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101.
Antonina A Mikocka-Walus Deborah A Turnbull Jane M Andrews Nicole T Moulding Ian G Wilson Hugh AJ Harley David J Hetzel Gerald J Holtmann 《Clin Pract Epidemiol Ment Health》2008,4(1):15
Background
In independent studies, IBD, IBS and HCV have each been associated with a substantially increased risk of psychological problems such as depression and anxiety and impairment of quality of life compared to the general healthy population. However, the relative psychological burden for each of these diagnoses is unknown as it has never been compared contemporaneously at one institution. Current local data are therefore needed to enable an evidence-based allocation of limited clinical psychological resources.Methods
Overall, 139 outpatients (64 IBD, 41 HCV, and 34 IBS) were enrolled in this cross-sectional study. The HADS, SCL90, SF-12 and appropriate disease-specific activity measures were administered. Differences between groups were assesed with ANOVA, the Chi-Square test and the independent samples t-test (two-tailed).Results
Each of the three groups had significantly lower quality of life than the general population (p < 0.05). Overall, a total of 58 (42%) participants met HADS screening criteria for anxiety and 26 (19%) participants for depression. The HCV group had a significantly higher prevalence of depression than either of the other groups (HCV = 34%, IBS = 15% and IBD = 11%, p = 0.009). In the SCL90, the three disease groups differed on 7 out of 12 subscales. On each of these subscales, the HCV group were most severely affected and differed most from the general population.Conclusion
Patients with these common chronic gastrointestinal diseases have significant impairment of quality of life. Anxiety is a greater problem than depression, although patients with HCV in particular, should be regularly monitored and treated for co-morbid depression. Evaluation of specific psychological interventions targeting anxiety is warranted.102.
O'Mahony S; Morris AJ; Straiton M; Murray L; MacKenzie JF 《QJM : monthly journal of the Association of Physicians》1996,89(9):685-690
We report our experience with small-bowel push enteroscopy in 50 patients.
The indications for push enteroscopy were: anaemia/occult gastrointestinal
bleeding (22 patients); overt gastrointestinal bleeding (17 patients);
abnormal small-bowel radiology (8 patients) and miscellaneous (3 patients).
In those with undiagnosed gastrointestinal bleeding/anaemia, abnormalities
were detected in 24/39 patients (62%): small bowel arteriovenous
malformations (AVMs) were detected in 19 (49%), and five (13%) had lesions
in the upper gastrointestinal tract. Seventeen patients had heater-probe
ablation therapy of vascular lesions: nine patients had small-intestinal
lesions, four patients gastric lesions, and four patients combined gastric
and small- intestinal lesions. In those with abnormal small-bowel
radiology, abnormalities were detected in 6/8 patients. We conclude that
(i) push enteroscopy can establish a diagnosis in a high proportion of
patients with gastrointestinal bleeding; (ii) heater-probe ablation therapy
of vascular lesions can be performed routinely at the time of enteroscopy;
(iii) a significant proportion of patients (9/50) referred for enteroscopy
with undiagnosed gastrointestinal bleeding have lesions in the
stomach/proximal duodenum missed at diagnostic endoscopy. Push enteroscopy
is a valuable diagnostic and therapeutic endoscopic procedure.
相似文献
103.
Body fat measurement in Indian men: comparison of three methods based on a two-compartment model 总被引:1,自引:0,他引:1
Bhat DS Yajnik CS Sayyad MG Raut KN Lubree HG Rege SS Chougule SD Shetty PS Yudkin JS Kurpad AV 《International journal of obesity (2005)》2005,29(7):842-848
Obesity is a major risk factor for diabetes and related disorders. The current classification of obesity is based on body mass index (BMI, kg/m(2)), which is a surrogate for the total body fat. Since the relationship between BMI and body fat varies in different populations, an independent validation of the BMI-body fat relationship in the population of interest is desirable. OBJECTIVES: (1) To study the validity of field methods of measuring body fat (multiple skinfolds and bioimpedance) against a criterion method (deuterium dilution) and (2) To compare the prevalence of obesity (WHO 2000 criteria for BMI) with adiposity (body fat >25%) in middle-aged Indian men in rural and urban Pune. DESIGN: Community-based multistage stratified random sampling of middle-aged men from rural and urban Pune for study of body composition and cardiovascular risk. A third of these men, selected to represent wide BMI distribution, were studied for body fat measurements by specific methods. SUBJECTS: A total of 141 healthy men, approximately similar number from rural, urban slums and middle class from Pune. They were 39.3 (+/-6.2) y old and had a BMI of 21.9 (+/-3.7) kg/m(2). MEASUREMENTS: Anthropometry (height, weight and multiple skinfold thicknesses) by trained observers using standardised technique to calculate body fat by Durnin and Womersley's equation. Total body water and body fat by bioelectrical impedance analysis (BIA) and deuterium oxide dilution (D(2)O). RESULTS: Mean total body fat was 14.3 kg (23.0%) by anthropometry, 16.5 kg (26.0%) by BIA and 15.3 kg (24.6%) by D(2)O method. Although there was a good correlation between fat estimation by three methods (r= approximately 0.9, P<0.001 all), compared to D(2)O method anthropometry underestimated body fat by 1.0 kg and BIA overestimated fat by 1.2 kg (P<0.001 both). Using the standard cut-point of 25% body fat for 'adiposity' 29.5% rural, 46.0% slum and 75.0% middle class men were adipose. These proportions were considerably higher than the number of men who were 'preobese' (BMI> or =25-29.9 kg/m(2), 9.0% rural, 22.0% urban slums and 27.0% urban middle class) and 'obese' (BMI >30 kg/m(2), 4.0% urban slums, none in rural and urban middle class). CONCLUSION: We recommend that future studies assessing risk for chronic diseases in Indians should measure adiposity by anthropometry (multiple skinfolds) or BIA (calibrated for Indians) rather than relying only on BMI cut-points. 相似文献
104.
A randomized double-blind placebo-controlled crossover study of subcutaneous sumatriptan in general practice 总被引:1,自引:0,他引:1
MB Russell OE Holm-Thomsen M Rishøj Nielsen A Cleal AJ Pilgrim J Olesen 《Cephalalgia : an international journal of headache》1994,14(4):291-296
Objective. To evaluate the therapeutic response to sumatriptan in the acute migraine attack. Material and methods. Two hundred and thirty migraineurs diagnosed by their general practitioners in accordance with their usual practice were included in the study. The patients treated two migraine attacks at home by subcutaneous injection of sumatriptan or placebo for the first attack and the alternative medication, i.e. placebo or sumatriptan, for the second attack (crossover). Following treatment, a neurology resident interviewed and examined the patients, Results. When sumatriptan was compared to placebo, significantly more of the 209 evaluable patients reported headache relief at I h (56% vs 8%, p < 0.001) and 2 h (62% vs 15%, p < 0.001) after the first injection. Resolution of nausea, photophobia, and phonophobia was significantly more common in patients on sumatriptan than in those on placebo ( p < 0.001 for all comparisons). The adverse events were usually transient and of mild or moderate severity; however, three patients withdrew due to adverse events. Ninety-five percent of patients evaluated by a neurology resident met the IHS criteria for migraine. Conclusion. In general practice, sumatriptan taken subcutaneously using an autoinjector at home was an effective and well tolerated acute treatment for migraine. 相似文献
105.
AJ Larner MRCP 《International journal of clinical practice》1994,48(5):272-274
SUMMARY A case is reported of pseudohyperphosphataemia in association with a monoclonal gammopathy of undetermined significance. 相似文献
106.
107.
A Hirsch F Windhausen JG Tijssen AJ Oude Ophuis WJ van der Giessen PM van der Zee JH Cornel FW Verheugt RJ de Winter 《European heart journal》2009,30(6):645-654
AIMS: In several observational studies, revascularization is associated with substantial reduction in mortality in patients with non-ST-segment elevation acute coronary syndrome (nSTE-ACS). This has strengthened the belief that routine early angiography would lead to a reduction in mortality. We investigated the association between actual in-hospital revascularization and long-term outcome in patients with nSTE-ACS included in the ICTUS trial. METHODS AND RESULTS: The study population of the present analysis consists of ICTUS participants who were discharged alive after initial hospitalization. The ICTUS trial was a randomized, controlled trial in which 1200 patients were randomized to an early invasive or selective invasive strategy. The endpoints were death from hospital discharge until 4 year follow-up and death or spontaneous myocardial infarction (MI) until 3 years. Among 1189 patients discharged alive, 691 (58%) underwent revascularization during initial hospitalization. In multivariable Cox regression analyses, in-hospital revascularization was independently associated with a reduction in 4 year mortality and 3 year event rate of death or spontaneous MI: hazard ratio (HR) 0.59 [95% confidence interval (CI) 0.37-0.96] and 0.46 (95% CI 0.31-0.68). However, when intention-to-treat analysis was performed, no differences in cumulative event rates were observed between the early invasive and selective invasive strategies: HR 1.10 (95% CI 0.70-1.74) for death and 1.27 (95% CI 0.88-1.85) for death or spontaneous MI. CONCLUSION: The ICTUS trial did not show that an early invasive strategy resulted in a better outcome than a selective invasive strategy in patients with nSTE-ACS. However, similar to retrospective analyses from observational studies, actual revascularization was associated with lower mortality and fewer MI. Whether an early invasive strategy leads to a better outcome than a selective invasive strategy cannot be inferred from the observation that revascularized patients have a better prognosis in non-randomized studies. 相似文献
108.
Irene M Dek Bram DJ van den Elzen Paul Fockens Erik AJ Rauws 《World journal of gastroenterology : WJG》2009,15(19):2423-2424
In this case report we present an elderly patient who was referred to our hospital with recurrent episodes of cholangitis that persisted after placement of five metal stents for a distal common bile duct (CBD) stenosis.All metal stents were endoscopically removed from the CBD by forceps after balloon dilatation of the papilla. A profoundly dilated CBD with sludge and concrements was seen. To ensure adequate bile drainage an enteral metal stent was inserted in the CBD. This case shows that proximally migrated uncovered metal stents in the CBD can be safely removed endoscopically under certain circumstances. We suggest that in the case of a CBD drainage problem due to an extremely dilated CBD, placement of an enteral metal stent in the CBD could be considered, especially in patients who are unfit for surgery. 相似文献
109.
Inactivation of factor XIa in human plasma assessed by measuring factor XIa-protease inhibitor complexes: major role for C1-inhibitor 总被引:2,自引:1,他引:2
Wuillemin WA; Minnema M; Meijers JC; Roem D; Eerenberg AJ; Nuijens JH; ten Cate H; Hack CE 《Blood》1995,85(6):1517-1526
From experiments with purified proteins, it has been concluded that factor XIa (FXIa) is inhibited in plasma mainly by alpha 1-antitrypsin (a1AT), followed by antithrombin III (ATIII), C1-inhibitor (C1Inh), and alpha 2-antiplasmin (a2AP). However, the validity of this concept has never been studied in plasma. We established the relative contribution of different inhibitors to the inactivation of FXIa in human plasma, using enzyme-linked immunosorbent assays (ELISAs) for the quantification of complexes of FXIa with a1AT, C1Inh, a2AP, and ATIII. We found that 47% of FXIa added to plasma formed complexes with C1Inh, 24.5% with a2AP, 23.5% with a1AT, and 5% with ATIII. The distribution of FXIa between these inhibitors in plasma was independent of whether FXIa was added to plasma, or was activated endogenously by kaolin, celite, or glass. However, in the presence of heparin (1 or 50 U/mL), C1Inh appeared to be the major inhibitor of FXIa, followed by ATIII. Furthermore, at lower temperatures, less FXIa-C1Inh and FXIa-a1AT complexes but more FXIa-a2AP complexes were formed. These data demonstrate that the contribution of the different inhibitors to inactivation of FXIa in plasma may vary, but C1Inh is the principal inhibitor under most conditions. 相似文献
110.
The purpose of the present study was to investigate a possible seasonal
pattern in various clinical and laboratory manifestations in a group of
systemic lupus erythamatosus (SLE) patients. One hundred and five SLE
patients were followed up during a 4 yr period. Data on each of the
clinical and laboratory variables examined, as well as the results of the
disease activity index (SLEDAI), were plotted against the month during
which they were obtained. Photosensitivity was the only variable to show a
seasonal pattern, having higher scores during the summer months (1.04 +/-
0.16 in July vs 0.58 +/- 0.12 in December). We were unable to show seasonal
patterns in any of the other variables examined. As a group, SLE patients
do not show any significant seasonal pattern in disease manifestations and
activity, except for photosensitivity. However, such a pattern may exist
for the individual patient.
相似文献