A case of diffuse pulmonary ossification in association with congenital protein C deficiency is presented. We propose that multiple pulmonary thrombi secondary to a long-term hypercoagulable state produced pulmonary ischemia that predisposed to intralveolar ossification.
Cost-effective evaluation and management of nutritional needs remains an ongoing challenge to those caring for older adults. Further elucidation of the factors that influence appetite and intake is needed, as is continuing research regarding the effects of various nutritional interventions upon clinically important outcomes.
Coronary artery ectasia is an uncommon expression of coronary artery atherosclerosis and other diseases. It occurs in about 1.4 percent of the adult population. It is not distinguishable from obstructive coronary artery disease in severity of angina, clinical presentation, electrocardiograms, mortality, or outcome of coronary artery surgery. Although there is debate, treatment is indicated in the form of chronic warfarin anticoagulation to prevent coronary thrombus formation and its sequelae. Aspirin therapy may suffice in asymptomatic individuals.
The annual incidence of acute appendicitis by gender, age, and race in Sedgwick County, Kansas was lower than values reported in most other communities. However, the trends of peak incidence during the second decade, male predominance among all races, and the highest incidence in Caucasians also were noted in the current study. The rates of perforation and gangrenous appendicitis were significantly higher in the elderly. No association was noted between the presence of fecalith and acute appendicitis or perforation. A better understanding of the etiology of acute appendicitis may explain the trends and differences in the incidence of acute appendicitis observed.
Much effort by the national cholesterol education program (NCEP) and others have been made to induce physicians to screen for and treat lipid abnormalities in patients with coronary heart disease. We measured the effect of these efforts in a single group of cardiovascular specialists. We reviewed 20 percent of applicable patient records from 1987, 1989, and 1994 was performed to identify documented screening (cholesterol levels or lipid profiles) and treatment over 12 months after an index admission for coronary heart disease, along with a survey of physician acquaintance with NCEP guidelines, among the eight cardiovascular physicians. In the 160 patients with angina pectoris or myocardial infarction, total cholesterol levels were determined in 77-95 percent and lipid profiles determined in 2-11 percent. Treatment for cholesterol, greater than 150 mg/dl was initiated in 14-32 percent. These rates did not significantly improve over the study period. Yet, all physicians were acquainted with the NCEP and five of the eight perceived their screening and treatment to be more aggressive in 1994 than in 1987. Lipid screening and treatment by cardiovascular specialists have not improved despite copious supportive literature. Barriers other than lack of knowledge may impede implementation of this effective therapy.
