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991.
S.A. GEORGE D.J. BILSLAND N.J. WAINWRIGHT J. FERGUSON 《The British journal of dermatology》1993,128(3):301-305
Despite a widely held belief that the use of emollients prior to broad-band UVB irradiation accelerates clearance of psoriasis, only one single-blind controlled study exists in support of this. No similar study has been carried out with photochemotherapy (PUVA) or narrow-band UVB (311–313 nm) phototherapy. As some emollients absorb UV radiation, and thereby inhibit psoriasis clearance, there is a need to identify emollients suitable for pre-irradiation use. Coconut oil may be useful in this respect. In two randomized groups of patients with chronic plaque psoriasis undergoing either routine PUVA(n=14) or narrow-band UVB phototherapy (n=15), a single-blind controlled (half-body) study was undertaken to assess the died of pre-irradiation application of coconut oil. Patients were given PUVA twice weekly, or TL-01 therapy thrice weekly. The initial UV dose was 70% of previously determined minimal phototoxic (MPD) or minimal erythema doses (MED), with 40% incremental steps at each visit (reduced if adverse effects occurred). Psoriasis severity was scored on each side after every three treatments. No significant acceleration of psoriasis clearance was seen in either group. We do not, therefore, recommend the routine use of emollients prior to PUVA or TL-01 therapy when using near erythemogenic irradiation regimens. 相似文献
992.
The nature and extent of aggressive behaviour amongst people with learning difficulties (mental handicap) in a single health district 总被引:1,自引:0,他引:1
P. HARRIS 《Journal of intellectual disability research : JIDR》1993,37(3):221-242
ABSTRACT. This paper describes the method and results of a survey of aggressive behaviour amongst people with learning difficulties. The study was confined to a single health district in the South Western Region of the UK with a general population of about 370000. At the time of the survey, the Handicap Register for the district recorded 1362 people as having a learning difFiculty. The overall prevalence of aggressive behaviour amongst people with learning difficulties for whom base population data was available was 17.6%. The lowest rate was identified amongst day facilities (9.7 %) and the highest in hospitals within the district (38.2%). The prevalence rate amongst those attending schools for children with severe learning difSculties was 12.6%. Proportionately more males than females were reported to present problems of aggressive behaviour. The gender difference appeared to be largely accounted for by the disproportionate number of men identified within day facilities. There was no significant evidence of an association between the person's gender and the presence aggressive behaviour within schools or hospitals. The results indicated that, although physical and verbal aggression were the most frequently reponed behaviours, many of the sample were also said to engage in other forms of challenging behaviour, particularly self-injurious, ritualistic, stereotypical and withdrawn behaviour. The risk of a serious or very serious injury to another person was very low; 0.7% or six people with learning difiSculties firom the district were reponed to be currently presenting such a risk. Similarly, only 2% of the base population (n=18) were reponed to be extremely difficult to manage. The implications of the findings are discussed. 相似文献
993.
Nine hundred and three patients undergoing diagnostic peritoneal lavage (DPL) over a 6-year period were retrospectively reviewed to evaluate the utility of the white blood cell (WBC) count in the lavage fluid. Eleven patients (1.2%) had dialysate WBC counts greater than 500/mm3, with erythrocyte counts less than 10(5)/mm3. Nine of these patients who were lavaged within 4 hours of injury had no intra-abdominal pathology. Two patients, lavaged after 4 hours, demonstrated intra-abdominal injury. Two hundred twenty-three patients (24.7%) had grossly clear dialysate which was not sent for laboratory analysis. None of these patients required laparotomy. We conclude that the WBC count in DPL fluid is of no diagnostic value in victims of blunt abdominal trauma who are lavaged within 4 hours of injury. In addition, laboratory analysis of clear dialysate is not required in these patients. 相似文献
994.
Gonadoblastoma, a rare gonadal neoplasm, presents most frequently in phenotypic female or phenotypically male patients with dysgenetic gonads or undescended testes. To date, only 2 cases of gonadoblastoma have been reported in anatomically normal male patients with scrotal testes. Both of these patients presented with testicular masses and germ cell tumors. We report a case of a genotypically and phenotypically normal, fertile man with descended testes who on evaluation for chronic orchialgia had a gonadoblastoma unaccompanied by a germ cell neoplasm. The tumor was nonpalpable and was initially discovered on scrotal ultrasound. 相似文献
995.
Gallstone dissolution 总被引:2,自引:0,他引:2
Many methods are available for gallstone dissolution, including oral bile salts; cholesterol solvents such as mono-octanoin or methyl tert-butyl either; and calcium or pigment solvents such as EDTA and polysorbate. Which of these approaches will be appropriate for an individual patient depends on the type of stones; whether they are in the gallbladder or the bile ducts; whether access to the biliary tree is available; the patient's age and general medical condition; and the availability of necessary expertise. In the US, both chenodeoxycholate and ursodeoxycholate are now available. Ursodeoxycholate is more expensive but appears to produce fewer side effects and may be more efficacious. These agents are most effective in thin women with small floating, radiolucent cholesterol stones in a functioning gallbladder. Only about half of the small subset of patients will experience partial or complete dissolution of stones within a year. Stone recurrence and the potential toxicity of long-term therapy are problems with this approach. Therefore, for most patients, cholecystectomy, either in the traditional fashion or using a laparoscopic approach (see article later in this issue by Gadacz et al), is the most cost-effective and perhaps the safest option. Intragallbladder instillation of methyl tert-butyl ether probably will be applicable only to a small subset of patients, and treatment is likely to be followed by a high recurrence rate. In patients with retained common duct cholesterol stones and access to the biliary tree, mono-octanoin therapy is advantageous in that it can be initiated as soon as cholangiography demonstrates no extravasation. In properly selected patients, a 90% success rate with this technique can be expected within 7 days. 相似文献
996.
B L Thiele 《The Surgical clinics of North America》1990,70(1):1-11
The diversity of testing methodologies and reporting practices has necessitated that standards be defined for both performance of testing as well as interpretation and reporting of results. The guidelines to be used for the noninvasive diagnosis of extracranial vascular disease and the rationale for their use are presented. Emphasis is placed upon realistic diagnostic features that have clinical relevance and the use of testing methods that can identity these features. Further developments in this field, particularly those addressing the overall performance of vascular diagnostic laboratories, are to be defined by a multiprofessional inter-societal commission in the near future. It is anticipated that a voluntary accreditation process will insure high quality of testing. 相似文献
997.
Technetium-99-labelled methylene diphosphonate uptake scans in patients with dialysis arthropathy 总被引:1,自引:0,他引:1
Patients on long-term haemodialysis suffer from dialysis arthropathy due to the deposition of dialysis amyloid. We investigated the use of 99Tc-labelled methylene diphosphonate bone scans in 17 patients as a possible in vivo diagnostic technique. In most clinically affected joints, with the exception of shoulders and hands, there was increased radioisotope uptake consistent with uptake by periarticular bone. In addition, we describe intense soft-tissue uptake around some clinically affected large joints. In contrast, control groups of patients on haemodialysis without arthropathy and patients without renal failure did not have increased uptake. A semi-quantitative scale of uptake was devised, and the following correlations were significant: pain perception and isotope uptake score in the ankles and feet, and the number of radiological lesions and isotope uptake scores in the wrists and knees. The following sites where the radioisotope might bind in the affected joints are proposed: amyloid deposits, areas of soft-tissue calcification, or areas of increased bone turnover. It is concluded that whereas the scanning technique cannot make a definite diagnosis of amyloid and, therefore, cannot be expected to supersede histological diagnosis, it is a useful adjuvant investigation, of particular importance in those patients unable or unwilling to undergo biopsy. 相似文献
998.
G Hasselgren R Jerre M Ullman A T?rnvall S Edshage 《The Journal of hand surgery, European volume》1990,15(1):35-39
Eleven patients with lunatomalacia were treated by excision of the lunate and instillation of liquid silicone. The silicone vulcanised and formed an in-situ molded prosthesis. The patients were reexamined after a mean of 7.1 years. Four patients were pain-free and two had pain only at work; three had not been improved by the operation and two had undergone arthrodesis. The patients with good results all belonged to group IV pre-operatively. Surprisingly, no patient showed any sign of silicone synovitis, although all the prostheses except one had either fractured or deformed. The reasons for this are discussed and the indications for the operation established. 相似文献
999.
Summary This study explores the effects of a calcium-deficient diet on patterns of bone remodeling, and examines regional differences
in the amount of bone lost. Skeletally mature female rabbits (n=6) were fed a calcium-deficient diet (0.10% Ca2+ and 0.50% P) for 14 weeks. A separate group of rabbits (n=4) were fed a maintenance diet (1.2% Ca2+ and 0.45% P). Bone mineral content, serum calcium, and serum phosphorus were measured each week during the experimental period.
Following sacrifice, the L3 vetebra, femoral head, proximal tibial metaphysis, and tibial midshaft were analyzed histomorphometrically. Rabbits had 20%
less vertebral bone after only 14 weeks of a calcium-deficient diet. As in human postmenopausal osteoporosis, bone loss in
calcium-deficient rabbits occurs in the trabecular bone of the lumbar spine before that in the trabecular bone of the lower
extremity. Calcium-deficient diets alone do not lead to increased osteoid volume or thickness. Because bone loss is relatively
rapid and because the pattern of loss is similar in some respects to that found in humans, adult rabbits may provide an attractive
model of calcium deficiency osteoporosis in a skeletally mature mammal in which remodeling is predominant over modeling. 相似文献
1000.
T. M. Skerry M.D. M.R.C.V.S. R. Suswillo A. J. El Haj N. N. Ali R. A. Dodds L. E. Lanyon 《Calcified tissue international》1990,46(5):318-326
Summary Previous studies of Alcian blue-induced birefringence in adult avian cortical bone showed that a short period of intermittent
loading rapidly produces an increased level of orientation of proteoglycans within the bone tissue. In the absence of further
loading, this persists for over 24 hours. We have proposed that this phenomenon could provide a means for “capturing” the
effects of transient strains, and so provide a persistent, constantly updated strain-related influence on osteocyte populations
related to the bones' averaged recent strain history, in effect, a “strain memory” in bone tissue. In our present study, we
use the Alcian blue-induced birefringence technique to demonstrate that proteoglycan orientation also occurs after intermittent
loading of both cortical and cancellous mammalian bonein vivo andin vitro. We also show that the change in birefringence is proportional to the magnitude of the applied strain, and that the reorientation
occurs rapidly, reaching a maximal value after only 50 loading cycles. Examination of electron micrographs of bone tissue
after staining with cupromeronic blue allows direct visualization and quantification of the change in proteoglycan orientation
produced by loading. This shows that intermittent loading is associated with a realignment of the proteoglycan protein cores,
bringing them some 5 degrees closer to the direction of collagen fibrils in the bone matrix. 相似文献