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101.
Polycystic Kidney Disease Re-evaluated: A Population-based Study 总被引:2,自引:0,他引:2
DAVIES F; COLES GA; HARPER PS; WILLIAMS AJ; EVANS C; COCHLIN D 《QJM : monthly journal of the Association of Physicians》1991,79(3):477-485
A genetic register of all known cases of autosomal dominantpolycystic kidney disease occurring in South and Mid-Wales hasbeen established. In a population of 2.1 million, 209 familieswith affected members were identified, 303 of whom are currentlyalive, 70 on renal replacement therapy. An additional 551 caseswould be predicted amongst family members at 50 per cent and25 per cent risk, giving an apparent prevalence of 1:2459 inthe general population. Five possible new mutations were seenwhere adults with phenotypic autosomal dominant polycystic kidneydisease had both parents alive, age > 55 years with no cystsvisible on ultrasound. The take-on rate for renal replacementtherapy increased during 197079 but has apparently reacheda plateau of 4.8 cases per million population per year overthe last 8 years, despite a rapidly increasing acceptance ofuraemic patients as a whole (72/106/year in 198889).Considerably more patients with autosomal dominant polycystickidney disease aged over 50 years were started on treatmentin 198089 than in 197079, but the survival overallimproved with time. All cases of autosomal dominant polycystickidney disease reaching end-stage renal disease are now beingtreated, but the apparent clinical prevalence of this conditionin our region is less than half the supposed gene frequency,suggesting that undiagnosed cases have a benign prognosis. 相似文献
102.
Oral cyclophosphamide versus chlorambucil in the treatment of patients with membranous nephropathy and renal insufficiency 总被引:4,自引:1,他引:4
Branten AJ; Reichert LJ; Koene RA; Wetzels JF 《QJM : monthly journal of the Association of Physicians》1998,91(5):359-366
We treated patients with idiopathic membranous nephropathy (iMGN) and renal
insufficiency, using: (i) (n = 15) monthly cycles of steroids (1 g
methyl-prednisolone i.v. on three consecutive days, followed by oral
prednisone 0.5 mg/kg/day months 1, 3 and 5) and chlorambucil (0.15
mg/kg/day months 2, 4 and 6); or (ii) (n = 17) oral cyclophosphamide
(1.5-2.0 mg/kg/day for 1 year) and steroids in a comparable dose. The
groups were comparable in age, renal function and levels of proteinuria.
During the 6 months preceding treatment, serum creatinine levels increased
from 148 +/- 50 to 219 +/- 73 mumol/l in the chlorambucil group and from
164 +/- 86 to 274 +/- 126 mumol/l in the cyclophosphamide group. Median
(range) follow-ups were: chlorambucil 38 months (8-71); cyclophosphamide 26
months (5-68) (NS). Renal function improved in both groups, but the
improvement was short-lived in the chlorambucil group; 12 months after
starting treatment, mean serum creatinine was 6.3 mumol/l lower in the
chlorambucil group and 121 mumol/l lower in the cyclophosphamide group (p
< 0.01). Four chlorambucil-treated patients developed ESRD, and five
needed a second course of therapy, whereas only one
cyclophosphamide-treated patient developed ESRD (p < 0.05). Remissions
of proteinuria occurred more frequently after cyclophosphamide treatment
(15/17 vs. 5/15; p < 0.01). Side-effects necessitated interruption of
treatment in six patients on cyclophosphamide and in 11 on chlorambucil (p
< 0.05). In our patients, oral cyclophosphamide was better tolerated
than oral chlorambucil. The suggested greater efficacy of the oral
cyclophosphamide regimen needs to be ascertained by longer follow-up.
相似文献
103.
Mycobacterial Infections After Renal Transplantation 总被引:5,自引:0,他引:5
HIGGINS RM; CAHN AP; PORTER D; RICHARDSON AJ; MITCHELL RG; HOPKIN JM; MORRIS PJ 《QJM : monthly journal of the Association of Physicians》1991,78(2):145-153
Mycobacterial infections occurred in 11 of 633 (1.7 per cent)recipients of successful renal transplants. There were no casesof tuberculosis in patients receiving chemoprophylaxis, butamongst those who did not receive prophylaxis disease occurredin six of the 27 (22 per cent) high-risk patients. The majorcause of morbidity during treatment was renal allograft rejection,largely due to reduction in immunosuppressive drug therapy. 相似文献
104.
105.
106.
107.
H Boralessa DR Goldhill K Tucker AJ Mortimer J Grant-Casey 《Annals of the Royal College of Surgeons of England》2009,91(7):599-605
INTRODUCTION
Blood is a scarce and expensive product. Although it may be life-saving, in recent years there has been an increased emphasis on the potential hazards of transfusion as well as evidence supporting the use of lower transfusion thresholds. Orthopaedic surgery accounts for some 10% of transfused red blood cells and evidence suggests that there is considerable variation in transfusion practice.PATIENTS AND METHODS
NHS Blood and Transplant, in collaboration with the Royal College of Physicians, undertook a national audit on transfusion practice. Each hospital was asked to provide information relating to 40 consecutive patients undergoing elective, primary unilateral total hip replacement surgery. The results were compared to indicators and standards.RESULTS
Information was analysed relating to 7465 operations performed in 223 hospitals. Almost all hospitals had a system for referring abnormal pre-operative blood results to a doctor and 73% performed a group-and-save rather than a cross-match before surgery. Of hospitals, 47% had a transfusion policy. In 73%, the policy recommended a transfusion threshold at a haemoglobin concentration of 8 g/dl or less. There was a wide variation in transfusion rate among hospitals. Of patients, 15% had a haemoglobin concentration less than 12 g/dl recorded in the 28 days before surgery and 57% of these patients were transfused compared to 20% with higher pre-operative values. Of those who were transfused, 7% were given a single unit and 67% two units. Of patients transfused two or more units during days 1–14 after surgery, 65% had a post transfusion haemoglobin concentration of 10 g/dl or more.CONCLUSIONS
Pre-operative anaemia, lack of availability of transfusion protocols and use of different thresholds for transfusion may have contributed to the wide variation in transfusion rate. Effective measures to identify and correct pre-operative anaemia may decrease the need for transfusion. A consistent, evidence-based, transfusion threshold should be used and transfusion of more than one unit should only be given if essential to maintain haemoglobin concentrations above this threshold. 相似文献108.
WY Khoder AJ Becker B Schlenker S Tritschler PJ Bastian CG Stief 《European journal of medical research》2009,14(7):320-322
Introduction
Rectal polypectomy causes thinning (or even perforation) of the rectal wall in addition to thermic injury at the polypectomy site.Case report
We present a rare case of spontaneous rectal perforation after uncomplicated nerve sparing endoscopic extraperitoneal radical prostatectomy in a patient with a previous history of rectal polypectomy at the perforation site. The patient could be treated conservatively. There was complete healing of the fistula without any effect on functional results. This Conservative therapy for such rectal perforations is indicated if the patient''s general condition remains stable without any signs of infection.Conclusions
Polypectomy is an important risk factor for rectal perforation during nsEERPE. Adequate time interval should be given to allow healing and avoid adding further thermal wall damage which may obscure healing leading to complications like fistula. Conservative therapy for small missed rectal perforations constitutes an attractive, feasible and non invasive treatment entity. Following this principle we have not faced this complication in following similar cases. 相似文献109.
A systems analysis of the chemosensitivity of breast cancer cells to the polyamine analogue PG-11047
Wen-Lin Kuo Debopriya Das Safiyyah Ziyad Sanchita Bhattacharya William J Gibb Laura M Heiser Anguraj Sadanandam Gerald V Fontenay Zhi Hu Nicholas J Wang Nora Bayani Heidi S Feiler Richard M Neve Andrew J Wyrobek Paul T Spellman Laurence J Marton Joe W Gray 《BMC medicine》2009,7(1):1-11
Background
When this trial was initiated, the combined measles, mumps and rubella (MMR) vaccine was licensed for subcutaneous administration in all European countries and for intramuscular administration in some countries, whereas varicella vaccine was licensed only for subcutaneous administration. This study evaluated the intramuscular administration of an MMR vaccine (M-M-RvaxPro®) and a varicella vaccine (VARIVAX®) compared with the subcutaneous route.Methods
An open-label randomised trial was performed in France and Germany. Healthy children, aged 12 to18 months, received single injections of M-M-RvaxPro and VARIVAX concomitantly at separate injection sites. Both vaccines were administered either intramuscularly (IM group, n = 374) or subcutaneously (SC group, n = 378). Immunogenicity was assessed before vaccination and 42 days after vaccination. Injection-site erythema, swelling and pain were recorded from days 0 to 4 after vaccination. Body temperature was monitored daily between 0 and 42 days after vaccination. Other adverse events were recorded up to 42 days after vaccination and serious adverse events until the second study visit.Results
Antibody response rates at day 42 in the per-protocol set of children initially seronegative to measles, mumps, rubella or varicella were similar between the IM and SC groups for all four antigens. Response rates were 94 to 96% for measles, 98% for both mumps and rubella and 86 to 88% for varicella. For children initially seronegative to varicella, 99% achieved the seroconversion threshold (antibody concentrations of ≥ 1.25 gpELISA units/ml). Erythema and swelling were the most frequently reported injection-site reactions for both vaccines. Most injection-site reactions were of mild intensity or small size (≤ 2.5 cm). There was a trend for lower rates of injection-site erythema and swelling in the IM group. The incidence and nature of systemic adverse events were comparable for the two routes of administration, except varicella-like rashes, which were less frequent in the IM group.Conclusion
The immunogenicities of M-M-RvaxPro and VARIVAX administered by the intramuscular route were comparable with those following subcutaneous administration, and the tolerability of the two vaccines was comparable regardless of administration route. Integration of both administration routes in the current European indications for the two vaccines will now allow physicians in Europe to choose their preferred administration route in routine clinical practice.Trial registration
ClinicalTrials.gov NCT00432523 相似文献110.