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Between 1978 and 1984 6 cases of ventricular septal defect after myocardial infarction were referred to this hospital. All 6 patients underwent cardiac catheterisation, had severe pulmonary hypertension and large left-to-right shunts (mean 64%). They were treated with high doses of diuretics and vasodilators, and underwent delayed surgery 6 weeks after rupture. Follow-up is from 1 to 7 years. There has been 1 late, non-cardiac death. The remainder are well. In our experience patients with congestive cardiac failure complicating ventricular septal defect after infarction can be stabilized initially on diuretic and vasodilator therapy, and surgery can safely be deferred until septal fibrosis allows adequate closure. 相似文献
3.
We report an adult female with a rare giant choledochal cyst. The patient presented following a normal pregnancy with the classical triad of an abdominal mass associated with jaundice and right upper quadrant abdominal pain. The cyst was excised using an intramural technique and biliary reconstruction achieved with a Roux-en-Y hepaticojejunostomy. Our patient has remained well with no evidence of malignancy over a 12 year review period. The aetiology and current management of this condition are discussed. 相似文献
4.
Na+ dependence of in vitro pancreatic amylase release 总被引:1,自引:0,他引:1
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Thyroid microsomal/thyroid peroxidase autoantibodies show discrete patterns of cross-reactivity to myeloperoxidase, lactoperoxidase and horseradish peroxidase. 总被引:5,自引:0,他引:5 下载免费PDF全文
The recent cloning of the thyroid peroxidase (TPO) has shown that it is identical to the thyroid microsomal antigen (TMA), a potent antigen involved in autoimmune thyroid disease (ATD), which shares significant sequence homology with myeloperoxidase. The present study shows that autoantibodies (aAb) to the TMA/TPO antigen cross-react with human leucocyte myeloperoxidase, bovine lactoperoxidase and horseradish peroxidase. Cross-reactivity to myeloperoxidase was only apparent by ELISA using reduced and alkylated antigen preparations or by immunoblotting following denaturation with SDS. Sequential absorption of sera on SDS-denatured thyroid microsomes immobilized on Sepharose-4B followed by absorption on native microsomes removed all aAb specificities to TMA/TPO and the three peroxidase preparations, giving compelling evidence on the genuine cross-reactive nature of these aAbs. Sera from different patients contain different qualitative and quantitative specificities of aAb to the TMA/TPO antigen, confirming the polyclonal nature of this autoimmune response. 相似文献
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C1-esterase inhibitor blocks T lymphocyte proliferation and cytotoxic T lymphocyte generation in vitro 总被引:1,自引:0,他引:1
We have previously shown that activated C1s complement and activated T
cells cleave beta2-microglobulin (beta2m) in vitro leading to the formation
of desLys58 beta2m. This process can specifically be inhibited by
C1-esterase inhibitor (C1-inh). Furthermore we showed that exogenously
added desLys58 beta2m in nanomolar amounts to a one-way allogenic mixed
lymphocyte culture (MLC) increased the endogenous production of IL-2 and
the generation of allo-specific cytotoxic T lymphocytes. C1-inh was
purified from fresh human plasma and added to human or murine MLC and
mitogen-stimulated lymphocyte cultures grown in the presence of
complement-inactivated serum. Read-outs were cell proliferation, lymphokine
production and development of T cell-mediated cytotoxicity. We found that
addition of C1-inh to MLC and mitogen- exposed murine and human lymphocyte
cultures inhibited proliferation, the development of allospecific cytotoxic
activity, and changed the endogenous production of IL-2, IL-4, IL-10, IL-12
and IFN-gamma. These data clearly demonstrate a regulatory function of
C1-inh on T cell- mediated immune functions.
相似文献
9.
How to use Chlamydia antibody testing in subfertility patients 总被引:1,自引:9,他引:1
Screening for tubal factor subfertility by means of Chlamydia antibody
testing (CAT) was introduced into the initial work-up of subfertile couples
several years ago. The results reported, however, are heterogeneous, and no
uniformity exists in cut-off levels of titres, or in definitions of tubal
factor subfertility. We performed a prospective cohort study to evaluate
the implications of varying the definitions of tubal pathology and of
modifying the cut-off levels on the clinical impact of CAT in predicting
tubal factor subfertility. In 227 consecutive patients who attended our
fertility clinic, the Chlamydia IgG antibody titre was determined and
related to tuboperitoneal abnormalities at laparoscopy as a reference
standard. According to received operating characteristic (ROC) curve
analysis, a titre of 16 is the optimum cut-off level. Increasing the
cut-off level improves specificity and positive likelihood ratio (LR+), at
the expense of sensitivity and negative LR (LR-). Changing the definition
of tubal factor subfertility from unspecified tuboperitoneal abnormalities
into extensive adhesions and/or bilateral distal tubal occlusion improves
LR+, LR- and kappa significantly. We conclude that CAT is more accurate in
predicting severe distal tubal pathology than unspecified tuboperitoneal
abnormalities. Although from a statistical point of view a titre of 16 is
the optimum cut-off level, from a clinical point of view 32 or 64 may be
preferable, depending on the aim of screening and the inception cohort.
相似文献
10.