Phytoestrogen blood levels and adverse outcomes in women with suspected ischemic heart disease.

Background/objectives: Prior studies linked higher blood phytoestrogen (phytoE) levels of daidzein to beneficial lipoprotein profiles, and higher genistein levels related to worse coronary microvascular dysfunction in women with suspected ischemic heart disease (IHD). However, relationships to adverse outcomes remain unclear. We investigated the associations between eight serum phytoE and major adverse cardiac events (MACE) including myocardial infarction, stroke, hospitalization for heart failure and angina, cardiovascular and all-cause mortality, in women undergoing functional coronary angiography (FCA) for suspected ischemia.

Even "WISE-R?"-an Update on the NHLBI-Sponsored Women's Ischemia Syndrome Evaluation.

Purpose Of Review: For over 20 years, the Women's Ischemia Syndrome Evaluation (WISE), a program sponsored by the National Heart, Lung, and Blood Institute, has explored diverse and important aspects of ischemic heart disease in women.

Recent Findings: Women with symptoms and signs of ischemia but no significant epicardial obstructive coronary artery disease (INOCA) were documented to be at elevated risk for recurrent angina hospitalization, major adverse cardiac events, death, and health resource consumption rivaling those with obstructive coronary disease. WISE investigators have advanced our understanding of cardiovascular outcomes, systemic manifestations, psychological variables, socioeconomic factors, genetic contributions, hormonal status, advanced imaging, coronary functional findings, biomarkers, patient-reported outcomes, and treatments pertaining to women with this disease entity.

Role of eye muscle antibody measurement in diagnosis of thyroid-associated ophthalmopathy: a laboratory update.

Objective: To review the current role of measurement of serum eye muscle antibodies in thyroid-associated ophthalmopathy (TAO).

Methods: We conducted laboratory studies to determine the prevalences of serum autoantibodies reactive with eye muscle antigens in patients with active and inactive TAO, Graves' hyperthyroidism, and Hashimoto's thyroiditis as well as in normal subjects.

Results: The two antigens most often recognized in immunoblotting with crude human or porcine eye muscle membranes by serum autoantibodies in patients with TAO are eye muscle membrane proteins of 55 and 64 kd.

Successful therapy for a mixed thyrotropin-and prolactin-secreting pituitary macroadenoma with cabergoline.

Objective: To describe the first case of a mixed thyrotropin (TSH)- and prolactin-secreting pituitary macroadenoma that responded to therapy with cabergoline.

Methods: We present a case report with clinical, laboratory, and radiologic details.

Results: An 84-year-old woman with central hyperthyroidism due to a mixed TSH- and prolactin-secreting pituitary macroadenoma was successfully treated with orally administered cabergoline, 0.

Heterogeneity of the vasoconstrictor effect of vasopressin in septic shock.

Objective: To determine whether pressor doses of vasopressin impair organ blood flow in endotoxic shock.

Design: Graded doses of vasopressin or phenylephrine, starting at the clinically recommended doses for pressure support in septic shock, were intravenously infused during endotoxic shock.

Setting: University hospital surgical research laboratory.

The prediction of premorbid memory ability.

An estimation of premorbid memory ability is necessary for clinical judgments of memory status following brain injury or illness. This paper describes the nature of clinical reasoning about memory ability and intelligence. The analysis of these reasoning problems has progressed from the simple contrast of clinical versus actuarial models to a theory that integrates all such models as applications of reasoning under uncertainty.

Neuropsychologists' practice patterns in assessing premorbid intelligence.

The current study surveyed practicing neuropsychologists about the methods they use to estimate premorbid levels of function, and their prior training with these methods. Doctoral level psychologists, who are members of the National Academy of Neuropsychology, were sent a questionnaire developed by the authors to assess these variables. Findings suggest that there is relatively little use of strategies specifically designed to assess premorbid ability.

Methods of estimating premorbid functioning.

Clinical neuropsychological assessment frequently requires the comparison of obtained scores against some estimate of premorbid level of functioning, but only recently has significant attention been turned to objective methods to accomplish this objective. Clinical judgment, although useful in some circumstances, is generally insufficient. Other methods of estimating premorbid function include demographic regression formulae, such as the Barona formula, subtest scatter methods, such as that suggested by Lezak, and the use of current scores on tests of presumably spared abilities, such as the National Adult Reading Test (NART).

Wisconsin Card Sorting Test performance in above average and superior school children: relationship to intelligence and age.

This study explores the relationship of intelligence and age to scores on the Wisconsin Card Sorting Test, a measure of executive function. A sample of 26 normal children with Wechsler Intelligence Scale for Children-III (WISC-III) Full-Scale IQS above 130 and 24 normal children with WISC-III Full-Scale IQS between 110 and 129 were administered the test. A comparison to published norms revealed that above average children outperformed the average 9- to 14-year-old child on every measure at every age.

Defining the acute in acute care nurse practitioner.

The role of the nurse practitioner in the tertiary care or hospital setting has become well established during the course of this decade. With the introduction of a national certifying examination for acute care nurse practitioners in 1995, it is important that the word acute be defined in a way that is acknowledged universally. Should an examination certifying acute care nurse practitioners contain critical care content? Are the terms acute care and critical care synonymous? The existing examination contains critical care content, but a review of relevant literature suggests a conflict.

A simple strategy for faster induction and more cost-effective use of anesthetic vapor.

Introduction: Inducing general anesthesia often involves mask ventilation using high fresh gas flow (FGF) to administer anesthetic vapor prior to endotracheal intubation. A common practice is to turn the vaporizer off when the mask is removed from the patient's face to avoid room contamination (VAPOff). An alternative approach is to leave the vaporizer on and turn the FGF to minimum to reduce the amount of vapor laden gas that can enter the room (FGFOff).

Comparison of irrigated electrode designs for radiofrequency ablation of myocardium.

Background: Previous reports have demonstrated that radiofrequency energy delivered to myocardium via an irrigated electrode results in a more voluminous ablation lesion than a non-irrigated electrode. Different irrigated electrode designs have been utilized; no direct comparisons have been reported.

Purpose: To compare different irrigated electrode designs.

Biophysics of radiofrequency ablation using an irrigated electrode.

Background: Previous reports have proposed that prevention of electrode-endocardial interfacial boiling is the key mechanism by which radiofrequency application using an irrigated electrode yields a larger ablation lesion than a non-irrigated electrode. It has been suggested that maximal myocardial temperature is shifted deep into myocardium during irrigated ablation.

Purpose: To examine the biophysics of irrigated ablation by correlating electrode and myocardial temperatures with ablation circuit impedance and lesion morphology, and to perform a comparison with non-irrigated ablation modes.

Electrogram-guided radiofrequency catheter ablation of atrial tissue comparison with thermometry-guide ablation: comparison with thermometry-guide ablation.

Objectives: To characterize a new method for radiofrequency energy titration during ablation of atrial tissue based on reduction in electrogram amplitude. To compare this method with energy titration using electrode thermometry.

Background: Complications associated with "anatomy-based" atrial endocardial radiofrequency ablation for suppression of atrial fibrillation may be due to flawed methods of energy titration.

CT Evaluation of Laryngotracheal Trauma.

Laryngotracheal injuries are rare, and typically associated with multisystem trauma. They may be blunt or penetrating in nature, and are in the great majority of cases related to motor vehicle accidents or ÒclotheslineÓ injuries with a small percentage due to direct blows sustained during assaults or athletic contests, hanging or manual strangulation, or other less common etiologies including iatrogenic causes. Missed diagnoses or mismanagement may result in the patient's death or significant long-term morbidity.

Imaging of Facial Trauma.

Severe injury to the facial skeleton is a frequent finding in victims of trauma. Severe facial fractures produce a variety of radiographic and CT abnormalities that are not difficult to recognize if one carefully analyzes the images. This discussion covers a number of radiographic findings that are characteristic of several families of major injuries to the midface.

Thoracic and Lumbar Vertebral Injuries.

Injuries to the thoracic and lumbar vertebral column are not uncommon and are the result of increased loading on structures endowed with little motion or flexibility. Conventional radiographs, when carefully analyzed for the ÒfootprintsÓ and ÒfingerprintsÓ of the injury, will define its nature and, to a degree, its extent. A system of radiologic analysis is described and the parameters for diagnosis and differentiation are given.

Vascularized orthotopic osteochondral transplantation of the canine proximal femur.

Osteochondral vascularized proximal femoral allografts were orthotopically transplanted in five adult beagles (four experimental and one control). The experimental animals were placed on 0.1 mg/kg of FK506 intravenously for 7 days, and then converted to 1.

Laparoscopic management of giant paraesophageal herniation.

Background: Many surgeons have found laparoscopic fundoplication effective management of medically recalcitrant gastroesophageal reflux disease (GERD) associated with sliding type I hiatal hernias. The anatomic distortion and technical difficulty inherent with repair has limited the use of laparoscopy for repair of "giant" paraesophageal hernias (gPH).

Methods: Since July 1993, we have accomplished laparoscopic repair of paraesophageal hiatal hernias in 54 of 60 (90%) patients.

Smoking after nicotine deprivation enhances cognitive performance and decreases tobacco craving in drug abusers.

This study investigated the effects of nicotine deprivation and smoking on cognitive abilities and tobacco craving. Twenty smokers with histories of drug abuse completed the Questionnaire on Smoking Urges (QSU) and two cognitive tests before and after smoking two cigarettes during two 90-min sessions. After two cigarettes were smoked at Session 1, subjects were tobacco abstinent for 18 h until Session 2 the next morning.