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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Although special residency programs preparing internists for primary care have been in existence for a decade, little is known about whether these tracks have achieved their goals. As part of a multicenter evaluation of ambulatory care at four university hospitals, 1,040 patient care encounters were reviewed for 16 primary-care and 41 traditional medicine residents. Using a chart-based audit, the authors examined 16 discrete items of patient care to assess resident management in the following areas: screening for colorectal carcinoma, management of hypertension, benzodiazepine drug prescribing, and management of chronic lung disease. Their hypothesis that primary care residents would score higher than traditional medicine residents in the areas of screening, prevention, and prescribing of drugs was not supported. There was no association between type of training and performance of a task with the following exception: second-year primary care residents screened for colorectal carcinoma in 86% (126) of patients whose charts were audited, while second-year traditional medicine residents did so in 77% (160) (P less than 0.025). This difference was not maintained when the residents were reaudited 1 year later. Both groups of residents scored high in all areas with the following exceptions: documentation of the amount of sedative dispensed and immunization of susceptible patients against pneumococcus and influenza. The ambulatory practices of both groups of residents exceeded expectations, probably because of the wider influence of primary care training.
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PMID:Comparing ambulatory care practices of primary care and traditional medicine residents. 401 Mar 63

Age-adjusted mortality rates from coronary heart disease (CHD) and other causes were examined in Minnesota for the years 1960-1978. Regions differed in CHD mortality levels and time trends. The greatest decline in CHD mortality occurred in the Twin Cities. The Northeast region had the highest CHD mortality. Influenza and pneumonia death rates were unrelated to CHD trends. Stroke mortality, which also declined sharply, showed no regional differences. Cancer mortality was highest in the Twin Cities and Northeast regions and increased significantly over the period; most of this increase was due to a striking increase in lung cancer mortality. The authors conclude that: (1) the CHD mortality decline in Minnesota was similar to that in the United States; (2) regional differences within the state in CHD mortality levels and trends were statistically significant; (3) CHD trends were not explained by influenza epidemics; (4) regions differed in mortality rates for hypertension in the same way as they did in CHD mortality, but differed little in stroke mortality. This leaves unclear the role of hypertension in regional CHD differences. (5) Trends in cancer mortality indicate that a general decline in mortality, due to factors affecting a wide variety of diseases does not explain the downward trends in CHD mortality.
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PMID:Cardiovascular mortality trends in Minnesota, 1960-1978. The Minnesota Heart Survey. 671 96

We describe a patient with recurrent thrombotic thrombocytopenic purpura (TTP) manifested solely by aphasia after influenza infection. The clinical diagnosis was not made during acute episodes, and during the intercurrent period the patient had features of chronic glomerular disease, including hypertension, proteinuria, RBC casts, and a nonspecific renal histological appearance. A final episode of aphasia, acute renal failure, and microangiopathic anemia and thrombocytopenia made the diagnosis of TTP apparent. Chronic glomerular disease may in rare instances be a manifestation of occult TTP or the sequel of a prior acute episode of this disorder.
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PMID:Recurrent thrombotic thrombocytopenic purpura after viral infection. Clinical and histologic simulation of chronic glomerulonephritis. 719 23

Since their initial description in 1957, the interferons (IFNs) have been increasingly used to treat a wide array of diseases. Acute adverse effects, i.e. 'flu-like' syndromes, hypo- or hypertension, tachycardia, headache, myalgias and gastrointestinal disorders, occur within the first hour or day after starting treatment. They are seldom treatment-limiting and are easily manageable. Sub-acute and chronic effects develop after several days, usually within 2 and 4 weeks of therapy. The most typical is neurological toxicity, including fatigue/asthenia, and behavioural and cognitive changes. Such symptoms may seriously impair quality of life and result in treatment discontinuation. Seizures have seldom been described. Other infrequent central nervous system adverse effects include vertigo, cramp and oculomotor nerve paralysis. Distal paraesthesias and peripheral neuropathy have been reported. IFN-associated autoimmunity is quite rare but a matter of concern. Biological or clinical manifestations usually require several months to become apparent. Autoantibodies have been shown to develop in most patients but have been inconsistently associated with clinical symptoms of systemic lupus erythematosus, rheumatoid-like arthritis and thyroiditis. Both hypo- and hyperthyroidism have been described but are usually reversible. Other infrequent autoimmune reactions include diabetes, pemphigus and worsening of multiple sclerosis. Although several patients present with a pre-existing autoimmune disorder, no predisposing factor has been clearly established. While hypotension and tachycardia are the most frequent acute cardiovascular complications, a few additional cases of cardiac arrhythmias and myocardial ischaemia have been reported after a short course or several weeks of treatment. These latter complications do not appear to be dose-dependent or age-related. Isolated cases of congestive heart failure have also been described. Mild proteinuria has been observed in 15 to 25% of patients, but acute renal toxicity is uncommon. A transient rise in serum aminotransferase levels is frequently noted during the first stage of therapy, especially in patients receiving the highest dosages. Direct hepatotoxicity is extremely rare. Autoimmune hepatitis, which is ill-diagnosed as chronic viral hepatitis, and de novo induction of autoimmune hepatitis, account for the majority of liver diseases. Haematotoxicity is relatively common but mild to moderate, and develops gradually during the first weeks of treatment. Neutropenia is the most common haematological toxicity, but is usually not dose-limiting and resolves rapidly upon drug discontinuation. Myelosuppression, autoimmune and immune allergic haemolytic anaemias and thrombocytopenias have seldom been described. Cutaneous adverse effects comprised nonspecific erythema and hair loss and, less frequently, vasculitis, local ulcerations at the site of injection and exacerbation of psoriasis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Clinical toxicity of the interferons. 751 63

We report on a very rare case of a primary, alveolar hypoventilation syndrome (Ondine's Curse syndrome) in a female patient who was first treated at the age of 26 years as a result of an influenza infection; however, the case history revealed a decreased performance in comparison to similar aged children from earliest childhood onwards as well as an intermittent zyanosis of the lips and distal extremities. Other diseases which could explain a global respiratory insufficiency and/or pulmonary arterial hypertension were excluded.
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PMID:[Clinical late manifestation of Ondine's syndrome with pronounced primary, especially sleep related alveolar hypoventilation]. 761 2

Although cyclosporin is effective in immunosuppression following organ transplantation and in the treatment of psoriasis, its use is limited by its side-effects, notably impaired renal function and hypertension. As SDZ IMM 125, a new derivative of the cyclosporin family, showed considerable immunosuppressive activity in experimental studies, with less effect on renal function, it was considered a potential successor to cyclosporin for both indications. In this multicentre, double-blind, placebo-controlled study, the efficacy and tolerability of 40, 100, 200 and 400 mg SDZ IMM 125 daily were studied in 59 patients with psoriasis. Patients were followed for a period of 5 weeks (4 weeks treatment, and 1 week post-treatment observation). A dose-dependent effect of SDZ IMM 125 was observed. A significant correlation was found between the dose of SDZ IMM 125 and changes in the sum of severity scores of three indicator plaques. There was a significant decrease in the body surface area affected by psoriasis in the 400-mg group (P < or = 0.01), whereas a decrease of the global psoriasis severity was observed in the 200-mg (P < or = 0.01) and the 400-mg groups (P < or = 0.001). No serious adverse events occurred during the 4 weeks of treatment. Three patients discontinued treatment because of adverse events (one sore throat, two influenza). Clinical adverse events were similar to those reported with cyclosporin, the most frequent being gastrointestinal disturbances. Estimation of renal function indices showed that increases from baseline values were dose-dependent, and appeared to be similar to those seen with cyclosporin.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Efficacy and tolerability of multiple-dose SDZ IMM 125 in patients with severe psoriasis. 766 49

Erythropoietin has been shown to be effective both in the reversal of anaemia in patients with end-stage renal failure and to increase the volume of autologous red blood cells donated preoperatively as well as to decrease the units of homologous blood transfused. This review analyzes the side effects of erythropoietin reported in the literature for long-term administration (mainly in patients with end-stage renal failure) as well as for acute/short-term administration (in patients participating in an autologous predeposit programme). The most important adverse events reported for long-term administration are as follows: (a) arterial hypertension; (b) cerebral convulsion/hypertensive encephalopathy; (c) thrombo-embolism; (d) iron deficiency; (e) influenza-like syndrome. The numbers given for these side effects are mainly taken from the first and dose-finding studies in patients with renal failure. These figures differ very much from the data given in controlled studies analyzing adverse events as well. Summarizing the results from controlled, multi-center trials in patients with end-stage renal failure or in AIDS patients, no significant differences have been observed between the control group and the patients treated with erythropoietin. The overall-incidence of side effects occurring in either group of these two studies was of approximately 83% and 95%, respectively. In contrast to these results the data published for the dose finding/treatment studies is approximately 30% for development of arterial hypertension, approximately 5% for occurrence of cerebral convulsion/hypertensive encephalopathy, approximately 10% for thrombo-embolic complications/clotting of vascular access, approximately 50% for development of iron deficiency, and approximately 10% for symptoms summarized as influenza-like syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Adverse events of erythropoietin in long-term and in acute/short-term treatment. 795 Jan 71

Seventy-five non-dialized patients with chronic renal failure (CRF) and severe renal anemia were enrolled in a study, receiving r-HuEPO subcutaneously thrice weekly for 6 months. In 64 patients (85%) 7 weeks of treatment with a weekly dose of 158 U/kg were required to achieve Hb concentrations within the target range of 10 to 12 g/dl. Of the 11 patients (15%) who failed to achieve the target Hb range, none were considered to be non-responders as they were excluded for unrelated reasons prior to week 16 (8 cases), or were iron deficient (2 cases), or had bleeding complications (1 patient). Maintaining the Hb concentration at a level of 10.5 g/dl required a mean r-HuEPO dose of 92 U/kg per week. Adverse events were generally mild or moderate. The most commonly reported were hypertension (8%), viral infection/including flu-like syndrome (7%), nausea (7%), and dizziness (5%). Statistically significant increases in mean creatinine concentrations observed after 12 and 24 weeks were most likely due to the progression of renal disease. These results confirm that 50 U/kg of r-HuEPO given 3 times per week subcutaneous provide a safe and effective therapy for anemic predialysis patients.
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PMID:Effectiveness and safety of recombinant human erythropoietin (r-HuEPO) in the treatment of anemia of chronic renal failure in non dialysis patients. European Multicentre Study Group. 807 Sep 41

Hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) were originally described as separate disease entities. Recently, HUS and TTP have been considered a single disease, because of the identical microangiopathic lesion. In the present study, we investigated the clinical and histological characteristics of HUS/TTP. Eleven patients with a definite diagnosis of HUS/TTP were found from a cohort of adult patients who were admitted to Kitasato University Hospital in the past two decades. Their clinical and histological characteristics were retrospectively analyzed. All of the 11 patients with HUS/TTP were sporadic and non-diarrheal cases with a mean age of 49 years +/- 10. Preceding episodes of flu-like syndrome and the administration of mitomycin C were observed in 3 and 5 patients, respectively. On admission, two of 10 patients with renal dysfunction required dialysis treatment, while none developed nephrotic syndrome. Six patients showed CNS manifestation, such as consciousness disturbance and convulsion. Three patients with severe hypertension did not show consciousness disturbance. As for the final outcome, 6 patients recovered and the remaining 5 died. Two died after 60 hospital days. In the histopathological investigation, renal biopsy specimen showed narrowing of the capillary loops in the glomeruli due to swelling of the endothelial cells, double contour of the glomerular basement membrane, or mesangial cell necrosis and sclerosis. In the autopsy specimen, internal organ infarction with fibrin thrombi in small arteries was observed in multiple organs, such as brain, kidneys, hearts, lungs, jejunum, liver, pancreas, adrenal glands and pituitary gland. A circumferential myocardial infarction with hyaline thrombi in the medial layer of myocardium was characteristic of HUS/TTP. In conclusion, microangiopathic lesions with infarction spread widely throughout various organs in HUS/TTP. Involvement of internal organs, not to mention kidneys and brain, is lethal and their prognosis remains poor.
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PMID:[Clinical characteristics of hemolytic uremic syndrome/thrombotic thrombocytopenic purpura (HUS/TTP) in adult]. 808 74

We studied the relative etiologic importance upon the development of Parkinson's disease (PD) of occupational exposure to herbicides and other compounds, ionizing radiation exposure, family history of PD and essential tremor, smoking, and history of various viral and other medical conditions. We identified patients (n = 130) with neurologist-confirmed idiopathic PD through contacts with Calgary general hospitals, long-term care facilities, neurologists, the Movement Disorder Clinic, and the Parkinson's Society of Southern Alberta, and selected two matched (by sex and age +/- 2.5 years) community controls for each case by random digit dialing. We obtained lifetime work, chemical, radiation, medical, and smoking exposure histories and family histories of PD and essential tremor by personal interviews, and analyzed the data using conditional logistic regression for matched sets. After controlling for potential confounding and interaction between the exposure variables, using multivariate statistical methods, having a family history of PD was the strongest predictor of PD risk, followed by head trauma and then occupational herbicide use. Cases and controls did not differ in their previous exposures to smoking or ionizing radiation; family history of essential tremor; work-related contact with aluminum, carbon monoxide, cyanide, manganese, mercury, or mineral oils; or history of arteriosclerosis, chicken pox, encephalitis, hypertension, hypotension, measles, mumps, rubella, or Spanish flu. These results support the hypothesis of a multifactorial etiology for PD, probably involving genetic, environmental, trauma, and possibly other factors.
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PMID:Parkinson's disease: a test of the multifactorial etiologic hypothesis. 817 May 64


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