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At least 775 records · Page 43Linked to original sources
PubMed1991

Radiation-associated valvular disease.

The prevalence of radiation-associated cardiac disease is increasing due to prolonged survival following mediastinal irradiation. Side effects of radiation include pericarditis, accelerated coronary artery disease, myocardial fibrosis and valvular injury. We evaluated the cases of three young patients with evidence of significant valvular disease following mediastinal irradiation. One patient underwent the first reported successful aortic and mitral valve replacement for radiation-associated valvular disease (RAVD) as well as concurrent coronary artery revascularization. A review of the literature revealed 35 reported cases of RAVD, with only one successful case of valve replacement that was limited to the aortic valve. Asymptomatic RAVD is diagnosed 11.5 years after mediastinal irradiation compared with 16.5 years for symptomatic patients, emphasizing that long-term follow-up is important for patients receiving mediastinal irradiation. This study defines a continuum of valvular disease following radiation that begins with mild asymptomatic valvular thickening and progresses to severe valvular fibrosis with hemodynamic compromise requiring surgical intervention.

Adolescent↗
PubMed2005

Update on linezolid: the first oxazolidinone antibiotic.

Linezolid is the first of an entirely new class of antibiotics, the oxazolidinones, in decades. It has a spectrum of activity against virtually all important Gram-positive pathogens. The unique mechanism of action of linezolid makes cross-resistance with other antimicrobial agents unlikely. Linezolid has both intravenous and oral formulations and the latter is 100% bioavailable. Since its first approval and marketing in March 2000 in the US, linezolid has gained approval for use in many other countries for the treatment of community-acquired and nosocomial pneumonia, complicated and uncomplicated skin and soft-tissue infections, and infections caused by methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci, including cases with concurrent bacteraemia. Several earlier comprehensive reviews summarised the chemistry, mechanism of action, pharmacokinetics, clinical efficacy and safety profile of linezolid. The present review provides an update on the latest data regarding the antimicrobial activity of linezolid versus other commonly used agents, the clinical and health-economic outcomes of linezolid versus vancomycin and teicoplanin, and safety issues.

Acetamides↗
PubMed2003

Clinical differentiation of acute necrotizing from chronic nonsuppurative pancreatitis in cats: 63 cases (1996-2001).

OBJECTIVE: To characterize clinical, clinicopathologic, radiographic, and ultrasonographic findings in cats with histologically confirmed acute necrotizing pancreatitis (ANP) or chronic nonsuppurative pancreatitis (CP) and identify features that may be useful in the antemortem differentiation of these disorders. DESIGN: Retrospective study. ANIMALS: 63 cats with histologically confirmed ANP (n = 30) or CP (33). PROCEDURE: Medical records were reviewed for signalment, clinical signs, concurrent diseases, clinicopathologic findings, and results of radiography and ultrasonography. RESULTS: Cats in both groups had similar nonspecific clinical signs, physical examination findings, and radiographic and ultrasonographic abnormalities. Abdominal ultrasonographic abnormalities, including hypoechoic pancreas, hyperechoic mesentery, and abdominal effusion, were found in cats in both groups and, therefore, were not specific for ANP. Cats with CP were significantly more likely to have concurrent diseases than were cats with ANP (100 and 83%, respectively). Clinicopathologic abnormalities were similar between groups; however, serum alanine aminotransferase and alkaline phosphatase activities were significantly higher in cats with CP. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that ANP and CP in cats cannot be distinguished from each other solely on the basis of history, physical examination findings, results of clinicopathologic testing, radiographic abnormalities, or ultrasonographic abnormalities.

Animals↗
PubMed2003

The incidence of vitreous loss and visual outcome in patients undergoing cataract surgery in a teaching hospital.

PURPOSE: To determine the incidence of vitreous loss in patients undergoing cataract surgery and the visual outcome in a tertiary teaching hospital. METHODS: Hospital records of 2095 consecutive patients undergoing cataract surgery between July 1999 and June 2000 were reviewed in this non-concurrent cohort study. Incidence and visual outcome of vitreous loss managed using standard vitrectomy techniques were assessed for different cataract surgical techniques (extracapsular, Blumenthal technique and phacoemulsification) as well as at different levels of surgical training. The outcome was compared with matched cases without vitreous loss (controls). RESULTS: Vitreous loss occurred in 160 of 2095 eyes (7.63%; CI -7 to 9.3): 8.3% for ECCE, 8.1% for the Blumenthal technique and 5% with phacoemulsification. Vision > or = 6/18 was achieved in 85% of cases and 95% of controls. For experienced surgeons, 95% of the cases and controls had vision > or = 6/18. 5.8% of cases and 0.7% of controls had vision < 6/60. One patient in each group was blind following cataract surgery; both had operable cataracts in the fellow eye. CONCLUSIONS: The vitreous loss rate in this tertiary teaching hospital is relatively high. This complication, managed with standard surgical techniques, is compatible with good visual outcome. In eyes with vitreous loss, the final visual acuity achieved by experienced surgeons was similar to that in uncomplicated cases.

Adult↗
PubMed1991

Future prospects of radiotherapy in pancreatic cancer.

To clarify the role of radiation therapy in the treatment of carcinoma of the pancreas studies with radiotherapy alone, combined interventional or concurrent radio-chemotherapy are reviewed. It is shown that in the case of inoperable tumour radiotherapy alone is inadequate, but by the means of a combination of chemotherapy, external beam or interventional (intra-operative, interstitial) irradiation, improvements in local control rates and median survival can be achieved. Following so-called curative resection, a number of studies have shown that adjuvant radio-chemotherapy or interventional treatments possibly prolong survival.

Combined Modality Therapy↗
PubMed1991

Otitis media: the pathogenesis approach. Assessment and treatment of associated upper respiratory tract pathology.

The communication of the middle ear with the nasopharynx via the Eustachian tube makes it susceptible to disease processes of the upper airway. It is therefore necessary for patients with otitis media to have a thorough evaluation of the upper airway for detection and management of any concurrent pathologic condition. This article reviews the various upper respiratory tract pathologic entities associated with otitis media.

Humans↗
PubMed1989

Orthopedic considerations of cervical syndrome and temporomandibular disorders.

Dental clinicians should be aware that symptomatology of the head, neck, shoulders and arms, associated with cervical syndrome may present concurrent to temporomandibular disorders. A review of some cervical complex alterations is presented as well as treatment procedures which could reflect upon temporomandibular treatment in dentistry.

Cervical Vertebrae↗
PubMed1988

Effect of clinical pharmacy services on appropriateness of serum digoxin concentration monitoring.

The effects of four levels of clinical pharmacy services on increasing the appropriate ordering of serum digoxin concentration (SDC) determinations for cardiothoracic surgery patients were studied. During four equivalent four-month periods from 1983 to 1986, the pharmacist on the cardiothoracic surgery service provided four different levels of clinical services: no services (Period 1), participation in ward rounds only (Period 2), participation in ward rounds supplemented by the regular provision of inservice education programs (Period 3), and participation in ward rounds only (Period 4). Explicit criteria for the appropriate monitoring of digoxin therapy were developed from published criteria and an extensive literature review; all SDC determinations that did not meet one of these criteria were deemed inappropriate. All adult patients who received digoxin therapy were included in the study; data collected for each patient included the time and amount of the daily digoxin dose and the route of administration, the time at which blood was drawn for each SDC determination, and the assay results. Data were collected through a retrospective chart review for Period 1 and concurrently thereafter. The number of appropriate SDC determinations in Period 1 were compared with the total number of appropriate SDC determinations in Periods 2, 3, and 4; Periods 2 and 4 were compared with Period 3; and Period 2 was compared with Period 4. The costs avoided as the result of decreased numbers of SDC determinations ordered were calculated as the differences between the cost of inappropriate SDC determinations in Period 1 and the costs in Periods 2, 3, and 4.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Surgical Procedures↗
PubMed1985

Pharmacologic principles of cardiovascular drug administration to the critically ill.

The critically ill patient presents a pharmaceutical dilemma, with the clinical condition often necessitating the administration of potent medications. The underlying disease process often includes or produces multi-system failure, which will subsequently alter the response to drugs, with the potential to further compromise the acutely ill patient. In summary, the interplay of patient and drug provides a challenge to the medical staff in the provision of effective pharmacotherapy. Several steps can be followed to facilitate the achievement of optimal drug therapy at minimal toxicity. These include the following. 1. Drug Choice. The agent to be administered must be assessed by the practitioner with respect to efficacy in the particular disease state. 2. Patient Variables. Patients must also be evaluated for the presence of factors such as cardiovascular compromise, renal or hepatic dysfunction, pulmonary disease, gastrointestinal integrity, and hypoalbuminemia, all of which are known to alter drug kinetics or dynamics. Concurrent drug therapy must be reviewed to identify those drugs with the potential to interact with the agent to be administered. 3. Dose of the Selected Agent. The dose of the drug must be altered commensurate with those diseases observed. In the presence of multiple organ involvement, further alterations in dosage may be required. 4. Route of Administration. The drug in the selected dose must be given by a route that will result in reliable blood concentrations. Intravenous therapy is usually the route of choice. 5. Monitoring of Therapy. Therapeutic endpoints of the individual agents must be clearly defined and will include variables such as control of arrhythmias, determination of systolic and diastolic blood pressure, heart rate, and so forth. Dose-related toxicity serves as a warning sign of excessive drug doses. Patients must be monitored carefully to insure early detection of adverse effects and subsequent dose reduction by the practitioner. The monitoring of serum concentrations of drugs that possess a well defined therapeutic or toxic range is useful, if the limitations of this practice are remembered. Determinations of plasma concentration must be readily and routinely available to the practitioner to be useful in guiding dosage alterations, especially in emergency situations. The availability of this laboratory service is often a limiting factor. Additionally, standard methods of quantifying serum levels of drugs measure both free and bound drug together, providing one value. Changes in the pharmacologically active free fraction may therefore be undetected.(ABSTRACT TRUNCATED AT 400 WORDS)

Cardiovascular Agents↗
PubMedDate not supplied

Postpartum stress: current concepts and the possible protective role of breastfeeding.

OBJECTIVE: To review stress during the postpartum and the research supporting that a unique, protective biology exists in breastfeeding mothers that may reduce reactivity to stress. DATA SOURCES: Publications from nursing and biomedical literature. STUDY SELECTION: Studies reviewed were those that have contributed to concurrent conceptualizations of postpartum stress. Additionally, studies with sufficient participants were analyzed for common findings. Animal literature was reviewed for studies on the stress response in lactating and nonlactating animal models. DATA EXTRACTION: Stress during the postpartum may be conceptualized as physical, intrapersonal, and interpersonal. Animal data and a few recent human studies suggest that the neuroendocrinology of the lactating mother may down-regulate the magnitude of the stress response. DATA SYNTHESIS: A diminished stress response may serve to protect the breastfeeding maternal-infant dyad from environmental stimuli and to direct the physiology of the mother toward milk production, energy conservation, and nurturance. CONCLUSION: Nurses understand the benefits of breastfeeding for optimal infant health, but new research suggests that maternal health may also be benefited in a biologic and as yet unexplored way.

Breast Feeding↗
PubMed1990

Quality assurance and quality of care: II. Monitoring treatment.

The absence of meaningful linkages between quality assurance programs and quality of care has alienated them from each other, especially in psychiatry, where standards of care and process and outcome of treatment are vaguely defined and vigorously debated. This paper describes several factors contributing to the gap between quality assurance and quality of care as well as a treatment-monitoring process that attempts to bridge the gap. The form and review process described are criteria-based and concurrent, and they use methodology that both assesses documentation and promotes an interactive clinical review. Preliminary data that demonstrate the clinical usefulness of the process and its impact on a treatment service are presented.

Forms and Records Control↗
PubMed2005

Chest and abdominal CT during extracorporeal membrane oxygenation: Clinical benefits in diagnosis and treatment.

RATIONALE AND OBJECTIVE: This study aims to evaluate the clinical usefulness of thoracic and abdominal computed tomography (CT) as an adjunct to bedside diagnostic imaging in patients on extracorporeal membrane oxygenation (ECMO) therapy because of severe acute respiratory failure. MATERIALS AND METHODS: Imaging records for 118 consecutive thoracic and abdominal CT examinations performed in 63 patients (22 neonates, 15 children, and 26 adults) on ECMO therapy during an 8-year period were retrospectively reviewed. Reported CT findings were compared with concurrent bedside radiographs and ultrasounds. The clinical importance and effect on treatment of each CT finding was determined by reviewing the medical records. RESULTS: CT showed 30 clinically important complications in 20 different patients that directly impacted on the treatment, but were not diagnosed with bedside imaging. Of the 30 complications, 15 (50%) were surgically treated, 11 (37%) required percutaneous invasive procedures, and 4 (13%) were managed conservatively. Despite the serious complications, 13 of 20 patients (65%) survived. CONCLUSION: Both chest and abdominal CT have an important clinical role in patients on ECMO therapy because of acute respiratory failure, as a complement to bedside imaging, to exclude or show complications and expedite early invasive treatment, when needed.

Adolescent↗
PubMed2006

Azathioprine and inhibition of the anticoagulant effect of warfarin: evidence from a case report and a literature review.

BACKGROUND: Warfarin and azathioprine may be prescribed concurrently in patients requiring both anticoagulation and immunosuppression. However, a potential interaction between the 2 drugs, resulting in an increased warfarin requirement, may be overlooked in clinical practice. CASE SUMMARY: A 67-year-old woman was treated with warfarin (initial mean dose, 24 mg/wk [3.5 mg/d]) for >3 years for recurrent deep vein thrombosis associated with systemic lupus erythematosus. Soon after commencing warfarin, azathioprine 150 mg/d was introduced for its steroid-sparing effect. Warfarin was titrated to a mean dose of 60 to 75 mg/wk (8.5-10.5 mg/d) over the next 18 months. Her dose of azathioprine was then increased to 200 mg/d. Subtherapeutic international normalized ratio (INR) levels required an increase in the warfarin dose to a mean of 130 mg/wk (18.5 mg/d). Subsequent discontinuation of azathioprine resulted in a dramatic increase in her INR levels (from 1.8 to 14.0 four weeks after discontinuation). DISCUSSION: A temporal relationship, demonstrating the interaction between warfarin and azathioprine, was evident at various times during therapy for our patient. This case, together with 7 additional published cases, is comprehensively reviewed here using previously described criteria for establishing a definite interaction between warfarin and other drugs. CONCLUSIONS: The evidence supports a clinically important inhibitory action of azathioprine on warfarin and calls for closer monitoring of INR levels when azathioprine doses are altered during concurrent administration with warfarin.

Aged↗
PubMed2006

Concurrent development of Crohn disease and myelodysplastic syndrome in a child: case report and literature review.

A small number of cases of Crohn disease associated with myelodysplastic syndromes or leukemia have been reported in adults in the last 25 years in the English-language medical literature. The authors report a case of a 9-year-old boy who developed Crohn disease and myelodysplastic syndrome concurrently. Analysis of his bone marrow showed a chromosome 20 abnormality. Although chromosome 20 abnormalities have been reported in a minority of these patients, the significance of this association remains unclear at the present time.

Anemia, Refractory, with Excess of Blasts↗
PubMed1996

Endophthalmitis in patients with retained lens fragments after phacoemulsification.

PURPOSE: To review the treatment and outcomes of patients presenting with concurrent endophthalmitis and retained lens fragments after phacoemulsification. METHODS: A retrospective chart review was conducted on patients presenting with culture-proven endophthalmitis and retained lens fragments after phacoemulsification between 1990 and 1994. RESULTS: Five patients were identified with culture-proven endophthalmitis and retained lens fragments after phacoemulsification. In all patients, coagulase-negative staphylococci were cultured from the vitreous fluid. One patient also had positive cultures for Proteus mirabilis and Escherichia coli. The interval between cataract surgery and treatment ranged from 5 days to 6 months. Echography was beneficial in showing retained lens fragments in five of five patients when media opacities obscured the view of the fundus. Four patients had vitrectomy and removal of retained lens fragments during their initial treatment. The fifth patient was treated with intravitreal antibiotics alone and continued to have marked inflammation, eventually requiring vitrectomy for removal of the retained lens fragments. A final visual acuity of 20/400 or better was achieved in four of the five patients. CONCLUSIONS: Patients may present with endophthalmitis in the setting of retained lens fragments after phacoemulsification. In such cases, the preferred initial management may be pars plana vitrectomy, removal of retained lens fragments, and injection of intraocular antibiotics. In eyes with endophthalmitis and opaque media, echography is a useful screening modality.

Aged↗
PubMed1982

Matching since Baum (1979).

Data from recent studies employing concurrent variable-interval schedules are reviewed. Subject species employed in different experiments have included rats, pigeons, and humans, and reinforcers have varied from food and shock avoidance to points exchangeable for money. Undermatching (a greater preference for the schedule of the concurrent pair that delivers the lower rate of reinforcement than the Matching Law predicts) has been preponderant in recent studies, irrespective of whether behavior has been measured in terms of response ratios or time allocation, with the possible exception of data produced by human subjects. Little difference in the degree of undermatching exhibited by response and time measures has been found, except in the results from a single laboratory, in which time-allocation measures have tended to undermatch less than response measures. Procedural features, such as type of manipulandum used and changeover delay, seem to have little effect on the degree of undermatching exhibited, but asymmetrical response manipulanda (such as lever and key) for the different concurrent schedules, or other asymmetries in the experimental situation, show up clearly in bias measures, in a manner consistent with previous analyses.

Animals↗
PubMed1980

Concurrence of anorexia nervosa and yellow mutant albinism.

A review of published clinical reports shows that anorexia nervosa has been found in association with several genetic anomalies, principally gonosomal aneuploidy. An additional, and unique, association is described here: a case of anorexia nervosa in a patient with the yellow mutant form of oculocutaneous albinism and no other apparent chromosomal abnormalities. While the concurrence of these two disorders in a single person is apparently a chance phenomenon, our review of experimental publications shows that feeding disturbances also occur in yellow mutant mice. Such complementary findings suggest the need for continuing investigation of the genetic foundations of eating behaviour.

Adult↗
PubMed1984

Concurrent Cushing's and Zollinger-Ellison syndromes in a patient with islet cell carcinoma. Case report and review of the literature.

This report documents the simultaneous occurrence of Cushing's and Zollinger-Ellison syndromes in a patient with islet cell carcinoma. The clinical concurrence of these two syndromes has been recorded in only three previous case studies, while three other case reports record evidence suggesting the presence of both gastrin and ACTH within the tumor but without clinical sequelae. In the present report, evidence based on multiple clinical and biochemical data supports the concept that both syndromes are a result of "ectopic" hormone production by the tumor.

ACTH Syndrome, Ectopic↗