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11.
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
12.
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
13.
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
14.
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
15.
JJ Rangasami DC Greenwood B McSporran PJ Smail CC Patterson NR Waugh 《Archives of disease in childhood》1997,77(3):210-213
OBJECTIVES: To calculate the incidence of type 1 diabetes in Scottish children aged less than 15 years between 1984 and 1993; to examine changes in incidence; and to calculate the prevalence of diabetes at the end of this period. DESIGN: Three data sources were used to construct the Scottish Study Group for the Care of Young Diabetics register: active reporting of all new cases; reports from the Scottish Morbidity Register 1; and local registers. SUBJECTS: All children resident in Scotland diagnosed with primary insulin dependent diabetes mellitus when less than 15 years of age between 1984 and 1993. MAIN OUTCOME MEASURES: Annual incidence and prevalence rate for Scotland; time trend in incidence over the 10 years; differences in incidence between the three different age groups; and completeness of the register. RESULTS: The average annual incidence for Scotland was 23.9/100,000 children. The prevalence rate was 1.5/1000 in 1993. A total of 2326 cases was identified from the three sources. Capture-recapture analysis suggests a case ascertainment of 98.6%. The annual incidence rates increased at a rate of 2% each year (rate ratio = 1.02, 95% confidence interval (CI) 1.01 to 1.03). The incidence was higher in boys than girls (rate ratio = 1.08, 95% CI 1.00 to 1.18), and the incidence rates increased with age: 15.3/100,000/year for age 0-4 years, 24.4/ 100,000/year for age 5-9 years, and 31.9/ 100,000/year for age 10-14 years. CONCLUSIONS: The incidence of type 1 diabetes in Scotland is increasing and the prevalence is relatively high. These findings have important implications for health service resource allocation. The Scottish Study Group for the Care of Young Diabetics' register provides a base for monitoring and research. 相似文献
16.
The palpation and enucleation of occult insulinomas (less than 15 mm) can be a difficult surgical problem even with good arteriographic localization. In the authors' limited experience, confirmation of arteriographic findings by pancreatic venous sampling provided little additional localizing information. However, if arteriography is negative or equivocal, venous sampling can indicate the segment of pancreas to be "blindly" resected if the adenoma is not palpable. Venous sampling may be misleading in polyendocrine syndromes because of the frequency of multiple adenomas and variable hormone production. 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
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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