Chylous pleural effusion as the initial manifestation of Waldenström's macroglobulinemia.
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Biomedical subjects
Publications and source records attributed to J Lima.
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Allergen specific blocking antibodies were measured in antopic patients undergoing allergen immunotherapy by three methods--(1) passive hemagglutination of red cells, (2) radioimmunoprecipitation (Farr Technique) and (3) a new inhibition method utilizing a laser nephelometer. The laser inhibition method was more sensitive than passive hemagglutination but less sensitive than radioimmunoprecipitation. The use of the nephelometer to measure blocking antibodies offers an alternative, when use of radioactive materials is not practical.
The effect of two reminder devices on compliance with a ten-day antimicrobial prescription was investigated in a health center population. The reminders, a clock printed on the prescription label with appropriate times circled and a 5 X 7 inch bright red sticker to be posted at home, were compared to a control group. A total of 158 patients were interviewed at home on the ninth or tenth day of therapy, and compliance estimated by measuring the amount of remaining medication. For children, both reminders improved compliance about two-fold over controls. The findings suggest that (1) several simple reminder devices can be effective and (2) the nature of the patient population may be a more important influence on compliance than the relationship to a physician or the type of health care system. In addition, the study demonstrates the influence of the pharmacist on patients' medication-taking behavior.
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Significant thoracic aortic plaques (>4 mm) are an independent risk factor for ischemic stroke. Within 1 week of stroke/transient ischemic attack (TIA) onset, 105 consecutive patients underwent transesophageal echocardiography assessment of aortic plaque thickness using the criteria of Amarenco et al. (N Engl J Med 1994;331:1474-1479). A proximo-distal gradient was found in the distribution of aortic atheroma >4 mm (p = 0.04). Symptomatic coronary artery disease was associated with plaque in the proximal aorta (p = 0.03); extracranial carotid stenosis >70% was associated with plaque in the arch and descending aorta (p < 0.01). The severity of aortic plaque was associated with age on multivariable analysis (p = 0.0003 to p < 0.01). Only smoking showed predictive regional specificity (p = 0.03);no other risk factors were associated with aortic atheroma in any segment. In stroke/TIA patients, carotid stenosis >70% predicts aortic arch atheroma plaques >4 mm which may predispose to reinfarction after endarterectomy. Atheroma of the ascending aorta is associated with ischemic heart disease, and cardiac screening should be considered in asymptomatic patients.
Nowadays, extradural vertebral neoplasms which compress the spinal cord are being diagnosed earlier and therefore laminectomy for decompression relieves many patients of their neurological deficits before permanent cord damage has set in. In addition, radiotherapy and oncological treatment have prolonged life expectancy as well as the quality of life in these patients. As the indications for surgery have grown, the problem of spinal instability resulting from direct involvement of the supporting structures of the spine or due to the surgical procedure per se, must be considered. Many of these patients would rapidly return to leading their normal activities if not confined to bed rest or uncomfortable orthopedic devices. The Authors present 9 patients with extradural vertebral lesions: 4 plasmacytomas, 3 metastatic carcinomas, 1 malignant lymphoma and 1 aggressive osteoblastoma treated by simultaneous decompression and stabilization of the spine. All patients showed remarkable improvement of neurological symptoms except in one case where massive pulmonary embolism caused death a few hours after surgery. This surgical treatment offers the advantages of performing wider and better decompressive maneuvers and, at the same time, assuring fast mobilization of the patient after surgery who is often in poor general conditions, thus reducing post-operative complications due to delayed physical therapy and bed confinement.
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