The treatment of gas gangrene has been revolutionized by oxygen drenching of tissues infected with Clostridia. This was used in a massive infection of the abdominal wall following a traumatic abortion attempt. The clostridial infection was controlled, but the patient almost succumbed to a secondary infection of gram-negative organisms. This responded to drainage, antibiotics and general supportive measures. In the course of treatment, the value of a team approach to complicated special problems was documented.

Abortion, Septic↗

PubMedDate not supplied

The combined insulin and sulfonylurea therapy in diabetes of elderly people.

The usefulness and safety of the combined insulin-sulfonylurea (gliclazide) therapy were investigated in 70 elderly diabetic patients poorly controlled by insulin alone. More than half (45 diabetics, 64% of total) ameliorated significantly their metabolic control after six months of the combined treatment: not only the glycemic profile and glycated hemoglobin Alc were significantly decreased, but the daily insulin dose was reduced by approx. 35% (p < 0.01). These positive results in terms of improved glycemic control as well as reduction of daily insulin needs were still present after a mean period of follow-up of 5 years. The good percentage of positive results, the small incidence of hypoglycemic episodes and the consistent reduction of peripheral hyperinsulinism make this intervention (insulin-gliclazide) a safe strategy that can be adopted in a population of elderly diabetics, poorly controlled on insulin alone.

Journal Article↗

PubMedDate not supplied

Inpatient or outpatient initiation of antiarrhythmic medications: why the controversy?

The decision of whether to initiate antiarrhythmic medications in or out of the hospital for patients with atrial fibrillation remains an issue of significant controversy. The current review analyzes the available data pertaining to the safety of antiarrhythmic agent initiation in patients with atrial fibrillation and provides a practice guideline.

Ambulatory Care↗

PubMedDate not supplied

[Course of recurrence of focal and segmental glomerulosclerosis after renal transplantation].

Explore the source record for details and available documents.

Adolescent↗

PubMedDate not supplied

[Malignant pulmonary neoplasms: diagnostic possibilities of magnetic resonance angiography].

The authors investigated the potentials of Magnetic Resonance Angiography (MRA) in the preoperative staging of malignant central lung neoplasms. Fifteen patients with malignant central lung neoplasms were submitted to MRA 48 hours before surgery, which was the gold standard. The patients were 7 women and 8 men; their mean age was 54.3 years (range: 39-65 years). MRA was performed with the 2D and 3D time-of-flight (TOF) technique. FLASH 2D sequences (FA 18 degrees, TR 40 ms, TE 10 ms, SL 4 mm) and FISP 3D sequences (FA 20 degrees, TR 30 ms, TE 3 ms, SL 1 mm) were used. The images were processed with the maximum intensity projection (MIP) and rotated on different planes with a 15 degrees step. A multiple choice card, implying preoperative reading by an MRA expert, was used; in the study of the relationship between neoplasms and contiguous vessels, only two diagnoses were possible--i.e., infiltrated, not infiltrated. This card included, in the preliminary phase, a code for each MRA pattern--i.e., the presence of a clear cleavage plane, vascular occlusion, stenosis, irregular vessel profile, turbulence and several of these patterns together. MRA was in agreement with surgery in 14/16 cases and overestimated two cases as infiltration. In our preliminary study, MRA had 100% sensitivity, 75% specificity and 87.5% diagnostic accuracy. To conclude, MRA proved to be a complementary tool to spin-echo MR sequences in the staging of malignant central lung neoplasms.

Adult↗