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101.
Victor Y. Fujimoto MD J.Heath Miller MD Nancy A. Klein MD Michael R. Soules MD 《American journal of obstetrics and gynecology》1997,177(6):1419-1425
OBJECTIVE: Our aim was to evaluate the clinical course and management of congenital cervical atresia. STUDY DESIGN: This retrospective analysis included 7 patients referred to our clinic and a review of the medical literature. RESULTS: Including this case series, 58 cases of congenital cervical atresia have been reported in the literature. Forty-eight percent of patients had isolated congenital cervical atresia with a normal vagina whereas the remainder had either complete or partial vaginal atresia (“shortened blind vaginal pouches”). Surgical management has included abdominal hysterectomy or uterovaginal cannulation with or without vaginoplasty. In 59% of patients who underwent uterovaginal canalization procedures (23/39), normal menstrual bleeding was achieved. Four of these patients subsequently became pregnant and were delivered at term. CONCLUSION: Surgical canalization in selected patients with congenital cervical atresia can be successfully performed to provide patients an opportunity for conservative management, resulting in normal menstrual bleeding, resolution of cyclic pelvic pain, and some potential (albeit limited) for fertility.(Am J Obstet Gynecol 1997;177:25) 相似文献
102.
Edward W. Lipkin M.D. Ph.D. Susan M. Ott Gordon L. Klein Leonard J. Deftos 《Calcified tissue international》1990,47(2):75-81
Summary Bone gamma-carboxyglutamic acid containing protein (BGP) has been utilized effectively as a serum marker of bone turnover
in healthy normals and in individuals with a variety of metabolic bone disorders including postmenopausal osteoporosis and
Paget's disease. The utility of this serum marker in other bone disorders, including that associated with the maintenance
of patients on long-term parenteral nutrition, still requires definition. Because of our interest in this clinical syndrome
and the availability of serum and of bone formation rates (BFR) measured directly from double tetracycline labeling in 11
long-term parenteral nutrition patients, we measured BGP levels in these patients and attempted to correlate this measure
with BFR. Serum vitamin D metabolites, immunoreactive parathyroid hormone (PTH), and alkaline phosphatase (alk phos) were
also measured. Serum BGP was only weakly and not significantly correlated (r=0.24, p=NS) with bone formation rate for the
group as a whole. However, in a subgroup of 10 patients without hyperparathyroidism, there was strong and significant correlation
(r=0.81,P<0.01) between BGP and BFR. There was also a strong correlation between bone formation rate and serum 1,25 dihydroxyvitamin
D [1,25(OH)2D] levels (r=0.89,P<0.01, n=11). The mechanism of this association could not be established. A correlation of borderline significance was observed
between bone formation rate and serum alk phos (r=0.60,P=0.05, n=11). The current data suggest that additional studies may help to more fully define the utility of serum measurements
in quantifying bone dynamics in parenteral nutrition patients, and that measures of vitamin D metabolites, BGP, and alk phos
may prove useful. 相似文献
103.
Fluoxetine in panic disorder 总被引:4,自引:0,他引:4
F R Schneier M R Liebowitz S O Davies J Fairbanks E Hollander R Campeas D F Klein 《Journal of clinical psychopharmacology》1990,10(2):119-121
Twenty-five patients with a primary DSM-III-R diagnosis of panic disorder with or without agoraphobia were treated openly with the serotonin uptake inhibitor fluoxetine for up to 12 months. For most patients, treatment was initiated at 5 mg/day to minimize adverse effects previously reported with initiation at higher doses. Nineteen (76%) experienced moderate to marked improvement in panic attacks. Four (16%) were unable to tolerate fluoxetine due to adverse effects. Initiating treatment of panic disorder with low doses of fluoxetine may increase its acceptability and permit more patients to benefit from fluoxetine. 相似文献
104.
105.
Observation units for children in an Emergency Department setting can serve to improve the quality of medical care provided as well as reduce overall costs; however, they must be properly organized with careful consideration for the needs of children. Policies must be written specifying who is in charge as well as who can be accepted into these units and for how long. Procedures regarding documentation and sign-out must be formulated. These units must be well staffed and fully equipped, and they should be pleasant places for the children to stay; otherwise, what might begin as assets can quickly become disorganized and potentially dangerous liabilities. 相似文献
106.
Pramod K Pal Joanne Leung Katya Hedrich Ali Samii Abraham Lieberman Paul A Nausieda Donald B Calne Xandra O Breakefield Christine Klein A Jon Stoessl 《Movement disorders》2002,17(4):789-794
There are few reports of positron emission tomography (PET) in juvenile parkinsonism (JP). We report on the results of (18)F-6-fluoro-L-dopa (FD) PET in a 14-year-old patient with JP of 5 years duration associated with atypical features. This is the youngest subject to be investigated to date. There was a severe asymmetric reduction in striatal FD uptake, with a rostrocaudal gradient in the putamen similar to that seen in adult-onset idiopathic parkinsonism. Extensive DNA analysis in this patient did not show mutations in the parkin gene. 相似文献
107.
This report describes a unique case of biliary and portal obstruction by a massive celiac artery aneurysm. Severe portal hypertension with extensive retroperitoneal varices and a perforated gallbladder complicated the surgical management. A survey of the literature emphasized the novelty of this case. 相似文献
108.
Despite the wide clinical use of lithium in the treatment of manic depressive illness there is no adequate explanation for its mechanism of action. In the light of lithium's suggestive effects on the second messenger system in the brain, we studied the effects of chronic dietary lithium treatment (achieving blood levels in the therapeutic range) on protein phosphorylation in different areas of rat brain. An increase in the phosphorylation of a 64-kDa membrane-associated protein was evident in the lithium-treated rats compared to controls. This increase was observed only under basal phosphorylating conditions and was abolished when the phosphorylation was performed in the presence of Ca2+ or Ca2+ and calmodulin. The possibility that this 64-kDa protein affected by lithium is the beta-subunit of the calmodulin-dependent protein kinase or a different protein which co-migrates with it is discussed. 相似文献
109.
110.
Steve H Murdock Md Nazrul Hoque Kenneth Johnson Mary A McGehee 《The Journal of rural health》2003,19(4):425-432
The diversification of the rural population of the United States provides substantial challenges to the current and to future health care systems in rural areas. Because of a variety of historical, discriminatory, and other factors, minority populations have had lower levels of access to health care in rural as well as urban areas and higher rates of both mortality and morbidity than nonminority populations. Although minority health issues have often been seen as primarily urban issues, this article demonstrates that minority population growth has become a major component of total population growth in rural areas in the past several decades (accounting for nearly 62% of the net growth in the nonmetropolitan population of the United States in the 1980s and for nearly 42% in the 1990s), that future US population growth is likely to be largely a product of minority population growth (nearly 89% of US net population growth from 2000 to 2100 is projected to be due to minority population growth), and that the incidence of diseases and disorders in the US population will come to increasingly involve minority populations (by 2050 roughly 43% of all disease/disorder incidences would involve minority population members). The growth of younger minority populations with disproportionately impoverished socioeconomic characteristics will pose challenges for rural areas and health care systems, which also are likely to face health issues created by disproportionately older populations. 相似文献