Thirty episodes of presumed infectious esophagitis in immunocompromised patients were investigated by means of esophagoscopy. Indications for esophagoscopy included dysphagia, odynophagia, and retrosternal pain. Factors potentially predisposing patients to esophagitis included previous exposure to radiation, recent cytotoxic chemotherapy, recent antibiotic therapy, corticosteroid therapy, and neutropenia. Sixteen of the 18 barium esophagograms done before esophagoscopy was performed revealed abnormalities; in 14 cases the results were consistent with infectious esophagitis. Abnormalities were noted during 27 of 30 esophagoscopy procedures. Visual findings were consistent with candidal esophagitis in 18 cases, with viral esophagitis in four, and with both in one. Specific infectious diagnoses were established by culture or histology in 17 episodes: 12 of candidal esophagitis, two of herpes simplex esophagitis, two of concomitant candidal and herpetic esophagitis, and one of enteroviral esophagitis. Specific noninfectious diagnoses were made in two episodes, and the esophagus was found to be normal in three. No specific diagnosis was made in eight episodes although visual examination indicated the presence of esophagitis. The only postesophagoscopy complications recorded were isolated episodes of spiking fever in three patients. In this compromised-host population with presumed infectious esophagitis, esophagoscopy resulted in a rapid and specific infectious diagnosis in 57% of episodes.

Adolescent↗

PubMedDate not supplied

Doppler transmitral flow pattern is an independent prognostic factor in acute myocardial infarction.

We analyzed the transmitral flow pattern on admission in 95 patients with acute myocardial infarction. Nineteen patients had a restrictive pattern, defined as a peak early to peak atrial filling wave ratio greater than 1.6, plus an early wave deceleration time shorter than 180 ms. Restrictive pattern, compared with nonrestrictive one, was associated with the development of heart failure (42 versus 11%, p = 0.001) and greater in-hospital mortality (32 versus 7%, p = 0.002). After multivariate analysis, it remained significantly predictive of death (p = 0.028). We conclude that a restrictive pattern of left ventricular filling in patients with acute myocardial infarction is an independent predictor of early outcome.

Adult↗

PubMedDate not supplied

[Psychosocial impact of violence in San Salvador].

This study had two objectives: (1) to describe the levels of victimization of Salvadorians due to criminal violence, and the population groups most affected by it; (2) to learn if these levels of victimization are related to the presence of norms, attitudes, and behaviors that encourage the occurrence of violence. For this purpose data from the ACTIVA project of El Salvador were used. The project was carried out by the University Institute of Public Opinion during October and November 1996, with a sample of 1,290 personal interviews that were presumed to be representative of people between 18 and 70 years of age living in the Metropolitan Area of San Salvador. The sample was obtained through multistage probability sampling. The results show that the level of victimization from violence is quite high in San Salvador and that it especially affects adult and young men. The results also indicate that persons who have been victims of serious aggression tend to show, more frequently than average, norms justifying and approving the use of violence, a tendency to use weapons, and aggressive behaviors toward other people.

Adolescent↗

PubMedDate not supplied

[Victimization by urban violence: incidence and associated factors in cities in Latin America and Spain].

This article looks at eight cities in Latin America and Spain and compares the chances of and variables associated with being a victim of various kinds of urban violence. The analysis was done using data from the ACTIVA Multicenter Study, which was coordinated by the Pan American Health Organization in 1996. The study sample consisted of 10,821 persons who were representative of residents between the ages of 18 and 70 in eight metropolitan areas of Latin America and Spain: Rio de Janeiro, Brazil; Salvador, Brazil; Santiago, Chile; Cali, Colombia; San José, Costa Rica; San Salvador, El Salvador; Caracas, Venezuela; and Madrid, Spain. The results show that the likelihood of being a victim of different types of violence varies from city to city. The variables associated with a greater likelihood of being a victim in most--though not all--of the cities are sex, age, and consumption of alcohol.

Adolescent↗

PubMedDate not supplied

An outbreak of legionnaires' disease in a municipality in northern Portugal.

Eleven cases of legionnaires' disease, all patients living in the same municipality, were admitted to a district hospital in northern Portugal. Preliminary investigations suggested an association with the events of the annual festivities in that municipality. Legionella pneumophila was not isolated from any of the suspected sources, but evidence from a case control study suggested that an aerosol produced by a decorative fountain in the main square during the night of a rock concert was the likely vehicle of infection. The prevalence of smoking was higher among cases than controls.

Antibodies, Bacterial↗

PubMedDate not supplied

[Prevalence of coronary disease in patients with aortic stenosis].

We analyzed a consecutive series of 188 patients, older than 44 years, with significant aortic stenosis, who underwent coronary arteriography (73 women and 115 men). There were 38 patients (20.2%) with coronary artery disease ( or = 50% reduction in the luminal diameter). Sixty-eight patients had typical angina pectoris, 52 atypical angina, and 68 did not have chest pain. We found to have coronary disease in 29.4%, 23.1% and 8.8% respectively. Sensitivity of typical angina to detect coronary disease was 52.6%, with an specificity of 68%, and a negative predictive value of 85%. Inclusion of atypical angina improved the sensitivity to 84.2%, and the negative predictive value to 91.2%, but lessened the specificity to 41.4%. Six patients among the 38 with coronary disease (15.7%), did not have chest pain, and 3 of them were younger than 60 years. We conclude that absence of angina is not enough to exclude coronary artery disease in patients 50 years old with aortic stenosis being considered for aortic valve replacement.

Aged↗

PubMedDate not supplied

[Results of the international hemodialysis study DOPPS in Spain and Europe].

The Dialysis Outcomes and Practice Pattern Study (DOPPS) is an international observational study of treatment conditions and medical outcomes in hemodialysis patients. Prospective sampling has yielded long-term observational data from randomly selected groups of patients receiving treatment at representative, randomly selected hemodialysis units in each country. The data shown were collected at 20 hemodialysis units/centers in Spain. The data pertaining to Spain--Sp--refers to 575 patients and their comparison with those of the Euro-DOPPS countries--Eu--(Germany, France, United Kingdom, Italy and Spain), which encompass 3,038 patients, represent the formal goal of this paper. Diabetes mellitus, at 21.5% in Eu and 21.7% in Sp, was the most common cause of renal insufficiency in dialysis and coronariopathy, as a concomitant disease, was present in 67.8% in Eu as opposed to 75.8% in Sp. Differences were observed in the incident of hypertension (73.4% in Eu vs 77.4% in Sp), hepatitis C (11.6% vs 19.5%), depression (12.7 vs 16.2%) and left ventricular hypertrophy (54.9% vs 62.3%). The patterns of vascular access were similar (79% vs 81% AV fistulas in Eu and Sp, and 10% synthetic grafts for both) and the mean applied dose of dialysis--Kt/V--smaller (1.19) in Sp than in Eu (1.24); likewise the duration of the dialysis (in minutes) was shorter (234 in Eu vs 217 in Sp) and the % of synthetic membranes used was smaller (60% in Eu vs 52% in Sp). There were no differences between the groups in the figures for urea, creatinine, albumin, nPCR, calcium, phosphate or PTH. There were also no differences in the mean values of Hb (10.7 for Eu vs 10.8 for Sp), given that the values of ferritin were noticeably lower in Sp (288 vs 355) and the dose of EPO/kg/week was higher to in Sp (115 vs 102); s.c. route was used in similar proportions (69% in Eu vs 67% in Sp). The level of medical care, understood as contact with the physician at all or almost all treatments, was noticeably better in Sp (90%) that in Eu (66%), whereas the number of patients per hour of specialized personnel and % of specialized staff, were smaller. Mortality (death/100 patients-years) was one point lower in Sp than in Eu (15.4 vs 16.3). These data suggest that an increment in dialysis time and in the percentage of synthetic membranes used, as well as in the supply of intravenous iron, would be justified.

Comorbidity↗

PubMedDate not supplied

Phase I study of high-dose cytarabine and cisplatin in patients with advanced malignancy.

Nineteen patients with advanced malignancy participated in a phase I trial of high-dose cytarabine (ara-C) and cisplatin in combination. Dose and schedule were based on laboratory data indicating synergy for concurrent use of these drugs. Cisplatin (100 mg/m2) was administered during the 2nd and 3rd hours of a 3-hour ara-C infusion. The ara-C dose was escalated in subsequent patients following a starting dose of 1 g/m2. Two brief responses were noted. The study was terminated prematurely due to protracted (several weeks) nausea, occasional vomiting, and severe lassitude.

Adult↗

PubMedDate not supplied

Reducing anxiety in newly diagnosed cancer patients: a pilot program.

This study tested the efficacy of a pilot orientation program in reducing distress levels of patients with newly diagnosed cancer. Thirty-three consecutive patients were randomly assigned to an intervention or to a usual-care control group. The intervention group received a clinic tour, general information, and the opportunity to pose questions to an oncology counselor. The dependent variables were measured by the Profile of Mood States-Short Form-Total Mood Disturbance Scale and the State Trait Anxiety Inventory. Scores on the dependent measures were significantly lower in the intervention group. These results suggest that a simple orientation can greatly benefit patients with newly diagnosed cancer. The orientation may reduce anxiety and overall distress by helping patients manage novelty and unpredictability in the unfamiliar clinic setting. This intervention can be delivered within the context of a busy hematology/oncology outpatient clinic.

Adaptation, Psychological↗

PubMedDate not supplied

[Pulmonary mass which cavitated after bronchoscopy].

Explore the source record for details and available documents.

Aged↗