Clinical and roentgenographic follow-up examinations of patients with juvenile rheumatoid arthritis (JRA) suggest that neurologic complications are less likely to develop in these patients than in ...patients with adult rheumatoid arthritis (RA). A review of the charts of 92 patients treated for JRA during the period from 1970 to 1976 revealed that 29 (31%) had clinical evidence of cervical spine involvement. Follow-up examinations in 15 of these 29 patients revealed that all had limited cervical spine motion, 14 had neck pain and stiffness, and two had torticollis. Roentgenographic evidence of atlantoaxial subluxation was present in five patients and ankylosis of the facet joints in four. Two patients with atlantoaxial subluxation had hypereflexia and clonus, but both long tract signs and subluxation spontaneously resolved in one of these patients. None of these patients had basilar invagination or subaxial instability, which can occur in adult RA.
Ozone (O3) and aerosol scattering ratio profiles were obtained from airborne lidar measurements on thirty‐eight flights over seven deployments covering the latitudes of 40°–85°N between 4 February ...and 23 May 2000 as part of the Tropospheric Ozone Production about the Spring Equinox (TOPSE) field experiment. Each deployment started from Broomfield, Colorado, with bases in Churchill, Canada, and on most deployments, Thule Air Base, Greenland. Nadir and zenith lidar O3 measurements were combined with in situ O3 measurements to produce vertically continuous O3 profiles from near the surface to above the tropopause. Potential vorticity (PV) distributions along the flight track were obtained from several different meteorological analyses. Ozone, aerosol, and PV distributions were used together to identify the presence of pollution plumes and stratospheric intrusions. Ozone was found to increase in the middle free troposphere (4–6 km) at high latitudes (60°–85°N) by an average of 4.6 ppbv/mo (parts per billion by volume per month) from about 54 ppbv in early February to over 72 ppbv in mid‐May. The average aerosol scattering ratios at 1064 nm in the same region increased rapidly at an average rate of 0.36/mo from about 0.38 to over 1.7. Ozone and aerosol scattering were highly correlated over the entire field experiment, and PV and beryllium (7Be) showed no significant positive trend over the same period. The primary cause of the observed O3 increase in the mid troposphere at high latitudes was determined to be the photochemical production of O3 in pollution plumes with less than 20% of the increase from stratospherically‐derived O3.
Specific, measurable health objectives for the nation have helped guide federal, state, and local policy in disease prevention and health promotion during the 1980s. About one half of these ...objectives will probably be achieved by 1990. Public awareness of hypertension and its consequences, for example, is at very high levels. Although the physician's office is a key setting for accomplishing many of the objectives, physicians remain largely uninformed about them and uninvolved in the broader process of public health policy formulation. Family medicine, as a specialty concerned about the care of the individual in the context of family and community, has much to contribute to future public health planning efforts. A plan for drafting the year 2000 objectives is beginning. Because the objectives will help shape health policy in the future, family physicians should be involved in developing appropriate health objectives for the nation and helping to implement them.
Clinical and pathologic data of 13 children, aged 5 to 16 years, with acute interstitial nephritis (AIN) are presented. The cause of AIN in these children was assessed as being related to infection ...in ten and methicillin in one; no infection, drug, or toxin could be implicated in two other patients. In addition to having various degrees of acute renal failure, all patients had systemic symptoms, most common of which were fatigue, fever, sore throat, and gastrointestinal disturbances. In six patients, the diagnosis of AIN was clinically suspected on the basis of tubular dysfunction such as low urinary specific gravity and glucosuria; in seven others the diagnosis was made after examination of the renal biopsy. Two patients had the nephrotic syndrome which resolved only after cytotoxic agents were added to corticosteroid therapy. The remaining 11 patients were given supportive therapy including peritoneal dialysis in one case. Complete recovery of renal function occurred in all patients within a mean interval of 69.5 +/- 34.7 days from the onset of symptoms, and all patients continue to have normal renal function during a follow-up period ranging from 1.5 to 10 years. We conclude that, in children, AIN is underdiagnosed, is most often associated with streptococcal infection, and carries an excellent prognosis.
Experiments were performed to investigate the effect 2-wk prior nephrectomy has on the recovery from a 40-min renal artery occlusion. Two groups were initially examined. Group 1 animals underwent ...sham nephrectomy and group 2 animals right nephrectomy 14 days prior to a 40-min left renal artery clamp. The percent recovery of inulin clearance in group 2 (33 +/- 6%) was not significantly different from that in the group 1 (36 +/- 8%) when measured 3 h after reflow. At 24 and 48 h of reflow, however, group 2 animals had a significantly higher percent recovery of inulin clearance (24 h: 31 +/- 5%; 48 h: 50 +/- 11%) than group 1 animals (24 h: 1 +/- 1%; 48 h: 8 +/- 4%). Similarly the histology was better preserved at 24 and 48 h in group 2. To further investigate this enhanced recovery, three additional groups were studied. Group 3 underwent right nephrectomy at the time of renal artery occlusion. Group 4 had right uretero-venostomies created immediately prior to the ischemic insult, and group 5 had their aortas rather than left renal arteries clamped. Each group shared with group 2, ischemia to all functioning excretory tissue. The percent recovery of inulin clearance in group 3 (48 +/- 9%), group 4 (54 +/- 5%), and group 5 (42 +/- 6%) were each significantly (P less than 0.005) higher than in group 1 (8 +/- 4%) when measured at 48 h. We conclude that the protection offered by uninephrectomy is not a consequence of hypertrophy but that alterations in the environment which follow ischemia to all functioning excretory renal tissue are responsible for the enhanced recovery seen.
We performed a follow-up study of forty consecutive combined Jones-Ellison anterior-cruciate reconstructions in a young, athletic population. The mean interval from injury to operation was 2.7 years. ...Preoperatively, all patients had a 3+ or 4+ pivot shift and instability. All but five patients had a meniscal tear, and thirty patients had arthritic changes in the knee at the time of operation. Postoperatively only four of the patients had any complaints of giving-way. Although thirty of the patients returned to their previous sports activities, only eight achieved the preinjury level of performance. Arthritic symptoms were present at operation in thirty patients, while thirty-four had no postoperative objective signs of pivot shift or instability.
A summary of some of the major historic achievements in the development of the computer is detailed from the ancient efforts represented by Stonehenge through the development of the transistor.
Pulmonary artery fistulas may occur as isolated lesions or as part of the complex of hereditary hemorrhagic telangiectasia. Surgical resection is generally advised because of the potential for severe ...complications; however, this may be difficult in diffuse telangiectasia or contraindicated in patients with severe obstructive lung disease. This article offers therapeutic embolization as an effective alternative in such patients, and presents a successful experience.
PDF
