Biomedical subjects

C Eng

Publications and source records attributed to C Eng.

274 records · Page 16Linked to original sources

PubMedDate not supplied

Integrating acute and long-term care for high-cost populations.

The inadequacies of our fragmented acute and long-term care financing and delivery systems have been well recognized for many years. Yet over the past two decades only a very small number of "boutique" initiatives have been able to improve the financing and the delivery of care to chronically ill and disabled populations. These initiatives share most of the following characteristics: prepaid, risk-adjusted financing; integrated Medicare and Medicaid funding streams; a flexible array of acute and long-term benefits; well-organized, redesigned care delivery systems that tailor these benefits to individual need; a mission-driven philosophy; and considerable creativity in engaging government payers. The experience of these "boutiques" illustrates both the obstacles to, and the opportunity for, meaningful, widespread care delivery reform for vulnerable chronically ill populations.

Acute Disease↗

PubMedDate not supplied

Medical management of orbital subperiosteal abscess in children.

The traditional treatment of subperiosteal orbital abscess consists of surgical drainage and antibiotic therapy. We successfully treated with antibiotics alone nine children (age range 26 months to 12 years) with clinical signs and symptoms of orbital cellulitis and computerized tomographic (CT) evidence of subperiosteal abscess and contiguous ethmoid sinusitis. Two additional patients successfully treated with nonsurgical therapy were identified retrospectively. All patients were admitted to the pediatric service with normal vision. Their visual function was assessed twice daily during the early stages of their illness. All patients improved with intravenous antibiotic therapy. One additional patient required surgical drainage for persistent pain after 1 week of slow but steady clinical improvement. All other patients were clinically cured with medical therapy alone. Five of the medical "cures" had posttreatment CT, which documented the resolution. No patient had a recurrence. We conclude that orbital subperiosteal abscess, like some other abscesses located elsewhere, may be amenable to non-surgical treatment, or that these patients may have had a phlegmon rather than an abscess and the currently accepted CT criteria for diagnosis of a subperiosteal abscess may require modification. We recommend that children with a subperiosteal abscess from contiguous ethmoidal sinusitis who have no evidence of compromised optic nerve function be given a trial of intravenous antibiotic therapy prior to consideration of surgical drainage.

Abscess↗

PubMedDate not supplied

Familial Barrett esophagus and adenocarcinoma of the gastroesophageal junction.

Barrett esophagus was found in seven members of a single family. Two of these patients also had adenocarcinoma of the gastroesophageal junction. Among family members who did not have Barrett epithelium, one had esophageal ulcerations with dysplasia in squamous epithelium and another had an esophageal stricture. The pattern of involvement suggests autosomal dominant inheritance of Barrett esophagus and/or gastroesophageal reflux disease in this family, with a strong predisposition for adenocarcinoma of the esophagus.

Adenocarcinoma↗

PubMedDate not supplied

Endothelin-3 gene mutations in isolated and syndromic Hirschsprung disease.

Hirschsprung disease (HSCR, aganglionic megacolon) is a frequent congenital malformation regarded as a multigenic neurocristopathy. Four susceptibility genes have recently been identified in HSCR, namely the RET proto-oncogene, the glial cell line-derived neurotrophic factor (GDNF), the endothelin B receptor (EDNRB) and the endothelin-3 genes (EDN3). Homozygosity for EDN3 mutations has been previously shown to cause the Shah-Waardenburg syndrome, a combination of HSCR with features of the Waardenburg syndrome. Here, we report on heterozygous EDN3 missense mutations in isolatec HSCR. The present data give further support to the role of the endothelin signaling pathway in the development of neural crest-derived enteric neurons. They also suggest the possibility that either recessive or weakly penetrant dominant alleles could occur at the EDN3 locus, depending on the nature of the mutation.

Endothelin-3↗