Diagnosis and Medical Management of Infective Endocarditis: Transthoracic and Transesophageal Echocardiography

The use of echocardiography in the diagnosis of vegetative endocarditis has been a keystone in the diagnosis and treatment of this important clinical syndrome. In addition, with the use of transesophageal echo this modality has now made important advances in not only diagnosis but in evaluation of global cardiac function. A considerable amount of information has been gathered on the vegetation and these data will be discussed.     

Pain location and associated symptoms in post-lumbar puncture headache

In this prospective study of 239 patients, 88 (37%) suffered from post-lumbar puncture headache (PPH). The pain was located within the region innervated by the trigeminal nerve in 49% of the drawings, within the occipital and/or suboccipital region in 11%, and within the combined trigeminal/occipital region in 39%. The headache was unilateral at least once in 34% of the patients. Changes in pain location from one region to the other and/or between bilateral and unilateral headache were observed in 54% of the patients throughout the PPH period. Associated symptoms were experienced by 85%, nausea (73%) and dizziness (60%) being the most frequently reported. In the upright position, nausea, dizziness, and tinnitus tended to be present during a fairly large part of the PPH period (57–63% of the days), vomiting occurring only occasionally (28%). The intensity of associated symptoms was positively correlated to PPH severity. Pain in the combined trigeminal/occipital region was most severe and related to more associated symptoms than pain in other regions, and unilateral pain was milder than bilateral pain. Pain in the occipital and/or suboccipital region was mildest. The severity of nausea decreased significantly on the last 2 days of the PPH period, and the intensity of dizziness decreased when PPH was about to subside. Tinnitus is probably due to a cochlear dysfunction, and presents special characteristics. Its incidence was not clearly related to PPH severity and it increased with increasing duration of PPH; its intensity did not decline when PPM was about to wane.     

医院间接成本分配方法之模拟比较

介绍了医院间接成本的四种分配方法,即:1直接分配法;2.顺序分配法或阶梯分配法;3.双重分配法;4.联立方程法,并进行了模拟比较,认为双重分配法和联立方程法将成为最主要的间接成本分配方法。     

Effect of Extracorporeal Shock Wave Lithotripsy on Prostate Specific Antigen

Purpose

We evaluated the effects of extracorporeal shock wave lithotripsy (ESWL^*) of distal ureteral calculi on serum prostate specific antigen (PSA).

Materials and Methods

A total of 29 consecutive men with distal ureteral calculi at a maximum of 25 mm. from the ureteral orifice, and without any history of urinary tract infection, benign prostatic hyperplasia or prostate cancer underwent ESWL with the Dornier MPL 9000 × lithotriptor. The therapeutic focus size was 48 × 7 mm. PSA was measured exactly 5 minutes before ESWL, as well as 120 minutes, 24 hours and 7 days after termination of treatment.

Results

Fragmentation rate was 100 percent and all patients were stone-free within 1 week of therapy. There was no statistically significant difference between PSA values before and after treatment. Only 15 patients had a slight increase in PSA at 120 minutes after treatment (range 0.01 to 0.41 ng./ml., mean 0.07).

Conclusions

ESWL can be performed in men at risk for prostate cancer without impairing the predictive value of PSA.     

Under-ascertainment of Aboriginality in records of cardiovascular disease in hospital morbidity and mortality data in Western Australia: a record linkage study

Background  

Measuring the real burden of cardiovascular disease in Australian Aboriginals is complicated by under-identification of Aboriginality in administrative health data collections. Accurate data is essential to measure Australia's progress in its efforts to intervene to improve health outcomes of Australian Aboriginals. We estimated the under-ascertainment of Aboriginal status in linked morbidity and mortality databases in patients hospitalised with cardiovascular disease.     

纺织工作环境及其噪声对女工心理健康的影响

目的：评价纺织工作环境及其噪声对纺织女工心理健康的影响,为有关部门制定卫生标准和防护措施提供科学依据。 方法：调查于2006-02/04进行,选取成都市某织布厂接触噪声高于85dB（A）的女工341名作观察组,另选取同厂接触噪声强度低于85dB（A）的女工154名作对照组,检测两组作业环境的噪声强度、风速、气温、气湿,并了解两组受试者的一般情况,采用SCL-90症状自评量表评价调查对象的心理健康状况,包括躯体不适、强迫症状、人际关系敏感、抑郁、焦虑、敌对、恐怖、偏执和精神病性9项因子,得分越高症状越重。 结果：495名受试者的资料进入结果分析。①两组作业环境检测,除观察组接触的噪声强度超过国家噪声卫生限值[85dB（A）]外,两组的其余各项指标均符合国家卫生标准,并且其一般情况的构成相似。②观察组SCL-90量表的9项因子分、总均分、阳性项目数以及阳性症状均分均高于对照组（P〈0.05）,躯体不适和强迫症状两项因子分≥3分的阳性检出率明显高于对照组（P〈0.05）。③观察组各个工龄组SCL-90的9项因子分、总均分和阳性项目数中,除躯体不适和敌对因子以外,其余指标均以1-年工龄组为最高（P〈0.05）。 结论：高强度的纺织噪声对女工心理健康有一定的影响,其中对1-年工龄组的影响最明显。建议采取积极有效的措施,以保护纺织女工的心理健康。     

Selection of platelets for refractory patients by HLA matching and prospective crossmatching

A multi-site clinical study compared platelets chosen for refractory patients by prospective platelet crossmatching using stored donor platelets and HLA-based selection. Seventy-three patients who were refractory to random-donor platelets received two plateletpheresis components, one chosen by HLA-based criteria and the other by crossmatching. Patients were carefully evaluated to exclude nonimmune factors that could adversely affect transfusion results. Each of the five study sites used a crossmatch procedure with which it had experience. Results from this study indicate the following: 1) The overall rate of successful transfusion was similar when an HLA-based method of donor selection that includes all grades of matching and mismatching was compared to a crossmatch-based method of donor selection. 2) HLA-based selection that restricts recipients to grade A and BU matches was superior to a selection method based upon crossmatching alone. Donor selection based on HLA matching (grades A or BU) was also superior to selection based on any degree of HLA mismatching (grades BX, C, or D). 3) Selection of donors based on HLA-cross-reactive groups (defined by in vitro serologic crossreactivity) was no more successful than that based on grade C and D mismatches and was no more successful than selection by crossmatching alone. 4) Lymphocytotoxic and platelet antibodies were not detected in many of the enrolled patients, even though patients demonstrating nonimmune factors were eliminated from the study. It can be concluded that HLA-compatible (grades A and BU) platelets provide optimal support for refractory patients, but that crossmatch-selected platelets are acceptable as an alternative component.     

Detecting fetomaternal hemorrhage: a comparison of five methods

Appropriate postpartum administration of Rh immune globulin relies on sensitive detection and accurate quantitation of fetomaternal hemorrhage (FMH). Recently, the microscopic Du test (micro Du) enhanced with polyethylene glycol (PEG Du) and flow cytometry (FC) have been advocated for this purpose. Three qualitative methods (micro Du, rosette test, and PEG Du) and two quantitative methods (acid elution and FC) for assessing FMH were evaluated with particular attention given to PEG Du and FC. In vitro studies comprised 10 series of dilutions of D+ cord cells in D- adult cells to yield D+ cell concentrations of 0.06, 0.12, 0.25, 0.50, 0.75, 1.0, and 2.0 percent. Additionally, 26 postpartum samples were tested. Of the qualitative techniques, the micro Du test was the least sensitive with 20 percent false-negative results occurring at 0.5 percent fetal cells. The PEG Du test was only slightly more sensitive and offered no clinical advantage. The rosette test was the most sensitive, consistently detecting fetal cells at concentrations of 0.25 percent or greater. FC and acid elution showed similar results, with good correlation obtained between measured and expected quantities of fetal cells (r = 0.99 and 0.96, respectively). One of 26 postpartum samples was positive by all screening techniques; acid elution and FC detected 0.3-percent concentrations of fetal cells and 0.17-percent concentrations of D+ cells, respectively. Although acid elution is a more commonly used method for quantitating FMH, FC offers an acceptable alternative that is capable of analyzing large numbers of cells with objectivity and reproducibility.