JAMA : the journal of the American Medical Association
-
Case Reports
Successful resuscitation from cardiac arrest using high-dose epinephrine therapy. Report of two cases.
A patient with cardiac arrest failed to respond to prolonged standard therapy for multiple dysrhythmias. High-dose intravenous epinephrine hydrochloride was administered 22 and 26 minutes after arrest. Coarsening of ventricular fibrillation and defibrillation with subsequent return of spontaneous circulation occurred. ⋯ Intensive treatment efforts were discontinued after admission to the hospital, and the patient died. The temporal sequence in these patients suggests that high-dose epinephrine therapy caused the return of spontaneous circulation. Recent studies suggest that presently recommended epinephrine doses may be too low, and investigation of graded epinephrine doses for the treatment of cardiac arrest is indicated.
-
A 24-year-old woman with non-pituitary dependent Cushing's syndrome was found to have bilateral adrenal myelolipomas at surgery. These benign tumors consist of bone marrow and fat and are uncommon incidental findings that are discovered by computed tomography. ⋯ Careful examination of the adrenal glands from our patient showed a fusion of myelolipoma elements and adrenal cells without distinct adenomas or the typical nodular pattern of adrenal hyperplasia. This report suggests that adrenal myelolipomas and atypical hyperplasia of the zona fasciculata may be anatomically and functionally related.
-
We analyzed patterns of receipt of preventive services among middle-aged women, with particular attention to health insurance coverage, based on data from the National Health Interview Survey. Lack of insurance was most prevalent among socioeconomically disadvantaged women at high risk for disease and was the strongest predictor of failure to receive screening tests. ⋯ We conclude that inadequate insurance coverage leads to "reverse targeting" of preventive care--that is, populations at highest risk are least likely to be screened. This compromises both the effectiveness and the cost-effectiveness of screening.