More articles from Original Study

  • Coronary artery disease in women: a risk-factor analysis
    Anita Zeiler Arnold, DO and Donald A. Underwood, MD
    Cleveland Clinic Journal of Medicine September 1993, 60 (5) 387-392;

    Coronary artery disease (CAD) has long been considered a disease of men. However, the risk factors for CAD are similar for women and men, and these factors need to be considered when counseling women for the prevention of CAD.

  • Stereotactic and computer-assisted neurosurgery at the Cleveland Clinic: review of 501 consecutive cases
    Heldo Gomez, MD, Gene H. Barnett, MD, Melinda L. Estes, MD, Joann Palmer, RN and Mellissa Magdinec, RN
    Cleveland Clinic Journal of Medicine September 1993, 60 (5) 399-410;

    By allowing precise preoperative planning, image-guided stereotactic neurosurgery provides a safe, accurate alternative to many traditional techniques in the diagnosis and treatment of intracranial lesions.

  • Coronary artery disease in young women: risk factor analysis and long-term follow-up
    Anita Zeiler Arnold, DO and Douglas S. Moodie, MD
    Cleveland Clinic Journal of Medicine September 1993, 60 (5) 393-398;

    Risk factors include hypertension, hypercholesterolemia, diabetes mellitus, familial coronary disease, and smoking. The long-term prognosis is excellent for those without advanced diabetes mellitus and renal failure.

  • Lung transplantation: the Cleveland Clinic experience
    Sunit R. Patel, MD, Thomas J. Kirby, MD, Patrick M. McCarthy, MD, David P. Meeker, MD, Paul Stillwell, MD, Thomas W. Rice, MD, Mani S. Kavuru, MD and Atul C. Mehta, MD
    Cleveland Clinic Journal of Medicine July 1993, 60 (4) 303-319;

    BACKGROUND Lung transplantation has been steadily developing as a therapeutic option for end-stage lung disease.

    METHODS Retrospective analysis of all 26 patients who underwent lung transplantation at the Cleveland Clinic Foundation between February 1990 and February 1992.

    RESULTS Nineteen single-lung transplantations and seven bilateral lung transplantations were performed. The 1-year actuarial survival for all recipients was 65%. A trend was noted towards better survival in recipients with emphysema (100%) and poorer survival in those with pulmonary hypertension (37.5%). Fungal sepsis and reimplantation lung injury were the most common causes of death, and most deaths (8 of 9) occurred within the first 4 weeks. Of 119 pulmonary complications, 82% occurred in the first 3 months, with infection (39%) and acute rejection (29%) being the most common. Bacterial and fungal infections occurred mainly in the first month, and cytomegalovirus infections occurred mainly in the second and third months. The majority of survivors have shown improvement in functional status.

    CONCLUSIONS The early perioperative and 1-month post-transplantation period appears critical to long-term survival. Even though the complications are numerous, they are usually manageable and, in general, do not result in long-term morbidity.

  • Stereotactically guided thrombolysis of deep cerebral hemorrhage: preliminary results
    David W. Miller, MD, Gene H. Barnett, MD, Donald W. Kormos, PhD and Charles P. Steiner, BS
    Cleveland Clinic Journal of Medicine July 1993, 60 (4) 321-324;

    BACKGROUND The neurologic outcome from conventional medical or surgical therapy of intracerebral hemorrhage (ICH) is poor; however, stereotactically guided instillation of thrombolytic agents to dissolve parenchymal clots due to hypertensive hemorrhage has recently produced results equal to or better than those obtained with conventional therapies.

    OBJECTIVE To determine whether stereotactic thrombolysis of deep ICH is safe and effective.

    METHODS We administered urokinase to clots in four patients with hypertensive ICH. After the hemorrhage was localized using angiography and computed tomography-assisted stereotactic technique, a ventricular catheter was used to administer urokinase to the clot.

    RESULTS Preliminary results showed dramatic reduction in clot volume within 48 hours of initiating treatment and modest clinical improvement in all four patients. No further hemorrhages were seen after treatment. Three patients ultimately died of non-neurologic causes.

    CONCLUSIONS With careful patient selection, stereotaxy-assisted thrombolytic therapy may be an advance in the treatment of certain cases of ICH.

  • Acquired immunodeficiency syndrome: case reporting at a university hospital
    Andrew Picken, BA, Robert Plona, RN, Pamela Parker, RN, John T. Carey, MD and Michael M. Lederman, MD
    Cleveland Clinic Journal of Medicine May 1993, 60 (3) 202-206;

    BACKGROUND Planning and allocating resources for care of patients with acquired immunodeficiency syndrome (AIDS) requires accurate assessment of disease incidence.

    OBJECTIVE To assess the accuracy and completeness of AIDS case reporting at our institution, we reviewed all inpatient and outpatient records of patients with AIDS seen at University Hospitals of Cleveland, Ohio, between January 1983 and July 1990.

    METHODS The patients were identified through review of hospital discharge summaries, ambulatory clinic listings, and laboratory identification of opportunistic infections.

    RESULTS We found that 24 of 291 AIDS cases (8%) seen at this institution had not been reported to state health departments. Of the 24 patients with unreported AIDS, 16 had received an AIDS diagnosis at other institutions, 11 had never been hospitalized at this institution, and 2 had used pseudonyms.

    CONCLUSIONS Review of AIDS case reporting can ascertain the magnitude of underreporting; the profile of patients who were unreported may be used to evaluate the accuracy of reporting elsewhere and to identify systematic problems in case reporting methods.

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