BACKGROUND: Recently, it has been proposed that discontinuation of antihypertensive medications is not necessarily essential for the measurement of plasma aldosterone-to-renin ratios. We examined the efficacy of adrenocortical scintigraphy performed without modification of antihypertensive medications. METHODS: A retrospective study was conducted on 119 patients, in whom functional tests, anatomic studies, ...

We describe a patient with multiple sclerosis (MS) who had detrusor hyperreflexia that was not responsive to oral medications or clean intermittent catheterization. This patient was successfully treated with 2 separate injections of botulinum toxin type B into the bladder. The results of the treatment lasted 4 months and there ...

PURPOSE: To assess the prevalence and location of Lisch nodules among patients with neurofibromatosis type 1. PATIENTS AND METHODS: This was a prospective observational case series in which 369 consecutive patients from a neurofibromatosis clinic participated. Predetermined inclusion and exclusion criteria were applied to these participants. The presence of Lisch ...

OBJECTIVE: To provide venous thromboembolism (VTE) prophylaxis according to national consensus guidelines while minimizing associated medication costs. METHODS: Patients admitted to our institution who were receiving VTE prophylaxis with the low-molecular-weight heparin (LMWH) enoxaparin were identified and evaluated for potential conversion to low-dose unfractionated heparin (LDUH). Patients admitted for general ...

BACKGROUND: Previous researchers have shown that non-medical endoscopists can perform lower gastrointestinal endoscopy as safely and effectively as medical staff. However, it is not known if upper gastrointestinal endoscopy performed by medical and non-medical endoscopists in clinical practice yields similar results in terms of performance, patient discomfort, and satisfaction. AIM: ...

BACKGROUND: Patients' awareness of the medical qualifications and duties of anesthesiologists outside the operating theatres may be limited. How are anesthesiologists ranked with regard to prestige and academic qualifications among other hospital employees? METHODS: One hundred and sixty operative patients were interviewed in one tertiary care center and another secondary ...

One of the goals of antireflux surgery (ARS) is to lower medications usage for heartburn symptoms. There has been some controversy as to whether this is accomplished by surgery. In addition, there is little comparative data of medical usage in patients suffering from gastroesophageal reflux disease (GERD) treated nonoperatively with ...

We describe a case in which an elderly woman is hospitalised for acute medical illness and ask how this patient's risk of venous thromboembolism should be assessed and managed. Venous thromboembolism was previously regarded as a surgical problem, but occurs at least as frequently among medical patients. The risk of ...

OBJECTIVE: The aim of the present study was to examine patients' views about the relative impact and function of lay and medical diagnoses for stomach and throat problems. METHODS: A questionnaire survey was carried out among 900 consecutive patients attending nine general practices across England. A total of 740 questionnaires ...

BACKGROUND: Commonly, a pneumothorax is induced before medical thoracoscopy to facilitate safe entry into the pleural space. OBJECTIVE: Evaluate the use of transthoracic ultrasound to locate a safe entry site for trocar placement during medical thoracoscopy without induction of a preprocedure pneumothorax. METHOD: The study was designed as a prospective ...

Epidemiologic and clinical evidence clearly documents the relationship between elevated levels of low-density lipoprotein cholesterol (LDL-C) and risk of coronary heart disease (CHD). In order to reduce CHD risk, the National Cholesterol Education Program (NCEP) has identified LDL-C goals that can be achieved through appropriate use of lipid-lowering medications, diet, ...

BACKGROUND: The main cause of brachioradial pruritus (BRP) is not known but there is evidence to suggest that BRP may arise in the nervous system. Cervical spine disease may be an important contributing factor. OBJECTIVE: Our aim was to determine whether spine pathology is associated with BRP. METHODS: Medical charts ...

The medical practitioner has always had to juggle several roles. First and foremost, the doctor is a healer, a provider of curative services. Second, he is an examiner, an assessor of the patient's health status. Third, he is a researcher, always trying to push the boundaries of medical knowledge. Fourth, ...

OBJECTIVE: This study describes the prevalence and pattern of use of psychotropic medications by HIV-positive patients receiving medical care in the United States and the search for possible predictors of use. METHOD: The HIV Cost and Services Utilization Study database was analyzed. From the estimated 231,400 HIV-positive patients in medical ...

All general medical patients should be assessed for clinical risk factors for VTE. The ACCP has recommended that general medical patients with clinical risk factors receive either LDUH twice or three times daily or once-daily LMWH. Current evidence suggests that twice-daily LDUH may not be efficacious enough in the acutely ...

BACKGROUND: Dementia is an organic mental disorder that is characterized by a general loss of intellectual abilities involving impairment of memory, judgment, and abstract thinking as well as changes in personality. Demented patients are a growing subgroup within the practice of dermatologic surgery and especially in Mohs surgery. These patients ...

To determine the prevalence of complementary and alternative medicine (CAM) use in pediatric oncology patients, the types of CAM used, and the factors associated with the use of CAM. A questionnaire regarding CAM use was administered to patients/families seen in the pediatric oncology clinic at Wake Forest University Baptist Medical ...

BACKGROUND: Hemodialysis (HD) patients are at risk for medication-related problems. Patient characteristics associated with the number of medication-related problems in HD patients have not been investigated. METHODS: Patient records were reviewed to identify medical problems, prescribed medications, medication indication(s), and medication-related problems. Medication classes and medication-related problems were compared between ...

Thymidine analogue mutations were determined and compared in patients who received zidovudine monotherapy and added didanosine or zalcitabine, and in patients who started with one of these dual nucleoside combinations. Although patients who started in the era of zidovudine monotherapy had a longer duration of therapy compared with the other ...

In recent philosophy of mind a non-holistic view on concept possession, originally developed by Tyler Burge, has emerged as an alternative to holistic analyses of language mastery. The article discusses the implications of this view for analyses of communication in doctor-patient-interaction. The central question Burge's theory gives an answer to ...

The hemorrhagic, necrotic and edematous effects observed in a 23-year-old patient from Lagunetica, Los Teques, state of Miranda, Venezuela, that was bitten by a common Venezuelan rattlesnake (Crotalus durissus cumanensi), were described. The patient was treated with polyvalente serum, antibiotics and autograft. This finding allows to suggest that the poison ...

The records of 510 elderly patients with hip fractures admitted to our institution between January 1995 and December 2000 were retrospectively reviewed to determine the incidence and type of developed medical complications and their economic implications. Of those 510 patients, 217 (43%) developed at least 1 medical complication, most frequently ...

OBJECTIVE: We report the presentation and 5-year follow-up of 89 African-American (AA) and Caribbean-Hispanic (CH) youths with type 2 diabetes mellitus (T2DM) followed at the Montefiore Medical Center, Bronx, N.Y., USA, from 1990 to 2000. METHODS: The medical records of 89 patients with T2DM diagnosed between 1990 and 2000 were ...

BACKGROUND AND PURPOSE: Tuberculous ureteral stricture causing progressive obstructive uropathy commonly complicates renal tuberculosis. The aim of our study was to evaluate the effectiveness of early ureteral stenting or percutaneous nephrostomy (PCN) in patients with tuberculous ureteral strictures. PATIENTS AND METHODS: Seventy-seven patients (84 renal units) with tuberculous ureteral strictures ...

When medical researchers test a new treatment procedure, they recruit patients with appropriate medical histories. An experiment with a new procedure is called a clinical trial. The selection of patients for clinical trials has traditionally been a labor-intensive task, which involves the matching of medical records with a list of ...

STUDY OBJECTIVES: Hypocretin (orexin) deficiency (< 40 pg/ml) is highly associated with narcolepsy with cataplexy (89.5%) and more specifically with patients with cataplexy who are HLA DQB1*0602 positive (95.7%). The relationship between hypocretin-1 levels and narcolepsy without cataplexy or the DQB1*0602 allele is less clear. METHODS/DESIGN: This study compared cerebrospinal ...

Skin rash is a common adverse effect of lamotrigine (LTG) in both add-on and monotherapy trials and is also the most common adverse event causing LTG withdrawal. From our series of 254 prospectively registered adult patients treated with LTG at a dosage of 25-100 mg/ day, the incidence of allergic ...

OBJECTIVE: This study was performed to evaluate the influence of medical problems on functional outcome measures of patients admitted for comprehensive inpatient rehabilitation. DESIGN: In this retrospective database review of patients, demographic information, length of stay, FIM scores at admission and discharge, and FIM efficiency were collected and analyzed. Preexisting ...

STUDY OBJECTIVE: To study the incidence and profile of elderly patients requiring early unplanned readmission within 15 days of discharge from a regional hospital and the predictive factors for readmission. PATIENTS: All patients (n = 150) aged 65 years old and above who were readmitted within 15 days into the ...

Computed tomography has had a questionable role in diagnosing blunt aortic injury (BAI). The objective of this study was to determine the effectiveness of helical computed tomography of the thorax (HCTT) for detection of BAI. Trauma Registry data and medical records were reviewed for 2,854 patients admitted over a 32-month ...

BACKGROUND: Hospital discharge against medical advice, especially among substance-abusing populations, is a frustrating problem for health care providers. Because of the high prevalence of injection drug use among HIV-positive patients admitted to hospital in Vancouver, we explored the factors associated with leaving hospital against medical advice in this population. METHODS: ...

Very few case reports dealing with chronic lymphocytic leukemia (CLL) and hyperleukocytosis have been reported in the medical literature and none with venous thrombosis as a complication. Here, we describe a 73-year-old woman who presented with newly diagnosed CLL, leukostasis, and hyperleukocytosis (2000 x 10(9)/l), affecting the respiratory and nervous ...

BACKGROUND: The ability to secure peripheral intravenous access is regarded as a basic medical skill that is often required for the management of patients admitted to acute medical admission wards. The decision to insert a peripheral intravenous catheter (PIC) is usually taken by relatively inexperienced members of the acute medical ...

Epidemiologic data have shown that the risk of venous thromboembolism (VTE) in medical patients is comparable to the risk in surgical patients. Moreover, autopsy studies demonstrated that 75% of all in-hospital deaths for pulmonary embolism occur in nonsurgical patients. Hospitalized medical patients represent a very heterogeneous population. Patients with medical ...

As part of a study in Danish internship pharmacies, 70 fourth-year pharmacy interns interviewed 123 angina pectoris patients. Information was collected about the patients' medication- and illness-related factual knowledge and perceptions as well as their medication use. The results obtained showed that patients' perceptions and factual knowledge about medications and ...

In 2000, the French authorities licensed the low-molecular-weight heparin (LMWH) enoxaparin for thromboprophylaxis in acutely ill medical patients. However, the lack of official recommendations for this group of patients has contributed to inappropriate use of LMWH. The recent College of Internal Medicine of Paris (CIMOP) and Données Epidémiologiques chez les ...

PURPOSE: To determine whether electroretinogram results can help predict the success in tapering of immunosuppressive medication in patients with birdshot retinochoroidopathy. METHODS: Fifteen patients with birdshot retinochoroidopathy who had at least three serial electroretinograms (ERG) during the course of their disease were included in the study. Charts of patients seen ...

An audit of surgical patients who requested discharge against medical advice over a 5 year period (July 1996-July 2001) at the University of BeninTeaching Hospital showed that 78 patients (66 males and 12 females) were involved. The age range was 3 days to 85 years (mean 37.86 years). The 21-40 ...

It is often considered important that clothing should not be visible in a good medical photograph. Medical illustrators offer the clinical professionalism to allow most of their patients to feel comfortable being photographed. For some patients, however, consenting to medical photography involves more than a temporary embarrassment. This paper seeks ...

Gasping respiration in the dying patient is the last respiratory pattern prior to terminal apnoea. The duration of the gasping respiration phase varies; it may be as brief as one or two breaths to a prolonged period of gasping lasting minutes or even hours. Gasping respiration is very abnormal, easy ...

In this paper I argue that it is morally important for doctors to trust patients. Doctors' trust of patients lays the foundation for medical relationships which support the exercise of patient autonomy, and which lead to an enriched understanding of patients' interests. Despite the moral and practical desirability of trust, ...

The prevalence, management, and adverse events associated with the use of a patient's personal medications in hospitals were studied. A questionnaire comprised of 17 questions was mailed in November 1999 to the pharmacy directors of a random sample of 300 small (< or = 200-bed capacity) hospitals selected from the ...

In this paper, I claim that the doctor-patient relationship can be viewed as a vessel of trust. Nonetheless, trust within the doctor-patient relationship has been impaired by managed care. When we conceive of trust as social capital, focusing on the role that it plays in individual and social well-being, trust ...

Patients expect holistic care from the medical profes-sion. In holistic care, the whole person comprising bodv, mind and spirit is given attention and six dimensions of health (physical, mental, emotional, spiritual, social and environmental) are recognised as being equally impor-tant. Patients&#x2032; needs and expectations have forced the medical profession to ...

CONTEXT: Allergies are the most common immunologic diseases among the general population. Increasing evidence suggests that the incidence of allergic disorders is rising dramatically. Conventional medicine provides only limited relief and does not offer a complete cure to this health problem. Consequently, patients seek additional approaches and therapies to integrate ...

Noncompliance with medication during a symptomatic phase is a common problem in the treatment of schizophrenia patients. In India, a majority of patients live with their families and those families supervise patients' medication intake. In a study of patients attending an urban outpatient care center in India, it was noted ...

PURPOSE: Long-term continuous intrathecal infusion of medications for chronic medical problems is common. We investigated the cause of a cluster of severe neurologic complications in patients with intrathecal catheters. METHODS: We performed an epidemiologic cohort study of patients who had intrathecal catheters in place in one neurosurgical practice, to assess ...

PURPOSE OF INVESTIGATIONS: A wide range of variation exists between the cesarean delivery rates of individual obstetricians in our health district, despite an overall cesarean delivery rate below the national average. This study tested the hypothesis that physician and patient determinants influenced the decision to perform a cesarean delivery by ...

Mr. Edwards is diagnosed with a heart arrhythmia and is treated with a successful regimen of medication. He joins an HMO and begins care under a new doctor who ponders whether he should switch Mr. Edwards' medical regimen. Changing the treatment would save the HMO money that could be allocated ...

The paper presents patterns of medical admissions into the intensive care unit of the Lagos University Teaching Hospital (LUTH) over an eight-year period from September 1990 to August 1998. Medical admission constituted 15% out of which 1% received surgery for medical complications. Patients with neurological diseases recorded the highest number ...