Thoracoscopic surgery: historical perspectives.

Recent technical advances have revolutionized the fields of surgical endoscopy, laparoscopy, thoracoscopy, and microsurgical spinal endoscopy. The authors discuss the rich history and recent evolution of these techniques. Thoracoscopy had been widely used for the treatment of pleural conditions associated with tuberculosis.

Clinical Experience with Dual Head Gamma Camera Coincidence Imaging.

The authors report their experience with F-18 FDG coincidence imaging (CI) on a Dual Head Gamma Camera system employed for more than 2 years starting on August 23, 1996 within a community hospital. The latest version of this system included attenuation correction since May 1998. The problems with such systems and approaches in correcting these problems are described.

Sociodemographic and health characteristics of older Chinese on admission to a nursing home: a cross-racial/ethnic study.

Objectives: To investigate sociodemographic characteristics (SDCs) and health status of older Chinese newly admitted to a nursing home (NH) and to compare them with the characteristics of residents from other racial/ethnic groups.

Design: Secondary analysis of the admission Minimum Data Set Plus (MDS+).

Setting: A New York City municipal NH near Chinatown.

Rescue of an in vitro palate nonfusion model using interposed embryonic mesenchyme.

The authors previously established an in vitro palate nonfusion model on the basis of a spatial separation between prefusion embryonic day 13.5 mouse palates (term gestation, 19.5 days).

Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction.

In the last 20 years there have been enormous advances in our understanding of the acute coronary syndromes and how to manage patients presenting with them. In the 1980s, we began to understand the importance of thrombus formation was in the pathophysiology of acute coronary syndromes. Randomized studies also showed that appropriate antithrombotic therapy reduced the subsequent occurrence of myocardial infarction and death.

Overview analysis of adjuvant therapies for melanoma--a special reference to results from vaccinia melanoma oncolysate adjuvant therapy trials.

A phase III, randomized, double-blind, multi-institutional vaccinia melanoma oncolysate (VMO) trial was performed for patients with stage III (AJCC) melanoma. When compared with the control vaccinia virus (V) therapy, VMO therapy did not show clinical efficacy in the final analysis of data from this trial. However, the data did allude to significant therapeutic efficacy with VMO therapy if it had been compared with an observation arm.

Sublingual capnometry and indexes of tissue perfusion in patients with circulatory failure.

Objective: To examine the relationship between sublingual PCO(2) (PslCO(2)) and other indexes of tissue perfusion.

Design: Prospective observational study.

Setting: Medical and coronary ICUs in a tertiary-care teaching hospital.

Recurrent pneumococcal bacteremia: risk factors and outcomes.

Background: Recurrent pneumococcal bacteremia receives infrequent mention in the literature, usually in association with patients who are immunocompromised.

Objective: To examine recurrent cases of pneumococcal bacteremia to determine risk factors and outcomes (mortality rates and emergence of resistance) associated with recurrences.

Methods: We retrospectively reviewed all cases of pneumococcal bacteremia identified by our microbiology laboratory from January 1, 1992, through December 31, 1996.

Corticosteroids depress IFN-alpha-producing plasmacytoid dendritic cells in human blood.

Glucocorticoids are strongly immunosuppressive and are associated with reactivation of some intracellular infections. The plasmacytoid dendritic cell is a rare blood mononuclear cell detected through its production of IFN-alpha in response to herpes simplex virus and by surface immunophenotyping. We here report that steroid administration results in a decrease of IFN-alpha generation of approximately 25-fold, accompanied by reduction in circulating plasmacytoid dendritic cell numbers.

At wit's end: forgiveness, dignity, and the care of the dying.

Medical commentators on the play W;t by Margaret Edson, have tended to highlight the play's medical themes in the hope that this will help to improve the care of the dying. In this essay, the author argues that a close reading of the play suggests an alternative approach. This approach would require physicians to become personally engaged with the play's broad underlying themes, in particular the themes of dignity, relationship, and forgiveness.

Role of interleukin-10 in monocyte hyporesponsiveness associated with septic shock.

Objectives: The purpose of this study was to examine the pattern of tumor necrosis factor (TNF)-alpha and interleukin (IL)-10 release in endotoxin-stimulated septic monocytes and to determine the role of IL-10 and transforming growth factor (TGF)-beta in monocyte hyporesponsiveness during septic shock.

Design: Monocytes isolated from ten healthy controls and ten patients with septic shock were incubated with endotoxin and cytokine release was assessed. Next, normal monocytes were incubated with either normal or septic serum and stimulated with endotoxin.

Non-Q-Wave Myocardial Infarction.

The treatment of non-Q-wave infarction involves the use of antithrombotic therapy (aspirin and heparin) along with appropriate antianginal medication to reduce myocardial oxygen demands and prevent coronary spasm. In certain high-risk patient subgroups (ie, those with recurrent ischemia, persistent or significant ST segment change, congestive heart failure, or hypotension with chest pain), the use of newer agents such as the platelet glycoprotein IIb/IIIa antagonists is indicated. The role of angiography appears to be changing.

Effects of perfusion pressure on tissue perfusion in septic shock.

Objective: To measure the effects of increasing mean arterial pressure (MAP) on systemic oxygen metabolism and regional tissue perfusion in septic shock.

Design: Prospective study.

Setting: Medical and surgical intensive care units of a tertiary care teaching hospital.

In vivo demonstration of an antithrombin effect of abciximab.

Abciximab prolonged the activated clotting time (ACT) in a post hoc analysis from the Evaluation of IIb/IIIa Platelet Receptor Antagonist 7E3 in Preventing Ischemic Complications trial and an in vitro study has suggested an antithrombin effect of platelet glycoprotein IIb/IIIa inhibition. The purpose of this study was to evaluate the in vivo effects of abciximab on ACT and thrombin generation. In 46 patients undergoing coronary intervention, 24 received heparin and abciximab (group I), whereas 22 received heparin alone (group II).

Unusual presentation of solitary bone metastasis from breast carcinoma mimicking acute osteomyelitis of the left midtibial shaft.

The authors report an unusual presentation of a solitary bone metastasis in the left midtibial shaft with no other skeletal involvement in a patient with breast carcinoma. The incidence of solitary bone metastasis below the knees is rare. Clinically, the lesion was tender when palpated.

Microvascular response in patients with cardiogenic shock.

Objective: To examine the mechanisms contributing to decreased microvascular blood flow in cardiogenic shock by comparing patients with cardiogenic shock with critically ill controls and with patients with septic shock.

Design: Prospective, consecutive entry of patients meeting the criteria for septic shock, cardiogenic shock, and critical illness without coexisting infection or shock.

Setting: University hospital, medical intensive care unit, coronary care unit, and respiratory care unit.

Glucose absorption in acute peritoneal dialysis.

Objective: During acute peritoneal dialysis (APD), it is known that glucose found in the dialysate solution contributes to the provision of significant calories. It has been well documented in continuous ambulatory peritoneal dialysis (CAPD) that glucose absorption occurs. In APD, however, it remains unclear how much glucose absorption actually does occur.

Diagnosis and treatment of sleep disorders caused by co-morbid disease.

Sleep disorders, both insomnia and hypersomnia, are commonly associated with various co-morbid conditions, including general medical and neurologic disorders, psychiatric illnesses, and secondary or symptomatic restless legs syndrome/periodic limb movements in sleep. Diagnosis of the co-morbidity is the first step in treatment, followed by an assessment of the sleep disturbance. This begins with a complete history and physical examination, followed by laboratory testing such as polysomnography, multiple sleep latency testing, and actigraphy.

Decreased response to recall antigens is associated with depressed costimulatory receptor expression in septic critically ill patients.

Anti-inflammatory substances are released during septic shock that modulate monocyte function. Decreased monocyte responsiveness to bacterial toxins and decreased expression of human-leukocyte-associated antigen-DR (HLA-DR) have been reported during septic shock and critical illness. Impaired antigen presentation has been inferred from these observations but has not been demonstrated.