Treatment of vertigo with betaserk in patients with vascular and traumatic cerebral injuries

Managed care's focus on patient-centered care has made the need for point-of-care (POC) clinical systems more critical than ever. This article examines some of the more common POC options available, explains what nurses need to know to choose among them, and suggests ways to ensure that nursing's needs are addressed in the selection process.     

Channel segregation during solidification and the effects of an alternating traveling magnetic field

The model proposed by Felicelli, Heinrich, and Poirier is used to simulate the solidification of a small two-dimensional domain of Pb-10 wt pct Sn alloy in the presence of electromagnetic stirring by different traveling fields, with or without gravity. Results show (a) enrichment of the bulk liquid by mush solute draining; (b) spontaneous formation of vertical channels, acting as ducts, significantly modified by the electromagnetic flow; and possibly (c) a finer periodic structure of subchannels. Only the last feature is sensitive to the mesh size and permeability value. Scaling analysis is used to balance Darcy, buoyancy, and electromagnetic phenomena. Attention is focused on the gradient zone at the solidification front. Electromagnetic forces can change the flow structure in the bulk liquid. In this way, they modify the pressure differences at the solidification front, changing the channel segregation pattern. Although they cannot eliminate the channels, they can control their positions and partly prevent the unsteadiness of buoyancy effects.     

The sublimation of an electrically conducting droplet through the use of an external alternating magnetic field

A nondimensionalized mathematical model is developed for a stationary, electrically conducting, spherical droplet undergoing equilibrium sublimation. Sublimation is caused by the presence of an external, alternating magnetic field generated by a current carrying solenoid. The model incorporates the influence of magnetic field parameters, phase change, and radiative heat transfer. Numerical results from the model are compared with sublimation rates obtained from experimentation.     

Detecting vascular problems in patients with diabetes treated with an intra-aortic balloon pump

Individuals with diabetes are at increased risk for both peripheral vascular disease and coronary artery disease. In patients with severe coronary artery disease, a cardiac assist device called an intra-aortic balloon pump (IABP) often is used to aid the failing heart and prevent further cardiac ischemia. Because this device is inserted via the femoral artery, patients are at risk of limb ischemia distal to the insertion site. Patients with diabetes are particularly prone to this complication. Detecting the early signs and symptoms of ischemia is crucial to preventing serious sequelae. Standard vascular examination techniques, in addition to being subjective and not easily reproducible, may be misleading in patients with diabetes. This article provides a review of the signs and symptoms of lower limb ischemia and noninvasive vascular tests that clinicians can use to evaluate lower extremity circulation. Also included are protocols for patient care during and after hospitalization, and two case studies of cardiac patients with diabetes who were treated with an IABP.     

Pattern of failure in patients with inflammatory breast cancer treated by alternating radiotherapy and chemotherapy

BACKGROUND: Patients with inflammatory breast cancer have a high risk of developing a local recurrence and/or distant metastases. Treatment with combined chemotherapy and locoregional radiotherapy contributes to a decrease in both risks. This study presents treatment results and evaluates the pattern of failure when an alternating chemoradiotherapy schedule is used. METHODS: One hundred twenty-five patients with nonmetastatic inflammatory breast cancer were treated with an alternating schedule of radiotherapy and chemotherapy. All women recruited were younger than 70 years of age and had a T4d, histologically proven infiltrating carcinoma with N0 to N2 axillary disease. The protocol consisted of three cycles of induction chemotherapy with doxorubicin, vincristine, cyclophosphamide, methotrexate, and 5-fluorouracil followed by three series of locoregional radiotherapy, delivering a total dose of 65-75 Gy to the breast tumor. Five additional cycles of chemotherapy with 5-fluorouracil/doxorubicin/cyclophosphamide were to be administered in between the first two and after the third radiotherapy course. A 1-week gap was respected between each course of chemotherapy and each series of radiotherapy. RESULTS: Toxicity was moderate and this strategy proved feasible although most of the patients only received six instead of the eight planned cycles of chemotherapy. Eighty-two percent of the patients achieved a complete response at the end of the treatment. The cumulative 5-year local failure and distant metastasis rates were 27% and 53%, respectively. Assuming competing events, local failures, contralateral recurrences, and distant metastases were the first site of failure in 18%, 5%, and 38% of patients, respectively. The 5-year overall and disease free survival rates were 50% and 38%, respectively. The main prognostic factor was tumor size. CONCLUSIONS: Alternating high doses of radiotherapy and chemotherapy is a feasible treatment schedule and permits breast conservation. Disease free survival is comparable to that of recently published series. As the main causes of failure are distant metastases, higher dose chemotherapy should be evaluated, in an attempt to further improve overall survival.     

Dynamics of cardiac and skeletal muscle lactate dehydrogenase activity following a single exposure to an alternating magnetic field]

Analysis of records of microscopic slides from 33 patients with pure squamous carcinoma of the bladder who underwent radical cystectomy and lymphadenectomy disclosed a 5-year survival rate of 48 per cent. This survival rate correlated closely with pathologic stage and histologic grade of tumor and was significantly better than for each corresponding stage of transitional cell carcinoma of the bladder. The favorable survival rate and reasonably low operative mortality rate support aggressive therapy of this uncommon lesion.     

交变电磁场与磁致振动对铸铁腐蚀的影响

 为了探究缠绕式电脉冲水处理技术应用过程中,电磁场与磁致振动协同作用对铸铁腐蚀过程的影响。选择铸铁为研究对象,研究了腐蚀过程中溶解氧质量浓度、pH值、铁释放、铸铁挂片表面形态、腐蚀后生成铁系氧化物的结晶形态及组分以及挂片腐蚀速率等参数的特性及变化规律。研究结果表明,交变电磁场与磁致振动协同作用能够有效加速并促进腐蚀反应的阳极反应和阴极反应,使水中溶解氧质量浓度及pH降低,促进铁离子在水中的释放,显著改变腐蚀产物的物相组成及晶体形态。     

Mortality in depressed patients treated with electroconvulsive therapy and antidepressants

The treatments of 519 depressed patients hospitalized from 1959 to 1969 were compared in a three-year follow-up study with particular reference to mortality. The electroconvulsive therapy (ECT) group had a significantly lower mortality than the inadequate antidepressant treatment group (P less than .05) and the group that received neither ECT nor antidepressants (P less than .025). Although the adequate antidepressant treatment group had a low mortality, statistically significant differences between this and other treatment groups could not be documented. Nonsuicidal deaths (P less than .005), and particularly myocardial infarctions (P less than .01), were significantly more frequent in the inadequately treated group compared to the adequately treated group. The superiority of adequate treatment is especially striking among men and among the older age groups. The results underscore the importance of adequate treatment of depression, especially in the older man.     

Surgical outcome in patients with epilepsy with occult vascular malformations treated with lesionectomy

PURPOSE: This retrospective study reports the long-term surgical outcome of patients with medically refractory epilepsy and vascular malformations who were treated with lesionectomy. A detailed analysis of surgical failures had been performed in an attempt to define predictors of surgical success and failure. METHODS: Fifteen patients with medically intractable epilepsy and angiographically occult vascular malformations (AOVMs) were treated surgically with lesionectomy at Duke University Medical Center. Lesionectomy consisted of removal of the AOVM and surrounding hemosiderin-stained brain only, without the use of electrocorticography (ECoG) to guide resection. RESULTS: Eleven (73%) patients are seizure free after lesionectomy. Three showed no significant improvement, and one patient died, presumably after a seizure. Age of onset, duration of seizures, age at resection, and gender did not affect outcome. All patients with neocortical AOVMs in whom EEG findings correlated with the site of the lesion were seizure free after lesional resection. Treatment failures were associated with the presence of multiple intracranial lesions, poorly localized or diffuse EEG findings, discordant positron emission tomography (PET) imaging, or with a lesion in close proximity to the limbic system. CONCLUSIONS: Lesionectomy, with removal of surrounding hemosiderin-stained brain, can be considered the procedure of choice in carefully selected patients with epilepsy with occult vascular malformations.     

Microemboli in cerebral circulation and alteration of cognitive abilities in patients with mechanical prosthetic heart valves

BACKGROUND AND PURPOSE: It has been shown previously that cerebral microemboli may occur frequently in patients with a normal mechanical heart valve (MHV) without prior history of stroke. Some arguments strongly suggest that these microemboli have a gaseous origin. In other circumstances such as extracorporeal circulation or decompression in divers, it has been demonstrated that cerebral microbubbles could lead to some deterioration in cognitive functions. Therefore, we have studied attention and memory, which are among the most impaired cognitive functions as demonstrated in previous studies, in patients with an MHV. METHODS: Three groups of 12 volunteers each were composed of patients with an MHV and embolic signals in the cerebral circulation (group 1), patients with biological prostheses (group 2), and healthy subjects (group 3). Groups were carefully matched for age and verbal intellectual abilities. For each group, a transcranial Doppler examination was performed and a set of cognitive tests assessing sustained and selective attention and episodic and working memory was administered. RESULTS: The mean embolic rate was 29 per hour in patients with an MHV. No embolus was detected in the other 2 groups. Episodic memory was significantly modified in both groups 1 and 2 compared with the control group for tasks that required high-processing resources. Working memory performance was significantly decreased in MHV patients. No between-groups differences were observed for the other parameters. CONCLUSIONS: Alteration of episodic memory can be attributed to a long-term effect of the surgical procedure. Deterioration of working memory can be related to the presence of cerebral microemboli in MHV patients.     

Treatment and prophylaxis of acute disorders of the cerebral blood circulation in patients with diabetes mellitus

Experiments were conducted on young female rats with the aid of morphological, morphometric and histochemical methods; a study was made of the adrenal glands, mammary and the thyroid glands under conditions of castration and administration of synestrol, progesterone, both sex hormones, hydrocortisone. Sex hormones proved to produce a fulminant growth of the glandular tree against the background of reduction of the functional activity of the thyroid gland and relatively high indices of the hormonal activity of the fasciculo-reticular zone of the adrenal glands. A harmonious development of the glandular tree of the mammary glands was noted only under the effect of a simultaneous administration of synesterol and progesteron. A shift in the hormonal balance in the direction of synestrol caused the appearance of pathological deviations in the mammary glands by the type of cystic mastopathy. Under conditions of castration hydrocortisone produced a moderate stimulating influence on the mammary glands only in case of a prolonged action.     

Iron and transferrin in the blood serum of the patients with acute cerebral vascular disease

A postmortem histopathologic investigation of temporal bones of patients with the acquired immunodeficiency syndrome (AIDS) was performed after microslicing, acid decalcification of the slices and paraffin embedding. Histopathologic changes in 49 temporal bones from 25 patients included severe otitis media in five patients (20%), low-grade otitis media in fifteen (60%), labyrinthine cryptococcosis in two, Kaposi's sarcoma deposit in the eighth nerve of one, and cytomegalovirus (CMV) inclusion-bearing cells in the inner and middle ear of six (24%). It was possible to identify the CMV genome by in situ hybridization in only two bones and expression of CMV antigen by immunohistochemistry in none, probably because of prolonged decalcification in acid. The ear is no less susceptible to AIDS-associated diseases than any other organ, and is particularly prone to CMV infection.