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At least 1,117 records · Page 62Linked to original sources
PubMed2002

B Cell lymphoma of the brain stem masquerading as myasthenia.

A 54 year old man is described with signs compatible with ocular myasthenia gravis and an apparent excellent response to pyridostigmine. Subsequent clinical progression and further investigation suggested the presence of an inflammatory brain stem lesion, which responded to corticosteroid therapy. Clinical relapse, including the development of central neurogenic hyperventilation, led to a brain stem biopsy, confirming a diagnosis of B cell lymphoma. This case illustrates the propensity of primary CNS lymphoma (PCNSL) to mimic other conditions. Brain MRI is mandatory in presumed "test negative" ocular myasthenia with atypical clinical findings. Spontaneous regression of PCNSL or response to corticosteroids is common and should not mitigate against the diagnosis. Histopathological confirmation should ideally be made before starting therapy, as this may obscure or delay the correct diagnosis. Although PCNSL is rare, it must be considered in all patients with brain stem syndromes, and in all patients 50 years or older with contrast enhancing focal lesions.

Biopsy↗
PubMed2006

The challenge of changing roles and improving surgical care now: Crew Resource Management approach.

Many surgeons are also pilots; the two activities demand similar skill sets. Surgeons have developed an interest in aviation models for managing risk and reducing adverse events, such as Crew Resource Management training. This article provides seven suggestions from aviators that might be adopted by surgeons in an effort to improve surgical care and mitigate patient harm. Each suggestion is offered based on the value added to aviation, with an acknowledgment that the suggestion may be more or less applicable in surgery. The suggestions for dealing with the changing roles for surgeons are: Crew Resource Management-type training to improve teamwork should be required for hospital credentialing, surgeons should brief the operating room team before an operation, surgeons should write standards specific to their organization, surgeons should recognize fatigue and age as factors in performance, surgeons should have "check-rides" as a part of the credentialing process, surgeons should abandon the mortality and morbidity conference in favor of a data collection system that effectively examines adverse events for root causes of error, and all members of the surgical team should be subject to mandatory, random drug testing.

General Surgery↗
PubMed2006

Tolerance to celecoxib in patients with a history of adverse reactions to nonsteroidal anti-inflammatory drugs.

BACKGROUND: Adverse reactions to nonsteroidal antiinflammatory drugs (NSAIDs) are frequently reported, particularly among asthmatic patients. To date, there is no causal treatment available apart from tolerance induction. Therefore, the search for safe alternative drugs is of pivotal importance in clinical practice. OBJECTIVE: The aim of our prospective study was to investigate the tolerance to celecoxib, a selective cyclooxygenase-2 inhibitor, in a large group of patients with positive case history of NSAID intolerance in comparison to paracetamol and nimesulide. METHODS: 106 NSAID-sensitive patients, 46 (43.4%) of whom had experienced reactions only to one NSAID (single hypersensitivity), 60 (56.6%) to several NSAIDs (multiple hypersensitivity), were included in a single-blinded drug challenge protocol with cumulative doses of 175 mg of celecoxib, 875 mg of paracetamol and 175 mg of nimesulide. Objective and subjective symptoms during challenge were documented. RESULTS: Of 261 challenges in 106 patients, 31 challenges were positive: 5 of 106 (4.7%) for celecoxib, 10 of 64 (15.6%) for paracetamol and 16 of 91 for nimesulide (17.6%). Adverse reactions to celecoxib were mainly mild in character: three patients reported subjective symptoms including generalised pruritus and thoracic oppression, whereas two patients reacted with angio-oedema. CONCLUSIONS: Our results demonstrate that celecoxib is well tolerated by the majority of patients with NSAID intolerance. However, since adverse reactions to celecoxib cannot be ruled out completely, a controlled oral challenge test is still mandatory for proper management of patients with NSAID intolerance.

Acetaminophen↗
PubMed1988

Substance abuse in the workplace: creating a responsible policy.

Catholic healthcare institutions seeking to address the problem of substance abuse must answer three basic questions: To whom does Catholic healthcare hold itself responsible? What is Catholic healthcare's responsibility to itself? What changes or actions will effectively and justly address the problem of substance abuse, now and for the future? Catholic healthcare organizations' primary responsibility is to provide safe, high-quality care for its patients, but their mission and philosophy also mandate that they be concerned for the well-being of their employees and physicians. Creating a drug-free workplace would benefit all groups. An effective substance abuse program also serves the self-interest of Catholic healthcare institutions. It helps to boost employee morale, increases productivity, improves the organization's image, and protects it against the threat of legal action. Studies have shown, however, that substance abuse programs which call for mandatory or random testing are unworkable. The best approach is an overall policy that combines for-cause testing with educational and rehabilitative programs. Such a policy not only answers to the self-interest of Catholic healthcare institutions; it also lives up to the values of our Catholic Christian ministry of healing.

Catholicism↗
PubMed1999

Blood alcohol concentration among injured drivers in Hualien County.

Vehicle-related injuries are the major cause of death and injuries in Hualien County. Driving under the influence of alcohol plays a major role in such crashes. From December 1997 to May 1998, we determined the blood alcohol concentrations of 750 injured drivers from vehicle crashes, visiting the two emergency rooms of teaching hospitals in Hualien. The objectives of this study were to investigate the incidence of alcohol used in vehicle crashes, to identify the prevalence groups for prevention and to discuss alcohol testing at emergency services. Sixty-four percent were male; 27.5% were aborigines. The mean age was 36.5 +/- 16.5 years. About 54.1% tested positive for blood alcohol concentration (BAC), which ranged from 13 to 611 mg/dL; 38.6% had BAC levels exceeding 50 mg/dL and 21.1% exceeding 200 mg/dL. The mean BAC was 85.9 mg/dL (+/- 118.5). Middle-aged males and aborigines were more likely to drive under the influence of alcohol. We recommend blood alcohol testing to be mandatory at the emergency service and to be used as evidence for prosecution in a court of law. Preventing drunk driving through community programs is imperative, especially in the aboriginal communities.

Adolescent↗
PubMed1999

[Adequacy of continuous ambulatory peritoneal dialysis in children].

When the use of dialytical therapy is decided after a careful assessment of clinical and laboratory variables, the close supervision of the procedure, that allows a feedback between our indications and its clinical efficacy, is essential. The correct and routine use of validated adequacy tools such as Kt/V and the Peritoneal Equilibration Test (PET) is mandatory. We compare the adequacy figures for adult and pediatric populations, mentioning the Kt/V and PET values obtained in eight patients followed during 12 months in a Nephrology Unit. An initial Kt/V of 2.04 and of 2.14 after 12 months of procedure are values that adjust to the general recommendations discussed in this paper. According to PET results, this group of patients were classified as low average for ultrafiltration and high average for creatinine clearance. Based on the local experience and literature review, some recommendations are made for the management of peritoneal dialysis in children.

Adult↗
PubMed2000

Serum antibodies in celiac disease.

Celiac disease is characterized by small intestinal damage which often leads to global malabsorption. For diagnosis an intestinal biopsy to demonstrate the mucosal changes is mandatory. However, serological tests are useful additional tools to confirm the diagnosis and to monitor therapy. These serological tests, which are based on the detection of antibodies against gliadin and autoantibodies against components of the extracellular matrix, are described in this article.

Autoantibodies↗
PubMed2002

Assessment of faecal occult blood loss by qualitative and quantitative methods.

BACKGROUND: Various methods exist for the assessment of faecal occult blood loss in a patient with suspected gastrointestinal blood loss. METHODS: The present study examined the effectiveness and financial implications of a qualitative guaiac-based method (Haemoccult) of faecal occult blood detection and a quantitative measure of haeme-derived porphyrins (Hemoquant) in 184 patients who underwent assessment of faecal blood loss by both methods over a three year period during assessment of iron deficiency anaemia. MAIN FINDINGS: At least one Haemoccult test was positive in 72.2% of patients while Hemoquant was suggestive of significant blood loss (> 2mg haemoglobin/g faeces) in 29.9%. Patients underwent a total of 324 further endoscopic or radiological investigations of which 76.5% demonstrated no abnormality. A diagnosis was reached in 60 patients (32.6%). A significant potential source of gastrointestinal bleeding was found in 48 patients (26.1%). Hemoquant achieved a sensitivity of 62.5% and a specificity of 81.6% while with Haemoccult it was 85.4% and 32.4%, respectively. Hemoquant was normal in 18 patients with significant gastrointestinal conditions including peptic ulcers and colonic polyps. While Haemoccult only missed 7 lesions, two of these were colonic cancers. The quantitative nature of the Hemoquant test gave little clue as to diagnosis. CONCLUSION: Neither of the tests examined was ideal but Hemoquant had an overall better performance and further investigation of patients with evidence of blood loss from this test should be mandatory.

Adolescent↗
PubMed1992

Sexual assault: review of a national model protocol for forensic and medical evaluation. New Hampshire Sexual Assault Medical Examination Protocol Project Committee.

A national hospital/community model protocol was developed for the forensic and medical examination of victims of sexual assault. This review is designed to assist states in the development of sexual assault protocols. Controversial issues were addressed, including the collection of hair evidence, the importance of semen, mandatory reporting, pregnancy testing and prophylaxis, and sexually transmitted diseases including human immunodeficiency virus. The current role of DNA profiling is reviewed. These issues at the interface of medicine, forensic science, victim advocacy, and the law are analyzed. Representatives of the medical, legal, law enforcement, victim advocacy, and forensic science communities contributed to the development of the protocols at the national and state levels. The importance of a collaborative effort is emphasized. The broad protocol goals are to minimize the physical and psychological trauma to the victim while maximizing the probability of collecting and preserving physical evidence for potential use in the legal system.

Clinical Protocols↗
PubMed2003

[Wrist pain of uncertain genesis].

The leading symptom wrist pain may be caused by a number of different pathologies. These cover traumatic and non-traumatic changes to the bone (including primary arthrosis, chronic polyarthritis, aseptic bone necroses, e.g. Kienböck's disease). Other possible sources of pain may be the capsule/ligament structures of the wrist, the predominant condition in terms of incidence and severity being injuries to the scapholunar ligament. In young women in particular, differential diagnostic considerations should include instability of the wrist. The diagnostic work-up comprises history-taking, physical examination including function tests and a mandatory x-ray. An MR tomogram and interventional procedures (e.g. arthroscopy) where indicated, can provide additional information. At the center of the management plan is amelioration of pain and restoration of function. For this purpose, a range of curative or palliative, conservative or operative measures are available. Early referral to the hand surgeon may avoid secondary sequelae resulting from long-lasting complaints.

Adult↗
PubMed1950

Antabus in the treatment of alcoholism in a private general hospital.

In 35 consecutive cases in which patients were admitted to a private hospital for alcoholism, antabus was contraindicated for eight patients and administered to 27. Sixteen patients, followed three to nine months, cooperated fully with treatment and did not return to use of alcohol. In four cases there was at least one episode of drinking, but the patients continued to cooperate with treatment and attained partial success. In seven cases, including three in which antabus was stopped because of organic disease, treatment was unsuccessful. Insufficient insight and lack of family cooperation accounted for four failures. The presence of cardiovascular or hepatic diseases contraindicates antabus. As the test of reaction to alcohol after antabus has been given is hazardous, continuous supervision by nurse and physician throughout the test reaction is mandatory. Sustained results depend upon psychotherapy, family cooperation, careful follow-up, and control of side-reactions to the drug. Antabus as an antagonist to alcohol is not safe enough to permit general use of the drug.

Alcohol Deterrents↗
PubMed1991

HIV-related practices and ethics--survey of opinions in a paediatric department.

Seventy-five doctors working in an academic paediatric department each completed an anonymous self-administered questionnaire. Questions were posed relating to the need for consent before human immunodeficiency virus (HIV) testing and the informing of sexual partners of HIV-infected mothers. Only 9% of the doctors thought that the sexual partner of an HIV-infected mother should never be informed if the mother refused to do so. Sixty-one per cent of the doctors thought that pre-test consent was never necessary when screening hospital admissions. This opinion conflicts with the view of the South African Medical and Dental Council that pre-test consent is mandatory.

AIDS Serodiagnosis↗
PubMed1988

Serological screening of cord blood for syphilis.

Meticulous antenatal screening for maternal syphilis can prevent congenital syphilis. In the event of inadequate antenatal screening, determination of reagin reactivity on cord blood becomes mandatory. A card test utilising the VDR carbon antigen (Wellcome) was used to screen cord blood samples for reagin reactivity. The same blood was also screened by a reference laboratory, where the VDRL card test was repeated and every result was substantiated by treponemal tests. The VDRL card test done at the local laboratory had a sensitivity of 83,3% and a specificity of 99,8% when compared with the results of the reference laboratory.

Evaluation Studies as Topic↗
PubMed1980

Uneventful recovery in a case of severe malignant hyperthermia.

Early clinical recognition, confirmed by blood gases analysis has permitted successfull management of a case of severe malignant hyperthermia. The authors stress the crucial importance for the theatres area to be fitted up with a huge crushed ice making device and with a large supply of cold saline solution. Due to the lack of easy and reliable preoperative screening test it is mandatory to put high risk patients on Dantrolene therapy when elective surgery is planned.

Child↗
PubMed1994

Equine hyperkalemic periodic paralysis: review and implications.

The purpose of this review is to present an up-to-date summary of the signs, diagnosis, treatment, and implications of equine hyperkalemic periodic paralysis. The review encompasses all original articles published between 1986 and early 1993. Hyperkalemic periodic paralysis is the result of a genetic mutation in the skeletal muscle sodium channel gene. It is inherited as an autosomal dominant trait; most affected horses are heterozygotes. The classical signs are muscle fasciculation, spasm, and weakness associated with hyperkalemia. However, these signs are only rarely observed in affected horses. Potential sequelae to attacks are abrasions and involuntary recumbency; these problems are not specific for hyperkalemic periodic paralysis, but they occur more frequently in hyperkalemic periodic paralysis-affected horses. It is also likely that hyperkalemic periodic paralysis results in greater muscle mass. There are suggestions that homozygotes may be more severely affected and show signs of upper respiratory obstruction as foals. The practitioner needs to be aware of the tests for hyperkalemic periodic paralysis, and their limitations, so that he can properly diagnose this condition. The industry has the difficult problem of deciding whether or not testing should be mandatory and the fate of positive horses.

Animals↗
PubMed1993

[Skier's thumb--osseous injury and rupture of the ulnar collateral ligament].

Injuries to the ulnar collateral ligament of the thumb are common in down hill-skiing, and are thus called "skier's thumb". In complete disruption of the ligament, surgical treatment is mandatory to restore stability. The management gets more difficult if a bony lesion is present: does a non-displaced fragment represent a non-displaced bony avulsion of the ulnar collateral ligament, thus allowing conservative treatment? We reviewed sixty-three consecutive patients with an acute skier's thumb injury in order to determine the anatomical nature of injuries in thumbs that were treated surgically either for fracture or for instability. Of all 63 thumbs, twenty-five (40%) had a fracture. Surgical exploration showed two types of fractures: a fragment attached to the ulnar collateral ligament, and a fragment not attached to the ulnar collateral ligament. The first type, corresponding to a true avulsion fracture of the ulnar collateral ligament, was found in eight cases. The same fracture type was seen in other seven cases with an additional isolated fragment not attached to the ligament. Such an isolated fragment was observed in ten other cases where the ulnar collateral ligament was completely disrupted. This type of bone fragmentation cannot be differentiated from a bony avulsion of the ulnar collateral ligament on routine films. Therefore, it is mandatory to stress test the injured thumb even when a bony avulsion fracture with no or minimal displacement is suspected on X-ray. The fracture may not represent a bony avulsion, but a fragmentation of the ulnar volar aspect of the proximal phalanx associated with a complete disruption of the ulnar collateral ligament.

Adolescent↗
PubMed1994

Evaluation of aging pilots: evidence, policy, and future directions.

Current Federal Aviation Administration (FAA) regulations require that pilots of large commercial passenger and cargo aircraft be under age 60. However, the requirement does not apply to other pilots and the courts have ruled that mandatory retirement of test pilots at age 60 violates the Age Discrimination in Employment Act. FAA medical standards establish three levels of medical qualification, which require certain age-specific screening tests. This paper reviews the epidemiologic and clinical evidence relevant to the evaluation of aging pilots. This evidence is compared and contrasted with the current FAA requirements and past recommendations of the American Medical Association, the Institute of Medicine, and the Office of Technology Assessment. An opportunity exists to assess the class I examination and other tests through the consent decree covering aging test pilots. Another course of action would be to implement special issuances for older pilots.

Accidents, Aviation↗
PubMed1993

AIDS and social work: the ethics and civil liberties agenda.

Social workers are becoming increasingly involved in casework and social policy debate related to the acquired immune deficiency syndrome (AIDS) crisis. To enhance their delivery of services and contribution to policy formulation, social workers need to be familiar with a wide range of ethical and civil liberties issues that have been generated by the AIDS epidemic. This article provides an overview of six major ethical and civil liberties issues pertaining to social work practice related to AIDS: (1) mandatory screening and testing of clients for the human immunodeficiency virus (HIV), (2) client access to health insurance, (3) professionals' duty to treat HIV-infected clients, (4) privacy and confidentiality, (5) client involvement in AIDS research, and (6) relevant legal issues. Implications for social work practice are highlighted, particularly with respect to protecting clients' rights and formulating a social action agenda.

AIDS Serodiagnosis↗