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61.
Demetrius Ellis Ron Shapiro Mark L. Jordan Velma P. Scantlebury Nisan Gilboa Laszlo Hopp Nancy Weichler Andreas G. Tzakis Richard L. Simmons 《Pediatric nephrology (Berlin, Germany)》1994,8(2):193-200
Clinical aspects of FK-506 or cyclosporine immunosuppression regimens were evaluated in 48 consecutive pediatric renal transplant recipients. Tapering and discontinuation of prednisone was employed only in children receiving FK-506 who experienced minor or no rejection episodes during the 1st posttransplant month. At 1 year follow-up, 17 of 22 (77%) of all children with functioning allografts were receiving no prednisone (n=13) or a mean dosage of 0.07 mg/kg per day (n=4). During the 1st month, acute cellular rejection was more common in the FK-506 group (0.58 vs. 0.21 rejections per patient,P<0.05) but allograft survival (92%) and renal function at 1 year posttransplant were identical in both groups. Compared with the cyclosporine regimen, FK-506 immunosuppression may be associated with a higher incidence of cytomegalovirus or reversible Epstein-Barr virus-induced lymphoproliferative disease. However, the FK-506 group had less hirsutism and gingival hypertrophy and required fewer antihypertensive medications independent of steroid use. Height standard deviation scores and weight-for-height index improved only in preadolescents receiving FK-506 but no prednisone (P<0.02 andP<0.05, respectively), but did not differ between children on FK-506 plus prednisone and those in the cyclosporine group. We conclude that the major advantages of FK-506 over cyclosporine immunosuppression are a reduced severity of hypertension and an improved cosmetic appearance which may improve long-term medical compliance. When used as monotherapy, FK-506 also shows promise in relieving the growth retardation associated with cyclosporine regimens that include prednisone. 相似文献
62.
P. Cortelli P. Parchi E. Sforza M. Contin G. Pierangeli G. Barletta E. Lugaresi 《Clinical autonomic research》1994,4(1-2):57-62
Cardiovascular autonomic function in normotensive awake patients with obstructive sleep apnoea syndrome was studied in 21 normotensive (mean age 48 ± 14 years), drug-free men with obstructive sleep apnoea syndrome. Cardiovascular reflex tests with continuous blood pressure monitoring and biochemical indices were performed the morning after a standard polygraphic sleep recording. A group of 20 agematched (mean age 49 ± 19 years) normal subjects was used as controls. The obstructive sleep apnoea syndrome patients showed higher heart rate and noradrenaline plasma levels (p < 0.05) at rest and a higher blood pressure response to head-up tilt (p < 0.01), suggesting sympathetic overactivity. Respiratory arrhythmia, baroreflex sensitivity index and Valsalva ratio were significantly lower in the obstructive sleep apnoea syndrome group (p < 0.01) whereas the decrease in heart rate induced by the cold face test was significantly higher (p < 0.05) showing a blunting of reflexes dependent on baroreceptor or pulmonary afferents with normal or increased cardiac vagal efferent activity. These abnormalities in autonomic regulation may predispose obstructive sleep apnoea syndrome patients to cardiovascular complications like hypertension and cardiac arrhythmias. 相似文献
63.
Doz. Dr. W. Klepetko T. Wekerle A. Moritz P. Mares M. Hiesmayer E. Tschernko I. Lang M. Kontrus W. Wisser E. Wolner 《European Surgery》1995,27(3):166-170
Zusammenfassung Grundlagen
Die pulmonale Thrombendarterektomie stellt eine effektive Therapie zur Behandlung von Patienten mit chronisch thromboembolischer
pulmonalar Hypertonie dar. Wir berichten über unsere Erfahrungen mit dieser Operationstechnik bei den ersten 9 Patienten.
Methodik
Zwischen 1992 und Oktober 1994 wurde bei 9 Patienten eine pulmonale Thrombendarterektomie durchgeführt. über eine mediane
Sternotomie wurden die Pulmonalarterien beider Seiten bis in ihre subsegmentalen Aufzweigungen im Sinne einer echten Endarterektomie
vom organisierten thromboembolischen Material befreit. Zumeist waren Perioden des totalen Kreislaufstillstandes in tiefer
Hypothermie notwendig, wobei diese zunehmend verkürzt werden konnten und 3 Patienten vollst?ndig ohne Kreislaufstopp operiert
wurden.
Ergebnisse
Die perioperative Mortalit?t betrug 11%, wobei der 1. Patient am 14. postoperativen Tag an den Folgen eines Reperfusions?dems
verstarb. Alle anderen Patienten sind 4 bis 22 Monate (im Mittel 13 Monate) nach dem Eingriff am Leben und zeigen eine Hochsignifikante
Verbesserung ihrer h?modynamischen Situation (mean PAP pr?operativ: 62 mm Hg, postoperativ: 30 mm Hg p<0,001; Cardiac Index
pr?operativ: 2,1 1/min/m2, postoperativ: 3,6 l/min/m2 p=0,001). W?hrend pr?operativ alle Patienten in NYHA-Klasse III oder IV waren, sind die 8 überlebenden jetzt alle in Klasse
I oder II.
Schlu?folgerungen
Die pulmonale Thrombendarterektomie bietet eine erfolgreiche Therapiem?glichkeit für Patienten mit chronisch thromboembolischer
pulmonaler Hypertonie mit einer in Anbetracht fehlender konservativer Altermativen akzeptablen Mortalit?t und ausgezeichneten
funktionellen Langzeitergebnissen.
相似文献
64.
65.
报告33例高血压性脑出血施行外科手术治疗的临床体会。结合术前病情分级、血肿类型、血肿量、中线结构移位程度等,对手术治疗的适应症选择、手术方式及入路、提高治疗效果、减少术后并发症等作了讨论。提出了手术治疗重要性。 相似文献
66.
Verna W. Y. Yiu Robert P. Dluhy Richard P. Lifton Lisa M. Guay-Woodford 《Pediatric nephrology (Berlin, Germany)》1997,11(3):343-346
In evaluating hypertensive children and adolescents, the etiological considerations should include a set of inherited disorders
that share very low plasma renin activity (PRA) as a common feature. In particular among these disorders, glucocorticoid remediable
aldosteronism (GRA) appears to be emerging as an important etiology of hypertension in the pediatric population. We report
the evaluation of a 9-year-old Caucasian girl who presented with severe hypertension and a strong family history of early-onset
hypertension. Her suppressed PRA, her family history, and her failure to respond to conventional antihypertensive therapy
raised GRA as a potential etiology. The diagnosis was confirmed by an elevated ratio of urinary 18-oxotetrahydrocortisol to
urinary tetrahydroaldosterone and genetic testing, which demonstrated the chimeric gene duplication. The molecular pathogenesis
of GRA and the clinical implications are reviewed.
Received May 15, 1996; received in revised form and accepted September 16, 1996 相似文献
67.
目的 探讨门脉高压症出血病人肝功能变化情况 ,同时评价应用乌司他丁 (Ulinastatin ,UTI)治疗的效果。方法 将 4 6例肝硬化门脉高压症出血病人分为两组 :Ⅰ组 (n =2 2 )为一般治疗组 ,Ⅱ组 (n =2 4 )为UTI治疗组 ,分别检测Ⅰ、Ⅱ组出血后 1,2 ,4 ,7,10 ,14d血ET变化情况 ,并检测1,7,14d的肝功能。另选肝硬化门脉高压症未出血病人 (n =2 0 ) ,检测血浆ET ,作为对照组。结果 出血后 7,14d ,Ⅰ、Ⅱ组总胆红素 (TBIL)均呈先升高后下降 ,但Ⅱ组较Ⅰ组下降快 (分别P <0 0 5 ,P <0 0 1)。ALT、AST亦呈先升高后下降 ,但于出血后 14日Ⅱ组较Ⅰ组下降快 (P <0 0 5 )。Ⅰ、Ⅱ组出血后 1d血ET浓度较对照组显著升高 (P <0 0 1) ,随后逐步下降。Ⅱ组ET下降较Ⅰ组快 ,于出血后 2d(P <0 0 5 )、4d (P <0 0 1)、7d(P <0 0 5 )有显著差异。出血后 1dⅠ、Ⅱ组ET浓度与TBIL呈正相关 (r=0 734,P <0 0 1) ;Ⅰ、Ⅱ组血ET下降指数与TBIL增高指数呈负相关 (r =- 0 4 86 ,P <0 0 5 )。结论 肝硬化门脉高压症大出血后应用UTI治疗可抑制TBIL、ALT、AST、ET等的升高 ,起到保护肝脏功能的作用。 相似文献
68.
目的 :探讨妊高征患者分娩期应用硫酸镁对母儿预后的影响。方法 :回顾性分析近 10年来在该院分娩的妊高征患者分娩期应用硫酸镁情况的临床资料。结果 :分娩的妊高征患者共 82 6例 ,其中分娩期硫酸镁治疗组 4 2 2例 ,未治疗组 4 0 4例。轻、中、重度妊高征分娩期硫酸镁用量分别为 :4 .33± 1.14 g ;5 .5 0± 1.6 4 g ;9.0 0± 1.70g。不同程度妊高征硫酸镁治疗组与未治疗组比较 ,产程、产后出血量及新生儿窒息率差异均无显著意义 (P >0 .0 5 ) ,而两组中轻、中度妊高征分别与重度妊高征比较 ,产后出血量差异均有显著意义 (分别P <0 .0 1,P <0 .0 5 )。硫酸镁配伍酚妥拉明预防子痫 (n =89)较单用酚妥拉明治疗组 (n =5 4 )子痫发生率显著降低 (P <0 .0 5 )。结论 :妊高征患者分娩期适量应用硫酸镁对母儿是安全的 ,有利于预防子痫等并发症。 相似文献
69.
血管紧张素转换酶基因与中国人群冠心病、高血压病及糖尿病的关系 总被引:1,自引:0,他引:1
目的:研究血管紧张素转换酶(ACE)基因与中国人群冠心病(CHD)、高血压病(EH)及2型糖尿病(T2DM)的关系。方法:250例呈不同组合的EH、T2DM以及CHD患者及90例正常对照用改良的聚合酶链反应(PCR)方法检测ACE基因型,比较基因型及等位基因频率分布。结果:①无合并CHD的T2DM及EH组ACE基因型及等位基因频率与正常对照无显著差异;②CHD组无论是否合并EH及/或T2DM,Ⅲ基因型及Ⅰ等位基因频率均显著低于正常对照,而DD基因型及D等位基因频率均显著高于正常对照;③T2DM合并CHD组及EH合并CHD组中Ⅱ基因型及Ⅰ等位基因频率均显著低于正常对照,而DD基因型及D等位基因频率均显著高于正常对照。结论:ACE基因多态性与中国人群CHD相关。这种关联亦见于EH或T2DM合并CHD中,但ACE基因仅是CHD发病的遗传学基础,而与是否合并EH及/或T2DM无关。 相似文献
70.
Michel Broyer Geneviève Guest Marie-France Gagnadoux Daniel Beurton 《Pediatric nephrology (Berlin, Germany)》1987,1(1):16-21
The files of 334 consecutive cadaver kidney (CK) and of 27 living related (LR) transplantations (T) in children and adolescents performed from 1973 to 1984 have been reviewed. Following cadaver transplantation, 52 patients (15%) never had hypertension (HT), 41 patients (12%) had only initial HT up to 6 months after transplantation and 18 other patients (5%) exhibited transient HT episodes while on high-dose steroid therapy. Finally, 209 patients (62%) had HT for periods longer than 6 months and 16 patients (5%) until death or graft failure within the first 3 months. Chronic graft rejection was the major cause of HT, but other factors either isolated or in association were also present. Renal artery stenosis (RAS) was diagnosed in 43 cases (13%) 2–17 months post-transplantation; 10 of these were operated upon (5 successfully) and 9 underwent transluminal angioplasty with a single success. Nine cases of RAS resolved spontaneously. HT was attributed to the host kidney in 10 cases (3%) and to recurrence of primary renal disease in 9 (3%). HT observed after CKT was sometimes severe and difficult to control. Acute complications from HT were recorded in 35 cases, with 6 deaths and 2 severe neurological sequelae. Among 25 LRT, 11 cases (40%) had no HT 13 (48%) had HT for longer than 6 months. In this group, no case of RAS was observed and only one complication (without sequelae) was noted. In conclusion, HT is a frequent and sometimes severe complication post-transplantation in children and adolescents. 相似文献