电针配合盆底肌锻炼治疗女性压力性尿失禁疗效观察

目的观察电针配合盆底肌锻炼治疗女性压力性尿失禁的疗效。方法将78例女性压力性尿失禁患者随机分为两组,电针结合盆底肌锻炼治疗(实验组)39例,服用维生素(安慰剂)配合盆底肌锻炼治疗(对照组)39例,对两组患者疗效进行分析。结果实验组有效率84.6%,对照组有效率59.0%,两组差异有统计学意义(P<0.01)。结论电针配合盆底肌锻炼治疗女性压力性尿失禁有效率明显优于安慰剂配合盆底肌锻炼治疗。     

毫针浅刺法治疗椎基底动脉供血不足的疗效观察

[目的]探讨毫针浅刺法针灸治疗椎基底动脉供血不足症(VBI)的临床疗效。[方法]将40例患者随机分为观察组和对照组各20例,观察组采用毫针浅刺法治疗,对照组采用常规针刺法治疗,两组均每日治疗1次,10天为1个疗程,均治疗两个疗程后判断疗效。[结果]观察组痊愈17例,显效2例,无效1例,总有效率为95.0%;对照组痊愈9例,显效7例,无效4例,总有效率为80.0%。观察组疗效明显优于对照组(P<0.05)。[结论]浅刺法针灸治疗椎基底动脉供血不足症(VBI)疗效显著。     

Measles outbreak among unvaccinated preschool-aged children: opportunities missed by health care providers to administer measles vaccine

A measles outbreak in an inner-city area primarily involved preschool-aged children younger than 5 years of age. The reasons why 31 unvaccinated preschool children with measles disease had not been vaccinated were investigated. For some patients, health care providers missed opportunities to vaccinate eligible patients against measles. Of the 26 patients whose full immunization status was known, ten (38%) were vaccinated with diphtheria and tetanus toxoids and pertussis vaccine and/or oral poliovirus vaccine at a time when they could have received measles vaccine simultaneously, according to recommendations of the Immunization Practices Advisory Committee and the American Academy of Pediatrics. In addition, five of ten health care providers interviewed missed at least one opportunity to administer measles vaccine because of a minor illness that was not a contraindication to vaccination. Unvaccinated patients were more likely to receive health care in the public sector, have single mothers, and have parents who had no knowledge of existing vaccines; they were less likely to be age-appropriately immunized with other antigens. If measles immunization levels among preschool children in the United States are to be increased, education of both health care providers and parents, coupled with innovative strategies targeted to preschool children, particularly of low socioeconomic groups in inner cities, are needed.     

Effects of iron deficiency on lead excretion in children with moderate lead intoxication

The effect of iron status on calcium disodium edetate (CaNa2EDTA)-induced lead diuresis was examined in 112 children with moderate lead intoxication. Patients whose blood lead levels were between 25 and 55 micrograms/dl and who had erythrocyte protoporphyrin concentrations greater than or equal to 35 micrograms/dl underwent provocative testing to determine the need for a full course of chelation therapy. A blood sample for lead, erythrocyte protoporphyrin, and serum ferritin determinations was obtained immediately before the intramuscular administration of CaNa2EDTA, 500 mg/m2. Determination of urinary lead level was based on an 8-hour urine collection. Blood lead and ferritin levels were significantly correlated with urinary lead excretion: r = 0.542 and 0.298, respectively, p less than 0.01 for both. Multiple regression models were tested to assess the independent effects of the variables. With blood lead level controlled, ferritin remained significantly associated with urinary lead excretion; for every 1 ng/ml increase in ferritin, urinary lead increased by 2.4 micrograms. This small effect of ferritin on urinary lead was illustrated in a discriminant analysis. Using blood lead level by itself as the independent variable resulted in a 76% correct assignment of provocative test outcomes. Knowing the ferritin level improved this assignment accuracy by only 3%. We conclude that the iron status, as measured by serum ferritin, of children with moderate lead intoxication, has a small but significant effect on CaNa2EDTA-induced lead diuresis. This effect may influence the interpretation of borderline provocative test outcomes. Although chelation therapy should not be withheld pending treatment of iron deficiency, lead stores should be reassessed after iron repletion.     

Hearing after retrolabyrinthine vestibular neurectomy

Thirty-four patients underwent vestibular neurectomies between September 1984 and January 1989. The first 15 patients operated on through January 1987 (and followed for a minimum of 2 years) were evaluated separately for long-term hearing preservation and freedom from vertigo spells. Audiograms taken at 1 postoperative month revealed no change in the pure tone averages of 25 patients and showed improved hearing of 20 to 30 dB in 5 patients. Two patients sustained losses of 18.5 dB and 21 dB, respectively. The speech discrimination scores remained the same in 17 patients, improved in 9, and were reduced in 6. Audiograms performed 12 to 40 months postoperatively showed preservation of the pure tone averages and speech discrimination scores when compared with the earlier 1-month postoperative audiograms in 73% of the patients. The speech discrimination scores, however, tended to fluctuate with the symptomatic course of each disease. Two patients developed major vertigo spells 1 1/2 years following surgery. Postoperative ice-caloric testing revealed no responses in 25 patients and markedly reduced responses in 6. There were no major complications or facial paralysis. The retrolabyrinthine vestibular neurectomy is an effective way to control vertigo with preservation of hearing and an acceptably low incidence of complications and side effects.     

Munchausen syndrome by proxy: considerations in diagnosis and confirmation by video surveillance

Munchausen syndrome by proxy is a form of abuse in which the child suffers from a factitious illness induced by a parent. A case report of an 18-month-old boy who suffered from intractable diarrhea because of the surreptitious administration of laxatives by his mother is presented. The evolution of this case is discussed, as are the legal and ethical considerations in the diagnosis of Munchausen syndrome by proxy.     

The effect of mild hypoxemia maintained for twenty-four hours on maternal and fetal glucose, lactate, cortisol, and arginine vasopressin in pregnant sheep at 122 to 139 days' gestation

The effects of prolonged mild hypoxemia on the fetus have received little attention. We investigated the response to a decrease in fetal arterial Po2 of 5 mm Hg or less sustained for a period of 24 hours in the chronically instrumented fetal lamb. Hypoxemia was induced by an infusion of nitrogen via the maternal trachea for 24 hours in 13 pregnant sheep at 122 to 139 days' gestation. Two control periods of air infusion via the maternal trachea for 24 hours were alternated with hypoxemia. Fetal hypoxemia was not associated with any change in fetal pH. During the first and second exposures to hypoxemia, there was an increase in fetal plasma lactate of 22.8 +/- 22.3 and 15.3 +/- 14.6 mg.dl-1 (mean +/- SD) above preliminary values (p less than 0.05) compared with the control period. Fetal plasma cortisol also increased by 5.7 +/- 6.1 and 9.5 +/- 5.4 ng.ml-1 (mean +/- SD) (p less than 0.05) compared with the control period. These results suggest that the fetal lamb at 122 to 139 days' gestation is highly sensitive to small decrements in Po2 of 5 mm Hg or less.     

The pediatric extended examination at three: a system for diagnostic clarification of problematic three-year-olds

The Pediatric Extended Examination at Three (PEET) is a neurodevelopmental assessment system designed to aid in the early detection and clarification of problems with learning, attention, and behavior in 3- to 4-year-old children. In this study the PEET was administered to 201 preschool children in the Boston area to ascertain standards of performance on this instrument and to demonstrate concurrent validity with the McCarthy Scales of Children's Abilities. When children with specific weaknesses on the PEET were analyzed with regard to their McCarthy scores on related indices, statistically significant agreement was documented in all areas. Data from the PEET administered to 59 children in a hospital clinic for behavioral and developmental concerns, was compared to results from the Boston area community sample. Performance on the PEET of the former group was significantly poorer, and a pattern of concerns emerged with specific therapeutic implications. Based on the two components of this study, the PEET was shown to be a valid and useful instrument which can help pediatricians clarify parental concerns about their preschool children.     

Self-reported visual dysfunction in multiple sclerosis: new data from the VFQ-25 and development of an MS-specific vision questionnaire

PURPOSE: To examine vision-specific health-related quality of life in a cohort of patients with multiple sclerosis (MS) using the 25-Item National Eye Institute Visual Function Questionnaire (VFQ-25), and to identify content areas for a brief MS-specific vision questionnaire. DESIGN: Cross-sectional survey. METHODS: The VFQ-25 and a modified version of the Optic Neuritis Treatment Trial (ONTT) Patient Questionnaire were administered by in-person interview to 80 patients at the University of Pennsylvania MS Center. Binocular visual acuities were obtained following a standard protocol using retroilluminated Early Treatment Diabetic Retinopathy Study charts. RESULTS: Despite a median binocular visual acuity of 20/16 (20/12.5-20/250), VFQ-25 subscale scores in the MS cohort were significantly lower (worse) compared with those of a published reference group of eye disease-free patients (P =.0001-0.009, two-tailed t tests). Rank-correlations of VFQ-25 composite (overall) scores with visual acuity were modest, but significant (r(s) = 0.33, P =.003), supporting construct validity for VFQ-25 scores in MS populations. Seven additional aspects of self-reported visual dysfunction in MS were also identified. CONCLUSIONS: Patients with MS have a high degree of self-reported visual dysfunction that is not entirely captured by visual acuity. The VFQ-25 is an effective measure of self-reported visual loss in MS. A brief MS-specific vision questionnaire may provide additional useful information when administered concurrently with the VFQ-25 in future investigations of MS and other neuroophthalmologic disorders.     

Selective serotonin reuptake inhibitor-induced rash: case report and review of the literature

Selective serotonin reuptake inhibitors (SSRIs) are one of the most frequently prescribed classes of drugs. Rashes induced by SSRIs seldom have been reported in the literature. Computerized MEDLINE and Current Contents searches yielded a report of two cases of rash induced specifically by paroxetine. We describe a patient who developed a rash that appeared on day 3 of treatment with oral paroxetine 20 mg/day. Her rash was morbilliform, pruritic, and generalized over the trunk and limbs, with some facial involvement. There was no palm or sole involvement. The patient reported that she had experienced a similar reaction to fluoxetine, which may suggest a drug class effect. The rash resolved within 2 days of drug discontinuation and treatment with oral diphenhydramine and topical hydrocortisone cream.