if so required. We choose to follow their criteria for nearly all of the drugs making only a few exceptions. 1) SM: DH-SM is not available in Japan as Japanese government prohibits its production. Growth on the medium containing SM (only concentration of less than 4 micrograms/ml) was more abundant than on DH-SM media. Not knowing the fact that when an air-tight cap was used on the medium tube, the result of susceptible test shows 4-10 times higher resistance, we first used an air permeable cork cap. Futamura noticed the fact later and devised the M-type cap, which is air-tight originally, but allows air to flow into the tube automatically when needed. But such cap seemed not necessarily to be expected when employed routinely in the case of a SM concentration of 4 micrograms/ml. Next for the clinical study, considering the combined triple-drug treatment and relapse rate of positive bacilli after six months and one year, we adopted an 1% SM solution (10 micrograms/ml) and the 0.2 microgram/ml of INH as the clinically significant criteria. 2) RFP: Among previously untreated patients, 1,346 were tested using only the indirect method, revealing a critical concentration at 10 micrograms/ml. Their critical proportions were 1-9% in 14 patients (1.0%) which might be technical mistakes, because retested 1/3 cases of them were found 0% to 10 micrograms/ml of RFP and the remaining 2/3 also must be 0%. For the detailed explanation, please see the literature (5). There were also 3 patients who critical proportion were 50% or more.(ABSTRACT TRUNCATED AT 400 WORDS) |
8041057 | [Studies on the problems of resistance to antituberculous drugs. II--1. Clinically applicable criteria of drug-resistance to rifampicin]. | Preliminary studies showed that some strains of tubercle bacilli were inhibited even by 2 micrograms/ml of rifampicin (RFP), but 10 micrograms/ml or higher concentrations were needed for the inhibition of all strains. Of 5,100 patients with pulmonary tuberculosis who were admitted to our hospital during 12 years since January 1970 through 1981, 1,344 patients had no previous antituberculous drug therapy. All of the strains of Mycobacterium tuberculosis isolated from such 1,344 patients showed no or less than 10% growth of control on 10 micrograms-RFP medium by indirect susceptibility tests. But, I defined the clinically applicable criteria of resistance to RFP as "more than 1% growth of control on 10 micrograms-RFP medium" because of following reasons: 1) the growth more than 1% and less than 10% of control on 10 micrograms-RFP medium could be reasonably explained as the results of some technical failures, 2) the results of follow-up observations of respective cases, 3) our previous studies on the distribution of RFP-susceptibility of natural resistant strains. Among total 5,100 cases, 605 cases had been treated with antituberculous drugs previously but failed to achieve negative conversion of the bacilli, and restarted the treatment with regimen including RFP (retreatment group), and the remains had no previous treatment (initial treatment group). The negative conversion rates within three months of treatment were almost same (more than 95%) in both groups, but the rates of RFP-resistance were 5.6% for the initial treatment group and 92.8% for the retreatment group. Among 605 retreated cases 129 were susceptible to RFP at the start of the treatment but became resistant to RFP, of which 11 were resistant to 10 micrograms/ml and 118 to 50 micrograms/ml RFP. Two of the 11 10 micrograms-resistant cases remained to be 10 micrograms-resistant until their death (8 and 15 months after the start of the therapy, respectively) though their critical proportions showed some fluctuations. Remaining 9 cases later became resistant to 50 micrograms/ml RFP. By the 50 micrograms-resistant cases with lower critical proportion, the increase of critical proportion was rarely observed and did not reach even 50%. "Fall-and-rise" phenomena were observed rather frequently during the course of treatment with regimens including RFP. The decrease of the number of bacilli in sputa, sometimes to culture-negativity, at the initial phase of the treatment may be an evidence of killing of susceptible bacilli. If bacilli reappeared or increased their number, it is a critical time to reassess the treatment schedule.(ABSTRACT TRUNCATED AT 400 WORDS) |
8041052 | Breast cancer detection: improving the efficacy of screening mammography. | Throughout the history of medicine, screening measures have had a positive impact in the early detection of numerous types of cancer. Mammography is a viable screening tool for breast cancer, especially if it is utilized by the entire population. Overcoming limitations such as uniformed patients, reluctant physicians, high cost, misconceptions regarding radiation and inconsistent accuracy will allow more women to be screened effectively. Mammographic screening does not prevent breast cancer, but by aiding detection it may prolong survival and prevent death from the disease. Increased awareness and involvement by patients and physicians, coupled with modern techniques of mammographic screening, may diminish the ever-constant mortality rate of breast cancer. |
8041050 | [A case of aspirin-induced asthma which developed due to rubbing a lotion containing a non-steroidal anti-inflammatory drug, ketoprofen, on the skin]. | A forty-year-old woman was admitted to our hospital because of a severe attack of bronchial asthma. The asthmatic attack developed 3 hours after her rubbing a large amount of a lotion containing a non-steroidal anti-inflammatory drug (NSAID), ketoprofen, over her skin. The patient had a past history of asthmatic attack induced by another NSAID (Sedes-G) given per os. The previous asthmatic attack developed about 3 hours after her rubbing the lotion containing the NSAID over her skin. The relatively long interval between the per cutaneous NSAID administration and the onset of the asthmatic attack indicates that the time delay is dependent on the absorption route of the administered NSAID. The severity of the attack is considered to be related to the amount of NSAID absorbed. |
8041049 | [A case of so-called benign metastasizing leiomyoma]. | A 44-year-old female was admitted to our hospital for the purpose of undergoing hysterectomy for removal of multiple uterine tumors. A chest X-ray film obtained on admission revealed a solitary nodule in the right lung field. The resected specimen containing the uterine tumors revealed well differentiated leiomyoma with no nuclear atypia or mitotic figures. The resected specimen from the pulmonary tumor revealed histologic findings similar to those of the uterine myomas, being devoid of any signs of mitosis. Similar cases have been reported as so-called benign metastasizing leiomyoma, and are generally regarded as low grade malignancy or leiomyomatosis. However, we consider this case to have had a primary pulmonary leiomyoma associated with uterine myoma since the pulmonary lesion was solitary and no mitotic figures were detectable. As the concept of metastasizing leiomyoma is confusing, the accumulation of additional case reports is necessary. |
8041048 | [A case of pleural tumor with hypoglycemia]. | A 72-year-old woman was admitted to the hospital because of hypoglycemia. Her glucose level on admission was 40 mg/dl. A giant intrathoracic mass was demonstrated on X-ray, Computerized tomographic scan of the cerebrum showed no abnormalities. Serum insulin and C-peptide levels were within normal limits. The mass (weight 2.3 kg) and the right lower lobe were excised by thoracotomy and the hypoglycemia ceased. Pathological examination revealed the mass to be a localized fibrous tumor of the pleura. |
8041047 | [A case of bronchiectasis accompanied by ulcerative colitis (UC) and HTLV-1 associated myelopathy (HAM)]. | We report a case of bronchiectasis with marked thickening of the respiratory tract wall occurring in a 37-year-old man with UC and HAM. He was diagnosed as UC at age 20. HTLV-1 was presumably transmitted to this patient by means of a blood transfusion he received at around age 30. On admission, chest X-ray films, tomography and CT-scan revealed dilated lumens and thickened airway walls extending from the trachea to subsegmental bronchi. Pulmonary function tests showed hypoxemia and mixed ventilatory disturbance with a predominantly obstructive component. HAM was diagnosed on the basis of neurological examination and cerebrospinal fluid analysis. A biopsy specimen from the carinal mucosa showed marked T cell infiltration. In these T cells, we detected polyclonal integration of HTLV-1 proviral DNA. Some of the infiltrating T cells showed atypia. In recent times, respiratory diseases other than infiltration of adult T-cell leukemia cells or opportunistic infection have been reported in HTLV-1 carriers and new clinical entities designated as HABA (HTLV-1 associated bronchiolo-alveolar disorder) and HBA (HTLV-1 associated bronchopneumopathy) have been proposed. This case is classified among these new entities, in a broad sense, and is a rare case in that the respiratory disorder is apparently related to UC. |
8041046 | [A case of bronchial leiomyoma with obstructive pneumonia]. | A 44-year-old man, who had suffered repeated episodes of pneumonia since 1984, was admitted with complaints of cough, low grade fever and sputum. Chest X-ray showed a mass shadow in the left lower lobe. Bronchofiberscopy revealed a tumor with a smooth surface which obstructed the B9 bronchus. Left lower lobectomy was performed despite the lack of evidence of malignancy because of the recurrent pneumonia. The resected specimen contained a smooth-surfaced tumor, 18 mm in size, protruding into a bronchial lumen. The pathological diagnosis was leiomyoma of the lower bronchus and the specimen showed organized pneumonia with necrosis in the left S8-S10 region. Primary benign tumors of the lung are rare and leiomyoma of the lung is particularly rare. Only 65 cases have been reported in the Japanese literature. We report here a case of leiomyoma of the lower bronchus. |
8041045 | [A case of adult T cell leukemia complicated with strongyloidiasis and amplification of pneumocystis carinii DNA in bronchoalveolar lavage fluid]. | The patient was a 75-year-old male, who simultaneously showed symptoms of bacterial meningitis during steroid treatment for erythroderma and symptoms of respiratory failure. Based on ground-glass shadows in both lungs on chest X ray, bronchoalveolar lavage (BAL) was carried out and strongyloides was detected. In addition to strongyloidiasis, the patient was shown to have the complication of pneumocystis carinii (PC) pneumonia after PC DNA was detected in BAL fluid using a PCR assay. When other causes for immunodeficiency affecting the incidence of opportunistic infection were investigated, the ATL virus was detected in peripheral blood cells and monoclonal amplification was indicated, though the presence of anti-ATL antibody was negative. According to the results, this patient was found to have early stage adult T cell leukemia. In conclusion, we treated this adult T cell leukemia patient who had strongyloidiasis and amplification of PC DNA in BAL and for which the PCR assay, a new technology used for diagnosing PC pneumonia, was considered to be effective. |
8041044 | [A case of acute interstitial pneumonia caused by blasticidin S]. | A 41-year-old male developed acute interstitial pneumonia after inhalation of Blasticidin S, an antibiotic effective against rice blast disease. He presented with diarrhea, followed by dry cough, dyspnea and fever. A chest roentgenogram showed bilateral diffuse ground glass appearance, superimposed by patchy shadows. Arterial blood gas analysis revealed severe hypoxemia. Bronchoalveolar lavage fluid specimen showed moderate increase in total cell count, lymphocytes, neutrophils and eosinophils with marked elevation of CD4/8 ratio. Antibiotic therapy with minocycline failed to improve his condition, and methylprednisolone pulse therapy followed by methylprednisolone (48 mg) resulted in clinical remission with resolution of the chest roentgenogram findings. Blasticidin S should be kept in mind as a causative agent of acute interstitial pneumonia. |
8041043 | [A case of primary pulmonary cryptococcosis with increased serum carcinoembryonic antigen]. | A case of primary pulmonary cryptococcosis with increased serum carcinoembryonic antigen (CEA) (7.0 ng/ml) is presented. The diagnosis was made by transbronchial lung biopsy (TBLB) and no abnormality was found in either gastrointestinal tract or immunity. Immunohistochemical study of the lung specimen showed that CEA was present on the surfaces of alveoli. The level of CEA fell to 0.8 ng/ml after administration of an antimycotic agent (Fluconazole) with simultaneous improvement of the chest radiographic findings. This case indicates that increased serum CEA depends on pulmonary cryptococcosis. TBLB and administration of antimycotic agents, instead of surgical resection, are useful in the diagnosis and treatment of this disease. |
8041042 | [An autopsied case of pleuro-pulmonary cryptococcosis]. | We report a case of pleuro-pulmonary cryptococcosis. An 86-year-old man was admitted to the hospital with dyspnea, a high fever and an oppressive sensation in the chest. Chest X-ray on admission revealed massive pleural effusions, interstitial shadows and consolidation with air bronchograms in both lung fields. The cause of pleural effusion was unknown. The patient died one month later. Autopsy revealed severe pleural cryptococcosis and organizing pneumonia with a small number of cryptococci but without granuloma. To our knowledge, there have been very few documented cases of pleuro-pulmonary cryptococcosis with such massive bilateral pleural effusions. |
8041041 | [A case of pulmonary sarcoidosis with circulatory insufficiency of segmental and subsegmental branches of pulmonary arteries]. | A 50-year-old woman was admitted to our hospital on April 4, 1992, because of progressive worsening of dry cough and exertional dyspnea. Moderate hypoxemia and obstructive ventilatory impairment were present. Her chest roentgenogram and CT films showed thickened bronchovascular bundles in the absence of significant parenchymal fibrosis. Transbronchial lung biopsy revealed the formation of noncaseous epithelioid cell granulomas. Pulmonary perfusion scintigraphy showed multiple perfusion defects predominantly in the upper lung fields. Pulmonary ventilation scintigraphy showed a normal pattern. After administration of prednisolone for 3 months, her chest roentgenogram and CT films demonstrated marked decrease of infiltrates, but there was no improvement of hypoxemia and perfusion defects on pulmonary perfusion scintigraphy. Pulmonary angiography revealed multiple stenoses and occlusions of segmental and subsegmental branches of pulmonary arteries. Long-term steroid treatment will be necessary for this rare form of pulmonary sarcoidosis to prevent the development of pulmonary hypertension. |
8041040 | [Spontaneous regression of small cell lung cancer]. | An 82-year-old man was admitted for evaluation of dry cough and low grade fever. A chest roentgenogram obtained on admission revealed an abnormal mass shadow at the left hilus. Trans-bronchial lung biopsy was used to make a diagnosis of small cell lung cancer. This tumor regressed spontaneously. |
8041039 | [Two fibrinopulurent empyema cases--treatment with early mini-thoracotomy and transcatheter urokinase instillation]. | We successfully treated two male patients with nontuberculous multiloculated empyemas by early mini-thoracotomy 3 and 6 weeks, respectively, after the onset of the disease. Transcatheter urokinase instillation facilitated drainage of a hemorrhagic loculated pleural collection in one patient after the operation. We believe that these treatments are less invasive and more effective than standard methods in providing early and complete resolution fibrinopurulent empyema in patients in whom this disorder might become chronic. |
8041038 | [Lung transplantation from non-heart-beating donor following brain death in canine model]. | Candidates for pulmonary transplantation have been limited because of extreme susceptibility to lung infections and pulmonary edema in the brain-dead donor. To ameliorate the donor shortage, two possibilities for expanding the donor source have been presented, i.e. xenotransplantation and transplantation from cardiac-dead donors. The present study was conducted to evaluate the possibility of lung transplantation from a non-heart-beating donor following brain death, using a canine model. Six mongrel dogs were put into a state of brain death by elevating intracranial pressure with a balloon catheter. Following the intravenous administration of methylprednisolone and heparin used for 6-hour management following brain death mechanical ventilation was discontinued leading to cardiac arrest with in a few minutes. Excision of the left lung was scheduled for twenty minutes after cardiac arrest, followed by washing out the pulmonary vasculature with cold Ep4 solution, and orthotopic transplantation into the recipient animal. Immunosuppression was achieved with methylprednisolone and azathioprine. A right pulmonary arterial occlusion test (RPAO) was performed to assess graft function immediately and 7 days postoperatively. All but one animal survived and three animals had an uneventful postoperative course, with the transplants alone according to immediate and 7 day postoperative, respectively, RPAO results. These outcomes indicate the possible feasibility of lung transplantation from non-heart-beating donors following brain death. |
8041037 | [Computed tomography findings of malignant pleural mesothelioma]. | Computed tomography (CT) findings were assessed in 7 patients with malignant mesothelioma. CT findings were also reviewed in 9 patients with lung cancer and pleuritis carcinomatosa and in 11 patients with tuberculous pleuritis. Five patients with malignant mesothelioma underwent CT scans twice, on admission and from 1 to 7 months after admission. Tuberculous pleuritis could be distinguished from pleuritis carcinomatosa and malignant mesothelioma by the presence or absence of pleural nodularity and chest wall invasion. Although it was difficult to identify specific CT features clearly distinguishing malignant mesothelioma from pleuritis carcinomatosa, characteristic findings of malignant mesothelioma appeared to include the rapid development and progression of pleural rind and a tendency to spread directly into the chest wall. We divided the pleura into the four regions; upper anterior, upper posterior, lower anterior and lower posterior regions. Pleural changes were more frequently seen in the lower pleural regions than in the upper pleural regions, in malignant mesothelioma. |
8041036 | [Effects of vasoactive cyclooxygenase products on shunt flow and extravascular lung water in acute lung injuries]. | Using 50 mongrel dogs with alveolar flooding produced by oleic acid administration, the possible roles of vasoactive cyclooxygenase products on intrapulmonary shunt flow (QS/QT) and extravascular lung water (ETVI) in acutely injured lungs were assessed. Suppressing cyclooxygenase activity with indomethacin administration diminished the concentrations of thromboxane (TX) B2 and 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha) in arterial blood, resulting in a significant reduction in QS/QT. Furthermore, indomethacin completely suppressed the increase in ETVI. Inhibition of TXA2 generation by OKY-046 (thromboxane A2 synthase blocker) diminished the concentration of TXB2 while increasing that of 6-keto-PGF1 alpha in blood. Administration of either OKY-046 or synthetic prostacyclin (PGI2) markedly enhanced QS/QT, in association with an increase in ETVI. In conclusion, the potent vasodilator prostacyclin was considered to enhance shunt flow, leading to the augmentation of edema formation. |
8041035 | [Psychosomatic aspects of chronic respiratory failure managed with home oxygen therapy (HOT)]. | Thirty-eight patients with chronic respiratory failure, including 28 patients receiving HOT, were studied from the psychosomatic viewpoint. Assessment of psychological state was based on the following 5 psychometrical tests; Cornell Medical Index (CMI), Self Rating Questionnaire for Depression (SRQ-D), State Trait Anxiety Inventory (STAI), Minnesota Multiphasic Personality Inventory Alexithymia Scale (MMPI-Alexithmia scale) and egogram Check List (ECL). Tweleve HOT patients were also interviewed individually over a three-year period. The ECL showed overadaptation of non-HOT female patients, as compared with their HOT counterparts. There was an inverse correlation between PaO2 (room air) and the SRQ-D score. A significant correlation was also found between age and the SRQ-D score in both HOT and non-HOT patients. HOT patients were observed for 3 years (1-4 years after HOT introduction). Depressive state was observed in 16.6-36.4% of the patients throughout this observation period. Alexithymia was noted in 25.0% only 1 year after the initiation of HOT. However, the average scores for SRQ-D, STA-I and the MMPI-Alexithymia scale remained unchanged for 3 years. PaCO2 (room air, O2, inhalation) was significantly related to the STAI-1 score up to 2 years after starting HOT. Furthermore, a significant correlation was seen between HOT duration and MMPI-Alexithymia scales in HOT patients. Blood gas analysis parameters (delta PaO2, PaCO2 and pH) correlated significantly with respiratory scores on CMI somatic profiles. These results suggest that blood gas status (PaO2, PaCO2) may have an effect on the psychological states of patients early in the course of HOT. However, social factors, such as familial or economical problems, seem to have a greater influence in later stages. Thus, more attention must be given to psychosomatic treatment in the care of HOT patients. |
8041034 | [Depressive state and related factors in nursery teachers and guidance workers in homes for mentally retarded children]. | A questionnaire survey was conducted in 1991 in order to elucidate depressive state among 352 nursing teachers and guidance workers working in 71 homes for mentally retarded children. The data were analyzed by means of Zung's SDS to study the causative factors in relation to personal attributes, conditions and variables pertaining to work, professional characteristics, and nearby people's expectations and mental support. The results obtained were as follows: 1) The level of depression in the subject population was not particularly higher than that in the general public or other professional groups. 2) The results of multiple regression analysis indicated that labor-related problems, including dissatisfaction with one's work and sense of being overburdened, constituted a factor that led to depression. The condition worsened in proportion to the excess in workload, work hours, and responsibility, irregularity of work shift, along with lack of a sense of fulfillment and teamwork. 3) The factor which counteracted depression was support and mutual reliance from colleagues and supervisors as well as from the children and their families. The more strongly a subject felt mentally supported by these people, and had someone to turn to for advice concerning personal problems, the lower his or her depression score tended to be. 4) Of the professional characteristics specific to the guidance of mentally retarded children, the factors leading to depression were not workload but dissatisfaction or doubt concerning one's own instruction and negative mental attitude toward the children and their families, that is, consciousness and emotion that partly resembled burnout syndrome. |
8041032 | Effects of 2,5-hexanedione on rat spinal pyramidal tract. | The present study was undertaken to investigate central axonal neuropathy caused by 2,5-hexanedione (2,5-HD) administration. The effects of 2,5-HD on rat pyramidal tract were studied electrophysiologically and histopathologically. Male rats were given 0.5% 2,5-HD in their drinking water for 4, 6 or 8 wk. Spinal motor conduction velocity was measured by direct electrical stimulation and was examined histopathologically by electron microscopy. Rats treated with 2,5-HD had reduced spinal motor conduction velocity at 6 wk and their pyramidal tract axons had decreased cross-sectional areas at 4 wk. The mean number of neurofilaments in myelinated axons of rats treated with 2,5-HD for 8 wk was 42.1% of that found in control rats, but the number of microtubules was not significantly different. The ratio of neurofilaments to microtubules in rats treated with 2,5-HD for 4 wk was less than 1.0 in 30.9% of myelinated fibers, while in control rats it was greater than 1.0 in all axons. These changes in spinal pyramidal tract were detected relatively early after 2,5-HD administration. These results in rats indicate the need for further studies of 2,5-HD neurotoxicity in the human central nervous system. |
8041028 | [Echocardiographic assessment of cardiac basal hypertrophy represented by increased base to mid thickness ratio (B/M ratio) in the ventricular septum and its relation to age]. | The basal part of the interventricular septum may easily become hypertrophic because it is exposed to strong hemodynamic stress compared to the other portions of the left ventricle. We measured the end-diastolic interventricular wall thickness both at the base and in the midsection by 2D echocardiography in 122 normotensives, and examined whether the basal thickness increases with age. The basal thickness (B) increased with age in both sexes. In males the thickness averaged 10.1 mm in the 50-59 age group, 10.2 m in those aged 60-69 and 11.4 mm (p < 0.01) in those 70 or older compared to 9.4 mm in those aged 49 or younger. In females it was 8.1 mm (p < 0.05) in the 50-59 age group, 8.3 mm (p < 0.05) in those aged 60-69 and 10.0 mm (p < 0.01) in those 70 or older compared to 6.8 mm in those 49 or younger. Concerning the midwall thickness (M), there were no significant changes among the respective age groups in either sex. As a result, a close correlation was found between the B/M ratio, a new and simple index for basal hypertrophy, and age (R = 0.46, p < 0.01 in males and R = 0.43, p < 0.01 in females). Comparison of the B/M ratio between the two age groups 49 or younger and 70 or older was as follows; 1.08 vs 1.30 (p < 0.01) in males and 1.01 vs 1.27 (p < 0.01) in females. Increase of basal hypertrophy in the aged was clearly indicated by the B/M ratio. |
8041027 | [Evaluation of transmitral flow velocity profile in supine and sitting positions by pulsed Doppler echocardiography in elderly hypertensives]. | To evaluate left ventricular diastolic filling properties in elderly hypertensive case with left ventricular hypertrophy (LVH), we investigated the influence of postural change from a supine to sitting position on transmitral flow velocity profile as assessed by pulsed Doppler echocardiography in 12 normotensives (N group) and 24 hypertensives, aged 65 to 80 years. Hypertensive subjects were divided into two groups on the basis of left ventricular mass index (LVMI): 12 hypertensives without LVH (H1 group; LVMI < 130 g/m2); 12 hypertensives with LVH (H2 group; LVMI > 130 g/m2). Peak early filling velocity (E), peak atrial filling velocity (A) and the E/A ratio were similar in the three groups in the supine position. The postural change decreased E and A in N and H1 groups. On the other hand, the change decreased E, but not A in the H2 group. The E/A ratio was decreased in the H2 group compared with both the N and H1 group in the sitting position. As a result, the sitting position increased atrial contribution to diastolic filling in the H2 group. These observations indicate that a reduction in preload changes the transmitral flow velocity profile in elderly hypertensives with left ventricular hypertrophy. The Doppler alterations may be related to impaired left ventricular diastolic function. |
8041026 | [Effects of pravastatin administration for 12 months on serum lipid levels in aged patients with hypercholesterolemia]. | To evaluate long-term efficacy of pravastatin, we administered this HMG-CoA reductase inhibitor at a mean dose of 9.9 mg/day to 208 aged patients with serum levels of total cholesterol (TC) over 220 mg/dl (mean +/- SD aged of 70 +/- 7 years; 62 males and 146 females) for 12 months. The mean serum value of TC significantly decreased from the basal level of 265 mg/dl to 216 mg/dl in the 3rd month, and this decrease was maintained throughout the observation period. Similar change was observed in the serum level of low density lipoprotein-cholesterol (LDL-C). Although the mean serum level of high density lipoprotein-cholesterol (HLC-C) in all patients did not change significantly, the HDL-C level in 34 patients with a HDL-C level below 40 mg/dl significantly increased from the 3rd month. The mean serum level of triglyceride (TG) in all patients significantly decreased from the 3rd month, and this decrease in the TG was more prominent in 101 aged patients with TG levels higher than 150 mg/dl. In 168 aged patients on 10 mg/day of pravastatin throughout the period, there were significant negative correlations between the ratio of the decrease in TC in basal serum and each of the basal serum TC levels (r = -0.345, p < 0.001) and age of the subjects (r = -0.208, p = 0.007). These results indicate that long-term administration of pravastatin is effective treatment for lipid metabolism even in aged patients. |
8041025 | [Risk factors related to the wall thickness of carotid artery assessed by ultrasonography]. | Progression of atherosclerotic lesion of the carotid artery is suggested to induce the development of cerebrovascular events. We evaluate the risk factors related to carotid artery, wall thickness by ultrasonography. A total of 159 patients, who had received no medication for hypertension or hyperlipidemia were enrolled in this study. The wall thickness of carotid artery was evaluated as an intima-media (IM) complex measured by B-mode ultrasonography with a 7.5 MHz probe. Simple regression analysis demonstrated significant correlation between the IM complex and both age and systolic blood pressure, but not with fasting levels of plasma glucose, hemoglobin A1c, total and HDL cholesterol, triglyceride or gender. Stepwise regression analysis showed age and systolic blood pressure contribute to IM thickness (r = 0.623). However, in patients aged 60 or over, blood pressure did not contribute to the IM wall thickness. Smoking was not a risk factor for IM thickness, but the Brinkman Index (daily consumption of cigarettes x years smoking) was significantly higher in patients with plaques in the carotid artery than those without it. These results suggest that high blood pressure is a risk factor for mild atherosclerotic lesions of the carotid artery for those aged under 60. Smoking may contribute to the formation of plaque, which may consequently lead to the ischemic cerebrovascular disease. |
8041024 | [Prospective study on the influence of social activity on development of dementia in the neurologically normal elderly]. | We investigated the rate of development of dementia in 84 neurologically normal elderly subjects living in an old-age home (30 subjects, mean 77.2 years) or their own home 954, 73.7) prospectively. We examined cerebral blood flow (CBF), Hasegawa's scale (HS) and Kohs' block design test 6 to 9 years before this study (1991). HS and Kohs' IQ were significantly lower in the old-age home group than that in their own home group at that time. However, there were no demented subjects. Mortality was 21%, and we confirmed 9 dementia and 6 stroke cases during the period of observation. Twenty-seven percent of the old-age home group showed dementia in 1991. This rate was significantly higher than that for the elderly living in their own home (6.7%). Occurrence of stroke was also significantly higher in the former group than in the latter group. The subjects who developed stroke during observation showed a high incidence of dementia. Mean CBF measured on the first examination was significantly lower in dementia cases with stroke than in dementia cases without it. We performed MRI in 4 demented cases in 1991 (Fig. 1). Two cases showed no significant lesions and the other cases showed cerebral infarction which could cause dementia. These results indicate that life style and social environment may have significant effect on aging of the brain and on development of dementia in the elderly. |
8041023 | [Effect of nifedipine and enalapril on cardiac autonomic activity in elderly hypertensive patients]. | To clarify the effect of the calcium antagonist Nifedipine and the ACE inhibitor Enalapril on cardiac autonomic activity, power spectral analysis of heart rate variability (PSA) was conducted in 39 elderly patients with essential hypertension (mean age: 63: +/- 11 years) before and after treatment. Twenty patients were treated with 10-20 mg of Nifedipine (N group) and 19 with 5 mg of Enalapril (E group) for 3 months. beta-blocker (Atenolol 12.5 mg) was added to Nifedipine in 12 patients of the N group for 1 month, and the modified effect of Atenolol on cardiac autonomic activity was also evaluated. Blood pressures were significantly reduced in both N and E groups after the treatment. The low frequency component (LF) in PSA, which was considered to be a quantitative marker of cardiac sympathetic activity, increased significantly and the high frequency component (HF), which was a marker of cardiac parasympathetic activity, significantly decreased with increase of PNA levels in N group after the treatment. However, the LF decreased significantly after addition of Atenolol. On the other hand, there was little significant change in LF and PNA in E group. These results suggest that Nifedipine increased cardiac sympathetic activity and that Enalapril had little influence on the cardiac sympathetic tone, while both antihypertensive agents significantly reduced blood pressure itself. |
8041022 | [A pathomorphological study of atherosclerotic plaque with central depression in the elderly]. | A total of 161 atherosclerotic plaques from 50 aortas in elderly autopsy cases were pathomorphologically investigated to clarify the pathogenesis of atherosclerotic plaque with central depression. Atherosclerotic plaques with central depression, with well defined borders were employed for this study, ulcerated plaques being excluded. Pathomorphological findings showed that plaques with central depression could be divided into four groups according to their derivation respectively; (a) fused lesion of multiple fibrous plaque, (b) regressing lesion of plaque, (c) healing lesion of ulcerated atheromatous plaque, (d) mixed type. Finally, it was suggested that atherosclerotic regression may cause some central depression in the atheromatous plaques. |
8041021 | [Desirable values of plasma lipids in the aged]. | Plasma lipids (cholesterol, triglyceride and HDL-cholesterol) were evaluated in order to estimate desirable values in the aged. Plasma lipids were determined by 6 multicenters among aged people with clinically uneventful backgrounds since the values measured by the different institutions were found acceptable and comparable. Plasma cholesterol level was mostly 200 mg/dl less in males and 210 mg/dl or more in females. Plasma cholesterol levels increase after menopause. HDL-cholesterol was also higher in females than in males over 60 years of age. Triglyceride was around 100 mg/dl or less in both sexes and tended to decrease with aging. There were no significant differences in the plasma lipid levels among the cohorts. To observe the angiographical changes in the coronary arteries, 102 patients were followed for 1 or 2 years. Progression was frequently observed in the subjects with a cholesterol level of over 220 mg/dl. These results indicate that even in the aged, plasma cholesterol level below 220 mg/dl is considered to be desirable to minimize vascular events. |
8041020 | [The reference value of plasma glucose in individuals over 65 years]. | The characteristics of plasma glucose in individuals aged over 65 years was investigated by analysis of age dependent changes of fasting and post glucose (75 g) load values in population based studies and some follow-up studies. Institutional differences were surveyed in central laboratory of institutions which joined this study and found that differences were the range of +3.0-3.5% from the mean glucose levels between 100-400 mg/dl. Therefore plasma glucose values around cutoff level should be confirmed by repeated determinations for reaching final diagnosis. The reference interval of plasma glucose does not differ in an age-dependent manner. We may use the reference interval proposed by the Committee of Diagnostic Criteria of Diabetes Mellitus of Japan Diabetes Society for adult individuals. Cases of diabetes diagnosed before 65 years old should be judged by the adult criteria. However, those who were not diabetic before age 65 and were found to be hyperglycemic after that age can be diagnosed classifying as follows: (1) Diabetes should be diagnosed in individuals with a fasting plasma glucose of 140 mg/dl or more and 2 hours after glucose (75 g) of 240 mg/dl or more. Those with some symptoms suggesting diabetes and either 140 mg/dl more or fasting or 240 mg/dl or more 2 hours post 75 g glucose load can also be diagnosed as diabetes.(ABSTRACT TRUNCATED AT 250 WORDS) |
8041019 | [Reference values of laboratory tests in elderly subjects--blood pressure]. | The upper limits of normal blood pressure have been considered to be 139 mmHg systolic and 89 mmHg diastolic for adults, but these values are not necessarily applicable to the elderly. This report presents blood pressure values of healthy persons aged 65 to 94 and estimates the upper limits of normal blood pressure in the elderly based on follow-up studies. The Blood Pressure Subgroup of the Study on Reference Values of Laboratory Tests in Elderly Subjects defined inclusion criteria for the healthy elderly as follows: (1) persons aged 65 to 94, (2) persons not complicated with cardiovascular diseases, (3) persons capable of living and walking freely, (4) persons without dementia, (5) persons without anemia, liver disease, renal failure, diabetes mellitus on drug treatment, lung disease, valvular disease or marked arrhythmias, (6) persons without neuromotor disease. The subgroup collected 2008 persons who fulfilled the criteria. Of the 2008 persons, 663 were not taking antihypertensive drugs, had body weight within an average Body Mass Index +/- standard deviation and had no abnormalities on ECG. The 663 persons were considered to be a group of most the normal elderly. Blood pressure values in this group were 133.3 +/- 18.9/77.0 +/- 10.6 mmHg for males (N = 318) and 134.3 +/- 18.7/75.7 +/- 10.2 mmHg for females (N = 345). Follow-up studies carried out by some members of the Blood Pressure Subgroup suggested that the upper limits of the normal blood pressure were 140 to 159 mmHg systolic and 80 to 89 mmHg diastolic for the elderly. |
8041018 | [Effects of mercury compounds on growth, cell composition and glucose uptake in Tetrahymena pyriformis]. | The effects of the mercuric compounds methylmercuric chloride (MMC) and mercuric chloride (MC) on growth, cell composition, and glucose uptake were studied in the ciliate protozoan Tetrahymena pyriformis GL. MMC was the most effective growth inhibitor of Tetrahymena among mercuric compounds and sulfhydryl inhibitors; it completely inhibited growth of Tetrahymena at concentrations of 1/30-1/3000 of the others. The growth inhibition of Tetrahymena was inversely proportional to concentrations of chemicals in medium. Particularly in the case of MMC and MC the relationship between the concentrations and growth were S-curved in shape. Contents of RNA and DNA in cells were shown to accumulate proportionally to the MMC concentration. Cell division was probably delayed by MMC. The value of the ratio of RNA to DNA content shown by DNA synthesis was inhibited more strongly than RNA at MIC/4 of MMC. MMC inhibited glucose uptake, and the inhibition was likely due to altered permeability of cell membranes. However, no difference was found in lipid compositions between control and MMC cells by thin-layer chromatography. |
8041017 | [A new estimation of the intake of contaminants, based on daily food consumption data]. | Recommended Dietary Allowances (RDAs) are allocated to each food article as published in the Denmark Budget Methods in the Codex Alimentalius of the WHO/FAO Joint Committee when standards of pollutants in food are needed. When daily intakes of Food Additives and Contaminants need to be calculated, the Theoretical Maximum Daily Intake. (TMDI) and the Estimated Maximum Daily Intake (EMDI) have been generally used. TMDI and EMDI are calculated using the formulae shown below: [formula: see text] i: food article (i = 1, ....., n) A: standard value for food additives and contaminants X: mean weight of food article consumed daily l: rate of residue after cooking Exposure assessment should be more exact in order to meet social health needs and to help avoid unnecessarily strict regulations. The U. S. Food and Drug Administration (FDA) is continually improving its estimates of the dietary intakes of pesticides and essential minerals, and comparing these intakes with established safe or recommended dietary intake levels. Dietary survey methods have also improved in parallel, with examples being the USDA's Household Food Consumption Survey (1955 and 1965) and National Health and Nutrition Examination Survey II (1976-1980). In Japan, TMDI and EMDI have received more attention as methods of estimating the daily intakes of food additives and contaminants than has the Total Diet Study, even though the former are not as exact as the latter. The Japanese National Nutrition Survey is one of the most respected nutrition surveys in the world, because it has continued nationwide yearly since 1946. Nevertheless, it is very unfortunate that no one utilizes the Household Food Consumption Survey data for the estimation of intakes of food additives and contaminants, because that is not the primary purpose of the Japanese National Nutrition Survey. Practically, there are neither foods which have an uniform of food additives and contaminants nor individuals who consume uniform amounts of each food item. In this report the authors propose a revised estimation method for the daily intake of food contaminants and additives, based on food consumption data of 159 female volunteers, without using the National Nutrition Survey data. The results obtained are as follows: 1) This method succeeded in making clear the intakes of food additives and contaminants. Mean, maximum and minimum values and distribution curves for the target population were obtained. 2) The suggested name for this method is "Estimated Ecological Daily Intake (EEDI)", which is processed in terms of the food consumption structure for calculation, and methodologically estimated by food ecology. |
8041016 | [A study of thyroid hormone levels of inhabitants of the cadmium-polluted Kakehashi River basin]. | We compared thyroid hormone levels of inhabitants (19 men and 16 women) of the cadmium (Cd)-polluted Kakehashi River basin in Ishikawa Prefecture, with those of subjects (23 men and 47 women) living in a non-polluted area. In addition, we investigated the relationships between the thyroid hormone levels and indices of renal dysfunction induced by Cd exposure. The following results were obtained: 1) The free T4 level of females was significantly lower than that of controls. 2) The T3 level of inhabitants of both sexes was significantly higher than that of controls. 3) The level of free T4 among females became lower with the increases of urinary beta 2-microglobulin (beta 2-MG), urinary protein, urinary sugar, urinary amino acids and serum creatinine (Cr) levels, and with decreases of creatinine-clearance (CCr) and %TRP. 4) We could not find any relationship between the increase of T3 and the indices of renal dysfunction induced by Cd exposure in either sex. |
8041015 | [Analysis of the seasonal variations in mean birth weight and mean gestational period of 47 prefectures in Japan]. | Seasonal variations of the mean gestational period (MGP) and mean birth weight (MBW) are examined by the traditional method of time-series analysis during the period from 1979 to 1983 in Japan. The results of the present study support the existence of a seasonal rhythm of MGP. Generally MGP showed a deep trough in winter and a shallow one in summer to early autumn. This pattern was similar to that of MBW. The two time series showed a statistically significant coincidence in their monthly fluctuations, and a statistically significant correlation was also observed for their amplitude. According to these results, we concluded that the seasonality in MGP plays an important role in creating the seasonality in MBW. However, the seasonality in MGP can not be the only definitive factor that totally regulates the seasonal variations in MBW. The relationship between the two time series is considered to be different among different seasons as well as regions. For example, we observed a decrease of the seasonal index in winter in the same month for both MBW and MGP, but not necessarily in summer. This suggests that the etiology of the decrease in seasonal variations is different between summer and winter. |
8041014 | [A study on stressful life events of workers in Japan]. | The experience rates of eighteen life events of Japanese workers were surveyed and the strength of each of the events was evaluated by a self-reported questionnaire. The fifteen professions surveyed included construction, transport, mailing, chemical production, banking, newspaper, TV services, commercial publishing, advertising, teaching and civil service. The number of workers who answered was 18,657 males and 4,443 females, aged 20 to 59 years. The male workers were divided and analysed in six job groups: clerical workers (n = 5,866), professionals (n = 3,696), blue collar day workers (n = 1,623), blue collar night or shift workers (n = 3,191), drivers (n = 1,663) and construction workers (n = 2,466). They were divided into groups and compared according to job, sex and five different age groups. The highest experience rate in each of the life events such as family trouble for both sexes, death of a family member, financial trouble and anxiety, death of a close friend, dissatisfactory transport to workplace or job, respectively. Comparing the experience rates between males and females we found no significant difference for five items. However, other items had higher experience rates for males than for females with the exception of family trouble. In regard to the age characteristics of each of the life events, as the age increased the experience rates of health-related life events such as the death of a spouse, child, family member or close friend and one's own illness or injury became higher. In contrast, the experience rates of items such as moving to a worse residence and failure in a school or training program became lower as the age increased for both sexes. Among job groups, construction workers had the highest experience rates of most life events except for the item of dissatisfactory transport to the workplace or job. Among other job groups, drivers had higher experience rates in the following four items: re-employment, death of spouse, divorce and financial trouble and anxiety. Blue collar day workers had higher rates for failure in school or training program and family trouble. The blue collar night or shift workers had higher rates for failure in school or training program and dissatisfactory transport to the workplace or job. The mean values of strength in six life events: re-employment, death of a family member, death of a close friend, serious physical illness, dissatisfactory transport to the workplace or job and family trouble were stronger in females than in males.(ABSTRACT TRUNCATED AT 400 WORDS) |
8041013 | [Changes in ischemic findings in ECG, obesity and serum lipids in the residents of an agricultural area in Shimane Prefecture]. | Changes in ischemic findings in ECG, obesity and serum lipids and the relations among them were investigated in Sada Town, a typical agricultural and mountaineous area in Shimane Prefecture, where the mortality rate from ischemic heart disease had increased. Compared with 1983, the percentage of ischemic findings in ECG in 1990 increased, and a marked elevation of total serum cholesterol level, and relative and absolute lowering of HDL cholesterol level were observed in 1990. By observing the relations of total serum cholesterol, HDL cholesterol and the atherosclerotic index to the ischemic findings in electrocardiograms (ECG), it was found that males showed a significantly lower HDL cholesterol level and higher atherosclerotic index than the control group. In males, a relation between obesity and ischemic findings in ECG was observed. In females, a relation between obesity and the atherosclerotic index was observed; however, no relations were observed between ischemic findings and obesity. These results support the hypothesis that a marked elevation of the total serum cholesterol level, relative and absolute lowering of the HDL cholesterol level and obesity have an effect on the recent increase of male deaths due to ischemic heart disease in Sada Town, Shimane Prefecture. |
8041012 | [Mental health services in Japan: development of community care for mentally ill patients and their families]. | Psychiatric care in Japan has received criticisms not only within Japan but from other parts of the world. In contrast, the services for the mentally ill in England are considered to be superior, despite serious criticisms. Psychiatric services in Japan and England are compared using government statistics. In Japan, the number of inpatients per 100,000 population has increased from the 1950s, while that of England has decreased since 1954. Since 1972 the prevalence of inpatients has been higher in Japan than in England. The history of psychiatric services in England where, after World War II, deinstitutionalization has been occurring is briefly described. For developing community care of the mentally ill in Japan, alternatives to inpatient care are thought to be important. These include primary care, day care and residential service in the community. Studies on families of mentally ill patients are crucial in community care and, among them, Expressed Emotion (EE) study is promising. Twenty cohort studies on EE and schizophrenic relapse, most of which successfully replicated the relationship between EE of the family and the course of the disease, are reviewed. Finally, some important aspects of EE study in Japan are discussed. |
8041011 | [Role of population-based cancer registry in cancer epidemiology--epidemiological studies in the Cancer Registration Scheme in Osaka, Japan]. | A population-based cancer registration scheme started in three areas in Japan in the 1950s solely for studying cancer incidence in their respective areas. Soon thereafter, several prefectural governments started their own schemes as part of their cancer control programs, effectively expanding the aims of cancer registration: to clarify cancer facts, to elevate the medical care for cancer patients, and to plan and evaluate cancer control programs. The Osaka Cancer Registry (OCR) started in 1962, and has been using epidemiological methods as a tool in constructing its registration scheme, as well as analyzing and utilizing registry data. This report deals with the results obtained in the OCR, classifying these results into four activities of epidemiology. 1. Clarifying cancer facts (descriptive epidemiology): The OCR has been observing incidence, medical care for cancer patients, distribution of cases by clinical stage, and the 5-year relative survival rate, and has estimated the prevalence rate, cured-case rate, and future incidence into the 21st century. Population-based data on histology and multiple cancers collected at the OCR have also contributed to the new approaches in cancer epidemiology. 2. Research on risk factors (analytical epidemiology): The OCR developed a computerized record-linkage system in 1970. This not only made registry work more effective and reliable, but many cohort studies were able to be conducted with relatively little effort and highly reliable results. The cancer case file in the OCR has been linked with the newly prepared data file of the study group, and cancer incidence among the study group has been observed. Finally, cancer risks of possible causal factors in that group have been estimated quantitatively. 3. Evaluation of control programs: Secondary prevention programs (early detection) have been conducted in Japan as major cancer control programs, because effective risk factors were not previously defined. OCR data have been used for estimating sensitivity and specificity of screening tests for various cancers, as well as for evaluating the effect of clinical work on improving survival and on decreasing cancer deaths. 4. Planning future cancer control programs: The OCR has reported on the probable rapid increase of cancer incidence in the 21st century, especially of elderly cancer cases, and cancer cases with poor survival. To control these difficult problems, new cancer programs should be urgently designed and implemented. The authors have recommended that programs be prepared by cancer site, and have already presented a detailed program for lung cancer control. |
8041010 | [The quality of life in aged people]. | The quality of life (QOL) in aged people is an important issue that has been discussed for a long time and led to a number of studies. In this review article, the relationship between subjective QOL of the aged and various factors is summarized by referring to articles published in the United States of America. In the first chapter, representative methods for the quantitative analysis of subjective QOL are described. Among a variety of methods for measuring subjective QOL, the LSI-A and the PGC Morale Scales are commonly used. In the next chapter, based on the studies using these methods, various factors that determined subjective QOL are analyzed. These studies indicate that physical well-being and socio-economic status are significant determinants of the QOL for the aged people. In addition, employment and social activity are shown to be associated with subjective QOL. On the other hand, age, gender, race and marital status do not have an influence on subjective QOL for the aged as individual factors. QOL can not be measured with a unidimensional scale. Therefore, it is necessary for the investigator to carefully choose an appropriate analytical method by understanding the characteristics of the research subject and the purpose of the study. It is also essential to keep it in mind that any method has its own limitations in analyzing QOL. |
8041005 | Frequency of Chlamydia trachomatis in pregnant women. | Frequency of chlamydia trachomatis infection was investigated in eighty-five pregnant women by direct immunofluorescence (IF) and iodine staining methods. The overall frequency of true positive by both methods was 8.2%. Direct immunofluorescence method alone detected chlamydia infection in 16.5% women with 50% sensitivity and 93% specificity and by iodine method in 14.1% women with 58.3% sensitivity and 90.4% specificity. This shows that as compared to IF iodine method is more sensitive and less expensive and easier to perform. The frequency of chlamydia trachomatis infection in our study population appears to be age dependent with younger patients being more likely to be infected than the older patients. |
8041003 | Beta-lactamase producing Neisseria gonorrhea strains in Karachi. | Urethral or cervical swab of 255 patients attending Skin and Social Hygiene Centre and found positive for gram negative intracellular diplococci on direct microscopy were inoculated on Modified New York City (MNYC) medium and chocolate (heated blood) agar for isolation of neisseria gonorrhea. Growth of N. gonorrhea was obtained in 134 (52.5%) cases. These strains were tested for penicillin susceptibility by disc diffusion method and for the production of beta-lactamase by rapid penicillinase paper strip test and rapid chromogenic cephalosporin method. Penicillin resistance was found in 31 (23%) strains, of which twelve (9%) were beta-lactamase producers (PPNG), the remaining 19 (14%) strains were penicillin resistant beta-lactamase negative (Pen RB Neg). We conclude that PPNG as well as other penicillin resistant strains (Pen RB Neg) of neisseria gonorrhea are prevalent in our country and appropriate changes in the conventional therapeutic regime are desirable. |
8041002 | Preterm birth--its etiology and outcome. | This is a retrospective case control study. Out of a total of 1238 births occurring over a period of 8 months at the Aga Khan University Medical Centre, Karachi, 9.4% were preterm. Factors found to be associated with preterm labour were age > 35, height < 156 cm, anaemia or urinary tract infection in pregnancy, abruptio placentae, polyhydramnios, preterm rupture of membranes, intrauterine growth retardation, fetal distress and intrauterine death. Previous bad obstetric history was also relevant. A preterm baby was found to be at higher risk of postnatal complications resulting in neonatal death or admission to the Neonatal Intensive Care Unit (NICU) than a full term baby. |
8041001 | Hepatoprotective effects of artemisia scoparia against carbon tetrachloride: an environmental contaminant. | The hepatoprotective activity of crude extract of artemisia scoparia (aerial parts) was investigated against experimentally produced hepatic damage using carbon tetrachloride (CCl4) as a model hepatotoxin. CCl4 at the dose of 1.5 ml/kg, produced liver damage in rats as manifested by the rise in serum levels of AST and ALT to 395 +/- 110 and 258 +/- 61 IU/l (mean +/- SEM; n = 10) respectively, compared to control values of 106 +/- 15 and 26 +/- 04. Pretreatment of rats with plant extract (150 mg/kg) significantly lowered (P < 0.01), the respective serum GOT and GPT levels to 93 +/- 05 and 27 +/- 03 IU/l, indicating hepatoprotective action. Pentobarbital sodium (75 mg/kg)-induced sleeping time in mice was found to be 140.8 +/- 1.5 min (n = 10) which was similar (P > 0.05) to that obtained in the group of animals pretreated with the plant extract (139.9 +/- 1.8 min). CCl4 treatment extended the pentobarbital sleeping time to 212.2 +/- 19.1 min and pretreatment of animals with plant extract reversed the CCl4-induced prolongation in pentobarbital sleeping time to 143.9 +/- 5.5 min (P < 0.001) which further confirms the protective action of the plant extract against CCl4-induced liver damage. These data indicate that the plant artemisia scoparia is hepatoprotective and validate the folkloric use of this plant in liver damage. |
8041000 | Semen characteristics of fertile Pakistani men. | Semen characteristics were studied among 200 fertile Pakistani men aged 24 to 48 years. Each subject had fathered at least two children. The mean +/- SD values of volume, sperm density, motility percentage, grade of motility and percentage of oval sperms were 3.11 +/- 1.2 ml, 58.21 +/- 26.41 million/ml, 61.2 +/- 21.3%, 3.01 +/- 0.94 and 70.2 +/- 15.36% respectively. There was no deteriorating effect of age on semen quality except some decrease in semen volume. The comparison has been made with studies from other countries. |
8040999 | Does aspiration of saliva trigger nocturnal asthma? | Five adult asthmatics with nocturnal symptoms (mean FEV1 2.31 1; 2 mean PD20 histamine 1.5 unmoles), 5 asthmatics with no nocturnal symptoms (mean FEV1 l 2.97 l; mean PD20 Histamine 3.7 unmoles) and 5 non-asthmatic control subjects (mean FEV1 3.63 l; mean PD20 histamine 78 unmoles) were challenged with nebulised solutions of their own saliva or isotonic saline in a double blind crossover study to investigate whether the inhalation of saliva during sleep could cause nocturnal asthma. The maximum % fall in FEV1 with saliva was -26.6, -6.5 and -4.1 for the nocturnal, non-nocturnal and control groups respectively. The corresponding values for the maximum % fall in FEV1 with saline was -12.4, -5.5 and -3.6. The difference in maximum % fall in FEV1 with both saliva and saline was significant (p < 0.01) for the nocturnal asthmatics when compared to the non-nocturnal asthmatics. These results lend support to the hypothesis that nocturnal symptoms in asthmatic patients may be triggered by inhalation of saliva during sleep. |
8040993 | Severe aplastic anaemia--an aetiological correlation. | Over 4 years, 43 cases of severe aplastic anaemia (SAA) were seen. Etiologically 58.1% had idiopathic, 39.5% secondary and 2.3% congenital aplastic, anaemia. Idiopathic SAA was more common in patients between 0-15 years of age, whereas secondary SAA was more frequent in 16-60 years age group. Males were more commonly affected with a male:female ratio of 3.3:1. Amongst 17 cases of secondary SAA, chloramphenicol was responsible for 4, septran for 3, insecticides for 2 and anti-scabitic drugs, anti-diabetic drugs and "kushta from hakeem" in one patient each. Hepatitis associated SAA was suspected in 3 cases. |
8040992 | Laparoscopic appraisal of infertility and pelvic pain in Pakistani women: a 5 years audit. | Five hundred and nine Laparoscopic examinations performed between 1987-91, (147 procedures for evaluation of gynaecologic pelvic pain and 313 for infertility) revealed ectopic pregnancy (27%), twisted ovarian cyst (18%) and acute pelvic inflammatory disease (14%) in cases of acute gynaecologic pain, and endometriosis (17%) and chronic pelvic inflammatory disease (16%) in chronic pelvic pain. Adhesions (20%), tubal block (15%), endometriosis (9%) and polycystic ovary (7%) were common findings in cases of infertility. These data support the usefulness of this minimally invasive procedure in accurate diagnosis of gynaecological disorders and provides insight into the spectra of diseases seen in Pakistani women with pelvic pain and infertility. |
8040991 | Comparative study of repair of incisional hernia. | Repair of incisional hernias was compared with four different techniques in 55 patients to determine the best method of repair with least chance of recurrence. The maximum incidence of incisional hernia was seen in 30-39 years age group and was most frequently seen after gynaecological surgery (37 cases). Forty eight (88%) patients were operated in emergency by trainee surgeons. Most hernias occurred within one year after surgery and the herniation of lower mid line incision was more frequent (70.9% cases). History of wound infection of previous surgery was recorded in 45.5% of cases which appeared to be the important risk factor in causation of incisional hernia. It was also observed that simple repair of incisional hernia was associated with a high recurrence than that where synthetic mesh was used in repair where no recurrence was recorded. |
8040990 | Evaluation of coronary artery disease using locally prepared myocardial perfusion agent 99mTc-MIBI. | Technetium (99mTc) labelled isonitrile complexes are recently introduced agents for imaging myocardial perfusion and viability. This study presents the first clinical experience with a locally prepared agent 99mTc methoxy iso butyl isonitrile (MIBI). Sixteen randomly selected cases (M:F 14:2, mean age 48 years) were included; clinically 4 patients were asymptomatic, 6 had history of MI while remaining 6 had angina with no previous incidence of MI. Separate injections were given for rest and stress studies either on the same day (9 cases) or on separate days (7 cases). All patients were stressed according to the Modified Bruce Protocol and 99mTc MIBI was injected at peak stress. Early blood pool and delayed static images showed reasonably good localization of MIBI in the viable myocardium and image quality was also comparable to what has been reported in literature. Scans were negative for any perfusion abnormality in 6 cases, positive for single vessel disease in 6 and for two vessels disease in 4 patients. We conclude that the locally prepared 99mTc MIBI has optimal sensitivity and pharmacokinetic properties for myocardial imaging and detection of CAD. Moreover the local preparation would also entail considerable foreign exchange saving. |
8040989 | Risk factors for intrauterine growth retardation: results of a community-based study from Karachi. | There is a serious lack of community-based information on low birthweight or intrauterine growth retardation from Pakistan. A community based prospective study was conducted in four squatter settlements of Karachi, to examine the prevalence and risk factors for adverse pregnancy outcome. This paper reports on the prevalence and risk factors for intrauterine growth retardation (<10th percentile birthweight gestational age) among 755 singleton births. The incidence of intrauterine growth retardation was 25.4% (192 intrauterine growth retarded and 563 appropriate for gestational age). Major socioeconomic risk factors identified were low maternal education (RR = 1.4, 95% CI = 1.0,2.1) and poor housing material (RR = 1.7, 95% CI = 1.0,3.0). Among the significant biologic factors, primiparity (RR = 1.9, 95% CI = 1.4,2.7), consanguinity (RR = 1.4, 95% CI = 1.4,2.7), consanguinity (RR = 1.4, 95% CI = 1.1,1.8), short birth to CI = 1.1,2.1), short stature (RR = 2.2, 95% CI = 1.6,3.0), low maternal weight (RR = 2.0, 95% CI = 1.6,2.5) and non-vegetarian diet (RR = 2.3, 95% CI = 1.3,4.2) were especially important. Investigations to assess the adverse mortality and morbidity effects of intrauterine growth retardation are ongoing. |
8040988 | Hepatitis-C virus antibodies (anti HCV) in haemodialyzed vs non-dialyzed patients. | Anti HCV was checked using Enzyme Immuno assay (EIA) (C100-3-Abbott) in 68 patients with chronic renal failure (CRF) who were on maintenance haemodialysis and 48 patients on conservative management. Mean age of the patients was 50 years. The duration of illness ranged from 3 months to 18 years (mean 3 years). All patients were Hepatitis B surface antigen (HBsAg) negative. In haemodialyzed group 31 (46%) and in conservative group only 3 (6%) were Anti HCV positive. High Frequency of Anti HCV positivity in haemodialyzed group was related to period on dialysis (1 year) and number of blood transfusions (>4 units). Patients in whom dialyzer was re-used showed 60% positivity as compared to only 17% in those with single use. Anti HCV positivity predominated in females as compared to males, 42.6% vs 20.3%. Nine out of 10 patients with a history of jaundice and six out of 8 patients with raised transaminase levels were Anti HCV positive. Fifteen of 37 Anti HBc (IgG) positive cases were Anti HCV +ve. |
8040983 | Features of HIV-1 that could influence maternal-child transmission. | To evaluate the biological and serological properties of the human immunodeficiency virus type 1 (HIV-1) for factors potentially involved in the mother-to-child transmission of HIV-1. Isolates of HIV-1 were recovered from the blood of 12 of 44 nontransmitting mothers and six of eight transmitting mothers and their corresponding infants. These 24 HIV-1 isolates were compared for their biological and immunologic properties to discern any parameters that correlate with vertical transmission of HIV-1. Replication capabilities of the above-mentioned HIV-1 isolates in human peripheral blood mononuclear cells (PBMCs), human macrophages, and various T-cell lines and the susceptibilities of the viruses to neutralization or enhancement by anti-HIV-1 antibodies in autologous serum samples from mothers and infants. San Francisco Bay Area, California. A cohort of 52 HIV-1-infected women and their infants in a prospective study on perinatal HIV transmission by the Bay Area Perinatal AIDS Center. The viral isolates from the transmitting mothers and their infants differed from the isolates from the nontransmitting mothers in their efficient replication in human PBMCs and in their ability to infect one or more human T-lymphocytic cell lines. All the HIV-1 isolates were able to infect human macrophages with only low-level replication and were unable to form syncytia in the MT-2-lymphocytic cells. No correlation between transmission and reactivity of maternal serum samples to the peptide corresponding to the principal neutralization domain of the third hypervariable region of the viral envelope was observed. However, the majority (9/12) of maternal isolates from the nontransmitters were neutralized by their autologous serum samples compared with only two among six in the transmitter group (P < .07). Moreover, five infant isolates were resistant to neutralization by their respective mother's serum samples, and one was sensitive to infection enhancement by the mother's serum. Another infant isolate was enhanced by his autologous serum. Viral factors that appeared to correlate with mother-to-child transmission of HIV-1 observed in a small cohort included rapid or high-titered replication in human PBMCs, T-cell line tropism, and resistance to neutralization or a sensitivity to enhancement of infection by the maternal serum. |
8040984 | The public health implications of AIDS research in Africa. | The human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic has led to greatly increased international collaboration for medical research, mainly epidemiologic in nature, in Africa. Greater understanding of HIV/AIDS has resulted, and considerable training and technology transfer have occurred. However, analytic and descriptive research in countries heavily affected by AIDS has been slow to turn to assessment of interventions, and practical benefits to those countries' public health and policies have lagged behind scientific knowledge. This article considers the public health implications of selected HIV/AIDS research in sub-Saharan Africa and discusses opportunities for interventions and more applied research. Topics covered include HIV testing and its role, surveillance, control of sexually transmitted diseases, the vulnerability of youth and women, tuberculosis, HIV/AIDS care, and the inadequacy of resources currently committed to HIV/AIDS prevention and control in resource-poor countries. Research on HIV/AIDS in Africa has yielded crucial information but now should prioritize interventions and their evaluation. Specific goals that might limit the effects of the HIV/AIDS epidemic in resource-poor countries are achievable given vision, commitment, and resources. |
8040982 | Prospective comparison of mother-to-child transmission of HIV-1 and HIV-2 in Abidjan, Ivory Coast. | To compare mother-to-child transmission of human immunodeficiency virus types 1 and 2 (HIV-1 and HIV-2, respectively) and to assess the impact of maternal HIV-1 and HIV-2 infections on child survival. Prospective cohort study. Maternal and child health center in a lower socioeconomic class district of Abidjan, Ivory Coast. A total of 18,099 women delivering between 1990 and 1992 were tested for HIV-1 and HIV-2 antibodies. A cohort of 613 pregnant women and their infants was followed prospectively (138 women reactive to HIV-1, 132 reactive to HIV-2, 69 reactive to both viruses, and 274 HIV-seronegative). Rates of perinatal transmission for HIV-1, HIV-2, and both viruses, determined from results of serological and polymerase chain reaction tests on children; survival of infants born to HIV-1-positive, HIV-2-positive, dually reactive, and HIV-seronegative women. Of the 18,099 women tested, 9.4% were reactive to HIV-1 alone, 1.6% to HIV-2 alone, and 1.0% to both viruses. The rate of perinatal transmission of HIV-1 was 24.7% (95% confidence interval [CI], 15.8% to 33.7%), compared with 1.2% (95% CI, 0.0% to 3.5%) for HIV-2 (relative risk, 21.3; 95% CI, 2.9 to 154.3). Overall, 19.0% (95% CI, 9.0% to 29.0%) of infants of dually reactive women became infected; of the 11 children concerned, 10 were infected with HIV-1 and one with HIV-1 and HIV-2. Infants of HIV-seropositive mothers had a reduced survival; mortality rates were 15.1, 13.0, 6.5, and 3.4 deaths per 100 child-years, respectively, for children of HIV-1-positive, dually reactive, HIV-2-positive, and HIV-seronegative women. The rate of perinatal transmission of HIV-2 (1.2%) was much lower than the rate of perinatal transmission of HIV-1 (24.7%), and this was associated with more favorable survival for infants of HIV-2-infected mothers. Dually reactive women could transmit both viruses, although transmission usually involved HIV-1 only. Public health guidelines should incorporate advice that perinatal transmission of HIV-2 is rare. |
8040981 | HIV and tuberculosis infection in San Francisco's homeless adults. Prevalence and risk factors in a representative sample. | To determine the prevalence and risk factors for human immunodeficiency virus (HIV) and tuberculosis (TB) infection and investigate the relationship between these two infections in homeless adults. Cross-sectional study. Inner-city shelters and free meal programs. A representative sample of 1226 adults (> or = 18 years) were enrolled from community sites. Serum HIV-1 antibody status and tuberculin skin test reactivity. Human immunodeficiency virus seroprevalence was 8.5% (95% confidence interval [CI], 7.0% to 10.1%) and the prevalence of TB infection was 32% (95% CI, 30% to 37%). Nineteen percent of the HIV-seropositive subjects had positive tuberculin skin tests. Independent risk factors for HIV infection included younger age, black race, male homosexual contact, injection drug use, use of injection drugs in shooting galleries, and selling sex. Tuberculosis infection was associated with the duration of homelessness and living in crowded shelters or single-room-occupancy hotels. Injection drug use, a risk factor for HIV, was also a risk factor for TB, with a particularly strong association in women. No evidence of an association between TB and HIV infection was found, even after accounting for anergy. The homeless population in the United States should be considered a group at high risk for HIV infection and TB. Given the constellation of risk factors present, the high prevalence of infection, and lack of access to medical services, we anticipate that these communicable diseases in this population will represent a growing public health problem. |
8040980 | Seroprevalence of HIV and risk behaviors among young homosexual and bisexual men. The San Francisco/Berkeley Young Men's Survey. | To estimate the prevalence of human immunodeficiency virus (HIV) infection and risk behaviors among young homosexual and bisexual men sampled from public venues in San Francisco and Berkeley, Calif. A survey of 425 young homosexual and bisexual men sampled from 26 locations during 1992 and 1993. Participants were interviewed and blood specimens were drawn and tested for HIV, level of CD4+ T lymphocytes, and markers of hepatitis B and syphilis. Public venues in San Francisco and Berkeley, including street corners and sidewalks, dance clubs, bars, and parks. Homosexual and bisexual men aged 17 to 22 years. Prevalence of HIV infection and risk behaviors. The HIV seroprevalence was 9.4% (95% confidence interval, 6.8% to 12.6%). The prevalence of markers for hepatitis B was 19.8% (95% confidence interval, 16.1% to 23.9%), and that for syphilis was 1.0% (95% confidence interval, 0.3% to 2.4%). The HIV seroprevalence was significantly higher among African Americans (21.2%) than among other racial/ethnic groups (P = .002). Approximately one third (32.7%) of the participants reported unprotected anal intercourse, and 11.8% reported injecting drug use in the previous 6 months. At the time of interview, 70.0% of the HIV-infected men did not know that they were HIV seropositive, and only 22.5% were receiving medical care for HIV infection. The prevalence of HIV infection is high among this young population of homosexual and bisexual men, particularly among young African-American men. The high rates of HIV-related risk behaviors suggest a considerable risk for HIV transmission in this population. Prevention programs and health services need to be tailored to address the needs of a new generation of homosexual and bisexual men. |
8040979 | Limited effects of HIV counseling and testing for women. A prospective study of behavioral and psychological consequences. | To assess the consequences of human immunodeficiency virus (HIV) counseling and testing for seronegative women in terms of sexual behavior and psychological outcomes. The design is prospective and longitudinal, using repeated measures. Participants were interviewed at recruitment, 2 weeks later (when tested women received results), and 3 months later. Four community health clinics in southern Connecticut; all provide HIV counseling and testing and other specialized and primary health care services. A sequential sample of women were recruited for two study groups: those seeking HIV counseling and testing (n = 152), and a comparison group never tested for HIV (n = 78), matched by clinic, race, and age. A composite measure of sexual risk was developed, based on sexual activity, condom use, and partner risk factors. Psychometrically valid and reliable measures of general psychological functioning and acquired immunodeficiency syndrome (AIDS)--specific psychological indicators were also used. Average level of sexual risk was lower for tested than nontested women at all three interviews. For both groups, there was no significant change in sexual risk from baseline to 3-month follow-up. At the individual level, there was no difference in the number of women who decreased or increased sexual risk. For tested women, intrusive thoughts about AIDS and estimated chance of getting AIDS decreased after counseling and testing. Behavioral and psychological consequences of HIV counseling and testing for women at risk for HIV were limited. These results have implications for further prevention interventions. |
8040958 | Reversal of delayed-onset paraplegia after thoracic aortic surgery with cerebrospinal fluid drainage. | We report two patients who had postoperative reversal of delayed-onset paraplegia after cerebrospinal fluid (CSF) drainage after type I thoracoabdominal aneurysm repair. CSF drainage was not initiated before operation because of the urgent presentation of both patients. Decompression of the spinal canal by CSF drainage may improve spinal cord circulation in certain patients and may avoid or decrease neurologic injury. In view of the low morbidity of this intervention, we recommend routine CSF drainage during elective repair of thoracic and thoracoabdominal aneurysms. |
8040957 | Candida infection with aneurysm formation in the juxtarenal aorta. | We report a case of an elderly patient with diabetes with calcific aortic atherosclerosis in whom a juxtarenal aortic aneurysm developed after Candida fungemia. Our approach included extra-anatomic reconstruction of the lower extremities, hepatorenal arterial bypass of the right kidney, retroperitoneal excision of the infected aortic segment, intravenous administration of amphotericin B after operation, and lifetime suppression of Candida organisms with oral antifungal therapy. |
8040956 | Epidural cooling for regional spinal cord hypothermia during thoracoabdominal aneurysm repair. | We investigated the feasibility of achieving regional hypothermia of the spinal cord with an infusion of iced (4 degrees C) saline solution administered into an epidural catheter while monitoring cerebral spinal fluid (CSF) temperature in eight patients undergoing thoracic or thoracoabdominal aneurysm resection. As part of the anesthetic management, an epidural catheter was placed at T11-12, and a subarachnoid thermistor catheter was placed at L3-4. Approximately 30 minutes before aortic cross-clamping, iced (4 degrees C) saline solution was infused into the epidural catheter until CSF temperature decreased to approximately 25 degrees C. The infusion was then adjusted to maintain this temperature until the aorta was unclamped. The subarachnoid catheter was also used to measure CSF pressure and provide for CSF drainage. Surgery was performed in all patients with a clamp-and-sew technique with selective intercostal vessel reattachment. Infusion of a mean volume of 489 ml (range 80 to 1700 ml) of iced saline solution into the epidural space before aortic cross-clamping led to a decrease in mean CSF temperature to 26.9 degrees C (range 25 degrees to 28.8 degrees C) in 15 to 90 minutes. During cross-clamping and aortic replacement the mean CSF temperature was maintained between 25.2 degrees to 27.6 degrees C and, with discontinuation of the infusion, returned to within 1 degrees C of body core temperature by the end of the procedure. Body core temperature was not significantly affected by the epidural infusion. Mean CSF pressure increased during the epidural infusion but could be reduced by removing saline solution from the epidural space. No postoperative neurologic deficits were observed. Epidural cooling appears to be a satisfactory method of achieving regional spinal cord hypothermia in patients requiring resection of thoracic or thoracoabdominal aortic aneurysms. |
8040955 | Design of the abdominal aortic Aneurysm Detection and Management Study. ADAM VA Cooperative Study Group. | This study describes the design of an ongoing randomized trial intended to determine which of two strategies is superior for managing small abdominal aortic aneurysms (AAA). Patients aged 50 to 79 years with AAA 4.0 to 5.4 cm in diameter as determined by computed tomography (CT) who are not at high surgical risk are randomized to either repair of the AAA, called "immediate surgery," or follow-up of the AAA with ultrasonography or CT every 6 months, reserving surgery for those aneurysms that enlarge to 5.5 cm, enlarge rapidly, or become symptomatic, called "selective surgery." The primary outcome measure is all-cause death, and secondary outcome measures are AAA-related death, morbidity, and general health status. The study design calls for 1350 patients to be randomized and monitored for a mean of 5 years. A second objective of the study is to accurately define the prevalence and risk factors for AAA with use of information from the large screening program established to detect AAA for recruitment into the randomized trial. By the end of 1993, 38,697 patients had been screened with ultrasonography, accounting for about three fourths of new randomizations, and 330 patients had been enrolled (70% of the target rate). |
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