Treatment of high altitude pulmonary edema at 4240 m in Nepal.

High altitude pulmonary edema (HAPE) is the leading cause of death from altitude illness and rapid descent is often considered a life-saving foundation of therapy. Nevertheless, in the remote settings where HAPE often occurs, immediate descent sometimes places the victim and rescuers at risk. We treated 11 patients (7 Nepalese, 4 foreigners) for HAPE at the Himalayan Rescue Association clinic in Pheriche, Nepal (4240 m), from March 3 to May 14, 2006.

Chest ultrasonography for the diagnosis and monitoring of high-altitude pulmonary edema.

Background: The comet-tail technique of chest ultrasonography has been described for the diagnosis of cardiogenic pulmonary edema. This is the first report describing its use for the diagnosis and monitoring of high-altitude pulmonary edema (HAPE), the leading cause of death from altitude illness.

Methods: Eleven consecutive patients presenting to the Himalayan Rescue Association clinic in Pheriche, Nepal (4,240 m) with a clinical diagnosis of HAPE underwent one to three chest ultrasound examinations using the comet-tail technique to determine the presence of extravascular lung water (EVLW).

Personality pathology and its relation to couple functioning.

The study aimed at understanding the relationship between personality pathology and couple functioning, both in terms of general functioning and communication specifically, in a sample of 146 psychiatric outpatients. The results indicated that couple communication was best predicted by a combination of the symptoms within each of the three personality disorder clusters and the total number of personality disorder symptoms while general family functioning was best predicted by the total number of Axis I disorders. No demographic variables were found to be related to the level of couple functioning.

Neurophysiologic assessment of neonatal sleep organization: preliminary results of a randomized, controlled trial of skin contact with preterm infants.

Background: Sleep is important to brain organization, but few strategies to promote sleep among premature infants have been tested. Behaviorally based measures of sleep have shown increased quiet sleep (QS) and decreased active sleep (AS) during skin-to-skin contact (SSC) with the mother, but these results have not been confirmed with objective electroencephalographic/polysomnographic measures of sleep organization. Important differences exist between behavioral and electroencephalographic/polysomnographic definitions of sleep state.

Autologous transplantation followed closely by reduced-intensity allogeneic transplantation as consolidative immunotherapy in advanced lymphoma patients: a feasibility study.

We report outcomes in advanced lymphoma patients (n = 32) who enrolled in a trial of prospectively planned combined autologous/reduced-intensity transplantation (RIT) (n = 25) or who received RIT shortly after prior autografting because of high relapse risk or progressive disease (n = 7). Nine patients on the autologous/RIT transplant protocol did not proceed to planned RIT because of patient choice (n = 4), disease progression (n = 3), toxicity (n = 1), or no adequate donor (n = 1). Among the 23 other patients, RIT was started a median of 59 days (range 31-123) after autologous transplant.

The right not to know and coronary angiography: is the common law of Australia consistent with patients' wishes?

In "The Right Not to Know: Patient Autonomy or Medical Paternalism?" (2000) 7 JLM 286 Judy Gutman qualitatively examined the direction of the law relating to the duty of medical practitioners to disclose information to their patients about risks associated with medical treatment. Prompted by theoretical issues raised in that article, a quantitative study was performed. The study focused on the wishes of patients referred for coronary angiography regarding information about the risks inherent in that procedure.

Service vs. satisfaction. The key to a competitive edge.

Understanding the difference between patient service and satisfaction can provide any medical practice with the competitive advantage to retain existing patients and attract new ones.

Results of complete soft tissue clubfoot release combined with calcaneocuboid fusion in the 4-year to 8-year age group following failed clubfoot release.

A subset of postoperative recurrent clubfeet was isolated in a group of patients 4 to 8 years old. Twenty-seven consecutive patients who underwent redo surgery consisting of complete soft tissue clubfoot release combined with a calcaneocuboid fusion were reviewed for this study. Twenty-six feet of 27 feet in 20 patients had a long-term good result, suggesting that this procedure is the one of choice for this age group.

Autistic subjects with comorbid epilepsy: a possible association with viral infections.

This study evaluates the comorbidity of epilepsy as a variable supporting a viral hypothesis in Autism. Data covering a 30-year period (1960-1989), including general population live births, autistic births, and incidence of viral encephalitis and viral meningitis, were collected for Israel. 290 autistic births were evaluated.

Forensic psychiatric service in Israel: ten years experience in an in-patient hospital unit.

In 1991 legislators revised the Mental Health Act in Israel, placing responsibility for forensic psychiatric evaluations with the district psychiatrist. The aim of the present paper is to describe the changing patterns of the forensic service in Israel's largest psychiatric hospital in the light of changing legislation. In the last 15 years a psychiatric forensic team provided evaluations both in an ambulatory clinic and a special in-patient ward.

Police attitudes toward mental illness and psychiatric patients in Israel.

The attitude of the public toward mental illness and toward psychiatric patients raises a serious and sensitive issue that indirectly affects the development of community mental health services. Most citizens feel that there is an association between mental illness and dangerous or violent behavior. Studies undertaken among police personnel in the 1970s demonstrated that their attitudes were similar to those of the general public in Israel.

Accuracy of DNA amplification from archival hematological slides for use in genetic biomarker studies.

Archival slides are a potentially useful source of DNA for mutation analyses in large population-based studies. However, it is unknown whether specimen age or histological stains alter the accuracy of Taq polymerase or induce secondary mutations in sample DNA. To address this question, we evaluated five methods for extraction of genomic DNA from archival bone marrow slides of 17 leukemia patients and analyzed exons 1 and 2 of the N- and K-ras genes for the presence of mutations.

c-Myc target gene specificity is determined by a post-DNAbinding mechanism.

Uncertainty as to which member of a family of DNA-binding transcription factors regulates a specific promoter in intact cells is a problem common to many investigators. Determining target gene specificity requires both an analysis of protein binding to the endogenous promoter as well as a characterization of the functional consequences of transcription factor binding. By using a formaldehyde crosslinking procedure and Gal4 fusion proteins, we have analyzed the timing and functional consequences of binding of Myc and upstream stimulatory factor (USF)1 to endogenous cellular genes.

Side effect profile of azathioprine in the treatment of chronic schizophrenic patients.

Various findings suggest auto-immune changes in schizophrenia. We have recently demonstrated that platelets from schizophrenic patients bear autoantibodies (PAA) which cross-react with brain antigens. Accordingly, treatment of schizophrenia with an immunosuppressant might be of potential benefit.

Opening Pandora's box: the unpredictability of reassurance by a normal test result.

Objectives: To determine the rate of failure of patient reassurance after a normal test result and study the determinants of failure.

Design: Replicated single case study with qualitative and quantitative data analysis.

Setting: University teaching hospital.

Adult epiglottitis and postobstructive pulmonary edema in a patient with severe coronary artery disease.

Epiglottitis is a rare cause of upper airway obstruction that may lead to death in the adult. We report the case of a patient with severe coronary artery disease with adult epiglottitis who required emergency endotracheal intubation. Relief of the airway obstruction was followed by the development of postobstructive pulmonary edema.

Two-dimensional Doppler echocardiographic flow imaging--exploration of clinical impact and problems.

Recent advances in electronic engineering have allowed Doppler echocardiography to be presented in the form of a real-time two-dimensional image. The resulting image of blood flow has been described as a 'non-invasive angiogram', but the analogy with angiography should not be pushed too far since the technical determinants of these images are entirely different. Nevertheless, the colour flow map does allow rapid and direct exclusion, detection and quantitation of regurgitant and stenotic lesions, and semi-quantitative assessment of valvular regurgitation and shunts.

Pneumomediastinum as a complication of "crack" smoking.

Three cases of pneumomediastinum related to smoking cocaine in the form of "crack" are presented. The patients complained of chest or neck pain occurring 1 to 6 hours after smoking crack. All three did not immediately divulge a history of cocaine use.