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Natasha Purai Arora Mouhammed Joumaa Howard Rosman Raj Mehta 《The American journal of the medical sciences》2017,353(6):597-602
Left main coronary artery (LMCA) thrombosis with acute myocardial infarction is a rare condition with very high mortality. The low incidence of this condition and exclusion of patients with LMCA thrombosis from clinical trials prevent the development of optimal management strategy in these patients. Therefore, there are no clear-cut guidelines describing an evidence-based approach for this condition. We describe a patient with LMCA thrombosis presenting with acute myocardial infarction, who was found to have hypercoagulable state related to homocysteinemia on further work-up. This case highlights the challenges faced during the management of this rare condition due to lack of clear-cut guidelines describing an evidence-based approach. 相似文献
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Jennifer S. Ringrose Raj Bapuji Wade Coutinho Omar Mouhammed Lindsay Bridgland Thirza Carpenter Raj Padwal 《Journal of clinical hypertension (Greenwich, Conn.)》2020,22(1):16-20
Use of 24‐hour ambulatory blood pressure monitoring is strongly endorsed by contemporary hypertension guidelines. The objective of this study was to assess patient perceptions of ambulatory blood pressure testing, tolerability, accessibility, and expense. A convenience sample of 50, consenting patients undergoing ambulatory blood pressure monitoring at the University of Alberta Hypertension Clinic in Edmonton, Canada was studied. A 16‐item structured questionnaire was administered in person or electronically. Questions regarding the tolerability of ambulatory monitoring were evaluated using a 5‐point Likert scale and wait times, expenditures, and willingness to pay were evaluated by direct questioning. Mean age was 53.1 ± 15.4 years, 32 (64%) were female, and 23 (46%) were employed. Mean 24‐hour ambulatory BP was 134 ± 12/79 ± 8 mmHg. Ambulatory monitoring caused discomfort in 40 (80%) patients and disturbed sleep in 39 (78%). Forty‐one (82%) patients perceived that the home (vs pharmacy, primary care clinic, and speciality care clinic) would be the easiest venue to access future testing. On average, patients waited 27.3 ± 23.7 days for testing; they felt that a wait time of 21.3 ± 12.3 days was appropriate. Mean time taken off work was 8.6 ± 10.8 hours. Twelve (24%) patients indicated that they would be willing to pay out‐of‐pocket to undergo testing sooner, at a mean expenditure of $120 ± 69. Nineteen (62%) patients were willing to buy a monitor and felt that a mean purchase cost of $125 ± 89 was appropriate. These findings extend current knowledge of patient perceptions of ambulatory monitoring and may help to refine and optimize future delivery of this essential test. 相似文献
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Yelda Jozaghi Mark E. Zafereo Nancy D. Perrier Jennifer R. Wang Elizabeth Grubbs Neil D. Gross Sarah Fisher Erich M. Sturgis Ryan P. Goepfert Stephen Y. Lai Conor Best Naifa L. Busaidy Maria E. Cabanillas Ramona Dadu Robert F. Gagel Mouhammed A. Habra Mimi I. Hu Camilo Jimenez Steven I. Sherman Sonali Thosani Jeena Varghese Steven G. Waguespack Steven Weitzman Anita K. Ying Paul H. Graham 《Head & neck》2020,42(6):1325-1328
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Autoimmune cytopenia does not predict poor prognosis in chronic lymphocytic leukemia/small lymphocytic lymphoma 总被引:3,自引:0,他引:3
Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is characterized by an acquired immune defect that can cause autoimmune complications, including anemia and thrombocytopenia. We conducted an observational study of the epidemiology, clinical presentation and significance of autoimmune complications of CLL/SLL in 132 patients from a large population (>45,000 veterans), in which at least 90% of patients with CLL/SLL have been previously identified. Over a period of 12.5 years, 12 patients (9.1%) had autoimmune complications; of these, 6 (4.5%) had autoimmune hemolytic anemia (AIHA), 5 (3.8%) had immune thrombocytopenia (ITP), and 1 (0.8%) had pure red blood cell aplasia (PRBA). All 6 cases of AIHA had a positive direct immunoglobulin test for IgG and C3d. In 6 patients, CLL/SLL was an incidental finding at the time of presentation with autoimmune cytopenia. Nine out of 10 patients responded to immunosuppressive therapy, which was complicated by serious infection in 7 cases, one of which was fatal. The major cause of mortality in patients with autoimmune complications of CLL/SLL was secondary malignancy. Survival of patients with immune cytopenia was not significantly different from CLL/SLL patients without immune cytopenia. Among patients with anemia or thrombocytopenia, mortality was significantly higher in those with bone marrow failure compared to an autoimmune etiology. We show that in a non-referred population with a high incidence of CLL/SLL, autoimmune cytopenia can occur early in the natural history of the disease. These data suggest that the Rai and Binet classifications for CLL need to be modified for patients with autoimmune cytopenia. . 相似文献
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We conducted a phase I/II trial to determine the maximum tolerated dose (MTD) and the efficacy of prolonged infusion of cisplatin and oral etoposide in the treatment of advanced non-small cell lung cancer (NSCLC). Cisplatin was given via an infuser in escalating doses of 5, 6.5, 8, 9 and 10 mg/m(2)/day for 14 days along with etoposide at a fixed dose of 50 mg/m(2)/day orally followed by a 2-week rest period. All patients had stage IIIB or IV NSCLC. A cisplatin dose of 8 mg/m(2)/day was determined as the MTD. In the 13 patients treated at this dose level, grade III and IV toxicities were mainly hematologic including neutropenia (n = 5), febrile neutropenia (n = 4), thrombocytopenia (n = 3) and anemia (n = 6). Grade III/IV renal toxicity occurred in one patient. There were no treatment-related deaths. One patient had a partial response and three patients had stable disease. Thus, although the described regimen of cisplatin/etoposide is reasonably well tolerated, it does not appear to be better than the same combination administered over a shorter duration, in spite of a cumulative dose of 112 mg/ m(2) of cisplatin and 700 mg/ m(2) of etoposide per cycle. 相似文献
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Hemorrhagic necrosis of a pheochromocytoma is a rare cause of acute presentation that is often devastating to patients. A 44-year-old woman with spontaneous hemorrhage into a previously undiscovered pheochromocytoma is described. The patient presented with acute cardiogenic pulmonary edema, shock, abdominal pain, myalgia and high fever. Her cardiac function recovered with aggressive medical treatment before the tumour was removed. This case illustrates an unusual presentation of pheochromocytoma and emphasizes the importance of aggressive and appropriate medical therapy in pheochromocytoma heart disease. 相似文献
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We present a patient with metastatic pheochromocytoma, who developed progressive and fatal hypoglycemia most likely secondary to direct tumor glucose consumption that did not respond to high-dose glucose infusion, corticosteroids, or glucagon therapy. The pattern of glucose uptake on (18)F-2-fluoro-2-deoxy-D-glucose positron emission tomography, with preferential tumor glucose uptake in association with a marked reduction in normal uptake in the heart, muscles, and brain, is highly suggestive of direct consumption of glucose by the tumor rather than insulin-like growth factor-2 mediated hypoglycemia. In patients with large-volume metastatic malignancies, direct tumor glucose consumption should be considered in the differential diagnosis of hypoglycemia. Nuclear medicine imaging techniques can illustrate the pathophysiology of hypoglycemia in such cases. 相似文献
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Thompson MA Habra MA Routbort MJ Holsinger FC Perrier ND Waguespack SG Rodriguez MA 《American journal of hematology》2007,82(4):299-303
We report the first case of a primary adrenal natural killer (NK)/T-cell nasal type lymphoma in adults. The patient presented with an enlarging left adrenal mass and the initial concern was for adrenocortical carcinoma. Surgical resection revealed NK/T-cell lymphoma. Rapid recurrence in the contralateral adrenal gland was treated with a single cycle of chemotherapy before he died due to infectious complications and progressive disease. This case demonstrates the aggressive presentation of a novel subset of primary adrenal lymphoma that should be considered in the differential diagnosis of a rapidly enlarging adrenal mass. 相似文献
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Rehman Su Al-Amoudi A Kelta M Awad A Bridges K Al-Ghamdi SM 《Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation》2007,5(2):698-700
There have been concerns about using kidneys from potential donors with sickle cell trait because kidneys from these donors may not concentrate urine properly. We report a case of living-related renal transplant, in which both the recipient and the donor had sickle cell trait, and the postoperative course for both was uneventful. 相似文献