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Biomedical subjects

R D Hurt

Publications and source records attributed to R D Hurt.

At least 91 records · Page 5Linked to original sources
PubMed1991

Development of smoke-free chemical dependency units.

Until recently, the country's chemical dependency units (CDUs) have not addressed nicotine dependence in a meaningful way for their patients. Most CDUs have accepted exemptions to the smoke-free hospital requirements enacted around the country. Twenty-nine CDU's have been identified which have developed progressive smoke-free policies and begun to treat nicotine dependence in the substance abuser. These CDUs cite three factors--concern for the smoker's health, concern for the health effects of involuntary smoking, and the strong opinion of a key leader--as motivations to implement these policies. Because of the significant resistance to these policies, the strong opinion of a key leader was considered one of the most important factors. Once the policy was in place, these CDUs were surprised that the programs ran so smoothly, including normal census counts. The CDUs used a variety of interventions to help smokers quit. There is considerable need to develop effective interventions suitable for CDUs in the treatment of nicotine dependence.

Health Policy↗
PubMed1990

Nicotine-replacement therapy with use of a transdermal nicotine patch--a randomized double-blind placebo-controlled trial.

The rate of smoking was significantly reduced in volunteer subjects by providing effective nicotine replacement, self-help material, and weekly visits with a nurse for 6 weeks. Nicotine-replacement therapy with a transdermal nicotine patch (Nicolan) almost doubled the 6-week smoking-cessation rate in comparison with that in a placebo group (77% versus 39%; P = 0.002) among subjects who were smoking at least 20 cigarettes per day at baseline. Although most subjects who used the active nicotine patches had skin reactions, the reactions were primarily mild. For use of both active and placebo patches, the level of patient compliance was high. Among subjects who continued to smoke, the use of cigarettes was decreased to less than 50% of the baseline smoking level in 7 of 7 with active nicotine patches and in 15 of 19 with placebo patches. Outcomes beyond 6 weeks showed a substantial relapse rate in both groups. Thus, when nicotine-replacement therapy is provided, a need exists for concurrent behavioral intervention and training for prevention of a relapse, neither of which was part of this protocol.

Administration, Cutaneous↗
PubMed1989

The making of a smoke-free medical center.

The concept of smoke-free medical facilities is in its formative stages, and such policies have received broad support. Although smoking has been restricted at Mayo Medical Center for many years, in 1986 it was decided that the medical center should become smoke free. This report summarizes the methods used in developing and implementing a smoke-free policy. This experience suggests that with proper planning, the implementation can be smooth. The message being given to patients and staff concerning the health risk of smoking is now more consistent, and there has been wide acceptance of the policy by staff and patients. It is concluded that such a policy can be effectively implemented, if it is well planned and supported.

Adult↗
PubMed1989

Mesenteric fibromatosis complicating familial adenomatous polyposis: predisposing factors and results of treatment.

Between January 1975 and December 1983, 24 of 183 patients (13%) with familial adenomatous polyposis (FAP) seen at the Mayo Clinic had mesenteric fibromatosis (MF). MF was found most often in FAP patients with associated extra-colonic "Gardner" signs (19 patients) and those who had had previous abdominal surgery (20 patients). In 4 patients, MF appeared spontaneously. The male-to-female ratio was 0.4, with a median age of 31 years in women and 37 years in men. Ten of 24 patients (42%) had been asymptomatic prior to diagnosis at time of surgery for FAP. Complications of the disease included intestinal or urinary tract obstruction. Minimal surgical manipulation seemed to be associated with fewer postoperative complications and a lesser risk of regrowth of the tumor. Nonsurgical treatment, including tamoxifen and sulindac in combination, may be beneficial. Surgery should be reserved for relief of obstruction, and bypass is preferred to resection.

Adenomatous Polyposis Coli↗
PubMed1988

Alcoholism in elderly persons: medical aspects and prognosis of 216 inpatients.

We describe 216 elderly patients (65 years of age or older) who were treated for alcoholism in an inpatient treatment program. Emphasis is placed on the demographics, medical characteristics, results of laboratory tests, outcome of treatment, and various comparisons of early- and late-onset alcoholism. The frequency of serious medical disorders among these patients was higher than would be expected for the overall population of a similar age. Elderly alcoholics have more abnormal results of commonly used laboratory tests than do younger alcoholics. Our data show that the elderly alcoholic can be successfully treated in a medically oriented inpatient treatment program. The concept of less-intensive treatment for the elderly alcoholic is generally not supported. More-intensive treatment may be necessary for some of these patients because of the high frequency of accompanying major medical and psychiatric problems. Early-onset alcoholism predominated, but we found no major differences between the two groups.

Adult↗
PubMed1988

Alcoholism in elderly persons: a study of the psychiatric and psychosocial features of 216 inpatients.

The medical records of 216 elderly persons, admitted to the hospital for treatment of alcoholism, were reviewed. Concern of family and friends was the most common factor motivating patients for admission. Patients with late-onset alcoholism reported an association between a life event and problem drinking more frequently than did the early-onset alcoholics. The most common associated psychiatric disorders were tobacco dependence (67%), organic brain syndrome (25%), atypical or mixed organic brain syndrome (19%), and affective disorder (12%). Fourteen percent of patients also had a drug abuse or dependence problem, all using legally prescribed drugs. Psychiatric diagnoses and results of psychologic testing did not differ between early-onset and late-onset alcoholism groups. In a 60-patient cohort studied for correlation of outcome of treatment for alcoholism with major psychiatric diagnoses, no associations were found.

Affective Disorders, Psychotic↗
PubMed1988

Legionella bozemanii pneumonia in an immunocompromised patient.

Legionella bozemanii, a rare cause of pneumonia, has a predilection for patients with impaired cellular immunity and underlying disease. We report the 12th culture-proven case of this infection, acquired in the community by a patient undergoing chemotherapy for chronic lymphocytic leukemia. The diagnosis was established when studies of bronchoalveolar lavage fluid produced a positive reaction with species-specific fluorescent antibody and growth on selective culture media. Although erythromycin was administered within 48 hours after the initial examination, the clinical condition did not improve substantially until rifampin was added to the antimicrobial regimen.

Aged↗
PubMed1988

Long-term follow-up of persons attending a community-based smoking-cessation program.

The long-term effectiveness of a smoking-cessation program based on education, behavior modification, and group support was evaluated. Because of the availability of long-term follow-up data, the natural history of cessation of smoking in persons who had attended a smoking-cessation program could be studied. At 1 year, the permanent rate of cessation of smoking was 22%, and permanent cessation continued to occur at least through 6 years of follow-up. Factors related to a higher rate of cessation of smoking were a white-collar occupation, having previously stopped smoking for more than 1 month or more than 1 year, being male, and wanting to stop smoking because of health concerns. In the absence of an almost complete return of questionnaires, sole reliance on mailed self-reports would have substantially overestimated the smoking-cessation rates. Although smoking-cessation programs alone involve relatively few smokers, analysis of the methods used in programs such as the one described continues to be important for the development of successful efforts to help people stop smoking.

Adolescent↗
PubMed1987

Computed tomography of benign mature teratomas of the mediastinum.

The computed tomography (CT) findings of five benign, mature teratomas of the anterior mediastinum collected during a ten-year period are described, and their case histories are reviewed. Three of the five were primarily cystic, with only small soft tissue components. One of the five contained equal cystic and solid elements. All cysts had a higher attenuation than water. Three tumors contained small foci of dense calcification or ossification. Only two contained fat. Computed tomography accurately predicted the presence of adherence to adjacent structures in all five. Four of five patients were less than 22 years of age, and benign teratoma of the mediastinum was not a common neoplasm at any age. The origin and pathology of germ cell tumors of the mediastinum are briefly reviewed.

Adolescent↗
PubMed1987

Discriminant analysis of the Self-Administered Alcoholism Screening Test.

For a sample of 1156 patients (520 alcoholics and 636 nonalcoholics), discriminant function analyses were performed on the total score, a nine-item version, and a two-item version of the Self-Administered Alcoholism Screening Test (SAAST). With sensitivities set at 90 and 95%, specificities for the total score and nine-item versions ranged from 96.4 to 99.4%. Cross-validation of the nine-item version with the "jackknife" procedure resulted in only one additional misclassification of the 1156 subjects. Separate analyses of the male and female samples revealed that more items entered the discriminant function for women than for men and resulted in a higher, although clinically nonsignificant, percentage of correct classification for women. The results strongly support the use of either the total score or the nine-item version of the SAAST in large-scale screening for alcoholism in a medical patient population.

Adult↗
PubMed1986

Isoniazid overdose in the Cambodian population of Olmsted County, Minnesota.

Eight cases of suicidal isoniazid overdose by Cambodian refugees are reviewed. In all patients generalized seizures and metabolic acidosis developed. Treatment included supportive measures and intravenous pyridoxine hydrochloride. There were no deaths. Psychiatric evaluation of each patient revealed usual and extraordinary life and social adjustment stresses. Indochinese immigrants are a subpopulation at risk for isoniazid overdose.

Acidosis↗
PubMed1986

Plasma lipids and apolipoprotein A-I and A-II levels in alcoholic patients.

This prospective study compared total plasma lipids, high-density lipoprotein cholesterol (HDL-C), and apolipoproteins A-I (apo A-I) and A-II (apo A-II) in 72 alcoholic patients and in 285 nonalcoholic controls. The HDL-C in the alcoholic group was not significantly different from that in the nonalcoholic controls. Alcoholic men had significantly higher levels of cholesterol and triglycerides and lower levels of apo A-I when compared with nonalcoholic controls. Alcoholic women had significantly higher levels of cholesterol and apo A-II when compared with nonalcoholic controls. Serial measurements in 25 alcoholic patients showed a significant decline in HDL-C, apo A-I, and apo A-II levels during the 4-wk hospital stay. HDL-C demonstrated its expected inverse relationship with plasma triglyceride level and its direct relationship with apo A-I, apo A-II, and the hepatic enzyme aspartate aminotransferase.

Adult↗
PubMed1985

Malignant germ cell tumors of the mediastinum.

A review of 56 cases of primary malignant germ cell tumors of the mediastinum revealed that, as with benign teratomas, the tumors occurred in young adults (mean age 29 years) but that the sex distribution differed (86% male and 14% female). A single germ cell element was found in 37 (66%) of the tumors, and various combinations were present in the remaining 19 (34%). The tumors were classified among five recognized types of germ cell tissues. There were 24 seminomas (22 pure and two with mature teratomas), 17 embryonal carcinomas (nine pure and eight with mixtures), five teratomas, seven choriocarcinomas (three pure and four with mixtures), and three pure yolk sac tumors. Most (86%) of the patients were symptomatic at the initial examination, with chest pain, cough, and loss of weight being the most frequent presenting symptoms. The standard posteroanterior and lateral roentgenograms were the most helpful diagnostic tool, showing evidence of an anterior mediastinal mass in 53 patients. The diagnosis was established by surgical exploration of the mediastinum or by biopsy of a lymph node in 55 patients. Of the 55, 24 (43.6%) had complete resection of the tumor and 31 (56.4%) had incomplete resection or biopsy alone. The overall prognosis for mediastinal germ cell tumors is poor, partly because the tumors are far advanced at the time of diagnosis but also because some of the tumors that contain embryonal cell carcinoma, choriocarcinoma, and yolk sac elements are very aggressive. Factors that were prognostic in patients with seminoma--such as age, presence of the superior vena caval syndrome, lymphadenopathy, evidence of hilar disease on the chest roentgenogram, and resectability--were not predictive in patients with other types of malignant germ cell tumors. Although aggressive combination chemotherapy may represent a significant treatment modality for nonseminomatous mediastinal tumors, the present study spanned many years in which no chemotherapy was available. Patients in the later years of the study received combination chemotherapy with various treatment regimens. No conclusions concerning specific chemotherapy, therefore, can be derived from this study.

Adolescent↗
PubMed1984

Alcoholism in physicians.

The Self-Administered Alcoholism Screening Test was completed by physicians attending an annual continuing medical education meeting. Of the responding physicians, 12% were identified as abstainers, 81% were classified as not alcohol-dependent drinkers, 5% were classified as possibly alcoholic, and 2% were classified as probably alcoholic. These results were similar to those obtained in a nonphysician general medical patient population previously given the same questionnaire. The data show that the prevalence of alcoholism among a group of physicians is not substantially different from that in a general medical population.

Alcoholism↗
PubMed1984

A study of HLA antigens in alcoholism.

The concept that alcoholism may be inherited has been suggested on the basis of twin and adoption studies and the further evidence that alcoholism is commonly seen in several members of a family. Genetic marker studies that have been conducted among alcoholics have often yielded seemingly contradictory results. Thus far, genetic marker studies involving HLA antigens have not been used in the study of alcoholism. In the current study, we identified and performed HLA typing in 52 alcoholics to determine whether a significant difference existed between the frequency of HLA-A and HLA-B locus antigens in an alcoholic population and that in a control population consisting of 1,704 nonalcoholic blood donors. In this study, we could not demonstrate a difference in the occurrence of these antigens between the two populations.

Alcoholism↗
PubMed1983

Fatal rectus sheath hematoma.

Rectus sheath hematoma is an uncommon, often misdiagnosed, and usually self-limited condition. In a recent review of autopsy cases at the Mayo Clinic, Rochester, Minn, we found two patients in whom hemorrhages into the rectus sheaths were considered the immediate cause of death and one in whom the hemorrhage was considered a contributing cause of death. Rectus sheath hematoma should be included in the differential diagnosis of an abdominal mass of sudden onset, especially in patients who have been given anticoagulants. The condition may be fatal if the volume of the hemorrhage is large and if treatment is delayed.

Abdominal Muscles↗