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Biomedical subjects

P J Dahlberg

Publications and source records attributed to P J Dahlberg.

At least 19 recordsLinked to original sources
PubMed1996

A quality improvement project to increase the use of postmenopausal hormonal replacement therapy (HRT)

Many medical institutions are initiating quality improvement and disease prevention programs. In this paper, we report the results of a program designed to increase the rate of hormonal replacement therapy (HRT) in a postmenopausal population. After initially assessing the rate of HRT use, we instituted an educational program directed at both physicians and patients. Reassessment two years later indicated the rate of HRT had increased from 31% to 48.4%. Further educational efforts were followed by a reassessment three years later that showed a further improvement in prescription rate to 64%. We conclude that our educational program directed at physicians and patients dramatically increased the rate of HRT prescription of postmenopausal women.

Education, Medical, Continuing↗
PubMed1995

Subclavian hemodialysis catheter infections: a prospective, randomized trial of an attachable silver-impregnated cuff for prevention of catheter-related infections.

OBJECTIVE: To determine if an attachable silver-impregnated cuff is effective in reducing subclavian hemodialysis catheter-related infections. DESIGN: Prospective, randomized, nonblinded study. SETTING: Community teaching hospital. PATIENTS: One hundred one acute and chronic renal failure patients requiring subclavian venipuncture and catheterization. After randomization, 47 patients underwent subclavian catheterization with a silver-impregnated cuff (Ag-CC), and 54 patients had routine catheter (RC) placements. MEASUREMENTS: Multiple presumed predictor variables for catheter-related infections, exit site infection rate, bacteremia rates, and semiquantitative cultures of all catheters.

Analysis of Variance↗
PubMed1993

Unilateral acquired renal cystic disease and neoplasia in a patient with renal artery stenosis.

We report a case of a sixty-two-year-old woman with longstanding unilateral renal artery stenosis in whom acquired renal cystic disease (ARCD) and neoplasia developed. ARCD has been frequently reported in the hemodialysis and peritoneal dialysis patients, but rarely reported in the nonuremic patient. To our knowledge it has not been previously reported in a patient with unilateral renal artery stenosis.

Carcinoma, Renal Cell↗
PubMed1990

Adrenal insufficiency secondary to adrenal hemorrhage. Two case reports and a review of cases confirmed by computed tomography.

We report two cases of adrenal hemorrhage and review 17 others that were confirmed by hormone measurements and computed tomography. Precipitating factors included heparin therapy, surgery, hypotension, and sepsis. Heparin-associated thrombocytopenia may be an underappreciated cause of adrenal hemorrhage. Despite the availability of computed tomography, adrenal hemorrhage mimics many other diseases, and an early diagnosis remains difficult.

Adrenal Gland Diseases↗
PubMed1989

Diagnostic studies for systemic necrotizing vasculitis. Sensitivity, specificity, and predictive value in patients with multisystem disease.

Forty patients with multisystem disease and suspected systemic necrotizing vasculitis were evaluated with a protocol designed to confirm the diagnosis with sequential testing. All patients underwent initial laboratory testing. Subsequent studies were individualized to the patient starting with "safe" tests (skin, muscle, rectal biopsies) and progressing to "invasive" tests (arteriography, kidney and lung biopsies). No single laboratory study was found to have adequate predictive value. Skin biopsy, rectal biopsy, and arteriography were insensitive, nonspecific, or had poor predictive values. Muscle biopsy was the most valuable safe procedure (sensitivity, 50%; specificity, 100%; predictive value, 100%; predictive value of negative biopsy, 76%; efficiency, 64%). A diagnostic approach to the patient with possible systemic necrotizing vasculitis is described.

Adult↗
PubMed1989

Ethylene glycol poisoning.

Seven men with ethylene glycol poisoning were treated at our institution during a ten-year period. Six patients survived. Ethylene glycol levels on admission did not directly correlate with the severity of metabolic abnormalities or subsequent complications. The timing of the patients' admissions altered the clinical picture and results of therapy. Patients who came to our facility later than 12 to 24 hours after ingestion had established renal failure and required prolonged hospitalization. We were able to prevent renal failure in the one patient started on dialysis less than 23 hours after ingestion. Our patients exhibited the metabolic, CNS, cardiopulmonary and renal manifestations of ethylene glycol poisoning.

Acute Kidney Injury↗
PubMed1989

Acute renal failure in octogenarians.

We analyzed hospital survival rates, severity of illness, and long-term outcomes in patients from three different age groups who were treated with hemodialysis for acute renal failure (ARF). Patients over age 80 had fewer bad prognostic factors. This selection bias was reflected in their hospital survival rates of 53%, compared to 57% of patients under age 70. No selection bias for patients ages 70 to 79 years was identified, and their hospital survival rate was 27%. The long-term outcome of hospital survivors was poor, particularly in the very elderly. Physicians should consider all of these factors when deciding whether to offer hemodialysis to elderly patients suffering from ARF.

Acute Kidney Injury↗
PubMed1989

Cholesterol embolism: experience with 22 histologically proven cases.

The records of 22 patients, aged 61 to 85 years, with histologically proven cholesterol embolism (CE) were reviewed. All had one or more risk factors. Twenty-one patients had preexisting symptomatic or recognized atherosclerotic disease. Twenty patients had one or more identifiable precipitating factors, including warfarin administration (4), angiography (15), angioplasty (2), intra-aortic balloon pump placement (2), vascular surgery (11), aortitis (2), and cardiopulmonary resuscitation (1). These preceded the onset of symptoms by as many as 3 months, but usually by less than 3 weeks. Eight patients had peripheral CE alone. Fourteen patients had visceral CE. All 14 had renal CE that was characterized by abrupt deterioration of renal function after a precipitating event (13), evidence of concurrent CE to the lower extremities or other organs (10), accelerated hypertension (9), gross hematuria (6), or flank and back pain (3). Unusual presentations included one case each of spinal cord infarction, penile gangrene, adrenal insufficiency, and symptomatic splenic infarct. If patients with visceral CE survived after initial hospitalization, they often required dialysis and later hospitalizations because of complications. Premortem diagnoses were made in 18 patients: nine from surgical specimens and nine from biopsies (one kidney, eight muscle and skin). Attempts at definitive vascular surgery were possible in only two patients and successful in one. The challenges encountered in managing these patients' conditions are reviewed.

Adult↗
PubMed1989

Diagnosis of renal osteodystrophy with the Jamshidi needle biopsy.

Nineteen bone biopsies with the Jamshidi needle were performed in 18 patients with renal osteodystrophy. The procedure was performed in the office or at the bedside and was tolerated well by all patients. These biopsies, plus clinical and laboratory studies provided all the information necessary to make therapeutic decisions. For most clinical purposes, serum calcium, phosphate, and alkaline phosphatase, a parathyroid hormone assay, spine and hand roentgenograms, and tetracycline-labeled Jamshidi needle biopsy of the iliac crest are satisfactory for the evaluation of renal osteodystrophy.

Biopsy, Needle↗
PubMed1988

Erosive spondyloarthropathy in long-term dialysis patients: relationship to severe hyperparathyroidism.

We describe the development of a destructive, erosive spondyloarthropathy in three long-term dialysis patients (mean duration of dialysis, 96 months). In all three patients, the lesions caused symptomatic vertebral pain and developed during a period of only a few months. All patients had extremely elevated levels of immunoreactive parathyroid hormone, and two patients had evidence of severe hyperparathyroidism on bone biopsy specimens. Two patients who underwent subtotal parathyroidectomy had rapid relief of symptoms and no further radiographic evidence of progression of the spondyloarthropathy. The third patient refused subtotal parathyroidectomy and had pronounced progression of the destructive spondyloarthropathy in the cervical spine. The limited experience of others, along with our currently reported findings, strongly suggests that hyperparathyroidism plays a major role in the development of this disorder. Erosive spondyloarthropathy is increasingly recognized in long-term dialysis patients and may be a unique clinical and radiographic manifestation of severe hyperparathyroidism in this population.

Aged↗
PubMed1987

Thrombolytic therapy of axillary-subclavian venous thrombosis.

Patients with axillary-subclavian vein thrombosis often have a poor outcome when treated with intravenous heparin sodium and oral warfarin sodium. Four patients were therefore treated with thrombolytic therapy. Good initial and excellent long-term results were achieved. In follow-up that has ranged up to four years, these patients do not have the common complaints of edema, fatigue, cramping, or weakness seen after traditional anticoagulation. Patients have returned to their previous occupations and have normal arm function. Noninvasive Doppler vascular laboratory studies suggest continued patency of axillary veins. Thrombolytic therapy should be considered in the treatment of spontaneous axillary-subclavian vein thrombosis.

Adult↗
PubMed1986

Subclavian hemodialysis catheter infections.

One hundred sixteen subclavian hemodialysis catheter placements in 88 patients were prospectively evaluated for catheter-related infections. Semiquantitative culture techniques and a rigid infection control protocol were used. The overall catheter colonization rate was 21.6% and catheter-associated bacteremia occurred in 9.4%. Catheters removed from febrile patients had much higher colonization (48.3%) and bacteremia (34.5%) rates. In a randomized study comparing infection rates in catheters tunneled subcutaneously or not tunneled, there was no significant difference in the incidence of infection. Catheters inserted over a guidewire to replace clotted or malfunctioning catheters were not associated with higher infection rates.

Adult↗
PubMed1985

Mesenteric ischemia in chronic dialysis patients.

6 chronic dialysis patients with acute mesenteric ischemia are described. 3 had nonocclusive infarctions, and 3 had occlusive disease. 5 of the patients had episodes of severe hypotension or hypovolemia immediately before the onset of abdominal symptoms. All patients had leukocyte counts of greater than 12,000 on admission, and 4 had stools positive for occult blood. The characteristic features of dialysis-induced hypotension followed by nonspecific abdominal symptoms and leukocytosis are emphasized.

Adult↗