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Biomedical subjects

W Kapoor

Publications and source records attributed to W Kapoor.

12 recordsLinked to original sources
PubMed1991

Syncope and orthostatic hypotension.

PURPOSE: The purpose of this study was to determine the postural blood pressure response over time, the prevalence of orthostatic hypotension in patients with syncope, and the relationship of orthostatic hypotension to recurrence of symptoms. PATIENTS AND METHODS: We prospectively evaluated 223 patients with syncope in a standardized manner. Orthostatic responses were measured in a standardized fashion at 0, 1, 2, 3, 5, and 10 minutes or until symptoms occurred. Follow-up was obtained at 3-month intervals. Causes of syncope were assigned by predetermined criteria. RESULTS: Orthostatic hypotension (20 mm Hg or greater systolic blood pressure decline) was found in 69 patients (31%). The median time to reach minimal standing systolic blood pressure was 1 minute for all subjects. In patients with orthostatic hypotension (20 mm Hg or greater), mean time to reach minimum blood pressure was 2.4 minutes. The vast majority of patients with significant orthostatic hypotension had this finding within 2 minutes of standing. Orthostatic hypotension was common in patients for whom other probable causes of syncope were assigned. The recurrence of syncope was not related to the degree of orthostatic hypotension; however, the recurrence of dizziness and syncope as end-points was lower in patients with 20 mm Hg or greater systolic blood pressure reductions as compared with patients with lesser degrees of orthostatic blood pressure declines. CONCLUSION: Orthostatic hypotension is common in patients with syncope and is detected in the vast majority of patients by 2 minutes. Although symptom recurrence on follow-up was lower in patients with more severe orthostatic hypotension, the clinical significance of this finding needs to be further defined by future studies.

Adolescent↗
PubMed1990

New and emerging etiologies for community-acquired pneumonia with implications for therapy. A prospective multicenter study of 359 cases.

Three hundred fifty-nine consecutive patients with community-acquired pneumonia admitted to university, community, and VA hospitals underwent a standardized evaluation, including specialized tests for Legionella spp. and Chlamydia pneumoniae (TWAR). The most common underlying illnesses were immunosuppression (36.3%), chronic obstructive pulmonary disease (32.4%), and malignancy (28.4%). The most frequent etiologic agents were Streptococcus pneumoniae (15.3%) and Hemophilus influenzae (10.9%). Surprisingly, Legionella spp. and C. pneumoniae were the third and fourth most frequent etiologies at 6.7% and 6.1%, respectively. Aerobic gram-negative pneumonias were relatively uncommon causes of pneumonia despite the fact that empiric broad-spectrum combination antibiotic therapy is so often directed at this subgroup. In 32.9%, the etiology was undetermined. Antibiotic administration before admission was significantly associated with undetermined etiology (p = 0.0003). There were no distinctive clinical features found to be diagnostic for any etiologic agent, although high fever occurred more frequently in Legionnaires' disease. Clinical manifestations for C. pneumoniae were generally mild, although 38% of patients had mental status changes. Mortality was highest for Staphylococcus aureus (50%) and lowest for C. pneumoniae (4.5%) and Mycoplasma pneumoniae (0%). We document that specialized laboratory testing for C. pneumoniae and Legionella spp. should be more widely used rather than reserved for cases not responding to standard therapy. Furthermore, realization that C. pneumoniae and Legionella spp. are common etiologies for community-acquired pneumonia should affect empiric antibiotic prescription.

Adolescent↗
PubMed1990

Health promotion and disease prevention in the elderly. Comparison of house staff and attending physician attitudes and practices.

The purpose of this study was to evaluate and compare attending physician and house staff attitudes and practices regarding health promotion and disease prevention in the elderly. Seventy-four physicians (38 house staff and 36 attending physicians) were surveyed from four sites in Pittsburgh, Pa, regarding their agreement with recommendations of the American Cancer Society and the Canadian Task Force. Two hundred fifty patients were interviewed and their charts were reviewed for performance of the recommendations. In all patients, physicians agreed highly with the American Cancer Society and the Canadian Task Force recommendations (agreement, 80% to 100%), with the exception of proctoscopy and thyroid examinations. Physicians performed screening procedures much less frequently. House staff and attending physicians differed regarding their attitudes about prevention. House staff felt the need for more formal instruction and were more positive regarding a healthy life-style and commitment to health promotion. The significant predictors of tests (defined as either examination or test ordered by a physician) were presence of a checklist, site of practice, and physician status. A logistic regression analysis was performed; however, this model could not entirely explain the variations found. Although physicians agreed with recommendations for screening, the attending physicians and house staff (particularly attending physicians) were less likely to perform the screening, especially in the elderly.

Aged↗
PubMed1989

Development of a central division of general internal medicine.

A division of general internal medicine was, by design, developed to be central to many of the activities of the department of medicine. Since 1979 the division has grown from five faculty members to 29 members and has the potential for substantial additional growth. The division provides approximately 70% of all inpatient teaching by attending physicians, provides all of the general medicine outpatient teaching, and has substantial impact on medical student training programs. The division is responsible for more than $1.5 million of clinical services and approximately 10% of hospital admissions, and it is responsible for approximately 40% of all patients on the general medicine service. Research activities are divided into several distinct modules, including medical informatics, clinical epidemiology, occupational medicine, geriatrics, medical competency testing, and ethics. The division receives approximately $1.2 million from external sources, including the federal government and foundations, for its research activities. Because of its success, it may serve as a potential model for similar divisions in other departments of medicine.

Academic Medical Centers↗
PubMed1988

Multiple strokes due to atrial myxoma with a negative echocardiogram.

We report a patient with three cerebrovascular events involving the posterior circulation, one of which occurred in conjunction with central retinal artery occlusion. The patient had constitutional findings but had a normal cardiac examination, negative echocardiogram, and negative blood cultures. Angiography on two separate occasions revealed left vertebral artery occlusion. Repeat echocardiography 10 months later, at the time of the third stroke, revealed a left atrial mass consistent with myxoma. In patients with repetitive unexplained embolic events in different vascular distributions and constitutional findings suggestive of atrial myxoma, repeat noninvasive studies are indicated even if the initial workup is negative.

Cerebrovascular Disorders↗
PubMed1987

A controlled study of survival with dementia.

Widely conflicting data exist regarding the relationship of dementia to mortality and the relative risk of senile dementia of the Alzheimer type vs multi-infarct dementia with respect to mortality. In a historic prospective study, 202 patients with dementia were matched by age and sex with 202 nondemented controls attending the same geriatric assessment clinic and receiving comparable medical and psychiatric care. The three-year survival rate was 70% for patients with dementia and 84% for controls. Patients with multi-infarct dementia survived more poorly than patients with senile dementia of the Alzheimer type, but the difference did not reach statistical significance. The relative risk associated with dementia in the context of a multivariate analysis was 1.92 (95% confidence [1.25, 2.97]). We conclude that dementia carries a significantly increased risk of mortality but that the survival of patients with dementia may be better than previous reports would suggest.

Aged↗
PubMed1987

Cholesterol crystal embolization: a review of 221 cases in the English literature.

Cholesterol crystal embolization (CCE) frequently presents with nonspecific manifestations that mimic other systemic diseases. The authors reviewed 221 cases of histologically proven CCE in the English literature to define the clinical, laboratory, and pathologic characteristics of this disorder. CCE affected predominantly elderly males (mean age sixty-six) with a frequent history of hypertension (61%), atherosclerotic cardiovascular disease (44%), renal failure (34%), and aortic aneurysms (25%) at presentation. At least one possible predisposing factor was present in 31% and included operative and radiological vascular procedures and the use of anticoagulants. Cutaneous findings (34%) and renal failure (50%) were two of the most common clinical findings throughout the course of CCE. The nonspecific signs and symptoms included: fever (7%), weight loss (7%), myalgias (4%), and headache (3%). Premortem diagnoses were established in 31% of patients most commonly by biopsy of the muscle, skin, and kidney. Mortality was high (81%) and was most commonly due to multifactorial, cardiac, and renal etiologies. The authors conclude that CCE should be strongly considered in elderly patients with atherosclerotic vascular disease who have the onset of renal insufficiency and cutaneous manifestations. CCE may be confirmed by a skin or muscle biopsy.

Cholesterol↗
PubMed1987

Clinical prediction rules for computed tomographic scanning in senile dementia.

The role of computed tomography (CT) of the head in evaluating patients with dementing illnesses remains a controversial issue. Several prediction rules to guide the selective application of CT in the evaluation of dementia have recently been proposed in the medical literature. The present authors examine the value of four such rules through a validation study performed in an outpatient geriatric assessment unit. The rules were assessed in terms of their diagnostic sensitivities, specificities, misclassification rates, and information contents. Prediction rule sensitivities ranged from 12.5% to 87.5%, specificities from 37.2% to 77.9%, and misclassification rates from 23.5% to 60.8%. Of the four prediction rules examined, one emerged as significantly more sensitive than the others, and also served to reduce diagnostic uncertainty a full order of magnitude more than the others, as determined by an information content analysis. Disadvantages to this rule, however, were found in its more complex nature and the assessment of a very high rate of misclassification. Through a critique of existing strategies, this study purports to determine the potential for establishing a useful clinical prediction rule to guide selective CT scanning in the diagnostic evaluation of dementia.

Aged↗
PubMed1986

Syncope in the elderly.

This report describes the evaluation of syncope in 210 elderly patients as compared with 190 younger patients. The elderly group had a mean age of 71 years (range 60 to 90) and the younger group had a mean age of 39 years (range 15 to 59). A cardiovascular cause was found in 33.8 percent of the elderly and in 16.8 percent of the young (p = 0.0001), a noncardiovascular cause in 26.7 percent of the elderly and 37.9 percent of the young (p = 0.02), and unknown cause in 38.5 percent of the elderly and 45.3 percent of the young (NS). Prolonged electrocardiographic monitoring established the diagnosis in 17 percent of the elderly but in only 8 percent of the young (p = 0.008). Syncope resulted in trauma in 39 percent of the elderly and in 32 percent of the young, but the elderly more often had major trauma. The two-year overall mortality was 26.9 +/- 3.4 percent in the elderly and 8.3 +/- 2.1 percent in the young (p less than 0.0001). The overall mortality and incidence of sudden death in the elderly with a cardiovascular diagnosis were similar to those in the young; however, in the elderly with a noncardiovascular diagnosis and syncope of unknown cause, the mortality and incidence of sudden death were higher. Multivariate analyses using mortality and sudden death as endpoints revealed that a cardiovascular cause of syncope was a very strong risk factor. In patients with a noncardiovascular cause or unknown cause of syncope, a history of congestive heart failure, older age, and male sex are important prognostic factors.

Adolescent↗
PubMed1985

Cerebral cysticercosis: diagnostic value of subcutaneous nodules. Report of two cases.

In North America cysticercosis is a rare disease and may cause serious diagnostic difficulties. We report two patients with cysticercosis with neurologic involvement and subcutaneous nodules. In both cases the nodules were small and few in number. Histologic examination showed the diagnostic scolex of the parasite only after subserial sections of the biopsy specimen. The presence of subcutaneous nodules in patients who have lived in endemic areas should raise the possibility of cysticercosis, particularly if neurologic signs or symptoms are present. We stress the importance of careful histologic examination of subcutaneous nodules when cysticercosis is suspected.

Adult↗