Puncture wounds were cuased in 9 patients by sea urchin spines and 1 patient by a date palm thorn. All 10 patients developed local inflammatory reactions, which were moderate to severe in 7. Two patients exhibited severe systemic illnesses, and a marked synovitis was present in 2 others. Several of the patients presented as difficult diagnostic problems with signs and symptoms suggestive of an arthritic disease. Six required surgical removal of the foreign body.

Adult↗

PubMedDate not supplied

Obesity: pathophysiology and practical management.

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Appetite Depressants↗

PubMedDate not supplied

Internal medicine training in ambulatory gynecology.

OBJECTIVE: To assess internists' perceptions of their training in the management of common problems in ambulatory gynecology and to compare these perceptions with their clinical practice experiences. METHODS: We surveyed 325 internists in the Portland, Oregon, metropolitan area about their residency training and practice experiences in the diagnosis and management of 25 clinical problems in ambulatory gynecology and five nongynecologic problems. RESULTS: Responses were received from 159 internists (48.5%). Overall, the internists reported relatively little residency training in the management of many common gynecologic disorders. Women internists managed gynecologic problems more than did their male counterparts, independent of the number of women patients in their practices. CONCLUSIONS: Internal medicine residency programs need to expand training in ambulatory gynecology to better prepare graduates for clinical practice.

Clinical Competence↗

PubMedDate not supplied

Evaluation of breath alcohol instruments. I. In vitro experiments with alcolmeter pocket model.

An Alcolmeter Pocket Model breath alcohol device, on an electrochemical (fuel cell) oxidation principle for ethanol analysis, has been evaluated under in vitro conditions. The result of a test is displayed on an analogue meter within 20--30 seconds after sampling: replicate tests may be made within 3--5 minutes. The electrochemical detector used was found to respond to acetaldehyde, methanol, isopropanol and n-propanol vapours besides ethanol, but it was insensitive to acetone vapour. The Alcolmeter response with a 0--2.0 mg/ml scale was linearly related to ethanol vapour concentration up to 1.0 mg/ml blood alcohol equivalent concentration; above this level the response was curvilinear, the Alcolmeter reading being too low. The standard deviation of an ethanol vapour determination in vitro was +/-0.0175 mg/ml at a mean concentration of 0.902 mg/ml. The accuracy of the device expressed as percent recovery at 0.50, 1.0 and 1.4 mg/ml blood alcohol concentrations was 96.8%, 98.3% and 88.3%, respectively. When the Alcolmeter was was calibrated at 0.50 mg/ml and used occasionally each day over an 18-day period, the drop in initial calibration was 0.01 mg/ml per week.

Alcoholic Intoxication↗

PubMedDate not supplied

Are blood glucose reagent strips reliable in renal failure?

In vitro studies have suggested that a low packed cell volume may cause reagent strips to overestimate blood glucose concentration. The reliability of such strips has therefore been investigated in diabetic patients with end-stage renal failure, all of whom had low haematocrits (24 +2- 4 (4/- SD) %). Three brands of strips were evaluated and their results were compared with laboratory whole blood glucose concentrations determined on the same samples. All over-read compared with the laboratory (BM Glycemie 1-44 strips 118 +/- 1%, Glucostix 132 +/- 2%, ExacTech strips 163 +/- 4%) and the percentage overread was negatively correlated with the haematocrit for each strip (all p less than 0.001).

Blood Glucose↗

PubMedDate not supplied

The effect of exercise on lipid metabolism in men and women.

Lipoprotein abnormalities constitute a major risk for development of cardiovascular disease. These substances, which are comprised of various lipids and proteins (apoproteins), are influenced by specific enzymes which effect their concentrations. It has been demonstrated that elevated total cholesterol and LDL cholesterol are directly associated with the development of coronary artery disease, whereas HDL cholesterol has an inverse relationship with coronary heart disease (CHD). Although more controversial, triglycerides may also be directly associated with coronary atherosclerosis. Favourable changes in lipid levels have been shown to reduce coronary mortality. Exercise may constitute a non-pharmacological approach to lipoprotein therapy. Many exogenous factors also influence lipoprotein concentrations. Changes in diet, body composition, age, as well as medication and alcohol usage may directly alter lipid levels. In addition, they can be artificially affected by the analytical method. The immediate effects of one to several bouts of physical activity appear to influence lipoprotein level. A reduction in triglycerides has been shown after physical exertion, especially among trained individuals and those with hypertriglyceridaemia. These acute changes may reflect the utilisation of both muscle and plasma triglycerides as fuels during exertion. After more prolonged training, changes in lipoproteins may also occur. However, since exercise is accompanied by many co-variables which also favourably alter these levels (e.g. lower percentage of body fat, dietary alterations), it is difficult to determine the direct effect of regular physical activity. Initial studies of exercise training's effects on total cholesterol did not differentiate changes in HDL and LDL cholesterol. Subsequent research has observed these specific cholesterol fractions. Consistent reduction in LDL cholesterol levels have not been convincingly demonstrated. Although HDL cholesterol has been shown to increase in certain studies, the response has been variable in other investigations. These latter responses may have been due to the fact that HDL cholesterol changes may be dependent on levels prior to conditioning. Assessment of HDL cholesterol subfractions (HDL2 and HDL3), which could additionally impact on cardiovascular risk reduction, have shown favourable increases in HDL2, but as yet these HDL moieties have not been adequately investigated. Reductions in triglyceride levels after training among those with elevated values and beneficial apoprotein changes post-training have been reported, although few studies exist.(ABSTRACT TRUNCATED AT 400 WORDS)

Arteriosclerosis↗

PubMedDate not supplied

The ABCs of DRGs.

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Costs and Cost Analysis↗

PubMedDate not supplied

Current role of thrombolytic therapy in the management of left-sided prosthetic valve obstruction.

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Aortic Valve↗

PubMedDate not supplied

Congenital aneurysm of the left main coronary artery with fistulous communication to the right atrium and coronary 'steal' phenomenon.

We describe a unique case of a left coronary arteriovenous fistula arising from an extremely short and aneurysmal left main coronary artery and selectively affecting the blood flow in the circumflex coronary artery. The relevant diagnostic contributions of two-dimensional echocardiography, colour flow Doppler, cardiolite stress testing and coronary angiography are discussed. The haemodynamic features of this anomaly are reviewed.

Adult↗

PubMedDate not supplied

Functional significance of coronary angiography in recognition of residual myocardial viability in patients with previous myocardial infarction.

The relationship between the epicardial blood supply to the akinetic area, its 'residual myocardial viability' and 'contractile reserve' were the subjects of this study involving 29 postinfarct patients with double- or triple-vessel coronary disease and ejection fraction less than 45%. Eighty-one of 232 analysed segments (34.9%) were akinetic. Nineteen akinetic segments (23.5%) were defined as viable and 12 (14.8%) demonstrated residual contractility. The epicardial blood flow supply to 32 (39.5%) akinetic segments was moderately decreased, 11 (34.4%) of them were viable, and 9 (28.1%) demonstrated contractile reserve. The epicardial blood flow to 49 (60.5%) akinetic segments appeared severely limited; only 8 (16.3%) of them were viable and 3 (6.1( demonstrated contactile reserve. The incidence of viability of the akinetic segments was not significantly (P<0.061) different in those regions with different epicardial blood supply (16.3% v. 34.4%). However, the contractile reserve was significantly (P<0.006) more often preserved in akinetic segments with better epicardial blood flow (28.1% v. 6.1%). We concluded that the extent of coronary disease defined by angiography does not predict residual myocardial viability of the akinetic myocardium in postinfarct patients. However, well&hyphen preserved epicardial flow is associated with a significantly increased incidence of preserved contractile reserve and weakly preserved epicardial flow is associated with a very low incidence of contractile reserve in these patients.

Coronary Angiography↗