Discovering asymptomatic biochemical abnormalities on a Baltimore internal medicine service

To assess the frequency of abnormalities that could be discovered through biochemical profile screening on patients admitted to a city hospital internal medicine ward service, we conducted a prospective cross-sectional chart and laboratory review. All unassigned patients admitted to the general medicine service during 1- to 2-month period in late 1993 and the spring of 1994 were eligible. The main outcome measures were frequency of abnormal test results and identification of significance. Admitted patients (N = 222) were evaluated with a 24-panel biochemical profile. Of 5,328 tests, 29% were outside the standard reference range. Of 3,851 tests classified as screening, 1,049 (27%) were outside the reference range. Of overall screening tests, 741 (19%) were judged potentially important by the predetermined criteria. The prevalence did not differ significantly when analyzed by age, race, gender, or history of substance abuse. Our experience indicates that asymptomatic biochemical abnormalities are common in patients admitted to a city hospital medical service and that admission biochemical screening is an effective method of identifying potential comorbidity. Further studies are needed to assess the impact of this approach.     

Withdrawal in opiate addicts in an internal medicine hospital unit

Withdrawal of opiates drug addicts in Internal Medicine is unusual in France. Four main preliminary conditions are requested: 1--Drug addict preparation and self motivation, 2--Inter and intra institution team collaboration, 3--Opening the hospital towards community agencies, 4--Hospital staff recruited on volunteer basis. Within two years (1992-1993), 210 opiates drug addicts were hospitalized for withdrawal. Two third were males, median age was 27, median years of addiction was 7. Thirty percent were seropositive for HIV, 70% for HCV. Hospitalisation lasted 7 days for heroin addicts and 10 days for morphin, codein or buprenorphin addicts. Successful withdrawn was observed for 70% patients but six months after withdrawal, only 15% remained abstinent.     

Thrombomodulin in internal medicine

PURPOSE: Analysis of the results of medical examination and treatment of infants with squint and undeveloped fixation reflex, and with nystagmus. MATERIAL AND METHODS: 215 babies with these distempers were classified to the treatment. The children were included into five prophylactic groups: group 1-66 babies with eccentric fixation and without squint or with periodic squint; group 2-60 babies with acentric fixation and with manifested convergent squint at a visual angle from 25 degrees to 45 degrees (average 35 degrees); group 3-55 babies with correct fixation and with manifested convergent squint at a visual angle from 25 degrees to 45 degrees (average 35 degrees), and with divergent squint at a visual angle from 5 degrees to 20 degrees (average 12.5 degrees); group 4-12 babies with correct fixation and with periodic squint; group 5-22 babies with nystagmus. The treatment consisted in wearing spherical and prismatic glasses strictly compensating the squint angle, and in the treatment of eccentric fixation with euthyscope irradiations. The babies with nystagmus were treated conservatively by prisms correcting head arrangement. RESULTS: Eventually the squint angle reduced and fixation reflex in part of all tested groups. In our opinion, the treatment of very small children by localisation method prisms is very useful.     

Diagnosis and treatment of cerebrovascular disorders as a common problem of neurology and internal medicine from the internal medicine point of view]

Efforts to predict a future event assume varying levels of confidence depending on its base rate and the error rate of the prediction instrument. Most researchers working with suicide prediction instruments seem tacitly to assume they will be able to predict a future suicide most of the time. Applying basic decision theory on a neuropsychiatric hospital population indicates that researchers using a prediction schedule will be unlikely to predict a future suicide beyond a 20% level of efficiency. Contrary to the general clinical view, eliminating false negatives was shown to be more practical than eliminating false positives in increasing the efficiency of a predictive schedule.     

Percutaneous biopsy of small hepatic lesions using an 18 gauge automated needle

This study evaluates the efficacy of ultrasound guided percutaneous biopsy using an 18 gauge automated side-cutting needle in the diagnosis of small (< or = 3 cm) focal hepatic lesions. 137 consecutive percutaneous biopsies of 131 different small (< or = 3 cm) focal hepatic lesions were included. 11 biopsies were performed on lesions of < or = 1 cm in diameter, 56 were on lesions 1.1-2 cm in size and 70 on lesions 2.1-3 cm in size (average 2.3 +/- 0.7 cm; median 2.3 cm; range 0.7-3 cm). The biopsy specimen was sufficient for diagnosis in 135 cases (98.5%). The sensitivity for diagnosing malignancy was 96.4%; specificity was 100%, positive and negative predictive values were 100% and 94.6%, respectively; accuracy was 97.8%. There was no statistically significant difference in the diagnostic efficacy for lesions of different pathology and size. No significant post-biopsy complication occurred. It is concluded that the 18 gauge Temno needle is safe and effective in diagnosing small hepatic lesions.     

Usefulness of fixed-dose drug combinations]

Diurnal rhythm of serum melatonin concentrations was estimated in 12 men with low back pain syndrome before and after exposure to a very low-frequency magnetic field (2.9 mT, 40 Hz, square wave, bipolar). Patients were exposed to the magnetic field for 3 weeks (20 min per day, 5 days per week) either in the morning (at 10:00 hr) or in the late afternoon (at 18:00 hr). Significant depression in nocturnal melatonin rise was observed regardless of the time of exposure. This phenomenon was characteristic for all the subjects, although the percent of inhibition of melatonin secretion varied among the studied individuals.     

Incidence and significance of psychovegetative syndromes--demonstration on an example of an internal medicine diagnostic station

It is reported on 215 patients in whom after detailed somatic and psychodiagnostic examination in a ward of internal diseases the diagnosis of neurosis was made. The cases in question were 33.3% of the whole number of patients during a selected period. In the majority of cases (74%) organic functional disturbances were diagnosed, above all cardiovascular and gastro-enterological syndromes. The screening diagnostics especially with the help of questionaires of complaints allowed of a comparatively certain conclusion to the existence of a psychovegetative syndrome. Altogether 51 patients exhibited the picture of a functional organic linkage syndrome, i.e. in an organic disease a characteristic functional syndrome remained ascertained. The duration of the diseases was always several years, they were chronified, mostly by iatrogenic influences and labelled by an organic pseudodiagnosis. Among the therapeutic measures possible in practice already the diagnosing of a neurosis represents a decisive step.