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Biomedical subjects

A F Shorr

Publications and source records attributed to A F Shorr.

17 recordsLinked to original sources
PubMed1999

D-dimer assay predicts mortality in critically ill patients without disseminated intravascular coagulation or venous thromboembolic disease.

OBJECTIVE: To determine if D-dimer predicts outcomes in critically ill patients. DESIGN: Observational, cohort study. SETTING: Medical intensive care unit (MICU) of a tertiary care hospital. PATIENTS AND PARTICIPANTS: Seventy-four patients consecutively admitted to the MICU. INTERVENTIONS: D-dimer was measured by latex agglutination within 12 h of admission to the MICU. MEASUREMENTS AND RESULTS: Of the study population, 43.2% had positive D-dimers. The in-hospital mortality rate in D-dimer positive patients was 28.1% as compared to 7.1% in D-dimer negative subjects (p = 0.024). D-dimer positive patients had significantly greater frequencies of venous thromboses (21.9% vs 4.8%, p = 0.035). CONCLUSIONS: The D-dimer assay identifies patients at increased risk for mortality and may be a more sensitive test to determine the presence of underlying microvascular pathology in critically ill patients. A positive D-dimer at admission to the MICU is associated with an increased risk for the later development of a venous thromboembolic event (VTE).

APACHE↗
PubMed1999

The American College of Physicians' Resident Abstract Competition: success of U.S. military trainees.

Research is a central aspect of internal medicine (IM) training, and accreditation organizations require that residency programs show that their residents participate in scholarly activity. To better understand the research productivity and the quality of research conducted by military IM trainees, we reviewed the records of the American College of Physicians' Resident Abstract Competition from 1995 to 1997. This national competition is prestigious, blindly judged, and highly selective. We found that although military residents account for less than 2% of all U.S. and Canadian IM trainees, they author more than 11% of the abstracts selected for presentation (p < 0.001). We conclude that military IM residents are disproportionately represented compared with their civilian peers in an objective, national competitive forum. This is consistent with the higher scores on in-service examinations and higher board-certification pass rates for military IM residents.

Abstracting and Indexing↗
PubMed1997

Serum angiotensin converting enzyme does not correlate with radiographic stage at initial diagnosis of sarcoidosis.

Serum levels of angiotension converting enzyme (ACE) are elevated in many patients who suffer from sarcoidosis. Few studies have correlated ACE levels at diagnosis with the radiographic stage of the disease. The present authors reviewed the charts of all patients who had the diagnosis of sarcoidosis made between 1990 and 1995, and correlated ACE level at diagnosis with radiographic stage. Only patients with biopsy-proven sarcoid were included. One hundred and sixteen cases were identified, and complete data were available for 104 individuals. Serum ACE levels were increased in approximately 63.5% of the study population. The relationships between both stage and ACE level, and stage and percentage of individuals with elevated ACE levels within that stage were not statistically significant (P > 0.05). This large, retrospective study of patients with histologic evidence of sarcoidosis demonstrated no association between serum ACE level and radiographic stage.

Biomarkers↗
PubMed1997

Dermatomyositis and malignant melanoma.

Patients with dermatomyositis may face an increased risk of malignancy. Malignant melanoma has been linked to dermatomyositis. We present a case of concomitant dermatoyositis and metastatic malignant melanoma and review the English literature concerning this topic. Analysis revealed that the development of dermatomyositis in patients with malignant melanoma heralds the diagnosis of metastatic disease. These patients face dismal prognoses.

Adult↗
PubMed1997

Endobronchial disease and racial differences in pulmonary sarcoidosis.

In a retrospective review of 7 years of Walter Reed Army Medical Center fiberoptic bronchoscopy records, 154 patients with biopsy specimen proved (122) and clinically diagnosed (32) sarcoidosis were identified. Endobronchial mucosal appearance was normal in only 70 (45%). Abnormal mucosal findings included erythema (29 patients), nodules (13), plaques (13), and cobblestoning (29). Fifty-nine patients were evaluated with endobronchial biopsies (EBBX), and non-necrotizing granulomata diagnostic of sarcoidosis were found in 42 (71%). The diagnostic yield from endobronchial biopsies was similar regardless of the type of mucosal abnormality. EBBX specimens were diagnostic in 85% of black patients and 38% of white patients (p = 0.00081), but diagnostic yield did not correlate with patient's sex, symptoms, radiographic stage of disease, or extent of physiologic abnormalities. Four patients with normal-appearing bronchial mucosa underwent EBBX, and sarcoidosis was diagnosed in two. Transbronchial lung biopsy (TBBX) specimens were diagnostic of sarcoidosis in 61 of 82 (74%) black and 28 of 56 (50%) white patients (p = 0.0038). We conclude that the bronchial mucosa appears abnormal in the majority (55%) of patients with sarcoidosis. EBBX specimens will diagnose sarcoidosis in a high percentage of such patients and should be performed routinely. EBBX may be preferable to TBBX because of its greater safety profile. In our patients, the yield of both EBBX and TBBX was significantly greater in African-Americans than white Americans.

Adolescent↗
PubMed1996

Meningitis and hepatitis complicating intravenous immunoglobulin therapy.

OBJECTIVE: To report a case of concomitant meningitis and hepatitis complicating the use of intravenous immune globulin (IVIG). CASE SUMMARY: A 39-year-old African-American woman with an autoimmune syndrome developed both acute meningitis and hepatitis following administration of IVIG. These resolved over several days and left no sequellae. DISCUSSION: This represents the first case of concomitant acute meningitis and hepatitis associated with IVIG. Thorough microbiologic and serologic evaluation of the patient failed to demonstrate an infectious etiology. We postulate that our patient's syndrome resulted from direct toxicity of IVIG. CONCLUSIONS: Both acute meningitis and hepatitis may simultaneously complicate IVIG therapy. The specific mechanism remains unclear.

Adult↗
PubMed1994

The effect of a class in medical ethics on first-year medical students.

PURPOSE: To assess the effect of a class in medical ethics on first-year medical students. METHOD: A test instrument was developed to measure the attitudes of medical students toward certain ethical questions and to assess their factual knowledge regarding particular legal and ethical issues. The instrument was administered in 1992-93 to 110 first-year students at the University of Virginia School of Medicine before and after the students took a required course in medical ethics. The instrument employed clinical vignettes as well as multiple-choice, true-false, and Likert-scale questions. Its reliability and validity were assessed. RESULTS: The required course in medical ethics had little influence on the students. There was only one significant change (p = .05) in the pattern of responses to any of the clinical vignettes. In a few of the attitude-oriented queries, there were statistically significant changes (p < .05) after the course. Although there were statistically significant changes for only four of the factual-knowledge questions, for all such questions more students identified the correct answers after the class (before the course the range of correct answers was 43% to 99% compared with 64% to 100% after the course). CONCLUSION: The class in medical ethics seemed to have little effect on the first-year students, probably because students arrive at medical school with well-established ethical perspectives.

Adult↗
PubMedDate not supplied

Abortion and fetal tissue research: some ethical concerns.

Proponents of human fetal tissue research argue that this endeavor is morally separate from abortion. They claim that one's views about the morality of abortion should not effect decisions about the ethics of fetal tissue research and transplantation efforts. In lifting the ban on federal funding for fetal tissue research, President Clinton embraced this logic. However, a careful review of (1) the impact fetal tissue research and transplantation will have on the rate of abortion; (2) the concept of informed consent, and (3) the question of complicity demonstrates that abortion and fetal tissue research are morally connected.

Aborted Fetus↗