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991.
G Nanni MD G Balduzzi MD R Capoluongo MD A Scotti MD G Rosso MD C Botta MD P Demichelis MD M Daffara MD E Coppo MD 《Obesity surgery》1997,7(1):26-29
Background: Biliopancreatic diversion (BPD), by ad hoc stomach resection (AHS-BPD) has been accepted as an effective surgical treatment for morbid obesity. Methods: Between 1.1.1992
and 31.7.1996, 59 patients (54 females, five males, mean age 40.3 years, range 23-61 years) underwent AHS-BPD. Mean preoperative
body-weight was 121.2 kg (range 94-160), with a mean body mass index of 48.6 (range 35-64). Three of these patients were converted
from a previous vertical banded gastroplasty to AHS-BPD (one patient with stomach preservation). After at least 36 months
follow-up, seven patients underwent abdominal dermolipectomy (five with associated incisional hernia repair, one with thigh
dermolipectomy). Results: Mean post-operative hospital stay was 13 days (range 10-30 days). Follow-up is currently in progress
in all patients. Excess body weight-loss was 78% in 33 patients with 24 months follow-up, with excellent long-term weight
loss maintenance. Protein deficiency was the main specific complication, encountered in two patients (3.4%). Mortality was
one patient (1.7%), due to pulmonary embolus. Conclusions: This clinical experience supports the effectiveness and safety
of AHS-BPD, despite some criticism. This procedure appears to be suitable for patients with clinically severe obesity who
will poorly tolerate food intake restriction but will accept long-term follow-up. Careful preoperative clinical assessment
and selection of patients who will be reliable in long-term follow-up are the keys to success with AHS-BPD, both in terms
of weight loss and reduction of specific metabolic complications. 相似文献
992.
993.
Marie-Francoise Dresse Michele David Heather Hume Herve Blanchard Pierre Russo Nicolas Van Doesberg Georges E. Rivard 《Pediatric hematology and oncology》1991,8(4):329-334
The Kasabach-Merritt syndrome is characterized by thrombocytopenia and localized coagulopathy associated with a hemangioma. Most techniques applied to eradicate the tumor or accelerate its involution (surgery, radiation therapy, embolization) are invasive and require transfusion of large amounts of blood products. In some cases, medical treatment is the only alternative. Efficacy of steroids and antifibronolytic agents has already been described, but even this approach is associated with the administration of blood products. We report two cases of infants with Kasabach-Merritt syndrome associated with cardiac and hepatic hemangiomas. At admission, both had signs of cardiac failure. They were successfully treated with prednisone and epsilon-aminocaproic acid (EACA). Blood products were not required once the diagnosis was made. These observations have important implications for the management of patients with Kasabach-Merritt syndrome because they show that even in severe cases blood transfusions can be avoided by the use of prednisone and EACA. 相似文献
994.
995.
David W. Smith 《Statistics in medicine》1994,13(10):1001-1013
The variation in mortality rates among hospitals has often been described informally as having three major components: patient severity, quality of care and random variation. These informal concepts are characterized formally by partitioning sums of squares and finding their expected values. The partition relates to commonly used tests for whether individual hospitals have unusual mortality rates. Application of the partition to the hospital mortality reports by the Health Care Financing Administration shows that their models for patient risk account for about one-half the variation among hospital mortality rates. An example using clinical measures of severity accounts for about two-thirds of mortality variation among hospitals. 相似文献
996.
Philip J. Larsen David S. Jessop Hardial S. Chowdrey Stafford L. Lightman Jens D. Mikkelsen 《Journal of neuroendocrinology》1994,6(2):153-159
The complete sequence of the cDNA encoding the neuropeptide Y (NPY) Y1-receptor has recently been deduced from a rat brain library, and the presence of messenger ribonucleic acid (mRNA) encoding Y1-receptor protein has been demonstrated within the brain. Using quantitative in situ hybridization histochemistry, the content and distribution of Y1receptor and preproNPY mRNAs have been investigated in the hypothalamic arcuate nucleus of adrenalectomized rats receiving glucocorticoid replacement therapy for 12 days by means of either high doses of dexamethasone in their drinking water or by subcutaneous corticosterone pellets. Basal metabolic parameters such as weight gain or loss, blood glucose and plasma insulin were monitored: Dexamethasone treatment induced weight loss and a state of hyperinsulinemia with normoglycemia, while corticosterone treated animals displayed metabolic parameters identical to sham ADX animals. Within the arcuate nucleus of glucocorticoid treated animals, levels of Y1receptor and preproNPY mRNAs were increased. In contrast, adrenalectomy itself had no effect upon Y1-receptor mRNA levels or preproNPY mRNA levels in the arcuate nucleus. These studies demonstrate that glucocorticoids exert a stimulatory action on levels of Y1-receptor mRNA and preproNPY mRNA levels in the hypothalamic arcuate nucleus. This is the first evidence to suggest that the expression of a neuropeptide-receptor gene in the central nervous system may be directly sensitive to peripheral hormonal signals. 相似文献
997.
998.
999.
1000.
Michael L. Graham Jonathan J. Shuster Barton A. Kamen David L. Cheo Matthew P. Harrison Brigid G. Leventhal D. Jeanette Pullen V. Michael Whitehead 《Cancer chemotherapy and pharmacology》1992,31(3):217-222
Summary We enrolled children with acute lymphoblastic leukemia (ALL) in a Pediatric Oncology Group (POG) pilot study to monitor erythrocyte (RBC) methotrexate (MTX) and folate (F) levels before and during treatment. The mean value for RBCF at diagnosis was 0.86±0.46 nmol/ml RBC in the 214 patients who achieved remission and 1.21±0.74 nmol/ml RBC in the 10 patients who did not (P=0.020). Folate levels tended to increase during remission induction, but they dropped following an intensive consolidation with methotrexate to levels that were sustained throughout chemotherapy treatment. Methotrexate levels reached mean values of approximately 0.15 nmol/ml RBC at the end of an intensive methotrexate consolidation, then fell to levels that were sustained throughout maintenance therapy. There was a weak correlation between improved event-free survival and higher RBCMTX levels after consolidation, but no correlation was found between improved survival and the level of RBCMTX or RBCF during maintenance therapy. A larger study with more complete data is needed to determine whether RBCMTX or RBCF might be useful in predicting event-free survival in patients with ALL.This work was supported in part by grants from the National Cancer Institute and the National Institute of Health (CA-30969, CA-28476, CA29139, CA-159-89, and CA-33587) 相似文献