RESUMEN
INTRODUCTION: Postoperative delirium is common in older patients. Despite its prognostic significance, the pathophysiology is incompletely understood. Although many risk factors have been identified, no reversible factors, particularly ones potentially modifiable by anaesthetic management, have been identified. The goal of this prospective cohort study was to investigate whether intraoperative hypotension was associated with postoperative delirium in older patients undergoing major non-cardiac surgery. METHODS: Study subjects were patients >65 years of age, undergoing major non-cardiac surgery, who were enrolled in an ongoing prospective observational study of the pathophysiology of postoperative delirium. Intraoperative blood pressure was measured and predefined criteria were used to define hypotension. Delirium was measured by the Confusion Assessment Method on the first two postoperative days. Data were analysed using t-tests, two-sample proportion tests and ordered logistic regression multivariable models, including correction for multiple comparisons. RESULTS: Data from 594 patients with a mean age of 73.6 years (sd 6.2) were studied. Of these 178 (30%) developed delirium on day 1 and 176 (30%) on day 2. Patients developing delirium were older, more often female, had lower preoperative cognitive scores, and underwent longer operations. Relative hypotension (decreases by 20, 30, or 40%) or absolute hypotension [mean arterial pressure (MAP)<50 mm Hg] were not significantly associated with postoperative delirium, nor was the duration of hypotension (MAP<50 mm Hg). Conversely, intraoperative blood pressure variance was significantly associated with postoperative delirium. DISCUSSION: These results showed that increased blood pressure fluctuation, not absolute or relative hypotension, was predictive of postoperative delirium.
Asunto(s)
Presión Sanguínea , Delirio/epidemiología , Hipotensión/epidemiología , Complicaciones Intraoperatorias/epidemiología , Procedimientos Quirúrgicos Operativos , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios Prospectivos , Factores de RiesgoRESUMEN
The objectives of this pilot-scale study were to (1) evaluate the effectiveness of bioremediation of trichloroethylene (TCE)-contaminated groundwater with the supplement of slow polycolloid-releasing substrate (SPRS) (contained vegetable oil, cane molasses, surfactants) under reductive dechlorinating conditions, (2) apply gene analyses to confirm the existence of TCE-dechlorinating genes, and (3) apply the real-time polymerase chain reaction (PCR) to evaluate the variations in TCE-dechlorinating bacteria (Dehalococcoides spp.). Approximately 350L of SPRS solution was supplied into an injection well (IW) and groundwater samples were collected and analyzed from IW and monitor wells periodically. Results show that the SPRS caused a rapid increase of the total organic carbon concentration (up to 5794mg/L), and reductive dechlorination of TCE was significantly enhanced. TCE dechlorination byproducts were observed and up to 99% of TCE removal (initial TCE concentration=1872µg/L) was observed after 50 days of operation. The population of Dehalococcoides spp. increased from 4.6×10(1) to 3.41×10(7)cells/L after 20 days of operation. DNA sequencing results show that there were 31 bacterial species verified, which might be related to TCE biodegradation. Results demonstrate that the microbial analysis and real-time PCR are useful tools to evaluate the effectiveness of TCE reductive dechlorination.
Asunto(s)
Chloroflexi/crecimiento & desarrollo , Coloides/química , Agua Subterránea/química , Tricloroetileno/aislamiento & purificación , Contaminantes Químicos del Agua/aislamiento & purificación , Purificación del Agua/métodos , Biodegradación Ambiental , Chloroflexi/genética , ADN Bacteriano/genética , Proyectos Piloto , ARN Ribosómico 16S/genética , Taiwán , Microbiología del AguaRESUMEN
AIM: In-hospital outcome of acute type B dissection (ABAD) is strongly related to preoperative aortic conditions. In order to clarify the influence of the clinical presentation on the outcome, we analyzed the patients of the International Registry of Acute Aortic Dissection (IRAD). All patients affected by complicated ABAD, enrolled in the IRAD from 1996-2004, were included. Complications were defined as the presence of shock, periaortic hematoma, spinal cord ischemia, preoperative mesenteric ischemia/infarction, acute renal failure, limb ischemia, recurrent pain, refractory pain or refractory hypertension (group I). All other patients were categorized as uncomplicated (group II). A comprehensive analysis was performed of all clinical variables in relation to in-hospital outcome. RESULTS: The overall in-hospital mortality among 550 patients was 12.4%. Mortality in group I (250 patients) was 20.0 %, compared to 6.1% in group II (300 patients) (P<0.001). Univariate predictors of ABAD complications were Marfan syndrome, abrupt onset of pain, migrating pain, any focal neurological deficits, need for higher number of diagnostic examinations and use of magnetic resonance and/or aortogram, abdominal vessels involvement at aortogram, larger descending aortic diameter, especially >6 cm, pleural effusion, and widened mediastinum on chest X-ray. Univariate predictors of a non complicated status were normal chest X-ray and medical management. In group I, in-hospital mortality following surgical and endovascular intervention were 28.6% and 10.1% (P=0.006), respectively. Independent predictors of overall in-hospital mortality included age >70 years, female gender, ECG showing ischemia, preoperative acute renal failure, preoperative limb ischemia, periaortic hematoma, and surgical management. The only independent variable protective for mortality was magnetic resonance as diagnostic test. CONCLUSION: ABAD is a heterogeneous disease that produces dissimilar clinical subsets, each of which can have specific clinical signs, management and in-hospital results. In IRAD ABAD uncomplicated patients, medical therapy was associated with best hospital outcome, while endovascular interventions were associated with better results than surgery when invasive treatments were required. Although selection bias may be possible, and irrespective of treatments, knowledge of significant risk factors for mortality may contribute to a better management and a more defined risk-assessment in patients affected by ABAD.
Asunto(s)
Aneurisma de la Aorta Torácica/cirugía , Disección Aórtica/cirugía , Evaluación de Resultado en la Atención de Salud , Sistema de Registros , Procedimientos Quirúrgicos Vasculares , Enfermedad Aguda , Anciano , Disección Aórtica/diagnóstico , Disección Aórtica/mortalidad , Aneurisma de la Aorta Torácica/diagnóstico , Aneurisma de la Aorta Torácica/mortalidad , Aortografía , Femenino , Estudios de Seguimiento , Mortalidad Hospitalaria/tendencias , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Estados Unidos/epidemiologíaRESUMEN
The objective of this study was to evaluate the potential of applying acid/H(2)O(2)/basic oxygen furnace slag (BOF slag) and acid/S(2)O(8)(2-)/BOF slag systems to enhance the chemical oxidation of trichloroethylene (TCE)-contaminated groundwater. Results from the bench-scale study indicate that TCE oxidation via the Fenton-like oxidation process can be enhanced with the addition of BOF slag at low pH (pH=2-5.2) and neutral (pH=7.1) conditions. Because the BOF slag has iron abundant properties (14% of FeO and 6% of Fe(2)O(3)), it can be sustainably reused for the supplement of iron minerals during the Fenton-like or persulfate oxidation processes. Results indicate that higher TCE removal efficiency (84%) was obtained with the addition of inorganic acid for the activation of Fenton-like reaction compared with the experiments with organic acids addition (with efficiency of 10-15% lower) (BOF slag=10gL(-1); initial pH=5.2). This could be due to the fact that organic acids would compete with TCE for available oxidants. Results also indicate that the pH value had a linear correlation with the observed first-order decay constant of TCE, and thus, lower pH caused a higher TCE oxidation rate.
Asunto(s)
Agua Dulce/química , Tricloroetileno/química , Contaminantes Químicos del Agua/química , Peróxido de Hidrógeno/química , Concentración de Iones de Hidrógeno , Oxidantes/química , Oxidación-Reducción , Ésteres del Ácido Sulfúrico/química , Tricloroetileno/análisis , Contaminantes Químicos del Agua/análisisRESUMEN
The main objective of this study was to evaluate the feasibility of remediating tetrachloroethylene (PCE)-contaminated groundwater (with initial PCE concentration of approximately 20 mg L(-1)) via persulfate oxidation activated by basic oxygen furnace slag (S(2)O(8)(2-)/BOF slag) with the addition of biodegradable surfactant (Tween 80). Results indicate that only 15% of PCE can be removed in experiment with the addition of S(2)O(8)(2-) only (S(2)O(8)(2-)/PCE=30/1). PCE removal can be increased to 31% while both S(2)O(8)(2-) and BOF slag (10 g L(-1)) were added. This indicates that BOF slag was able to activate the persulfate oxidation mechanism, and cause the decrease in PCE concentration via oxidation process. Results also reveal that PCE degradation rates increased to 92% with the presence of Tween 80 (S(2)O(8)(2-)/Tween 80/PCE=30/2/1). In the presence of 10 g L(-1) BOF slag, the reaction rate constant (k(obs)) values were found to be 3.1 x 10(-3), 8.7 x 10(-3), 1.6 x 10(-2), and 5.8 x 10(-2)h(-1), as the S(2)O(8)(2-)/Tween 80/PCE molar ratios were 30/0/1, 30/0.5/1, 30/1/1, and 30/2/1, respectively. The reaction rate constant increased as the Tween 80 concentration increased. The significantly increased k(obs) could be caused by the enhanced solubilization of PCE by Tween 80. The increase in initial surfactant concentration would cause the increase in the solubilization of PCE, and thus, enhance the oxidation rate. This was confirmed by the total amount of chloride ions produced after the reaction. Results from this study indicate that BOF slag-activated persulfate oxidation enhanced by surfactant addition is a potential method to efficiently and effectively remediate chlorinated solvents contaminated groundwater.
Asunto(s)
Tetracloroetileno/química , Contaminantes Químicos del Agua/análisis , Purificación del Agua/métodos , Cloro/química , Peróxido de Hidrógeno/química , Concentración de Iones de Hidrógeno , Cinética , Modelos Químicos , Oxígeno/química , Polisorbatos/química , Solubilidad , Solventes/química , Sulfatos/química , Tensoactivos/química , Agua/química , Contaminantes Químicos del Agua/aislamiento & purificaciónRESUMEN
The contamination of subsurface soils with petroleum hydrocarbons is a widespread environmental problem. The objective of this study was to evaluate the potential of applying waste basic oxygen furnace slag (BOF slag) as the catalyst to enhance the Fenton-like oxidation to remediate fuel oil or diesel contaminated soils. The studied controlling factors that affect the removal efficiency of petroleum hydrocarbons included concentrations of H(2)O(2), BOF slag dosages, types of petroleum hydrocarbons (e.g., fuel oil and diesel), and types of iron mineral. Experimental results indicate that oxidation of petroleum hydrocarbon via the Fenton-like process can be enhanced with the addition of BOF slag. Results from the X-ray powder diffraction analysis reveal that the major iron type of BOF slag/sandy loam system was iron mineral (e.g., alpha-Fe(2)O(3) and alpha-FeOOH). Approximately 76% and 96% of fuel oil and diesel removal were observed (initial total petroleum hydrocarbon (TPH) concentration=10,000 mg kg(-1)), respectively, with the addition of 15% of H(2)O(2) and 100 g kg(-1) of BOF slag after 40 h of reaction. Because BOF slag contains extractable irons such as amorphous iron and soluble iron, it can act as an iron sink to supply iron continuously for Fenton-like oxidation. Results demonstrate that Fenton-like oxidation catalyzed by BOF slag is a potential method to be able to remediate petroleum-hydrocarbon contaminated soils efficiently and effectively.
Asunto(s)
Hidrocarburos/química , Peróxido de Hidrógeno/química , Residuos Industriales/prevención & control , Petróleo , Contaminantes del Suelo/química , Catálisis , Restauración y Remediación Ambiental/métodos , Oxidación-ReducciónRESUMEN
Acute aortic dissection is a rare but deadly disease first described over 200 years ago by the physician to the late King George II on necropsy. Over the ensuing 2 centuries, the understanding of the pathophysiology, presentation, diagnosis, treatment and follow-up has matured. In an effort to understand the contemporary treatment of this disease, the International Registry of Acute Aortic Dissection (IRAD) has enrolled over 2000 patients over the past 12 years. In this article we summarize the key lessons learned from this multi-national registry of patients presenting with acute aortic dissection.
Asunto(s)
Aneurisma de la Aorta/terapia , Disección Aórtica/terapia , Cooperación Internacional , Sistema de Registros , Procedimientos Quirúrgicos Vasculares , Enfermedad Aguda , Anciano , Disección Aórtica/diagnóstico , Disección Aórtica/etiología , Disección Aórtica/mortalidad , Aneurisma de la Aorta/diagnóstico , Aneurisma de la Aorta/etiología , Aneurisma de la Aorta/mortalidad , Progresión de la Enfermedad , Femenino , Hematoma/complicaciones , Mortalidad Hospitalaria , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/efectos adversos , Procedimientos Quirúrgicos Vasculares/mortalidadRESUMEN
The industrial solvent trichloroethylene (TCE) is among the most ubiquitous chlorinated solvents found in groundwater contamination. The main objectives of this study were to evaluate the feasibility of using non-ionic surfactant Simple Green (SG) to enhance the oxidative dechlorination of TCE by potassium permanganate (KMnO4) employing a continuous stir batch reactor system (CSBR) and column experiments. The effect of using surfactant SG to enhance the biodegradation of TCE via aerobic cometabolism was also examined. Results from CSBR experiments revealed that combination of KMnO4 with surfactant SG significantly enhanced contaminant removal, particularly when the surfactant SG concentrated at its CMC. TCE degradation rates ranged from 74.1% to 85.7% without addition of surfactant SG while TCE degradation rates increased to ranging from 83.8% to 96.3% with presence of 0.1wt% SG. Furthermore, results from column experiments showed that TCE was degraded from 38.1microM to 6.2microM in equivalent to 83.7% of TCE oxidation during first 560min reaction. This study has also demonstrated that the addition of surfactant SG is a feasible method to enhance bioremediation efficiency for TCE contaminated groundwater. The complete TCE degradation was detected after 75 days of incubation with both 0.01 and 0.1wt% of surfactant SG addition. Results revealed that surfactant enhanced chemical oxidation and bioremediation technology is one of feasible approaches to clean up TCE contaminated groundwater.
Asunto(s)
Técnicas de Química Analítica/métodos , Compuestos de Manganeso/química , Óxidos/química , Tensoactivos/química , Tricloroetileno/química , Contaminantes Químicos del Agua/química , Agua/análisis , Agua/química , Técnicas de Química Analítica/instrumentación , Oxidación-Reducción , SolucionesRESUMEN
Monitoring eye movements is clinically important in diagnosis of diseases of the central nervous system. Electrooculography (EOG) is one method of obtaining such records which uses skin electrodes, and utilizes the anterior posterior polarization of the eye. A new EOG diagnostic system has been developed that utilizes two off-the-shelf portable notebook computers, one projector and simple electronic hardware. It can be operated under Windows 95, 98, NT, and has significant advantages over any other similar equipment, including programmability, portability, improved safety and low cost. Especially, portability of the instrument is extremely important for acutely ill or handicapped patients. The purpose of this paper is to introduce the techniques of computer animation, data acquisition, real time analysis of measured data, and database management to implement a portable, programmable and inexpensive contacting EOG instrument. It is very convenient to replace the present expensive, inflexible and large-sized commercially available EOG instruments. A lot of interesting stimulation patterns for clinical application can be created easily in different shape, time sequence, and colour by programming in Delphi language. With the help of Winstar (a software package that is used to control I/O and interrupt functions of the computer under Windows 95, 98, NT), the I/O communication between two notebook computers and A/D interface module can be effectively programmed. In addition, the new EOG diagnostic system is battery operated and it has the advantages of low noise as well as isolation from electricity. Two kinds of EOG tests, pursuit and saccade, were performed on 20 normal subjects with this new portable and programmable instrument. Based on the test result, the performance of the new instrument is superior to the other commercially available instruments. In conclusion, we hope that it will be more convenient for doctors and researchers to do the clinical EOG diagnosis and basic medical science research by using this new creation.
Asunto(s)
Electrooculografía/instrumentación , Movimientos Oculares , Interpretación de Imagen Asistida por Computador , Adulto , Computadores , Costos y Análisis de Costo , Electrooculografía/economía , Movimientos Oculares/fisiología , Femenino , Humanos , Masculino , Modelos Teóricos , Movimientos Sacádicos/fisiología , Seguridad , Programas InformáticosRESUMEN
BACKGROUND: Wide variation exists in acute myocardial infarction (AMI) management, leading to differences in outcomes. OBJECTIVE: To assess the impact of the quality improvement initiative on appropriate management of AMI. DESIGN: Prospective patient identification, retrospective medical record review. PATIENTS: All patients with AMI discharged alive (N = 497) from our institution between April 1, 1995, and February 28, 1997. MAIN OUTCOME MEASURE: The effect of quality improvements directed at the patient, nurse, and physician on the adherence to key quality indicators. RESULTS: The quality improvement initiative correlated with more frequent use of reperfusion therapy (98%), and with aspirin use in the emergency department (95%), in ideal eligible patients. Similarly, adherence to discharge quality indicators, including use of aspirin (97%), beta-blockers (94%), angiotensin-converting enzyme inhibitors (90%), and lipid-lowering agents (67%); avoidance of calcium channel blockers (93%); a low-fat diet (96%); smoking cessation counseling (94%); and outpatient rehabilitation referral (70%) was higher, including in the very old (those aged >/=80 years) and in women. The use of a patient education tool was associated with a higher adherence to most quality indicators compared with patients in whom this was not used: discharge aspirin (99% vs 96%; P =.02), beta-blocker (98% vs 91%; P =.002), angiotensin-converting enzyme inhibitor (95% vs 86%; P =.01), and lipid-lowering agent (71% vs 62%; P =.04) use; outpatient rehabilitation (82% vs 63%; P=.001); and documentation of smoking cessation counseling (98% vs 87%; P =. 001). CONCLUSIONS: Implementation of a quality improvement program was associated with a high adherence to quality-of-care indicators for AMI. Patient-directed feedback before discharge improved adherence to key indicators for AMI beyond that achieved with tools only directed at caregivers.
Asunto(s)
Servicio de Cardiología en Hospital/normas , Infarto del Miocardio/terapia , Gestión de la Calidad Total/organización & administración , Adulto , Anciano , Anciano de 80 o más Años , Vías Clínicas , Femenino , Adhesión a Directriz , Humanos , Masculino , Michigan , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Educación del Paciente como Asunto , Estudios Prospectivos , Estudios RetrospectivosRESUMEN
A 40-year-old normotensive man suddenly developed diplopia, tinnitus and a burning sensation on the left side of his body while driving a motorcycle. He did not complain of headache, nausea or vomiting. Neurologic examination revealed left trochlear nerve palsy and impaired pinprick, temperature and joint position sensation of the left limbs. There was no ptosis or motor deficit. He had a mild bleeding diathesis due to alcoholic liver cirrhosis. Computerized tomography and magnetic resonance image of the brain disclosed hemorrhages in the right midbrain tectum and the left temporal lobe. After nine months of observation, there was nearly complete recovery of symptoms, except for mild residual diplopia. From a literature review, only nine case of midbrain tectal hemorrhage involving the inferior colliculus have been reported. These patients had a unique clinical presentation. Diplopia due to trochlear nerve palsy, either unilateral or bilateral, was present in all of the cases. Tinnitus and sensory disturbance contralateral to the lesion side were very common. Only three patients had risk factors for hemorrhage, including bleeding diathesis, hypertension and vascular anomalies. In the majority of patients, no underlying causes were detected. The outcome was favorable with conservative treatment.
Asunto(s)
Colículos Inferiores , Hemorragias Intracraneales/complicaciones , Enfermedades del Nervio Troclear/etiología , Adulto , Humanos , MasculinoRESUMEN
The antisaccadic paradigm can be applied to test the suppression of reflexive saccades and the activation of volitional saccades simultaneously. The impaired frontal cortex has been shown to have difficulty in suppressing reflexive saccade (prosaccade) to make a successful antisaccade. Degraded antisaccade performance can also be observed in patients with Parkinson's disease (PD). The studies of PD based on the prosaccadic and antisaccadic paradigms have shown controversial findings; the latency between patients and age-matched controls could be either with or without significant difference. Even with this inconsistency, our previous study and recent analysis have supported that the latency of both prosaccade and antisaccade increases significantly for patients with PD. The objective of this study is to investigate whether prolonged antisaccade latency is caused by the affected volitional decision process (volition latency) or simply by the delayed initiation of saccade with direction opposite to the cue, by measuring prosaccade and antisaccade latency from the intermingled paradigms. Eleven mildly affected patients with idiopathic PD and eight age-matched normal subjects were tested in this study. As compared to the age-matched control, the results showed that prosaccade, antisaccadic, and volition latency of the patients was significantly elevated (P<0.01). We conclude that antisaccade performance for the PD patients was degraded for both the volition decision process and the initiation of saccade with direction opposite to the cue. Also, volition latency analysis is a more objective method than prosaccade and antisaccade latency analysis, which can be compared among results obtained from different analysis methodologies.
Asunto(s)
Tiempo de Reacción , Movimientos Sacádicos/fisiología , Volición/fisiología , Anciano , Electrooculografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedad de Parkinson/fisiopatología , Reflejo/fisiologíaRESUMEN
Traditional parameters, such as latency and peak velocity, have been used for quantitative analysis of saccade dynamics. However, saccades of equal magnitude which differ substantially in dynamics may still have the same peak velocity. This lack of selectivity might degrade the efficacy of the peak velocity measurement in discriminating patients from normal subjects. In this study, an alternative parameter, the damping ratio of a second-order response, is proposed to concisely and accurately describe saccadic dynamics. A measurement of damping ratio is made by considering the response curve of saccade as the step response of a second-order transfer function. Using the least-mean-square algorithm, the second-order function has been optimized to fit the response of the saccade dynamics with the latency removed. Nineteen normal subjects (ten young and nine older) and 16 patients of Parkinson's disease (eight mildly affected and eight advanced affected) were tested for eye movements in response to pseudorandom saccadic stimuli. While the traditional peak velocity had difficulties in differentiating between the saccadic dynamics of normal and Parkinson subjects, the damping ratio is sensitive enough not only to highlight the difference between a group of patients mildly affected with Parkinson's disease and an age-matched normal group (p<0.01; abnormal versus normal), but also to distinguish between groups at different ages (p<0.01; younger versus older). It is proposed that the damping ratio could be a useful parameter in analyzing saccadic dynamics.
Asunto(s)
Enfermedad de Parkinson/fisiopatología , Movimientos Sacádicos/fisiología , Adulto , Anciano , Algoritmos , Ingeniería Biomédica , Estudios de Casos y Controles , Humanos , Persona de Mediana Edad , Modelos Biológicos , Estimulación LuminosaRESUMEN
This study was designed prospectively to evaluate the development of anti-p53 antibodies (Abs) in lung cancer patients in relation to their clinical outcome. Sera, derived from 125 lung cancer patients, consisting of 14 small cell lung cancers (SCLC) and 111 non-SCLCs (NSCLC), were surveyed. The p53-null human NSCLC cell line, NCI-H1299, transfected with a human mutant p53 gene was prepared as the source of p53 antigen for immunoblotting analyses to detect the presence of serum anti-p53 Abs. The control group included sera from 10 healthy adults and 14 patients with benign pulmonary diseases. Clinical data including staging and survival were recorded for statistical analyses. The anti-p53 Abs were found in 8% (10 of 125) of the lung cancer patients studied (8.1% of NSCLC versus 7.1% of SCLC patients), whereas none of the control sera had detectable anti-p53 Abs. The presence of anti-p53 Abs was closely associated with malignant pleural effusions (P = 0.001). The p53 Ab-positive patients had a worse prognosis than the p53 Ab-negative patients (P < 0.02; median survival, 20 versus 41 weeks). In both univariate and multivariate analyses, the tumor extension and probably the presence of anti-p53 Abs were significant predictors for cancer death. The development of anti-p53 Abs (n = 9) was also a predictor for poor survival in patients with malignant effusions (n = 51). In conclusion, the presence of serum anti-p53 Abs is closely associated with malignant pleural effusions in lung cancer patients. It may serve as a negative prognostic factor for survival independent of malignant pleural effusions and tumor staging.
Asunto(s)
Anticuerpos Antineoplásicos/sangre , Autoanticuerpos/sangre , Biomarcadores de Tumor/sangre , Carcinoma de Pulmón de Células no Pequeñas/inmunología , Carcinoma de Células Pequeñas/inmunología , Neoplasias Pulmonares/inmunología , Derrame Pleural Maligno/inmunología , Proteína p53 Supresora de Tumor/inmunología , Anticuerpos Antineoplásicos/inmunología , Autoanticuerpos/inmunología , Carcinoma de Pulmón de Células no Pequeñas/sangre , Carcinoma de Pulmón de Células no Pequeñas/complicaciones , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico , Carcinoma de Células Pequeñas/sangre , Carcinoma de Células Pequeñas/complicaciones , Carcinoma de Células Pequeñas/diagnóstico , Femenino , Humanos , Neoplasias Pulmonares/sangre , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/diagnóstico , Masculino , Análisis Multivariante , Estadificación de Neoplasias , Derrame Pleural Maligno/sangre , Derrame Pleural Maligno/etiología , Pronóstico , Estudios Prospectivos , Tasa de SupervivenciaRESUMEN
Sarcoidosis is a multisystem disorder of unknown causes, characterized by widespread noncaseating epithelioid cell granuloma in more than one organ. It is rare among Chinese people. In recent years, a rapidly increasing incidence among inpatients of the Veterans General Hospital-Taipei has been noted. We retrospectively reviewed the records at our hospital from January 1960 through December 1995. We found 38 cases of sarcoidosis with biopsy-proven involvement of at least one organ system, in addition to either a typical clinical manifestation or chest radiograph. The disease-specific rate per thousand admissions increased from 0.0025 in the 1960s to 0.004 in the 1980s: for 1990 to 1995, it jumped to 0.027. Two possible explanations for the increasing incidence are greater awareness and recognition of this disease among physicians and pathologists, and advances in invasive diagnostic techniques and histopathology. Compared with patients in Western countries, sarcoidosis among Chinese patients in Taiwan had the following characteristics: 1) a higher frequency of patients (97%) had intrathoracic involvement, 2) there was a low incidence of hypercalcemia and hyperglobulinemia, and 3) there was an inclination toward older age at presentation. In conclusion, the incidence of sarcoidosis among Chinese in Taiwan has increased in the past 3 decades. The clinical presentations of patients differed from those reported from Western countries.
Asunto(s)
Sarcoidosis/epidemiología , Adulto , Anciano , Calcio/sangre , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Taiwán/epidemiologíaRESUMEN
Pleural effusion is often a manifestation of the superior vena cava (SVC) syndrome. However, pleural effusion has never been reported to be a cause of the SVC syndrome. We report the case of a 68 yr old male patient who presented with SVC syndrome and respiratory failure, both attributable to an encapsulated pleural effusion over the right upper mediastinum. Simple drainage was performed as a diagnostic and therapeutic procedure. The pleural effusion was confirmed to be a tuberculous empyema. Chest computed tomography (CT) scan is the most appropriate initial diagnostic procedure for superior vena cava syndrome.
Asunto(s)
Empiema Tuberculoso/complicaciones , Derrame Pleural/complicaciones , Síndrome de la Vena Cava Superior/etiología , Anciano , Drenaje , Empiema Tuberculoso/diagnóstico por imagen , Empiema Tuberculoso/terapia , Humanos , Masculino , Derrame Pleural/diagnóstico por imagen , Derrame Pleural/terapia , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVES: Foreign body aspiration into the lower airway in adults is uncommon. We designed this study to investigate the clinical presentations, precipitating factors, management choice, and complications of foreign body aspiration in Chinese adults. PATIENTS AND METHODS: We analyzed 43 consecutive adult patients with foreign body aspiration between February 1980 and December 1995 from the medical record registry and cross index system of a tertiary medical center. RESULTS: The most common symptoms are chronic cough, hemoptsis, fever, and dyspnea. Only three patients (7%) presented with choking. Chest radiograph demonstrated the foreign body in nine cases (21%). The most common foreign body was bone fragments (21/43, 49%). Lodgment is more common in the right, especially the right intermediate bronchus and basal bronchus. Three patients were also diagnosed as having lung cancers. Precipitating factors include CNS dysfunction, facial trauma, intubation, dental procedure, and underlying pulmonary diseases. Flexible fiberoptic bronchoscopy removed the foreign body in 25 cases (58%) during the first attempt and 32 cases (74%) in total. Complications include obstructive pneumonitis (including one case of actinomycosis infection), atelectasis, bronchiectasis, lung abscess, and lung torsion (two cases). CONCLUSION: The nature of foreign body in Chinese adults was different from the Western adults. The initial clues to foreign body aspiration in adults are usually obscure or indirect. We suggest flexible fiberoptic bronchoscopy as the first-line approach. Follow-up bronchoscopy and chest radiograph are recommended to detect chronic complications or coexisting lung cancer.
Asunto(s)
Bronquios , Cuerpos Extraños/epidemiología , Pulmón , Adulto , Anciano , Broncoscopía , Femenino , Cuerpos Extraños/complicaciones , Cuerpos Extraños/diagnóstico , Cuerpos Extraños/terapia , Humanos , Inhalación , Masculino , Persona de Mediana Edad , Taiwán/epidemiologíaRESUMEN
Alterations in the tumor suppressor gene p53 may represent a useful prognostic marker of premalignant or malignant disease in Barrett's dysplasia or esophageal adenocarcinoma. Immunohistochemistry was used to establish the ability to detect nuclear accumulation of altered p53 protein in esophageal brushings as well as biopsies, and to examine for p53 alterations in a group of 18 patients with Barrett's esophagus enrolled in a surveillance and endoscopy program, p53 protein accumulation was easily detected in esophageal brushings, and the results correlated well with matched biopsies (9/11). In patients enrolled in surveillance endoscopy, 1 brushing of 22 was positive for p53 protein accumulation. In this patient, who received preoperative radiation and chemotherapy, the positive p53 result correlated with positive cytology for residual adenocarcinoma. All Barrett's esophagus brushings negative for p53 protein were benign by cytologic, morphologic criteria. The immunohistochemical detection of p53 alterations in esophageal brushing and biopsy specimens may provide useful information in patients undergoing surveillance for esophageal dysplasia and adenocarcinoma.
Asunto(s)
Adenocarcinoma/diagnóstico , Esófago de Barrett/diagnóstico , Neoplasias Esofágicas/diagnóstico , Proteína p53 Supresora de Tumor/análisis , Adenocarcinoma/patología , Esófago de Barrett/patología , Biopsia , Endoscopía , Neoplasias Esofágicas/patología , Esófago/química , Esófago/citología , Humanos , Técnicas para InmunoenzimasRESUMEN
BACKGROUND: Monoamine oxidase B (MAO-B) may play a role in the progression and cause of Parkinson's disease (PD), given consideration of the biochemistry and pathophysiology of the disease, and experiments on primates and humans. Assuming that the structural gene determines enzyme activity, an association study was undertaken to examine MAO-B genetic polymorphisms and look for the unique MAO-B gene alleles which occurred at a higher frequency in PD patients. METHODS: Sixty-five PD patients, diagnosed according to the criteria set by a Core Assessment Program for Intracerebral Transplantations Committee, and 108 healthy controls were enrolled in this study. Genomic DNA was extracted from peripheral leukocytes by using a puregene kit. Polymerase chain reaction (PCR) was used to amplify the MAO-B genome. The PCR products were screened by restriction enzyme Hae III digestion and analyzed by single-stranded conformational polymorphism (SSCP). RESULTS: Two bands with different mobility shifts, defined as MAO-B allele 1 and allele 2, were observed in SSCP analysis. Neither genotypes nor allelic frequencies of MAO-B showed a significant difference between PD patients and controls in our study. CONCLUSIONS: Polymorphism of MAO-B genome was demonstrated in this study. It failed to show an association of a genetic marker with PD. However, this did not necessarily exclude the MAO-B locus from playing a role in causing PD because a polymorphism different from the one evaluated here may show some disease association.
Asunto(s)
Monoaminooxidasa/genética , Enfermedad de Parkinson/genética , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Polimorfismo Genético , Polimorfismo Conformacional Retorcido-SimpleRESUMEN
Studies of eye movements in patients with Huntington's disease (HD) have suggested that frontal lobe-basal ganglia structures are more involved in HD than the parietal lobes. To test this hypothesis further we compared the ability of HD patients and normal subjects to direct "covert" visual attention, using saccade latency and thumb press reaction time tasks that have been shown to be sensitive to parietal lobe dysfunction. Subjects were instructed to move their eyes or to press a button when a peripheral target was illuminated. The peripheral stimulus appeared at various intervals after the appearance of a central arrow(s) that pointed in the direction of the target (valid cue), in the opposite direction (invalid cue), or pointed simultaneously in both directions (neutral cue). For both saccade and thumb press paradigms, the difference in the latencies for trials with invalid and valid cues was the same in HD patients and normals. These findings suggest that the ability to direct visual attention is normal in HD and are compatible with the hypothesis that in HD, frontal-basal-ganglia circuits are more affected than parietal lobe pathways.