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131.
Oral cyclophosphamide versus chlorambucil in the treatment of patients with membranous nephropathy and renal insufficiency 总被引:4,自引:1,他引:4
Branten AJ; Reichert LJ; Koene RA; Wetzels JF 《QJM : monthly journal of the Association of Physicians》1998,91(5):359-366
We treated patients with idiopathic membranous nephropathy (iMGN) and renal
insufficiency, using: (i) (n = 15) monthly cycles of steroids (1 g
methyl-prednisolone i.v. on three consecutive days, followed by oral
prednisone 0.5 mg/kg/day months 1, 3 and 5) and chlorambucil (0.15
mg/kg/day months 2, 4 and 6); or (ii) (n = 17) oral cyclophosphamide
(1.5-2.0 mg/kg/day for 1 year) and steroids in a comparable dose. The
groups were comparable in age, renal function and levels of proteinuria.
During the 6 months preceding treatment, serum creatinine levels increased
from 148 +/- 50 to 219 +/- 73 mumol/l in the chlorambucil group and from
164 +/- 86 to 274 +/- 126 mumol/l in the cyclophosphamide group. Median
(range) follow-ups were: chlorambucil 38 months (8-71); cyclophosphamide 26
months (5-68) (NS). Renal function improved in both groups, but the
improvement was short-lived in the chlorambucil group; 12 months after
starting treatment, mean serum creatinine was 6.3 mumol/l lower in the
chlorambucil group and 121 mumol/l lower in the cyclophosphamide group (p
< 0.01). Four chlorambucil-treated patients developed ESRD, and five
needed a second course of therapy, whereas only one
cyclophosphamide-treated patient developed ESRD (p < 0.05). Remissions
of proteinuria occurred more frequently after cyclophosphamide treatment
(15/17 vs. 5/15; p < 0.01). Side-effects necessitated interruption of
treatment in six patients on cyclophosphamide and in 11 on chlorambucil (p
< 0.05). In our patients, oral cyclophosphamide was better tolerated
than oral chlorambucil. The suggested greater efficacy of the oral
cyclophosphamide regimen needs to be ascertained by longer follow-up.
相似文献
132.
SR Kulkarni MS Gohel RA Bulbulia MR Whyman KR Poskitt 《Annals of the Royal College of Surgeons of England》2009,91(3):210-213
INTRODUCTION
Early carotid endarterectomy (CEA) in symptomatic patients may prevent repeat cerebral events. This study investigates the relationship between waiting time for CEA and the incidence of repeat cerebral events prior to surgery in symptomatic patients.PATIENTS AND METHODS
A prospective database of consecutive patients undergoing CEA between January 2002 and December 2006 was reviewed. Repeat event rates prior to surgery were calculated using Kaplan–Meier analysis and predictive factors identified using Cox regression analysis.RESULTS
A total of 118 patients underwent CEA for non-disabling stroke, TIA and amaurosis fugax. Repeat cerebral events occurred in 34 of 118 (29%) patients at a median 51 days (range, 2–360 days) after the first event. The estimated risk of repeat events was 2% at 7 days and 9% at 1 month after first event (Kaplan–Meier survival analysis). Age (HR 1.059; 95% CI 1.014–1.106; P = 0.009] was identified as a predictor of repeat events. Patients underwent surgery at median 97 days (range, 7–621 days) after the first event. Eleven of 60 (18%) patients waiting ≤?97 days for surgery and 23 of 58 (40%) patients waiting >?97 days had repeat events. (P = 0.011, chi-squared test).CONCLUSIONS
Delays in surgery should be reduced in order to minimise repeat cerebral events in patients with symptomatic carotid stenosis, particularly in the elderly population. 相似文献133.
RA Pearl W Townley D Stott AO Grobbelaar 《Annals of the Royal College of Surgeons of England》2009,91(6):494-499
INTRODUCTION
Accurate clinical diagnosis depends on the reliable recognition of signs and symptoms. This expertise comes from experience in seeing patients which has been traditionally gained over a long training period. Shortened specialist training (Modernising Medical Careers) has led to a greater reliance on structured teaching and skills transfer programmes. The accuracy of clinical diagnosis and the rate at which diagnostic skills improve during training is important for the assessment of trainees, and the delivery of care.PATIENTS AND METHODS
This study assessed the accuracy of clinical diagnosis of skin lesions by two junior plastic surgery trainees. They were asked to diagnose 120 consecutive skin lesions seen in a pigmented skin lesion clinic in 2005, with the histological diagnosis being confirmed following subsequent excision. The process was repeated a year later in 2006 to enable the rate of correct diagnosis to be compared.RESULTS
Initially, 53.3% of diagnoses were correct. A year later, this had risen to 65.0%. Twenty-two different skin pathologies were present in excised specimens, and skin cancers comprised 30%. The trainees demonstrated 93.8% sensitivity in their initial diagnosis of malignancy (95% CI, 79.2–99.2) and 97.4% a year later (95% CI, 86.5–99.9). However, specificity was 69.3% (95% CI, 58.6–78.7) in 2005 and 71.6% (95% CI, 60.5–71.4) in 2006.CONCLUSIONS
Accuracy in the diagnosis of the wide range of skin conditions presenting to an out-patient clinic was shown to increase over a 1-year period. We feel that this improvement resulted from regular clinical exposure supported by a structured learning programme. The shortening of the specialist training period may affect the acquisition of diagnostic skills by trainees and impact on the confidence with which they commence consultant practice. 相似文献134.
135.
de Herder WW Reijs AE Feelders RA van Aken MO Krenning EP van der Lely AJ Kwekkeboom DJ 《European journal of endocrinology / European Federation of Endocrine Societies》2007,156(Z1):S53-S56
Dopamine D2 receptor scintigraphy of pituitary adenomas is feasible by single-photon emission computed tomography using (123)I-S-(-)-N-[(1-ethyl-2-pyrrolidinyl)methyl]-2-hydroxy-3-iodo-6-methoxybenzamide ((123)I-IBZM) and (123)I-epidepride. (123)I-epidepride is generally superior to (123)I-IBZM for the visualization of D2 receptors on pituitary macroadenomas. However, (123)I-IBZM and (123)I-epidepride scintigraphy are generally not useful to predict the response to dopaminergic treatment in pituitary tumour patients. These techniques might allow discrimination of non-functioning pituitary macroadenomas from other non-tumour pathologies in the sellar region. Dopamine D2 receptors on pituitary tumours can also be studied using positron emission tomography with (11)C-N-raclopride and (11)C-N-methylspiperone. 相似文献
136.
Cademartiri F La Grutta L Runza G Palumbo A Maffei E Mollet NR Bartolotta TV Somers P Knaapen M Verheye S Midiri M Hamers R Bruining N 《European radiology》2007,17(7):1842-1849
Attenuation variability (measured in Hounsfield Units, HU) of human coronary plaques using multislice computed tomography
(MSCT) was evaluated in an ex vivo model with increasing convolution kernels. MSCT was performed in seven ex vivo left coronary
arteries sunk into oil followingthe instillation of saline (1/∞) and a 1/50 solution of contrast material (400 mgI/ml iomeprol).
Scan parameters were: slices/collimation, 16/0.75 mm; rotation time, 375 ms. Four convolution kernels were used: b30f-smooth,
b36f-medium smooth, b46f-medium and b60f-sharp. An experienced radiologist scored for the presence of plaques and measured
the attenuation in lumen, calcified and noncalcified plaques and the surrounding oil. The results were compared by the ANOVA
test and correlated with Pearson’s test. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated.
The mean attenuation values were significantly different between the four filters (p < 0.0001) in each structure with both solutions. After clustering for the filter, all of the noncalcified plaque values (20.8 ± 39.1,
14.2 ± 35.8, 14.0 ± 32.0, 3.2 ± 32.4 HU with saline; 74.7 ± 66.6, 68.2 ± 63.3, 66.3 ± 66.5, 48.5 ± 60.0 HU in contrast solution)
were significantly different, with the exception of the pair b36f–b46f, for which a moderate-high correlation was generally
found. Improved SNRs and CNRs were achieved by b30f and b46f. The use of different convolution filters significantly modifief
the attenuation values, while sharper filtering increased the calcified plaque attenuation and reduced the noncalcified plaque
attenuation. 相似文献
137.
RA Stein 《Clinical genetics》2009,75(2):121-123
Age-related macular degeneration is associated with an unstable ARMS2 ( LOC387715 ) mRNA
Fritsche et al. (2008)
Nature Genetics 40 (7): 892–896 相似文献
Fritsche et al. (2008)
Nature Genetics 40 (7): 892–896 相似文献
138.
RA Kumar 《Clinical genetics》2009,76(6):499-501
139.
RA Coleman 《British journal of pharmacology》2009,158(1):180-182
The mechanism of the long duration of action of salmeterol at β2-adrenoceptors has long been a matter of debate, and is still unresolved. Szczuka and colleagues have both summarized the position to date and suggested a new mechanistic contender, receptor rebinding. Despite this, they still do not come to any clear conclusion. Much of the literature data that they have drawn upon appears contradictory, and mathematical models are inevitably flawed by the questionable validity of key values applied to them. Although the issue will undoubtedly eventually be resolved, it will probably require investigators to apply carefully designed studies on simple experimental systems such as isolated membranes or cultured cells. Only then should studies be extended to more complex systems such as isolated preparations of airways smooth muscle, where tissue bulk inevitably presents a complicating factor, particularly where relatively lipophilic compounds are concerned. 相似文献
140.
KD McCloskey UA Anderson RA Davidson YR Bayguinov KM Sanders SM Ward 《British journal of pharmacology》2009,156(2):273-283