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51.
David R. Holmes Jr. MD Gordon K. Danielson MD Bernard J. Gersh MB ChB DPhil Michael J. Osborn MD Douglas L. Wood ND Christopher Mclaran MD Declan D. Sugrue MD MRCP Co-Burn J. Porter MD Stephen C. Hammill MD 《The American journal of cardiology》1985,55(13):1509-1512
Twenty-seven patients aged 21 years or younger (mean 15) with symptomatic tachycardia underwent operation for ablation of an accessory atrioventricular pathway. Six patients had associated Ebstein's malformation of the tricuspid valve. Supraventricular tachycardia had been present for a mean of 5 years. At electrophysiologic study, 4 patients were found to have 2 accessory pathways. Left ventricular free wall pathways were found In 14 patients, right ventricular free wall pathways in 10 and septal pathways in 6. Successful initial ablation of all the pathways was achieved in 26 of the 27 patients. No patient died perioperatively and none had persistent complete heart block. During a mean follow-up of 11 months, no patient had recurrence of an arrhythmia related to the accessory pathway. Thus, the surgical treatment of children and young adults with accessory atrioventricular pathways and symptomatic supraventricular tachycardia is safe and effective. For these patients, unless the tachycardia can be easily controlled with a minimal number of drugs and adverse effects, surgical ablation should be considered early in the clinical course. 相似文献
52.
A patient with a history of "leukemia" for 19 yr and documented hairy cell (HC) leukemia for 10 yr developed mycosis fungoides and the Sezary syndrome. The manifestations of both diseases were diagnostic on clinical and pathologic grounds. Ultrastructural, immunohistochemical, and surface marker techniques proved the HC to have phenotypic characteristics of the T-helper subset of lymphocytes to which the Sezary cells (SC) also belonged. Both types of cells contained tartrate- resistant acid phosphatase. HC did not infiltrate the skin. SC did not contain ribosome lamellar complexes. Because of otherwise overlapping morphology and the apparent replacement of HC by SC, it is likely that the Sezary cells constituted a genetic variant of the original neoplastic clone represented by the hairy cells. Since the biologic and therapeutic implications of such clonal evolution may be important, subtle phenotypic changes should be looked for repeatedly in patients with these diseases. 相似文献
53.
Expression of the cutaneous lymphocyte antigen and its counter-receptor E-selectin in the skin and joints of patients with psoriatic arthritis 总被引:2,自引:0,他引:2
We have investigated whether the skin-homing T lymphocytes identified by
the cutaneous lymphocyte antigen (CLA) are increased in the synovial
membrane of patients with psoriatic arthritis. Twenty-six synovial samples
(13 psoriatic arthritis, seven rheumatoid arthritis, six osteoarthritis)
were obtained from involved knees. Lesional skin biopsies were taken from
nine of the patients with psoriatic arthritis and six patients with
psoriasis alone. All samples were single- and dual-stained for CLA and CD3
(to identify T lymphocytes) using HECA-452 (anti-CLA) and anti-CD3
monoclonal antibodies. E-selectin expression was also determined. The
percentage of dual-stained lymphocytes was significantly greater in
psoriatic skin than in synovium (P < 0.001) and similar between
psoriatic and rheumatoid synovium. There was no significant difference in
the percentages of CLA-positive cells in psoriatic skin in patients with
psoriatic arthritis compared with psoriasis alone. The intensity of
endothelial E-selectin expression was significantly greater in skin
psoriasis than in synovium (P < 2 x 10(- 5)), and rheumatoid synovium
had significantly greater expression than psoriatic synovium (P < 0.05).
However, there was no significant correlation between E-selectin expression
and the percentages of CLA- positive lymphocytes. This study provides
further evidence that the CLA antigen is enriched on skin-homing
lymphocytes. Conversely, the link between skin and joint inflammation in
psoriatic arthritis does not seem to be explained by increased trafficking
of CLA T cells to psoriatic synovium.
相似文献
54.
Rhonda Nay BA MLitt PhD RN Michael Bauer BA DipEd MGeront PhD RN ND Wendy Moyle DipAppSci BN MHSc PhD RN Linda McAuliffe BBSc MPsych MAPS 《Health & social care in the community》2015,23(5):550-558
This paper reports on a study exploring the experiences and meaning of social participation for family carers of people living with dementia. Participants were 33 family carers (17 spouses and 16 adult children) of older adults diagnosed with dementia (any stage or type) who responded to advertisements by the national Alzheimer's association, Alzheimer's Australia. Data were collected through semi‐structured face‐to‐face and/or telephone interviews using an interview guide, which included prompts such as ‘Tell me about what social participation means to you’, and ‘How did this change…’. The methods of grounded theory were drawn upon to guide sampling and analysis of data, which continued until theoretical saturation was achieved and occurred over the period September 2011 to March 2012. Data arising from the interviews were analysed line‐by‐line and coded and categorised using the constant comparative method, with codes clustered into themes and with abstraction from the themes to arrive at the core process. The core category arising from the data was adaptation, which encompassed four main themes: autonomy to choose; the impact of care‐giving; employing strategies; and establishing meaningful connections. Carers went through a process whereby the ways in which they had previously participated socially were compromised, which often prompted an exploration of new ways in which to remain socially engaged. 相似文献
55.
Vinette Cross PhD MMedEd FCSP DipTP CertEd C. M. Janine Leach BSc PhD ND DO Carol A. Fawkes MSc PGCert DO MBAcC Ann P. Moore PhD FCSP FMACP DipTP Cert Ed 《Health expectations》2015,18(5):1114-1126
Background
Research has shown that patients'' expectations of health care and health‐care practitioners are complex and may have a significant impact on outcomes of care. Little is known about the expectations of osteopathic patients.Objectives
To explore osteopathic patients'' expectations of private sector care.Design
Focus groups and individual interviews with purposively selected patients; this was the qualitative phase of a mixed methods study, the final phase being a patient survey.Setting and participants
A total of 34 adult patients currently attending for treatment at private osteopathic practices across the United Kingdom.Intervention
Focus group discussions and individual interviews around expectations before, during and after osteopathic care.Outcome measures
Thematic analysis of text data to identify topics raised by patients and to group these into broad themes.Results
Many components of expectation were identified. A preliminary conceptual framework describing the way the therapeutic encounter is approached in osteopathy comprised five themes: individual agency, professional expertise, customer experience, therapeutic process and interpersonal relationship.Discussion and Conclusion
The components of expectation identified in this phase of the study provided potential question topics for the survey questionnaire in the subsequent phase of the investigation. The model developed in this study may add a new perspective to existing evidence on expectations. Further research is recommended to test the findings both within private practice and the National Health Service. 相似文献56.
WJ Wilkinson HC Gadeberg AWJ Harrison ND Allen D Riccardi PJ Kemp 《British journal of pharmacology》2009,158(3):862-871
Background and purpose:
Carbon monoxide (CO) is a potent modulator of a wide variety of physiological processes, including sensory signal transduction. Many afferent sensory pathways are dependent upon purinergic neurotransmission, but direct modulation of the P2X purinoceptors by this important, endogenously produced gas has never been investigated.Experimental approach:
Whole-cell patch-clamp experiments were used to measure ATP-elicited currents in human embryonic kidney 293 cells heterologously expressing P2X2, P2X3, P2X2/3 and P2X4 receptors and in rat pheochromocytoma (PC12) cells known to express native P2X2 receptors. Modulation was investigated using solutions containing CO gas and the CO donor molecule, tricarbonyldichlororuthenium (II) dimer (CORM-2).Key results:
CO was a potent and selective modulator of native P2X2 receptors, and these effects were mimicked by a CO donor (CORM-2). Neither pre-incubation with 8-bromoguanosine-3′,5′-cyclomonophosphate nor 1H-[1,2,4]Oxadiazolo[4,3-a]quinoxalin-1-one (a potent blocker of soluble guanylyl cyclase) affected the ability of the CO donor to enhance the ATP-evoked P2X2 currents. The CO donor caused a small, but significant inhibition of currents evoked by P2X2/3 and P2X4 receptors, but was without effect on P2X3 receptors.Conclusions and implications:
These data provided an explanation for how CO might regulate sensory neuronal traffic in physiological reflexes such as systemic oxygen sensing but also showed that CO could be used as a selective pharmacological tool to assess the involvement of homomeric P2X2 receptors in physiological systems. 相似文献57.
ND Appleton D Bosanquet G Morris-Stiff H Ahmed P Sanjay MH Lewis 《Annals of the Royal College of Surgeons of England》2010,92(6):499-502
INTRODUCTION
Extra-anatomical bypass grafting is a recognised method of lower limb re-vascularisation in high-risk patients who cannot tolerate aortic cross clamping, or in those with a hostile abdomen. We present a single surgeon series of such procedures and determine relevant outcomes.PATIENTS AND METHODS
A retrospective review was performed on a prospectively maintained database of patients undergoing femoro-femoral or axillo-femoral bypass surgery between 1986 and 2004.RESULTS
Patency rates for femoral (n = 28; 32%) versus axillary (n = 59; 68%) bypass procedures at 1 month, 1, 3 and 5 years were (92% vs 93%), (69% vs 85%), (60% vs 72%) and (55% vs 67%), respectively. Patient survival rates for the corresponding procedures and time intervals were (96% vs 90%), (96% vs 67%), (85% vs 45%) and (73% vs 38%) and revealed a significantly lower survival rate in those undergoing axillary procedures (P = 0.002). Limb salvage rates were calculated at (100% vs 91%), (96% vs 84%), (96% vs 81%) and (92% vs 81%) with no statistically significant difference found between the two groups (P = 0.124). Two-thirds of the patients who required major amputation died within 12 months of surgery.CONCLUSIONS
Acceptable 30-day morbidity, long-term primary patency and survival rates are obtainable in patients suitable for extra-anatomical bypass surgery despite having significant co-morbidities. We have shown 5-year patency rates in those that survive axillary procedures to be as good as those undergoing femoral procedures. Furthermore, surviving patients who evade amputation within a year have an excellent chance of long-term limb salvage. 相似文献58.
H Nageswaran A Belgaumkar R Kumar A Riga N Menezes T Worthington ND Karanjia 《Annals of the Royal College of Surgeons of England》2015,97(5):349-353
IntroductionAfferent loop syndrome (ALS) is a recognised complication of foregut surgery caused by mechanical obstruction at the gastrojejunostomy anastomosis itself or at a point nearby. Acute ALS has only been reported following pancreaticoduodenectomy (PD) after several years due to recurrence of malignancy at the anastomotic site. We report five cases of acute ALS in the first postoperative week.MethodsThe presentation, clinical findings and successful management of the 5 patients with ALS were obtained from a prospectively collected database of 300 PDs. All five patients with early acute ALS presented with signs and symptoms of a bile leak. Since the fifth patient, the surgical technique has been modified with the creation of a larger window in the transverse mesocolon and a Braun enteroenterostomy.ResultsThere have been no further incidents of ALS since the adoption of these modifications to the standard technique of PD and there has also been a reduction in postoperative bile leaks (6.4% vs 3.6%, p=0.416).ConclusionsAcute ALS is a rare but important complication in the immediate postoperative period following PD and causes disruption to adjacent anastomoses, resulting in a bile leak. A prophylactic Braun anastomosis and wide mesocolic window may prevent this complication and subsequent deterioration. 相似文献
59.
60.
HV Melendez M Rela AJ Baker C Ball B Portmann G Mieli-Vergani ND Heaton 《Archives of disease in childhood》1997,77(3):249-251
Giant cell hepatitis (CGH) with autoimmune haemolytic anaemia (AHA) is a distinct entity with an aggressive course. Immunosuppression may help early disease. A case is reported of a child with GCH and AHA with early disease recurrence after liver transplantation for end stage liver disease. 相似文献