Conservative management of lumbar spinal stenosis. Identifying patients likely to do well without surgery.

Lumbar spinal stenosis is a painful condition that often leads to irreversible neurologic damage and functional disability. Thus, early diagnosis and management are important. Conservative therapy, which is appropriate for many patients, minimizes invasive intervention and decreases the risks of morbidity.

Avascular necrosis of bilateral knees secondary to corticosteroid enemas.

Avascular necrosis (AVN) is a devastating adverse effect of corticosteroid therapy rarely reported in the setting of inflammatory bowel disease. We describe a 48-year-old woman with 6 weeks of progressive bilateral knee pain resulting in the inability to ambulate. Her symptoms developed suddenly, 9 months after treatment with hydrocortisone enemas for ulcerative proctitis.

Standards of care and clinical algorithms for treating schizophrenia.

Health care changes and improved understanding of the course and management of schizophrenia have provided the propitious environment to develop guidelines for treating patients with schizophrenia. This article describes two recent guidelines and highlights how these may be used to enhance clinical practice. Although still at a nascent stage that is awaiting more widespread acceptance by clinicians, the introduction of guidelines represent a significant advance in mental health care.

Effects of psychoeducational intervention for married patients with bipolar disorder and their spouses.

The relative benefit of adding a structured psychoeducational intervention to standard medication treatment for married patients with bipolar disorder and their spouses was assessed. Patients were randomly assigned to receive either medication management or medication management plus a marital intervention with their spouses for an 11-month period. Patients' symptoms, functioning, and adherence to their medication regimens were measured at study entry and at 11 months.

Generation or large numbers of immature and mature dendritic cells from rat bone marrow cultures.

We have defined conditions for generating large numbers of dendritic cells (DC) in marrow cultures from 10-12-week-old ACI or WF rats. The combination of granulocyte-macrophage colony-stimulating factor (GM-CSF) and TNF-alpha, known to induce DC from human CD34+ progenitors, was not effective with rat. In contrast, GM-CSF plus IL-4 generated DC in high yield, corresponding to 30-40% of the initial number of plated marrow cells.

The use of pneumatic retinopexy to delay surgical repair of a retinal detachment associated with the ganciclovir intraocular device.

Rhegmatogenous retinal detachments are associated with cytomegalovirus (CMV) retinitis and the use of the ganciclovir intraocular device. Pars plana vitrectomy with silicone oil tamponade is the preferred technique to repair such detachments. The authors describe the use of pneumatic retinopexy as part of a treatment strategy in the management of multiple retinal detachments in a patient with CMV retinitis treated with ganciclovir implants.

The relationship between alexithymia, depression, and axis II psychopathology in eating disorder inpatients.

Objective: The major purpose of this study was to examine alexithymia in relationship to depression and Axis II psychopathology in eating disorder patients.

Method: Fifty-three female inpatients representing three DSM-IV eating disorder diagnostic groups and 14 control subjects completed the Toronto Alexithymia Scale (TAS), the Eating Disorder Inventory-2, and the Beck Depression Inventory within the first week of their hospital admission and shortly before discharge. Structured Clinical Interviews for DSM-III-R (SCID) I and II were also conducted.

Presenting signs of retinoblastoma.

A retrospective chart review was performed on the charts of 1265 patients with retinoblastoma who were on file at New York Hospital and whose conditions had been diagnosed between the years 1960 and 1990. The mean follow-up was 90 months, ranging from 0 to 409 months. Thirty-two distinct presenting signs of retinoblastoma were identified, the most common of which were leukocoria (56.

Second nonocular tumors in survivors of bilateral retinoblastoma: a possible age effect on radiation-related risk.

Objective: This study aimed to investigate the relationship in bilateral retinoblastoma survivors between the incidence of second tumors and the age when external beam radiation (EBR) was used.

Design: A retrospective analysis of patients diagnosed with retinoblastoma was performed by examining records for background information and treatment information as well as reviewing documentation of patients with second nonocular tumors. Two telephone interviews were conducted for follow-up as well as inquiries directed to tumor registries and state databases.

Time-voltage QRS area of the 12-lead electrocardiogram: detection of left ventricular hypertrophy.

Identification of left ventricular hypertrophy (LVH) using 12-lead ECG criteria based primarily on QRS amplitudes has been limited by poor sensitivity at acceptable levels of specificity. Because the product of QRS voltage and duration, as an approximation of the time-voltage area of the QRS complex, can improve accuracy of the 12-lead ECG for LVH, we examined the diagnostic value of true time-voltage area measurements of QRS complexes from the standard 12-lead ECG. Standard 12-lead ECGs and echocardiograms were obtained in 175 control subjects without LVH and in 74 patients with regurgitant valvular heart disease and LVH defined by echocardiographic criteria (indexed LV mass >110 g/m2 in women and >125 g/m2 in men).

Relation of left ventricular midwall function to cardiovascular risk factors and arterial structure and function.

Left ventricular (LV) midwall shortening (MWS) is subnormal in relation to LV circumferential end-systolic stress (ESS) (ESS-corrected MWS) in many hypertensive patients with normal LV chamber function and predicts subsequent morbidity and mortality. However, little is known of the relations of LV midwall function to demographic and metabolic variables or to arterial geometry. Asymptomatic, unmedicated normotensive (n=366) or hypertensive (n=282) adults were assessed with echocardiography and carotid ultrasound.

An investigation of vancomycin-resistant Enterococcus faecium within the pediatric service of a large urban medical center.

Background: Between 1990 to 1992 and 1993 to 1995 there was a >5-fold increase (16.7% to 89.8%) in vancomycin-resistant Enterococcus faecium isolates as a percentage of all isolates of vancomycin-resistant enterococci on the pediatric units of The New York Hospital-Cornell Medical Center (NYH-CMC).

Mechanisms and management of acute renal allograft rejection.

We used RT-PCR for the molecular characterization of human renal graft rejection. The studies showed that intragraft display of mRNA encoding cytotoxic attack molecule granzyme B, and immunoregulatory cytokines IL-10 or IL-2 are correlates of acute rejection, and intrarenal expression of TGF-1 mRNA, of chronic rejection. The current immunosuppressive protocol involves the use of multiple drugs, each directed at a discrete site in the T-cell activation cascade and each with distinct side effects.

The "Wedge" resection device for electrosurgical transurethral prostatectomy.

The "Wedge" (Microvasive, Natick MA) is a new electroresection device for transurethral prostatectomy (TURP) using the standard resectoscope. The design, which is broader than the standard loop and thickens from front to back, results in better hemostasis when used at 275 to 300 W because of its ability to cut and coagulate tissue simultaneously. In the canine model, histologic examination demonstrated a 2-mm zone of coagulation around the chips and in the resection bed; this response was not observed in the specimens resected by the standard tungsten loop.

Recurrent spontaneous hemarthrosis associated with reflex sympathetic dystrophy.

Reflex sympathetic dystrophy is a mysterious entity with unclear pathogenesis. The diagnosis is largely clinical and based on signs and symptoms of pain and vasomotor dysfunction. Treatment is a challenge because the underlying mechanism remains unknown.

Clinical experience with anti-D in the treatment of idiopathic thrombocytopenic purpura.

Idiopathic thrombocytopenic purpura (ITP), an autoimmune disease of children and adults, is characterized by low platelet counts and bleeding through mucous membranes. While not uncommon among otherwise healthy adults and children, ITP is a frequent complication of human immunodeficiency virus (HIV) infection. Anti-D is a gamma globulin (IgG) fraction containing a high proportion of antibodies to the Rh0 (D) antigen of the red blood cells.

Nutritional support of the cancer patient.

Malnutrition, a common problem in cancer patients, adversely affects survival and quality of life. It results from several factors that alter nutritional intake and cause massive metabolic disturbances. Anticancer therapies may compound the malnutrition.

Reconstruction of upper cranial and cranial base defects utilizing the scalping flap.

Reconstruction of midfacial defects by means of a scalping flap has been widely practiced and described in the literature. The advantages of the flap are familiar to surgeons who perform extirpations and reconstruction of the head and neck and include contiguous availability, simplicity of application, and a robust and redundant blood supply. Despite these merits, the flap has not been widely used for reconstructions of large anterior cranial defects or defects of the cranial base.

Uveitis associated with human immunodeficiency virus infection.

Purpose: To report uveitis associated with human immunodeficiency virus (HIV) infection and to suggest guidelines for treatment.

Methods: Six HIV-seropositive patients (10 eyes) with anterior or posterior uveitis or both were evaluated. After ineffective prolonged treatment with systemic and topical corticosteroids, specific systemic antiretroviral therapy with zidovudine was initiated in all patients.

Diagnosis and management of congenital adrenal hyperplasia.

Congenital adrenal hyperplasia is a family of inborn errors of steroidogenesis, each characterized by a specific enzyme deficiency that impairs cortisol production by the adrenal cortex, and can lead to sexual ambiguity in both genetic males and females. The enzymes most often affected are 21-hydroxylase, 11 beta-hydroxylase, and 3 beta-hydroxysteroid dehydrogenase, and less often, 17 alpha-hydroxylase/17, 20-lyase and cholesterol desmolase. Decreased production of cortisol results in increased pituitary secretion of adrenocorticotropic hormone.

Fluorescent virions: dynamic tracking of the pathway of adenoviral gene transfer vectors in living cells.

The pathogenic agent, adenovirus (Ad), has taken on a new role as a vector for gene transfer in both laboratory and clinical settings. To help understand the intracellular pathways and fate of Ad gene transfer vectors, we covalently conjugated fluorophores to E1-, E3- Ad vectors and used quantitative fluorescence microscopy to assess essential steps of Ad vector gene transfer to the A549 human epithelial lung cell line including binding, internalization, escape from endosomes, translocation to the nucleus, dissociation of capsids and gene expression. The data demonstrate that Ad internalizes with a t1/2 2.