The Western journal of medicine最新文献_第4页

Congenital heart disease in adults. 成人先天性心脏病。

The Western journal of medicine Pub Date : 2008-09-04 DOI: 10.3109/9780203091685

E. Foster

{"title":"Congenital heart disease in adults.","authors":"E. Foster","doi":"10.3109/9780203091685","DOIUrl":"https://doi.org/10.3109/9780203091685","url":null,"abstract":"Patients reaching adulthood with unoperated and operated congenital heart disease require attention to issues of exercise, antibiotic prophylaxis, contraception, and pregnancy. A careful clinical history is important to establish the degree of a person's disability, if any, and the symptoms responsible for the disability, whether due to heart failure, cyanosis, or both. The findings of a physical examination and a noninvasive evaluation, including electrocardiogram, chest x-ray film, and echocardiography, are often sufficient to establish a diagnosis and to assess the adequacy of a previous operation. Transesophageal echocardiography and magnetic resonance imaging are adjunctive procedures that are indicated when routine transthoracic echocardiography is limited. Cardiac catheterization may be necessary when the noninvasive data are ambiguous and to assess coronary artery disease (congenital and acquired) in patients considered for surgical therapy. Cardiac catheterization is increasingly therapeutic (such as percutaneous pulmonary balloon valvuloplasty) as well as diagnostic. Primary surgical repair or additional surgical palliative procedures should be considered in symptomatic adults. A patient with Eisenmenger's syndrome--severe pulmonary hypertension--is a special case that may be amenable only to transplantation.","PeriodicalId":22925,"journal":{"name":"The Western journal of medicine","volume":"35 1","pages":"492-8"},"PeriodicalIF":0.0,"publicationDate":"2008-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85009388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 6

Attention deficit hyperactivity disorder. 注意缺陷多动障碍。

The Western journal of medicine Pub Date : 2008-03-28 DOI: 10.18578/bnf.804609619

J. Guevara, M. Stein

引用次数: 1

Internal medicine. 内科。

The Western journal of medicine Pub Date : 2007-04-01 DOI: 10.1001/jama.279.19.1578

Evan Dale Abel

引用次数: 0

Nuclear medicine. 核医学。

The Western journal of medicine Pub Date : 2007-01-01 DOI: 10.1001/jama.293.10.1267-a

Richard Zimmermann

引用次数: 0

Wouldn't It Be Wonderful! 那该多好啊!

The Western journal of medicine Pub Date : 2003-07-01 DOI: 10.1308/147363503322103836

P. Morris

引用次数: 0

Alcohol and substance abuse. 酗酒和滥用药物。

The Western journal of medicine Pub Date : 2002-09-01 DOI: 10.4135/9781483369532.n18

M. Naegle, A. Ng, Charles T. Barron, T. F. Lai

引用次数: 5

The conundrum of height and mortality. 身高和死亡率的难题。

The Western journal of medicine Pub Date : 2002-05-01 DOI: 10.1136/EWJM.176.3.209

G. Smith

{"title":"The conundrum of height and mortality.","authors":"G. Smith","doi":"10.1136/EWJM.176.3.209","DOIUrl":"https://doi.org/10.1136/EWJM.176.3.209","url":null,"abstract":"Samaras and Elrick reiterate a claim they have made else-where—thatanimal and human data show that greater body size is related to shorter lifeexpectancy. The confidence of their claim could lead readers to think that itis based on clear and consistent evidence of a positive association betweenheight and mortality rates. Even the evidence they cite, however, does notsupport this association. For example, they describe a study by Liao andcolleagues as finding no relation between height and heart disease and a studyby Okasha et al as finding no association between height and all-causemortality. \u0000 \u0000It is unclear, however, why such studies, which find no association betweenheight and an outcome, support their claim that “larger body sizeindependently reduces longevity.” Also puzzling is why Samarasand Elrick cite these particular studies out of the body of literature onheight and health. When considered in total, this literature indicates that aconsistent inverse association exists between height and all-causemortality in developed countries. This inverse association has consistentlybeen found in prospective studies that appropriately analyze data fromrepresentative population samples. \u0000 \u0000Samaras and Elrick cite one study from our research group (Okasha et al.)as showing no association between height and all-cause mortality. The resultsof the study, in fact, showed an inverse association, although this was notstatistically significant at conventional levels. They fail to cite studieswith greater statistical power in which we showed robust inverse associationsbetween height and all-causemortality.1,2Rather than carry out a systematic review of population-based prospectiveepidemiologic studies, they refer to unrepresentative (and sometimes basicallyuninterpretable) data derived from their own previous reviews (Samaras andElrick and Miller). \u0000 \u0000What is a sensible conclusion to draw from the literature on height andmortality? In developed countries, taller people have lower all-causemortality rates and live longer. The association between height and mortalityfrom specific causes, however, is heterogeneous, with taller people havinghigher mortality rates from cancers that are unrelated tosmoking3 and fromaorticaneurysm.4 \u0000 \u0000The association between height and some cancers may reflect higher levelsof calorie intake during growth in infancy and childhood, which has been shownto increase later-life cancer risk in a variety of animal models. Insulin-likegrowth factors may mediate thisassociation.5 Thepositive association between height and risk of aortic aneurysm may simplyreflect the mechanical correlation of height and aortic length. Alternatively,it could indicate a Marfan syndrome-like tendency, being more common in tallerpeople. \u0000 \u0000But these positive associations are more than counter-balanced by theinverse associations between height and mortality resulting from coronaryheart disease, stroke, and respiratorydisease,1,2at least in developed countries. Suc","PeriodicalId":22925,"journal":{"name":"The Western journal of medicine","volume":"90 1","pages":"209"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83555078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 8

Pink urine and a petechial rash. 粉红色的尿液和点疹。

The Western journal of medicine Pub Date : 2002-05-01 DOI: 10.1136/EWJM.176.3.155

H. M. Ramos, R. Bertken, D. Pepper

{"title":"Pink urine and a petechial rash.","authors":"H. M. Ramos, R. Bertken, D. Pepper","doi":"10.1136/EWJM.176.3.155","DOIUrl":"https://doi.org/10.1136/EWJM.176.3.155","url":null,"abstract":"QUESTIONS: A 52-year-old Hispanic woman with a long history of bilateralknee pain and type 2 diabetes mellitus sees her family physician because inthe past 4 days she has had pink urine, generalized malaise, and a rash on herhands and feet. \u0000 \u0000On physical examination, the patient has oral and lingular submucosalhemorrhages (figure 1),injected sclerae with subconjunctival bleeding, and tenderness of both knees.She also has a vesiculomacular rash with a dark erythematous base that isclustered and more severe on her legs than on her arms(figure 2). She has sparsepinpoint macular lesions on her torso. Her temperature is 38.3°C(101°F), and she has a new ejection systolic murmur at the left uppersternal border. On reexamination several hours later, the number of lesions onher legs has increased. \u0000 \u0000 \u0000 \u0000Figure 1 \u0000 \u0000Submucosal hemorrhages and diffuse petechiae on oral and lingularsurfaces \u0000 \u0000 \u0000 \u0000 \u0000 \u0000Figure 2 \u0000 \u0000Vesiculomacular rash with a dark erythematous base \u0000 \u0000 \u0000 \u0000What additional questions would you ask this patient, and what other partsof the body would you examine? What kind of skin lesions are these, and whatis your differential diagnosis? What tests would help make the diagnosis? Whatis the diagnosis, and how would you treat it?","PeriodicalId":22925,"journal":{"name":"The Western journal of medicine","volume":"18 1","pages":"155-6"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89308575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Parallels between community environmental health and occupational health. 社区环境卫生与职业卫生的相似之处。

The Western journal of medicine Pub Date : 2002-05-01 DOI: 10.1136/EWJM.176.3.162

W. Hinds

{"title":"Parallels between community environmental health and occupational health.","authors":"W. Hinds","doi":"10.1136/EWJM.176.3.162","DOIUrl":"https://doi.org/10.1136/EWJM.176.3.162","url":null,"abstract":"Since September 11, 2001, there has been increased attention on whatindividuals and communities can do to minimize the effects of terroristattacks, and other disasters, on the health and safety of our family, friends,and community.1 Thearticle by Mott and colleagues focuses on one such disaster—a forestfire. It provides retrospective data that can give us some idea about whichinterventions work and which do not in preventing respiratory healthproblems. \u0000 \u0000Unlike most disaster situations, the forest fire that occurred from Augustto November 1999 near the Hoopa Valley National Indian Reservation in northernCalifornia caused a gradual buildup of smoke concentration in the residentialarea of the reservation. This gradual buildup provided an opportunity forlocal health officials to implement health-protective measures. The results ofa follow-up study, reported here, provide some guidance for health planning infire-prone areas and more generally for response to other natural andhuman-made disasters. \u0000 \u0000Over the 7-week period of the fire, smoke particulate concentration(PM10) exceeded 150 μg/m3 for 15 days and reached apeak of more than 500 μg/m3 for 3 days. The EPA has designatedthe health-based national air quality standard for PM10 as no morethan 150 μg/m3 (measured as a dailyconcentration).2Hence, the PM10 in the study area reached hazardous levels. Toreduce the health effects of the smoke exposure on susceptible members of thecommunity, local health officials implemented four types of interventions:distributing respiratory protective masks, providing free vouchers to stay athotels in nearby towns, providing portable HEPA filter units to residences,and releasing PSAs. After the fire, a study was conducted to determine thehealth effects of the fire and the effectiveness of the interventions. \u0000 \u0000The situation faced by these health officials is analogous to thatfrequently encountered in the field of industrial hygiene, so it is ofinterest to compare the approaches taken by community health officials withthose used to address chemical exposures in industrial settings. The basicindustrial hygiene paradigm includes three steps: recognition, evaluation, andcontrol.3 The firststep is to identify the contaminant. In the case of the forest fire, it wasidentified as smoke particulate, although irritating gases in thesmoke—such as aldehydes—could also have been present. Theevaluation step is a quantitative measurement of the environment and anassessment of the health risk it presents. This was done in Mott andcolleagues' study by comparing air-monitoring data with EPA standards. Thethird step, to control the exposure to safe levels, was undertaken by the fourinterventions mentioned above. \u0000 \u0000In industrial hygiene, control methods are ranked hierarchically byefficacy andreliability.4 Thebest methods are engineering controls, such as substituting safer materials,isolating workers from the exposure, and ventilation. The analogy for thiscategory would include evacu","PeriodicalId":22925,"journal":{"name":"The Western journal of medicine","volume":"25 1","pages":"162-3"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85068218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 4

Why torture must not be sanctioned by the United States. 为什么酷刑不能被美国批准。

The Western journal of medicine Pub Date : 2002-05-01 DOI: 10.1136/EWJM.176.3.148

V. Iacopino, A. Keller, Deborah Oksenberg

引用次数: 2