Tuberculous abscess of the pancreas. Case report and review of the literature.
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Abscess↗
Biomedical subjects
R Levine
Publications and source records attributed to R Levine.
Periventricular white matter changes and oropharyngeal swallowing in normal individuals.
Cranial magnetic resonance imaging (MRI) has revealed patchy periventricular white matter lesions or "unidentified bright objects" (UBOs) in otherwise neurologically intact individuals. Quantitative videofluoroscopic swallowing evaluations and cranial MRI examinations were studied in 49 neurologically normal volunteers (ages 43 to 79 years). Total swallowing duration (TSD) and its subcomponents of oral transit duration (OTD), stage transition duration (STD), and pharyngeal response duration were measured for liquid and semisolid swallows. MRIs were graded from 0, or no UBOs, to 3, or multiple and confluent lesions. The effect of the presence of UBOs on swallowing durational measures and risk factors was analyzed with age differences accounted for statistically (ANCOVA). TSD and OTD for semisolids were significantly differentiated by MRI score (P less than 0.009 and P less than 0.047, respectively). That is, a demonstrable effect was found for an increased number of UBOs on duration of oropharyngeal swallowing in normal individuals.
Adult↗
Acalculous abdominal pain in patients with abnormal cholescintigraphy: is cholecystectomy the answer?
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Abdominal Pain↗
Prevention and early detection of colorectal cancer.
Adherence to a low-fat, high-fiber diet and regular screening to detect and identify polyps at an early, more treatable stage may reduce deaths from colorectal cancer. Patients should be told that they can reduce their risk of colorectal cancer by increasing their intake of fruits, vegetables and whole grain cereals and decreasing their intake of fat. Although scientific controversy exists regarding the specific methods and intervals of screening for colorectal cancer, family physicians should adopt a regular approach to screening in their patients. In adults 50 years of age or older, annual fecal occult blood testing is recommended. If positive results are obtained, follow-up examination should be performed with either colonoscopy or flexible sigmoidoscopy plus air-contrast barium enema. Persons between 50 and 75 years of age may also benefit from screening with flexible fiberoptic sigmoidoscopic examination every three to five years.
Aged↗
Stimulation of the periaqueductal gray matter of the rat produces a preferential ipsilateral antinociception.
The few studies analyzing somatotopic organization of stimulation-produced antinociception (SPA) from the periaqueductal gray matter (PAG) have reported contradictory results. In the present study, the distribution of SPA on the hindquarters was assessed by measuring the threshold for inhibition of withdrawal reflexes to noxious heat applied to the hindpaws and tail in pentobarbital-anesthetized rats. Of the 3 body regions tested, the hindpaw contralateral to the stimulating electrode required the highest level of PAG stimulation to inhibit withdrawal. Reducing the intensity of the heat stimulus applied to the hindpaws caused a concomitant reduction in SPA threshold. As before, a higher stimulation current was needed to inhibit the withdrawal reflex in the contralateral than in the ipsilateral paw. These data indicate the antinociception from PAG stimulation is not equally distributed throughout the body, and that the intensity of the noxious stimulus influences the threshold for SPA.
Animals↗
Little help from article on anabolic steroids.
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Adolescent↗
Emergency cardiopulmonary bypass for resuscitation from prolonged cardiac arrest.
After cardiac arrest (no flow) of more than approximately 5 minutes' duration, standard external cardiopulmonary resuscitation (CPR) basic, advanced, and prolonged life support (BLS, ALS, PLS) do not reliably produce cerebral and coronary perfusion pressures to maintain viability and achieve stable spontaneous normotension; nor do they provide prolonged control over pressure, flow, composition, and temperature of blood. Since these capabilities are often needed to achieve conscious survival, emergency closed-chest cardiopulmonary bypass (CPB) by veno-arterial pumping via oxygenator is presented in this review as a potential addition to ALS-PLS for selected cases. In six dog studies by the Pittsburgh group (n = 221; 1982 through 1988), all 179 dogs that received CPB after prolonged cardiac arrest (no flow) or after CPR (low flow) states had restoration of stable spontaneous circulation. The use of CPB enhanced survival and neurological recovery over those achieved with CPR-ALS attempts only. With CPB and standard intensive care, it was possible to reverse normothermic ventricular fibrillation (VF) cardiac arrest (no flow) of up to 15 minutes and to achieve survival without neurologic deficit; VF of 20 minutes to achieve survival but with neurologic deficit; and VF of 30 minutes to achieve transient restoration of spontaneous circulation followed by secondary cardiac death. CPB could restore stable spontaneous circulation after ice water submersion of up to 90 minutes. Other groups' laboratory and clinical results agree with these findings in general. Clinical feasibility trials are needed to work out logistic problems and to meet clinical challenges. Future possibilities for emergency CPB require further research and development.
Animals↗
Barrier and spermicidal contraceptive methods and risk of invasive cervical cancer.
The effects of barrier and spermicidal methods of contraception on cervical cancer risk were examined by studying 479 cases of histologically confirmed invasive cervical cancer cases and 788 random digit dialing controls. In addition to a detailed history of contraceptive practices, information was available on numerous potential confounders, including demographic characteristics, sexual behavior, reproductive factors, Pap smear screening history, and smoking. After adjustment for relevant confounders, diaphragm and condom use were found not to be significantly associated with risk of cervical cancer. Although there was a small reduction in risk (OR = 0.8) associated with long-term use (5+ years) of the diaphragm, the effect appeared to relate to concomitant spermicide use, since there was evidence of further decreases in risk for women using spermicides alone for extended periods (OR = 0.7 for 5+ years). Effects were only seen among subjects of higher income and education levels, suggesting that patterns of usage may be important. The potential ability of spermicides to reduce cervical cancer risk by neutralizing viral agents warrants further attention.
Adult↗
Leiomyoma of spermatic cord with unusual features.
We describe a case of a patient with osseous metaplasia and chronic inflammatory changes in a leiomyoma of the spermatic cord, as well as a lipoma of the cord with similar changes. The differential diagnosis and possible etiology of these findings are presented.
Aged↗
Long-term follow-up of idiopathic central serous chorioretinopathy by fluorescein angiography.
Idiopathic central serous chorioretinopathy (ICSC) is typically described as a self-limited, unilateral disease that affects healthy, young adult males. The authors studied 13 patients (14 eyes) who had documented spontaneous resolution of symptomatic macular detachments. These patients were evaluated in a longitudinal fashion to determine the fate of the retinal pigment epithelium (RPE) as viewed angiographically, both in the initially affected eyes and the fellow eyes. At the time of follow-up examination of the initially affected eyes, nonleaking RPE defects had developed inside the areas of previous serous detachment in all cases. Nonleaking RPE defects had developed outside these areas in six (43%) eyes. Two (14%) eyes had new, asymptomatic macular detachments. Six (42%) fellow eyes had new RPE window defects; two (17%) of them also had active RPE dye leakage resulting in asymptomatic macular detachment at the final examination. Four (29%) originally involved eyes and one (8%) fellow eye lost more than two lines of Snellen visual acuity during the follow-up period. The authors' results suggest that ICSC may be a progressive bilateral disease that develops asymmetrically and causes diffuse RPE changes not localized to the area of serous detachment. Long-term follow-up of these patients may, therefore, be advisable.
Adult↗
Nonoperative treatment of trigger fingers and thumbs.
This article reports our experience with the management of 93 consecutive patients with 108 trigger digits initially treated by triamcinolone acetonide injections into the flexor tendon sheath. It appears that two distinct clinical types of trigger digits exist--nodular and diffuse. Ninety-three percent (63/68) success was obtained in the nodular type compared with 48% (10/33) in the diffuse type (p less than 0.05). We conclude that the patients with the nodular type should be offered a simple cortisone injection. Those patients seen initially with the diffuse type should probably be offered surgical decompression.
Adult↗
Role of the pituitary-adrenal hormones in the acquisition of schedule-induced polydipsia.
Adrenalectomized female rats failed to develop schedule-induced polydipsia (SIP). Dexamethasone (DEX) injections failed to reinstate SIP in adrenalectomized rats. They did not prevent intact rats from acquiring SIP but interfered with subsequent expression of this behavior. In contrast, corticosterone, the rats' normally occurring glucocorticoid, fully restored the acquisition and subsequent expression of SIP in adrenalectomized rats. This strongly suggests that corticosterone plays an essential role in the normal acquisition and development of this behavior. Data are interpreted in the context of current information concerning adrenal hormone receptors. It is hypothesized SIP acquisition is at least partly regulated by the Type I (mineralocorticoid) receptor.
Adrenalectomy↗
Hepatitis A outbreak on a floating restaurant in Florida, 1986.
In April and May 1986, the largest reported foodborne outbreak of hepatitis A in Florida state history occurred among patrons and employees of a floating restaurant. A total of 103 cases (97 patrons and six employees) were identified. The exposure period lasted 31 days (March 20-April 19), making this the most prolonged hepatitis A outbreak to occur in a restaurant that to date has been reported to the Centers for Disease Control. The exposure period was divided into time intervals (peak, early, late, and total) for calculation of food-specific attack rates. The authors showed that green salad was an important vehicle of transmission for each phase of the exposure period, with the highest adjusted odds ratio for the three-day peak exposure interval (March 28-30), 6.8 (p = 0.001). Non-salad pantry items and mixed bar drinks were also identified as vehicles of transmission; both were more important during the early interval of the exposure period than during the late interval. Two of six infected employees worked in the pantry and may have sequentially infected patrons. Though rare, this outbreak suggests that hepatitis A infection among employees may allow for transmission to patrons for prolonged periods of time. Prevention of such outbreaks requires prompt reporting of ill patrons with rapid identification of infected employees and correction of food handling practices.
Adolescent↗
Long-term fluoxetine treatment of a large number of obsessive-compulsive patients.
A group of 75 outpatients suffering from obsessive-compulsive disorder began treatment with the bicyclic antidepressant fluoxetine in an open clinical setting. Their progress was evaluated using the Hamilton Depression Scale, the Hamilton Anxiety Scale, and a global scale of severity of obsessive-compulsive symptoms. The group showed significant improvement on all measures. This improvement continued and was progressive over a 5-month period. Weight loss was present but not significant by the end of the 5-month period.
Adult↗
A modification of the modified barium swallow.
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Adult↗
Prenatal sonographic assessment of the fetal thorax: normal values.
Fetal thoracic circumference and thoracic length measurements were obtained by ultrasonographic examination on 576 women between 16 and 40 weeks gestation. Nomograms for thoracic circumference and thoracic length with respect to gestational age were developed. Growth of both thoracic parameters was observed to be linear throughout gestation. In normal pregnancy the ratios of thoracic circumference to abdominal circumference and thoracic length to humerus length remained virtually constant at 0.89 and 0.93, respectively.
Adolescent↗
Cardiopulmonary bypass after cardiac arrest and prolonged closed-chest CPR in dogs.
We studied a clinically realistic field-to-hospital scenario in dogs with four-minute ventricular fibrillation (VF) cardiac arrest followed by 30-minute standard external CPR basic life support (BLS). At the end of this 34-minute insult, cardiopulmonary bypass (CPB) was used for early defibrillation and assisted circulation for one hour (n = 10). Recovery was compared with that of control dogs (n = 10) in which standard CPR with advanced life support (ALS) for another 30 minutes was used for restoration of spontaneous circulation (ROSC). Both groups had hemodilution and heparinization; controlled blood pressure, blood gases, ventilation, and other parameters for 20 hours; and intensive care to 72 hours. During CPR-BLS of 30 minutes in both groups signs of cerebral viability returned. CPB achieved ROSC more successfully (ten of ten vs five of ten CPR-ALS controls) (P less than .02); and more rapidly, with less defibrillation energy (first countershock in eight of ten) and with less epinephrine (P less than .01). CPB improved 72-hour survival (seven of ten vs three of ten controls) (P less than .05). Between two and 24 hours, of those with ROSC, cardiac complications killed three of ten CPB dogs (after weaning), and two of five CPR-ALS dogs (NS). All seven CPB survivors to 72 hours were neurologically normal; of the three CPR-ALS survivors, one remained with severe neurologic deficit and two were neurologically normal (seven of ten CPB vs two of ten controls, P = .025). Starting CPR-BLS within four minutes of arrest can maintain cerebral viability.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗