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991.
Silvia Barril Ana Alonso José Antonio Rodríguez-Portal Margarita Viladot Jordi Giner Francisco Aparicio Ana Romero-Ortiz Orlando Acosta Diego Castillo 《Archivos de bronconeumología》2018,54(3):123-127
Introduction
Interstitial lung diseases (ILD) and, in particular, idiopathic pulmonary fibrosis, may have a significant impact on patient survival. Recent studies highlight the need for palliative care (PC) in the management of ILD patients. The aim of this study was to determine the current situation of PC in patients in Spain.Methods
A 36-question survey addressing the main aspects of PC in ILD patients was designed. The survey was sent via email to all members of the Spanish Society of Pulmonology and Thoracic Surgery. Participation was voluntary.Results
One hundred and sixty-four participants responded to the survey. Ninety-eight percent said they were interested in PC, 46% had received specific training, and 44% reported being responsible for PC in their ILD patients. Symptom control and end-of-life stage were the most frequent reasons for referral to PC teams. Regarding end-of-life, 78% reported consensual agreement with patients on the limitation of therapeutic efforts, 35% helped prepare an end-of-life advance directive, and 22% agreed on the place of death.Conclusion
Despite the well-known need for PC in patients with ILD and the notable interest of the survey participants in this subject, there are clear formative and organizational gaps that should be addressed to improve care in this area in ILD patients in Spain. 相似文献992.
Bártolo I Epalanga M Bartolomeu J Fonseca M Mendes A Gama A Taveira N 《AIDS research and human retroviruses》2005,21(4):306-310
To investigate which HIV-1 genetic forms are circulating in Angola, we have determined the gag and/or env genotypes of 48 isolates from patients living in Cabinda and Luanda provinces. The following subtypes were identified: A1 (18 samples, 38%), C (7, 15%), H (5, 10%), J (3, 6%), G (2, 4%), A2 (2, 4%), F1 (1, 2%), and D (1, 2%). The env gene fragment was untypable in one sample. Discordant subtype classifications in the gag and env genes were found in eight (17%) samples. There were six different recombination patterns (gag/env): A1/H (3, 6%), A1/G (1, 2%), C/A2 (1, 2%), F1/B (1, 2%), G/B (1, 2%), and G/H (1, 2%). The A1/H recombinant may represent a new circulating recombinant form. The marked genetic heterogeneity of HIV-1 in Angola has important implications for vaccine development. 相似文献
993.
994.
J. Batlle E. Gömez E. Rendal J. Torea E. Lourés M. Couselo P. Vila C. Sedano X. Tusell M. Magallönö M. Quintana R. González-Boullosa M. F. Löpez-Fernández 《Annals of hematology》1996,72(5):321-326
Non-neutralizing factor VIII (FVIII) antibodies (FVIII-Ab) in hemophilia A may be associated with an abnormal clinical response
to FVIII concentrates. Patients with FVIII inhibitors may develop noncoagulation FVIII-Ab after the induction of immunotolerance.
Natural FVIII-Ab may be detected in the plasma of some healthy subjects. The aim of this study was to analyze the presence
of FVIII-Ab in the plasma of 53 normal blood donors and 124 patients with hemophilia A (18 patients had a previous history
of FVIII inhibitor, but only 12 had inhibitor at the moment this study was performed). FVIIII inhibitor was measured using
the Bethesda method. FVIII-Ab were analyzed by a specific ELISA assay using purified FVIII from a monoclonal concentrate and
a standard plasma containing 26 Bethesda units (BU) of FVIII inhibitor. Purified FVIII was used to coat wells of a microtiter
plate and was incubated with dilutions of plasma to be tested. Bound human IgG FVIII-Ab were detected by incubation with polyclonal
sheep anti.human IgG alkaline phosphatase conjugate, and the OD405 was quantitated. A linear fit was obtained (by plotting FVIII-Ab positivity [OD 405nm] versus BU titer) when serial dilutions
of this standard inhibitor plasma, containing titers of 0.5 BU or higher, were used. Four different levels of FVIII-Ab positivity
[OD 405nm] were distinguished in this assay: Negative levels (–) were obtained with dilutions of the standard inhibitor containing
<0.5 BU. Mild levels (+) were obtained with dilutions of 0.5–5 BU. Moderate levels (++) were obtained for dilutions ranging
from 5–25 BU. Maximum positivity (+++) was obtained for dilutions of titers > 25 BU. FVIII-Ab positivity was detected in eight
of the normal subjects (15%): three were found to be moderately positive (++) and five mildly positive (+). No inhibitory
activity was detectable when whole plasma was used. All the hemophilic patients with a presence of FVIII inhibitor at the
time of the study were found to be positive for FVIII-Ab. In addition, the level of positivity correlated with the corresponding
BU. Four of the six patients who had a history of inhibitor were negative and two positive. Twenty additional patients (16.12%)
in whom no inhibitory activity was detected were found to be positive for FVIII-Ab: 16 + and four ++. The mean age of patients
with FVIII-Ab positivity was significantly higher than that of patients of the FVIII-Ab negative group (p<0.005). In conclusion, FVIII-Ab positivity in patients with hemophilia A was 17.7% higher than the level of positivity detected
by an inhibitory assay. We propose that this method for FVIII-Ab analysis could be used for patients with hemophilia A, at
least to complement the functional inhibitor assay. FVIII recovery or half-life should be assessed in patients who test positive
for FVIII-Ab and who show no evidence of inhibitor.
Received: 31 July 1995 / Accepted: 25 January 1996 相似文献
995.
Severe hypoleptinaemia associated with insulin resistance in patients with common variable immunodeficiency 总被引:1,自引:0,他引:1
Ferraroni NR Geloneze B Mansour E Perroud AP Muscelli EO Tambascia M de Lima Zollner R Velloso LA 《Clinical endocrinology》2005,63(1):63-65
Objective Common variable immunodeficiency (CVI) is a primary immunodeficiency syndrome characterized by impaired production of antibodies and recurrent infections. Delay in diagnosis leads to metabolic wastage and low body weight. Leptin, a hormone produced by white adipose tissue, modulates insulin action by signal transduction cross‐talk and by direct action on pancreatic beta‐cells. We hypothesized that patients with CVI might present a defective regulation of leptin production and insulin resistance. Patients Thirteen CVI patients (39 ± 11 years) under gammaglobulin replacement were evaluated in parallel with 13 gender‐, age‐, body weight‐ and body mass index (BMI)‐matched healthy voluntaries, and with data from two large population series, the Bruneck and the Hoorn Studies. Measurements Serum leptin and insulin levels, homeostasis model assessment – insulin resistance (HOMA‐IR), body composition, haematological, biochemical and immunoglobulin measurements were obtained. Data were analysed by a one‐way analysis of variance (anova ) and by Pearson's rank analysis. The institutional ethics committee approved the study, and informed consent was obtained from patients and controls. Results No differences were found between CVI and the control group when comparing gender distribution, age, body weight, BMI, waist/hip ratio, relative body fat and fasting glucose levels. Leptin levels were lower (P < 0·05) in CVI patients than in controls and lower than fasting leptin levels detected in a large population study. CVI patients’ serum leptin levels did not correlate with BMI (r = 0·074, P = 0·8) and their high HOMA‐IR indicated insulin resistance. Conclusions CVI patients are relatively hypoleptinaemic and insulin resistant, and their serum leptin levels are not correlated to their BMI. 相似文献
996.
P López Vallejos M V García Sánchez A González Galilea C Gálvez Calderón A Naranjo Rodríguez J L Montero Alvarez J F de Dios Vega 《Revista española de enfermedades digestivas》2003,95(10):700-6, 692-9
OBJECTIVES: to evaluate the efficacy of endoscopic treatment in patients with upper gastrointestinal (UGIH) due to duodenal ulcer with high risk of persistent or recurrent bleeding and to determine the associated failure factors of this procedure. PATIENTS AND METHOD: three hundred and thirty-six patients with UGIH due to duodenal ulcer requiring endoscopic treatment were analyzed between January 1992 and December 2001. The patients were classified according to the endoscopic findings: a) patients with limited bleeding; and b) patients with persistent and/or recurrent bleeding due to therapeutic failure. The clinical guidelines followed in patients with endoscopic treatment failure were previously established in the internal protocol. The variables that obtained statistical significance in the univariate analysis were included in the logistic regression model to identify those with an independent predictive value for failure of the endoscopic treatment. RESULTS: mean age of the patients was 60 +/- 17 years, 271 (81%) were male. Bleeding with severe hemodynamic affectation was detected in 82 patients (24%). The most common location of the duodenal ulcer was on the anterosuperior part of the duodenal bulb (227 patients, 68%). In 43 patients (13%) the ulcer was larger than 2 cm. The bleeding stigmata were classified as: Forrest I in 125 (38%) and Forrest II in 211 (62%). It was initially reached in 297 patients (88%). Twenty-two patients required emergency surgery (6,5%) and the global mortality rate was 3%. Severe hemodynamic affectation at admission (OR 11.8, p>0.001), ulcers exceeding 2 cm (OR 6.95, p = 0.019) and the presence of active bleeding during endoscopy (Forrest I) (OR 3.55, p = 0.08) were the variables included in the multivariate analysis independently associated to endoscopic therapy failure. CONCLUSION: endoscopic therapy is an efficient treatment of upper gastrointestinal bleeding due to duodenal ulcer. By means of a clinical variable, the hemodynamic status and two endoscopies, bleeding stigmata and the size of the ulcer, a group of patients with high risk of endoscopic treatment failure can be selected. 相似文献
997.
Serum leptin levels in women with systemic lupus erythematosus 总被引:10,自引:0,他引:10
Garcia-Gonzalez A Gonzalez-Lopez L Valera-Gonzalez IC Cardona-Muñoz EG Salazar-Paramo M González-Ortiz M Martínez-Abundis E Gamez-Nava JI 《Rheumatology international》2002,22(4):138-141
The purpose of this study was to evaluate serum leptin levels in systemic lupus erythematosus (SLE). Forty-one women with SLE were compared with 23 healthy women of similar age and body mass index (BMI). Clinical characteristics and Mexican systemic lupus erythematosus disease activity index (Mex-SLEDAI) score were assessed. Serum leptin levels (ng/dl) were measured by enzyme-linked immunosorbent assay (ELISA). Comparisons of leptin levels were made with the Mann-Whitney U-test. In a multiple regression analysis, those factors that could influence the leptin levels were adjusted. Patients with SLE had higher leptin levels than the control group (SLE median 31 vs control median 15, P=0.023). After adjusting by other variables, the serum leptin levels remained higher in SLE than in controls (P=0.02). Patients with SLE had no association between leptin levels and Mex-SLEDAI score, age, duration of disease, or prednisone doses. Those with SLE had higher leptin levels than controls. Further longitudinal studies are required to evaluate the role of this hormone in the exacerbations of SLE. 相似文献
998.
Perianal abscesses and fistulas 总被引:2,自引:0,他引:2
Paravasthu S. Ramanujam M.D. M. Leela Prasad M.D. Dr. Herand Abcarian M.D. Ana B. Tan R.N. E.T. 《Diseases of the colon and rectum》1984,27(9):593-597
In a five and one-half year period, 1023 patients with anorectal abscesses and fistulas were treated. Under regional anesthesia
the abscesses were unroofed and debrided and a primary fistulotomy was performed whenever a low fistula was identified. In
355 (34.7 per cent) an internal fistulous opening was demonstrated at the time of abscess drainage. Thirty-two patients had
suprashincteric fistulas and underwent two-stage fistulotomy using a seton. Perianal abscesses were encountered in 42.7 per
cent of the patients, followed by ischiorectal (22.7 per cent), intersphincteric (21.4 per cent), and supralevator (7.33 per
cent). The patients with supralevator and intersphincteric abscesses had a high incidence of fistula identified during abscess
drainage. The recurrence rates were 3.7 per cent in the group with abscess drainage only and 1.8 per cent in the group that
had primary fistulotomy along with abscess drainage. The follow-up period averaged 36 months. To accomplish adequate drainage
and identify the deeper components and associated fistulous opening (34.7 per cent of the entire group), careful examination
under regional anesthesia is recommended. Early aggressive treatment of an anorectal abscess and fistula significantly reduces
the possibility of recurrent abscesses and/or the need for further surgery.
Read at the meeting of The American Society of Colon and Rectal Surgeons, Boston, Massachusetts, June 5 to 9, 1983.
Recipient of the 1983 Rowell Laboratories Education Committee Award. 相似文献
999.
Clinical, endoscopic, and functional studies in 408 patients with Barrett's esophagus, compared to 174 cases of intestinal metaplasia of the cardia 总被引:10,自引:0,他引:10
Csendes A Smok G Quiroz J Burdiles P Rojas J Castro C Henríquez A 《The American journal of gastroenterology》2002,97(3):554-560
OBJECTIVE: The pathophysiology of gastroesophageal reflux disease (GERD) has been studied extensively in patients with long-segment Barrett's esophagus (LSBE), but few reports have explored GERD pathophysiology in patients who have short-segment Barrett's esophagus (SSBE) or intestinal metaplasia at the cardia (IMC). We aimed to compare clinical, endoscopic, histological, and functional features in patients with LSBE, SSBE, and IMC. METHODS: We identified 582 patients who had intestinal metaplasia at the squamocolumnar junction in the distal esophagus and divided them into three groups based on the extent of columnar-lined esophagus observed endoscopically: 1) patients with IMC who had no columnar-lined esophagus (i.e., the squamocolumnar and gastroesophageal junctions coincided), 2) patients with LSBE who had >3 cm of columnar-lined esophagus, and 3) patients with SSBE who had <3 cm of columnar-lined esophagus. All patients had esophageal manometric evaluation, and 24-h esophageal pH monitoring was performed to determine the extent of acid and bile (bilirubin) reflux. RESULTS: There were 174 patients with IMC, 155 with LSBE, and 25 with SSBE. Compared to patients with LSBE and SSBE, patients with IMC had significantly lower frequencies of GERD symptoms, hiatal hernia, and erosive esophagitis; significantly higher lower esophageal sphincter pressures; and significantly shorter durations of acid and bile reflux. Between patients with SSBE and LSBE, significant differences were found in the frequency of hiatal hernia and duration of acid reflux (both greater in the patients with LSBE). Also, dysplasia was significantly more frequent in patients with LSBE than in those with SSBE or IMC. CONCLUSION: GERD symptoms, signs, and physiological abnormalities are found more often in patients with Barrett's esophagus than in those with IMC, and the duration of acid reflux in patients with LSBE is greater than that in patients with SSBE. These findings suggest that the extent of intestinal metaplasia in the esophagus is related directly to the severity of underlying GERD. 相似文献
1000.
Carmona L González-Alvaro I Balsa A Angel Belmonte M Tena X Sanmartí R 《Annals of the rheumatic diseases》2003,62(9):897-900
Methods: Cross sectional analysis of a cohort of patients with RA randomly selected from the clinical databases of 34 centres. Standard definitions and measurements were used, and radiographs read centrally. Estimates and confidence intervals were adjusted to sampling. Results: Data were available for 788 patients. Extra-articular RA was present in 285 (36.2%) patients. Cumulative prevalence and 95% confidence intervals of extra-articular manifestations were estimated: nodules 24.5% (21.5 to 27.5), Sjögren''s syndrome 17.0% (14.4 to 19.6), atlantoaxial subluxation 12.1% (9.8 to 14.4), carpal tunnel syndrome 10.7% (7.8 to 13.6), interstitial lung disease 3.7% (2.4 to 5.0), serositis 2.5% (1.4 to 3.5), eye disease 2.5% (1.1 to 3.9), vasculitis 1.3% (0.5 to 2.1), amyloidosis 0.6% (0.1 to 1.2), and Felty''s syndrome 0.3% (<0.6). Mean (SD) activity/progression indexes were: DAS28-3 3.4 (1.2), HAQ 1.6 (0.4), Larsen score 54.7 (26.4). Less than 5% of the patients were in remission. 205 (72%) patients were receiving disease modifying antirheumatic drugs (DMARDs). Conclusion: Spanish patients with RA ever seen by a rheumatologist have, on average, a moderate degree of activity, despite widespread use of DMARDs. Measures of the degree of progression do not show a benign disease. The proportion of extra-articular manifestations in Spanish patients with RA is similar to that found in other Mediterranean populations, and lower than that reported in Anglo Saxon countries. 相似文献