The role of growth hormone replacement in a growth hormone deficient patient with underlying cardiomyopathy and severe congestive heart failure.

It has been reported that growth hormone (GH) deficiency induced cardiomyopathy responds to growth hormone replacement therapy. We describe the case of a middle-aged male with cardiomyopathic heart failure and growth hormone deficiency of the adult secondary to surgical panhypopituitarism. We demonstrate clinical and hemodynamic improvement of cardiac function with growth hormone replacement therapy despite underlying structural heart disease.     

Reoperations and visual results after failed pneumatic retinopexy

A single pneumatic retinopexy (PR) procedure failed to achieve permanent retinal reattachment in 23 (23%) of 101 cases of simple primary retinal detachment (RD). In 12 (16%) of 76 cases that were phakic or had an intact posterior capsule, a single PR failed compared with 11 (44%) of 25 cases without an intact posterior capsule. A total of 27 reoperations including eight repeat PRs (5 of which were successful) was required to achieve permanent retinal reattachment. Comparison of the final visual acuity and change from preoperative to final visual acuity between the initially failed and the successful cases demonstrated that initial failure of PR does not adversely affect the visual outcome. In all cases, the retina remained reattached at latest follow-up.     

Evaluating very small and rapidly evolving programs. Consultation in the case of a health careers information program.

The case of a health careers program evaluation illustrates some aspects of evaluating very small and rapidly evolving programs. Such programs can change quickly, since there is no massive bureaucracy to restrain them. Rigid evaluation research methods would frustrate both researchers and program staff. The authors suggest that flexible design, use of specialized interviewing and analytical experiments--in this case, telephone surveys testing program response--and a recognition that a consultative relationship exists will result in outcomes useful to the program and rich in evaluation data.     

Exercise performance of collegiate rodeo athletes.

In this study we examined the physical, hematologic, and exercise response of 20 male and 10 female athletes of the National Intercollegiate Rodeo Association, Central Rocky Mountain Region. Male subjects were grouped by roughstock, steer wrestling, and roping events. Female athletes were grouped separately. Maximal aerobic capacity, pulmonary ventilation, respiratory exchange ratio, energy expenditure, maximal heart rate, blood pressure, treadmill time, pre- and postexercise lactate, percent body fat, lean body mass, blood chemistry, serum lipids, and reaction/movement time were analyzed by event. No significant differences (P greater than 0.05) were found in any of these categories between male events. Mean resting blood chemistry parameters of rodeo athletes were within normal ranges. Steer wrestling athletes possessed greater body size and lean body mass than other groups. When analyzing body composition, blood pressure, and total cholesterol:high-density lipoprotein (HDL) cholesterol ratios, results indicate average to low risk for coronary heart disease. When compared to other intermittent-activity sport athletes, college rodeo athletes appear to have similar aerobic capacities, but possess lower lean body mass and greater percent body fat.     

Autologous Fat Injection for Vocal Cord Medialization in the Canine Larynx

This study examined the use of autologous fat as an alternative to Teflon® and collagen as the implantable material in vocal cord medialization. Five animals underwent left recurrent laryngeal nerve sections with subsequent fat harvest and implantation into the left true vocal cords. Three animals were killed after 48 hours and 2 after 3 weeks; their larynges were examined with light microscopy. The results of the 48-hour samples show moderate acute inflammation and few areas of focal necrosis. The 3-week samples show no necrotic foci, minimal foreign-body reaction, and maintenance of structure and volume of the injected fat. Autologous fat may prove to be a valuable alternative to nonautologous injectable material in vocal cord augmentation.     

High-dose VP-16 with intermediate-dose cytosine arabinoside in the treatment of relapsed acute nonlymphocytic leukemia

Summary In a study of 11 adult patients with acute nonlymphocytic leukemia (ANLL), infusion therapy with high-dose VP-16 and intermediate-dose cytosine arabinoside was administered. Response was assessed with reference to bone marrow aspirations performed on days 1; 12, 13, or 14; and 21 of treatment. All 7 of the patients with ANLL in relapse achieved marrow hypoplasia, and 3 of them achieved complete response. LFTs were elevated in most patients but no evidence of hepatocellular necrosis was observed. It is concluded that the value of VP-16 in ANLL may have been underestimated in the past because of inadequate dosing.Abbreviations ANLL acute nonlymphocytic leukemia - CGL chronic granulocytic leukemia - DNR daunorubicin - VNC vincristine - ID Ara-C, intermediate-dose Ara-C (500 mg/m² for 12 doses) - HD Ara-C, high-dose Ara-C (3 g/m² for 12 doses) - SGGT serum glutamic transaminase - LDH lactic dehydrogenase - SGOT serum glutamic oxaloacetic transaminase     

臂丛神经根性损伤膈神经移位术对青壮年患者早期呼吸功能的影响

目的研究臂丛神经损伤膈神经移位术对青壮年患者早期呼吸功能的影响.方法对16例接受膈神经移位治疗的患者,在术前、术后（10 d）进行肺功能指标的比较,同时定期进行门诊随访,观察呼吸系统自觉症状程度.结果13例术后出现了不同程度的供氧不足症状,16例全部出现一侧膈肌抬高,术后第10天肺活量（VC）、肺活量预计值百分数（VC%）分别比术前减少37.98%和26.88%,两者差异有统计学意义（tvc=11.532、tvc%=0,P＜0.01）.其它项目如残气量（RV）较术前轻度下降,肺总量（TLC）下降值达到术前肺总量的36.49%,残气量/肺总量比值（RV/TLC%）较术前上升了4.75%,上述各指标的差值均有统计学意义.1 s用力呼气量/用力肺活量比值（FEV1/FVC）和术前比基本无改变,但其差值有统计学意义.膈神经移位右侧（10例）与左侧（6例）术前、术后肺活量比较差异有统计学意义.术后随访8个月～2年,所有患者均无明显呼吸困难和胸闷等症状.结论膈神经移位术后对青壮年患者肺容量有较大的丧失,肺通气功能减弱和小气道阻力增加,但其丧失程度在机体自身代偿耐受范围内,不会导致急剧发生的严重呼吸功能障碍.建议对右侧臂丛神经根性损伤的患者,术前进行严格的肺、心功能检查,避免发生较为严重的并发症.     

Kawasaki disease manifesting with acute cholangitis. A case report.

A 3-year-old boy, who developed the signs and symptoms characteristic of Kawasaki disease, is described. The child also had an 8 cm tender hepatomegaly. Hydrops of the gallbladder could not be shown. Liver biopsy showed marked infiltration of inflammatory cells, including neutrophil and eosinophil leucocytes in the portal tracts involving the periphery of the portal arteries and veins, and acute inflammation of the bile ducts with neutrophil and eosinophil infiltration of the walls. Overt cholangitis has been described only once before in Kawasaki disease, when a viral agent was suggested as being important in the pathogenesis. Although the clinical and laboratory findings in cases of Kawasaki disease clearly suggest an acute infection--as they did in this case--no aetiological agent has yet been incriminated. The possibility of a drug-induced auto-allergic or hypersensitivity state is considered. Evidence for such a state includes a history of drug administration, pathological findings similar to peri-arteritis nodosa--a condition often associated with a hypersensitivity state--the presence of eosinophils in the lesions and a response to treatment with aspirin, a drug known to ameliorate hypersensitivity states.