Sinus Node Dysfunction.

Sinus node dysfunction (SND) is a multifaceted disorder most prevalent in older individuals, but may also occur at an earlier age. In most cases, the SND diagnosis is ultimately established by documenting its ECG manifestations. EPS has limited utility.

Sinus Node Dysfunction.

Sinus node dysfunction (SND) is a multifaceted disorder most prevalent in older individuals, but may also occur at an earlier age. In most cases, the SND diagnosis is ultimately established by documenting its ECG manifestations. EPS has limited utility.

Cauda Equina Syndrome as a Clinical Presentation of Primary Angiitis of the Central Nervous System (PACNS).

Primary angiitis of the central nervous system (PACNS) is a form of vasculitis affecting the central nervous system (CNS) that is not associated with systemic disease or vasculitis outside the CNS. It is a rare disease with significant morbidity and mortality. Delay in diagnosis and treatment is common due to its nonspecific clinical symptoms and lack of efficient noninvasive diagnostic tests.

Genetic Counselors' Experiences with Paternal Involvement in Prenatal Genetic Counseling Sessions: An Exploratory Investigation.

Limited research exists concerning male partners' participation in prenatal genetic counseling (R. Kenen, A. C.

Initial validation of a diagnostic questionnaire for gastroesophageal reflux disease.

Objectives: Brief, reliable, and valid self-administered questionnaires could facilitate the diagnosis of gastroesophageal reflux disease in primary care. We report the development and validation of such an instrument.

Methods: Content validity was informed by literature review, expert opinion, and cognitive interviewing of 50 patients resulting in a 22-item survey.

An 11-year-old girl with syndrome of inappropriate antidiuretic hormone secretion.

An 11-year-old girl presented with a syndrome of inappropriate antidiuretic hormone secretion, which was transitory and, initially, of obscure origin. Subsequently, the patient's hypothalamic disorder emerged as a component of a steroid-responsive relapsing encephalomyelitis with cerebral pathology restricted to the basal ganglia and brainstem. Where such a disorder fits in the spectrum from acute disseminating encephalomeylitis to multiple sclerosis is discussed.

An adolescent with complicated migraine.

During an evaluation for complicated migraine, a 14-year-old adolescent female was found to have a left frontoparietal cortical infarction on magnetic resonance imaging study. A transthoracic echocardiogram was normal, but a transesophageal echocardiogram, with contrast study, showed occasional right to left shunting through a patent foramen ovale. The role of cardiac anomalies in the pathogenesis of migraine-associated stroke is discussed.

Acute or subacute cranial computed tomography findings in patients with congenital lactic acidemia.

Two patients with congenital lactic acidemia of unknown etiology developed striking and extensive cranial computed tomography abnormalities of acute or subacute onset. In addition to Leigh syndrome and MELAS (mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes), other lactic acidemia disorders may produce evolving cerebral radiographic abnormalities. An aggressive effort should be made in such patients to obtain a specific diagnosis through biochemical and molecular genetic studies.

Effectiveness of a nurse-based intervention in a community practice on patients' dietary fat intake and total serum cholesterol level.

Objective: To evaluate the effect of a nurse-based intervention for patients with high total cholesterol (TC) levels in a community practice.

Design: Clinical trial without a control followed by a nonrandomized control trial.

Setting: Suburban primary care practice.

Chemical abuse and pain management.

This article provides additional direction for nurses in altering the pain management plan for individuals who are currently abusing chemicals. There is a definition of terms (i.e.

Breath-holding spells.

Two particularly common, and frequently frightening, forms of syncope and anoxic seizure in early childhood are pallid and cyanotic breath-holding spells. Pallid breath-holding spells result from exuberant vagally-mediated cardiac inhibition. Cyanotic breath-holding spells are of more complex pathogenesis, involving an interplay among hyperventilation, Valsalva maneuver, expiratory apnea, and intrinsic pulmonary mechanisms.

New oral agents for type II diabetes. Taking a more aggressive approach to therapy.

Status quo obviously is not optimal in the management of patients with non-insulin-dependent diabetes, given the fact that the average hemoglobin A1c value in this diabetic population is between 9% and 10%. There is an impetus, therefore, to move up the treatment ladder more quickly than at present. The availability of new oral hypoglycemic agents provides the potential for expanding the role of this category of agents and for improving overall glycemic control in these patients.

A comprehensive initiative to manage the incidence and cost of occupational injury and illness. Report of an outcomes analysis.

A comprehensive initiative utilizing an in-house preferred provider organization, medical case management, and application of ergonomic techniques was implemented in an effort to control the incidence and cost of workplace injuries. The program was evaluated utilizing OSHA 200 Logs to compare the incidence and lost time due to compensable injury and illnesses before and after beginning the program. After the introduction, there was a significant decrease in injuries and illnesses (53/1000 vs 27/1000, P<.

Evaluation of oncology registry follow-up methods.

Background: The accuracy and completeness of oncology (tumor) registry patient follow-up information directly affects the validity of the oncology registry system for determining outcomes, as a quality assurance measure, and for research activities. At this institution, if a hospital-based patient encounter has not been identified during the previous year, a follow-up letter is sent to the attending physician to obtain current information about the patient. Difficulties using this method include (1) correct identification of the appropriate physician (2) constraints on physician and staff time to provide information, and (3) accuracy, currentness, and completeness of information provided.

Comparison of intranasal triamcinolone acetonide with oral loratadine for the treatment of patients with seasonal allergic rhinitis.

This multicenter, double-blind, randomized, controlled, parallel-group study compared the safety and efficacy of intranasal triamcinolone acetonide with oral loratadine in relieving symptoms of ragweed-induced seasonal allergic rhinitis. Patients from community-based allergy practices with a history of at least two seasons of seasonal allergic rhinitis verified by a positive skin test received either once-daily treatment with intranasal triacinolone acetonide 220 micrograms plus 1 placebo capsule or oral loratadine 10 mg plus placebo nasal spray. Other medications for rhinitis were prohibited.

Acute transverse myelitis and brainstem encephalitis associated with hepatitis A infection.

A 4-year-old boy became paraplegic during the course of hepatitis A infection. There were significant magnetic resonance imaging changes in the cervical spinal cord and brainstem. The patient's cervical myelopathy resolved entirely after 10 weeks.

Insect sting allergy: analysis of a cohort of patients who initiated venom immunotherapy from 1978 to 1986.

Background: The proper duration of venom immunotherapy remains uncertain.

Objective: We report our experience with a cohort of patients who started venom immunotherapy from 1978 to 1986.

Methods: In a midwestern allergy practice, the cohort of 204 stinging insect-allergic patients who commenced venom immunotherapy from 1978 to 1986 were identified and evaluated by retrospective chart analysis and patient telephone inquiry.

Diabetic ketoacidosis. Treatment strategies to avoid complications.

Diabetic ketoacidosis is a serious and complex metabolic disorder that usually occurs in young persons. Appropriate management includes administration of fluids, insulin, and potassium and a thorough search for a precipitating cause. Careful and frequent follow-up and careful record keeping are needed to track important data.

Intensified insulin regimens. Should they be used in all patients with type I diabetes?

The results of the Diabetes Control and Complications Trial demand a more aggressive approach to glucose control for patients with insulin-dependent diabetes mellitus. Intensified insulin regimens offer the potential for implementing this mandate. Goals of treatment should be jointly set by the patient and the professional healthcare team.

Unusual forms of pulmonary embolism.

The first word of the title, unusual, captures the theme of this article. The entities discussed here: fat embolism, tumor embolism, venous air embolism, and amniotic fluid embolism, as well as other unusual embolic events are uncommon disorders that occur in specific circumscribed clinical settings. We have attempted to provide a cognitive jolt to remind the reader to consider these unusual events in appropriate differential diagnoses.

Cloudy lenses and issues: a pedigree of unoperated congenital cataracts.

The issue of when congenital cataracts should be removed seems to be well resolved, with most recommendations stating that all significant central lens opacities should be removed by 4 months of age, with removal most commonly occurring the first month. Although there are many strong recommendations regarding congenital cataracts in the literature, little has been written about the initial decision of whether or not to operate. A pedigree is presented of multiple generations with inherited bilateral central cataracts.