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.

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.

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.

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.

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.

Microvascular function and rheologic changes in hyperdynamic sepsis.

Objective: To investigate the rheologic changes and circulatory abnormalities at the microvascular level during severe sepsis.

Design: Prospective, controlled trial.

Setting: Medical and surgical intensive care units of a university-affiliated hospital.

Diffuse Tl-201 uptake in the lungs. Etiologic classification and pattern recognition.

Diffuse Tl-201 uptake in the lungs could be because of cardiac, neoplastic, inflammatory, or interstitial lung disease. Examples from the different categories, differential diagnosis, and different patterns are presented. The authors discuss the different mechanisms of increased Tl-201 uptake in the lungs which vary according to the underlying pathology.

Clinical characteristics of adult asthmatics requiring intubation.

Fifty eight admissions for 52 adult asthmatics who required intubation were reviewed for the years of 1988-1995 to examine factors related to specific clinical patterns and profile the course of these patients. Of the 56 admissions where patients were intubated for respiratory failure and/or cyanosis, 5 were associated with significant complications of mechanical ventilation/intubation (pneumothorax, subcutaneous emphysema, aspiration pneumonia, and laryngeal edema) and there were no fatalities. Patients > or = 35 years of age had significantly more profound respiratory acidosis in initial arterial blood gases (pH = 7.

Pretreatment of normal humans with monophosphoryl lipid A induces tolerance to endotoxin: a prospective, double-blind, randomized, controlled trial.

Objectives: Endotoxin is one of the principal mediators of Gram-negative septic shock. Pretreatment with monophosphoryl lipid A, a hydrolyzed derivative of endotoxin from Salmonella minnesota R595, induces endotoxin tolerance and nonspecific resistance to infection in experimental animals. The present clinical trial was undertaken to test the response to monophosphoryl lipid A in humans and the ability of monophosphoryl lipid A to attenuate the response of normal human volunteers to U.

A phase III randomized, double-blind multiinstitutional trial of vaccinia melanoma oncolysate-active specific immunotherapy for patients with stage II melanoma.

Background: In a Phase II trial, surgical adjuvant active specific immunotherapy using a live vaccinia virus-augmented allogeneic polyvalent melanoma cell lysate, vaccinia melanoma oncolysate (VMO), produced a significant disease free interval (DFI) in patients with International Union Against Cancer Stage II melanoma with positive lymph nodes. Therefore, a Phase III randomized prospective, double-blind, multiinstitutional, surgical adjuvant VMO trial was performed to determine the efficacy of VMO to increase the DFI and the overall survival in this group of patients with Stage II disease.

Methods: Two hundred and fifty patients with Stage II melanoma were divided into two postsurgical groups.

A comparison of zidovudine, didanosine, zalcitabine and no antiretroviral therapy in patients with advanced HIV disease.

Three nucleoside analogues, zidovudine (AZT), didanosine (ddI), and zalcitabine (ddC), are approved for use in the treatment of patients with HIV infection. This retrospective study compares the 3 drugs and examines the overall utility of antiretroviral therapy by way of comparisons to a no treatment (No Rx) group in patients with advanced HIV disease. Patients with advanced HIV disease were enrolled in didanosine (August 1989-December 1990) or zalcitabine (October 1990-February 1992) expanded access programmes; continued on zidovudine treatment despite fulfilling criteria for zidovudine failure or intolerance; or maintained on no antiretroviral treatment.

Antagonism of mivacurium-induced neuromuscular blockade in humans. Edrophonium dose requirements at threshold train-of-four count of 4.

Background: Mivacurium's rapid rate of recovery has led to the suggestion that routine reversal of its residual effects may be unnecessary once signs of spontaneous recovery are evident. When antagonism is attempted at 90% twitch depression, the time saved to return to train-of-four (TOF) ratios > 0.70 compared to control has been reported to average < or = 8 min.

Total knee arthroplasty in Parkinson's disease.

Total knee arthroplasty in Parkinson's disease (PD) has been reported only twice in the literature. Parkinson's disease is considered a contra-indication for total knee replacement by some authors. We report on a 77-year-old man with PD who underwent total knee arthroplasty for severe degenerative joint disease.

Immunotherapy of a vaccinia colon oncolysate prepared with interleukin-2 gene-encoded vaccinia virus and interferon-alpha increases the survival of mice bearing syngeneic colon adenocarcinoma.

Therapeutic effect of a vaccinia colon oncolysate prepared with interleukin-2 (IL-2) gene-encoded vaccinia virus (IL-2VCO) in combination with recombinant interferon-alpha (IFN-alpha) was studied in a syngeneic murine CC-36 colon hepatic metastasis model. Treatment with this IL-2VCO+IFN-alpha produced a higher survival rate (90% on day 60 after tumor transplantation) in mice having CC-36 hepatic metastases when compared to treatment with IFN-alpha (0%), VCO+IFN-alpha (0%), or IL-2VCO (11%). The only treatment that produced a survival rate similar to the survival rate of IL-2VCO+IFN-alpha was VCO+IL-2 + IFN-alpha (survival rate was 67%).

Early single-photon emission computed tomography in mild head trauma. A controlled study.

Although computed tomography (CT) and magnetic resonance imaging scans often appear normal after mild head trauma, many patients experience attentional or other cognitive disturbances that are difficult to quantify by neuropsychological testing in the absence of a premorbid profile. Within 2 days of mild head trauma, 14 patients with normal-appearing brain CTs were studied with single-photon emission computed tomography (SPECT). They were compared to 15 normal control subjects and to 12 patients with mild human immunodeficiency virus (HIV) encephalopathy.

Relationships between plasma cytokine concentrations and leukocyte functional antigen expression in patients with sepsis.

Objective: To determine the relationships between cytokine concentrations and alterations in leukocyte functional antigen expression in sepsis.

Design: Prospective, cross-sectional study.

Setting: Respiratory, coronary, and medical intensive care units in a university hospital.

Monophosphoryl lipid A protects against gram-positive sepsis and tumor necrosis factor.

Monophosphoryl lipid A (MPL) is a less toxic derivative of lipid A that enhances survival from endotoxemia. This study examined whether MPL induced resistance to Gram-positive sepsis and cytokines. Mice were administered MPL or saline (phosphate-buffered saline) and challenged 24 h later with live Staphylococcus aureus (SA), staphylococcus enterotoxin B (SEB), toxic shock syndrome toxin (TSST-1), and tumor necrosis factor (TNF).

Gastric emptying patterns in Kaposi's sarcoma and gastroenteritis secondary to human immunodeficiency virus infection.

The study included 11 patients with AIDS who underwent gastric emptying studies for solid food, endoscopy (esophagogastroduodenoscopy), and gastric biopsy whenever gastritis was diagnosed on endoscopy. All studies were performed within 1 week. The studies were retrospectively reviewed to analyze the changes in gastric emptying secondary to Kaposi's sarcoma (KS) with or without opportunistic infections.