Out-of-hospital cardiac arrests: an 8-year New York City experience.

A retrospective study was conducted to determine the outcome of out-of-hospital cardiac arrests by one prehospital system in New York City from January, 1986, through December, 1993. The results were recorded consistent with the Utstein Style. Of 481 attempted patient resuscitations 406 were of cardiac etiology, with 382 patients having arrested prior to EMS arrival; their overall survival rate was 2.

Sacramental psychology: Treating intimacy failure in catholic priests.

The treatment of intimacy failure in Roman Catholic priests in an outpatient program designed to treat sexual misconduct is discussed here. Three case vignettes highlight a particular feature of an intimacy deficit that sets the stage for the priests' sexual acting out. Intimacy, hypocrisy, and self-deception and the Catholic sacramental world view are discussed to shed light on the treatment of sexual addiction in the clergy.

MMPI-2 critical item norms in chemically dependent inpatients.

The present study investigates the frequency of critical item endorsement for two MMPI-2 critical item sets in a population of inpatients being treated for chemical dependency. Base rates of endorsement in the current study are compared to the results of previous studies using the original MMPI, and relationships between item endorsement and various demographic and diagnostic variables are explored. Implications regarding the utility of critical items in chemically dependent populations are discussed.

Infective endocarditis: ten-year review of medical and surgical therapy.

Background: Infective endocarditis is a complex disease process. Optimal outcome often requires both medical and surgical expertise. The need for and timing of surgical intervention is controversial and continues to evolve in parallel to advancements in diagnosis and treatment.

Tuberculosis, HIV disease, and directly observed therapy.

Directly observed therapy (DOT) to enable completion of antituberculous therapy works. DOT is largely responsible for the recent improvement in tuberculosis case rates in New York City. Despite this favorable trend, the factors of significant HIV disease rates and of multidrug resistant forms of tuberculosis bacteria in the population are of grave concern.

Odontoid fracture and C1-C2 subluxation in psoriatic cervical spondyloarthropathy. A case report.

Study Design: Case presentation and review of pertinent literature.

Objectives: To present an unusual case and alert other physicians to possible missed diagnoses.

Summary Of Background Data: An unusual case is presented of a young man with server psoriatic spondyloarthropathy and fusion of C2-C7 (Type II cervical psoriatic ankylosing disease) who fell at home, sustaining an unrecognized fracture of the odontoid process leading to subluxation of C1-C2 and the transitory tetraplegia.

Successful treatment of progressive outer retinal necrosis syndrome.

Purpose: Progressive outer retinal necrosis is a destructive retinopathy found in patients with acquired immune deficiency syndrome. Treatment of this disorder has been unsuccessful in reported patient series, with the patients experiencing profound bilateral loss of vision.

Methods: We treated six patients with combination antiviral therapy, usually with intravenous foscarnet and either ganciclovir or acyclovir.

A clinical study of competency in psychiatric inpatients.

A 15-item questionnaire used to evaluate competency to consent to psychiatric hospitalization was validated using a blind forensic psychiatric interview. The statistical correlation was excellent with p < .001.

Central venous puncture versus cutdown for permanent pacemaker lead insertion: a modified double introducer technique.

Objective: The comparative safety of central venous puncture versus cutdown technique for access to the right heart.

Experimental Design: A retrospective review of five hundred and fifty-five single and dual chamber permanent pacemaker implants performed between January of 1987 and December of 1993.

Setting: Review was performed at St.

Response of locoregional and systemic symptoms to breast implant replacement with autologous tissues: experience in 37 consecutive patients.

This paper addresses the effectiveness of implant removal as treatment for systemic symptoms perceived to be related to breast implants. We reviewed our experience with 37 consecutive patients who underwent autologous tissue replacement of reconstructive breast implants. All patients were motivated primarily by concern regarding systemic symptoms for which diagnoses could not be provided.

Teaching medical staff psychological concepts via a hospital newsletter.

Despite the increased recognition of the critical role of social and psychological factors in health and illness, the teaching of psychology is rarely integrated in medical education. Staff generally have minimal formal training in psychological concepts. Patients on the inpatient rehabilitation unit frequently present with unexpected reactions in response to acute trauma and resulting changes in identity and capabilities.

Risk factors for cotton-wool spots and for cytomegalovirus retinitis in patients with human immunodeficiency virus infection.

Purpose: To investigate the risk factors for cotton-wool spots and for cytomegalovirus retinitis in patients with human immunodeficiency virus infection (HIV).

Methods: A cross-sectional study was performed on 453 consecutive male patients with a positive serodiagnosis for HIV. The possible risk factors of age, race, absolute T-lymphocyte CD4+ count, and mode of HIV acquisition were evaluated.

The influence of changes in hand temperature on the indirectly evoked electromyogram of the first dorsal interosseous muscle.

The evoked EMG response commonly decreases in amplitude during the first few minutes of anaesthesia. The purpose of this study was to determine if a relationship exists between changes in hand temperature, which are known to occur with induction of anaesthesia, and drift in the EMG signal. The indirectly evoked response of the 1st dorsal interosseous muscle was measured using a Datex Relaxograph in 15 patients undergoing elective surgery.

Ligation device assisting low anterior anastomosis.

Unlabelled: The use of the circular stapler has enabled surgeons to perform very low anterior resections where previously abdominoperineal proctectomy would be performed for carcinoma of the rectum. The use of the roticulator or other linear stapler devices has facilitated these anastomoses and precluded the necessity for pursestring sutures, thereby reducing the incidence of incomplete tissue rings, which should reduce the risk of anastomotic leaks. One significant drawback to the roticulator, especially in the narrow male pelvis, is its application for very low lesions.

Coronary pseudoaneurysm after angioplasty.

Coronary pseudoaneurysm is a complication of angioplasty occurring in 4-5% of cases. The likely etiology of the pseudoaneurysm is an iatrogenic dissection. Although increasingly identified, they are infrequently reported and no large series has been documented.

Non-Hodgkin's lymphoma of the external auditory canal in an HIV-positive patient.

This is a case report of non-Hodgkin's lymphoma of the external auditory canal, and infratemporal fossa, which presented with multiple cranial nerve palsies. The diagnosis was achieved via biopsy of tissue from the external auditory canal, and treatment with radiation therapy led to improvement of the symptoms. The management of AIDS-related lymphoma of the skull base with cranial neuropathies is reviewed.

Meta-analysis of surgical outcome in adolescent idiopathic scoliosis. A 35-year English literature review of 11,000 patients.

Study Design: Meta-analysis of the English literature on the surgical treatment of adolescent idiopathic scoliosis.

Objective: To gather comparable data from a number of different sources and combine the data to create a larger, more statistically significant pool of information for the analysis of surgical outcome.

Summary Of Background Data: Meta-analysis is a technique of scientific literature review used in outcome evaluation of medical treatment.

Detection of a 2.1 cm hepatocellular carcinoma in an 11-year-old boy by Tl-201 chloride. Case presentation and correlative imaging findings.

Abnormal uptake of Tl-201 chloride in the liver along with correlative radiologic imaging is presented in an unusual case of an 11-year-old boy with a small 2.1 cm hepatocellular carcinoma. Although planar Tl-201 images were normal, triple-headed SPECT Tl-201 images showed a focal area of increased liver activity at the site of the tumor which corresponded to a photopenic area on Tc-99m SC SPECT images.

Asthma and related atopic disorders in outpatients attending an urban HIV clinic.

Background: Drug hypersensitivity and pruritic cutaneous disorders are common in human immunodeficiency virus (HIV)-infected patients. Systematic cross-sectional studies, detailing the pattern of atopic disease, however, have not been performed in patients with HIV infection.

Objective: To analyze the relationships between atopic disease and factors relating to lifestyle, environment, gender, genetics, and HIV disease-associated immune cell depletion.

The role of the 'pericardial window' in AIDS.

Background: The leading cause of pericardial effusion in urban hospitals is now AIDS-related pathologies. Clinically, these effusions are a diagnostic and management dilemma. In our institution, pericardial biopsy and operative drainage have become part of the diagnostic and management plan.

Diffuse bilateral lung uptake of TI-201 chloride in CMV pneumonitis. Case presentation with histopathologic correlation.

Diffuse intense lung uptake of TI-201 chloride without abnormal Ga-67 citrate in a case of cytomegalovirus pneumonitis in a patient with AIDS is presented. An autopsy performed within 4 days of imaging revealed no pulmonary pathology other than diffuse cytomegalovirus infection with abundant histiocytes and inclusion bodies and pulmonary congestive heart failure. Among the various mechanisms of TI-201 accumulation, active transport through Na-K ATPase appears to be predominant in this case, as suggested by innumerable histiocytes.

Single-photon emission computed tomography of the brain in acute mania and schizophrenia.

Single-photon emission computed tomography (SPECT) imaging with n-isopropyliodoamphetamine (IMP) was performed on 11 patients with bipolar mania, 21 acute schizophrenics, and 15 healthy control subjects. Subjects were evaluated with neuropsychological tests and psychiatric rating scales. SPECT brain studies were blindly evaluated to assess the degree of radiopharmaceutical uptake in three neuroanatomical regions of interest in each hemisphere.

201T1-chloride uptake ratios in differentiating benign from malignant lesions: recommendations for ratio calculations and interpretation.

Thallium-201 (201T1) chloride ratios have been used to differentiate benign from malignant lesions in bones and soft tissues, brain, breast, lungs and thyroid. Different values of these ratios have been reported by various authors. The need to standardize the methods for calculating thallium ratios is discussed in this paper.