Chronic constipation in infants and young children is frequently ascribed to psychogenic causes or an intestinal motility disorder. However, it has been suggested that allergy to proteins in cow's milk may play a role in this disorder. Iacono and collea
Various strategies have been considered to reduce the rate of readmission and mortality in recently discharged elderly hospital patients. Kravitz and colleagues prospectively studied frail elderly patients to evaluate the impact of a geriatric home asse
Tricyclic antidepressants and intranasal desmopressin are among the pharmacologic agents most widely used for the treatment of nocturnal enuresis. Intranasal desmopressin has a better safety profile and milder side effects than tricyclic antidepressants
Marfan syndrome is an autosomal dominant inherited disorder of the connective tissue. The lifespan of patients with the disorder is shortened, with most mortality resulting from cardiovascular disease. Recently, treatment has been more aggressive, inclu
Laparoscopic cholecystectomy has been associated with shorter periods of hospitalization and recovery. Despite the need for specialized training and equipment, the procedure has been widely adopted. Kane and associates describe the outcomes of elective
The use of levonorgestrel contraceptive implants (Norplant) during the immediate postpartum period has not been studied in controlled trials. Theoretically, implant use during this time would offer patients the convenience of effective contraception bef
Recently, several reports of the alarming rates of morbidity and mortality associated with highly virulent "flesh-eating" strains of Streptococcus pyogenes (group A) have been published in the lay and medical press. Similarities in clinical presentation
The American College of Obstetricians and Gynecologists (ACOG) has published a technical bulletin on pediatric gynecologic disorders (ACOG Technical Bulletin No. 201). The bulletin includes a discussion on the evaluation of prepubertal and peripubertal
The hematopoietic colony-stimulating factors (CSFs) have been introduced into clinical practice as additional supportive measures that can reduce the likelihood of neutropenic complications caused by chemotherapy. Because of the high cost of this treatm
In 1990, an estimated 61,000 U.S. women over 35 years of age died from cardiovascular diseases related to cigarette smoking. Because the risk for myocardial infarction can be reduced by 50 percent after one year of abstaining from smoking, interventions
Date: March, 1991
Recent angioscopy and autopsy studies have shown fissures in atheromata after percutaneous transluminal coronary angioplasty. It has been postulated that the increase in vascular diameter seen on angiography may be a result of stretching of the normal vascular wall in eccentric coronary lesions. Balloon inflation does not reduce the mass of atheromatous lesions. Consequently, intravascular interventions are needed to reduce the mass without disrupting normal vasculature. Litvack and associates conducted a study to determine the efficacy of excimer laser coronary angioplasty as an adjunct or alternative to conventional balloon angioplasty.
Fifty-five patients underwent a modified balloon angioplasty. The technique used a 1.6-mm diameter catheter constructed of 12 individual silica fibers arranged concentrically around a guidewire lumen. The procedure was considered successful if the stenotic diameter increased by 20 percent or more and the vessel diameter was greater than 1 mm.
In 46 (84 percent) of the patients, laser angioplasty was initially successful. Adjunctive balloon angioplasty was necessary in 41 patients (75 percent). The authors believe that the need for adjunctive angioplasty in these patients could be obviated by the use of a catheter with a larger diameter.
Stenosis as determined by quantitative angiography decreased from a mean baseline of 83 [+ or -] 14 percent to a mean of 49 [+ or -] 11 percent after laser treatment and to a mean of 38 [+ or -] 12 percent after adjunctive balloon angioplasty. There were no deaths and no vascular perforations. Only one patient required emergency coronary artery bypass surgery.
The authors suggest that percutaneous excimer laser coronary angioplasty can safely ablate atheroma and reduce coronary stenosis. (American Journal of Cardiology, November 1, 1990, vol. 66, p. 1027.)
COPYRIGHT 1991 American Academy of Family PhysiciansCOPYRIGHT 2004 Gale Group