Mycophenolate mofetil for myasthenia gravis: a double-blind, placebo-controlled pilot study.

Mycophenolate mofetil (MM) is an immunosuppressive agent developed and originally used to prevent acute rejection of solid-organ transplantation. There have been preliminary reports of its successful use in the treatment of autoimmune myasthenia gravis (MG). We conducted a double-blind, placebo-controlled pilot trial of MM in the treatment of suboptimally controlled, stable MG.

Optimizing care for African-American HIV-positive patients.

The African-American community has been disproportionately affected HIV/AIDS, as noted by higher reported rates of HIV infection, higher proportion of AIDS cases, and more deaths caused by complications of AIDS than whites and other ethnic groups. In addition, epidemiologic trends suggest that African Americans with HIV infection are more often diagnosed later in the course of HIV disease than whites. Numerous reasons account for this disparity, including the lack of perception of risk and knowledge about HIV transmission as well as a delays in HIV testing and diagnosis in the African-American community.

The impact of adjunctive adenosine infusion during exercise myocardial perfusion imaging: Results of the Both Exercise and Adenosine Stress Test (BEAST) trial.

Background: Failure to achieve an adequate heart rate limits the sensitivity of exercise myocardial perfusion imaging (MPI) for the detection of coronary artery disease. In addition, it is often not possible to discontinue medications that may blunt the heart rate response to exercise, because of conditions such as hypertension or angina. However, if pharmacologic stress testing is performed, the ability to assess functional capacity is lost.

Steroids for septic shock: back from the dead? (Pro).

The use of corticosteroids as adjunctive therapy for severe sepsis and septic shock has been a source of controversy for the past 35 years. Despite a wealth of preclinical data supporting both survival and physiologic benefit for early steroid use, the data in human sepsis have been much less convincing. There have even been reports suggesting the potential for harm associated with the administration of early high-dose corticosteroids in patients with severe sepsis and septic shock.

The middle-aged patient with hip arthritis: the case for extensively coated stems.

Younger patients with a long life expectancy and higher activity levels who require total hip arthroplasty present a unique challenge to the reconstructive surgeon. To improve the longevity of total hip arthroplasty, particularly in younger, more active patients, femoral components inserted without cement have been used in an attempt to create a more durable reconstruction. Extensively-coated implants are an attractive option because they are associated with excellent initial implant stability and contact a large area of strong cortical bone in the femoral diaphysis where bony ingrowth reliably occurs.

An approach to evidence-based therapeutic apheresis.

This review is derived from a memorial lecture honoring Dr. Francis Morrison, a former President of the American Society For Apheresis (ASFA). The author had numerous professional contacts with Dr.

Endotoxemia in critically ill patients: why a reliable test could be beneficial.

The detection of endotoxemia may provide a clue to the cause of sepsis or may indicate translocation of endotoxin from the gastrointestinal tract. A reliable endotoxin activity assay (EAA) offers the potential to determine Gram-negative infections in critically ill patients. In addition, a reliable EAA may indicate the adequacy of gastrointestinal tract perfusion, as well as potentially help to predict morbidity and mortality.

Collaborative practice in advanced practice nursing in acute care.

APN in the United States encompasses a variety of collaborative models of care. Collaborative relationships with other disciplines such as medicine, pharmacy, social service, and physical, respiratory, and occupational therapy are an important component of the APN role. The collaborative relationship of the APN and physician is a unique one for providing optimal patient and family care.

A look to the future: new treatment guidelines and a perspective on statins.

New National Cholesterol Education Program treatment guidelines incorporate a global measure of coronary heart disease (CHD) that alters risk categorization in primary prevention by identifying individuals with CHD risk equivalence on the basis of estimated absolute CHD risk. Increasing recognition of the association of on-treatment non-high-density lipoprotein (HDL) cholesterol levels with risk of CHD events is also reflected in the new guidelines by incorporation of secondary non-HDL cholesterol goals. The increased complexity of the guidelines and the likelihood of more individuals being assigned to higher risk groups with lower low-density lipoprotein (LDL) cholesterol goals is of some concern, because most patients receiving lipid-lowering therapy do not achieve current guideline LDL cholesterol goals.

Association between blood pressure and cognitive function in a biracial community population of older persons.

We examined whether or not blood pressure is related to cognitive function in a cross-sectional study of a biracial community of 5,816 persons aged 65 years and older. Blood pressure had a curvilinear association with cognitive performance in linear regression models adjusted for age, sex, race and education. Scores were lower by 2-5 percentiles at 100 mm Hg systolic pressure compared to scores at the mean of 140 mm Hg and lower by <1 percentile at 180 mm Hg.

Aging effects on memory encoding in the frontal lobes.

Functional magnetic resonance imaging (fMRI) was used to compare frontal-lobe activation in younger and older adults during encoding of words into memory. Participants made semantic or nonsemantic judgments about words. Younger adults exhibited greater activation for semantic relative to nonsemantic judgments in several regions, with the largest activation in the left inferior frontal gyrus.

Scapulothoracic bursectomy for snapping scapula syndrome.

Seventeen patients (9 women and 8 men) were prospectively evaluated to determine the results of open scapulothoracic bursectomy in the treatment of unremitting, painful scapular crepitus (snapping scapula syndrome). The mean duration of symptoms was 2 years (range, 4 months-6 years). Twelve related an injury history, and 5 had insidious onset of symptoms.

Improved detection of substantia nigra pathology in Alzheimer's disease.

The role of substantia nigra pathology in Alzheimer's disease (AD) is uncertain. Detection of pathology may be obscured by intraneuronal neuromelanin and influenced by stains. We determined methods for optimal visualization of nigral pathology in 45 cases of AD.

Annual incidence of Alzheimer disease in the United States projected to the years 2000 through 2050.

Alzheimer disease will affect increasing numbers of people as baby boomers (persons born between 1946 and 1964) age. This work reports projections of the incidence of Alzheimer disease(AD) that will occur among older Americans in the future. Education adjusted age-specific incidence rates of clinically diagnosed probable AD were obtained from stratified random samples of residents 65 years of age and older in a geographically defined community.

Suprascapular neuropathy.

Suprascapular neuropathy is an uncommon cause of shoulder pain and weakness and therefore may be overlooked as an etiologic factor. The suprascapular nerve is vulnerable to compression at the suprascapular notch as well as at the spinoglenoid notch. Other causes of suprascapular neuropathy include traction injury at the level of the transverse scapular ligament or the spinoglenoid ligament and direct trauma to the nerve.

Down-regulation of procollagen alpha1[I]] messenger RNA by titanium particles correlates with nuclear factor kappaB (NF-kappaB) activation and increased rel A and NF-kappaB1 binding to the collagen promoter.

Previously, we showed that exposure of human osteoblasts to titanium particles stimulates protein tyrosine phosphorylation (PTP), activates the transcription factor nuclear factor kappaB (NF-kappaB), and causes an approximately 50% decrease in the steady-state messenger RNA (mRNA) level of procollagen alpha1[I]. In this study, we identify three NF-kappaB binding sites within the human procollagen alpha1[I] gene promoter, show that titanium particles stimulate their binding of the NF-kappaB subunits Rel A (p65) and NF-kappaB1 (p50), and find NF-kappaB activation correlates with collagen gene suppression by titanium particles in osteoblasts. Protein tyrosine kinase (PTK) inhibitors, which significantly reduce the suppressive effect of titanium particles on collagen gene expression, inhibited NF-kappaB binding activity showing that titanium particle stimulation of PTK signals in osteoblasts are critical for both NF-kappaB activation and collagen gene expression.

The right ventricular tachycardias.

A variety of tachycardias originate from the right ventricle or use right ventricular structures as part of their circuit. They are characterized by a left bundle branch block pattern. Many of these tachycardias are relatively easy targets for radiofrequency catheter ablation.

Anterior tibial tendon transfer in residual dynamic clubfoot deformity.

Residual forefoot adduction and supination deformities with functional problems and difficulty with shoe wear may occur during the course of management of the congenital clubfoot. Between 1975 and 1988, 55 patients with 71 feet who had residual dynamic clubfoot deformity underwent anterior tibial tendon transfer. There were 42 full anterior tibial tendon transfers (FTs) and 29 split anterior tibial tendon transfers (STs).

Lethal ventricular arrhythmias following one-step pacemaker reprogramming for rapid tracking of atrial tachyarrhythmias.

An abrupt decrease in the pacing rate in patients with dual-chamber pacemakers tracking atrial tachyarrhythmias carries a high risk of malignant ventricular arrhythmia. The pacing rate should be reduced by multistep programming over several days.

Is the risk of developing Alzheimer's disease greater for women than for men?

A large proportion of people with Alzheimer's disease (AD) are women; however, it is not clear whether this is due to higher risk of disease or solely to the larger number of women alive at ages when AD is common. Beginning in 1982, two stratified random samples of people aged > or =65 years in East Boston, Massachusetts underwent detailed, structured clinical evaluation for prevalent (467 people) and incident (642 people from a cohort previously ascertained to be disease-free) probable AD. The prevalence sample was followed for mortality for up to 11 years (through December 1992).