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Erectile dysfunction is a common problem that may be definitively treated with the implantation of an inflatable penile prosthesis (IPP). The preponderance of available data on IPP surgery derives from institutional studies, most notably from academic centers or large single-surgeon series, where the majority of procedures are performed in a hospital setting. Because insurance companies and health systems look to reduce health care costs, IPP surgery in outpatient freestanding ambulatory surgery centers (ASC) is becoming more prevalent.

The social sciences do threaten theology/religious studies even when they do not challenge either the reality of God or the reality of belief in the reality of God. The entries in RPP ignore this threat in the name of some wished-for harmony. The entries neither recognize nor refute the challenge of social science to theology/religious studies. They do, then, stand antithetically both to those whom I call "religionists" and to many theologians, for whom there is nothing but a challenge.

One perennial issue in the study of religion is the relationship between explanation and interpretation. Explanation provides causes. Interpretation provides meanings. The issue is the relationship between causes and meanings, for which rough synonyms are reasons, motives, intentions, and purposes. This article presents three of the most common positions on the relationship: those of Max Weber, Clifford Geertz, and Paul Ricoeur. The aim is not to endorse any of the positions but simply to compare them.

Inhibition of surfactant function and abnormal surfactant synthesis lead to surfactant dysfunction in children with acute hypoxemic respiratory failure. We evaluated whether intratracheal lucinactant, a synthetic, peptide-containing surfactant, was safe and well-tolerated in infants with acute hypoxemic respiratory failure, and assessed its effects on clinical outcomes.

The article reports on the energy retrofit created by Menlo Business Park (MBP) for its tenants. MBP is a multi-tenant commercial property in Silicon Valley's Santa Clara County in California. MBP Dave Tarlton started a multi-year program to standardize and modernize the building campus in the park by laying white reflective roofs and installing rooftop heating, ventilation, and air-conditioning (HVAC) units. Gee and SiteOn conducted an audit of the property and ran a pilot program.

Tracheal instillation of surfactant to premature newborns improves their survivability but may transiently obstruct airways resulting in undesirable acute effects on cerebral blood flow (CBF) and oxygenation. The acute peridosing hemodynamic effects of surfactant administration may be avoided by minimizing the volume of surfactant administered, but smaller surfactant volumes may also result in less even distribution of surfactant throughout the lung. These experiments were undertaken to compare responses to two surfactants with different dose volumes (porcine-derived poractant alfa, 2.5 mL/kg vs peptide-based synthetic lucinactant, 5.8 mL/kg) given to newly delivered lambs at 85% gestation. Both surfactants resulted in similar improvements in blood gas values, a doubling of dynamic compliance, increases in brain tissue oxygen tension, and stable blood pressure with no significant change in CBF. Distribution of surfactant throughout the lungs was more uniform with lucinactant than poractant alfa when assessed by labeled microspheres. We conclude that improvements in lung mechanics, gas exchange, and changes in CBF are comparable for a porcine-derived and peptide-containing synthetic surfactant, despite instilled volumes differing by 2-fold. Intrapulmonary distribution of surfactant is more uniform after a larger volume is instilled.

Tracheal instillation of surfactant to premature newborns improves their survivability but may transiently obstruct airways resulting in undesirable acute effects on cerebral blood flow (CBF) and oxygenation. The acute peridosing hemodynamic effects of surfactant administration may be avoided by minimizing the volume of surfactant administered, but smaller surfactant volumes may also result in less even distribution of surfactant throughout the lung. These experiments were undertaken to compare responses to two surfactants with different dose volumes (porcine-derived poractant alfa, 2.5 mL/kg vspeptide-based synthetic lucinactant, 5.8 mL/kg) given to newly delivered lambs at 85% gestation. Both surfactants resulted in similar improvements in blood gas values, a doubling of dynamic compliance, increases in brain tissue oxygen tension, and stable blood pressure with no significant change in CBF. Distribution of surfactant throughout the lungs was more uniform with lucinactant than poractant alfa when assessed by labeled microspheres. We conclude that improvements in lung mechanics, gas exchange, and changes in CBF are comparable for a porcine-derived and peptide-containing synthetic surfactant, despite instilled volumes differing by 2-fold. Intrapulmonary distribution of surfactant is more uniform after a larger volume is instilled.

These clinical practice guidelines summarize the recommendations of the American Association of Clinical Endocrinologists for the diagnostic evaluation of hyperthyroidism and hypothyroidism and for treatment strategies in patients with these disorders. The sensitive thyroid-stimulating hormone (TSH or thyrotropin) assay has become the single best screening test for hyperthyroidism and hypothyroidism, and in most outpatient clinical situations, the serum TSH is the most sensitive test for detecting mild thyroid hormone excess or deficiency. Therapeutic options for patients with Graves' disease include thyroidectomy (rarely used now in the United States), antithyroid drugs (frequently associated with relapses), and radioactive iodine (currently the treatment of choice). In clinical hypothyroidism, the standard treatment is levothyroxine replacement, which must be tailored to the individual patient. Awareness of subclinical thyroid disease, which often remains undiagnosed, is emphasized, as is a system of care that incorporates regular follow-up surveillance by one physician as well as education and involvement of the patient.

BackgroundThe mechanism by which angiotensin-converting enzyme inhibitors reduce mortality rates and disease progression in patients with heart failure is likely mediated in part through prevention of adverse ventricular remodeling. This study examined the effects of the angiotensin-converting enzyme inhibitor captopril and the angiotensin II type 1 receptor antagonist losartan on ventricular volumes and function in elderly patients with heart failure and reduced left ventricular ejection fraction (≤40%). MethodsPatients underwent radionuclide ventriculograms (RVG) at baseline and were randomized to either captopril (n = 16) or losartan (n = 13). After 48 weeks, another RVG was obtained. Therapy was then withdrawn for at least 5 days, and the RVG was repeated while the patient was not receiving the drug. ResultsAt 48 weeks both captopril and losartan significantly reduced left ventricular (LV) end-diastolic volume index (135 ± 26 to 128 ± 23 mL/m2for losartan, P<.05 vs baseline; 142 ± 25 to 131 ± 20 mL/m2for captopril, P<.01; mean (SD). Captopril also reduced LV end-systolic volume index (98 ± 24 to 89 ± 21 mL/m2, P<.01 vs. baseline), whereas a nonsignificant trend was observed for the losartan group (97 ± 23 to 90 ± 16 mL/m2, P= not significant). The between-group differences in the changes in LV volumes were not statistically significant. After drug withdrawal, LV end-diastolic volume index remained significantly lower than baseline in the captopril group (P<.01). ConclusionsBoth captopril and losartan prevent LV dilation, representing adverse ventricular remodeling, previously seen with placebo treatment. Reverse remodeling was observed in the captopril group. On the basis of these results, the relative effects on LV remodeling do not provide a rationale for a survival benefit of losartan over captopril. (Am Heart J 2000;139:1081-7.)

The expressive therapies, which utilize music, art, and creative movement, can be an effective treatment intervention with elderly mentally retarded persons as a means of helping them expand their socialization and communication skills, thereby reducing problems of social isolation and withdrawal.

Twelve patients with primary lymphoma of the thyroid gland were reviewed. Based on clinical observations of this group of patients and a review of the literature, a composite clinical picture can be drawn of the patient at high risk of having primary lymphoma of the thyroid gland. This condition should be considered in the differential diagnosis in patients with a history of lymphocytic thyroiditis and an enlarging neck mass, tender or nontender. The mass may be cold or cool with areas of patchy uptake shown on scintillation scanning. The patient has a greater than 50% chance of having hoarseness with or without vocal cord paralysis. We also review the pathogenesis and prognosis of primary lymphoma of the thyroid gland.(JAMA 242:1743-1746, 1979)

Communication barriers erected by grieving children delay problem resolution. Use of the expressive arts—music, art, and body movement—in symbolic communication helps them to express overwhelming feelings and cope with trauma and stress.

Losartan (COZAARΟχιρχ†) is the prototype of a new class of potent and selective angiotensin II (AII) type 1 (AT1) receptor antagonists with the largest published preclinical and clinical data base. Since all of the AII antagonists are selective for the AT1 receptor, these drugs should exhibit similar cardiovascular effects. However, since the pharmacokinetic/pharmacodynamic profiles of these agents and their degree of affinity for the AT1 receptor differ, it is likely that differences in clinical profiles between these drugs exist and will require investigation. Losartan (parent compound), has moderate affinity for the AT1 receptor (competitive inhibition). Losartan is well-absorbed orally as an active drug and is rapidly converted via oxidation in the human liver to a more potent metabolite (designated E3174) with an affinity 20- to 30-times greater for the AT1 receptor (non-competitive inhibition). E3174 has a half-life of 6 - 9 h; elimination is via renal and hepatic routes. Antihypertensive and, in heart failure patients, haemodynamic activity is observed over a 24 h period with once daily dosing. Over 6 million patients have been treated for hypertension with continued excellent tolerability. Clinical experience in heart failure is growing, and recent data suggest an improved survival with losartan versus captopril, a drug from the angiotensin-converting-enzyme inhibitor class with proven benefit in this population. The current comprehensive losartan clinical end-point programme (4 large scale morbidity/mortality trials) should provide evidence regarding the efficacy of direct blockade of the AT1 receptor with losartan compared to standard therapy: 1) The Losartan Heart Failure Survival Study - ELITE II, 2) The Losartan Post-Myocardial Infarction Survival Study - OPTIMAAL, 3) The Losartan Hypertension Survival Study - LIFE and 4) The Losartan Renal Protection Study - RENAAL.

The theory of weight distributions of irreducible cyclic codes over a finite field has been extensively developed by R. J. McEliece and others. We apply that theory to compute the weight enumerators of some binary codes which have hitherto not been possible. In so doing, we correct an error by McEliece and describe his process in somewhat more detail.

Art form experiences that utilize music, dance, and art are suggested alternatives for participants in family therapy who cannot express themselves verbally but communicate nonverbally. Collaborative efforts with art form therapists will enhance the treatment skills and facilitate the achievement of desired goals.

Advances in interactive communication will dramatically alter the structure of distribution. Will end users direct access to online product and purchasing data eliminate the need for many specialty resellers Will large distributors become more like public warehouses What is the longterm potential of “electronic commerce”

Microbubble contrast visualization within the right heart is almost always due to intravenous injections containing microbubbles. In the absence of immediate administration of agitated solutions, several other mechanisms for the occurrence of echo contrast spontaneously in the cardiovascular system have been postulated. Often overlooked as a source of contrast are microbubbles from remotely injected solutions that persist in the circulation because of markedly delayed clearance. Two patients were observed with apparently spontaneous contrast detected in the right heart chambers, both of whom had congestive heart failure, tricuspid regurgitation, and pulmonary hypertension. Regardless of the exact mechanism involved, the finding of this phenomenon reflects the presence of right heart failure and a low flow state.

The Story of Gotama Buddha (Jatakanidana) translated by N. A. Jayawickrama, Oxford, Pali Text Society, 1990, xvi, 141 pp. ISBN 0 860 293 5, £4.95.Dan Cohn-Sherbok, Issues in Contemporary Judaism. London, Macmillan Academic & Professional, 1991. ISBN 0 333 535 37.Raymond L. Weiss, Maimonides' Ethics— The Encounter of Philosophic and Religious Morality. Chicago, University of Chicago Press, 1991. ISBN 0 226 8915 26.Peter Harrison, 'Religion' and the Religions in the English Enlightenment. Cambridge, Cambridge University Press, 1990, 277 pp. ISBN 0 521 38530 X, £35 (U.K.).Michael Dames, Mythic Ireland. London, Thames and Hudson, 1992, 272 pp. ISBN 0 500 01530 9, £14.95 (hardback).Stephen and Robin Larsen. A Fire in the Mind: The Life of Joseph Campbell. New York, Doubleday, 1991, 636 pp. ISBN 0 385 26635 9. $30.00 U.S.

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Among six patients who were proved at operation to have carcinoma of the thyroid three were found in whom the preoperative roentgenographic findings would have sufficed to give the diagnosis. In each of these three cases psammoma bodies were found in sections of the carcinoma. One out of four patients with local recurrences of thyroid carcinoma also showed characteristic malignant calcifications. In a total of 45 patients studied by soft-tissue radiography there were no false-positive diagnoses. In the differential diagnosis by roentgenography it is borne in mind that malignant calcifications are not dense but are poorly marginated, approximately uniform in size, grouped in streaks or in nebular formation, and without a calcific rim.

Hyperthyroidism was treated with I131 in 1,603 cases. These included cases of diffuse toxic goiter and nodular goiter with hyperthyroidism. There were 187 patients with congestive heart failure, 30 with angina pectoris, and 32 with combined angina pectoris and congestive failure. In addition, there were 107 patients with atrial fibrillation but without congestive failure or angina. Radioiodine was the only treatment used for the hyperthyroid state. The cardiac status was strikingly improved in all groups studied. The number of treatments and incidence of myxedema was almost the same for the cardiac and noncardiac patients. The total administered dose averaged 7.0 millicuries for the entire series and 11.5 for the cardiac patients. The recurrence rate was less than 1%. The authors believe that I131 is the treatment choice for thyrocardiac disease.