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Articles 451 - 480 of 2166
Full-Text Articles in Public Health
Azathioprine-Lnduced Reversible Severe Dyserythropoiesis As A Cause Of Anemia, Sundara B. K. Raman, Joseph P. Abraham, Sheikh M. Saeed, Maria Sawdyk
Azathioprine-Lnduced Reversible Severe Dyserythropoiesis As A Cause Of Anemia, Sundara B. K. Raman, Joseph P. Abraham, Sheikh M. Saeed, Maria Sawdyk
Henry Ford Hospital Medical Journal
A 43-year-old woman with a 20-year history of systemic lupus erythematosus was treated with azathioprine for progressive complications of the disease. She developed pancytopenia within four weeks after starting azathioprine therapy. Bone marrow examination showed marked dyserythropoiesis and varying degrees of marrow hypoplasia. Changes seen in normoblasts consisted of nuclear buds, multinucleation, Howell-Jolly bodies, and abnormal mitoses. Azathioprine was discontinued. Peripheral blood counts improved in the next four weeks. A progress bone marrow examination six weeks later showed marked improvement in red blood cell abnormalities. An additional bone marrow examination performed four months after discontinuation of azathioprine showed complete disappearance …
Bilateral Dislocation Of The Crystalline Lens In A Patient With Presumed Syphilitic Uveitis, Jeffrey S. Rapkin, David D. Bogorad
Bilateral Dislocation Of The Crystalline Lens In A Patient With Presumed Syphilitic Uveitis, Jeffrey S. Rapkin, David D. Bogorad
Henry Ford Hospital Medical Journal
Dislocation of the crystalline lens has been described in association with numerous systemic disorders and as a complication of ocular trauma. We present a case of bilateral lens dislocation in a patient with presumed syphilitic uveitis. The mechanism of lens dislocation is related to humoral and cellular effects of inflammation, although the role of trauma cannot be ignored. Persistent uveitis should be considered as a sign of active infection.
Heart Failure: New Questions And Insights About An Old Foe, Jeffrey B. Lakier
Heart Failure: New Questions And Insights About An Old Foe, Jeffrey B. Lakier
Henry Ford Hospital Medical Journal
No abstract provided.
Indications For Acute And Chronic Digitalis Administration In Heart Failure, Mihai Gheorghiade
Indications For Acute And Chronic Digitalis Administration In Heart Failure, Mihai Gheorghiade
Henry Ford Hospital Medical Journal
No abstract provided.
Pathophysiology Of Heart Failure, Mihai Gheorghiade, Jeffrey B. Lakier
Pathophysiology Of Heart Failure, Mihai Gheorghiade, Jeffrey B. Lakier
Henry Ford Hospital Medical Journal
Heart failure occurs when the heart is unable to maintain a cardiac output sufficient to satisfy the oxygen requirements of the body despite adequate blood volume and hemoglobin content. Regardless of the initial cause of heart failure and in spite of compensatory mechanisms, patients often follow a course of worsening heart failure that is characterized by a low cardiac output, high filling pressures, and increased peripheral vascular resistance. In addition to persistence of the initiating event, cardiac deterioration may be caused or aggravated by a variety of factors including depletion of cardiac norepinephrine stores, down-regulation of myocardial beta-adrenergic receptors, microvascular …
Altered Platelet Function In Patients With Severe Congestive Heart Failure, Syed M. Jafri, Jeanne M. Riddle, Sundara B. K. Raman, Sidney Goldstein
Altered Platelet Function In Patients With Severe Congestive Heart Failure, Syed M. Jafri, Jeanne M. Riddle, Sundara B. K. Raman, Sidney Goldstein
Henry Ford Hospital Medical Journal
Platelet function was assessed in 15 patients with severe congestive heart failure (CHF) and in 26 control subjects of similar ages. The platelet count (mm3), surface reactivity, aggregometry studies, release factors, and circulating aggregates were investigated. The mean number of circulating platelets was normal, but a hyperactive platelet response was found in 53% of the CHF patients. CHF patients had a 42% mean for the spread type platelet, and the average number of aggregates was 64: control subjects had a 12% mean for the spread type platelet, and the average number of aggregates was 40 (p < 0.05). Aggregation with all of the inducers was normal, although 27% of CHF patients showed spontaneous aggregation. The mean plasma levels of both platelet factor 4 and betathromboglobulin were abnormally elevated. No circulating platelet aggregates were detected. Our studies indicate that platelet function is abnormal in patients with CHF. The abnormal platelet reactivity found might contribute to the increased incidence of thromboembolic events observed in CHF patients.
"Congestion": An Infrequent Feature In Patients With Chronic Heart Failure On Therapy, Syed M. Jafri, Jeffrey B. Lakier, Howard S. Rosman, Sidney Goldstein
"Congestion": An Infrequent Feature In Patients With Chronic Heart Failure On Therapy, Syed M. Jafri, Jeffrey B. Lakier, Howard S. Rosman, Sidney Goldstein
Henry Ford Hospital Medical Journal
The clinical presentation of chronic heart failure has changed with advances in therapy, and the physical findings of congestion are now inconsistently present. To determine the clinical signs of congestion, we studied the clinical findings of 44 patients who had chronic heart failure and abnormal left ventricular ejection fractions (23 ± 10%). Signs of pulmonary edema manifested as rales were absent in all patients in New York Heart Association (NYHA) classes I and II, in 66% of patients in NYHA class III, and in 14% of patients in NYHA class IV. Signs of right heart failure manifested as elevated jugular …
Echocardiographic Evaluation Of Patients With Congestive Heart Failure, Mohsin Alam
Echocardiographic Evaluation Of Patients With Congestive Heart Failure, Mohsin Alam
Henry Ford Hospital Medical Journal
Echocardiography is a useful noninvasive test for evaluating patients with suspected heart failure and enlarged cardiac silhouette. This test can obtain the dimensions and wall thickness of all four cardiac chambers and can evaluate left ventricular function. The test results are reproducible, and in many instances the etiology of heart failure can be determined.
The Effect Of Aortic Valve Replacement On Left Ventricular Function In Patients With Aortic Valvular Disease, Tennyson Lee, Cathy L. Glick, Jeffrey B. Lakier, Sidney Goldstein
The Effect Of Aortic Valve Replacement On Left Ventricular Function In Patients With Aortic Valvular Disease, Tennyson Lee, Cathy L. Glick, Jeffrey B. Lakier, Sidney Goldstein
Henry Ford Hospital Medical Journal
Despite improved surgical techniques and survival in patients following aortic valve replacement for aortic stenosis and aortic insufficiency, the proper timing for surgery remains controversial. The incomplete reversibility of left ventricular dysfunction remains a concern, and postoperative improvement of left ventricular function is not consistently demonstrated. We studied 11 patients with aortic stenosis and nine patients with aortic insufficiency using angiographic and radioisotope assessment of left ventricular function preoperatively. Postoperative left ventricular function was assessed over nine to 13 months by radioisotope multiple-gated acquisition (MUGA) scan. All patients with impaired left ventricular function preoperatively showed slow but significant recovery toward …
Status Of Cardiac Transplantation With A Report Of The First Year's Experience At Henry Ford Hospital, Fraser M. Keith, Donald J. Magilligan Jr., Jeffrey B. Lakier, Conrad Drost
Status Of Cardiac Transplantation With A Report Of The First Year's Experience At Henry Ford Hospital, Fraser M. Keith, Donald J. Magilligan Jr., Jeffrey B. Lakier, Conrad Drost
Henry Ford Hospital Medical Journal
Cardiac transplantation is now widely accepted as effective treatment for selected patients with end-stage heart disease. Improvements in immunosuppressive treatment and monitoring in the past 15 years have resulted in impressive one-year and five-year survival rates of 80% and 60%. In general, survivors have enjoyed a considerably improved quality of life. A cardiac transplantation program was initiated at Henry Ford Hospital in 1985, and a total of 15 patients received heart transplants in the first 12 months. Fourteen patients are currently alive and well at various stages posttransplant. This early clinical success has prompted the consideration of both combined heart-lung …
A Tribute To Dr. Szilagyi, Roger F. Smith
A Tribute To Dr. Szilagyi, Roger F. Smith
Henry Ford Hospital Medical Journal
No abstract provided.
Gravid Uterine Rupture Following Cesarean Section And Intervening Vaginal Delivery, Anthony Udo-Inyang, Chang Lee, Elizabeth Evans
Gravid Uterine Rupture Following Cesarean Section And Intervening Vaginal Delivery, Anthony Udo-Inyang, Chang Lee, Elizabeth Evans
Henry Ford Hospital Medical Journal
No abstract provided.
Critical Surgical Services And The Fragmented Patient, Brack A. Bivins
Critical Surgical Services And The Fragmented Patient, Brack A. Bivins
Henry Ford Hospital Medical Journal
No abstract provided.
The Clinical Usefulness Of Measuring Apolipoproteins In Diabetic Patients: A Preliminary Report, J. David Fachnie, Janet Mcgill, Craig Foreback, Dorothy M. Kahkonen
The Clinical Usefulness Of Measuring Apolipoproteins In Diabetic Patients: A Preliminary Report, J. David Fachnie, Janet Mcgill, Craig Foreback, Dorothy M. Kahkonen
Henry Ford Hospital Medical Journal
A commercial assay for apolipoproteins A-1 and B as well as total cholesterol, triglyceride, and high-density lipoprotein (HDL) cholesterol was applied to 12-hour fasted serum from 24 insulin-dependent and 19 noninsulin-dependent diabetic persons. Women with noninsulin-dependent diabetes mellitus (NIDDM) had the highest levels of total cholesterol and apolipoprotein B. Apolipoprotein B values fell within the normal range in all patients except the NIDDM females, where four of the ten (40%) samples were elevated. When apolipoprotein B was elevated, total cholesterol was also elevated, over 220 mg/dL. Apolipoprotein A-1 values fell within or above the normal range in all subjects, and …
Management Of Alcohol Withdrawal In The Critically Ill Patient: A Selected Review, Rebecca B. Kantz, H. Mathilda Horst
Management Of Alcohol Withdrawal In The Critically Ill Patient: A Selected Review, Rebecca B. Kantz, H. Mathilda Horst
Henry Ford Hospital Medical Journal
No abstract provided.
Trauma In Pregnancy, Victor J. Sorensen, Brack A. Bivins, Farouck N. Obeid, H. Mathilda Horst
Trauma In Pregnancy, Victor J. Sorensen, Brack A. Bivins, Farouck N. Obeid, H. Mathilda Horst
Henry Ford Hospital Medical Journal
Management of 12 pregnant trauma patients is reviewed. These patients had injuries to the neck, chest, abdomen, and extremities. Six patients had penetrating wounds, and six others had blunt injuries. Eight of the 12 women required surgical intervention during their hospitalization. Liberal use of diagnostic procedures such as roentgenograms, diagnostic peritoneal lavage, and angiography aided in the evaluation of these patients. None of the 12 patients died, and only two developed major complications. One fetus died as a result of shock in the mother and only one major neonatal complication occurred. Rapid resuscitation combined with thorough diagnostic evaluation and early …
The Safety And Efficacy Of A New Patient-Controlled Analgesia Device In Hospitalized Trauma And Surgery Patients, Terry J. Baumann, Luz Maria Gutschi, Brack A. Bivins
The Safety And Efficacy Of A New Patient-Controlled Analgesia Device In Hospitalized Trauma And Surgery Patients, Terry J. Baumann, Luz Maria Gutschi, Brack A. Bivins
Henry Ford Hospital Medical Journal
The objective of this investigation was to evaluate a new patient-controlled analgesia (PCA) device. Eighteen trauma and surgical patients were allowed to use a self-activated, intravenous infusion device for two to seven days for postoperative pain relief. Initial PCA dosage/interval settings were adjusted to provide a 0.5 to 1 mg dosage of morphine per injection with a six-minute lockout interval. Adjustments were made to these initial settings based on the individual patient's response. Pain and sedation scores and respiratory rates were recorded. Subjective evaluations of PCA indicated that 17 of the 18 patients (94.4%) participating in the study "preferred this …
Pulmonary Microembolism In The Canine Model: Report Of A Pilot Study, Brack A. Bivins, Robert P. Rapp, Richard M. Bell
Pulmonary Microembolism In The Canine Model: Report Of A Pilot Study, Brack A. Bivins, Robert P. Rapp, Richard M. Bell
Henry Ford Hospital Medical Journal
Use of in-line final filters to prevent the infusion of foreign particulates has lowered the rates of postinfusion phlebitis in several controlled studies. The systemic effect of particulate infusion, however, has not been thoroughly studied. In this study, 12 mongrel dogs recovering from a right pneumonectomy were studied following infusion of various-sized particulates. Ten of the dogs were infused with either 10 or 40 million, 9 or 25 μm, latex particles. The remaining two dogs were control animals. Hemodynamic parameters were monitored in each animal. At death or 72 hours following particle injection, the left lung was examined grossly and …
Mortality From Postoperative Myocardial Infarction In Nonthoracic Surgical Patients At A Community Hospital, Martha L. Gray, Randall S. Reimer, Michael D. Thompson
Mortality From Postoperative Myocardial Infarction In Nonthoracic Surgical Patients At A Community Hospital, Martha L. Gray, Randall S. Reimer, Michael D. Thompson
Henry Ford Hospital Medical Journal
In a 20-month prospective study, 35 patients with postoperative myocardial infarction were identified. All patients referred to cardiologists by nonthoracic surgeons were evaluated for evidence of postoperative myocardial infarction as defined by symptoms, electrocardiographic changes, and cardiac enzyme elevation. Ten of the 35 patients (29%) subsequently died, seven (20%) from the myocardial infarction. Twenty-five of the 35 patients (71%) had preexisting coronary artery disease. Reported experience with patient mortality following postoperative myocardial infarction varies from 28% to 69%. Our patient mortality rate at 29%, though still substantial, is lower than many current reports. Despite close perioperative surveillance of patients with …
Nineteen-Year Radiographic Follow-Up Of Untreated Paget's Disease Of Bone, Christopher K. Shier, Burton I. Ellis, Gregory Tennyson, Michael Kleerekoper
Nineteen-Year Radiographic Follow-Up Of Untreated Paget's Disease Of Bone, Christopher K. Shier, Burton I. Ellis, Gregory Tennyson, Michael Kleerekoper
Henry Ford Hospital Medical Journal
Radiographic and histologic findings in Paget's disease of bone have been previously well described, and characteristic features of each stage have been determined. Long-term radiographic follow-up of untreated patients is rarely reported. We had the opportunity to observe the radiographic evolution of untreated Paget's disease of the tibia. Sequential radiographic studies spanning a 19-year period have allowed us the opportunity to study the natural course of this disease.
Endodermal Sinus Tumor In A 14-Year-Old Girl, Lorenzo C. Boyce, Kiran Balchandani, Roshinder Padda
Endodermal Sinus Tumor In A 14-Year-Old Girl, Lorenzo C. Boyce, Kiran Balchandani, Roshinder Padda
Henry Ford Hospital Medical Journal
A case report on a 14-year-old girl with a large pelvic and abdominal mass is presented. Initial evaluation suggested the mass to be of ovarian origin, and the diagnosis of endodermal sinus tumor was confirmed by the pathological specimen. Alpha fetoprotein (AFP) levels on admission were 12,700 mg/dL. but AFP decreased immediately in the postoperative period and has continued to decline toward normal levels over the past four months of combination chemotherapy. After completion of chemotherapy, AFP levels will continue to be monitored and a second-look procedure may be in order.
Injection Sclerotherapy Of Bleeding Esophageal Varices: The Henry Ford Hospital Experience, Stephen R. Verbeck, Martin C. Zonca, Dominic K. H. Wong
Injection Sclerotherapy Of Bleeding Esophageal Varices: The Henry Ford Hospital Experience, Stephen R. Verbeck, Martin C. Zonca, Dominic K. H. Wong
Henry Ford Hospital Medical Journal
An update is provided of our ongoing sclerotherapy experience at Henry Ford Hospital, based on 47 patients who have undergone this procedure. One-month mortality rates for Child's classes C, B, and A were 50%, 22%, and 0%, respectively. Follow-up after one month revealed ten additional mortalities, but none were secondary to esophageal variceal hemorrhage. Strictures secondary to sclerotherapy were amenable to dilation. We advocate sclerotherapy as the treatment of choice for esophageal variceal hemorrhage.
Chest Radiographs In Surgical Intensive Care Patients: A Valuable "Routine", H. Mathilda Horst, Brian Fagan, Gordon H. Beute
Chest Radiographs In Surgical Intensive Care Patients: A Valuable "Routine", H. Mathilda Horst, Brian Fagan, Gordon H. Beute
Henry Ford Hospital Medical Journal
A total of 411 "routine" chest films were evaluated to determine their clinical value for surgical intensive care unit patients. There were 138 unexpected findings on 112 chest radiographs. These unexpected findings were equally divided between pulmonary problems (72) and device malposition (66). Of the unexpected findings, 30% were considered potentially life-threatening. On the basis of this study, we recommend "routine" chest films for monitoring in critically ill surgical intensive care patients.
Hemodynamic Response To Fluid Challenge: A Means Of Assessing Volume Status In The Critically Ill, H. Mathilda Horst, Farouck N. Obeid
Hemodynamic Response To Fluid Challenge: A Means Of Assessing Volume Status In The Critically Ill, H. Mathilda Horst, Farouck N. Obeid
Henry Ford Hospital Medical Journal
Cardiovascular and oxygen transport variables were studied during fluid challenges in 50 critically ill patients. The results show three distinct patterns of response: hypovolemic, normovolemic, and hypervolemic. Colloid fluid challenge is a rapid, effective diagnostic modality for determination of cardiovascular function in the surgical critical care patient.
The Failure Of Anthropometry As A Nutritional Assessment Tool, Judith J. Bencich, Diana L. Twyman, Ann Fierke
The Failure Of Anthropometry As A Nutritional Assessment Tool, Judith J. Bencich, Diana L. Twyman, Ann Fierke
Henry Ford Hospital Medical Journal
Anthropometric measurements are commonly used to assess body composition changes and adequacy of nutritional support in the hospitalized patient. To test their utility as nutritional assessment tools in the intensive care unit (ICU) patient, body weight, triceps skinfold (TSF), mid-arm muscle circumference (MAMC). and fluid balance and intake were collected on 21 critically ill patients during their ICU stay. Correlations were sought between adequacy of nutritional support and changes over time in weight. MAMC, fluid balance, and TSF. A significant change over time in mean body weight (p < 0.0001) was seen, reflecting a mean weight loss despite a positive cumulative fluid balance of almost 20 L by day 14 for all patients (p < 0.0001). There was a significant change over time in the mean fractional intake of required calories ranging from 41.7% on observation day 1 to a peak of 84.0% on day 22 (p < 0.001). TSF and MAMC could not be obtained on a large percentage of ICU patients due to severe edema including the mid-upper arm. Obtained measurements showed no change over the study period in TSF (p = 0.24) and MAMC (p = 0.71) despite significant changes in weight (p < 0.0001). caloric intake (p = 0.0001). and cumulative fluid balance (p = 0.0001). From these data it appears that anthropometric indices of TSF and MAMC are unrelated to nutritional intake and weight in ICU patients and are therefore not of use in the nutritional assessment of this population.
Evaluation Of The Economic Impact Of Pharmacist Involvement In Hyperalimentation Therapy, Larry Crots, Larry Shoup
Evaluation Of The Economic Impact Of Pharmacist Involvement In Hyperalimentation Therapy, Larry Crots, Larry Shoup
Henry Ford Hospital Medical Journal
A prospective parallel study of patients receiving total parenteral nutrition (TPN) was undertaken to identify characteristics of TPN solution use and waste. Thirty consecutive patients receiving TPN by order of the primary clinical service (control group) were compared with 25 consecutive patients receiving TPN under the supervision and monitoring of the Nutritional Support Service (study group). The patients were evenly divided between medical and surgical problems, with 53% of the control group being surgical patients compared to 56% of the study group. There were 136 L of TPN or 4.5 L/patient discarded in the control group compared to 65 L …
D-Penicillamine-Induced Polymyositis Occurring In Patients With Rheumatoid Arthritis: A Report Of Two Cases And Demonstration Of A Positive Lymphocyte Stimulation Test To D-Penicillamine, Takayuki Matsumura, Takamichi Yuhara, Kazuhide Yamane, Ichiro Kono, Teizo Kabashima, Heihachiro Kashiwagi
D-Penicillamine-Induced Polymyositis Occurring In Patients With Rheumatoid Arthritis: A Report Of Two Cases And Demonstration Of A Positive Lymphocyte Stimulation Test To D-Penicillamine, Takayuki Matsumura, Takamichi Yuhara, Kazuhide Yamane, Ichiro Kono, Teizo Kabashima, Heihachiro Kashiwagi
Henry Ford Hospital Medical Journal
Two patients with erosive, seropositive rheumatoid arthritis developed polymyositis during treatment with D-penicillamine. In both patients the HLA tissue typing revealed the presence of DR4. The myopathy improved promptly after withdrawal of D-penicillamine and institution of prednisolone therapy. In one patient, hypersensitivity to D-penicillamine was demonstrated by a lymphocyte stimulation test. This is the first case of D-penicillamine-induced polymyositis in which T-cell proliferative response to D-penicillamine was demonstrated in vitro.
Idiopathic Bilateral Chylothorax Presenting As A Left-Sided Neck Swelling, Larry B. Tankanow, Carlos Petrozzi, Joseph C. Ward, George C. Bower
Idiopathic Bilateral Chylothorax Presenting As A Left-Sided Neck Swelling, Larry B. Tankanow, Carlos Petrozzi, Joseph C. Ward, George C. Bower
Henry Ford Hospital Medical Journal
No abstract provided.