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排序方式: 共有700条查询结果,搜索用时 140 毫秒
1.
A F Shorr J L Wainright C S Cors C J Lettieri S D Nathan 《The European respiratory journal》2007,30(4):715-721
Pulmonary hypertension (PH) may complicate idiopathic pulmonary fibrosis (IPF) but the prevalence of PH in IPF remains undefined. The present authors sought to describe the prevalence of PH in IPF. The lung transplant registry for the USA (January 1995 to June 2004) was analysed and IPF patients who had undergone right heart catheterisation (RHC) were identified. PH was defined as a mean pulmonary arterial pressure ((Ppa)) > or =25 mmHg and severe PH as a (Ppa) >40 mmHg. Independent factors associated with PH were determined. Of the 3,457 persons listed, 2,525 (73.0%) had undergone RHC. PH affected 46.1% of subjects; approximately 9% had severe PH. Variables independently associated with mild-to-moderate PH were as follows: need for oxygen, pulmonary capillary wedge pressure (P(pcw)) and forced expiratory volume in one second (FEV(1)). Independent factors related to severe PH included the following: carbon dioxide tension, age, FEV(1), P(pcw), need for oxygen and ethnicity. A sensitivity analysis in subjects with P(pcw) <15 mmHg did not appreciably alter the present findings. Pulmonary hypertension is common in idiopathic pulmonary fibrosis patients awaiting lung transplant, but the elevations in mean pulmonary arterial pressure are moderate. Lung volumes alone do not explain the pulmonary hypertension. Given the prevalence of pulmonary hypertension and its relationship with surrogate markers for quality of life (e.g. activities of daily living), future trials of therapies for this may be warranted. 相似文献
2.
Andrew F Shorr William L Jackson Brendan M Weiss Lisa K Moores 《Blood coagulation & fibrinolysis》2007,18(4):309-316
Multiple options exist for the prevention of deep vein thrombosis (DVT) in medical inpatients. We sought to determine the cost-effectiveness of low-molecular-weight heparin (LMWH) relative to unfractionated heparin (UFH) for DVT prevention in this setting. We conducted a cost-effectiveness analysis from the perspective of a third-party payer employing a decision model and literature-based estimates for inputs. In the base-case analysis, LMWH had little impact on the rate of DVT. Despite higher acquisition costs, however, LMWHs resulted in net savings. Routine use of LMWH saves approximately US$89 per patient. The lower rate of heparin-induced thrombocytopenia (HIT) with LMWH accounted for this differential. Univariate sensitivity analysis revealed the model was moderately sensitive to the odds ratio of HIT with LMWH and the cost of HIT. Multivariate sensitivity analysis confirmed the LMWH approach dominated financially. 'Worst-case' scenario modeling, where LMWH actually increased the risk for DVT, had little effect on the rate of HIT, and was substantially more costly than UFH, still demonstrated that LMWHs were economically superior. Monte-Carlo simulation indicated the 95% confidence interval around the estimate for savings with LMWH ranged from US$7 to US$373. We conclude that, despite their higher cost, LMWHs for thromboprophylaxis in medical patients result in savings. 相似文献
3.
4.
A retrospective analysis of 515 cases of blunt chest trauma is presented. The overall thoracic morbidity rate was 36% and mortality rate was 15.5%. Atelectasis was the most common complication. Severe chest trauma can be present in the absence of rib or other thoracic bony fractures. Emergency thoracotomies for resuscitation of the patient with blunt chest trauma with absent vital signs proved unsuccessful in 39 of 39 patients. A high index of suspicion for blunt chest injury occurring in blunt trauma, coupled with an aggressive diagnostic and therapeutic approach, remains the cornerstone of treatment to minimize the morbidity and mortality of such injuries. 相似文献
5.
Selective management of abdominal stab wounds. Importance of the physical examination 总被引:3,自引:0,他引:3
R M Shorr M M Gottlieb K Webb L Ishiguro T V Berne 《Archives of surgery (Chicago, Ill. : 1960)》1988,123(9):1141-1145
The treatment of patients with anterior abdominal stab wounds remains controversial. We reserve celiotomy for patients who have clinical findings of peritonitis or hemorrhage. Repeated physical examination is the most important element of observation. Recently, 330 patients with stable abdominal stab wounds presented over a 12-month period. These patients were followed up with serial physical examinations and laboratory measurements. Of the 330 patients, 107 patients (32%) required celiotomy for the repair of a life-threatening injury (group 1); 28 patients (8%) underwent nontherapeutic celiotomies (group 2); 19 patients (6%) had negative explorations (group 3); and 176 patients (53%) were observed and discharged (group 4). There were three missed injuries in group 4. Serial physical examination can be a reliable technique in the management of abdominal stab wounds and is comparable to other approaches. 相似文献
6.
Brandon JC; Teplick SK; Haskin PH; Sammon JK; Muhr WF; Hofmann AF; Gambescia RA; Zitomer N 《Radiology》1988,166(3):665-667
The authors describe their experience with methyl tertiary butyl ether (MTBE) in a larger series of patients than previously reported in order to acquaint physicians with both its effectiveness for dissolution of common bile duct calculi and the limitations of its use. Ten patients with 13 biliary calculi underwent percutaneous stone dissolution treatment with the experimental cholesterol solvent, MTBE. Three stones completely dissolved within 30 minutes, seven were reduced in size, and three were visibly unaffected. All stones not completely dissolved were easily extracted by means of a stone basket except for one in a patient taken to surgery. Although MTBE perfusion is an effective technique for management of biliary calculi, practitioners should be aware that its use is quite time consuming and its odor difficult to control. 相似文献
7.
Darai E; Leblanc M; Walker-Combrouze F; Bringuier AF; Madelenat P; Scoazec JY 《Human reproduction (Oxford, England)》1998,13(5):1346-1352
We evaluated the immunohistochemical expression of cadherins and CD44
variants in 20 endometriomas, 20 cystadenomas, 20 borderline ovarian
tumours as well as 20 ovarian carcinomas, and the serological and cystic
fluid concentrations of soluble E-cadherin and soluble CD44 standard
(sCD44sdt) in 20 endometriomas, 20 cystadenomas, six borderline and 11
carcinomas of the ovary. In endometriomas, immunostaining of E- and
N-cadherin was negative (20 and 30% respectively). CD44 H, v3 and v6
immunostaining were detected in 63, 10 and 40% respectively. A difference
in immunostaining for E-cadherin was found between endometriomas and
cystadenomas (P < 0.001) and for N- cadherin between endometriomas and
carcinomas (P < 0.001). A difference in CD44H immunostaining was
observed between endometriomas and cystadenomas (P < 0.035) but not with
borderline ovarian tumours and carcinomas. No difference in serum
concentrations of soluble E- cadherins and CD44 standard was found between
the four groups of tumours. Cystic fluid concentrations of E-cadherin were
lower in endometriomas than in borderline tumours and ovarian carcinomas (P
< 0.001). High concentrations of soluble CD44 standard cystic fluid were
found in endometriomas than in other ovarian cysts. Endometriomas and
borderline tumours share alterations of cadherins and CD44 isoforms which
may help in the understanding of the aggressive and invasive potentials of
endometriotic cells.
相似文献
8.
Genital asymmetry in men 总被引:1,自引:0,他引:1
This study examined genital asymmetry in a large sample of men. The
probands were 6544 non-delinquent men who were interviewed by the Kinsey
Institute for Research in Sex, Gender and Reproduction from 1938 to 1963.
The measures were four indicators of penile and scrotal asymmetry, along
with self-reported handedness, from Kinsey's interview protocol. Most men
reported some degree of lateral asymmetry in their flaccid penis and in
their testicles; less asymmetry was reported for their erect penis. The
asymmetry typically occurred in the left direction, and this pattern
occurred in both right- and nonright- handers. However, this 'leftward'
pattern was significantly less pronounced in nonright-handers. The results
are discussed in relation to previous findings of genital asymmetry in men,
the possible relationship of genital asymmetry to functional cerebral
asymmetry, and recent data suggesting genital asymmetry may predict
patterns of cognitive performance and genital/sexual organ cancers.
相似文献
9.
Immune deficiencies in chronic intestinal pseudo-obstruction 总被引:1,自引:0,他引:1
ML Forchielli MC Young AF Flores D. Richardson CW Lo 《Acta paediatrica (Oslo, Norway : 1992)》1997,86(10):1077-1081
Aim: Chronic intestinal pseudo-obstruction has been associated with urinary disorders, myopathy, and ophthalmoplegia in adults and cholelithiasis in children. We observed a high percentage of total-parenteral-nutrition-dependent patients with pseudo-obstruction and recurrent infections requiring gammaglobulin infusions. Methods: AH records for 23 children with chronic intestinal pseudo-obstruction (10 females and 13 males, mean age 9.8 y ± 4.9 y, range 4–24 y) referred for a nutritional evaluation from 1992 to 1995 were reviewed. Chronic intestinal pseudo-obstruction was diagnosed by clinical, radiographic findings and antroduodenal manometry. Intestinal full-thickness biopsies were performed in seven children. Results: Hypogammaglobulinemia was diagnosed in 18 patients (78%): 16 patients had various immunoglobulin deficiencies and 2 had selective antibody deficiency. Intravenous gammaglobulin was administered in 14 patients. Other medical conditions affecting the children are summarized as follows: autonomic dysfunction in 10 patients (43%), recurrent hypoglycemia in 9 (39%), asthma in 9 (39%), cholecystitis in 7 (30%), low serum carnitine level in 6 (26%), urinary dysfunction in 6 (26%), pancreatitis in 5 (22%), behavioral problems in 5 (22%), myopathy in 2 (9%), idiopathic thrombocytopenia in 2 (8%), velopharyngeal insufficiency in 1 (4%), oculocutaneous albinism in 1 (4%), Pierre-Robin syndrome in 1 (4%), and protein C deficiency in 1 (4%). Munchausen syndrome was suspected in two patients. Conclusions: Chronic intestinal pseudo-obstruction appears to be associated with immune deficiencies. It is unclear if the immune deficiencies, intestinal pseudo-obstruction, and the other medical conditions have a common underlying etiology. Repeated infections may be due to impaired immune function in children with chronic intestinal pseudo-obstruction. We recommend screening for immune deficiencies in children with chronic intestinal pseudo-obstruction. 相似文献
10.
Complications from improperly placed biliary stents are not uncommon. Free loose wires from the ends of an uncovered stent can irritate and damage adjacent mucosal surfaces. Effective management can be achieved via percutaneous placement of a second stent to alter the orientation of the original stent. 相似文献