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41.
Three recent publications have reported the development of erythema multiforme and Stevens-Johnson syndrome in patients receiving cranial irradiation and sodium phenytoin. Some authors have recommended that patients receiving whole brain radiation therapy and who have had seizures should not be prescribed phenytoin but an alternative anticonvulsant. This article reviews the current literature pertaining to the development of this potentially lethal complication in patients receiving whole brain radiation and phenytoin, with reference to the single recorded case of Stevens-Johnson syndrome in a patient receiving cranial irradiation and phenytoin in Auckland, New Zealand. While the clinical picture in the 16 patients reported in the literature and the current case report differed from the classical form of erythema multiforme, a similar pattern of presentation and outcome appeared in all patients reviewed, suggesting that the combination of phenytoin, cranial irradiation and the gradual reduction of concomitant steroids seem to lead to the development of erythema multiforme and/or Stevens-Johnson syndrome. The data presented, although sparse, suggest that phenytoin should not be prescribed in patients receiving cranial irradiation. 相似文献
42.
1临床资料2002-01/2004-02收治临床症状典型且无并发症毛细支气管炎患儿116例,发病年龄3-24(平均8.4)mo,男61例,女55例,按就诊时间顺序分为氨溴索雾化吸入组(观察组)、氨溴索静脉点滴组(对照Ⅰ组)和常规治疗组(对照Ⅱ组),分别为38,39,39例.常规治疗组给予头孢噻肟钠50mg/kg,2/d及穿琥宁80-120mg/d分别静脉滴注及对症治疗(如吸氧、镇静、退热等处理);观察组在常规治疗的基础上加用氨溴索4mg加生理盐水10mL超声雾化吸入10~15min,2/d; 相似文献
43.
J John LJ Björklund NW Svenningsen B Jonson 《Acta paediatrica (Oslo, Norway : 1992)》1994,83(9):903-909
Failure of neonatal patient triggered ventilation may reflect a delay in delivery of flow relative to the inspiratory effort of the infant. Transmission of diaphragmatic contraction to the sensor site (patient delay) and further transmission to and within the sensing device (device delay) both contribute to the delay in triggering. Patient and device delays were studied for different sensing systems in 36 infants, 24 of whom were intubated. Device delay was long (<40 ms) with a conventional apnoea monitor compared with sensors placed at the airway opening (2 ms), the inspiratory (12 ms) and expiratory (3 ms) pressure transducers of the ventilator, the Graseby capsule (8 ms), strain gauges (3 ms) and oesophageal pressure (6 ms). In near normal infants, the sum of patient and device delays for the latter sensors was less than 20 ms and a minor component of the total delay. However, in severe lung disease the total delay may be more than 100ms even for airway sensors. 相似文献
44.
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46.
Acquired pendular nystagmus: its characteristics, localising value and pathophysiology 总被引:5,自引:4,他引:1 下载免费PDF全文
Investigations were made of 16 patients with acquired pendular nystagmus and a further 32 cases reported in the literature were reviewed. Amongst our own patients two thirds had multiple sclerosis, almost one third a cerebrovascular accident or angioma and two had optic atrophy with squint. The nystagmus took forms which could be monocular or binocular, conjugate or disconjugate and could involve movements about single or multiple axes. Spectral analysis was used to characterise the amplitude and frequency of the movements and to estimate the degree of relationship (coherence) between movements of the two eyes or between movements of one eye about several axes. The oscillations ranged in frequency from 2·5 Hz to 6 Hz, with typical amplitudes between 3° and 5°. In a given patient all oscillations, regardless of plane, were highly synchronised. Somatic tremors of the upper limb, face and palate associated with the nystagmus were often at similar frequencies to the eye movement. The other ocular signs common to all our patients were the presence of squint with failure of convergence. Most patients also had skew deviation or internuclear ophthalmoplegia or both. The major oculomotor systems, that is, saccades, pursuit, optokinetic and vestibulo-ocular reflexes could be intact. It is inferred that the mechanism responsible for the pendular nystagmus lies at a level which is close to the oculomotor nuclei so that it can have monocular effects but is not part of the primary motor pathways. It is possible that this mechanism normally subserves maintenance of conjugate movement and posture of the eyes. The periodicity of the nystagmus is likely to arise from instability in a certain type(s) of neurone, for the associated somatic tremors have similar characteristics and yet involve very different neuronal muscular circuitry. Prognosis for cessation of the nystagmus is poor. In five patients with multiple sclerosis it was suppressed by intravenous hyoscine with, however, unacceptable subsequent side effects. 相似文献
47.
Understanding diet and energy balance as risk factors for breast, colon,
and other cancers requires information on the contribution of each factor
and of interactions among factors to cancer risk. Rodent models for breast
cancer provide extensive data on effects of dietary fat and calories,
energy balance, body weight gain, and physical activity on tumor
development. Analyses of the combined data from many studies have shown
clearly that quality and quantity of dietary fat and energy balance
contribute independently to increased mammary gland tumorigenesis. These
findings were seen in female rats fed diets high in fat (35-40% of
calories) compared to rats fed control diets, with approximately 10% of
calories as fat (Fay and Freedman, 1997, Breast Cancer Res. Treat. 46,
215-223). The methods used permit comparison of experimental and
epidemiological data, and they may be useful in extrapolating between
species and developing public health recommendations. In addition to the
contributions of lifetime-diet composition, intake, energy balance, and
physical activity to cancer risk, there are questions about the timing and
duration of alterations in these factors and about the "dose-response"
characteristics of cancer risk to the factors. Endocrine mechanisms may be
significant in mammary gland tumor risk, but experimental and
epidemiological data indicate that cancers at other sites, such as colon
and liver, also are influenced by the factors listed. Other diet and
lifestyle factors that influence energy, or specifically fat, metabolism
may also affect risk for cancers that are promoted by increased intake of
fat and calories. Studies of separate and interactive effects of dietary
fat, black tea, weight gain, and mammary gland tumorigenesis (Rogers, et
al, 1998, Carcinogenesis 19, 1269-1273) have been analyzed. Using
adjustment of carcinogenesis endpoints for body weight, tumor burden, and
latency, they were found to be related to weight gain within treatment
groups in 2 of 3 experiments.
相似文献
48.
Meniscal injuries: detection using MR imaging 总被引:15,自引:0,他引:15
Reicher MA; Hartzman S; Duckwiler GR; Bassett LW; Anderson LJ; Gold RH 《Radiology》1986,159(3):753-757
Both retrospective and blinded analyses of thin-section, high-resolution magnetic resonance (MR) images of the knee joint, produced using a solenoid surface coil, indicate that MR imaging is an effective technique for evaluating meniscal injuries. Images of 49 patients were evaluated, and the results were correlated with those of subsequent arthroscopy. A grading scale was developed to rate the index of suspicion of a meniscal tear based on the MR images. Overall, approximately 80% of menisci rated grade 4 (definite tear) or 3 (probable tear) were found to have corresponding tears at arthroscopy. In many other patients with a grade 4 or 3 meniscus in whom a corresponding tear was not found arthroscopically, meniscal tears at other sites or other abnormalities were correctly diagnosed using MR. A majority of the false-positive MR images involved the posterior horns of the menisci, the sites of most false-negative arthroscopic diagnoses. The predictive value of a negative MR image was almost 100%. Even in patients with moderate-to-large effusions, the menisci were accurately evaluated. The results imply that MR imaging is useful in the preoperative evaluation of suspected meniscal tears. 相似文献
49.
Chlorpropamide-induced pure white cell aplasia 总被引:2,自引:0,他引:2
We investigated the mechanism for isolated agranulocytosis and marrow pure white cell aplasia in an elderly man receiving 0.5 to 1.0 g per day of chlorpropamide (Chl) without other toxic drug exposure or overt systemic illness. Patient marrow revealed an absence of recognizable granulocytic precursors; megakaryocytes and erythroid precursors were normal. The WBC count was 1800/mm3 on admission with only 2% neutrophils; the absolute neutrophil count first exceeded 500/mm3 on the 17th day following cessation of Chl. A serum Chl level on admission was 100 micrograms/mL (acute phase, AP); no Chl was detected in serum (convalescent phase, CP) assessed on the 22nd hospital day. Antineutrophil antibodies were not detected, and T cell depletion failed to augment patient in vitro granulopoiesis. Patient AP serum produced potent complement-mediated inhibition (87% +/- 7%) of autologous granulocyte progenitors (CFU-GM) with minimal inhibition of erythroid (11% +/- 5%) or multipotent (5% +/- 4%) progenitor cells. Selective inhibition by patient AP serum of CFU-GM (74% +/- 11%) was also seen against two allogeneic marrows. Patient CP serum no longer inhibited (6% +/- 4%) autologous CFU-GM. Addition of Chl (5 to 120 micrograms/mL) to CP serum but not to control serum resulted in potent drug concentration-dependent complement-mediated inhibition of autologous and allogeneic CFU-GM. Inhibition of CFU-GM in the presence of Chl was no longer demonstrable following immunoabsorbent removal of IgG from patient serum. Patient serum in the presence of Chl had limited activity against morphologically recognizable marrow granulocytic precursors in a microimmunofluorescence assay. These results are most consistent with the development of Chl-dependent, selective antibody-mediated immune inhibition of granulopoiesis. 相似文献
50.
T Sand LJ Stovner G Myhr O Sjaastad 《Cephalalgia : an international journal of headache》1990,10(1):9-16
Various possible risk factors for postlumbar puncture (and postiohexol-myelographic) headache and associated side effects were analysed. Headache and nausea occurred significantly more often in patients without clinical findings than in those with findings. We found significantly different incidences of severe headache and nausea between diagnostic subgroups after a lumbar puncture. The greatest headache incidence was found in patients without a definite neurological diagnosis, while nausea occurred most frequently in patients with various painful disorders. Following iohexol myelography, nausea occurred most often in patients who had a history of previous mental symptoms and in patients with a history of previous headache disorders. Mental symptoms were more frequently reported in patients who also had experienced mental symptoms previously. The relationship between side effects and negative clinical findings was stronger than the relationship between side effects and previous mental symptoms. 相似文献