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61.
Abstract: A prospective study was performed to determine whether low-density lipoprotein (LDL) apheresis, when performed only immediately before and after percutaneous transluminal coronary angioplasty (PTCA), is effective in preventing restenosis of coronary artery lesions following PTCA. Thirty-six patients with coronary heart disease (CHD) and hypercholesterolemia were divided into 2 groups. The 9 patients in the LDL group underwent LDL-apheresis 1 day before and 5 days after PTCA while the 27 patients of the control group underwent PTCA but did not undergo LDL-apheresis. Follow-up coronary angiography (CAG) was performed 4 months after PTCA. The rate of restenosis of coronary artery lesions was significantly lower in the LDL group (0%) than in the control group (30%). These findings suggest that LDL-apheresis, when performed before and after PTCA, is effective in preventing restenosis of coronary artery lesions in patients with CHD and hypercholesterolemia. 相似文献
62.
BERNHARD FREY MICHAEL WUTTE RUDOLF BERGER CLEANTHIS IOANNIDES MARTIN HÜLSMANN BRIGITTE STANEK RICHARD PACKER 《Pacing and clinical electrophysiology : PACE》1995,18(1):152-158
To investigate the impact of staged therapy for advanced heart failure on therapeutic endpoints, 236 consecutive patients (coronary artery disease/dilated cardiomyopathy in 61/175 patients, left ventricular ejection fraction 14%± 5%, New York Heart Association Class IIl/IIIIV in 102/79/55 patients, respectively) with advanced heart failure were prospectively followed. One hundred thirtyseven patients enrolled from January 1989 to December 1991 were treated conventionally with digoxin, furosemide, and low dose angiotension converting enzyme (ACE) inhibition. Patients refractory to this therapy underwent urgent heart transplantation. Ninetynine patients enrolled from January 1992 to August 1993 underwent staged therapy: stage 1: maximal tolerated ACE inhibition; stage 2: therapy with PGE1 for preand afterload reduction to achieve hemodynamic stabilization; or stage 3: refractory patients bridged to heart transplantation with continuous outpatient dobutamine. Sudden death was defined as death within 1 hour of symptoms if heart failure symptoms remained stable over the previous 7 days. Conventionally treated patients were followed for 10 ± 9 months; patients who underwent staged therapy for 9 ±5 months. In the group of patients that underwent standard therapy, 39 of 137 (28%) patients died: 5 (13%) deaths occurred suddenly, and death due to progressive pump failure occurred in the remaining 34 (87%) patients. In the group of patients that underwent staged therapy, 25 of 99 (25%) patients died: 13 (52%) deaths occurred suddenly, and 12 (48%) deaths occurred due to progressive pump failure. Thus, patients who underwent staged therapy were at increased risk for sudden death (P = 0.01, relative risk 3.4, 95% confidence interval 1.2–9.7) but were at lower risk for death from pump failure (P = 0.009, relative risk 0.44, 95% confidence interval 0.22–0.84). In patients who underwent therapy with continuous outpatient PGE1 (n = 7) or dobutamine (n= 21), risk for sudden death (P = NS by log rank test) did not increase. In conclusion, staged therapy significantly reduced death from pump failure; however, patients who could be stabilized and considered too well for heart transplantation were at increased risk for sudden death. Thus, overall survival did not improve. Of note, outpatient dobutamine did not increase the risk for sudden death. 相似文献
63.
HA Carpay P Matthijsse M Steinbuch PGH Mulde 《Cephalalgia : an international journal of headache》1997,17(5):591-595
In an open, randomized cross-over study in 124 patients, we compared the efficacy, safety and patient preference of oral and subcutaneous sum triptan in the acute treatment of migraine. Patients were treated for 3 attacks or 3 months and then crossed over. Primary clinical efficacy was defined as a reduction in headache severity on a four-point self-rating scale from severe (3) or moderate (2) to mild (1) or none (0), or mild (1) to none (0). Efficacy was evaluated 2 h after the administration of subcutaneous and 4h after the administration of oral sumatriptan. Subcutaneous sumatriptan was significantly more effective than oral sumatriptan in relieving headache (over all three attacks 78% vs 61% improvement), improving clinical disability (55% vs 41 % improvement) and relieving nausea (69% vs 53%), vomiting (72% vs 32%) and phono- or photophobia (67% vs 49%). Median time to recurrence was shorter after subcutaneous (12.5 h) than after oral sumatriptan (18 h); the number of patients experiencing a recurrence was similar Patients reported more adverse events after subcutaneous sumatriptan (1.32 per attack) than after the oral form (0.85 per attack), but all adverse events were mild to moderate in intensity and of short duration. Patient opinion was more often positive after subcutaneous sumatriptan. These results may be useful in counselling patients to choose between the available marketed formulations of sumatriptan. 相似文献
64.
S.L. Atkin A.M. Coady D. Horton N. Sutaria L. Sellars C. Walton 《Diabetic medicine》1995,12(3):267-270
A 15-year-old girl presented de novo in diabetic ketoacidosis having been comatose for 24 h (day 1). A CT scan and lumbar puncture performed on admission were normal and her conscious level slowly improved over several days. On day 7 she had central neurological signs of bilateral knee clonus and an extensor plantar response. In addition, she had developed lower motor neurological signs of an ulnar nerve palsy of the left forearm, and ulnar, median, and radial nerve palsies of the right forearm. Magnetic resonance imaging (MRI), performed on day 12, showed multiple small cerebral haematomata with appearances at least several days of age. The scattered lesions were localized particularly to the parieto-occipital region, with sparing of the basal ganglia and without cerebral oedema, a novel feature not previously described in juvenile ketoacidosis. Four months later there was minimal residual disability of her right arm. The clinical findings together with the MRI images suggested that the peripheral nerve and central lesions were temporally related, suggesting a common aetiology. However, it is likely that MRI showed cerebral lesions which may have been missed by the conventional CT scanning performed initially. 相似文献
65.
通过42例重型肺心病、7例轻型肺心病、16例肺心病伴发冠心病患者和30例正常人在静息状态下的左右心脏射血分数及其临床资料的分析表明,重型肺心病患者在病情的急性发作期,存在有不同程度的左心功能不全,而轻型肺心病患者则无左心功能不全的表现。表明慢性肺心病仅在病程晚期,才由以右心为主的疾病发展成为全心病。本文还对重型肺心病与肺心病伴发冠心病患者的左心功能进行比较,结果表明,肺心病伴发冠心病患者左室功能受损程度更为明显,双重病因导致的左室功能减退,常造成心肌更严重的损害而且不容易恢复。 相似文献
66.
S. Aziz L. A. Soine S. L. Lewis A. P. Kruse W. C. Levy K. M. Wehe D. P. Fishbien M. D. Allen 《Transplant international》1997,10(6):446-450
A review of factors contributing to early mortality after cardiac transplantation revealed that up to 25 % of deaths were
due to primary graft dysfunction unrelated to rejection or infection. In light of this finding, evaluation of a donor heart
with regard to its suitability for transplantation takes on added importance. In an effort to screen the suitability of donor
hearts in the region covered by the Northwest Organ Procurement Agency (USA), all donors are evaluated by two-dimensional
transthoracic echocardiography as part of the initial evaluation. A total of 110 donor echocardiograms were reviewed and an
attempt was made to correlate the 30-day outcome with the parameters measured. An unexpected finding was that the presence
of left ventricular hypertrophy in the donor heart was associated with an increase in the incidence of donor heart dysfunction
compared with donors with normal echocardiographic profiles (33 % vs 3 %, P = 0.007).
Received: 12 February 1996 Received after resision: 27 June 1997 Accepted: 14 July 1997 相似文献
67.
K. Hamano Hiroshi Ito Andrew Bushell Kathryn J. Wood Kensuke Esato 《Transplant international》1997,10(4):293-298
In this study, the effect of combining anti-CD4 monoclonal antibody (mAb) and cyclosporin (CyA) therapy at the time of transplantation
was examined. A mouse cardiac allograft model was used. Anti-CD4 mAb administered perioperatively induces long-term survival.
The addition of a short course of CyA given subcutaneously in a regimen of either a high-dose treatment or a standard dose
treatment to the anti-CD4 mAb treatment protocol did not have a detrimental effect on graft survival. Despite having no significant
effect on graft survival, the addition of CyA to the treatment protocol did result in a significant decrease in the level
of IL-2 present in the hearts 7 days after transplantation. The decrease in IL-2 production was directly related to the presence
of CyA in vivo. When CyA treatment was continued throughout the period during which unresponsiveness to the graft is induced
by anti-CD4 mAb therapy, 50 % of the grafted hearts were rejected once the CyA was discontinued. In conclusion, the combined
use of anti-CD4 mAb therapy and CyA did not have a negative effect on graft survival in this model when the two agents were
used concurrently at the time of transplantation.
Received: 2 October 1996 Received after revision: 31 January 1997 Accepted: 5 February 1997 相似文献
68.
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
69.
风心病并发脑栓塞病人的瓣膜替换术 总被引:11,自引:0,他引:11
报告64例风心病并发脑栓塞病人的瓣膜替换术。术前心功能I级10例、II级38例、IV级16例。伴房颤者54例。脑栓塞史半年以上者44例,6个月以内20例,其中2个月以内者14例。34例有程度不同的脑栓塞后遗症。行二尖瓣替换术47例、双瓣膜替换术17例,同期行三尖瓣环环缩或成形术43例。术中证实有左房血栓25例(39%)。手术死亡率6.25%。术后并发颅内出血和栓塞各1例。结果表明风心病并发脑栓塞病人的手术效果良好。作者指出,脑栓塞2个月以上者应尽早手术,2个月以内者则应根据脑栓塞程度、恢复情况及有无左房血栓,选择手术时机。并介绍了围术期的处理经验。 相似文献
70.
小儿肾脏疾病血,尿内皮素的变化 总被引:9,自引:0,他引:9
目的研究小儿肾脏疾病血、尿内皮素(PET、UET)的水平及其相互关系。方法采用同位素放免方法检测了肾病综合征(NS),肾小球肾炎(GN),肾功能衰竭(RF)共72例患儿血及尿中ET,血心钠素(ANP)水平。结果NS,GN,RF三组的PET及UET值明显高于对照组,尤其RF组(P<005,P<0.01)。ANP值在GN组和RF组明显高于对照组(P<001)。8例ARF患儿恢复期血ET水平下降,6例CRF患儿虽经治疗,但血ET水平不降或上升。结论ET在小儿肾脏疾病发病机理及病情进展中可能起重要作用,其值高低与病情严重程度及预后有关。 相似文献