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651.
Background Oesophagogastrectomy for carcinoma has a high operative mortality rate. Patients are elderly and ischaemic heart disease
(IHD) is a recognised and frequent risk factor.
Aim To illustrate the use of the intra-aortic balloon pump (IABP) as prophylaxis against cardiac complications in a group of
such patients.
Methods Five patients aged from 63 to 78 years were presented with operable adenocarcinoma of the oesophagus. They had IHD of a severity
thought to pose a risk of myocardial infarction (MI) and/or failure at the time of oesophagogastrectomy. With the induction
of anaesthesia, the IABP was inserted and left in situ for up to 24 hours.
Results There were no major adverse perioperative cardiac events. Four patients were discharged from hospital on the eighth and one
on the tenth postoperative day.
Conclusion The prophylactic use of IABP has a potential role in the prevention of cardiac complications in patients with IHD undergoing
high risk non-cardiac surgery. 相似文献
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At diagnosis peripheral blood (PB) or bone marrow from patients with juvenile chronic myelogenous leukemia (JCML) have shown two reproducible abnormalities when studied in cell culture: impaired growth of normal hematopoietic progenitors and excessive proliferation of malignant monocyte-macrophage elements. We used these findings to assess quality of treatment response by serially studying PB specimens from four JCML patients (patients 5, 7, 8, and 9) in complete chemotherapy-induced remission. PB readily yielded high numbers of monocyte-macrophage colonies in CFU-C and CFU-GEMM assays when cultured in early remission, and the colonies were cytogenetically proven to have arisen from a malignant clone in patient 9. When studied later in remission, the abnormal cell proliferation persisted in three of the four patients, but in patient 8 PB colony growth resembled controls. Similarly, when PB from patient 8 was studied in liquid culture without using added growth factor, cell proliferation declined identical to controls, whereas PB from the other three patients showed exuberant growth of monocyte-macrophage elements. Patient 8 successfully completed therapy and has been in a long-term, disease-free remission. The other three had recurrent, ultimately fatal disease. The cell cultures have allowed detection of residual abnormal cells that circulate in PB of JCML patients in remission. Although patient numbers were small because of the rarity of JCML, the data suggested that persistence of leukemia cells in these patients had a bearing on clinical outcome. 相似文献
654.
Evidence that multiple myeloma Ig heavy chain VDJ genes contain somatic mutations but show no intraclonal variation 总被引:16,自引:4,他引:12
To investigate whether somatic hypermutation occurs in multiple myeloma (MM) Ig VH region genes, we have cloned and sequenced the expressed VH genes from five cases of MM. The sequences were obtained after polymerase chain reaction (PCR) on total RNA isolated from the bone marrow, using 5' VH family-specific leader and 3' C gamma- or C alpha- specific primers. MM-specific CDR3 oligonucleotides were produced to isolate VH genes expressed by the malignant plasma cells. In all five cases, the productive Ig gene used the VH3 family. Extensive sequence analysis of multiple independent M13 clones showed no intraclonal variation with no evidence for ongoing somatic hypermutation in MM VH region genes. We were able to identify possible germline counterparts of the expressed VH genes in two cases. Comparison of these genes shows that the MM VH region genes have somatic mutations characteristic for an antigen-driven process. In the other three cases, no close homology could be found with published VH3 sequences. These findings implicate that, in MM, clonal proliferation takes place in a cell type that has already passed through the phase of somatic hypermutation. 相似文献
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Bock GW; Garcia A; Weisman MH; Major PA; Lyttle D; Haghighi P; Greenway GD; Resnick D 《Radiology》1993,186(2):461
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