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101.
A Decade of Change in Obesity Surgery 总被引:4,自引:0,他引:4
Edward E Mason MD PhD Shenghui Tang MS Kathleen E Renquist BS Dwight T Barnes Joseph J Cullen MD Cornelius Doherty MD James W Maher MD 《Obesity surgery》1997,7(3):189-197
Background: The International (formerly National) Bariatric Surgery Registry began collecting data in January 1986. The aim
of this study was to examine changes in the practice of surgical treatment of severe obesity that occurred during the decade
of 1986 through 1995, as observed in the IBSR data. Methods: All data submitted to the IBSR during the decade were transferred
to the IBM mainframe computer for analysis. Characteristics of operative type populations were compared over time using analysis
of variance (ANOVA) for age, body mass index (BMI), operative weight and Chi-square (χ2) test for gender. Results: There has been a steady increase over the decade in mean patient weight. The operations used have
changed from predominantly ‘simple’ operations to more frequent use of ‘complex’ operations. Within the categories of ‘simple’
and ‘complex’, an increase in the variety of operations occurred. As a group, patients with ‘simple’ operations have been
heavier, more often male and public pay patients than those who have undergone ‘complex’ operations. One year weight loss
was greater for Roux-en-Y gastric bypass (RGB) than vertical banded gastroplasty (VBG), but follow-up rates were too low to
study the relative merits of the operations used. The reported incidence of operative mortality and serious complications
(leak with peritonitis, abscess and pulmonary embolism) remained low. Conclusions: These observations and their implications
can be summarized in three statements which relate to action for improved patient care in the beginning of the new century:
(1) increasing weight of candidates for surgical treatment during this decade indicates the need for earlier use of operative
treatment before irreversible complications of obesity can develop; (2) low risk of obesity surgery, decreasing postoperative
hospital stay, and early weight control support the continued and increased use of surgical treatment; (3) continued widespread
use of both ‘simple’ and ‘complex’ operations with increased modifications of standard RGB and VBG procedures emphasizes the
need for standardized long-term data and analyses regarding both weight control and postoperative side-effects. 相似文献
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Dr. Michael Gosland Pharm.D. Dr. Bert Lum Pharm.D. Dr. Julia Schimmelpfennig Pharm.D. Dr. James Baker Pharm.D. Dr Michael Doukas M.D. 《Pharmacotherapy》1996,16(1):16-39
Cisplatin in combination with other cytotoxic agents is the backbone for a potential cure of testicular germ cell neoplasms and is a critical factor in the substantial activity observed in the treatment of small cell lung cancer, bladder cancer, and ovarian germ cell tumors. Resistance to cisplatin at the onset of treatment or at relapse limits its curative potential, however. Laboratory studies using both cells selected for cisplatin resistance by exposure to sublethal concentrations and biopsy specimens from patients' tumors provide insights for the potential mechanisms of resistance. The mechanisms identified in vitro include a complex and wide array of related and unrelated pathways such as alterations in cellular drug transport, enhanced DNA repair dependent and independent of signal transduction pathways, and enhanced intracellular detoxification such as glutathione and metallothionein systems. Studies of these mechanisms have identified a number of agents with known potential for administration to humans and that reverse cisplatin resistance in vitro; for example, reversal of cellular accumulation defects by dipyridamole; inhibition of DNA repair by hydroxyurea, pentoxifylline, and novobiocin; inhibition of the glutathione system by ethacrynic acid and buthionine sulfoximine; and inhibition of signal transduction pathways by cyclosporine, tamoxifen, and calcium channel-blocking agents. Current phase I clinical trials are focusing on the most effective doses and schedules to administer these agents in combination with cisplatin. Initial uncontrolled trials in limited numbers of patients suggest that the addition of modulators of cisplatin has the potential to reverse resistance in patients previously failing therapy. Another promising avenue for circumventing cisplatin resistance is the development of noncross-resistant platinum analogs. 相似文献
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It is well established that painful distension of hollow viscera such as the oesophagus can evoke a reflex tachycardia and pressor response; however, the nature of the oesophageal afferent pathway(s) remains controversial. This study investigated the afferent arc which mediates these reflex cardiovascular changes in the decerebrate rat. In addition, the effect of oesophageal distension on the respiratory activity of the costal diaphragm was studied. Focal distension of the oesophagus (volume of 0.3 ml applied for 10 s) just above the diaphragmatic hiatus evoked a reproducible pressor response and tachycardia in the decerebrate rat. Respiration was transiently inhibited at the beginning of oesophageal distension and prior to the rise in blood pressure. Neuromuscular blockade with the nicotinic acetylcholine receptor blocker alpha-bungarotoxin (140 microg bolus) had no effect on the magnitude of the cardiovascular response. Therefore the efferent supply to the striated muscle of the rat oesophagus was not essential in mediating this reflex. Signal averaging of the mean blood pressure response showed that neither selective ablation of oesophageal spinal afferents nor bilateral vagotomy altered the early trajectory of the pressure response. Bilateral vagotomy reduced the peak magnitude of the response to sustained oesophageal distension. In contrast, selective removal of spinal afferents had no effect on the response. Ablation of both neural pathways was essential to abolish the reflex cardiovascular and respiratory responses. It can be concluded that both vagal and spinal afferent pathways are utilised in the reflex cardiorespiratory response to painful oesophageal distension. Although ablation of one neural pathway had no effect on the response it was still implicated in the reflex, since ablation of both pathways was necessary to prevent the cardiorespiratory changes. This study emphasises the need for caution when inferences are made concerning single selective ablations of multiply innervated organs. 相似文献
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109.
Alpha-adrenoreceptor reagents. 4. Resolution of some potent selective prejunctional alpha 2-adrenoreceptor antagonists 总被引:1,自引:0,他引:1
A P Welbourn C B Chapleo A C Lane P L Myers A G Roach C F Smith M R Stillings I F Tulloch 《Journal of medicinal chemistry》1986,29(10):2000-2003
The resolution of three 2-substituted derivatives of idazoxan is described. The enantiomers show large separations in activity in a variety of in vitro and in vivo tests, and the active isomers are all potent and selective antagonists at the alpha 2-adrenoreceptor. The significance of these results in relation to those published on the enantiomers of idazoxan and to those on optically active alpha 2-adrenoreceptor agonists is discussed. 相似文献
110.
Joshua E. Lane MD Christopher M. Peterson MD John L. Ratz MD 《Dermatologic surgery》2002,28(7):617-618
BACKGROUND: Pearly penile papules are angiofibromas found on the corona and sulcus of the glans penis. While these represent a benign condition, psychological and cosmetic concerns often prompt patients to seek therapeutic removal of these lesions. Multiple therapeutic modalities have been reported; however, use of CO2 laser has proven to be the most effective to date. OBJECTIVE: To demonstrate the efficacy of CO2 laser in treating pearly penile papules. METHODS: Case report. RESULTS: We report the successful treatment of pearly penile papules in an African American man with CO2 laser. CONCLUSION: The use of CO2 laser is an effective treatment for pearly penile papules. J. E. Lane, MD, C. M. Peterson, MD, and J. L. Ratz, MD have indicated no significant interest with commercial supporters. 相似文献