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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An analysis of 10,159 normal spontaneous vaginal deliveries was performed to examine racial differences in mean birth weight of infants whose mothers were without antepartum or intrapartum medical complications of pregnancy. The study was limited to black and white infants of low-income mothers who were inborn, singleton, and weighed greater than or equal to 500 gm at birth. High-risk maternal transfer patients and patients with hypertension, toxemia, bacteriuria, pyelonephritis, renal failure, diabetes, anemia, polyhydramnios, oligohydramnios, prolapsed cord, vaginal bleeding, placenta previa, abruptio placentae, prolonged rupture of membranes, maternal fever on admission, amnionitis, sexually transmitted diseases, or fewer than five prenatal care visits were excluded. When statistically significant differences in demographic characteristics were controlled, black infants had an average birth weight 181 gm less than that of white infants.
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PMID:Birth weights of infants of black and white mothers without pregnancy complications. 203 72

We performed a prospective study in 106 patients with acute stroke. The main purpose was to evaluate the associated diseases and to determine their prevalence and incidence in two different types of cerebrovascular disease: the intracerebral hemorrhage (HI) and ischaemic events (AI). The studied population included 54 men and 52 women with a mean age of 66.8 +/- 10.3 years. A clinical examination was performed in all patients by different specialists and all were submitted to diverse complementary tests, including a computed tomography scan of the brain (TAC) and an echocardiogram (ECO). We found 24 (23%) HI and 82 (77%) AI. In the past history, previous stroke were more prevalent in AI (p less than 0.01). Heart disease was present in 87 (82%) patients but, among them, only atrial fibrillation which was found in 19 (18%) patients, was significantly more frequent in AI (p less than 0.02). Hypertension (HTA) existed in 79 (75%) patients, respiratory complications and periferic vascular disease in 9 (8%), diabetes in 44 (42%) and dyslipidemia in 31 (29%) patients. No significant difference was found between the two groups of stroke regarding these diseases; however, there was a tendency for HTA and diabetes to be more prevalent in HI and for periferic vascular disease in AI. In the blood tests, high haematocrit was found in 35 (33%) patients, anemia in 21 (20%), hypercholesterolemia in 17 (16%), hypertrigliceridemia in 18 (17%) and uremia or creatinemia or ionic alteration in 32 (30%) patients, without any difference in their prevalence and incidence in the two groups of stroke. In conclusion, in this prospective study of patients with an acute stroke, there was 23% of HI and 77% of AI, a high prevalence of previous stroke, heart disease and HTA, but only the previous stroke and, within heart disease, the atrial fibrillation were significantly more frequent in the AI group. Also, periferic vascular disease had a tendency to be more frequent in AI, as well as diabetes and HTA had in HI.
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PMID:[The patient with acute cerebrovascular disorders: assessment of associated diseases]. 208 57

At post-mortem we examined heart tissue of (i) 31 patients with uraemia not on dialysis, (ii) 42 patients on haemodialysis for less than 6 months, (iii) 60 patients on haemodialysis for more than 6 months, (iv) 16 patients after renal transplantation, and (v) 11 patients on CAPD. Patients with stenosing coronary lesions were excluded. Diffuse non-coronary intermyocardiocytic fibrosis, assessed by a score system in trichrome-stained sections, was found in 91% of chronically uraemic patients, but not in non-hypertensive, non-diabetic controls. The lesion was present even in non-dialysed uraemic patients; in dialysed patients its severity was related to the duration of dialysis; it was demonstrable even years after renal transplantation. On electron-microscopy, collagen fibres were seen, while beta 2-M amyloid was consistently absent. Logistic regression analysis showed that uraemia was a determinant of intermyocardiocytic fibrosis independent of hypertension, diabetes mellitus, anaemia, heart weight, and presence or absence of dialysis procedure.
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PMID:Diffuse intermyocardiocytic fibrosis in uraemic patients. 210 83

Data on 100 consecutive non-emergency coronary artery bypass (CABG) patients were analyzed retrospectively. Sixty-nine patients received no homologous blood (Group I). Thirty-one patients received a total of 118 units of blood products averaging 2.23 units of red cells (Group II). The average red cell transfusion rate for all patients was 0.7 units per patient. The median age for Group I was 61 and Group II was 68 years (p less than 0.05). The average number of grafts was the same for both (3 per patient) with 75% of Group I and 58% of Group II receiving internal mammary artery (IMA) grafts (p less than 0.05). Twelve of the Group II patients who received intraoperative transfusions on cardiopulmonary bypass to maintain adequate hemoglobin levels were older and had lower admission hematocrits: 36 +/- 0.8% compared to 41 +/- 0.5% for all other patients (p less than 0.05). Average postoperative blood loss was 889 +/- 38 ml for Group I and 1077 +/- 104 ml for Group II (p less than 0.05). Increased hemorrhage was correlated with bypass time and IMA use but not with preoperative heparin administration, pre-existing risk factors (diabetes, hypertension, etc.), bleeding time, post-bypass clotting time, age or number of grafts. Two patients in Group II and none in Group I required exploration for excessive postoperative hemorrhage. Mortality rate was 2% (both in Group II, neither transfusion related). Discharge hematocrits were the same for all at 29.4 +/- 0.4%. Among anemia-related postoperative symptoms, only sinus tachycardia was significantly higher in Group I (20%) compared to Group II (6.5%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Aggressive blood conservation in coronary artery surgery: impact on patient care. 222 48

Glucagonomas, considered among the rarest of the islet cell neoplasms, produce a well-defined clinical syndrome characterized by necrolytic migratory erythema, diabetes mellitus, glossitis, anemia, and weight loss. This report describes seven patients with glucagonoma treated at our institution. All seven had the characteristic dermatologic manifestations, present from 1 to 6 years prior to diagnosis. Five patients had extensive disease at the time of initial operation, three of whom underwent aggressive cytoreductive surgery, whereas the other two had biopsy only. The remaining two patients presented with a single nodule each, underwent distal pancreatectomy and splenectomy, and remain free of disease 2 and 6 years postoperatively. Earlier recognition of the distinctive physical findings peculiar to this syndrome should increase survival. Aggressive cytoreductive surgery results in prolonged remission.
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PMID:Glucagonoma syndrome is an underdiagnosed clinical entity. 225 25

This study was undertaken to investigate the extent to which the major arteries, particularly the aorta, iliac and leg arteries are involved in certain peripheral occlusive vascular disease, e.g. diabetes mellitus and sickle-cell anaemia. By using a non-invasive Doppler technique, vessel compliance (C) was measured in the aorta, iliac and leg arterial segments of 25 juvenile and adult-onset diabetics of recent diagnosis and also in seven sickle-cell subjects (sicklers) whose conditions were known to have reached crisis state. Results have been compared with values obtained from normal subjects of the same ethnic origin and age group. Abnormal aortic compliances was found in the juvenile diabetics in marked contrast with the lower than normal aortic compliance found in the adult diabetics of over 40 years of age, but also of recent diagnosis. The results further showed that some of the young sicklers (under 30 years of age) have slightly higher blood vessel compliance than normal while the older ones have lower values. These differences in compliance are discussed in the light of previous findings in animal and man.
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PMID:A Doppler ultrasound study of vessel compliance changes in occlusive arterial diseases. 227 28

This article reviews the history of screening in the elderly, the conditions that should be considered, whether or not screening in the elderly is of benefit, whether we should look for disability or diseases and where screening should take place. Thirteen conditions are discussed: hearing loss and anaemia in some detail. Both disability and precise diagnostic criteria are considered. The place where screening is best carried out depends on the mobility of the subject and the nature of the particular screening tests selected for the 13 conditions. The desirability of screening was assessed on the following criteria: prevalence of the condition, severity of the problem, acceptability by the patient of the screening test, false positive rate, consequences of making a false positive diagnosis, the false negative rate and the consequences of this error, the effect of treatment, the cost of the screening test and the burden on the health services produced by the screening test. The criteria were scored 1-5 on a scale defined for each assessment, with higher scores favouring screening. We provide evidence that screening may be worthwhile for: need for chiropody, varicose veins/ulcer, hearing loss, obesity, visual impairment, hypothyroidism, hypertension, anaemia and diabetes mellitus. However, the assessments discussed in this paper need to be tested prospectively in randomised controlled trials.
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PMID:Should medical screening of the elderly population be promoted? 227 26

In this paper we summarise the results of a study of the use by two general practices of the Reflotron dry chemistry analyser, and discuss the findings in the light of recent literature on the use of desk top analysers in general medical practice. We conclude that, in the present economic environment there is little incentive for general practitioners to carry out their own diagnostic tests. The accuracy and precision of desk top analysers operated by unskilled personnel are problematical, but with adequate back-up from the centralised hospital laboratory such equipment could be useful for the diagnosis and control of such problems as diabetes and anaemia. However, the most important factors necessary for the spread of desk top analysers are the availability of more tests, guarantees of reliability, and competitive prices. Desk top analysers could fulfil a role in practices which control their own budgets, but this would depend on the costs of hospital laboratory tests compared with those performed in the surgery.
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PMID:Desk top analysers in general medical practice: how useful are they? 228 27

We describe an 8-year-old boy who was diagnosed as having diabetes mellitus at the age of 3 months. During the follow-up the diabetes was uncontrolled, and he presented nephrotic syndrome with renal function impairment, a renal biopsy showing a membranous nephropathy. Subsequently he had episodes of anemia and dyspnea, due to alveolar hemorrhage, and he also developed Fanconi's syndrome. A later renal biopsy showed membranous glomerulonephritis and interstitial nephritis. The presence of antitubular basement membrane antibodies was noted but antialveolar basement membrane antibodies were not detected. We do not believe that this unusual clinical picture was a coincidence, and we speculate about a possible explanation.
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PMID:Membranous nephropathy, antitubular basement membrane antibodies and alveolar hemorrhage in a diabetic child. 228 22

In one regional perinatal network between 1982-1987, 101,506 women delivered infants greater than 500 g, of which 1253 were twin pregnancies (1.2%). This latter group was compared statistically with a 5% random sample of the singletons (N = 5119). The results showed that the women with twin pregnancies were slightly older, had a higher parity, gained more weight during the gestation, and had a heavier body weight at delivery. Twin pregnancies were complicated by increases in hypertension (odds ratio 2.5; 95% confidence interval 2.1-3.1), abruption (odds ratio 3.0; 95% confidence interval 1.9-4.7), and anemia (odds ratio 2.4; 95% confidence interval 1.9-3.0). There was no increased risk of pyelonephritis, placenta previa, or diabetes mellitus in mothers with twins. The twin pregnancies delivered earlier and the infants were smaller, had lower Apgar scores, and were at increased risk for congenital anomalies. Fetal and neonatal mortality rates were significantly increased in the twin infants; the perinatal mortality rates for twin A and twin B were 48.8 and 64.1, respectively, compared with 10.4 per 1000 births for the singleton controls. When the twin infants A and B were of similar weight, they had a similar perinatal mortality (odds ratio 1.0; 95% confidence interval 0.6-1.8). For infants less than 2500 g, twins A and B had lower fetal and neonatal mortality rates than did singletons, but twins heavier than 2500 g were at increased risk of perinatal death.
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PMID:A case-control study of 1253 twin pregnancies from a 1982-1987 perinatal data base. 230 Mar 44


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