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Proteinuria in atherosclerotic renovascular disease 总被引:7,自引:0,他引:7
Makanjuola AD Suresh M Laboi P Kalra PA Scoble JE 《QJM : monthly journal of the Association of Physicians》1999,92(9):515-518
Proteinuria is well described in atherosclerotic renovascular disease (ARVD), but the prevalence is unknown, and the pathogenesis may vary between patients. Substantial proteinuria (> 2 g/day) however, would be regarded by many as atypical of ARVD. We studied 94 patients (52 male) with ARVD, median age 67 years (range 49-87). Digital subtraction angiography was performed on all patients. Protein was assayed in 24-h urine samples and GFR derived using the Cockroft-Gault formula. Forty-nine patients (52%) had proteinuria < 0.5 g/24 h. Proteinuria increased with worsening renal function. Biopsies from seven non-diabetic patients with substantial proteinuria showed: minimal changes (1); glomerular sclerosis with marked ischaemic changes (3); focal glomerulosclerosis (2); and athero-emboli (1). Proteinuria, rather than being indicative of other pathology, is often a marker of severity of parenchymal disorder in atherosclerotic nephropathy, which itself is the major determinant of renal dysfunction in patients with ARVD. 相似文献
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Atherosclerotic renovascular disease (ARVD) is a disease of ageing. It is usually a manifestation of widespread vascular disease and although it may be symptomless, many patients with ARVD present with the effects of extra-renal vascular disease, such as peripheral vascular (PVD), coronary heart (CHD) and cerebrovascular disease. ARVD is a common cause of hypertension and chronic renal failure (CRF), and it is one of the most common renal diagnoses in elderly patients accepted on to dialysis programmes with end-stage renal failure (ESRF). The cause of renal impairment in these patients is still a matter of debate. Patients with ARVD have a high mortality, especially those with renal failure. In this review we examine the relationships between ARVD and co-morbid extra-renal vascular disease, and the impact of these associated vascular pathologies upon renal functional and mortality outcomes is considered. The latest evidence concerning the likely pathogenesis of renal dysfunction in patients with ARVD is also reviewed. 相似文献
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Atherosclerotic renovascular disease (ARVD) is a common condition in both elderly patients and those with other vascular disease. No published randomized controlled trial has demonstrated an overall benefit of revascularization on any clinical or biochemical end-point, and optimal medical therapy in this condition is not clearly defined. In this review we consider the epidemiology of ARVD and discuss the evidence for current medical treatment. We also address the literature on revascularization, consider settings in which an interventional approach may still be considered, and touch upon on-going areas of research. 相似文献
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A review of adults with septic arthritis was undertaken to evaluate outcome of treatment and intensive care requirements in a community-based teaching hospital. During an 80-month period (1986-1992), 38 cases of septic arthritis were identified. Underlying joint disease was present in 84% of patients. Mean age was 68 years, with a range of 26 to 100 years and a median of 70 years. Patients did not always initially display signs of infection; fever was present in only 42%, and leukocytosis was present in 67%. Total in-hospital mortality was 26%, but the mortality attributed to septic arthritis was 13%. Polyarticular septic arthritis occurred in 26% of patients and carried a 40% mortality. Twenty-four percent of patients required transfer to the intensive care unit (ICU); they had a 67% mortality. Three of four patients with polyarticular septic arthritis requiring intensive care died. Average length of hospital stay for survivors receiving a full course of antibiotics was 35 days; it diminished to 14 days for 5 uncomplicated cases who received home IV antibiotics. Eighty-nine percent of survivors had return of function of the affected joints. Thirty-two percent required surgical intervention, and 5% were complicated by osteomyelitis. Septic arthritis remains a costly disease affecting primarily the elderly with underlying joint disease. Polyarticular septic arthritis and the need for ICU care portend a high mortality. The functional outcome of those who recovered was generally good. 相似文献
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Kevin John Amos Lal Nitish Sharma Amr ElMeligy Ajay K Mishra 《World Journal of Critical Care Medicine》2022,11(3):129-138
Among the cardiac complications of coronavirus disease 2019 (COVID-19), one increasingly reported in the literature is myocardial infarction with non-obstructive coronaries (MINOCA). We reviewed all reported cases of MINOCA in COVID-19 patients to summarize its clinical features, evaluation, and treatment. We performed a literature search in Pubmed using the search terms ‘COVID-19’ and ‘MINOCA’ or ‘non-obstructive coronaries’. Among the reported cases, the mean age was 61.5 years (SD ± 13.4), and 50% were men. Chest pain was the presenting symptom in five patients (62.5%), and hypertension was the most common comorbidity (62.5%). ST-elevation was seen in most patients (87.5%), and the overall mortality rate was 37.5%. MINOCA in COVID-19 is an entity with a broad differential diagnosis. Therefore, a uniform algorithm is needed in its evaluation to ensure timely diagnosis and management. 相似文献
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OBJECTIVE: Hyperemia is a known phenomenon after aneurysmal subarachnoid hemorrhage, but only a few reports describe and analyze hyperemia in these patients. This could be the result of diagnostic difficulties in order to identify elevated cerebral blood flow; thus, it seems that hyperemia could be an underdiagnosed clinical state. The aim of the study was to evaluate this phenomenon in comparison with clinical outcome and imaging data in order to describe the frequency of hyperemia after subarachnoid hemorrhage and maybe improve clinical diagnosis. DESIGN: Retrospective analysis of our cerebral blood flow and transcranial Doppler sonography data bank. SETTING:. Neurosurgical/Anesthesiological intensive care unit University of Regensburg, Regensburg, Germany. PATIENTS AND PARTICIPANTS: A total of 37 patients were included (24 women and 13 men). All patients suffered from aneurysmal subarachnoid hemorrhage. MEASUREMENTS AND RESULTS: Standard transcranial Doppler ultrasonography, as well as the Xenon(133) clearance technique for cerebral blood flow measurements, was employed. We observed 37 increases of flow velocities in 37 patients according to Doppler ultrasonography. In order to distinguish between ischemia and hyperemia a Xenon(133) regional cerebral blood flow examination was performed. Global hyperemia was detected in 5 patients (14%). Hyperemia correlated only to favorable outcome ( p=0.01) and fewer ischemic lesions in the computed tomography ( p<0.05). CONCLUSION: The results indicate that while global hyperemia is a frequent phenomenon that cannot be detected by standard Doppler ultrasonography or clinical examination, hyperemic cerebral blood flow values following aneurysmatic subarachnoid hemorrhage are correlated to favorable outcome. 相似文献
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Lawton S Littlewood S 《Nursing standard (Royal College of Nursing (Great Britain) : 1987)》2006,20(42):57-63; quiz 64
This article outlines the issues involved in assessing and managing patients who present with a vulval skin condition. It describes the anatomy of the vulval area, many of the skin conditions that nurses may encounter in their practice and potential treatment options for these conditions. The importance of accurate history-taking is emphasised and described, and appropriate referral to a specialist is also discussed. 相似文献
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J F Martin 《Postgraduate medicine》1966,40(3):289-301
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A E Raine 《The Quarterly journal of medicine》1990,77(282):997-999
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目的探讨Kimura’s病的临床特点及高频超声对该病的诊断价值。方法回顾性分析6例经穿刺活检或术后病理证实的Kimura’s病患者的临床资料和高频超声声像图特点,并结合文献进行讨论。结果 6例Kimura’s病患者病程较长(平均11年),血常规嗜酸性粒细胞均明显增多;5例为颈部无痛性肿块,1例为右侧大腿及右侧上臂皮下无痛性肿块。高频超声表现:①位于颈部的病灶呈边界清晰、包膜完整的单发椭圆形低回声肿块,亦可为多个肿块融合的混合回声团块,位于四肢皮下的病灶呈夹杂高回声及不规则片状低回声的混合回声肿块;②病灶附近均可见肿大淋巴结,淋巴门结构清晰或欠清晰,多无融合、囊性变、钙化等表现。结论 Kimura’s病的超声表现有一定特点,结合临床表现及实验室检查有助于定性诊断。 相似文献
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目的:探讨甲状腺淋巴瘤及其不同病理类型的超声特征。方法:回顾性分析2014年1月至2019年11月上海交通大学医学院附属瑞金医院病理证实为甲状腺淋巴瘤的患者30例。对其临床表现、声像图特征进行分析。并进一步比较不同病理类型的淋巴瘤超声图像特征之间的差异。结果:纳入分析的30例患者中,病理诊断为弥漫大B细胞淋巴瘤17例(56.7%),黏膜相关淋巴组织淋巴瘤8例(26.7%),滤泡性淋巴瘤3例(10.0%),灰区淋巴瘤1例(3.3%),淋巴母细胞淋巴瘤1例(3.3%)。临床表现有短期内颈部肿大(60.0%),伴有压迫症状(46.7%),Ⅲ/Ⅳ区颈部淋巴结肿大(63.3%),甲状腺功能异常(10.0%),合并桥本甲状腺炎(63.3%)。弥漫大B细胞淋巴瘤与黏膜相关淋巴组织淋巴瘤之间在病灶的纵径(P=0.036)、回声特征(P=0.036)以及病灶边缘(P=0.005)上的差异有统计学意义。不同侵袭性之间在回声特征(P=0.005)以及病灶边缘(P=0.020)上的差异有统计学意义。结论:发现桥本甲状腺炎患者短期内增大明显的甲状腺内极低回声肿块,且伴有颈部Ⅲ/Ⅳ区淋巴结肿大时,应怀疑甲状腺淋巴瘤发病。边缘不规则的极低回声病灶伴片状高回声是弥漫大B细胞淋巴瘤的特征性表现,边缘规则的极低回声病灶伴网格状回声是黏膜相关组织淋巴瘤的特征性表现。 相似文献