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At least 991 records · Page 55Linked to original sources
PubMedDate not supplied

Heart rate during group flooding therapy for PTSD.

The objective of this study was to assess, via heart rate, the arousal levels of participants in group trauma reexposure therapy for posttraumatic stress disorder, and so to better understand this common mode of treatment, particularly in regards to its presumed curative factor, extinction. Six Vietnam combat-related PTSD inpatients participated twice weekly in group trauma reexposure therapy during which their electrocardiograms were recorded. Heart rate was quantified continuously off-line. Heart rates of participants not directly engaged in imaginal reexposure to their personal combat traumas consistently exhibited mild linear declines from the beginnings to the ends of the approximately 2.5 hour sessions. Participants actively engaged in personal combat trauma reexposure exhibited higher whole-session heart rates. Most also exhibited more specific elevation extending over the later portions of therapy sessions during which intensive reexposure usually occurred. Surprisingly, no patients exhibited focal increases in heart rate concurrent with periods of most intensive traumatic incident review as judged from videotape. Administering imaginal reexposure in a group context does not preclude substantial physiological (sympathetic) arousal, as is preconditional for extinction. Under conditions in which the actively engaged reexposure patient is reliably identified, group trauma reexposure therapy may not provide an opportunity for "vicarious" flooding in nonengaged participants.

Adult↗
PubMedDate not supplied

A picture archiving and communication system module for radiology.

This paper presents the design and implementation of a clinical picture archiving and communication system (PACS) module within the radiology department of a 700-bed teaching hospital. The system is composed of an integrated network of digital devices used to electronically acquire, store, manage, and display radiological text and image information. Operationally the system behaves as a large queueing network allowing processes to operate concurrently in a coordinated and prioritized fashion. Secondary reviews (radiology conferences and fast case reviews by clinicians) are being conducted from a 512 X 512 CRT viewing station. Preliminary evaluation based on formal survey and usage statistics shows that the system is rapidly being accepted by radiologists and clinicians for the review and processing of digital radiographic images.

Hospital Bed Capacity, 500 and over↗
PubMed1989

Angiographic morphology of coronary artery stenoses in prolonged rest angina: evidence of intracoronary thrombosis.

Previous clinical and angiographic/histopathologic correlative studies have demonstrated that angiographic findings of occlusive thrombus, intraluminal filling defects and complex lesion morphology indicate the presence of intracoronary thrombosis. The purpose of this study was to determine whether the presence of these descriptors of intracoronary thrombosis is associated with the syndrome of prolonged rest angina. The coronary angiograms of 50 patients with prolonged rest angina without myocardial infarction (group I) and 42 concurrent patients with stable angina (group II) were reviewed without knowledge of the clinical syndrome. Patients with prior myocardial infarction, coronary angioplasty or coronary artery bypass graft surgery were excluded, as were patients with important aortic stenosis. Each coronary artery stenosis in a major epicardial vessel was evaluated for the presence or absence of intracoronary thrombus (defined using standard criteria), complex lesion morphology (defined as the presence of haziness, a smudged appearance or irregular lesion margins) and eccentricity, and the frequency of each of these findings in groups I and II was compared. Intracoronary thrombus was present significantly more often in group I patients (42%) than in group II patients (17%) (chi 2 5.77; p less than 0.02). Complex lesion morphology was also present significantly more often in group I (44%) than in group II (14%) patients (chi 2 8.17; p less than 0.01). Either standard criterion for intracoronary thrombus or complex morphology was present in 70% of group I but only 21% of group II patients (chi 2 19.7; p less than 0.001). These results support a strong association of the angiographic descriptors of intraluminal thrombosis with the clinical syndrome of prolonged rest angina.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Chronic beta-blocker therapy complicating the presentation of cardiac tamponade of malignancy.

A case report is related of an elderly patient with metastatic carcinoma who presented to the emergency department with mental status change and ultimately proved to have cardiac tamponade. All of the classic cardiovascular signs of this condition were obscured by chronic beta-blocker therapy and concurrent hypovolemia. A discussion of pertinent pathophysiology and review of the literature is included.

Cardiac Tamponade↗
PubMed2002

Declining hemoglobin during chemoradiotherapy for locally advanced non-small cell lung cancer is significant.

BACKGROUND AND PURPOSE: Tumor hypoxia and anemia have been linked to poor overall survival and local control in carcinomas of both the uterine cervix and the head and neck for patients undergoing radiotherapy. Little is known about the effect of these factors on the outcome of NSCLC patients with locally advanced disease undergoing chemoradiation therapy. MATERIALS AND METHODS: To examine the impact of anemia in stage III NSCLC patients undergoing combined modality therapy, we reviewed our database from three sequential trials of concurrent weekly paclitaxel +/- carboplatin and radiation therapy. 115 pts from 17 institutions were enrolled from 4/94 to 5/97. In this series, hemoglobin values were collected before treatment and weekly during radiotherapy. We correlated baseline Hb and Hb changes during chemoradiation treatment with overall survival. RESULTS: Although pretreatment anemia was common (30% Hb = 110-130 g/l, 16% Hb <110 g/l), log-rank analyses of presenting Hb, average Hb and minimum Hb during treatment were not statistically significantly predictive of survival. However in a Cox model, declining hemoglobin during chemoradiation had a statistically significant impact on survival. CONCLUSIONS: These analyses reveal that a decline in hemoglobin during chemoradiation for stage III NSCLC has a statistically significant correlation with overall survival. Strategies maximizing hemoglobin during combined modality therapy need further exploration in well-planned randomized trials.

Adult↗
PubMed2001

Radiosensitization with chemotherapeutic agents.

The combination of low-dose chemotherapy and thoracic radiotherapy is one of the treatments proposed in an attempt to improve the prognosis of locally advanced non-small cell lung cancer. Chemotherapeutic drugs administered at subtoxic doses act by means of a radiosensitization mechanism. Platinum-derived drugs have been historically used as radiosensitizers, without cumulative unacceptable toxicity. Many new chemotherapeutic agents, which have shown promising results in terms of disease control in advanced non-small cell lung cancer, show also a radiosensitizing activity. However, the optimal dose and timing of such drugs when used concurrently to radiotherapy are unknown. This paper will review the results obtained using new chemotherapeutic drugs as radiosensitizers.

Antineoplastic Agents↗
PubMed1997

Hair analysis, a novel tool in forensic and biomedical sciences: new chromatographic and electrophoretic/electrokinetic analytical strategies.

Hair analysis for abused drugs is recognized as a powerful tool to investigate exposure of subjects to these substances. In fact, drugs permeate the hair matrix at the root level and above. Evidence of their presence remains incorporated into the hair stalk for the entire life of this structure. Most abusive drugs (e.g. opiates, cocaine, amphetamines, cannabinoids etc.) and several therapeutic drugs (e.g. antibiotics, theophylline, beta 2-agonists, etc.) have been demonstrated to be detectable in the hair of chronic users. Hence, hair analysis has been proposed to investigate drug abuses for epidemiological, clinical, administrative and forensic purposes, such as in questions of drug-related fatalities and revocation of driving licences, alleged drug addiction or drug abstinence in criminal or civil cases and for the follow-up of detoxication treatments. However, analytical and interpretative problems still remain and these limit the acceptance of this methodology, especially when the results from hair analysis represent a single piece of evidence and can not be supported by concurrent data. The present paper presents an updated review (with 102 references) of the modern techniques for hair analysis, including screening methods (e.g. immunoassays) and more sophisticated methodologies adopted for results confirmation and/or for research purposes, with special emphasis on gas chromatography-mass spectrometry, liquid chromatography and capillary electrophoresis.

Chromatography↗
PubMed1997

Breast carcinoma associated with pregnancy and lactation.

The most common malignancy concurrent with pregnancy is breast cancer. Since an increasing number of women are electing to postpone pregnancy to their late thirties and forties, the incidence of breast cancer concurrent with pregnancy is increasing. This article critically reviews the incidence, unique diagnostic and therapeutic considerations, the natural history and ultimate prognosis of breast carcinoma associated with pregnancy and lactation.

Adult↗
PubMed1998

Histologic evidence of a radiosensitizing effect of Taxol in patients with astrocytomas.

The new anticancer agent Taxol appears to potentiate the effects of radiation on brain tumor cell lines in vitro and was recently evaluated by our group as a radiosensitizer in a phase I study for primary brain tumors. In that study, we administered Taxol as a three-hour IV infusion repeated every week for six weeks and gave daily cranial irradiation concurrently for a total of 6000 rads. We reviewed the charts of the 60 patients who participated in the study, and identified twelve patients who underwent a second surgery after treatment because of progressive symptoms and an enlarging intracranial mass on MRI. Pathologically, each patient showed prominent radionecrosis, and other evidence of accelerated radiation changes (confluent areas of coagulative necrosis, bizarre nuclei, marked thickening and fibrinoid changes in multiple blood vessels). These changes were noted many weeks earlier than would be expected after radiation therapy alone and were independent of age, and tumor histology. We postulate that the accelerated radiation changes may be due to the radiation sensitizing effects of Taxol. We also noted a change of the pattern of tumor recurrence, compared to historic reports, and a dose-necrosis relationship where the resected tumor is formed completely of necrotic tissue in patients who received 150 mg/m2 or higher dose of Taxol. These observations may be of significance for future study design.

Adult↗
PubMedDate not supplied

QT prolongation and torsades de pointes associated with concurrent use of cisapride and erythromycin.

Prolongation of QT interval may lead to serious, potentially life-threatening, ventricular tachyarrhythmia, such as torsades de pointes. The cause may be an inherited or an acquired malfunction of ion channels at the myocardial cell membrane. Metabolic abnormalities, starvation, nervous system injury, and drug administration cause the much more frequent acquired long QT syndrome (LQTS). Types Ia and III antiarrhythmic drugs account for the majority of these life-threatening events, whereas a number of drugs widely used in otolaryngology, such as antibiotics and antihistamines, have been recently implicated. A case of a life-threatening ventricular tachyarrhythmia after the concurrent administration of cisapride and erythromycin is presented. Reviewed are drugs commonly prescribed in otolaryngology, as well as the associated risk factors that potentially lead to LQTS.

Anti-Bacterial Agents↗
PubMed2001

Value of flow cytometry in the evaluation of head and neck fine-needle lymphoid aspirates: a 3-year retrospective review of a community-based practice.

OBJECTIVE: To study the clinical efficacy of flow cytometry in patients suspected of having a lymphoma with head and neck pathology. STUDY DESIGN: Retrospective review of 49 patients with lymphoid aspirates having concurrent flow cytometry studies. SETTING: Private practice office-based study. CONCLUSION: Fine-needle aspiration with concurrent flow cytometry is a useful, convenient adjunct to the diagnosis of head and neck non-Hodgkins lymphomas. SIGNIFICANCE: Flow cytometry is a significant improvement over fine-needle aspiration derived cytologic diagnosis alone. Tissue open biopsy may be avoided altogether in some patients with non-Hodgkins lymphoma.

Adolescent↗
PubMed1994

Comparative risk of bloodstream infection in organ transplant recipients.

To determine relative rates and sources of nosocomial bloodstream infection in solid organ transplant recipients, concurrently collected data on 277 consecutive patients were reviewed. Twenty-eight patients developed 40 infections. Liver recipients experienced a higher rate (28%) than either kidney (5%) or heart, heart-lung (10%). Primary infections (60% overall) caused by gram-positive bacteria (59% overall) predominated at all three sites.

Alberta↗
PubMed1995

Hospital costs of firearm injuries.

UNLABELLED: The purpose of this study was to provide economic, epidemiologic, and clinical data on initial hospitalizations of patients with firearm injuries. DESIGN: Concurrent prospective study; data obtained by medical records review. SETTING: A county university teaching hospital designated a level I trauma center. SUBJECTS: 34,893 persons first hospitalized for firearm injuries at the King/Drew Medical Center in Los Angeles from January 1978 through December 1992. RESULTS: The aggregate hospital cost for 34,893 firearm injuries, exclusive of professional fees, was $264,506,455.00, of which 96% was borne directly or indirectly by public funds. The charge for initial hospitalizations was $240,700,855.00. Mean and median initial charges per case were $6898.00 and $1,022.00, respectively (range, $944.00 to $296,232.00). The 5% of patients with charges greater than $100,000 accounted for 42% of all charges; 45% of all patient days were attributable to the 4% patients, with hospitalizations lasting more than 30 days. Three thousand thirty-one patients were rehospitalized a total of 4,578 times; charges for rehospitalization totaled $23,805,600.00. At least 55% (75% of identifiable weapon and missile injuries) of all charges resulted from handgun injuries. Treating the majority of patients on an outpatient basis and by using selective angiography for extremity wounds, a savings of more than $775,000,000.00 resulted. The potential cost of treating gunshot wounds at a single county hospital was more than $1 billion, or more than $100 million per year. CONCLUSIONS: The costs for hospital treatment of firearm injuries are substantial. A lack of rehabilitation facilities forces prolonged acute hospital admissions in many cases. Avoiding prolonged hospitalization may be helpful in controlling these costs, but will be difficult to achieve. Ninety-six percent of the patients in this report had their costs of care covered by the government, because they had no primary insurance coverage. Primary prevention of firearm injuries, especially those caused by handguns, may be the most effective cost-control measure.

Firearms↗
PubMedDate not supplied

Attention deficit/hyperactivity disorder (ADHD): complex phenotype, simple genotype?

Complex genetic traits refer to those phenotypes not fitting patterns of Mendelian segregation and/or assortment but exhibiting a preferential familial clustering that cannot be explained by cultural or environmental causes. Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder of childhood and probably the most controversial. ADHD has been considered a complex genetic trait based upon the absence of a clear-cut boundary between affected and unaffected status. Furthermore, its high comorbidity with other disorders strongly suggests complex epistatic or pleiotropic effects acting in common with the environmental influences. This implies that the same gene or genes is or are associated with different and concurrently occurring phenotypes. In this study, we will review clinical and epidemiological aspects related to the ADHD phenotype, which are considered either as categorical or continuous traits. We also will discuss genetic models underlying the complexity of this behavioral phenotype and the probable role of epistatic interactions between major genes contributing to the ADHD phenotype.

Attention Deficit Disorder with Hyperactivity↗
PubMed1976

Does coronary surgery prolong life in comparison with medical management?

This analysis attempts to utilize natural history controls to answer the question as to whether coronary surgery prolongs life in comparison to medical management. Selected natural history studies are compared and contrasted in an effort to obtain an average survival curve for patients with coronary artery disease comparable to those presently being operated. The Duke University Medical Center series of concurrent operated and non-operated patients is reviewed to demonstrate the difference of prognosis of patients with coronary artery disease and the complexities involved in answering the question. It is concluded that, on average, coronary surgery does not prolong life in comparison to medical management over the span of 2-5 years. There may be certain higher risk patients whose lives may be prolonged by aortocoronary bypass surgery but more patients and more prolonged follow-up are needed fully to answer the question.

Coronary Disease↗
PubMed1982

Diastolic collapse of the right ventricle with cardiac tamponade: an echocardiographic study.

The value of a newly described echocardiographic sign for the detection of cardiac tamponade was retrospectively evaluated in 91 patients. M-mode echocardiograms were reviewed in 86 patients, 36 of whom had concurrent two-dimensional echocardiographic examinations; in five patients, only two-dimensional echocardiography was performed. Cardiac tamponade was clinically present in 17 patients, 14 of whom had abnormal posterior motion of the right ventricular free wall in early diastole. Two of the 17 patients with tamponade had equivocally abnormal motion and one had normal wall motion. The patient with normal wall motion was later proved to have predominantly constrictive pericardial disease. In all cases, the abnormal wall motion reverted to normal after a definitive drainage procedure. Two-dimensional echocardiography confirmed that the abnormal right ventricular wall motion represented a true collapse of the right ventricular cavity in early diastole. Of the 69 patients without clinical cardiac tamponade, only seven had abnormal right ventricular wall motion. Detection of abnormal diastolic right ventricular free wall motion may be a sensitive indicator or a hemodynamically significant pericardial effusion. Conversely, the presence of normal motion of the right ventricular free wall appears to be a reliable indicator that the pericardial effusion is exerting little effect on overall cardiac function.

Cardiac Tamponade↗