Asunto(s)
Relaciones Interpersonales , Rol Judicial , Jurisprudencia , Relaciones Raciales , Conducta Social , Identificación Social , Antropología Cultural/educación , Antropología Cultural/historia , Colonialismo/historia , Etnicidad/educación , Etnicidad/etnología , Etnicidad/historia , Etnicidad/legislación & jurisprudencia , Etnicidad/psicología , Historia del Siglo XVIII , Historia del Siglo XIX , Humanos , India/etnología , Rol Judicial/historia , Jurisprudencia/historia , Prejuicio , Psicología Social/educación , Psicología Social/historia , Relaciones Raciales/historia , Relaciones Raciales/legislación & jurisprudencia , Relaciones Raciales/psicología , Grupos Raciales/educación , Grupos Raciales/etnología , Grupos Raciales/historia , Grupos Raciales/legislación & jurisprudencia , Grupos Raciales/psicología , Autoimagen , Sociedades/economía , Sociedades/historia , Sociedades/legislación & jurisprudencia , Factores SocioeconómicosRESUMEN
OBJECTIVE: The purpose of this study is to provide a review of the ocular injuries sustained by survivors of the April 19, 1995, bombing of the Alfred P. Murrah Federal Building in Oklahoma City. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: The authors retrospectively evaluated data collected on all surviving persons receiving ocular injuries during the bombing and on all at-risk occupants of the federal building and four adjacent buildings. METHODS: Injury data from survivors were collected from multiple sources to include hospital medical records, a physician survey, emergency medical services run reports, written survivor accounts, building occupant survey, telephone interviews, and mail surveys. MAIN OUTCOME MEASURES: The types of ocular injuries, the associated systemic injuries, and the location of the injured at the time of the blast were evaluated. RESULTS: Fifty-five (8%) of the 684 injured bombing survivors sustained an ocular injury. Persons injured in the Murrah building were more than three times more likely to sustain an ocular injury than other injured persons. Seventy-one percent of ocular injuries occurred within 300 feet of the point of detonation. The most common serious ocular injuries included lid/brow lacerations (20 patients, 23 eyes), open globe injuries (12 eyes), orbital fractures (6 eyes), and retinal detachment (5 eyes). A retained intraocular foreign body accounted for only two of the injuries (4%). Glass accounted for nearly two thirds of the ocular injuries. CONCLUSIONS: Blasts involving explosions inflict severe ocular injury, mostly as a result of secondary blast effects from glass, debris, etc. Eye injuries in bombings can probably be prevented by increasing the distance from and orientation away from windows (i.e., by facing desks away from windows). Use of such products as laminated glass, toughened window glazing, and Mylar curtains may reduce glass projectiles in the blast vicinity.
Asunto(s)
Traumatismos por Explosión/patología , Explosiones , Cuerpos Extraños en el Ojo/patología , Lesiones Oculares Penetrantes/patología , Cejas/lesiones , Párpados/lesiones , Órbita/lesiones , Adolescente , Adulto , Traumatismos por Explosión/epidemiología , Traumatismos por Explosión/etiología , Niño , Preescolar , Víctimas de Crimen , Cuerpos Extraños en el Ojo/epidemiología , Cuerpos Extraños en el Ojo/etiología , Lesiones Oculares Penetrantes/epidemiología , Lesiones Oculares Penetrantes/etiología , Femenino , Vidrio , Humanos , Lactante , Masculino , Persona de Mediana Edad , Oklahoma/epidemiología , Fracturas Orbitales/epidemiología , Fracturas Orbitales/etiología , Fracturas Orbitales/patología , Desprendimiento de Retina/epidemiología , Desprendimiento de Retina/etiología , Desprendimiento de Retina/patología , Estudios Retrospectivos , SobrevivientesRESUMEN
BACKGROUND: Before the "era" of optimal stent deployment, very few data concerning multiple stents in a single coronary artery showed restenosis rates up to 60%. OBJECTIVE: To evaluate the 6-month outcome of patients receiving multiple Palmaz-Schatz stents (> or =2 stents) in a single coronary artery compared to those receiving single stents. METHODS: Three hundred and forty-eight patients having multiple stents were compared to 174 patients receiving single stents during a 6-month follow-up. RESULTS: Repeat target lesion revascularization (RTLR), either repeat PTCA or CABG, was 10.4% in the single-stent group, 22.6% in the two-stent group, and 23.1% in the > or =2 stent group (p = 0.001, single versus 2 or > or =2 stents). There was not a significant difference between single stent and multiple stent groups in myocardial infarction and death during 6-month follow-up. Multivariate analysis showed multiple stents, diabetes mellitus, and type C lesion to be predictors of RTLR. CONCLUSIONS: Placement of two or more stents was associated with a significantly higher RTLR compared with single stent placement. The optimal approach to diffuse coronary artery disease remains to be defined.
Asunto(s)
Implantación de Prótesis Vascular/efectos adversos , Reestenosis Coronaria/terapia , Stents/efectos adversos , Anciano , Angioplastia Coronaria con Balón , Implantación de Prótesis Vascular/mortalidad , Puente de Arteria Coronaria , Reestenosis Coronaria/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/etiología , Infarto del Miocardio/terapia , Reoperación , Factores de Tiempo , Resultado del TratamientoRESUMEN
PURPOSE: The authors compare the intravitreal efficacy of ciprofloxacin, vancomycin and imipenem, in treating experimental Bacillus cereus endophthalmitis. METHODS: Thirty-three Yorkshire pigs received a surgically induced injury to the right eye, which was then repaired and injected with 8400 colony forming units of live B. cereus. Nine pigs received no therapy and served as a natural history group. Twenty-four other pigs then were randomized into a treatment group with ciprofloxacin (n = 6), vancomycin (n = 6), imipenem (n = 6), or normal saline (n = 6). Eyes were examined clinically 1, 2, 3, 4, 5, 6, 8, 12, and 24 hours after inoculation. After 24 hours, the eyes were enucleated for histologic study. RESULTS: Experimental disease was characterized by an aggressively developing endophthalmitis, with retinitis and vitritis developing at 4 hours. Histologic examination showed vitreous abscess and retinal necrosis. Both vancomycin- and imipenem-treated group had less inflammation and tissue destruction than control animals, based on the Wilcoxon rank sum test (P < 0.05). Ciprofloxacin-treated animals showed significantly more intraocular destruction and were indistinguishable from controls. CONCLUSION: Vancomycin and imipenem appear to limit inflammation and tissue destruction when given early in the course of experimental posttraumatic endophthalmitis caused by B. cereus. Results with ciprofloxacin are less conclusive and warrant further investigation.
Asunto(s)
Antibacterianos/uso terapéutico , Infecciones por Bacillaceae/tratamiento farmacológico , Bacillus cereus/aislamiento & purificación , Endoftalmitis/tratamiento farmacológico , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Lesiones Oculares Penetrantes/tratamiento farmacológico , Animales , Antiinfecciosos/uso terapéutico , Infecciones por Bacillaceae/etiología , Infecciones por Bacillaceae/patología , Ciprofloxacina/uso terapéutico , Modelos Animales de Enfermedad , Endoftalmitis/microbiología , Endoftalmitis/patología , Oftalmopatías/tratamiento farmacológico , Oftalmopatías/etiología , Oftalmopatías/microbiología , Infecciones Bacterianas del Ojo/etiología , Infecciones Bacterianas del Ojo/patología , Lesiones Oculares Penetrantes/microbiología , Lesiones Oculares Penetrantes/patología , Imipenem/uso terapéutico , Proyectos Piloto , Distribución Aleatoria , Retinitis/tratamiento farmacológico , Retinitis/etiología , Retinitis/microbiología , Porcinos , Tienamicinas/uso terapéutico , Vancomicina/uso terapéutico , Cuerpo Vítreo/efectos de los fármacos , Cuerpo Vítreo/microbiología , Cuerpo Vítreo/patologíaRESUMEN
Pericardial adhesions subject patients requiring cardiac reoperation to potential injuries of the heart, great vessels, and extracardiac grafts during resternotomy. We evaluated polyvinylpyrrolidone (PVP) and a methlycellulose derivative (MCD) as intraoperative irrigating solutions in the prevention of postoperative pericardial adhesions. Fifteen dogs weighing 15 to 20 kg were divided into three equal cohorts and subjected to left thoracotomy with pericardiotomy. Prior to surgical manipulation, the pericardial cavity was irrigated with either PVP, MCD, or Ringer's lactate (RL). Serosal injury stimulating intraoperative trauma was induced by gauze sponge abrasion of the epicardium and inner surface of the pericardium and by allowing desiccation of serosal surfaces for 30 min. The pericardial cavity was evaluated for adhesion formation 6 weeks postoperatively by reoperation. Two independent observers, unaware of the study solution, evaluated the extent and severity of pericardial adhesions on a 0-4 scale. All dogs in the RL control group had surgically significant adhesions and a mean adhesion score of 3.2 +/- 1.1. In contrast, no PVP- or MCD-treated dog had surgically significant adhesions. The mean adhesion scores were 0.2 +/- 0.4 for PVP and 0.5 +/- 0.7 for MCD. Our results indicate that PVP (P less than 0.004) and MCD (P less than 0.024) significantly reduce pericardial adhesion formation when compared to RL. Clinical application of PVP or MCD for the prevention of pericardial adhesions should reduce morbidity and mortality of cardiac reoperation.
Asunto(s)
Metilcelulosa/uso terapéutico , Pericardio , Complicaciones Posoperatorias/prevención & control , Povidona/uso terapéutico , Adherencias Tisulares/prevención & control , Animales , Cardiopatías/prevención & control , Polímeros , Soluciones , Adherencias Tisulares/patologíaRESUMEN
Generally, the incidence of peritonitis in maintenance peritoneal dialysis programs is calculated as a percentage of the total number of treatments or as the number of episodes per patient-months. Both statistical methods give the wrong impression that peritonitis is seldom observed. However, peritonitis is still the major and unsolved challenge to successful long-term peritoneal dialysis. The lack of a standard and homogeneous definition of peritonitis is another critical point that prevents a rational interpretation of the published experiences. In the present study, dialysate cell counts of greater than 1,100 cells/mm3 were assumed to be the first sign of peritoneal infection. As long as more signs and symptoms are required for recognizing peritonitis (fever, abdominal pains, positive cultures), the statistical probability of making such a diagnosis shows the characteristics of a Poisson distribution. It is concluded that in long-term peritoneal dialysis, the currently used statistical methodology for evaluation of the incidence of peritonitis, including the clinical definition of this complication, is misleading. Dialysate cell counts appear to be the more sensitive sign for early diagnosis of peritonitis.
Asunto(s)
Diálisis Peritoneal/efectos adversos , Peritonitis/etiología , Uremia/terapia , Adulto , Anciano , Humanos , Persona de Mediana Edad , Peritonitis/diagnóstico , Estudios ProspectivosAsunto(s)
Fonética , Adolescente , Adulto , Anciano , Femenino , Humanos , Lenguaje , Masculino , Persona de Mediana EdadRESUMEN
The effectiveness of 1alpha-hydroxycholecalciferol [1alpha-OH)D3] in healing uremic bone disease was investigated in 10 uremic patients on maintenance dialysis. Seven patients received 1alpha-(OH)D3, 2 microgram/day, for six months, and three patients served as a control group. Bone density was determined from X-rays of the second phalanx of the second digit. The apparent intestinal calcium absorption improved on treatment with 1alpha-(OH)D3, serum calcium levels and bone density significantly increased, and a significant decrease in serum alkaline phosphatase activity was observed. In one patient, reversal of uremic myopathy occurred after 17 days of 1alpha-(OH)D3 therapy.
Asunto(s)
Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/tratamiento farmacológico , Hidroxicolecalciferoles/uso terapéutico , Absorciometría de Fotón , Fosfatasa Alcalina/sangre , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/sangre , Humanos , Hipocalcemia/sangre , Hipocalcemia/tratamiento farmacológico , Mucosa Intestinal/metabolismo , Uremia/tratamiento farmacológicoRESUMEN
Persistence in the serum of free and conjugated sulphamethoxazole was estimated in five normal controls and in nine uraemic patients with creatinine clearances under 20 ml/min, after a single one-gram dose of the drug. In the uraemic group delayed disappearance of the free drug was found. Conjugated sulphamethoxazole retention was 62.44% at 24 hr after the oral load, and 13.7% 19 days later. Risk of accumulation of sulphamethoxazole in uraemia is emphasised. Re-evaluation of the use of this drug in patients with impaired renal function is recommended.