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71.
72.
Diaphragm pacing in infants and children. A life-table analysis of implanted components 总被引:1,自引:0,他引:1
D E Weese-Mayer A S Morrow R T Brouillette M N Ilbawi C E Hunt 《The American review of respiratory disease》1989,139(4):974-979
Since 1976, we have implanted bilateral phrenic nerve electrodes for diaphragm pacing in 33 infants and children. This population includes 23 patients with congenital central hypoventilation syndrome (CHS), two with late onset CHS and hypothalamic dysfunction, three with hypoventilation associated with Chiari II malformation and myelomeningocele, and five with quadriplegia. Our experience, totalling 192 system-years and 96 patient-years of pacing, has enabled us to document the nature and frequency of problems related to the implanted components of the Avery Laboratories (S-232-1) pacemaker system when used in a pediatric population. By life table analysis, the mean time to need for replacement of any implanted component was 56.3 months. A total of 26 failures requiring component replacement occurred and were classified into four types: (1) receiver failure (15 cases), (2) electrode wire or wire insulation breakage (six cases), (3) infection requiring diaphragm pacer system removal (three cases), and (4) mechanical nerve injury (two cases). We conclude that the present diaphragm pacing system is effective but not without risk of biomedical component failure. The present system might be substantially improved by (1) a modified receiver design with a hermetic seal to prevent fluid penetration, (2) stronger, better insulated electrode wires, and (3) modifications of surgical technique and electrode type to prevent phrenic nerve damage. 相似文献
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Kovacs MJ Rodger M Anderson DR Morrow B Kells G Kovacs J Boyle E Wells PS 《Annals of internal medicine》2003,138(9):714-719
75.
Allergen-induced synthesis of F(2)-isoprostanes in atopic asthmatics. Evidence for oxidant stress 总被引:6,自引:0,他引:6
Dworski R Murray JJ Roberts LJ Oates JA Morrow JD Fisher L Sheller JR 《American journal of respiratory and critical care medicine》1999,160(6):1947-1951
It is thought that reactive oxygen species (ROS) participate in the inflammation which characterizes asthma, but the evidence supporting this contention is incomplete. F(2)-isoprostanes (F(2)-IsoPs) are arachidonate products formed on membrane phospholipids by the action of ROS and thereby represent a quantitative measure of oxidant stress in vivo. Using a mass spectrometric assay we measured urinary release of F(2)-IsoPs in 11 patients with mild atopic asthma after inhaled allergen challenge. The excretion of F(2)-IsoPs increased at 2 h after allergen (1.5 +/- 0.2 versus 2.6 +/- 0.3 ng/mg creatinine) and remained significantly elevated in all urine collections for the 8-h period of the study (analysis of variance [ANOVA]). The measured compounds were of noncyclooxygenase origin because neither aspirin nor indomethacin given before challenge suppressed them. Urinary F(2)-IsoPs remained unchanged after inhaled methacholine challenge. In nine atopic asthmatics, F(2)-IsoPs were quantified in bronchoalveolar lavage fluid (BALF) at baseline values and in a separate segment 24 h after allergen instillation. F(2)-IsoPs were elevated late in the BALF (0.9 +/- 0.2 versus 11.4 +/- 3.0 pg /ml, baseline versus allergen, respectively, p = 0.007). The increase was inhibited by pretreatment of the subjects with inhaled corticosteroids. These findings provide a new evidence for a role for ROS and lipid peroxidation in allergen-induced airway inflammation. 相似文献
76.
T R Ziegler L S Young K Benfell M Scheltinga K Hortos R Bye F D Morrow D O Jacobs R J Smith J H Antin 《Annals of internal medicine》1992,116(10):821-828
OBJECTIVE: To determine whether glutamine-supplemented parenteral nutrition improves nitrogen retention and reduces hospital morbidity compared with standard parenteral nutrition after bone marrow transplantation. DESIGN: Double-blind, randomized, controlled clinical trial. SETTING: University teaching hospital. PATIENTS: Forty-five adults receiving allogeneic bone marrow transplants for hematologic malignancies. INTERVENTION: Parenteral nutrition was initiated the day after bone marrow transplantation (day 1). The experimental solution was supplemented with L-glutamine (0.57 g/kg body weight per day) and provided estimated requirements for energy and protein. The control solution was a standard, glutamine-free, isonitrogenous, isocaloric formula. MEASUREMENTS: Nitrogen balance was determined between days 4 and 11 in the initial 23 patients. The incidence of clinical infection and microbial colonization, time until bone marrow engraftment, indices of clinical care, and other data related to hospital morbidity were recorded for all patients. RESULTS: The glutamine-supplemented patients (n = 24) were clinically similar to the controls (n = 21) at entry. Nutrient intake was similar in both groups; however, nitrogen balance was improved in the glutamine-supplemented patients relative to the controls (-1.4 +/- 0.5 g/d compared with -4.2 +/- 1.2; P = 0.002). Fewer experimental patients developed clinical infection (three compared with nine in the control group; P = 0.041), and the incidence of microbial colonization was also significantly reduced. Hospital stay was shortened in patients receiving glutamine supplementation (29 +/- 1 d compared with 36 +/- 2 d; P = 0.017). CONCLUSION: Patients receiving glutamine-supplemented parenteral nutrition after bone marrow transplantation had improved nitrogen balance, a diminished incidence of clinical infection, lower rates of microbial colonization, and shortened hospital stay compared with patients receiving standard parenteral nutrition. These effects occurred despite no differences between groups in the incidence of fever, antibiotic requirements, or time to neutrophil engraftment. 相似文献
77.
Infection by the retrovirus associated with the acquired immunodeficiency syndrome. Clinical, biological, and molecular features 总被引:14,自引:0,他引:14
J A Levy L S Kaminsky W J Morrow K Steimer P Luciw D Dina J Hoxie L Oshiro 《Annals of internal medicine》1985,103(5):694-699
Peripheral mononuclear cells from more than 160 persons from groups at risk for the acquired immunodeficiency syndrome (AIDS) have yielded AIDS-associated retroviruses (ARV). Antibodies to ARV can also be found in these risk groups. Antibody-negative, virus-positive persons have been identified with early infection or possible viremia with immune complex formation. Established lines of human T and B cells, monocytes, and promyelocytes have been infected with ARV. Moreover, infectious virus has been recovered from macrophages cultured from the blood of some persons with AIDS. The cytopathic effects of ARV in T cells is associated with the accumulation of unintegrated viral forms in the infected cells. The ARV has also been isolated from plasma, serum, saliva, semen, urine, cerebrospinal fluid, and brain tissue. All these results reflect the wide host range of ARV and support its role in neurologic abnormalities seen in some patients. Molecular studies of independent ARV isolates indicate a polymorphism of nucleotide sequences, particularly in the viral envelope region. All these features place ARV in the lentivirus subfamily of human retroviruses. 相似文献
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80.
NA Hanchard DR Murdock PL Magoulas M Bainbridge D Muzny YQ Wu M Wang AL McGuire JR Lupski RA Gibbs CW Brown 《Clinical genetics》2013,83(5):457-461
The advent of whole‐exome next‐generation sequencing (WES) has been pivotal for the molecular characterization of Mendelian disease; however, the clinical applicability of WES has remained relatively unexplored. We describe our exploration of WES as a diagnostic tool in a 3½‐year old female patient with a 2‐year history of episodic muscle weakness and paroxysmal dystonia who presented following a previous extensive but unrevealing diagnostic work‐up. WES was performed on the proband and her two parents. Parental exome data was used to filter potential de novo genomic events in the proband and suspected variants were confirmed using di‐deoxy sequencing. WES revealed a de novo non‐synonymous mutation in exon 21 of the calcium channel gene CACNA1S that has been previously reported in a single patient as a rare cause of atypical hypokalemic periodic paralysis. This was unexpected, as the proband's original differential diagnosis had included hypokalemic periodic paralysis, but clinical and laboratory features were equivocal, and standard clinical molecular testing for hypokalemic periodic paralysis and related disorders was negative. This report highlights the potential diagnostic utility of WES in clinical practice, with implications for the approach to similar diagnostic dilemmas in the future. 相似文献