Panic disorder in the medically ill.

The authors describe five patients with concurrent panic disorder and medical illness. Panic disorder either caused worsening of the medical illness or was associated with continued physiologic symptoms that mimicked the symptoms of the medical illness after the illness had improved. In both cases, panic disorder was associated with high rates of medical utilization, increased patient suffering, and often costly medical tests. Accurate diagnosis and treatment decreased physiologic and psychiatric symptoms as well as medical utilization.

A case-control study of epithelial ovarian cancer.

With data from a study of 296 patients with primary epithelial ovarian cancer and 343 patients hospitalized because of other conditions, we estimated ovarian cancer risk in accordance with reproductive and other factors. Risk was greatest among women of lower parity, especially among women who said they planned to have children but could not. The protective effect of oral contraceptives seen in other studies was observed only in subgroups of our study population. Women who had breastfed their children had decreased risk, but the number of months of breastfeeding was not related to risk. Incomplete pregnancies did not provide the protection seen for live births. A family history of ovarian cancer and a medical history of breast cancer were both strong risk factors. None of the nonreproductive factors that we examined, including childhood illnesses, tobacco and alcohol consumption, obesity, and selected adult diseases, was convincingly associated with risk.

A comparison between a conventional and a fiberoptic flow-directed thermal dilution pulmonary artery catheter in critically ill patients.

Invasive hemodynamic monitoring is frequently required in the management of patients in intensive care units. A fiberoptic flow-directed thermal dilution pulmonary artery catheter capable of continuously monitoring the mixed venous saturation, while more expensive than a conventional pulmonary artery catheter, theoretically could result in better patient care, and might be cost-effective if it resulted either in fewer blood tests being ordered or in less time in the intensive care unit. To test this hypothesis, we designed a randomized trial in our Medical Intensive Care Unit to compare a standard pulmonary artery catheter with a fiberoptic catheter. Twenty-six patients received a standard catheter and 25 patients received the fiberoptic catheter. There were no statistical differences between the groups in age, time in the intensive care unit, number of tests ordered, hours of mechanical ventilator therapy, hours of vasoactive drug therapy, or mortality rate. The only statistically significant differences between the groups were that (1) the fiberoptic catheter required a longer insertion time and (2) there were more technical problems in consistently obtaining the wedge pressure in the patients with the fiberoptic catheters. We conclude that routine substitution of a fiberoptic catheter for the standard pulmonary artery catheter is not indicated.

Natural killer (NK) cells in chronic progressive multiple sclerosis patients treated with lymphoblastoid interferon.

Natural killer (NK) cell functional activity, as defined by the lysis of 51Cr-labelled K-562 cells, and number, defined phenotypically by anti-Leu-11, are significantly decreased in chronic progressive multiple sclerosis (MS) when compared to normal controls. When age- and sex-matched populations are compared, NK cell functional activity is again significantly reduced in MS compared to controls but not when compared to a control group of other medical disease (OMD). The MS group could be differentiated from the OMD group, however, when results of NK cell functional activity are combined with NK cell phenotype. With the administration of lymphoblastoid interferon daily for 6 months, NK cell activity increased significantly at 48 h and at 1 week. By 1 month, activity decreased to a level slightly above placebo treatment values. The results likely reflect interferon's enhancement of mature NK cell activity combined with a variable effect on recruitment of pre-NK cells.

Biological control systems in health and disease.

Research into mammalian organ systems remains essential to proving the significance of new advances at the molecular level. Computational analysis, histology, controlled experimental conditions, require skills lying outside those of the traditional medical sciences. Medical graduates who want partnership in the research teams of the future will need formal training in science.

Common systemic diseases in geriatric patients.

The elderly population will substantially increase by the year 2000, leading to an increased number of elderly patients in the optometric practice. The elderly differ substantially from other patient groups as aging is accompanied by many functional deficits. However, the majority of these decrements do not result in illness or disability. Disease states exist separately or are superimposed upon the already compromised body systems of the elderly. The average geriatric patient suffers from two or more chronic diseases. As primary care practitioners, optometrists should be familiar with the more prevalent diseases of the elderly and their impact upon performance during the vision examination. A review of the common diseases associated with aging is presented.