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At least 1,153 records · Page 64Linked to original sources
PubMed1982

Clinical significance of the interaction between lithium and a neuromuscular blocker.

Reports of delayed recovery from anesthesia by patients concurrently receiving lithium carbonate and a neuromuscular blocker have been followed by a recommendation to avoid such a combination and, hence, concurrent treatment with lithium and electroconvulsive therapy (ECT). The authors review the literature and their clinical experience with such a drug combination at one psychiatric hospital. They conclude that the clinical and experimental findings to date are insufficient to warrant proscribing the combination of lithium and ECT on the basis of possible potentiation of neuromuscular blockade by lithium.

Adult↗
PubMed2005

Biliary brush cytology and the detection of cholangiocarcinoma in primary sclerosing cholangitis: evaluation of specific cytomorphologic features and CA19-9 levels.

Interpreting biliary brush cytology (BBC) findings in primary sclerosing cholangitis (PSC) is problematic. In our study, BBC findings and CA19-9 serum levels were evaluated for their effectiveness in diagnosing cholangiocarcinoma in patients with PSC. We reviewed 107 biliary brushings from 51 patients with PSC and concurrent CA19-9 levels between January 1995 and March 2004 at the University of Washington Medical Center, Seattle. A portion of the brushings were evaluated and scored according to specific cytologic criteria; statistical analysis showed which criteria were most predictive in diagnosing malignancy: nuclear/cytoplasmic ratio, prominent nucleoli, nuclear membrane irregularities, and discohesion were significant predictive features. Sensitivity and specificity of BBC were 62.5% and 100%, respectively. Sensitivity and specificity of CA19-9 at a cutoff of 186 IU/mL were 100% and 94%, respectively. BBC is a specific and relatively sensitive method of detecting cholangiocarcinoma, even in patients with PSC, especially when certain cytomorphologic features are identified. Combining biliary cytology and CA19-9 levels might have an important diagnostic role in PSC.

Bile Duct Neoplasms↗
PubMed1986

Localization of 99mTc-HMDP in hepatic metastases from colonic carcinoma.

To evaluate the significance and frequency of skeletal imaging agent localization in hepatic metastases from colonic carcinoma, scintigrams from 54 patients were retrospectively studied. Of 54 patients, 22 had hepatic metastases, and skeletal metastases were present in seven of 54. Six of the seven patients with skeletal metastases had concurrent hepatic deposits. Two patterns of bone agent localization in liver metastases occurred: diffuse and mild (10 patients) and ringlike in appearance (two patients). Twelve of the 22 patients had localization of skeletal imaging agent in hepatic metastases and extensive or large liver lesions. Concurrent serum calcium values for nine of 12 patients were reviewed; none had a high level of serum calcium. Among available plain films and /or CT scans of the abdomen for 21 of the 22 patients, only one patient with extensive colonic metastases had multiple calcifications shown on CT but not seen in plain films. The data indicate a high frequency of hepatic metastases in colon carcinoma (22/54, 40%) and a high frequency of skeletal imaging agent localization in the hepatic colonic metastases (12/22, 54.5%). Once skeletal metastases are observed, there are almost always hepatic metastases present (6/7). There was no relation between elevated serum calcium values and bone agent localization in hepatic deposits. The relation between skeletal imaging agent localization or radiographic calcifications and histopathology of colonic carcinoma was inconclusive. The presence of bone agent localization in a 99mTc hydroxymethylene diphosphonate (HMDP) bone study indicates colonic hepatic metastases that are substantially widespread and/or bulky.

Aged↗
PubMed2004

Two dermoid cysts developing in an accessory ovary and an eutopic ovary.

Accessory ovary is a rare gynecologic condition, and tumors arising in accessory ovaries are extremely rare. Accessory ovary may result from separation of migrating ovaries during embryogenesis and injuries such as inflammation and operation on normal ovary. Congenital malformations, most frequently malformations of the genitourinary organ, are seen in connection with the accessory ovary. We experienced the first case of two dermoid cysts developing in an accessory ovary located in the left infundibulopelvic ligament and another in the eutopic ovary at the same side concurrently. Here, we present this extremely rare case with a review of the literature.

Adult↗
PubMed1987

Complete posterior acromioclavicular dislocation. A case report.

While acromioclavicular joint injury is not uncommon, a complete posterior dislocation in which the distal clavicle penetrates and is entrapped by the trapezius muscle is among the most rare. Early open reduction with reconstruction of the periosteal-muscular envelope as well as repair of the coracoclavicular ligaments permitted a rapid and full recovery. No previous report has indicated any concurrent pulmonary problems, but as this case report and literature review indicate, a careful evaluation of the pulmonary status is mandatory since pneumothorax and pulmonary contusions are possible.

Acromioclavicular Joint↗
PubMed1987

Metastatic cancer in Paget's disease of bone. A case report.

A 50-year-old white male presented with concurrent Paget's disease of bone and metastatic adenocarcinoma. Our review of the literature and our clinical experience suggests that carcinoma coexisting at the site of bone involved with Paget's disease occurs more commonly than has been recognized. The paucity of reports of tumor metastatic to sites of Paget's disease of bone may be due to an artifact of data collection. The differentiation of metastatic from de novo tumors must be accomplished by biopsy, and the diagnosis is essential for appropriate treatment. Commonly a correlation of known tumor types with Paget's disease is made, and metastatic tumors are excluded.

Adenocarcinoma↗
PubMed2006

Patients, pathogens, and protective immunity: the relevance of virus-induced alloreactivity in transplantation.

Successful transplantation requires the establishment of an ongoing state in which there is simultaneous inhibition of the undesired T cell-dependent rejection response and yet retention of the ability to develop effective cell-mediated primary and memory responses to pathogens. The complexity of attaining such a precarious state is underscored by the growing body of evidence that alloreactivity can be profoundly influenced by infections that occur before, concurrent with, or subsequent to an organ transplant. In this review, we explore the growing list of mechanisms that have been identified by which pathogen-host interactions might influence rejection, including the degeneracy of TCR recognition leading to cross-reactive immune responses, the effects of pathogens on innate immune mechanisms, and the potential impact of virally induced lymphopenia.

Humans↗
PubMed1999

Haemorheological disturbances in hypertension: the influence of diabetes and smoking.

Patients suffering from diabetes or hypertension commonly exhibit increased blood viscosity compared with healthy controls. This is primarily the result of elevated plasma fibrinogen concentration. Cigarette smokers also exhibit raised blood viscosity but in their case the main cause is a raised haematocrit. In this paper the effects of concurrent hypertension, diabetes and cigarette smoking on blood viscosity is reviewed. Evidence is presented that the haemorheological disturbances associated with each of these modalities are additive when present together in a subject.

Blood Viscosity↗
PubMed2001

Issues in validation of a dermatologic surgery simulator.

At the University of Washington, we have been developing a suturing simulator using novel finite element model techniques which allow real-time haptic feedback. The issues involved in measuring validity in a suturing model have not been examined in a systematic way. Very few studies exist on the surgical factors that lead to good sutures. We have examined published data on these factors as well as previously studied metrics in suture training. This information has been combined with a review of types of validity (e.g., face, construct, predictive and concurrent) and reliability that must be considered in assessing any surgical simulator.

Computer Simulation↗
PubMed1992

The use of hetastarch for plasma expansion.

The use of colloids in hypo-oncotic individuals to increase plasma volume has been shown to have distinct and consistent advantages compared with the use of crystalloid fluids. Colloids increase plasma colloid oncotic pressure, whereas crystalloids decrease it, an effect that can be extremely detrimental in individuals with low basal plasma colloid oncotic pressure. Increasing plasma volume in hypo-oncotic individuals without inducing large increases in interstitial water content is difficult when crystalloid fluids are used. However, colloids have much better plasma volume expansion ability without the induction of concurrent increases in interstitial water content, even in hypooncotic individuals. Review of the literature indicates that hetastarch is an extremely safe colloid for acute and long-term use in humans and dogs. Its excellent safety record probably is attributable to its structural analogy to the natural compound glycogen. The lack of availability of a substance analogous to human 5% serum albumin and the scarcity of plasma in veterinary medicine leaves hetastarch as the safest option of available colloids. Its ability to increase plasma volume and colloid oncotic pressure is equal to or better than dextran 70 and 5% albumin and is clearly better than plasma or whole blood. Increases in plasma volume and colloid oncotic pressure usually last approximately 48 hours after a single injection, but the duration of increases significantly after multiple infusions. Contraindications to its use include heart failure and oliguric renal failure, because of its excellent ability to increase plasma volume, and the presence of von Willebrand's disease, because of its ability to significantly lower all components of Factor VIII-related complex in humans.

Animals↗
PubMed1990

Phlebographic findings in venous thrombosis following total hip replacement.

The specific appearance of venous thrombosis following total hip replacement was analysed by reviewing 45 positive phlebograms from 122 patients participating in a concurrent trial against thromboembolism. Almost all thrombi were asymptomatic and non-occlusive. Forty-four per cent of the thrombi were exclusively confined to the calf. The muscular veins were the most common location, followed by the fibular and posterior tibial veins. Ipsilateral thrombi predominated over thrombi in the non-operated leg. Thirty-six per cent were located in the ipsilateral thigh and the major part was found in the proximal part of the femoral veins. Nearly all were related to valve cusps, free-floating and were of small size. In 20 per cent, thrombi were found in both the calf and the thigh. Neither contralateral thigh thrombi, nor pelvic thrombi were found. Of 25 patients with pulmonary embolism, all but 3 asymptomatic, 64 per cent had thigh thrombi. A multifocal location of thrombi was present but two major types of thrombosis were distinguished; calf vein thrombosis probably due to venous stasis and femoral thrombosis caused by the local surgical trauma.

Heparin↗
PubMed1989

Parkinson's disease.

In Parkinson's disease there is degeneration of neurons in the substantia nigra, with consequent depletion of the neurotransmitter dopamine. The triad of tremor, rigidity and bradykinesia is the clinical hallmark. Drugs currently used for palliative therapy fall into three categories: anticholinergic agents, dopamine precursors (levodopa combined with extracerebral decarboxylase inhibitors) and artificial dopamine agonists. It has been argued, on theoretical grounds, that some drugs slow the progress of Parkinson's disease, although no firm evidence has supported this. Treatment must be individualized, and more than one type of drug can be given concurrently after a careful build-up in dosage. We review the adverse effects of various drugs and consider new developments such as slow-release preparations, selective D-1 and D-2 agonists and transplants of dopaminergic cells into the brain. The treatment of Parkinson's disease can be demanding, rewarding and sometimes frustrating, but it remains a most challenging exercise in pharmacotherapy.

Adrenal Glands↗
PubMed1985

Luteinized unruptured follicle syndrome in mild endometriosis. Assessment with biochemical parameters.

Failure to extrude an ovum, with subsequent luteinization of the unruptured follicle (LUF), has been proposed as a cause of infertility in women with mild endometriosis. To assess the incidence of this process we performed laparoscopies in the early luteal phase on 16 women with mild endometriosis and 8 control subjects. Peritoneal fluid was aspirated and a plasma sample obtained concurrently. Estradiol (E2) and progesterone (P) concentrations were determined. A review of the literature suggested that the following hormonal criteria correlated with follicular rupture: fluid E2 greater than or equal to 500 pg/ml, E2 fluid/plasma ratio greater than or equal to 3.1, fluid P greater than or equal to 3,000 ng/dl and P fluid/plasma ratio greater than or equal to 5:1. All control subjects met at least one E2 and one P criterion: 75% met all. In contrast, less than one-third with mild endometriosis met all, and three (19%) met none. Five met only E2 criteria. These findings suggest that LUF occurs occasionally in association with mild endometriosis. Additionally, ovarian steroidogenesis, particularly P secretion, was impaired frequently in the absence of LUF in women with endometriosis.

Ascitic Fluid↗
PubMed1985

Combined prostaglandin therapy and ductal formalin infiltration in neonatal pulmonary oligemia.

Prostaglandins and ductal formalin infiltration, singly and together, have been used in efforts to improve pulmonary flow in very ill newborn infants with right ventricular outflow tract obstruction. To evaluate the efficacy of concurrent use of prostaglandins and ductal formalin infiltration, we have reviewed our experience with 25 infants with right ventricular outflow tract obstruction and prostaglandin-ductal formalin infiltration therapy. Prostaglandin therapy was begun 22 +/- 21 hours (range 20 to 93 hours) before and was continued 20 +/- 18 hours (range 0 to 62 hours) following ductal formalin infiltration; prostaglandin administration was initiated at a dose of 0.05 to 0.1 microgram/kg/min and tapered postoperatively. Clinical cyanosis was diminished in 20 of 25 infants (80%) postoperatively. Systemic arterial pH and oxygen saturation both improved following prostaglandin-ductal formalin infiltration therapy from 7.35 to 7.41 (p less than 0.001) and from 35.7 to 50.3 (p less than 0.001), respectively. Persistent ductal patency (mean 219 +/- 191 days) was observed in 17 survivors of the early postoperative period (more than 14 days). Two of five infants who died within 14 days of operation had a widely patent ductus with resultant progressive congestive heart failure. The other three infants died as a result of operative technical problems, dysrhythmias, and thrombotic ductal closure, respectively. No correlation was observed between duration of ductus patency and operatively determined size of ductus, total prostaglandin dose, or duration of prostaglandin infusion. Secondary operative intervention was delayed by 92 +/- 74 days with prostaglandin-ductal formalin infiltration therapy; thus prostaglandin-ductal formalin infiltration therapy may have a role in selected neonates with right ventricular outflow tract obstruction.

Alprostadil↗
PubMed1994

Concurrent use of clozapine and valproate in affective and psychotic disorders.

BACKGROUND: This pharmaco-epidemiologic study was undertaken to determine if the combination of clozapine and valproate poses an increased risk of blood dyscrasias, liver function abnormalities, or other side effects and to develop dosing guidelines when the combination is utilized. METHOD: The charts of 55 patients receiving clozapine and valproate concurrently between May 8, 1989, and May 8, 1992, were reviewed to determine the indication for and length of time on each medication, abnormalities in liver function test results, blood cell dyscrasias, seizures, nausea, vomiting, sedation, sialorrhea, and enuresis. In addition, the efficacy of the combination was measured. RESULTS: The combination of clozapine and valproate was efficacious and well tolerated in the majority of patients. Major adverse effects such as blood dyscrasias or seizures were not experienced by the study population. The side effect that led to discontinuation of the combination most frequently was sedation. CONCLUSION: The combination of clozapine and valproate is safe and efficacious.

Adult↗
PubMed1999

Evaluation of risk factors for fatal acute pancreatitis in dogs.

OBJECTIVE: To identify risk factors associated with fatal acute pancreatitis in dogs. DESIGN: Case-control study. ANIMALS: 70 case dogs with clinical evidence and histopathologic confirmation of fatal acute pancreatitis and 104 control dogs that had trauma, underwent necropsy, and did not have histologic evidence of acute pancreatitis. PROCEDURE: Information on signalment, weight, body condition, medical history, concurrent disease, and results of histopathologic examination was obtained by reviewing medical records. Logistic regression analysis included calculation of univariate and multivariate (adjusted) odds ratios and 95% confidence intervals. RESULTS AND CLINICAL IMPLICATIONS: Dogs with fatal acute pancreatitis were largely middle- to older-aged dogs. Risk of developing fatal acute pancreatitis was increased by overweight body condition, diabetes mellitus, hyperadrenocorticism, hypothyroidism, prior gastrointestinal tract disease, and epilepsy. Additionally, Yorkshire Terriers were at increased risk, and Labrador Retrievers and Miniature Poodles were at decreased risk, of developing fatal acute pancreatitis. Males and neutered females appeared to have an increased risk of developing fatal acute pancreatitis, compared with sexually intact females. Thrombus formation was more likely in dogs that developed fatal acute pancreatitis than in control dogs.

Acute Disease↗
PubMed2003

Chemoradiation for adenocarcinoma of the anus.

PURPOSE: To assess the efficacy and limitations of definitive chemoradiation for adenocarcinoma of the anal canal and to propose a treatment strategy that addresses the limitations of treatment. METHODS AND MATERIALS: Between 1976 and 1998, 16 patients with localized adenocarcinoma of the anal canal were treated with radiotherapy with or without chemotherapy with curative intent. Available histologic slides were reviewed for evidence of primary adenocarcinoma of anal duct origin. The treatment results for these patients were compared with those of a group of patients with epidermoid histologic features who were all treated with definitive chemoradiation (55 Gy with concurrent 5-fluorouracil and cisplatin, n = 92) between 1989 and 1998. The hospital records were reviewed for all patients. Patients with epidermoid carcinoma presented with more advanced primary tumors (42% vs. 19% Stage T3 or greater). All adenocarcinoma patients were treated with radiotherapy (median dose 55 Gy): 11 received concurrent 5-fluorouracil-based chemotherapy and 5 received radiotherapy alone. The initial surgical procedures included abdominoperineal resection, excisional biopsies (n = 5), and local excision (n = 1). Abdominoperineal resection was performed as salvage therapy after local recurrence in 5 patients. The Kaplan-Meier method was used to calculate 5-year actuarial pelvic control, distant disease control, disease-free survival, and overall survival. The median follow-up was 45 months (range 5-196) for patients with adenocarcinoma and 44 months (range 9-115) for patients with epidermoid histologic features. RESULTS: Both local and distant recurrence rates were significantly greater in the adenocarcinoma patients. Of 16 patients with adenocarcinoma, 7 (5-year actuarial rate 54%) had recurrence at the primary site compared with 16 (5-year actuarial rate 18%) of 92 patients with epidermoid histologic features (p = 0.004). Distant disease developed in more patients with adenocarcinoma (5-year actuarial rate 66%) than in patients with epidermoid carcinoma (5-year actuarial rate 10%, p <0.001). The 5-year actuarial disease-free survival and overall survival rate for adenocarcinoma patients was 19% and 64%, respectively, compared with 77% (p <0.0001) and 85% (p = 0.017) for those with epidermoid carcinoma. CONCLUSION: Patients with localized adenocarcinoma of the anus treated with definitive chemoradiation had high rates of pelvic failure and distant metastasis compared with comparably staged patients with epidermoid histologic features treated similarly. On the basis of these limitations, we recommend preoperative chemoradiation followed by abdominoperineal resection to maximize pelvic disease control and consideration of adjuvant chemotherapy to address the problem of micrometastatic disease.

Adenocarcinoma↗
PubMed1998

Does teaching medical students in the office affect the way physicians complete patient-encounter forms?

PURPOSE: To determine whether teaching medical students has concurrent economic effects on physicians and their practices. METHOD: The authors reviewed 869 patient-encounter forms completed in April 1994 and July 1995 by four family medicine physicians who were clinical faculty at the State University of New York Health Science Center at Syracuse. The authors compared those forms that were completed when a third-year medical student was present for the patient encounter with those completed when a student was not present. The authors looked for differences in the distributions of billing codes and in the frequencies of in-office procedures performed and diagnostic tests ordered. RESULTS: The presence or absence of a third-year medical student had no significant effect on the variables studied. CONCLUSION: In the clinical settings studied, concurrent medical student teaching did not appear to affect the distribution of billing codes or the frequency of in-office procedures performed or diagnostic tests ordered.

Accounting↗