A new aerosol bronchodilator, carbuterol, was compared with isoproterenol during a three-month double-blind trial in 15 matched pairs of patients with relatively stable and partially reversible obstructive airways disease. Pulmonary function tests were performed at baseline and at 30 and 120 minutes after bronchodilator administration on days 1, 15, 28, 56, and 84. Isoproterenol and carbuterol produced improvement in all parameters at 30 and 120 minutes. The per cent changes produced by isoproterenol were superior at 30 minutes, while carbuterol was as effective as isoproterenol at 120 minutes. Atrial and ventricular premature contractions and palpitations were more frequent in the isoproterenol group. Evaluation of the patients' symptomatic responses showed carbuterol to be superior to isoproterenol. We conclude that carbuterol is a useful bronchodilator when aerosolized.

Adult↗

PubMedDate not supplied

The relationship between childhood sexual abuse and subsequent onset of bulimia nervosa.

Seventy-two young adult women identified by the Bulimic Investigatory Test, Edinburgh (BITE) as having a high probability of suffering from bulimia nervosa were compared with 72 matched controls who did not display bulimic symptoms. Both groups were given measures of sexual abuse history, dissociation, and early family mealtime experiences. Rates of self-reported sexual abuse after the age of 12 with an adult relative as the perpetrator were significantly greater in the women diagnosed as bulimic. Nonsignificant but high rates of sexual abuse prior to age 12 were also found for this group. Dissociative experiences were also significantly more common in the bulimic group overall, and higher still for bulimic women who reported sexual abuse as children. Bulimic women had more negative and unusual mealtime experiences than nonbulimic women. Results suggest that sexual abuse may be related to the subsequent onset of bulimia nervosa for some women.

Adaptation, Psychological↗

PubMedDate not supplied

Vaginal birth after cesarean in a hospital-based birth center staffed by certified nurse-midwives.

The efficacy and safety of a trial of labor after previous cesarean were evaluated in selected, low-risk women in a hospital-based birthing center staffed by certified nurse-midwives. A total of 303 low-risk women with one previous cesarean delivery underwent a trial of labor in the birthing center. A matched control, without a previous uterine incision, was selected for each study patient. Hospital charts of 298 matched pairs were available for analysis. Outcome measures included the requirement for intrapartum transfer to medical management, use of oxytocin, method of delivery, uterine scar separation, Apgar scores, birth weights, maternal febrile morbidity, and length of hospital stay. Intrapartum transfer to medical management was necessary in 26 (8.7%) study patients and 31 (10.4%) control subjects. The overall rate (98.3%) of vaginal birth after cesarean among study patients was not statistically different from the vaginal birth rate (99.3%) among control subjects. There were no differences in maternal or neonatal morbidity. The high percentage (84%) of study patients having had a previous uncomplicated vaginal birth after cesarean must be considered a potential limitation of the outcome data; however, the overall vaginal birth rate between study patients with and study patients without previous vaginal birth after cesarean was not statistically different. The latter group was more likely to require transfer to medical management and/or oxytocin augmentation. On the basis of these results, we concluded that for selected, low-risk patients, a trial of labor after one previous cesarean may be managed safely and effectively by certified nurse-midwives in a hospital setting.

Case-Control Studies↗

PubMedDate not supplied

Cortical localization of human sustained attention: detection with functional MR using a visual vigilance paradigm.

PURPOSE: Our goal was to determine whether functional MRI on a standard 1.5 T system can localize activation during a visual vigilance sustained attention task and whether this corresponds to results described in a PET investigation of a similar task. METHOD: Sixteen volunteers were studied on a 1.5 T system using a gradient echo technique. A single axial section was oriented within a stereotaxic coordinate space, 40 mm superior to the anterior-posterior commissure line. Images with eyes closed were followed by images during subject concentration on a small dim spot. Motion correction and pixel-by-pixel statistical analysis were performed. Talairach grids were applied for summary statistical analysis and comparison to PET data, with analysis using a series of planned contrasts within a repeated measures analysis of variance. RESULTS: Predominantly right-sided frontal and parietal activation was observed, with statistical significance across subjects in the right frontal lobe (F > or = 5.9, p < or = 0.041). Comparison with previously reported PET data yielded a very similar pattern of activation (F = 13.2; df = 1,8; p = 0.007). CONCLUSION: Activation of the right middle frontal gyrus and right parietal lobe during visual vigilance is detectable across functional imaging modalities.

Adult↗

PubMedDate not supplied

The AAPM/RSNA physics tutorial for residents: digital fluoroscopy.

A digital fluoroscopy system is most commonly configured as a conventional fluoroscopy system (tube, table, image intensifier, video system) in which the analog video signal is converted to and stored as digital data. Other methods of acquiring the digital data (eg, digital or charge-coupled device video and flat-panel detectors) will become more prevalent in the future. Fundamental concepts related to digital imaging in general include binary numbers, pixels, and gray levels. Digital image data allow the convenient use of several image processing techniques including last image hold, gray-scale processing, temporal frame averaging, and edge enhancement. Real-time subtraction of digital fluoroscopic images after injection of contrast material has led to widespread use of digital subtraction angiography (DSA). Additional image processing techniques used with DSA include road mapping, image fade, mask pixel shift, frame summation, and vessel size measurement. Peripheral angiography performed with an automatic moving table allows imaging of the peripheral vasculature with a single contrast material injection.

Angiography, Digital Subtraction↗

PubMedDate not supplied

Economic feasibility of a primary care practice.

To make informed career decisions, the new physician must acquire basic skills in medical management and health care economics and learn how to evaluate the potential survival and growth of a primary care practice. The authors have developed a model designed to aid physicians in determining the economic feasibility of establishing a practice in a specific community or joining an established practice.

Career Choice↗

PubMedDate not supplied

Adverse effects resulting from nitrofurantoin administration.

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Drug Eruptions↗

PubMedDate not supplied

An evaluation of the Beltman traffic safety program for children.

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Accidents, Traffic↗