Voice-activated dictation for autopsy pathology.

Dictation with report preparation using computer-aided voice recognition software and hardware is described for use in autopsy pathology. The system utilizes standardized modular fill-in forms that automatically generate preprogrammed text when key descriptive phrases or words are spoken, and it can be trained to recognize the voice of individual operators. The system has the potential for reducing personnel time in dictation and transcription, increasing accuracy of reports, and encouraging uniformity with completeness through adherence to built-in standard forms.

Transmission of parasitic and bacterial infections through blood transfusion within the U.S.

The American public has become aware that viral infections can be transmitted by blood transfusions; however, less attention has been paid to nonviral agents that are similarly transmitted. Although donors are tested routinely for serologic evidence of Treponema pallidum infection (syphilis), there are no other bacterial infections for which donors are routinely tested, and no testing is done routinely to detect parasitic infections. Although current preventive strategies appear effective in preventing the transmission of nonviral agents by transfusion, changing population demographics, increased travel and immigration, and increased occurrence of certain asymptomatic bacterial infections in blood donors may require new policies to maintain the safety of the U.

Type III fractures of the tibial tubercle in adolescents.

Fifteen patients with Type III avulsion fractures of the tibial tubercle treated surgically were reviewed at an average of 9.6 years after injury. Six patients had a history of Osgood-Schlatter disease, and two patients had Type I osteogenesis imperfecta.

Carbon dioxide digital subtraction arteriography: a pilot study.

To investigate the diagnostic value of carbon dioxide arteriograms in patients with peripheral vascular disease, ten patients in whom standard contrast arteriography was contraindicated underwent carbon dioxide digital subtraction arteriography. Lower extremity ischemia or severe hypertension with renal insufficiency were the indications for arteriography. Standard contrast arteriography was precluded by chronic nondialysis-dependent renal insufficiency, severe congestive heart failure or contrast hypersensitivity.

Metallic ballistic fragments: MR imaging safety and artifacts.

The ferromagnetism of various bullets and shotgun pellets was tested in vitro. Magnetic deflection showed that four of 21 metallic specimens tested (all bullets) demonstrated marked ferromagnetism. Three of these four were made outside the United States; two of the four were known to contain steel, and the other two were reportedly either copper or copper-nickel-jacketed lead bullets (indicating that the ferromagnetism was due to impurities in the bullet jackets or cores).

Computerizing medical records: software criteria for systems to document patient encounters.

It is difficult to design and build computer systems to document medical care, especially if the entries are to be made by health care professionals. Not all software approaches are equally well suited to the task. Twenty-one specific software characteristics were identified that promote efficient development and support clinical needs.

Delayed intracranial hemorrhage following cerebral infarction in sickle cell anemia.

Clinical and necropsy findings in 11 patients with sickle cell anemia (SS) indicate that intracranial hemorrhage (IH) is a delayed sequela of the same vasculopathy that causes cerebral infarction during childhood. Evidence of prior cerebral infarction during childhood included hemiparesis, seizures, an episode of coma, or mental retardation. Computerized tomography (CT) scans showed cerebral infarcts with lucent areas and dilated ventricles or cerebral atrophy.

Selective management of nonocclusive arterial injuries.

Between 1978 and 1988, 50 patients were demonstrated arteriographically to have 61 nonocclusive arterial injuries (44 major arteries, 17 minor arteries). The 61 injuries consisted of 19 intimal defects, 4 intimal flaps, 26 pseudoaneurysms, 2 arterial stenoses, and 10 arteriovenous fistulas. End-organ ischemia or ongoing hemorrhage were not present.

Immediate reconstruction of contaminated central craniofacial injuries with free autogenous grafts.

Free autogenous osseous and soft tissue grafts were used for the immediate, one-stage reconstruction of central craniofacial injuries involving the frontal sinus in 95 patients with wounds contaminated by either skin or nasal bacteria. Graft removal and delayed reconstruction were necessary in only one patient who suffered an infection in the first postoperative week. To date, no delayed complications are known to have occurred in any patient.

Safety in transfusion practice. Is it safe to eliminate the major crossmatch for selected patients?

If a patient has no clinically significant unexpected antibodies, a major crossmatch is not required prior to blood transfusion so long as a test method that demonstrates ABO incompatibility is done. In this study, the safety of using a noncrossmatch method for detecting ABO incompatibility was compared with the use of an immediate spin crossmatch (ISCX). This noncrossmatch method consisted of the duplicate ABO testing of blood recipients, the repeated ABO testing of donor blood, and a clerical check to assure that only ABO matched or compatible blood was selected for transfusion.

Magnetic resonance imaging of pediatric spinal dysraphism.

Thirty pediatric patients with spinal dysraphism were studied with magnetic resonance imaging. A variety of dysraphic anomalies were visualized, including syringohydromyelia, tethered cord, widened spinal canal, meningomyelocele, lipomyelomeningocele, lipomeningocele, intraspinal lipoma, congenital dermal sinus tract, and scoliosis. In 29 of 30 cases, MRI diagnostically visualized spinal cord and dysraphic anatomy.

Central and renal hemodynamic effects of a new agonist at peripheral dopamine- and beta-2 adrenoreceptors (dopexamine) in patients with heart failure.

The effect of dopexamine, a new dopamine analogue, on central and renal hemodynamics was evaluated in nine patients with chronic, congestive heart failure caused by severe left ventricular (LV) systolic dysfunction. The administration of the maximally tolerated dose (7.2 +/- 4 micrograms/kg/min) resulted in a significant increase in cardiac index from 1.

Comparison of computer and non-computer-assisted technologies in noninvasive cardiac imaging.

We compared gated magnetic resonance imaging (MRI) and dynamic computed tomography (DCT) with two-dimensional cardiac ultrasound (ECHO) to assess differences in diagnostic information. Magnetic resonance imaging was performed in 41 patients; ECHO in 36, and DCT in 28 patients with various pathologic conditions. We measured the left and right ventricular (LV, RV) long and short axes (LA, SA), LV free wall and septal thickness (WT, ST) at end systole (ES) and end diastole (ED) on the apical four-chamber view (ECHO) or appropriate transaxial slice (MRI, DCT) on a subset of 14 patients.

Improvement in exercise capacity and exercise hemodynamics 3 months after double-balloon, catheter balloon valvuloplasty treatment of patients with symptomatic mitral stenosis.

Clinical status, exercise treadmill performance, and hemodynamics were determined in 24 patients with symptomatic mitral stenosis before catheter balloon valvuloplasty (CBV) and at 3 months follow-up. Hemodynamic determinations at rest showed that mitral CBV performed by the double-balloon technique resulted in significant immediate decreases in mean pulmonary arterial wedge pressure (28 +/- 7 to 16 +/- 5 mm Hg, p less than .01), mean pulmonary arterial pressure (41 +/- 11 to 33 +/- 10 mm Hg, p less than .

Red blood cell distribution width in untreated pernicious anemia.

The red blood cell distribution width (RDW) was studied in 26 unselected patients with untreated pernicious anemia. RDW changes were also sequentially followed after therapy in 12 patients. The mean (+/- 1 SD) RDW values were significantly higher in pernicious anemia patients than in controls (21.

Pregnancy in mixed connective tissue disease, poly/dermatomyositis and scleroderma.

Pregnancy related problems in mixed connective tissue disease, polydermatomyositis and scleroderma are analysed. Particular attention is also elevated to the therapeutical approach to these diseases during pregnancy and delivery.

Rheumatic diseases and pregnancy: a perspective.

The interaction between certain rheumatic diseases, sex hormones and their wide fluctuation during pregnancy and postpartum may be responsible for the variable course of rheumatic diseases during pregnancy. Important issues include effects on the mother and fetus by the disease, pregnancy and maternal drug therapy.

Electrophysiologic effects of intravenous magnesium in patients with normal conduction systems and no clinical evidence of significant cardiac disease.

Parenteral magnesium has been used for several decades in the empiric treatment of various arrhythmias, but the data on its electrophysiologic effects in man are limited. We evaluated the electrophysiologic effects of magnesium sulfate (MgSO4) administration in eight normomagnesemic patients with normal mononuclear cell magnesium content, who had no clinically significant heart disease and had normal baseline electrophysiologic properties. After administration of intravenous MgSO4, serum magnesium rose significantly from 1.

Mechanisms of hyperkalemia in systemic lupus erythematosus.

We found that nearly 10% of 142 patients with systemic lupus erythematosus (SLE) had persistent, unexplained hyperkalemia. Renal mineralocorticoid resistance has been suggested to account for the hyperkalemia in SLE. We studied the renin-aldosterone response to intravenous furosemide (60 mg) and upright posture and the renin response to converting enzyme inhibition (captopril, 50 mg) and upright posture in five patients with SLE and hyperkalemia (group 1) and five normokalemic patients with SLE (group 2).

Gallium-67 uptake in cutaneous lesions of mycosis fungoides.

The literature on gallium imaging in mycosis fungoides is limited and conflicting. A case of mycosis fungoides with increased uptake of Ga-67 in clinically noninfected skin lesions is reported. The literature regarding mycosis fungoides and gallium imaging is reviewed.

Effect of pharmacologic therapy on angina frequency, ST segment depression during ambulatory ECG monitoring, and treadmill performance in patients with chronic stable mild angina.

Fifteen patients aged 55 +/- 6 years (mean +/- SD) with mild, chronic stable angina were evaluated after 2 weeks of sublingual nitroglycerin therapy (control) and also after 12 weeks of treatment with either propranolol, up to 320 mg per day, or nifedipine, up to 120 mg per day, in order to measure signs of ischemia and the response of symptoms to therapy. Compared with the control period, there was a decrease in average daily episodes of angina from 1.0 +/- 0.

The course of fever during treatment of pulmonary tuberculosis.

We studied 161 patients with pulmonary tuberculosis: 55 (34%) were afebrile and 106 (66%) were febrile at presentation. Febrile patients were younger and more symptomatic than afebrile individuals. Fever was also associated with a higher incidence of lymphopenia, hyponatraemia, hypoalbuminaemia and many acid-fast bacilli on sputum smear.