Internal mammary artery bypass: thirteen years of experience. Influence of angina and survival in 5125 patients.

Internal mammary artery (IMA) bypass to the anterior descending coronary artery (ADA) was performed in 5125 patients from January 1978 to December 1990. The average age of patients was 68 years; males accounted for 68% (3485 patients) and 82% (4203) were NYHA Class III. Left ventricular function was impaired (ejection fraction < 40%) in 68% (3485 patients).

Incidence of skin disease in Cuzco, Peru.

In the nations of the developing world, the incidence of skin disease is especially affected by geography. While most studies focus on the tropics, this report records the pattern of skin diseases encountered in a South American mountain city. Among 1277 patients examined, the noninfectious dermatoses predominated.

Osteomyelitis caused by Mycobacterium haemophilum: successful therapy in two patients with AIDS.

Objective: Difficulties involved in diagnosis and response to antimicrobial therapy are described in detail for two cases of biopsy-proven osteomyelitis caused by Mycobacterium haemophilum in AIDS patients.

Setting: Two large, private teaching hospitals in New York City, New York, USA.

Patients, Participants: A 31-year-old woman with previous diagnoses of candida esophagitis and peripheral neuropathy (patient 1), and a 37-year-old man with Kaposi's sarcoma (patient 2).

Frosted branch angiitis associated with cytomegalovirus retinitis.

We examined three patients with acquired immunodeficiency syndrome who had frosted branch angiitis associated with small patches of cytomegalovirus retinitis. Each patient had a low CD4-helper T-lymphocyte count and a T-lymphocyte helper-suppressor ratio of less than 0.1.

A perspective on penicillin allergy.

Clinical situations for which penicillin is indicated as the sole effective treatment are not infrequent and may be increasing in incidence. Penicillin allergy in these circumstances complicates their medical management. The proper evaluation of penicillin allergy is thus crucial to making decisions about alternative antibiotic therapy vs penicillin and the need for desensitization in allergic individuals.

Active specific immunotherapy with vaccinia melanoma oncolysate.

Based on antitumor effects observed with vaccinia virus infected tumor cell lysate in animal models, adjuvant immunotherapeutic clinical trials were undertaken in patients with melanoma using vaccinia virus infected melanoma oncolysate (VMO). Preliminary clinical trials showed that the VMO is safe except minimal side effects such as mild fever, pain, and tenderness at the site of VMO injection, and mild lymphadenopathy. The effective dose of VMO was investigated in a following trial using 0.

Monophosphoryl lipid A attenuates the effects of endotoxic shock in pigs.

Monophosphoryl lipid A (MPL) is a nontoxic lipid A derivative that maintains many of the beneficial immunomodulatory activities of the parent lipopolysaccharide molecule, including the induction of tolerance to endotoxin. The hemodynamic effects of Salmonella minnesota MPL (300 mg/kg) and S. minnesota lipopolysaccharide (300 micrograms/kg) were compared in 20 minipigs.

Zidovudine-induced leukocytoclastic vasculitis.

Cutaneous reactions, including acne, pruritus, urticaria, and nail dyschromia, have been associated with zidovudine use. Cutaneous leukocytoclastic vasculitis is characterized by distinctive patterns of dermal perivascular inflammation without visceral involvement. We treated two cases of cutaneous leukocytoclastic vasculitis associated with fever in patients with severe human immunodeficiency virus-related immunodeficiency in which symptoms resolved on withdrawal of zidovudine therapy and recurred after rechallenge with the drug.

Pattern of C3, iC3b, and C3d in patients hospitalized for acute asthma.

Twenty-three patients hospitalized for acute asthma were studied for a peripheral blood complement profile consisting of C3, C4, C3d, iC3b, C4d, and Bb concentrations. Compared with normals (n = 22) and patients (n = 10) with acute bacterial infections (ABI), asthmatic patients had significantly higher serum C3 concentrations (P less than .001).

The effects on toxicity of circadian patterning of continuous hepatic artery infusion.

Long term continuous hepatic artery infusion of FUDR was carried out in 34 rats. In the animals who received a constant infusion schedule of 15 mg/kg/day all died of toxicity with a mean survival of 9.3 days.

Trigeminal neuralgia.

Although the full and precise etiology of TN still awaits further elucidation, this extremely painful disorder can be treated successfully by a variety of techniques, pharmacologic and surgical, with minimal side effects. There is no excuse in the 1990's for patients with TN not to be diagnosed promptly and treated expeditiously and successfully.

PDQ-R personality disorders in bipolar patients.

The prevalence of personality traits and disorders in bipolar patients as reported in the literature varies widely. The Personality Diagnostic Questionnaire-Revised (PDQ-R) is a self-report instrument for DSM-IIIR personality disorders found to have validity, but with high sensitivity and moderate specificity. This study was designed to assess personality disorders in bipolar patients using the PDQ-R.

A case for giving. Stressing its mission to care helps an inner-city hospital attract charitable donations.

In the current economic environment, voluntary not-for-profit hospitals must rely increasingly on private philanthropy. At St. Vincent's Hospital and Medical Center, New York City, leaders in the Division of Development and Public Affairs have found that emphasizing the commitment to mission in all the hospital's fund-raising, public-relations, and marketing efforts is an effective way to attract philanthropic support.

A modified broth dilution assay for antibiotic sensitivity testing of Mycobacterium avium-intracellulare using paraffin slide cultures.

Mycobacterium avium-intracellulare (MAI) can utilize paraffin wax as the sole carbon source in basal media. Paraffin slide culture (Para SL/C) has been employed for isolation and speciation of MAI derived from clinical sources. We have evaluated an adaptation of this method for antimicrobial sensitivity testing.

Localized Aspergillus infestation in primary lung carcinoma. Clinical and pathological contrasts with post-tuberculous intracavitary aspergilloma.

Saprophytic infestation with Aspergillus was observed in pathologic specimens of primary squamous cell lung carcinoma. In one case, the fungus grew in cystic scarred parenchyma and bronchi distal to an obstructing carcinoma of a segment bronchus. In the other, fungi colonized the inner surface of a peripheral cavitary carcinoma.

Pathophysiology and treatment of septic shock.

The mortality from septic shock continues to range between 40% to 60% despite advances in cardiovascular support and antibiotic therapy. Impairment of host defenses predisposes to the development of both severe infection and septic shock. The activation of a myriad of cellular and plasma mediators by microbial toxins produces the systemic and metabolic manifestations of sepsis.

Population characteristics of tuberculosis in an HIV/AIDS registry from an East Harlem Hospital.

The recent increase of tuberculosis nationally and in New York City has been attributed in part to the progression of the acquired immunodeficiency syndrome (AIDS)/human immunodeficiency syndrome (HIV) epidemic. The East Harlem/South Bronx/Bushwick sections of New York City have an especially high incidence of tuberculosis. An HIV/AIDS registry (1986-1990) consisting of 1,312 patients from a community hospital serving East Harlem was examined for population characteristics associated with documented tuberculosis in the registrants.

Peripheral vascular tone in sepsis.

Septic shock is characterized as a distributive form of circulatory failure. We examined the relationship of changes in forearm arterial, venous, and microvascular tone to the severity of sepsis. The study population consisted of ten control patients, 15 patients with sepsis, and eight patients with sepsis and shock.

Cervical spine diastematomyelia in adulthood.

Adult cervical diastematomyelia is a rare malformation and is usually associated with posterior element anomalies. A case of isolated cervical diastematomyelia, which was initially thought to be a herniated cervical disc, is described. Diagnosis and surgical management are discussed.

Controlling hospital readmission of elderly persons living at home: a risk factor analysis.

A large proportion of hospital stays stem from rapid readmission of elderly patients. These patients represent high cost users of inpatient care. Intervention in the hospital admission-readmission cycle may serve the interests of patients and payors alike.

The teres major muscle flap in breast reconstruction.

We describe the teres major as a muscle flap. The results of anatomical and radiographic studies demonstrate the surgical anatomy. The details of 4 clinical cases illustrate its application in breast reconstruction.

Human immunodeficiency virus infection among homeless men in a New York City shelter. Association with Mycobacterium tuberculosis infection.

The human immunodeficiency virus (HIV) seroprevalence among a selected sample of 169 high-risk homeless men residing in a congregate shelter in New York City, NY, was 62%. Seropositivity for HIV correlated significantly with intravenous drug use (odds ratio, 3.3; 95% confidence interval, 1.

Hodgkin's disease after non-Hodgkin's malignant lymphoma in acquired immune deficiency syndrome.

Hodgkin's disease (HD) after treatment of non-Hodgkin's lymphoma (NHL) has been reported but is extremely rare, and to the authors' knowledge has not been reported in patients with acquired immune deficiency syndrome (AIDS). The authors present a case of an AIDS patient who developed mixed cellularity type HD 2.5 years after chemotherapy and radiotherapy for Stage II NHL.