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11.
Summary Forty three patients, admitted to the department of Neurological Surgery for management of central nervous system tumours, were studied pre-operatively for serum myelin basic protein immunoreactivity as a marker of central nervous system lesion and for circulating immunoglobulins and complement (C3) levels. Myelin basic protein concentration did not appear to correlate with tumour type or grade. Serum immunoglobulin levels were found to be within the normal range but the mean IgM level was significantly higher in the glioma group when compared with meningiomas. 相似文献
12.
There have been significant changes in the doctor patient relationship with the impact of technology in day-to-day practice. More and more patients are aware of their rights and are keen to make free choice and decision on their treatment. This helps them to choose the treatment of their choice from the options available and to select a physician of their choice. Doctor's decisions are being questioned regarding their correctness and there is a need to educate the patient, on what one offers by way of treatment. In some procedures and types of treatment, patient needs to be educated and informed of the merits and demerits of the treatment available. This will help the patient to make appropriate choice and also to accept some adverse outcome of treatment. Towards this end, all countries are looking afresh at the necessity of Informed Consent. Methods adopted by some countries are highlighted to help our physicians practice them in an appropriate way. A lot of remedial work needs to be done to minimize future litigation, as many doctors misunderstand their legal obligations and haven't caught up with the change in judge's thinking. 相似文献
13.
A case of hypochloraemic metabolic alkalosis in an infant with chloride losing ileostomy drainage and cystic fibrosis is described. It is speculated that intestinal loss of chloride played a major role in the development of metabolic alkalosis. 相似文献
14.
Results of randomized controlled trials of low-versus high-osmolality contrast media 总被引:1,自引:0,他引:1
The authors reviewed 100 randomized controlled trials (RCTs) conducted in humans to compare safety or efficacy of new low-osmolality contrast media (LOM) with that of high-osmolality contrast media (HOM). Findings of the 43 RCTs judged to be of the highest quality suggest that the efficacy of LOM in imaging is equal or superior to that of HOM for all routes of administration. Heat sensation occurred less often with LOM for all routes and pain occurred less often with LOM for intraarterial routes. No differences were seen in nephrotoxicity or in frequency of nausea, vomiting, urticaria, bronchospasm, laboratory test abnormalities, or neurologic events. Greater cardiovascular changes were seen with HOM, including increased or decreased heart rate, increased left ventricular end-diastolic pressure, decreased systolic pressure, and QT prolongation, depending on route of administration. To demonstrate whether a reduction in clinically significant adverse outcomes truly occurs with LOM, trials will need to enlist larger numbers of patients and employ appropriate outcome measures. Future trials should stratify patients according to their risk of adverse reactions to provide better information about benefits of LOM in low- versus high-risk patients. 相似文献
15.
Dunnick NR; Svetkey LP; Cohan RH; Newman GE; Braun SD; Himmelstein SI; Bollinger RR; McCann RL; Wilkinson RH Jr; Klotman PE 《Radiology》1989,171(1):219-222
Intravenous digital subtraction renal angiography (DSRA) has been compared with conventional angiography only in small, selected series of hypertensive patients. The authors prospectively examined with intravenous DSRA 94 patients at increased risk for renovascular hypertension and compared these studies with conventional angiography. A stenosis of at least one main renal artery was identified with intravenous DSRA in 22 patients and confirmed in 20 patients. No significant stenoses were seen with conventional angiography in any of the 64 patients in whom lesions were not seen with intravenous DSRA. Since inadequate DSRA studies were considered positive for renal artery stenosis, the sensitivity of intravenous DSRA was 100% (25 of 25); specificity, 93% (64 of 69); positive predictive value, 83% (25 of 30); and negative predictive value, 100% (64 of 64). The authors conclude that intravenous DSRA is a sensitive test for identifying stenosis of the main renal arteries and is appropriate to use as a screening test among patients at increased risk for renovascular hypertension. 相似文献
16.
Cyclosporin nephrotoxicity in heart and lung transplant patients 总被引:1,自引:0,他引:1
Griffiths MH; Crowe AV; Papadaki L; Banner NR; Yacoub MH; Thompson FD; Neild GH 《QJM : monthly journal of the Association of Physicians》1996,89(10):751-763
Twenty-two patients with heart, lung or heart and lung transplants
maintained on cyclosporin for periods ranging from 3 months to 10 years
developed renal insufficiency which was investigated by renal biopsy. The
histopathological changes were: (i) severe vascular and glomerular damage
due to thrombotic microangiopathy (TM); (ii) a form of focal segmental
glomerulosclerosis (FSGS); (iii) glomerular ischaemia. Rather than being
separate entities, these changes appeared to represent a spectrum of
pathology, some biopsies showing all three forms of glomerular injury. In
all cases the glomerular changes were accompanied by arteriolar and
arterial pathology, and we identified novel ultrastructural changes in the
arteriolar endothelial basal lamina. Tubular atrophy was a consistent
feature, the severity of which reflected the severity of the glomerular
sclerosis, and which appeared to be a consequence of glomerular loss. Our
findings are consistent with the nephrotoxic effects of cyclosporin being
mediated chiefly via damage to preglomerular vessels and glomerular
capillary endothelium. From an analysis of the clinical aspects of these
cases, the effects of cyclosporin appear to be to some extent
idiosyncratic, and therefore not entirely preventable, but strict
monitoring of blood cyclosporin levels is essential to minimize the risk of
permanent renal damage. Monitoring urinary protein in addition to plasma
creatinine may detect the onset of FSGS, as proteinuria precedes creatinine
elevation.
相似文献
17.
18.
Expression of phosphorylcholine-specific B cells during murine development 总被引:1,自引:0,他引:1 下载免费PDF全文
NH Sigal AR Pickard ES Metcalf PJ Gearhart NR Klinman 《The Journal of experimental medicine》1977,146(4):933-948
The TEPC 15 (T15) clonotype, a putatively germline antibody specificity, does not appear in the neonatal B-cell repertoire until approximately 1 wk of age. This report extends this observation by the demonstration that (a) the T15 clonotype follows similar kinetics of appearance in germfree as well as conventionally-reared mice; (b) maternal influences and genetic background play a minor role in the development of the T15 clonotype since CBFI neonates raised by C57BL/6 or BALB/c mothers acquire the T15 clonotype at the same time in ontogeny as BALB/c neonates; (c) the lack of phosphorylcholine (PC)-specific B cells shortly after birth is reflected in a dearth of PC-binding cells in the neonate as well; and (d) no PC-specifc B cells are found in 19-day fetal liver or in bone marrow until 7 days of life, coincident with their appearance in the spleen. These findings, along with a previous report that PC-specific splenic B cells are tolerizable as late as day 10 after birth, confirm the invariant, late occurrence of the T15 clonotype and support a highly- ordered, rigorously predetermined mechanism for the acquisition of the B- cell repertoire. The results are discussed in light of other studies on the ontogeny of B-cell specificity, and in terms of the implications on the mechanism by which antibody diversity is generated. 相似文献
19.
Tumor necrosis factor alpha-induced endothelial tissue factor is located on the cell surface rather than in the subendothelial matrix 总被引:3,自引:0,他引:3
Mulder AB; Hegge-Paping KS; Magielse CP; Blom NR; Smit JW; van der Meer J; Hallie MR; Bom VJ 《Blood》1994,84(5):1559-1566
Because there is no consensus regarding the precise distribution of induced endothelial tissue factor (TF), we studied TF activity in and on tumor necrosis factor alpha-stimulated cultured human umbilical vein endothelial cells (ECs) and their underlying matrix. TF was mainly expressed on the cell surface. Only small traces were found on the apical surface suggesting that TF is predominantly located on the basolateral side of the cell membrane. The presence of TF on the cell surface was confirmed by flow cytometry. Subendothelial TF activity appeared to be dependent upon the procedure used to remove the stimulated EC monolayer. Whereas ammonium hydroxide or hypotonic lysis resulted in relatively high levels of matrix-associated TF, virtually no TF was found on the matrix after mild enzymatic detachment of stimulated ECs. Cell removal with EDTA resulted in intermediate levels of matrix-associated TF. Neither the enzymatic treatment nor EDTA degraded or removed this TF activity. Similar patterns were observed for matrix-associated TF antigen and EC surface markers. Electron microscopic analysis showed cell fragments on the matrix after monolayer lysis. The findings strongly suggest that induced endothelial TF associated with the subendothelial matrix actually represents TF on EC remnants. 相似文献
20.
ZJ Daruwalla KL Davies A Shafighian NR Gillham 《Annals of the Royal College of Surgeons of England》2012,94(7):496-501