Intrapartum fetal stimulation tests: a meta-analysis.

Objective: To assess the performance of stimulation tests for the prediction of intrapartum fetal acidemia.

Data Sources: We conducted a MEDLINE (Internet Grateful Med) literature review from 1966 to 2000 using the terms "fetal scalp pH," "fetal scalp stimulation," and "fetal acoustic stimulation."

Study Selection: Articles were included if sensitivity, specificity, and predictive values for intrapartum fetal acidemia could be calculated.

Nosocomial transmission of imipenem-resistant Pseudomonas aeruginosa following bronchoscopy associated with improper connection to the Steris System 1 processor.

Objective: To assess nosocomial transmission of imipenem-resistant Pseudomonas aeruginosa (IRPA) following bronchoscopy during August through October 1998.

Design: Traditional and molecular epidemiological investigation of a case series.

Setting: University-affiliated community hospital.

Fluoroquinolone-resistant Streptococcus pneumoniae associated with levofloxacin therapy.

Fluoroquinolone-resistant cultures of Streptococcus pneumoniae were isolated from 2 patients who were treated for pneumonia with levofloxacin. Nucleotide sequence analysis of bacterial DNA showed that the isolates contained mutations in both parC (DNA topoisomerase IV) and gyrA (DNA gyrase), which were shown previously to confer fluoroquinolone resistance. With the resistant isolates, the MICs for ciprofloxacin, gatifloxacin, grepafloxacin, levofloxacin, and trovafloxacin were above the maximal serum drug concentrations reported for standard dosage regimens.

The diagnosis of acute appendicitis: clinical assessment versus computed tomography evaluation.

The goal of this study was to validate Alvarado's predictive model as a diagnostic test and to assess the effectiveness of computed tomography (CT) scan as a supplemental tool in the evaluation of acute appendicitis. Clinical and radiologic data of 215 patients with acute abdominal pain were evaluated. Clinical assessment was based on positive findings of migration of pain, anorexia, nausea and vomiting, tenderness of the lower right quadrant, rebound tenderness, fever, and leukocytosis with a left shift.

Role of the nephrologist in the intensive care unit.

Intensive care units (ICUs) are increasingly becoming a focal point for tension between medical specialists. In an extreme approach to this issue, some ICUs have become closed units managed by intensivists, with other specialists, such as nephrologists, having a restricted supportive role. The nephrologist, a subspecialist with broad skills in general internal medicine, has trained and appropriately can serve as the primary physician for patients with significant renal failure and end-stage renal disease in multiple hospital settings, including the ICU.

Effect of immediate hemoglobin A1c results on treatment decisions in office practice.

Objective: To assess the effect of an immediately available hemoglobin A1c (HbA1c) result on glycemic control and physician decisions about pharmacologic therapy in an office practice.

Methods: In a 1-year retrospective review of medical records, HbA1c results were analyzed in 115 patients beyond the age of 65 years, who had type 2 diabetes and were referred for the first time to a private endocrinology practice between April 1, 1997, and March 31, 1998. These patients were classified into two groups: group A (N = 93, insured by standard Medicare) had immediate HbA1c results (during the patient encounter) and group B (N = 22, insured by Medicare health maintenance organization [HMO]) had commercial laboratory HbA1c results available within 2 to 3 days.

Solitary fibrous tumor of the oral soft tissues: a clinicopathologic and immunohistochemical study of 16 cases.

We describe the clinicopathologic and immunohistochemical features of 16 solitary fibrous tumors (SFTs) originating within the oral soft tissues. There were 10 women and six men with a mean age at diagnosis of 56 years. In all cases the tumors were slow-growing, asymptomatic, submucosal growths of variable size and duration.

Child health status, neurodevelopmental outcome, and parental satisfaction in a randomized, controlled trial of nitric oxide for persistent pulmonary hypertension of the newborn.

Objective: To describe health and neurodevelopmental outcomes and parental satisfaction with hospital care among surviving intervention and control enrollees in a randomized, controlled trial of nitric oxide for persistent pulmonary hypertension of the newborn (PPHN).

Methods: All surviving enrollees 1 to 4 years of age were eligible for follow-up. Outcomes were assessed by telephone using a trained interviewer and standardized instruments.

Propylthiouracil-induced perinuclear-staining antineutrophil cytoplasmic autoantibody-positive vasculitis in conjunction with pericarditis.

Objective: To describe a case of propylthiouracil-induced vasculitis manifesting with pericarditis.

Methods: We present the first case report of a woman with hyperthyroidism treated with propylthiouracil in whom a syndrome of pericarditis, fever, and glomerulonephritis developed. Serologic testing and immunologic studies were done, and a pericardial biopsy was performed.

Lichen striatus. Histological, immunohistochemical, and ultrastructural study of 37 cases.

Background: Lichen striatus (LS) is a papulosquamous disorder with a distinctive linear distribution. The linearity has been shown to correspond in many cases to the pattern of Blaschko's lines. The etiology is unknown.

The retinoid fenretinide inhibits proliferation and downregulates cyclooxygenase-2 gene expression in human colon adenocarcinoma cell lines.

Fenretinide [N-(4-Hydroxyphenyl)retinamide, 4-HPR] (10(-10)-10(-6) M) treatment of HT-29 human colon cancer cells for 24-72 h significantly inhibited their growth. Using HCT-15 cells, 4-HPR had limited inhibitory effects on cell proliferation over the same concentration range and time period. The inhibitory effects of 4-HPR on cell growth in HT-29 cells were markedly reduced in the presence of exogenously added prostaglandins (PGs), suggesting a possible role for inhibition of PG synthesis as a mechanism for 4-HPR's antiproliferative effects.

Efficacy and safety of iron sucrose for iron deficiency in patients with dialysis-associated anemia: North American clinical trial.

Iron sucrose has been used to provide intravenous (IV) iron therapy to patients outside the United States for more than 50 years. In a multicenter North American clinical trial, we determined the efficacy and safety of iron sucrose therapy in patients with dialysis-associated anemia, evidence of iron deficiency, and below-target hemoglobin (Hgb) levels despite epoetin therapy. Evidence of iron deficiency included a transferrin saturation (Tsat) less than 20% and ferritin level less than 300 ng/mL, and below-target Hgb levels included values less than 11.

Practical considerations in setting up an intracoronary brachytherapy program: results of a multicenter survey.

Purpose: To identify logistic issues faced by radiation oncologists in initiating intracoronary radiation therapy (RT) and to delineate their role in these procedures.

Materials And Methods: Radiation oncologists from 12 sites (with combined experience of >500 cases) that participated in a randomized, double-blinded study of intracoronary RT completed a questionnaire that included demographics and experience, regulatory issues, scheduling and interaction with patients, time commitment, involvement of the radiation oncologist, and ideas for overcoming hurdles.

Results: Licensing was perceived as a substantial hurdle; Nuclear Regulatory Commission approval took more than 5 months at five of 12 sites.

Refractory priapism of unknown etiology in a pediatric patient.

Priapism is a urologic emergency that can occur in any age group and every patient should receive prompt urologic consultation. Management of priapism is based on the recognition of underlying pathophysiology; ready differentiation between high-flow and low-flow priapism; reversal of any potential precipitating factors; the use of corporal aspiration irrigation combined with intracavernosal alpha adrenergic therapy; and when necessary, a shunting procedure. Delay in recognition or treatment can be crucial as the incidence of long-term complication rises substantially with the duration of the priapism.

Lasers in a hospital-based dental practice.

Lasers have been shown to be excellent additions to the dental armamentarium. When used on medically compromised patients in a hospital-based setting or private practice setting sufficiently equipped to deal with potential medical emergencies, lasers can make treatment of these patients much simpler and safer. As more uses are found for dental lasers and more wavelengths are developed for dentistry, lasers will become an increasingly useful tool for the hospital dental practice.

Twin-twin transfusion syndrome: an update.

Twin-twin transfusion syndrome leads to high rates of perinatal morbidity and mortality due to its poorly understood etiology and difficult diagnosing and treatment. Current therapies are suboptimal and have not been tested through randomized controlled trials. Parent counseling at the time of diagnosis includes informing on poor chance of double survival, relatively high chance of long term neurologic handicap, almost certain prematurity, and the probability of cesarean delivery.

Lactic acidosis associated with nucleoside analog therapy in an HIV-positive patient.

A 44-year-old African-American female, HIV positive treated with highly active antiretroviral therapy (HAART), consisting of two nucleoside analogues and one nonnucleoside reverse transcriptase inhibitor, who was initially admitted with severe lactic acidosis. Liver biopsy was performed on the ninth hospital day, which revealed moderate microvesicular and macrovesicular fatty changes. The possible mechanism of lactic acidosis in patients on nucleoside analogues is discussed.

Intranodal hemangioma of the oral soft tissues: a case report of a rare entity with review of the literature.

The presentation of a primary vascular tumor in a lymph node is a rare occurrence. Only 16 documented cases have been reported to date, with none described in the oral soft tissues. This case report presents the first occurrence of an intra-nodal hemangioma of the oral soft tissue in an 11-year-old girl.