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71.
Improved Pain Relief With Burst Spinal Cord Stimulation for Two Weeks in Patients Using Tonic Stimulation: Results From a Small Clinical Study 下载免费PDF全文
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Francesca F. Norman MBBS MRCP BMedSci Pilar Martín-Dávila MD PhD Jesús Fortún MD PhD Fernando Dronda MD PhD Carmen Quereda MD PhD Aurora Sánchez-Sousa MD PhD Rogelio López-Vélez MD PhD DTM&H 《Journal of travel medicine》2009,16(4):258-262
Background. Histoplasmosis is acquiring importance in nonendemic areas due to the increase in travel and immigration, being the most common systemic mycosis acquired by European travelers. Epidemiological studies show that the incidence of Histoplasma infection in these patients may be higher than previously believed and a wide clinical spectrum of disease may be observed.
Methods. Cases of histoplasmosis diagnosed at a Tropical Medicine Referral Unit in Madrid, Spain, during the period January 1996 to December 2006 were reviewed.
Results. Ten cases of histoplasmosis in travelers and immigrants are described. Five HIV-positive patients (four immigrants and one expatriate) all presented with progressive disseminated disease. Five HIV-negative patients (travelers) all presented with pulmonary disease: four with an acute pulmonary form (one with pleural involvement) and one patient was found to have residual pulmonary disease (lung nodule). Three of the travelers also had rheumatologic manifestations (arthromyalgias or arthritis).
Conclusions. Clinicians in nonendemic areas may be faced with patients with a diagnosis of histoplasmosis and although Histoplasma infection can have a varied and nonspecific clinical presentation, imported histoplasmosis may have two distinct profiles. Previously, healthy travelers may be exposed in endemic areas and mainly develop acute forms of the disease with a favorable outcome. Immigrants or expatriates from endemic areas who may be immunosuppressed due to HIV infection may experience reactivation of latent disease developing disseminated forms with high mortality rates. This infection should be considered in the differential diagnosis of diseases affecting travelers and immigrants. 相似文献
Methods. Cases of histoplasmosis diagnosed at a Tropical Medicine Referral Unit in Madrid, Spain, during the period January 1996 to December 2006 were reviewed.
Results. Ten cases of histoplasmosis in travelers and immigrants are described. Five HIV-positive patients (four immigrants and one expatriate) all presented with progressive disseminated disease. Five HIV-negative patients (travelers) all presented with pulmonary disease: four with an acute pulmonary form (one with pleural involvement) and one patient was found to have residual pulmonary disease (lung nodule). Three of the travelers also had rheumatologic manifestations (arthromyalgias or arthritis).
Conclusions. Clinicians in nonendemic areas may be faced with patients with a diagnosis of histoplasmosis and although Histoplasma infection can have a varied and nonspecific clinical presentation, imported histoplasmosis may have two distinct profiles. Previously, healthy travelers may be exposed in endemic areas and mainly develop acute forms of the disease with a favorable outcome. Immigrants or expatriates from endemic areas who may be immunosuppressed due to HIV infection may experience reactivation of latent disease developing disseminated forms with high mortality rates. This infection should be considered in the differential diagnosis of diseases affecting travelers and immigrants. 相似文献
74.
Fiona Hicks BMedSci MRCP Damian Murphy MRCOG David Dodwell MD MRCP 《The Australian & New Zealand journal of obstetrics & gynaecology》1994,34(2):174-177
Summary: There is a body of conflicting evidence regarding the place of dose intense chemotherapy for advanced ovarian cancer. It remains unproven whether dose intensity is more important than total dose delivered, and measures of drug delivery to the tumour itself are absent or crude. There are various methods under evaluation for reducing the toxicity of chemotherapeutic drugs, thus enabling larger doses to be given. However, we must not lose sight of the fact that current treatment is palliative for the majority of women, making the quality of life an important issue. The place of dose intense cytotoxic chemotherapy, for the treatment of advanced ovarian cancer, must be evaluated in large, carefully designed, prospective trials which, if possible, should include a quality of life assessment. 相似文献
75.
R. D. KIMBER BMedSci V. J. HYLAND BA PhD E. A. HAAN BMedSc MB BS FRACP J. C. MULLEY BSc MSc PhD 《Journal of paediatrics and child health》1989,25(5):292-295
Abstract Forty-three unrelated South Australian boys diagnosed as having either Duchenne or Becker muscular dystrophy were screened for deletions using DNA probes to the dystrophin gene. For the 35 boys with Duchenne muscular dystrophy, the deletion frequency was 43% using a simplified probing strategy based on the probes Cf56a, Cf56b, pERT87-15 and XJ (XJ1.1 or XJ2.3). The corresponding deletion frequency for the eight boys with Becker muscular dystrophy was 38%. Members of families in which these disorders result from a deletion can now choose to prevent the birth of further affected boys, using an accurate prenatal test for the specific mutation occurring within the family. Deletion analysis also has the potential to clarify the carrier status of women in these families. 相似文献
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77.
Edward D. Nicol BMedSci BM BS MRCP James Stirrup MBBS BSc MRCP Eliana Reyes MD Michael Roughton MSc Simon P. G. Padley MBBS FRCP FRCR Michael B. Rubens MBBS FRCR S. Richard Underwood MD FRCP FRCR 《Journal of nuclear cardiology》2008,15(3):311-318
Background. Multislice computed tomography coronary angiography (CTA) was proposed as a method for investigating possible coronary artery
disease (CAD) in patients who present with chest pain but with a low to intermediate likelihood of CAD. Sixty-four-channel
CTA was compared prospectively with 99mTc-tetrofosmin myocardial perfusion scintigraphy (MPS) (as the gold standard in the detection of flow-limiting stenoses) for
the detection of functionally significant CAD.
Methods and Results. Fifty-two consecutive symptomatic patients with a low to intermediate likelihood of coronary artery disease, and who were
referred for MPS, also underwent CTA. The CTA datasets were analyzed by two experienced observers who were blinded to the
MPS data, and coronary artery segments were reported as <50%, 50% to 69%, 70% to 99% stenoses, or occluded. The MPS images
were similarly analyzed for inducible perfusion abnormalities, and coronary territories were identified. At the patient level,
agreement between CTA and MPS for CTA lesions at ≥50% was 87% (sensitivity, 100%; specificity, 84%; positive predictive value,
50%; negative predictive value, 100%). For CTA lesions, agreement at ≥70% was 96% (sensitivity, 86%; specificity, 98%; positive
predictive value, 86%; negative predictive value, 98%).
Conclusions. In patients with a low to intermediate likelihood of CAD, there is good correlation between MPS and CTA for the detection
of functionally significant coronary artery stenoses when CTA detects a narrowing of ≥70% severity. Computed tomography coronary
angiography stenoses of 70% should be used to determine functional significance, and not 50%, as is the usual practice at
present.
This work was funded by an unrestricted research grant from the United Kingdom Defence Postgraduate Medical Deanery. We also
thank the Royal Air Force Medical Branch for financial support. 相似文献
78.
Instability in patient and nurse characteristics,unit complexity and patient and system outcomes 下载免费PDF全文
79.