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991.
AM Taylor A Bush A Thomson PJ Oades JL Marchant C Bruce-Morgan J Holly L Ahmed DB Dunger 《Archives of disease in childhood》1997,76(4):304-309
OBJECTIVES: Despite improved nutrition and intensive treatment, subjects with cystic fibrosis have difficulty in maintaining anabolism during intercurrent infections, which can result in reduced body mass index and impaired skeletal growth. Insulin-like growth factor-I (IGF-I) and its binding protein IGFBP3 are sensitive to changes in nutritional status. The aim of this study was to determine the relation between circulating concentrations of these peptides, body mass index, and clinical status in cystic fibrosis. METHODS: Serum concentrations of IGF-I and IGFBP3 were measured in 197 subjects (108 males, 89 females; mean age 9.69 years, range 0.41-17.9 years) and these data were analysed with respect to body mass index, pubertal stage, and clinical status as assessed by Shwachman score and forced expiratory volume in one second (FEV1). RESULTS: The mean height SD score of the children studied was -0.2 (SD 1.14) and the body mass index SD score -0.26 (1.4). The body mass index SD score declined with increasing age (r = -0.18) and paralleled changes in IGF-I concentrations, which also declined. The IGF-I SD score (calculated from control data) correlated with age (r = -0.53). The abnormalities were most obvious during late puberty, when IGF-I and IGFBP3 concentrations were significantly reduced compared with those in control subjects matched for pubertal stage. The IGF-I SD score correlated with height SD score (r = 0.14) and the decline in IGF-I concentrations with the fall in body mass index SD score (r = 0.42). IGF-I SD scores also correlated with the Shwachman score (r = 0.33) and FEV1 (r = 0.17). CONCLUSIONS: The close relation between declining IGF-I and IGFBP3 concentrations and body mass index in patients with cystic fibrosis may simply reflect poor nutritional status and insulin hyposecretion. Nevertheless, IGF-I deficiency could also contribute towards the catabolism observed in these patients, and IGF-I SD scores correlated with other measures of clinical status such as the Shwachman score and FEV1. 相似文献
992.
993.
We review the etiology and the management strategy of genital burns. The incidence of genital burns ranges from 2.8 to 13%. Most are part of larger injuries. Scald burns are typical for children, whereas flame and chemical burns happen more often in adults. For first and second‐degree genital burns, a conservative approach with physiological dressings and topical antimicrobials is advised. Only third degree burns need to be treated with removal of necrotic tissue and grafting. Indwelling catheters or suprapubic drainage systems must be avoided whenever possible. 相似文献
994.
995.
BACKGROUND: The communication between GP and specialists is vital for the
patient suffering from breast cancer. OBJECTIVES: The aim of this study was
to investigate (i) the speed and type of communication between GPs,
specialists and patients with breast cancer, and (ii) the problems that GPs
encounter in the communication with specialists concerning these patients.
METHOD: In April 1995, 246 Dutch GPs from the Zwolle region (600 000
inhabitants) were invited to complete a questionnaire, using the
information from the medical record and focusing on the last patient
consulted with a confirmed diagnosis of breast cancer. RESULTS: Valid
replies were received from 150 (61 %) GPs. The median period between
initial referral date and receipt of the definite diagnosis from the
surgeon was 4 weeks. After the patient's first appointment with the
surgeon, the GPs received reports for 24% of the patients within 3 days;
for 31% within 3-7 days; and for 16% of the patients after more than 2
weeks. After the first consultation between patient and surgeon, 68 (45%)
of the 150 GPs reported that the patient contacted them; at this stage only
30 (20%) of these GPs had received a report from the surgeon. Thirty-one
(21%) GPs did not contact the patient after receival of the definite
diagnosis. GPs stated that the communication on patients with breast cancer
is too slow (49%), or not frequent enough (25%); 25% of GPs found that the
distribution of tasks between them and the specialists are not well
described. CONCLUSION: In the diagnostic stage of breast cancer the
communication between GPs, specialists and patients varies widely, is too
slow and is incomplete. An effect of this unsatisfactory communication is
that the patient herself is the messenger of the bad news.
相似文献
996.
997.
The automatic implantable cardioverter-defibrillator is used in patients with ventricular tachyarrhythmias resistant to medical or surgical therapy. The device, which has a unique radiographic appearance, senses ventricular tachycardia or fibrillation and automatically delivers a cardioverting or/defibrillating electric shock. 相似文献
998.
999.
Arrhythmias in general practice: diagnostic value of patient characteristics, medical history and symptoms 总被引:3,自引:3,他引:0
Zwietering PJ; Knottnerus JA; Rinkens PE; Kleijne MA; Gorgels AP 《Family practice》1998,15(4):343-353
BACKGROUND: Complaints possibly caused by arrhythmias are frequently seen
in general practice. It is unclear to what extent such complaints can
differentiate between arrhythmias and other pathology in general practice.
OBJECTIVES: We aimed to assess the value of symptoms (a) in diagnosing
arrhythmias in general practice and (b) in identifying patients with
clinically relevant arrhythmias. METHOD: During a 2-year period, a
structured history from 762 patients with new complaints possibly related
to an arrhythmia was taken by the GP, and a transtelephonic
electrocardiogram (ECG) was made. RESULTS: In 28.3% of the patients,
arrhythmias were detected and 8.8% were clinically relevant. Several
patient characteristics, symptoms and medical history findings have high
predictive values in diagnosing arrhythmias. In the logistic regression
analysis, age and, to a lesser extent, male gender, palpitations and
dyspnoea during consultation and the use of cardiovascular drugs are
associated with the presence of arrhythmias. In detecting clinically
relevant arrhythmias the same parameters apart from gender are important,
as well as a history of arrhythmias. The use of central nervous system
medication and frequent psychosomatic complaints are negatively associated
with the presence of clinically relevant arrhythmias. CONCLUSIONS: In
general practice, patient characteristics, symptoms and medical history
findings can be used in the detection of arrhythmias and the assessment of
their severity. They can help in the decision of whether to make an ECG
recording.
相似文献
1000.