ABSTRACT
The aims of this study were to document the risks and benefits of total parenteral nutrition (TPN) by comparing two groups of patients with advanced HIV disease. This case-control study took place from June 1992 through June 1994. Medical Records were the primary source of data. Bailey-Boushay House, a 24-h skilled nursing facility in Seattle, Washington was the resident location of participating patients. TPN was commonly used in this long-term care facility for persons with AIDS. Eighty patients with AIDS, 40 of whom were receiving TPN and 40 of whom were not receiving TPN but who had central venous access (control group) were chosen. No significant differences were found between the two groups in the number of positive blood cultures (10% vs. 3%), however, the number of abnormal lab values was higher in the TPN group (6 vs. 4) (p < 0.05). The TPN group also gained an average of 2.2 kg in weight compared to an average loss of 1.4 kg in the control group (p < 0.05); the control group had a higher number of patients with weight loss > 10% of admit weight (28% vs. 8%) (p < 0.05). The length of stay was similar between groups (91 vs. 77 days), as were several quality of life indicators. The conclusions of the investigators was that TPN did not appear to lead to clinically important positive or negative health effects when compared to a group not receiving TPN but with central venous access. Benefits or detriments to certain sub-groups of AIDS patients may well exist that were not apparent in this study.
Subject(s)
Acquired Immunodeficiency Syndrome/therapy , Parenteral Nutrition, Total , Acquired Immunodeficiency Syndrome/complications , Adult , Case-Control Studies , Cost-Benefit Analysis , Female , Humans , Length of Stay , Male , Middle Aged , Parenteral Nutrition, Total/adverse effects , Parenteral Nutrition, Total/economics , Quality of Life , Sepsis/etiology , Weight LossABSTRACT
Systemic vasculitis is a confusing subject which has been difficult to classify and understand. Improvements in therapy increase the importance of early diagnosis. This paper reviews the clinical and pathological differences of the systemic vasculitides, and a working approach to the differential diagnosis of vasculitis is formulated based on the size of the vessel involved. Vessel size and histopathology determine to what group of diseases a particular syndrome belongs, thereby allowing subclassification and a more rational approach to management.
Subject(s)
Vasculitis/classification , Arteritis/diagnosis , Arteritis/pathology , Diagnosis, Differential , Granuloma/diagnosis , Granuloma/pathology , Granulomatosis with Polyangiitis/diagnosis , Granulomatosis with Polyangiitis/pathology , Humans , Necrosis , Polyarteritis Nodosa/diagnosis , Polyarteritis Nodosa/pathology , Vasculitis/diagnosis , Vasculitis/pathologyABSTRACT
The State of Nevada has now given its fourth series of acupuncture licensing examinations. In all, 62 candidates have taken examinations. Licenses have been granted to 27 persons as master acupuncturists (Doctors of Traditional Chinese Medicine or Doctors of Acupuncture) and to 6 as Acupuncture Assistants. At present, 4 acupuncturists practice in the Reno area and 13 in Las Vegas.
Subject(s)
Acupuncture Therapy , Licensure, Medical , Humans , Medicine, East Asian Traditional , NevadaSubject(s)
Arthritis/immunology , Histocompatibility Antigens , Uveitis/immunology , Adult , Humans , MaleABSTRACT
Renal homotransplantaion and chronic hemodialysis are accepted methods of treating end-stage kidney disease. However, these procedures are fraught with complications involving bones, joints, and soft tissues. Transplantation and immunosuppressive therapy problems include "connective tissue-like" reactions, infections in joints and avascular necrosis of bone. Long term hemodialysis may accentuate secondary hyperparathyroidism, renal osteodystrophy, and metastatic calcification, which can be minimized by phosphorous control or calcium loading in the dialysate. In the presence of osteomalacia, vitamin D may be helpful and parathyroidectomy is indicated if autonomy is present. In one patient undergoing long term hemodialysis, a chalky material was aspirated from the olecranon bursa. Two inorganic solid phases were identified as being present - a major phase, octacalcium phosphate (ocp) and a minor phase, calcite (CaCO3). Because of its elusive properties, the role of OCP in biological systems is poorly known and can easily escape detection. Methods of identification of OCP and its potential role in crystal deposition syndromes are discussed.
Subject(s)
Bone Diseases/etiology , Joint Diseases/etiology , Kidney Failure, Chronic/therapy , Kidney Transplantation , Renal Dialysis/adverse effects , Transplantation, Homologous/adverse effects , Humans , MaleABSTRACT
Nevada's Senate Bill 448 was signed into law by Governor Mike O'Callaghan on 20 April 1973. The law permits the practice of Chinese medicine, including acupuncture, by practitioners who do not have to be physicians. The state legislature rapidly approved it with only two dissenters, one of them a physician. Similar legislation may be considered in other states this year.
