Southern medical journal
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Although intracranial gliomas carry a poor long-term prognosis, retreatment at the time of tumor progression may prolong survival and maintain or improve the quality of life. Thirty-three patients who underwent retreatment with surgery, radiotherapy, and chemotherapy were reviewed retrospectively. Median survival after initiation of retreatment was 8 months for glioblastoma, 13 months for anaplastic astrocytoma, 22 months for astrocytoma, and 47 months for oligodendroglioma/mixed glioma. ⋯ Chemotherapy and radiotherapy produced expected adverse reactions. Retreatment of intracranial gliomas carries acceptable risk and is beneficial in selected patients. Decisions regarding retreatment must be carefully individualized with consideration of the quality of life and the wishes of the patient and family.
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Southern medical journal · Feb 1994
Comparative StudyEndotracheal tube misplacement: incidence, risk factors, and impact of a quality improvement program.
To assess the impact of a quality improvement program on the occurrence of serious complications related to endotracheal tube misplacement and to identify risk factors, we did a before and after comparison in the adult intensive care units of a military referral hospital. All adult patients requiring endotracheal intubation during two 12-month periods comprised the study population. After the identification of a sentinel case, a retrospective review identified 278 adult patients requiring endotracheal intubation over a 12-month period. ⋯ The incidence of serious complications related to endotracheal tube misplacement was significantly less during the implementation of the quality improvement program (0 of 246 patients) than during the retrospective period (5 of 278 patients). Multivariate analysis showed that a longer duration of endotracheal intubation, the lack of chemical paralysis, and the occurrence of cardiac arrest were independently predictive of endotracheal tube misplacement. These results suggest that a specific ICU quality improvement program can have a favorable impact on patient outcome.
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Southern medical journal · Feb 1994
Anticardiolipin antibodies in a sample of chronic schizophrenics receiving neuroleptic therapy.
Drug-induced antiphospholipid antibodies have been considered insignificant, a belief that has recently been questioned. Previous studies noted an association between chlorpromazine treatment and the presence of anticardiolipin antibodies (ACA), especially IgM ACA, and have suggested that thrombosis might be more likely in the presence of IgG ACA. ⋯ IgG ACA was present in 7 (26%) of the 27, and IgM ACA was present in 5 (19%), yet none had shown any manifestations of cerebrovascular disease since initiation of neuroleptic therapy. These data suggest that drug-induced ACA do not predispose to cerebrovascular disease, even when IgG ACA is predominant.
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Southern medical journal · Feb 1994
Case ReportsFulminant pancreatitis associated with lisinopril therapy.
Adding to the growing awareness of medications that can cause pancreatitis is a small but significant number of reports implicating the angiotensin converting enzyme (ACE) inhibitors. In this report, I describe the case of a patient who had no risk factors for pancreatitis and who was taking no medications known to cause pancreatitis other than lisinopril. The abruptness, severity, and fulminant course of this case of probable ACE inhibitor-induced pancreatitis are unprecedented in the medical literature. ⋯ The medical literature concerning pancreatitis and articles reviewing ACE inhibitors do not make note of the relationship between the two. Greater awareness of this association will promote a higher index of suspicion in appropriate clinical settings. Further reporting of cases and clinical research into the cause and prevention of drug-induced pancreatitis appears to be indicated.