Preoperative evaluation of patients with bronchogenic carcinoma.

The preoperative evaluation of patients with suspected or proven bronchogenic carcinoma is directed at establishing the diagnosis, the extent of disease, and the ability of the patient to withstand the removal of lung tissue. The diagnosis may not be established until thoracotomy, but sputum cytologies or specimens taken at the time of fiberoptic bronchoscopy may diagnose a malignant process preoperatively.     

Cutaneous candidiasis. A practical guide for primary care physicians

Cutaneous candidiasis is a common fungal infection that can affect intertriginous or occluded areas, mucous membranes, the glabrous skin, and the nails. The diagnosis is confirmed by microscopic examination of a potassium hydroxide preparation, by Gram's stain or Polysciences Multiple Stain, or by culture when appropriate. Safe, simple, and effective treatment is available. Physical measures that promote dryness are helpful.     

Tinea versicolor. A practical guide for primary care physicians

The characteristic pigmentary changes in tinea versicolor are easy to distinguish from dermatophyte infections of the skin. When specific identification is needed, the diagnosis can be confirmed microscopically with a potassium hydroxide preparation or Polysciences Multiple Stain. Tinea versicolor responds readily to topical therapy or oral ketoconazole, but recurrences are common.     

血友病A患者总体止血能力检测及临床应用

目的探讨血友病A患者总体止血能力(OHP)、总体凝血能力(OCP)、总体纤溶能力(OFP)的异常改变,研究血浆FⅧ∶C水平与OHP、OCP、OFP的相关性。方法测定不同FⅧ∶C血浆OHP、OCP及OFP,采用对数曲线回归分析及Pearson相关分析法分析血浆FⅧ∶C水平与OHP、OCP、OFP的相关性。检测38例血友病A患者及50名健康体检者血浆OHP、OCP及OFP,比较2组间3个参数的差异。结果 FⅧ∶C与OHP、OCP及OFP相关指数(r2)分别为:0.994 2、0.997 0、0.988 4,P<0.01;回归方程分别为:Y=1.508 6 ln(X)+2.842 5,Y=1.769 7 ln(X)+5.793 2,Y=-3.736 4 ln(X)+43.167,表明FⅧ∶C与OHP、OCP、OFP呈对数相关。血友病患者活化部分凝血活酶时间(APTT)及OFP明显高于正常对照组(P<0.01);OCP明显低于对照组(P<0.01)。结论 OHP、OCP及OFP可反映血友病A患者血浆FⅧ∶C水平高低,为血友病A诊断提供新的实验依据。     

血友病A患者总体止血能力检测及临床应用

目的探讨血友病A患者总体止血能力（OHP）、总体凝血能力（OCP）、总体纤溶能力（OFP）的异常改变,研究血浆FⅧ∶C水平与OHP、OCP、OFP的相关性。方法测定不同FⅧ∶C血浆OHP、OCP及OFP,采用对数曲线回归分析及Pearson相关分析法分析血浆FⅧ∶C水平与OHP、OCP、OFP的相关性。检测38例血友病A患者及50名健康体检者血浆OHP、OCP及OFP,比较2组间3个参数的差异。结果 FⅧ∶C与OHP、OCP及OFP相关指数（r2）分别为：0.994 2、0.997 0、0.988 4,P〈0.01;回归方程分别为：Y=1.508 6 ln（X）＋2.842 5,Y=1.769 7 ln（X）＋5.793 2,Y=-3.736 4 ln（X）＋43.167,表明FⅧ∶C与OHP、OCP、OFP呈对数相关。血友病患者活化部分凝血活酶时间（APTT）及OFP明显高于正常对照组（P〈0.01）;OCP明显低于对照组（P〈0.01）。结论 OHP、OCP及OFP可反映血友病A患者血浆FⅧ∶C水平高低,为血友病A诊断提供新的实验依据。     

Selective blockade of the antigen-receptor-mediated pathway of T cell activation in patients with impaired primary immune responses.

We investigated impaired cellular immune responses of individuals on chronic hemodialysis by using monoclonal antibodies that trigger differential pathways of T cell activation. Reduced cellular reactivity, which exists in a high proportion of such patients, can be attributed to a failure of the monocyte population to support the process of primary T cell activation in vitro. This defect results in a lack of interleukin 2 production, which is critically dependent on a monocyte-derived signal. In contrast, T lymphocyte function was found to be physiologic. Perhaps more important, the degree of monocyte dysfunction in vitro correlated with the same patients' in vivo responses to hepatitis B vaccination. Addition of recombinant human interleukin 2 fully reconstituted their deficient immune response in vitro.     

Superficial fungal infections. A practical guide for primary care physicians

Clinicians who establish a proper diagnosis should have little difficulty managing dermatophyte infections. Diagnosis can be confirmed by direct microscopic examination with a potassium hydroxide preparation or by culture with the dermatophyte test medium. Safe, reliable antifungal therapy is available. Treatment will be more effective if antifungal therapy is not prescribed until fungal organisms have been identified and if topical steroids are not prescribed until fungal organisms have been excluded.     

A monoclonal immunoglobulin A (kappa) factor VIII:C inhibitor associated with primary amyloidosis: identification and characterization

Factor VIII:C inhibitors associated with primary amyloidosis have not been previously reported. A patient with autopsy-proved primary amyloidosis developed renal failure requiring peritoneal dialysis. Purpura and a prolonged partial thromboplastin time (PTT) were first observed 3 years later, after treatment was changed from peritoneal dialysis to hemodialysis. Plasma contained a time-dependent factor VIII:C inhibitor. The inhibitor on isoelectric focusing showed two peaks of activity, one with an isoelectric point (pl) of approximately 4 and the second larger, with a pl of approximately 8. Both were neutralized only by antisera to IgA and kappa light chain. A monoclonal antibody prepared in Balb/c mice against the variable region of the kappa light chain also blocked the inhibitor. The delayed onset of the coagulopathy could be explained by the change from peritoneal to hemodialysis, because in the former, significant amounts of the paraprotein, indicated by an "M-spike," were recovered in the dialysate. N-terminal amino acid sequencing of the first 20 amino acids of the variable region of the kappa light chain from the urinary protein and the splenic amyloid subunit showed identity.     

Pharmacokinetics of carumonam (AMA-1080) in patients with impaired renal function and in those undergoing hemodialysis.

The pharmacokinetics of carumonam (AMA-1080) were studied after a single intravenous 1.0-g dose was given to 26 subjects grouped according to their renal functions. Creatinine clearance (CLCR) was above 85, 50 to 84, 10 to 49, and below 10 ml/min/1.73 m2 in groups 1, 2, 3, and 4, respectively. All of the six patients in groups 4 were receiving maintenance hemodialysis, and they were studied both during and between hemodialysis sessions. Carumonam obeyed two-compartment model kinetics in all four group. The volume of distribution based on the area under serum concentration-time curve (Varea) did not differ significantly among the four groups, the mean value being 0.309 +/- 0.084 liter/kg. The elimination-phase (beta) half-lives were 1.53 +/- 0.36, 2.00 +/- 0.64, 5.08 +/- 1.85, and 12.8 +/- 4.1 h in groups 1, 2, 3, and 4, respectively. The 0- to 24-h cumulative urinary recoveries of carumonam were 83 +/- 11, 76 +/- 20, 58 +/- 25, and 12 +/- 9% of the administered dose in groups 1, 2, 3, and 4, respectively. The systemic and the renal clearances of carumonam decreased according to the severity of renal dysfunction, and the nonrenal clearance, which was calculated as the difference between renal and systemic clearances also decreased as CLCR decreased. A significant positive correlation existed between beta and CLCR (r = 0.847, P less than 0.01), and the beta of carumonam could be predicted by the following equation: beta (h-1) = 0.00460 X CLCR (ml/min/1.73 m2) + 0.049. Hemodialysis shortened the elimination-phase half-lives from 12.8 +/- 4.1 to 2.66 +/- 1.49 h in the six subjects in group 4. A 5-h hemodialysis in a hypothetical anephric subject weighing 60 kg was estimated to remove 51.4% of the drug present in the body at the start of hemodialysis.     

A home-based method for the detection of impaired glucose tolerance in hypertensive primary care patients

Objective. The aim of this project was to compare an oral glucose tolerance test (OGTT) partly performed in the patient''s home (OGTTh) with a clinic-obtained OGTT with regard to the ability of the tests to identify patients with impaired glucose tolerance (IGT) and type 2 diabetes mellitus (DM-2). Design. A method comparison. Setting. The study was completed at two primary health care centres. Subjects. Fifty-one patients with hypertension aged 50–79 years completed both OGTT tests. Main outcome measures. Values for capillary P-glucose obtained two hours after a glucose load were compared between the two OGTT tests. Fasting plasma glucose (fP-glucose) and HbA1c were also measured. Results. Thirty-seven patients were classified in the same group (normal/IGT/DM-2) by the two tests. The index of validity based on the test''s ability to identify normal or pathological values (≥ 8.9 mmol/l) was 0.75. The value for kappa was 0.66 with a sensitivity of 0.54 and a specificity of 0.82. Conclusion. OGTTh may be a useful screening method for IGT in risk groups such as hypertensive patients.Key Words: Diabetes, general practice, home test, hypertension, IGT, OGTT, Sweden, validity

• A home-based oral glucose tolerance test (OGTTh) in which the glucose load was consumed at home was compared with a routine oral glucose tolerance test (OGTT) obtained in a clinic setting. The OGTTh classified 75% of the study participants in the same group as the clinic OGTT (normal/pathological).
• This study demonstrates that OGTTh is comparable to OGTT and that the home-based test may be a useful screening tool for the detection of impaired glucose tolerance (IGT) in hypertensive patients in the age range 50–79 years.

     

A home-based method for the detection of impaired glucose tolerance in hypertensive primary care patients

Abstract

Objective. The aim of this project was to compare an oral glucose tolerance test (OGTT) partly performed in the patient's home (OGTTh) with a clinic-obtained OGTT with regard to the ability of the tests to identify patients with impaired glucose tolerance (IGT) and type 2 diabetes mellitus (DM-2). Design. A method comparison. Setting. The study was completed at two primary health care centres. Subjects. Fifty-one patients with hypertension aged 50–79 years completed both OGTT tests. Main outcome measures. Values for capillary P-glucose obtained two hours after a glucose load were compared between the two OGTT tests. Fasting plasma glucose (fP-glucose) and HbA1c were also measured. Results. Thirty-seven patients were classified in the same group (normal/IGT/DM-2) by the two tests. The index of validity based on the test's ability to identify normal or pathological values (≥ 8.9 mmol/l) was 0.75. The value for kappa was 0.66 with a sensitivity of 0.54 and a specificity of 0.82. Conclusion. OGTTh may be a useful screening method for IGT in risk groups such as hypertensive patients.     

Reproducibility of impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) classification: a systematic review.

BACKGROUND: The classifications of impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) represent glucose levels above normal, but below the decision threshold for diabetes. We sought to determine what the reproducibility of these classifications was when repeat tests were performed by conducting a systematic review of the literature. METHODS: All primary studies published in English of any study design were included. Studies were excluded if they did not follow the World Health Organization or American Diabetes Association diagnostic criteria, used whole blood as the specimen type, a glucose meter for analysis, or performed repeat testing greater than 8 weeks apart. RESULTS: Five papers had reproducibility data for IGT or IFG, two of which where from the same population but sampled differently. The kappa coefficients, indicating agreement between repeat tests that exceeded chance, indicated poor to fair agreement for IGT (0.04, 0.22, 0.38, 0.42) and moderate agreement for IFG (0.44 and 0.56). Similarly, the observed reproducibility was slightly lower for IGT (33%, 44%, 47%, 48%) compared to IFG (51%, 64%). In two studies for which data were available for both IGT and IFG, the average reproducibility was lower (49%) for the prediabetes group compared to the diabetes group (73%) or the normal group (93%). CONCLUSIONS: Poor reproducibility of IGT and IFG classification suggests caution should be exercised when interpreting a single test result.     

Preoperative identification and evaluation of the patient with lung disease

Preoperative pulmonary function evaluation begins with the bedside, clinical identification of the presence of significant lung disease. Once a patient is so identified, preoperative pulmonary-function studies are indicated. The optimal screening studies for most patients are spirometry and arterial blood gas analysis. Patients who are identified as having marginal function by screening techniques should be studied further by more specialized studies, including radioisotopic evaluation of regional lung function. If a patient is identified as an operative candidate, but one who has increased risk of postoperative morbidity, prophylactic measures should be instituted to reduce postoperative complications. The essence of such measures is increased care preoperatively, intraoperatively, and postoperatively. The use of preoperative evaluation of pulmonary function presents a different magnitude of problem in defining the risk of morbidity in contrast to that of mortality. Available data provide a firm basis for the identification of the patient at increased risk of morbidity. After 23 years and dozens of spirometric studies involving thousands of patients, it is apparent that there is no spirometric number, percentage, or category that will absolutely separate the operable from the inoperable patient. There are estimates of risk--guidelines, to be sure--but no absolutes. The patient whose lung function would have been considered to prohibit lung resection in the 1950s has been successfully operated on in the 1980s. In dealing with the risk of mortality, the physician should always bear in mind that, although statistics apply to groups, they often do not apply to individual patients.