Diagnosis of malignant pericardial effusion during dynamic hepatic scintigraphy.

Three clinically unsuspected malignant pericardial effusions were discovered during routine dynamic hepatic scintigraphy. The only common clinical feature shared by the patients was dyspnea. Static scintigrams alone would not have detected these effusions, which points out again the importance of including dynamic scintigraphy in routine radionuclide evaluations of the liver.

Where is the pastoral counselor in the hospice movement?

Offers a brief historical summary of the hospice movement in America, noting particularly the inclusion of the term "pastoral counselor" in the law's language. Discusses the utilization and contribution of pastoral counselors based on a survey of 153 hospice programs. Concludes that pastoral counselors need to demonstrate their competencies and contributions, that the American Association of Pastoral Counselors ought to assume a greater role in fostering and nurturing pastoral counselors for participation in hospice activities, and the pastoral counselors should teach sister disciplines therapeutic technologies which are a part of the religious community.

Facial paralysis.

This article discusses peripheral facial paralysis of nontraumatic origin. The term idiopathic facial paralysis is used generically, in place of the often ambiguous term, Bell's palsy, to indicate all types of peripheral facial palsy/paralysis for which no cause is apparent. Included is a brief resumé of the pertinent anatomy and pathophysiology, a synopsis of etiologic considerations, and a discussion of current therapeutic options.

Quantitation of pneumatic otoscopy.

Pneumatic otoscopy has long been espoused as an easily and rapidly used, inexpensive method for routine evaluation of the tympanic membrane and middle ear. This widely used technique, however, has not been explored in a quantitative manner. Therefore, we measured the differential pressure and frequency of the pressure pulse used by a group of experienced otoscopists during routine pneumatic otoscopic examination.

Characterization of insulin-like growth factor binding to human granulosa cells obtained during in vitro fertilization.

Insulin and IGF-I affect in vitro ovarian stromal and follicular cell function in several species. We previously characterized insulin receptors on human granulosa cells obtained from in vitro fertilization procedures but were unable to demonstrate specific binding of IGF-I. Following modification of the assay conditions, we now report specific, high affinity IGF-1 binding sites on human granulosa cells.

Splenic "disappearance" during gated exercise nuclear angiocardiography.

Decreasing splenic activity occurred during the maximum exercise phase of gated stress testing in 24 patients who underwent 26 such studies. This event was related to increasing exercise, and correlated with the relative increase in heart rate, pulse-pressure product, and cardiac output, but not ejection fraction. A multiple linear regression analysis showed that the combination of increases in pulse-pressure product and cardiac output had the best correlation with decreasing splenic activity at the conclusion of exercise.

Efficacy of acoustic reflectometry in detecting middle ear effusion.

The acoustic otoscope measures the amount of sound reflected from the tympanic membrane. Since the amount of reflected sound is increased by fluid in the middle ear, it seemed likely that the acoustic otoscope could be used for detection of otitis media. We compared acoustic reflectometry with over 4,000 tympanometric and otoscopic examinations in 451 children who were examined at regular intervals following surgery for chronic otitis media with effusion.

Post-tympanostomy otorrhea.

Otorrhea is the most common complication of surgical drainage of the tympanum for the treatment of chronic secretory otitis media. Otorrhea present at the first postoperative visit may be due to the operative procedure, the underlying disease process, or both. After analyzing data from 525 operations on 1045 ears of 396 children with chronic secretory otitis media, and finding an over-all incidence of immediate postoperative otorrhea of 3.

Estrogen receptors in the temporomandibular joint of the baboon (Papio cynocephalus): an autoradiographic study.

Using an autoradiographic method, the temporomandibular joint (TMJ) complex of five aged female baboons was studied for the presence of receptors for estradiol-17 beta. The study was performed in an effort to learn more of the pathophysiology of this joint and in an attempt to provide a scientific basis to explain the reported preponderance of women who seek and undergo treatment for signs and symptoms referable to the TMJ. This experiment revealed that the TMJ complex contains numerous cells with receptors for estrogen, particularly the articular surface of the condyle, articular disk, and capsule.

Bone marrow island vs focal infection. An indium-111 leukocyte imaging dilemma.

An island of bone marrow surrounded by the glue used in securing a hip prosthesis accumulated In-111 leukocytes in a patient being imaged for hip pain. This was shown to be normal marrow uptake of labeled cells and not an abscess by performing bone marrow imaging. The appearance of the leukocyte and bone marrow scans of the area were identical.

Differential otomanometry.

Management of otitis media, both acute and chronic, is one of the most common problems in clinical medicine. Among the many unresolved issues in otitis media research is accurate diagnosis which, in turn, depends heavily on valid otoscopic observation. Yet even today clinical otoscopy remains more of an art than a science.

Medical treatment of chronic otitis media with effusion (secretory otitis media).

To determine whether antimicrobial therapy is of value in the treatment of chronic otitis media with effusion (secretory otitis media), we treated 1,429 4- to 8-year-old children--2224 affected ears--with a fixed regimen of an antibiotic mixture (Pediazole) for 10 days and a decongestant (Novafed) for 30 days. We observed the children monthly to determine the rate of clearance. Validity of diagnosis was greater than 90% with an algorithm of pneumatic otoscopy and tympanometry.

Management of neonatal subglottic stenosis.

When considering management of subglottic stenosis, all conservative efforts to establish a satisfactory airway must be considered prior to surgical reconstruction. However, the approach which allows for the earliest possible decannulation is the one which is sought because of high morbidity and mortality of tracheostomy in the pediatric population.

Predictive value of tympanometry in middle ear effusion.

The presence of middle ear effusion may be inferred from a tympanogram by the configuration of the pressure compliance curve. Not infrequently, however, effusion is absent at the time of surgery when strongly indicated by preoperative tympanometry. We evaluated this discrepancy by contrasting preoperative tympanograms with the findings at surgery in 462 children, aged 4 to 8 years, with clinical evidence of persistent effusion in 909 ears.

Effect of beta blockade on singing performance.

The symptoms associated with performance anxiety, or the so-called stage fright syndrome, are similar to those of alpha and beta adrenergic stimulation. Suppression of symptoms and improvement in instrumentalist's performance after beta blockade suggest that this modality would be of benefit for singers as well. To evaluate the dose-effect relationship of beta blockade upon singing performance and the possible effect of these agents upon performance maturation, we studied 34 singing students during end of semester juries, using a double-blind crossover paradigm.

Changes in the nuclear uptake and retention of 3H-estrogen in gonadotrophs and lactotrophs as a function of age.

A quantitative autoradiographic immunocytochemical study was performed in which the nuclear uptake and retention of 3H-estradiol (3H-E2) by luteinizing hormone (LH) and prolactin (PRL) cells was examined in 19-21-year-old baboons. 3H-E2 concentrating cells were found in all of the three lobes of the pituitary in varying percentages (38.7%, pars distalis; 17.

Treatment of chronic otitis media with effusion: results of tympanostomy tubes.

Insertion of tympanostomy tubes to provide prolonged aeration and drainage of the tympanum in cases of chronic secretory otitis media has become the most commonly performed operation in children. To investigate the therapeutic efficacy of current treatments of chronic secretory otitis media, the authors undertook a randomized clinical trial with four treatment arms: myringotomy alone, tympanostomy tubes, adenoidectomy and myringotomy, and the combination of adenoidectomy and tympanostomy tubes. This report describes the preliminary (one-year) outcome in the group of children who were treated with tympanostomy tubes.

Creatinine clearance estimation from serum creatinine values: an analysis of three mathematical models of glomerular function.

The logarithmic relationship of serum creatinine and creatinine clearance was analyzed in 100 adult patient studies using a geometric regression technique. Each sex was independently analyzed, and the subsequently derived regression formulae were age corrected resulting in mathematical models useful in estimating creatinine clearance from serum creatinine concentrations. These formulae were tested prospectively in another group of 100 patient studies in which creatinine clearance had been determined, and the results compared to values derived by use of two other published formulae.