The American journal of the medical sciences
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The objective of this prospective study was to assess the incidence and magnitude of fat emboli after cardiopulmonary resuscitation and intraosseous infusions. An animal laboratory at a university center was used to study 33 mixed-breed piglets. The piglets underwent hypoxic cardiac arrest followed by chest compressions and mechanical ventilation for a minimum of 30 minutes. ⋯ The use of the intraosseous cannula for infusion of emergency drugs and fluids did not increase the magnitude of fat embolization over cardiopulmonary resuscitation alone in this animal model. The benefits of using this procedure in critically ill children as a means of rapid vascular access for resuscitation is well established. However, the risk of fat embolism in this population needs further study.
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The purpose was to ascertain risk factors for HIV infection in a predominantly rural population using descriptive epidemiologic studies performed at a university health sciences center. Participants included adult patients with HIV infection or AIDS who were cared for between January 1982 and January 1993. The relative frequency of cases in minority and female heterosexual patients increased significantly. ⋯ Patients who believed they had acquired infection in Virginia were more likely to cite a rural area of acquisition and to have had multiple heterosexual partners but were less likely to have had male homosexual contact than patients who believed they had been infected in other states. HIV continued to spread into rural areas of Virginia, and the gender ratio among blacks with HIV declined throughout the study. Having multiple heterosexual partners, the main risk factor for HIV transmission worldwide, may now result in HIV infection in rural Virginia.
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Leflunomide is a new immunomodulatory drug that is effective in experimental models of autoimmune diseases and in allo or xenotransplantation. In a phase II clinical trial, leflunomide showed high tolerability and efficacy in patients with advanced rheumatoid arthritis. The immunomodulatory activity of leflunomide is attributed to its primary metabolite A77 1726, which is a malononitrilamide. ⋯ Phase III randomized, placebo-controlled trials that use daily dosages of 10 mg or 20 mg are under way in the United States and Europe to confirm and extend the results of the phase II study. Malononitrilamide analogues of A77 1726 are being evaluated for immunosuppressive efficacy in preclinical models of transplantation. If these analogues show efficacies and therapeutic indexes that are similar to leflunomide in these models and that have shorter half-lives than A77 1726 in phase I trials, the preclinical and phase I data will be used to select the analogues for phase II trials in organ transplant recipients.
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Considerable progress has been made regarding pathophysiology, diagnosis, and medical prevention of recurrent renal stone formation. The medical approach is not applied widely because of the availability of extracorporeal shockwave lithotripsy and the complexity of medical diagnostic and treatment modalities. In this review, a simplified program for the medical management of stones is described. ⋯ The uncomplicated calcium stone disease, comprising the illness in the majority of patients with recurrent renal calculi, is characterized by normocalcemia, normouricemia, calcium stones, and the absence of urinary tract infection, bowel disease, or marked hyperoxaluria. Uncomplicated calcium stone disease is separated into a hypercalciuric group and a normocalciuric group. In the simplified treatment program, the hypercalciuric group would be offered thiazide plus potassium citrate, whereas the normocalciuric group would receive potassium citrate alone.
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Abnormalities of thyroid function are associated with hyperlipidemia, a risk factor for coronary artery disease that starts in childhood. We investigated the age-, race-, and sex-related differences in thyroid function and its relation to serum lipoprotein levels in children (n = 363) aged 6 to 18 years from the biracial (black/white) community of Bogalusa, Louisiana, using an ultrasensitive thyroid-stimulating hormone (TSH) assay. Serum levels of lipoprotein cholesterol fractions, triglycerides, triiodothyronine (T3), thyroxine (T4), and the Tanner stage of sexual development were determined. ⋯ Overall, no significant correlation was noted between serum lipoprotein variables and TSH. However, those with the highest low-density lipoprotein to very low-density lipoprotein cholesterol fractions had a higher T4 and a T4/TSH ratio than those with the lowest low-density lipoprotein to very low-density lipoprotein cholesterol fractions. In summary, it is concluded that there is no simple relationship between lipoproteins and TSH or thyroid hormone levels in children.