Normal clotting.

Objective: To review the normal coagulation process and the mechanisms that lead to abnormal clotting.

Data Sources: Primary and tertiary literature and the authors' clinical experience.

Conclusion: The process of coagulation is complex and can be easily misunderstood.

Multiple bilateral masses detected on screening mammography: assessment of need for recall imaging.

Objective: When multiple bilateral partially circumscribed masses having a similar appearance are detected on screening mammography, some radiologists recommend recall examination to identify imaging features suggestive of malignancy that are not evident on standard screening views. This study assesses the need for such recall imaging.

Subjects And Methods: Cases of multiple masses were identified by reviewing the mammographic reports of 84,615 consecutive screening examinations.

Novel diagnostic tests to detect Helicobacter pylori infection: A pediatric perspective.

Because of the widespread problem of Helicobacter pylori infections, there is an increased need for rapid, reliable and inexpensive diagnostic tests. Five recently developed tests that offer potential advantages because they are less invasive or permit easier acquisition of samples than available tests are assessed. The tests assessed are whole blood, saliva and urine assays that measure systemic antibody response to H pylori, stool tests that measure H pylori antigens and string tests that recover H pylori organisms.

Measurement of the distribution volume of gadopentetate dimeglumine at echo-planar MR imaging to quantify myocardial infarction: comparison with 99mTc-DTPA autoradiography in rats.

Purpose: To measure the fractional distribution volume of gadopentetate dimeglumine in normal and reperfused infarcted myocardium at magnetic resonance (MR) imaging by using the fractional distribution volume of technetium 99m-diethylenetriaminepentaacetic acid (DTPA) as an independent reference.

Materials And Methods: Rats were subjected to 1 hour of coronary artery occlusion and 1 hour of reperfusion before inversion-recovery echo-planar imaging or autoradiography. Regional change in relaxation rate (delta R1) ratios for myocardium over blood were compared with radioactivity ratios for myocardium over blood after the injection of 99mTc-DTPA.

Return of motion after simultaneous repair of displaced bucket-handle meniscal tears and anterior cruciate ligament reconstruction.

Patients with displaced bucket-handle (DBH) meniscal tears in anterior cruciate ligament (ACL)-deficient knees are prone to flexion contracture following meniscal repair and simultaneous ACL reconstruction. It has been suggested that ACL reconstruction be delayed until full range of motion has returned after the meniscal repair. A retrospective analysis was performed comparing the return of extension in patients undergoing simultaneous ACL reconstruction and repair of DBH tears (group A) versus a control group of patients with non-DBH tears (group B).

Chronic anemia as a complication of parvovirus B19 infection in a pediatric kidney transplant patient.

This is a report of unexplained anemia that persisted for 4 months in an adolescent renal transplant patient receiving immunosuppression that included prednisone, tacrolimus, and mycophenolate mofetil. This patient required monthly blood transfusions for fatigue, palpitations, and hematocrit levels between 15% and 17%. In addition, his posttransplant course was notable for the development of insulin-dependent diabetes mellitus.

European experience with a system for bifurcated stent-graft insertion.

Purpose: To test an endovascular aneurysm exclusion system in the presence of a wide range of challenging anatomic features.

Methods: Bifurcated endovascular stent-grafts were inserted in 52 patients and followed with serial computed tomography for up to 3 years. The device underwent several modifications during this time, the most significant of which represent the difference between the homemade (n = 42) and industry-made (n = 10) versions.

Endovascular surgical approach to intracranial vascular diseases.

Purpose: The endovascular surgical approach to complex disorders of the central nervous system has made rapid and significant advancements over the past decade. Patients with intracranial arterial aneurysms, traumatic carotid and vertebral artery lesions, including fistulas and pseudoaneurysms, hemodynamically significant atherosclerotic lesions, vasospasm, and acute stroke are now being approached and treated by newer and less invasive techniques, including cerebral angioplasty and thrombolytic therapy.

Methods: All procedures are usually performed from a transfemoral approach utilizing a variety of occlusion devices, including detachable silicone balloons, microcoils, electrolytic detachable coils, liquid tissue adhesives, and particulate emboli for vessel occlusion.

Interventional neurovascular techniques for cerebral revascularization in the treatment of stroke.

Recent advances in interventional neurovascular radiology have altered the management of cerebrovascular diseases by providing alternative treatments in three areas. (1) Cerebral percutaneous transluminal angioplasty is being used more often as an alternative to surgical endarterectomy or bypass grafting for patients with high-grade vascular stenosis of the innominate, subclavian, carotid, vertebral, and intracranial blood vessels. To date, the success rate has been greater than 90%, with less than 10% morbidity.

Successful treatment with hydrochlorothiazide and amiloride in an infant with congenital nephrogenic diabetes insipidus.

We report a 9-month-old male Latino infant with congenital nephrogenic diabetes insipidus (NDI) who presented with hypernatremic dehydration aggravated by severe gastroenteritis. Initially, the infant was managed with intravenous fluids followed by standard 20 cal/ounce formula and pharmacological therapy, resulting in normalization of his serum sodium level. While hydrochlorothiazide therapy alone or in combination with prostaglandin inhibitors or amiloride has been successful in children and adolescents, this is the first report of the successful use of hydrochlorothiazide and amiloride in an infant with congenital NDI.

The development of B-cell lymphoma in a patient with psoriasis treated with cyclosporine.

A 67-year-old Nicaraguan man with a history of chronic, severe, recalcitrant psoriasis participated in a multicenter study investigating oral cyclosporine in the treatment of psoriasis. He received cyclosporine for approximately 8 months at doses of 5 mg/kg/day or less. Treatment with cyclosporine was eventually discontinued because of progressive nephrotoxicity.

Antiglucocorticoid strategies in hypercortisolemic states.

Major depressive illness is frequently associated with cortisol hypersecretion. The pathophysiologic significance of this is unknown, although it is possible that hypercortisolemia exacerbates or perpetuates depressive symptoms. In both depression and Cushing's syndrome, certain depressive symptoms are correlated with cortisol levels and, in the latter condition, therapeutic lowering of cortisol levels is associated with remission of psychiatric symptomatology.

Value of electrocardiographic leads MCL1, MCL6 and other selected leads in the diagnosis of wide QRS complex tachycardia.

To compare the modified precordial leads MCL1 and MCL6 with the conventional precordial leads V1 and V6 and assess the diagnostic accuracy of selected leads for continuous bedside electrocardiographic (ECG) monitoring, 121 wide QRS complex tachycardias were recorded from 92 patients during cardiac electrophysiologic study. As ascertained from intracardiac recordings, 86 tachycardias were ventricular and 35 were supraventricular with aberrant conduction. Early or late peaking of the predominant QRS deflection in lead MCL6 or V6 proved valuable in diagnosing wide complex tachycardia.

Visual hierarchical analysis of Block Design configural errors.

Patients have been frequently observed to violate the overall configuration on the WAIS-R Block Design subtest. The significance of these configural errors was investigated with hierarchical patterns consisting of large "global" shapes made from smaller "local" shapes. Subjects were administered two similarity judgment tasks in which they were asked to decide which of two hierarchically structured comparison figures most resembled a standard figure.

Magnetic resonance imaging of intractable complex partial seizures: pathologic and electroencephalographic correlation.

Prior studies indicate variable usefulness of magnetic resonance imaging (MRI) in the evaluation of patients with complex partial seizures (CPS), but sensitivities as low as 12% have been reported. We analyzed the MRI examinations of 20 patients with medically refractory CPS who later underwent resection of the seizure focus proven by electroencephalography (EEG). MRI studies were correlated with surgical pathology in all patients.

Interventional neurovascular treatment of a giant intracranial aneurysm using platinum microcoils.

A 70-year-old woman presented with symptoms of progressive cerebellar dysfunction due to mass effect from a giant, expanding, posterior fossa aneurysm arising from the distal vertebral artery. The aneurysm contained thrombus and had a broad-based neck. From a transfemoral approach, with the patient under local anesthesia, a 2.

The role of IFN-gamma in the pathology of experimental endotoxemia.

Proinflammatory cytokines provoked by circulating bacterial LPS mediate many of the destructive host responses characteristic of septic shock. To determine if the lymphokine IFN-gamma has a similar pathogenic role during endotoxic shock, mice were pretreated with murine rIFN-gamma (rMuIFN-gamma) at various times relative to challenge with Salmonella enteritidis LPS. Subsequent mortality was increased when rMuIFN-gamma was administered before or up to 4 h after endotoxin challenge.

HIV infection control for podiatric practitioners.

Although significant advances have been made in the treatment of acquired immunodeficiency syndrome (AIDS), neither a curative therapy nor a vaccine is available. Protecting practitioners, medical staff members, and patients from infection with human immunodeficiency virus (HIV) remains a particularly important issue. Fortunately, this virus is not readily transmitted in the health care setting.

Release of interleukin 1 inhibitory activity (contra-IL-1) by human monocyte-derived macrophages infected with human immunodeficiency virus in vitro and in vivo.

Infection of monocyte-macrophages with human immunodeficiency virus may be central to the pathogenesis of the acquired immunodeficiency syndrome. The ability of infected macrophages to prime T cells through IL-1 production was investigated in vitro. Purified human monocytes maintained in suspension culture were infected with strain HIV-DV.

Murine cutaneous leishmaniasis: susceptibility correlates with differential expansion of helper T-cell subsets.

BALB/c mice develop fatal illness following infection with Leishmania major despite expansion of helper L3T4+ T cells in the draining lymph nodes and spleen. Healer mice, either genetically resistant C57BL/6 or BALB/c that have been pretreated with monoclonal antibody GK 1.5, also develop expanded numbers of L3T4+ T cells at the time of healing.