A comparison of physicians who did or did not respond to a postal questionnaire.

Responses were received from 80.4% of 997 male physicians and 82.8% of 122 female physicians; the sex difference was not significant. Relationships to willingness to reply were examined in regard to family background, medical school academic performance, age, year of graduation, and scales on the Adjective Check List, the California Psychological Inventory, and the Strong Vocational Interest Blank. Only 12 of the 128 quantified variables produced significant differences. It is concluded that responders to mail surveys will constitute an unbiased sample of a professional group if they represent 75% or more of Ss. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A putative role for larval nematode infection in diarrhoeas of lambs which did not respond to anthelmintic drenches

Attempts to control a summer diarrhoea in grazing Finnish landrace lambs which had been unresponsive to anthelmintics and coccidiostats were made by supplementing them with cupric oxide particles and withdrawing a magnesium-rich mineral, while maintaining parasite control measures. The diarrhoea persisted from July to September and plasma pepsinogen activities were raised, suggesting that the anthelmintic did not prevent abomasal damage; the jejunum of an affected lamb showed lesions of parasitic gastroenteritis. Small responses to cupric oxide particles and larger responses to the withdrawal of magnesium were deceptive, possibly being confounded by differences in parasite challenge. In another experiment Finnish landrace lambs were more susceptible to diarrhoea than Suffolk cross lambs in autumn. The susceptibility was then linked to a strong inhibition of worm egg output and may have been caused by a hypersensitive mucosal response to the larval challenge. Plasma pepsinogen concentrations were again raised in the Finnish landrace lambs and did not decline after treatment with anthelmintic, whereas the concentrations increased later in the Suffolk cross lambs, and were apparently responsive to anthelmintic. The cases of diarrhoea were similar to 'July disease' and may have been caused by continuous nematode infections which were only briefly controlled by drenches. Anthelmintic-unresponsive diarrhoea is the term proposed for the disorder, which may be controllable by devices releasing anthelmintic continuously or by a move to less infected pasture. Faecal egg counts remained low in the condition and were diagnostically misleading.     

Effects of an acute exacerbation on nutritional and metabolic profile of patients with COPD

In this study, we investigated the influence of an acute disease exacerbation on the nutritional and metabolic status of patients with chronic obstructive pulmonary disease (COPD). The study group consisted of 23 patients acutely admitted to the hospital for standardized medical treatment. Dietary intake (dietary records and diet history), resting energy expenditure (ventilated hood), body composition (bioelectrical impedance spectroscopy) and disease symptoms (visual analogue scale) were assessed on admission, daily throughout the hospitalization period, at discharge and 3 months thereafter in stable clinical condition. Dietary intake, since aggravation of disease symptoms, prior to admission, (5,640+/-2,671 kJ) was significantly lower than habitual intake (7,863+/-2,005 kJ). The balance between dietary intake with measured resting energy expenditure and estimated diet-induced thermogenesis was severely impaired during the first 3 days of hospitalization, stabilizing thereafter to 145+/-24% at discharge. Resting energy expenditure decreased from 6,812+/-900 kJ (123+/-11%) on admission to 6,196+/-795 kJ (113+/-14%) at discharge (p<0.001). During treatment, no significant shift in water compartments, fat-free mass and body weight was seen. Follow-up data were obtained from 10 out of 23 patients. Three months after admission, dietary intake was not significantly different from usual dietary intake (8,512+/-2,290 and 8,415+/-2,600 kJ, respectively), resting energy expenditure was similar to the value at discharge, and a significant body weight gain was seen. We conclude that an acute exacerbation of chronic obstructive pulmonary disease is accompanied by an impaired energy balance due to a decreased dietary intake and an increased resting energy expenditure.     

Malignant atrophic papulosis of Degos. Report of a patient who failed to respond to fibrinolytic therapy

A 21-year-old woman with eventually fatal malignant atrophic papulosis (Degos disease) was treated primarily with the fibrinolytic agents phenformin hydrochloride and ethylestrenol. In spite of therapy, primarily central nervous system manifestations led to the patient's death.     

Characteristics of underserved women who did and those who did not use a free/low-cost voucher as part of a mammography screening program

The effects of pneumoperitoneum on peak venous flow velocity in the common femoral vein and the vena cava have already been studied. The results suggested that venous stasis occurs during surgical pneumoperitoneum. This study determines the effects of pneumoperitoneum on the overall venous outflow resistance of the lower limbs. Venous outflow resistance was measured during surgical procedures by impedance plethysmography in 12 patients undergoing laparoscopic cholecystectomy, 4 patients undergoing laparoscopic herniorrhaphy, 4 patients undergoing conventional cholecystectomy, and 2 patients undergoing conventional herniorrhaphy. Venous outflow resistance did not change significantly during laparoscopic cholecystectomy or herniorrhaphy. No difference in venous outflow resistance between laparoscopic cholecystectomy and herniorrhaphy was found. During pneumoperitoneum, no obstruction to total lower limb venous outflow could be demonstrated, indicating that venous stasis in the limbs did not occur, and consequently, flow in the iliac and inferior caval veins was not compromised. Hypothetically, active vasodilatation resulting from mild compression may explain this. In our view, no special measures to prevent deep venous thrombosis have to be taken during laparoscopic procedures.     

Use of ofloxacin in infections which do not readily respond to treatment

The properties of ofloxacin such as a new mechanism of action, broad spectrum and high antimicrobial activity, 100-percent bioavailability and rapid penetration to the body tissues, etc. which defined the antibiotic high efficacy in the therapy of infections difficult for the treatment with other antibacterial drugs are presented. The intensive use of ofloxacin within the last years was no accompanied by an increase in the resistance of the main pathogens to it. High concentrations of ofloxacin provided in the nasa sinuses and the antibiotic broad spectrum including the majority of gram-positive and gram-negative microbes conditioned its high therapeutic efficacy in the treatment of chronic sinusitis and otitis. Successful treatment of tuberculosis resistant of other drugs with ofloxacin supplementing the standard 3-component combination of rifampicin, isoniazid and pyrazinamide was shown possible. By its bioavailability ofloxacin proved to be superior to ciprofloxacin and its oral dose of 200 mg was equivalent by the efficacy to the oral dose of 500 mg of ciprofloxacin. The usual regimen of the ofloxacin use in the treatment of severe infections was 400 mg intravenously twice a day. The further oral use in a dose of 400 mg once a day was possible after the infectious process stabilization.     

Enterohemorrhagic Escherichia coli O157 infection in an elderly patient with secondary hemolytic uremic syndrome who developed recurrent acute exacerbation of chronic cholecystitis]

The risk of hepatocellular carcinoma (HCC) varies significantly among hepatitis B virus (HBV) carriers from different geographic regions. We compared serological markers of HBV infection in adult male carriers from Haimen City, China and Senegal, West Africa, where the prevalence of chronic infection is similar. HCC mortality among HBV carriers is much higher in Haimen City than it is in Senegal (age-standardized rate, 878 versus 68 per l0(5) person-years). A dramatic difference was observed when HBV DNA levels in serum were assessed among carriers by Southern blot. In the Senegalese group (n = 289), 14.5% were HBV DNA positive by Southern blot in their 20s, and this percentage declined in each subsequent decade of age to 3.3, 2.9, and 0% thereafter. In the Chinese group (n = 285), a higher prevalence of HBV DNA positivity and a less consistent reduction were seen; 29.4% were positive in their 20s, and 30.2, 23.6, and 20.6%, respectively, were positive in each subsequent decade of age. Among 102 male Asian-American HBV carriers, the prevalence of HBV DNA positivity was intermediate between the Chinese and Senegalese populations (36.8, 10.7, 3.0, and 4.6% in each subsequent decade of age). Viral titers were similar among those who were HBV DNA positive in all three populations [median value, 10(7) virions/ml (range, 10(6)-10(9) virions/ml)]. The presence of HBV DNA in serum was positively associated with serum glutathione S-transferase, a marker of liver damage. These findings suggest that the more prolonged maintenance of productive virus infection in the Chinese carriers compared with the Senegalese carriers may explain their higher risk of HCC. This profound difference in the natural history of chronic infection may be due to earlier age of infection in China or to as yet unknown environmental or genetic factors.     

MRSA-induced prosthetic valve endocarditis complicated by synthetic graft infection that did not respond to repeated vancomycin administration but improved after surgery]

We performed AVR and OMC in a 55-year-old male with ASR complicated by MS and ASO. Postoperatively, an ulcer formed on the left lower extremity, resulting in methicillin-resistant Staphylococcus aureus (MRSA) infection. Axillo-bilateral-femoral artery bypass was performed using synthetic grafts. However, infection developed in the anastomosis site, leading to MRSA sepsis. Since MRSA is highly susceptible to vancomycin (VCM), this drug was administered at a dose of 1.5 g/day. With negative conversion of MRSA, the infected wound healed, and the general status improved. However, after discontinuation of VCM administration, sepsis recurred. VCM administration was resumed with prolongation of the administration period and an increase in the dose. Drug administration was discontinued 3 times after 2-4 weeks each, but recurrence was observed each time. During this period, AR due to prosthetic valve endocarditis (PVE) developed. AVR and MVR were performed again, and the synthetic graft was left in place. However, after discontinuation of postoperative VCM administration, infection of the synthetic graft was also demonstrated. The graft was removed, and revascularization was performed by another route. The patient improved after these procedures. When MRSA-induced PVE or synthetic graft infection develops, the infectious foreign material should be completely removed at an early stage before progression of tissue destruction or ulcer formation even if antibiotics are effective.     

Effects of combined treatment with glycopyrrolate and albuterol in acute exacerbation of asthma

STUDY OBJECTIVE: Recent reports suggest that glycopyrrolate is as effective as metaproterenol in the treatment of acute bronchospasm. The purpose of this study was to investigate whether the addition of a single aerosolized dose of glycopyrrolate to an albuterol regimen results in a greater improvement in pulmonary function than treatment with an albuterol regimen alone in patients with acute asthma. DESIGN: Prospective, randomized, double-blinded, controlled study. All patients received a total of three aerosol treatments and 60 mg solumedrol IV push. Patients were randomized to receive 2 mg aerosolized glycopyrrolate (combination therapy) or aerosolized placebo (control) in addition to their first 2.5 mg albuterol aerosol treatment. Both groups received 2.5 mg aerosolized albuterol alone for the next two treatments. SETTING: An urban teaching hospital emergency department. PARTICIPANTS: One hundred twenty-five patients with acute exacerbation of asthma were entered into the study. MAIN RESULTS: There was no difference in pretreatment forced expiratory volume (one second) (FEV1) between the control group and the glycopyrrolate group. Asthmatic patients receiving combination therapy had less of a change in FEV1 (52%) than did control patients (82%, P < .05). CONCLUSION: The combination of glycopyrrolate and albuterol does not appear to be beneficial over albuterol alone in treating patients with acute exacerbation of asthma.     

Amnestic mild cognitive impairment: Difference of memory profile in subjects who converted or did not convert to Alzheimer's disease.

Episodic long-term, short-term, and implicit memory were investigated in 79 elderly subjects who fulfilled criteria for the amnestic form of mild cognitive impairment (a-MCI; i.e., by having an idiopathic amnestic disorder with absence of impairment in cognitive areas other than memory and without confounding medical or psychiatric conditions) and who developed Alzheimer's disease (AD) after 2 years as well as in 111 subjects affected by a-MCI who did not develop dementia. Results document a memory profile in a-MCI subjects characterized by preserved short-term and implicit memory and extensive impairment of episodic long-term memory. In virtually all episodic memory indexes examined (learning, forgetting, recognition abilities), a-MCI subjects who converted to AD were more severely impaired than were subjects who did not become demented. This memory profile, which closely resembles that exhibited by amnestic patients with bilateral mesial-temporal lobe lesions, confirms a precocious phase in preclinical AD characterized by selective involvement of mesial-temporal areas and worsening of the memory impairment as atrophic changes progress in hippocampal structures. In this context of pervasive episodic memory impairment, tests assessing the free recall of verbal material following a delay interval demonstrated the greater sensitivity to memory deficits of a-MCI subjects who developed AD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

In vitro fertilization with low-dose clomiphene citrate stimulation in women who respond poorly to superovulation

PURPOSE: Our experience with IVF using low-dose clomiphene citrate for stimulation in "non-" and "poor" responders was reviewed and the treatment outcomes with the previous controlled ovarian stimulation cycles in which hMG and GnRH agonist were used were compared. METHODS: The treatment outcome in 11 non- and 20 poor responders having 30 and 53 clomiphene citrate IVF treatment cycles, respectively, were compared with the treatment outcome in the previous long-protocol buserelin/hMG cycles. RESULTS: The clinical pregnancy rates per oocyte collection achieved in the first clomiphene citrate cycle in non (9.1%)- and poor (10%) responders were comparable to those achieved by poor responders (11.9%) who had buserelin/hMG using the long protocol. Although the numbers were small, a similar pregnancy rate could still be achieved in poor responders up to the third attempt using clomiphene citrate. CONCLUSIONS: IVF using long-protocol buserelin/hMG is more successful than using clomiphene citrate stimulation. However, this advantage may not be significant in those women with a previous poor response to buserelin/hMG. It is suggested that for such poor responders, three attempts of IVF in a clomiphene citrate cycle may offer a viable therapeutic alternative before reverting to more stressful, expensive, and time-consuming treatment.     

Rats given dopamine-depleting brain lesions as neonates do not respond to acute homeostatic imbalances as adults.

The 1st and 3rd authors and A. M. Snyder (see record 1984-19832-001) found that rats given near-total dopamine-depleting brain lesions as neonates exhibited none of the severe sensorimotor or ingestive dysfunctions that result when adult rats are given comparable lesions. The present study showed that the apparent sparing of function is incomplete. When tested as adults, male Sprague-Dawley rats that had received intracerebroventricular injections of 6-hydroxydopamine HBr (200 μg) at 3 days of age did not eat in response to acute glucoprivation, nor did they drink water and saline in response to hypovolemia. After receiving these homeostatic challenges, Ss became much less able to simply move about. In contrast, dopamine-depleted Ss ate normally after glucoprivation when they were handled hourly instead of being left alone. Similarly, administration of caffeine permitted them to drink while hypovolemic. Observations suggest that some central neurons other than those containing dopamine are responsible for maintaining behavioral activation in rats after neonatal destruction of dopaminergic fiber systems in the brain and that the homeostatic challenges compromise their function and thereby disrupt behavior. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does interpersonal therapy help patients with binge eating disorder who fail to respond to cognitive-behavioral therapy?

The aim of this quasi-experimental study was to examine the effectiveness of group interpersonal therapy (IPT) in treating overweight patients with binge eating disorder who did not stop binge eating after 12 weeks of group cognitive-behavioral therapy (CBT). Participants in this study were randomly allocated to either group CBT or to an assessment-only control group. After 12 weeks of treatment with CBT, 55% of participants met criteria for improvement and began 12 weeks of weight loss therapy, whereas the nonresponders began 12 weeks of group IPT. Over the 24-week period, participants who received treatment reduced binge eating and weight significantly more than the waiting-list control group. However, IPT led to no further improvement for those who did not improve with CBT. Predictors of poor outcome were early onset of, and more severe, binge eating. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Widespread tinea corporis in an immunocompetent patient resistant to all conventional forms of treatment

A 70-year-old immunocompetent man with a more than forty-year history of tinea corporis unresponsive to multiple systemic and topical antifungal agents, including systemic terbinafine, is described. The literature with respect to persistent dermatophyte infection is reviewed.     

A five-day course of dirithromycin in the treatment of acute exacerbation of severe chronic obstructive pulmonary disease

As in other areas of society, the Internet and the World Wide Web are becoming important topics in medical informatics. This is evident from the recent American Medical Informatics Association's 1996 Annual Fall Symposium, where the theme was "Beyond the Superhighway: Exploiting the Internet with Medical Informatics." Of the over 330 papers and abstracts published in the Proceedings, one third dealt with the Internet and/or the Web. In some cases, system developers demonstrated how this technology can do old tasks in new ways. In other cases, researchers described new tasks that are now possible with this technology. Still others examined this technology to show how it can be evaluated and improved. This paper summarizes their accomplishments.     

Behavioral and environmental factors associated with acute exacerbation of asthma

Micellar catalysis plays a crucial role in NO metabolism because media in vivo are heterogeneous and the concentration of NO in different phases at different levels of solubility differs by degrees of magnitude. The relative volumes of the hydrophobic phases are usually small. At small volumes (which are calculated) of these phases the reaction rates of NO metabolism change. The dependence on the relative volumes is resonance-like. Not only regulation, but bifurcations and catastrophes are possible in vivo as a result of this changing due to the small change of effectiveness of micellar catalysis.     

Bomocriptine treatment of patients with acromegaly resistant to conventional therapy

Eleven patients with active acromegaly resistant to conventional therapy were treated with bromocriptine for 15 (12--22) months by increasing the daily dose stepwise from 5 to 10--60 mg. A satisfactory response was achieved in all but one of the eight patients, in whom the mean diurnal level of serum GH was less than 50 ng/ml, whereas patients with grossly elevated serum GH levels responded poorly. In the longterm, no overall effects on glucose tolerance or plasma insulin (IRI) levels were observed but the chemical diabetes of three patients ameliorated in two. On the other hand, a dose-dependent acute suppressive effect of bromocriptine on plasma IRI response to oral glucose was observed, suggesting a direct effect of bromocriptine on the release of insulin from beta cells. Bromocriptine seems to be a good alternative in the treatment of patients with acromegaly who have not responded to conventional therapy.     

Effects of biofeedback and psychotherapy on patients with myofascial pain dysfunction who are nonresponsive to conventional treatments.

Assessed the effects of biofeedback (BF) alone or BF with psychotherapy on 18 adult patients with myofascial pain dysfunction syndrome who did not respond to conventional physical treatments. Ss were randomly assigned to 1 of 3 treatment conditions: (1) masseter muscle BF on the symptomatic side of the face, (2) frontalis BF, or (3) frontalis BF plus psychotherapy. Findings indicate that (a) frontalis BF with psychotherapy was more effective than frontalis BF alone, (b) frontalis and masseter BF were about equally effective with these Ss, and (c) frontalis or masseter BF as well as frontalis BF plus psychotherapy, was more effective with these Ss than was escalated treatment or no further treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)