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81.
Hepatitis C and cognitive impairment in a cohort of patients with mild liver disease 总被引:12,自引:0,他引:12
Forton DM Thomas HC Murphy CA Allsop JM Foster GR Main J Wesnes KA Taylor-Robinson SD 《Hepatology (Baltimore, Md.)》2002,35(2):433-439
Patients with chronic hepatitis C virus (HCV) infection frequently report fatigue, lassitude, depression, and a perceived inability to function effectively. Several studies have shown that patients exhibit low quality-of-life scores that are independent of disease severity. We therefore considered whether HCV infection has a direct effect on the central nervous system, resulting in cognitive and cerebral metabolite abnormalities. Twenty-seven viremic patients with biopsy-proven mild hepatitis due to HCV and 16 patients with cleared HCV were tested with a computer-based cognitive assessment battery and also completed depression, fatigue, and quality-of-life questionnaires. The HCV-infected patients were impaired on more cognitive tasks than the HCV-cleared group (mean [SD]: HCV-infected, 2.15 [1.56]; HCV-cleared, 1.06 [1.24]; P =.02). A factor analysis showed impairments in power of concentration and speed of working memory, independent of a history of intravenous drug usage (IVDU), depression, fatigue, or symptom severity. A subgroup of 17 HCV-infected patients also underwent cerebral proton magnetic resonance spectroscopy (1H MRS). The choline/creatine ratio was elevated in the basal ganglia and white matter in this group. Patients who were impaired on 2 or more tasks in the battery had a higher mean choline/creatine ratio compared with the unimpaired patients. In conclusion, these preliminary results demonstrate cognitive impairment that is unaccounted for by depression, fatigue, or a history of IVDU in patients with histologically mild HCV infection. The findings on MRS suggest that a biological cause underlies this abnormality. 相似文献
82.
Waterston–Cooley anastomosis may be carried out in patients with tricuspid atresia to provide pulmonary perfusion. It is associated with several complications, including preferential blood flow to the right lung, hypoplasia of the left pulmonary artery, obstruction of the anatomosis or rupture of pulmonary aneurysms. We study a patient with thrombosis in the pulmonary arteries following surgical construction of a Waterston shunt in childhood. Imaging findings and clinical symptoms are discussed with emphasis on echocardiogram‐gated multislice spiral CT. 相似文献
83.
Victoria KM Tay Robert Fitridge Mark LH Tie 《Journal of Medical Imaging and Radiation Oncology》2002,46(2):163-166
Demographic, clinical and laboratory data were retrospectively collected from records of 146 cases of CT fluoroscopy‐guided chemical lumbar sympathectomy for the palliation of inoperable peripheral vascular disease (PVD) between January 1997 and August 1999. Of these, 16% had claudication, 39% had rest pain and 44% had ischaemic ulcers or gangrene. Seventy‐three percent of elective cases were outpatients. At 3 months, 27 cases were lost to follow up, leaving 119 cases. Within 3 months, improvement, defined as doubling of the walking distance, cessation of rest pain or healing of ulcers, occurred in 30.3% of cases. No change was observed in 45.4% of cases and 24.3% of cases deteriorated. Patients with ulcers or gangrene had significantly poorer results than those without any ischaemic lesions, as only 19% versus 39% of patients improved (P < 0.05). The presence of hypertension, diabetes mellitus, hyperlipidaemia and smoking had no value in predicting clinical outcome (P > 0.05). There were no major complications noted. CT fluoroscopy‐guided chemical lumbar sympathectomy is safe and effective, with a complication rate of less than 1%, and efficacy of at least 30% measured within 3 months. It is a simple and minimally invasive procedure, easily performed on an outpatient basis. CT fluoroscopy‐guided chemical lumbar sympathectomy should be considered for all patients in the early stages of inoperable PVD. 相似文献
84.
OBJECTIVE: In a selected low-risk population with spontaneous term labor we sought to determine whether there was a continuous effect of maternal age on uterine function. STUDY DESIGN: With our comprehensive computerized database and medical record system, we identified 8496 patients who were nulliparous and in spontaneous labor at term (> or =37 weeks' gestation) with singleton fetuses in vertex presentation. This group was then analyzed according to maternal age for measures of labor dysfunction and rates of operative delivery. Analysis of variance and chi(2) statistics were used. RESULTS: Use of oxytocin, duration of second stage of labor, cesarean delivery, cesarean delivery for failure to progress, and operative vaginal delivery rates were significantly increased with advancing maternal age (P <.0001). These increases appeared to be continuous functions beginning during the early 20s rather than new phenomena beginning after age 35 years. CONCLUSION: Among nulliparous patients with uncomplicated labor there is a continuously increasing risk of uterine dysfunction related to maternal age. 相似文献
85.
Dietary zinc deficiency in rats induces hyperplasia in the esophagus and
increases N-nitrosomethylbenzylamine (NMBA)-induced esophageal tumor
incidence. Previous work showed a direct relationship between epithelial
cell proliferation and esophageal tumor incidence in rats given multiple
doses of NMBA. We investigated the effects of single low doses of NMBA in
zinc-deficient rats since a single dose of 5.0 mg/kg was reported to be
non-carcinogenic in rats. Zinc-sufficient and deficient rats received a
single i.g. dose of NMBA at 0.5 or 2.0 mg/kg. At week 14, tumor incidence
was 50% with 0.8 +/- 1.0 tumors/rat, and 80% with 2.2 +/- 1.9 tumors/rat,
in deficient groups, D(0.5) and D(2.0), that received the lower and higher
dose, respectively. In addition, two small papillomas were found in one out
of eight untreated zinc-deficient rats. None of the NMBA-treated or
untreated zinc- sufficient rats had any tumors. Esophageal cell
proliferation, as determined by proliferating cell nuclear antigen (PCNA)
immunohistochemistry, showed that, irrespective of NMBA treatment,
deficient esophagi had significant increases in the number of labeled
cells, the total number of cells, and the labeling index, as compared with
zinc-sufficient ones. Mutations in Ha-ras and p53 genes in esophageal
tumors were detected by single strand conformation polymorphism (SSCP)
analysis. DNA sequencing of variant conformers revealed a point mutation
(GGA-->GAA, codon 12) in Ha-ras in 4/5 (80%) and 5/8 (63%) tumors, from
D(0.5) and D(2.0) rats, respectively. Three out of eight tumors from D(2.0)
rats exhibited SSCP mobility shifts within p53 exons 5 and 7: two tumors
(2/8, 25%) had missense mutations and the third, a silent mutation. Of the
two tumors with p53 mutations, one had a double mutation (transition at
codon 164, TCA-->TTA; transversion at codon 241, AGT-->TGT), and the
other tumor, a transition at codon 172 (AGA-->GGA), with amino acid
changes in all cases. In parallel with PCNA expression, elevated p53
expression was associated with hyperplastic and dysplastic regions, as well
as with tumors, in deficient esophagi. In short, these data indicate that
dietary zinc deficiency, with its associated sustained increased cell
proliferation in the esophagus, can drive an otherwise non-tumorigenic dose
of NMBA into a highly tumorigenic one.
相似文献
86.
Recently, the beneficial role of steroids for acute laryngotracheobronchitis has been more clearly defined for both intubated and unintubated patients. However, corticosteroids also improve the clinical signs of airway haemangiomata. Two patients are described who illustrate how this can be a source of diagnostic confusion. 相似文献
87.
H Thom PE Carter P Duffty MJC Main S Brown 《Acta paediatrica (Oslo, Norway : 1992)》1994,83(7):687-691
Immunoglobulin G subclass concentrations were measured in paired foetal (cord) and maternal serum specimens at delivery from 27 IgA-deficient (serum IgA < 0.01 g/l) and 15 control women. IgA-deficient women had significantly higher serum IgGl and IgG3 concentrations than control women but 2 of the group had concomitant IgG2/IgG4 deficiency and a further 12 had low IgG4 concentrations (serum IgG4 < 0.025 g/l). Foetal serum also had significantly higher IgGl concentrations than control foetal serum but lower IgG2 and IgG4 levels. Concentrations of IgG subclasses and IgM were measured in breast milk collected on the fifth day postpartum from 19 of these IgA-deficient and 18 control women. Between-group differences in IgG subclass levels resembled those in serum. Compared with serum, proportionally less IgG3 was present in milk in both groups although the contribution of IgG3 to total IgG was not less than that of IgG4. Slightly higher IgM was found in milk from the IgA-deficient mothers. 相似文献
88.
Colorectal hemangioma: radiologic findings 总被引:1,自引:0,他引:1
The authors correlated radiographs with the clinical and histologic data of 12 patients with colorectal hemangioma. All patients presented with rectal bleeding, which was chronic in seven. Phleboliths were also visible in seven cases, which correlated with chronic bleeding in five. On barium studies, three masses were soft and three produced rigid narrowing. The atypical features of rigid luminal narrowing, which might mimic a carcinoma, and hypovascularity correlated with chronic bleeding or visible phleboliths, which suggest the correct diagnosis of colorectal hemangioma. 相似文献
89.
KM FOCK JY KANG HS NG TM NG KA GWEE CC LIM 《Journal of gastroenterology and hepatology》1995,10(4):379-382
Roxatidine acetate, a new H2 receptor antagonist, was compared with ranitidine in the treatment of duodenal ulcers in a double-blind multicentre study. Eighty-four patients with endoscopically proven duodenal ulcer were randomized to receive 150 mg roxatidine acetate or 300 mg ranitidine at bedtime. Repeat endoscopy was performed after 4 weeks (25–33 days) and if the ulcer had not healed, another endoscopy was performed after a further 4 weeks of treatment. Using per protocol analysis 73.6% of ulcers treated with roxatidine healed at 4 weeks compared to 72.2% of ulcers treated with ranitidine (P=NS). The healing rates at 8 weeks were 92% with roxatidine and 83.3% with ranitidine (P=NS). Using equivalence tests, the healing rate of roxatidine was found to be equivalent to that of ranitidine within a 20% region. Roxatidine users took significantly less antacids than ranitidine users (P < 0.05). There were no significant adverse effects due to roxatidine or ranitidine. Roxatidine is a safe effective drug in the treatment of duodenal ulcers with a healing rate comparable to that of ranitidine. 相似文献
90.
Blood pressure recordings in 116 female psychiatric inpatients were analysed. Sixty-nine women had schizophrenia, the remainder a variety of psychiatric conditions. All had been in hospital continuously for more than one year, the average for 19 years continuously. An average of seven recordings of blood pressure per patient had been made during that time. The latest of these compared well with measurements made independently using a sphygmomanometer free from observer bias. On admission to hospital the blood pressure of these patients was close to that of two normal populations. Thereafter it failed to rise at the normal rate and after an average of 19 years, in the women having measurements made by special sphygmomanometer, systolic pressure was 28 mmHg lower than controls of the same age while diastolic pressure was 12.8 mmHg lower. Lower than control blood pressure was apparent in schizophrenic and non-schizophrenic women and in women taking no drugs, phenothiazines, and other drugs. Weight loss is an unlikely explanation: the mean weight of these women was 61.5 kg compared with 64.1 kg in a local control population of the same age. Some factor related to prolonged isolation in hospital seems more important. 相似文献