Fluoxetine in depressed patients with renal failure and in depressed patients with normal kidney function.

Nine depressed patients with normal kidney function and seven depressed patients with renal failure undergoing hemodialysis were treated with open-label fluoxetine 20 mg/day in an 8-week study. The study was designed to evaluate the pharmacokinetics of fluoxetine during repeated administration and to acquire preliminary data regarding the effectiveness of this antidepressant in a population undergoing hemodialysis. Six patients in each group completed the study.

Splenic venous hypertension presenting as variceal hemorrhage caused by portal hypertension.

Background: Splenic venous hypertension (SVH) may cause variceal hemorrhage that is clinically indistinguishable from similar bleeding caused by portal hypertension (PH). This may lead to erroneous treatment, including inappropriate portosystemic shunt placement.

Study Design: A retrospective review of 58 cases of variceal hemorrhage referred for transmesenteric variceal sclerotherapy and transvenous intrahepatic portosystemic shunt (TIPS) placement revealed that seven patients had SVH as a cause of bleeding, and required treatment other than TIPS.

Prospects for a vaccine to prevent Lyme disease in humans.

Vaccination with recombinant outer-surface protein A (OspA) preparations has been highly successful in protecting laboratory animals against challenge by strains of Borrelia burgdorferi closely related to the one from which the OspA was derived. Humoral immunity is sufficient for protection. Against natural infection introduced by ticks, the vaccine-induced immune response may begin to take effect in the tick itself--i.

Pretreatment of human myocardium with adenosine during open heart surgery.

Background: Depressed myocardial performance after cardiac surgery can be contributed to ischemic reperfusion injury (IRI) incurred during and following the cardiopulmonary bypass (CPB). Myocardial preconditioning (PC) achieved by brief ischemia and subsequent reperfusion appears to be a clinically useful method of improved cardiac protection during surgery involving CPB by retarding IRI. Based on animal studies, activation of cardiac adenosine (ADO) receptors prior to the prolonged ischemic period appears to mimic this PC phenomenon.

Acute appendicitis in pregnancy and the occurrence of major intraventricular hemorrhage and periventricular leukomalacia.

Background: Infection and endotoxemia have been associated with neurologic injury in the newborn. In addition, recent reports have noted an increased incidence of fetal neurologic injury in the presence of intrauterine infection.

Cases: Three pregnancies complicated by acute appendicitis and refractory preterm labor resulting in the delivery of neonates who developed early major intraventricular hemorrhage and/or periventricular leukomalacia are described.

Recurrent chorioamnionitis and second-trimester abortion because of an enterouterine fistula.

Background: Chorioamnionitis, a common cause of second-trimester abortion, is usually secondary to an ascending infection. Recurrent chorioamnionitis with second-trimester abortion secondary to an occult enterouterine fistula has not been reported previously.

Case: A 26-year-old Indian woman, para 0-0-2-0, presented with two spontaneous second-trimester losses.

Selective sacral rhizotomy for the management of neurogenic bladders in spina bifida patients: long-term followup.

Selective sacral rhizotomy was introduced for the management of high pressure neurogenic bladders commonly encountered in myelodysplastic patients. In 1992, 2 of us (I.F.

Laparoscopic-assisted percutaneous endoscopic gastrostomy.

The authors report the successful use of laparoscopic-assisted percutaneous endoscopic gastrostomy (LAPEG) in two children. Attempts at simple percutaneous endoscopic gastrostomy in both patients had failed. Subsequently, LA-PEG was easily accomplished.

Intraoperative spermatic venography reconsidered.

We review our most recent experience with varicocelectomy and post-ligation venography in 58 adolescents as followup to our previously reported series. A single injection venogram confirmed the completeness of varicocele ligation in 82% of cases while 2 or more injections were required in the remainder. Venography was not performed in 8 cases because of technical difficulties in 5 or surgeon choice in 3.

Tuberculin skin test conversion in hospital employees vaccinated with bacille Calmette-Guérin: recent Mycobacterium tuberculosis infection or booster effect?

Objective: A rise in the incidence of purified protein derivative (PPD) skin test conversions among employees at our medical center between 1991 and 1993 prompted an examination of factors associated with PPD skin test conversion. We focused on the effect of bacille Calmette-Guérin (BCG) vaccination on PPD skin test conversion because of changes in employee health service policies in 1990 regarding testing of persons who had received BCG vaccination.

Methods: The study took place in a university teaching hospital employee health service.

Lyme disease: insights into the use of antimicrobials for prevention and treatment in the context of experience with other spirochetal infections.

Unanswered questions in the management of patients with Lyme disease or those who have had Ixodes tick bites include: Is antimicrobial therapy effective in preventing Lyme disease during the incubation period of the infection? Which oral agents are most effective in treatment? Are macrolides efficacious? For how long a time should antimicrobial therapy be given? Potentially useful insights into these questions can be gained by examining experience with other spirochetal infections. Using this information in conjunction with existing data from recent studies on Lyme borreliosis, tentative answers to these questions can be formulated. A short course of antibiotic therapy, perhaps even a single dose, can be anticipated to be effective in preventing Lyme disease after a tick bite.

Balloon dilation of inferior vena cava stenosis causing hemodialysis graft failure.

Inferior vena cava stenosis developed after an unsuccessful renal transplant in a 3-year-old child. Resulting venous outflow obstruction consequently prevented construction of a functional hemodialysis arteriovenous shunt at the femoral area. Transluminal balloon angioplasty of the stenosis completely eliminated the obstruction and allowed creation of the shunt.

The human genome exposed: a glimpse of promise, predicament, and impact on practice.

Purpose/objectives: To review basic gene biology, discuss current genetic advances, and project the potential impact of these advances on oncology nursing practice.

Data Sources: Published professional articles, tests, proceedings, governmental and lay publications.

Data Synthesis: The Human Genome Project seeks to better describe the human complement of genes, which may hold the key to further defining the mechanism of carcinogenesis.

Genetics in cancer care: confronting a Pandora's Box of dilemmas.

Purpose/objectives: To provide an overview of sociopolitical, bioethical, and psychological issues emerging from the application of genetic technologies in cancer care in the United States and to provoke oncology nurses to consider the impact that advances in genetics may have on their practice.

Data Sources: Published professional articles, tests, and proceedings as well as government and lay publications.

Data Synthesis: This article reviews underlying sociopolitical issues and forecasts bioethical dilemmas and psychological responses likely to emerge from expanding genetic screening and treatment options in oncology.

Do changes in end-tidal PCO2 quantitatively reflect changes in cardiac output?

In anesthetized patients, acute decreases in cardiac output (CO) are often reflected as decreases in end-tidal CO2 tension (PETCO2), but the quantitative relationship between the changes in CO and the changes in PETCO2 is uncertain. We hypothesize that a quantitative relationship can be demonstrated if timing of the measurements in each episode of hemodynamic perturbation is standardized. In 24 patients undergoing abdominal aortic aneurysm surgery with constant ventilation, we prospectively performed 33 measurements of CO, PETCO2, and CO2 elimination (VECO2) within 10 min of hemodynamic changes.

Middle cerebral to umbilical artery Doppler ratio in post-date pregnancies.

Objective: To determine which antepartum test is the best predictor of post-date-related adverse outcome among the amniotic fluid index (AFI), nonstress test (NST), biophysical profile, or middle cerebral artery to umbilical artery Doppler ratio.

Methods: Pregnant women of 41 or more weeks' gestation with singleton fetuses and vertex presentations underwent antepartum testing twice a week. Pulsed Doppler ultrasound was used to obtain the flow velocity waveforms from the umbilical and middle cerebral arteries.

Epidemiologic predictors of hepatitis C virus infection in pregnant women.

Objective: To identify sensitive epidemiologic predictors of a positive hepatitis C virus antibody test in asymptomatic persons, and to compare the cost of testing only persons with an epidemiologic predictor to that of universal screening.

Methods: Seventeen hundred consecutive pregnant women were tested by enzyme-linked immunosorbent assay for antibody to hepatitis C virus. Seventy-five subjects tested positive and were compared with 257 pregnant women who tested negative.

Comparison of transesophageal and transthoracic echocardiography with contrast and color flow Doppler in the detection of patent foramen ovale.

We directly compared the utility of agitated saline solution contrast echocardiography and color flow Doppler with both transthoracic and transesophageal echocardiography in the detection of patient foramen ovale (PFO). Forty-three patients referred for contrast echocardiography and transesophageal echocardiography were prospectively studied. Three were excluded because of technically inadequate contrast, and two were excluded because of hemodynamically significant atrial septal defect.

Low-dose dexamethasone as adjunctive therapy for disseminated Mycobacterium avium complex infections in AIDS patients.

Five human immunodeficiency virus-infected patients with disseminated Mycobacterium avium complex infection had progressive weight loss and persistent fever despite multidrug antimycobacterial therapy. These patients were given daily low-dose oral dexamethasone (typically 2 mg/day) as adjunctive therapy. All had substantial and sustained weight gain (12 to 50% of pre-steroid treatment body weight [P < 0.

Experience with the Mitroflow aortic bioprosthesis.

From October 1985 to May 1990, the Mitroflow bovine pericardial valve was placed in the aortic position in 168 patients (97 men, 71 women) with a mean age of 69.7 years. Eighty-nine patients had isolated aortic valve replacement, and 79 had aortic valve replacement and additional procedures.

Focus on: Westchester County Medical Center Division of Biomedical Engineering.

The Division of Biomedical Engineering (DBME), a vital element in the structure of any medical center, provides complete biomedical equipment services at Westchester County Medical Center (WCMC), through a Biomedical Instrumentation Program. Under this program, the DBME assumes direct responsibility for all diagnostic imaging equipment in radiology, radiation medicine and nuclear medicine; and patient care, surgical life support (respiratory care) equipment in critical care units, operating rooms, G.I.

Sustained cellular immune responses to Borrelia burgdorferi: lack of correlation with clinical presentation and serology.

Fifty-one patients with erythema migrans were followed up prospectively with serial clinical evaluations, serologic determinations for antiborrelial antibodies, and lymphocyte stimulation responses to Borrelia burgdorferi antigens to determine (i) the factors associated with sustained cellular immune responses and (ii) whether lymphocyte stimulation is a good indicator of prior exposure to B. burgdorferi in patients treated early after erythema migrans. Positive lymphocyte stimulation responses ( > 2 standard deviations above normal control values) were found in 15 (29%) of 51 patients 3 months after treatment for erythema migrans and in 8 (18%) of 44 patients 1 year posttreatment.