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991.
J. G. Boonstra Johan W. van der Pijl Yves F. C. Smets Herman H. P. J. Lemkes Jan Ringers Leendert A. van Es F. J. van der Woude Jan A. Bruijn 《Transplant international》1997,10(6):451-456
To examine the incidence of interstitial and vascular
rejection in pancreas allografts and its impact on graft survival, we studied 36 percutaneous pancreas biopsies and 10 pancreas
transplantectomy specimens from 32 patients who had undergone simultaneous pancreas-kidney transplantation. Interstitial rejection
(IR) was predominantly found in the biopsies, while vascular rejection (VR) was most prominent in the transplantectomies.
Pancreas graft survival was significantly decreased for pancreas grafts that had suffered from vascular rejection when compared
to those with only interstitial rejection. Potential rejection markers, i. e., serum amylase, glucose, creatinine, and urinary
amylase, did not correlate with histological signs of rejection, although increased levels of serum amylase were, in all but
one case, associated with rejection.We conclude that a percutaneous pancreas biopsy remains the most reliable method to determine
pancreas rejection, and that by distinguishing between IR andVR, a pancreas biopsy may provide important diagnostic as well
as prognostic information.
Received: 6 March 1997 Received after revision: 5 June 1997 Accepted: 30 June 1997 相似文献
992.
Abstract One hundred eighty-one consecutive patients with fulminant hepatic failure (FHF) presenting in a 2-year period were reviewed. In this cohort we examined the impact of pretransplant renal failure on mortality and morbidity following orthotopic liver transplantation (OLTx). Twenty-seven patients (18 female, 9 male) with a median age of 43.5 years (range 19–65 years) underwent OLTx. FHF was due to idiosyncratic drug reaction ( n = 4), paracetamol overdose ( n = 3), seronegative hepatitis ( n = 17), hepatitis B ( n = 1), veno-occlusive disease ( n = 1), and Wilson's disease ( n = 1). Renal failure was present in 14 patients, 7 of whom died (whereas there was 100 % survival in patients without renal failure). Pretransplant renal failure was associated with prolonged mechanical ventilation (13 days vs 6 days, P = 0.05), prolonged intensive care stay (17 days vs 8 days, P - 0.01) and prolonged hospital stay (27 vs 21 days, P = NS). Pretransplant renal failure did not predict renal dysfunction at 1 year after OLTx. We conclude that the survival of patients transplanted for FHF is inferior to that of patients transplanted for chronic liver disease (67 % vs 88 % 1-year survival in Birmingham). For patients with FHF undergoing transplantation, pretransplant renal failure strongly predicts poor outcome with significantly greater consumption of resources. 相似文献
993.
994.
Preventive care for patients following myocardial infarction. The Wessex Research Network (WReN) 总被引:2,自引:1,他引:1
OBJECTIVE: We aimed to assess general practice care for patients following
a myocardial infarction (MI). METHOD: A structured review was carried out
of general practice records of patients identified from hospital
administration data. A total of 266 survivors following MI were identified
from the discharge data of 13 hospitals in Southern England and registered
with 71 GPs belonging to the Wessex Research Network. Median time since
hospital discharge was 2.1 years. The main outcome measures were the
provision of appropriate preventive care, including cardiac rehabilitation,
drug therapy, and lifestyle advice for modifiable risk factors. RESULTS:
Basic care was provided to nearly all patients; 253 (95.1%, 95% Cl
91.8-97.4) had blood pressure documented after their MI, 216 of 234
patients eligible for aspirin (92.3%; 88.1-95.4) had been recommended
treatment, and the provision of advice on smoking cessation was documented
for 27 of 33 continuing smokers (81.8%; 64.5-93.0). However, only 73 of 236
patients eligible to attend a structured rehabilitation programme (30.9%;
25.0-36.8) were documented as having received rehabilitation. Of 89
patients with heart failure following MI, 33 (37.1%; 27.1-48.0) had no
record of having been offered treatment with an ACE inhibitor. Total
cholesterol measurement was documented for only 144 patients (54.1%;
48.1-60.1). We estimate that there is still the potential to prevent
between 4 and 9 deaths in this group of 266 surviving patients in the next
2 years by further improving the quality of follow-up care. CONCLUSIONS:
Preventive care in patients with proven ischaemic heart disease in general
practice remains haphazard, even among doctors enthusiastic to participate
in research and to audit their quality of care. As general practitioners we
should ensure that we are providing high quality preventive care to
patients with clinical disease before we focus on the even more demanding
task of primary prevention.
相似文献
995.
Janice F. Munro Debra Haire-Joshu Edwin B. Fisher H. James Wedner 《The Journal of asthma》1996,33(5):313-325
Low-income minority patients from East St. Louis, Illinois, a depressed midwestern urban city, who had visited acute care settings with asthma symptoms, participated in a focus group. Questions were constructed around the Health Belief Model to characterize participants' experiences in receiving asthma care, their confidence in long-term asthma self-management, barriers they perceived to managing their asthma, and recommendations they would make for improving asthma care in their community. Analysis of comments suggests an appreciable understanding of asthma triggers, limited coping behaviors for asthma symptoms, very limited practice of active asthma management, perception of the health care system as frequently insensitive to their needs or their knowledge of their own care, exchange of well-articulated information regarding how to deal with the system, and an apparent lack of awareness of any potential contribution of patient education or support system. 相似文献
996.
997.
998.
HUGH F. MOLLOY F.A.C.D. ERIC LAMONT-GREGORY M.SC. CHRIS IDZIKOWSKI PH.D. F.B.PS.S. TERENCE J. RYAN D.M. F.R.C.P. 《International journal of dermatology》1993,32(9):668-672
Background. Extensive questioning of patients with a wide variety of skin disorders led to the impression that nocturnal overheating was probably an important factor in the initiation and the perpetuation of many skin disorders. Methods. In order to test the hypothesis, 12 “clean-skinned” subjects (6M/6F) aged 18 to 45 years were monitored electronically every 30 seconds during an 8 hour sleep period (2300 to 0700 hours), sleeping under a standard 10 tog duvet. Results. All the subjects were too hot by 3 to 4°C. All showed changes in their EEG patterns with reduced REM sleep, increased awakenings, and all showed changes in their sleep stage patterns. In addition, they all showed evidence of increased sweating in the “heat-sink” area. Conclusions. The mechanisms where by such changes could be implicated in the precipitation and perpetuation of skin disease are discussed. “Lifestyle” modification as a very effective, noninvasive, therapeutic regime is recommended. Further research along these lines would probably be very valuable and instructive. 相似文献
999.
Giant aneurysm of the pericallosal artery 总被引:1,自引:0,他引:1
A rare case of a giant aneurysm of the pericallosal artery, evaluated by computed tomography, magnetic resonance imaging, and angiography, is reported, and the other 7 cases in the literature are reviewed. Giant aneurysms are exceptional in the distal segments of the anterior cerebral arteries, and may simulate a callosal tumor or hematoma on computed tomographic scan. The clinical, radiological, surgical, and pathological findings of giant aneurysms of this location are discussed and the other reported cases are analyzed. The role of magnetic resonance imaging in diagnosing and characterizing giant aneurysms is stressed. 相似文献
1000.
de Caro R. Parenti A. Capitanio G. Ori C. Bracco F. Ricchieri G. L. 《Acta neurochirurgica》1990,104(1-2):73-76
Summary A vascular malformation, consisting of a venous vessel bridgeing the right inferior petrosal sinus and the anterior spinal veins, was found in the posterior fossa. The vessel presented a ring-like course around the right trigeminal root, and it was parallel and dorsal to the basilar artery. The malformation was associated with cutaneous and hepatic angiomas and peri-osteal lipomas. It had been clinically silent for 52 years, when it thrombosed causing death. The authors think that, within a general mesenchymopatic state, this is a result of the persistence of an embryonal cerebral venous pattern. 相似文献