Arterio-enteric fistula following pelvic radiation: a case report.

Two cases of arterial perforation into the small bowel are reported. Etiology was not determined in one case, but surgical trauma leading to localized infection in the irradiated tissue seemed responsible in the other. After the initial episode of hemorrhage, there was a symptom-free interval before its reappearance and vascular collapse. This is believed to be due to the distensibility of the large bowel. The site of arterial perforation was determined pre-operatively in one case by selective arteriography. Review of the recent literature relevant to transcatheter arterial embolization suggests that it may have potential in management of the arterio-enteric fistula as an alternative to or an aid in surgical correction by stabilizing the patient in a favorable condition.     

A new familial syndrome characterized by pigmentary retinopathy, hypogonadism, mental retardation, nerve deafness and glucose intolerance.

Torulopsis glabrata, an opportunistic pathogen, was found to be the etiologic agent of infections in patients with cancer. This observation prompted a retrospective review to determine the incidence and underlying factors of infection with this organism. This study showed that T. glabrata had been cultured frequently and that the incidence of infection has been progressively increasing. During a 48-month period (9/70-8/74), T. glabrata was cultured from routine surveillance and diagnostic cultures in 167 patients, 27 of whom had either presumed or documented infection. Review of clinical and necropsy records implicated T. glabrata infections as a contributory factor in the death of 14 of the 27 patients. Etiologic diagnosis of infection was established antemortem in only three patients. Pulmonary isolation in pure growth occurred in 24 of the 27 patients. Seventeen of 19 infected patients who had prior routine surveillance cultures were colonized prior to infection. Infection occurred in the setting of far advanced malignancy or leukopenia and followed the use of systemic, broad spectrum antibiotics. T. glabrata is a frequently overlooked opportunistic pathogen which, in the proper setting, appears to be producing increasing numbers of infections.     

Effect of amiodarone on serum quinidine and procainamide levels

Serum levels of quinidine or procainamide were measured in patients who had amiodarone added to their antiarrhythmic regimen. Dosages of quinidine or procainamide were held constant. Eleven of 11 patients had an increase in the serum quinidine level, and 11 of 12 other patients had an increase in the serum procainamide level. The dose requirement to maintain a stable plasma level of quinidine or procainamide decreased by 37% and 20%, respectively. Clinical toxicity occasionally occurred with the increase in serum levels of quinidine and procainamide, and the dose of these drugs should be decreased when amiodarone is administered concurrently.     

武汉市妇女绝经相关因素的调查

目的评估武汉市40~65岁妇女自然绝经过程中绝经相关症状的发生及影响因素。方法选取2014年4~10月武汉市参加年度健康体检、年龄40~65岁的956名妇女为调查对象,采用问卷形式调查妇女的基本信息、月经状况、运动锻炼情况、重要躯体疾病以及围绝经期相关症状,用Greene评分法评估绝经症状,分析绝经症状的发生情况及影响因素。结果月经不规律妇女出现的得分高的前五位绝经相关症状是:感到疲惫或精力不足、失眠、感到头晕或无力、潮热、肌肉或关节酸痛(P0.05);得分高的常见的症候群是:焦虑症状、躯体症状、抑郁症状和血管舒缩症状(P0.05)。绝经后妇女出现的得分高的绝经症状是:失眠、潮热、感到疲倦或精力不足和肌肉关节酸痛(P0.05);常见症候群是血管舒缩症状和性生活问题(P0.05)。躯体疾病对5种绝经症候群均有显著影响(P0.05);40~50岁者较61~65岁者更易有抑郁症状(P0.05);体质量指数增加更易有血管舒缩症状(P0.05)。结论绝经症状在绝经的各个阶段侧重表现不同,慢性躯体疾病是绝经症状的不良影响因素。     

Respiratory monitoring. Recent developments in automatic monitoring of gas concentration, flow, pressure, and temperature

Advances in instrumentation and programming techniques have resulted in the expansion of a previously reported 12-bed respiratory gas-concentration monitoring system to now include automatic calibrated measurements of bidirectional airflow, airway pressure, and airway temperature as well as other vital signs (rectal temperature, arterial blood pressure, central venous pressure, and heart rate). The more expensive hardware, including a programmable digital desk calculator, interfacing, a mass spectrometer, signal conditioners, and a major portion of the airflow instrumentation, are time-shared to provide an acceptable per-bed cost. Calculated and edited measurements of pulmonary mechanics (tidal and minute volume, mean and end-expiratory airway pressures, compliance, resistance, respiratory rate) and gas exchange (oxygen consumption, carbon dioxide production, respiratory exchange ratio, alveolar P_O2, and alveolar P_CO2) are printed out and stored in an extended memory. The memory is accessed by a second calculator, which prints out summaries of data every 8 hours, correlates off-line blood gases and other measurements with automatically acquired data, and communicates with a commercial time-sharing system for more sophisticated data processing.     

Pancoast's Tumor: Irradiation or Surgery?

Seventy-three patients with Pancoast's tumor treated at the University of Maryland Hospital between 1955 and 1978 were reviewed. There were 34 squamous cell carcinomas, 13 undifferentiated, 10 adenocarcinomas, 4 mixed adeno-squamous, 1 alveolar cell, and 11 undetermined. Twenty-nine patients received irradiation, with 7% survival at 3 years; 19 patients underwent preoperative irradiation followed by en bloc resection of chest wall, with 23% survival at 3 years; 5 patients underwent extended resection, with 60% survival at 3 years; and 18 patients underwent operation followed by irradiation, with 7% survival at 3 years. Retrospective staging of 42 patients undergoing operation indicated that 22 (52%) were inoperable. Prognosis was related to staging of the disease, the extent of local invasion, nodal involvement, cell type, and adequacy of operation.