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661.
Patients, clinicians, and the science of investigation 总被引:1,自引:0,他引:1
662.
The records of all patients who had dudenojejunal manometry (DJM) from 1989 to 1995 were retrospectively reviewed. We evaluated the main symptoms of the patients, the indication for the study, its result, and the impact on therapy and management. One hundred sixteen patients out of 154 were included in the study, of whom 96 were women and 20 were men, with a mean age of 41.2 years. Twenty-five had perfused tube studies, and 91 had prolonged ambulatory recordings. Forty-one patients were referred for evaluation of abdominal pain, 34 for chronic constipation, 24 for nausea and vomiting, 8 for pseudoobstruction, and the remaining 9 for other reasons. All patients had appropriate endoscopic, radiographic, or scintigraphic studies prior to manometry. Forty-seven (40.5%) had abnormal manometry: 20 of 41 (48.8%) for abdominal pain, 7 of 34 (20.6%) for chronic constipation, 10 of 24 (41.7%) for nausea and vomiting, 5 of 8 (62.5%) for pseudoobstruction, and 5 of 9 (55.6%) for the miscellaneous group. The various subgroups did not have specific patterns of motor abnormalities. In 22 patients (18.9%) manometry helped in the choice of therapy: in 15 patients by affecting surgical approach, particularly in the constipation group, and in 7 patients by affecting feeding options and prokinetic agents. Detection of motor abnormalities was helpful in patients with severe symptoms thought to have functional disease even when no specific therapy was rendered. Thus, DJM was abnormal in ? patients referred for evaluation of suspected motility disorders. It directly affected therapy in approximately ? patients, particularly in those with constipation. It is helpful in the management of patients even when specific therapy is not rendered, particularly in those with abdominal pain. The modest impact on specific therapy is related to limited availability of effective prokinetic drugs and the limited specificity and predictive value of tests results. 相似文献
663.
Israel is a small country with a unique trauma system that was developed from the experience gained in peace and in war. That trauma system was designed to fit the state's current health system, which is different from the European and American systems. This article describes the infrastructure of both prehospital and in-hospital trauma management, as well as the main cornerstones of their development. The experience that was gained from multiple mass casualty incidents is discussed. The protocols of mass casualty management in the prehospital and in-hospital setup are described. 相似文献
664.
665.
The common 'thermolabile' variant of methylene tetrahydrofolate reductase is a major determinant of mild hyperhomocysteinaemia 总被引:11,自引:0,他引:11
Harmon DL; Woodside JV; Yarnell JW; McMaster D; Young IS; McCrum EE; Gey KF; Whitehead AS; Evans AE 《QJM : monthly journal of the Association of Physicians》1996,89(8):571-577
Mild hyperhomocysteinaemia is a major risk factor for vascular disease and
neural tube defects (NTDs), conferring an approximately three-fold relative
risk for each condition. It has several possible causes: heterozygosity for
rare loss of function mutations in the genes for 5,10-methylene
tetrahydrofolate reductase (MTHFR) or cystathionine-&bgr;-synthase
(CBS); dietary insufficiency of vitamin co-factors B6, B12 or folates; or
homozygosity for a common 'thermolabile' mutation in the MTHFR gene which
has also been associated with vascular disease and NTDs. We quantified the
contribution of the thermolabile mutation to the hyperhomocysteinaemic
phenotype in a working male population (625 individuals). Serum folate and
vitamin B12 concentrations were also measured and their relationship with
homocysteine status and MTHFR genotype assessed. The homozygous
thermolabile genotype occurred in 48.4, 35.5, and 23.4% for the top 5, 10
and 20% of individuals repectively) ranked by plasma homocysteine levels,
compared with a frequency of 11.5% in the study population as a whole
establishing that the mutation is a major determinant of homocystein levels
at the upper end of the range. Serum folate concentrations also varied with
genotype, being lowest in thermolabile homozygotes. The MTHFR thermolabile
genotype should be considered when population studies are designed to
determine the effective homocysteine-lowering dose of dietary folate
supplements, and when prophylactic doses of folate are recommended for
individuals.
相似文献
666.
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