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1.
2.
H L Elliott P A Meredith L Campbell J L Reid 《Clinical pharmacology and therapeutics》1988,43(5):554-560
An exaggerated fall in blood pressure has been reported with the combination of an alpha 1-blocker and a calcium antagonist. This study investigated, in a placebo-controlled, randomized crossover trial, the clinical usefulness of the combination of prazosin (2 mg b.i.d.) and verapamil (160 mg b.i.d.). Therapeutic efficacy was monitored at regular outpatient visits: average supine and erect blood pressures were, respectively, 175/99 and 176/103 mm Hg with placebo, 160/91 and 164/96 mm Hg with single drug treatment, and 152/84 and 152/89 mm Hg with combination therapy. This significant and clinically useful reduction in blood pressure had an overall magnitude of approximately 28/18 mm Hg (supine) and 29/19 mm Hg (erect). Further measurements were made during a series of intensive study days, and the most important additional finding was a pharmacokinetic interaction that resulted in increased peak concentrations and bioavailability of prazosin. In conclusion, the combination of prazosin and verapamil proved effective in the treatment of 12 patients with essential hypertension who had been poorly responsive to conventional treatment with a beta-blocker and thiazide diuretic. 相似文献
3.
B Lu J M Lee R Elliott C F Dreyfus J E Adler I B Black 《Brain research. Molecular brain research》1991,11(3-4):359-362
Nerve growth factor (NGF) gene expression in central nervous system (CNS) glia appears to be associated with active glial growth. To study the underlying molecular mechanisms, we examined the effects of a number of growth-related factors on NGF mRNA expression in glial cultures. Our results suggest that glial membrane interaction, as a consequence of growth, actively inhibits NGF gene expression in CNS glia. 相似文献
4.
J Thornton D M Ashcroft M Z Mughal R A Elliott T W O'Neill D Symmons 《Archives of disease in childhood》2006,91(9):753-761
AIMS: To evaluate the currently available evidence for the effectiveness of bisphosphonates in children with low bone mineral density (BMD) and fragility fractures associated with juvenile idiopathic arthritis (JIA), and the safety of bisphosphonates in JIA and other conditions. METHODS: Literature databases were searched using a structured search strategy. The effectiveness review included any studies of children with JIA treated with bisphosphonates. The safety review also included studies of osteogenesis imperfecta. Quantitative data analysis was not undertaken because of the heterogeneity of the studies; findings were summarised using tables and narrative synthesis. RESULTS: Ninety four studies were identified. Sixteen studies (78 JIA children) were included in the effectiveness review: one randomised controlled trial, three controlled cohort studies, 11 case series, and one case report. At baseline, children had low BMD below the expected values for age and sex matched children. In all studies, treatment with bisphosphonates increased BMD compared with baseline: the mean percentage increase in spine BMD ranged from 4.5% to 19.1%. Overall, studies were heterogeneous and of variable quality. A total of 59 papers were included in the safety review; treatment durations were up to three years. The most common side effect was a flu-like reaction with intravenous treatment. This occurred during the first infusion and was transient; the symptoms were managed with paracetamol and did not occur during subsequent cycles. CONCLUSIONS: Bisphosphonates are a promising treatment for low BMD and fragility fractures in children with JIA. However, the quality of the current evidence is variable and better studies are needed to more clearly assess their role. 相似文献
5.
John P Elliott Hugh S Miller Suzanne Coleman Debbie Rhea Diana Abril Karen Hallbauer Niki B Istwan Gary J Stanziano 《Journal of perinatology》2005,25(10):626-630
OBJECTIVE: To assess the impact of activity restriction (AR) on the incidence of preterm birth in women treated for preterm labor testing negative for fetal fibronectin (fFN). STUDY DESIGN: Women who were diagnosed with preterm labor and tocolyzed with magnesium sulfate were concurrently screened with fFN for the purpose of subsequent management. Included were consenting patients with negative fFN, gestational age 23 0/7-33 6/7 weeks, cervical dilation < or =3 cm, and minimal vaginal bleeding. Patients were randomized to AR or no AR. Primary study outcome was incidence of preterm delivery and interval from randomization to delivery. RESULTS: A total of 73 women with negative fFN were randomized (36 with AR, 37 without AR). The overall preterm birth rate was 40%, with 44.4% of patients with AR and 35.1% of patients without AR delivering preterm, p=0.478. CONCLUSION: Maternal AR did not impact pregnancy outcome. The incidence of preterm birth in symptomatic women testing fFN negative was higher than previously reported. 相似文献
6.
Transabdominal sacrocolpopexy has been shown, in multiple long-term studies of its success and durability, to be the definitive
treatment option for post-hysterectomy vaginal vault prolapse. It is, however, associated with greater morbidity than vaginal
repair. We describe a minimally invasive technique for vaginal vault prolapse repair and present our experience with a minimum
of one-year follow-up. The surgical technique involves five laparoscopic ports—three for the da Vinci robot and two for the
assistant. After appropriate dissection a polypropylene mesh is attached to the sacral promontory and to the vaginal apex
by use of Gore-Tex sutures. The mesh material is then covered by the peritoneum. Patient analysis focused on complications,
urinary continence, patient satisfaction, and morbidity, with a minimum of 12 months follow-up. Forty-two patients with post-hysterectomy
vaginal vault prolapse underwent robot-assisted laparoscopic sacrocolpopexy at our institute and 35 have a minimum of 12 months
follow-up, with a mean follow-up of 36 months (range 12–48) in the group. Mean age was 67 (47–83) years and mean operating
time was 3.1 (2.15–4.75) h for the entire cohort. All but one patient were discharged home on postoperative day one; one patient
left on postoperative day two. One developed recurrent grade three rectocele, one had recurrent vault prolapse, and two suffered
from vaginal extrusion of mesh. All patients were satisfied with their outcome. The robot-assisted laparoscopic sacrocolpopexy
is a minimally invasive technique for vaginal vault prolapse repair, combining the advantages of open sacrocolpopexy with
the reduced morbidity of laparoscopy. We observed reduced hospital stay, low occurrence of complications, and high patient
satisfaction, with a minimum of 1-year follow-up. Most importantly, the long-term results of the robotic repair are similar
to those of open repair, but with significantly less morbidity. 相似文献
7.
F T McDermott G Whelan D J St John G L Barnes R Elliott R Herrmann G T Schmidt R A Smallwood 《The Medical journal of Australia》1987,146(10):525, 528-525, 529
Information on the relative incidence of Crohn's disease and ulcerative colitis was obtained by a prospective investigation at six Melbourne teaching hospitals. One hundred and eleven patients who presented with chronic inflammatory bowel diseases between 1980-1981 were admitted to the study. Forty (36%) patients were diagnosed as having Crohn's disease and 63 (57%) patients as having ulcerative colitis. The type of chronic inflammatory bowel disease could not be determined in eight (7%) patients. These findings suggest that the relative frequency of Crohn's disease and ulcerative colitis in Melbourne hospitals is within the range that is reported for northern Europe and the United States. 相似文献
8.
Both cyproterone acetate (CPA) and the gonadotrophin-releasing hormone
agonist (GnRHa) have been shown to be effective for the treatment of
hirsutism. We wished to compare the effectiveness of CPA in two standard
doses with GnRHa and add-back therapy and to compare the length of
remission after these treatments. A total of 60 hirsute hyperandrogenic
women was assigned to the following treatment groups: CPA 2 mg with 35
microg of ethinylestradiol for 21 days each month (Diane group), CPA 50 mg,
days 5-15, and ethinylestradiol 50 microg, days 5-25, each month (CPA
group) or Decapeptyl 3.75 mg i.m. every 28 days with the addition of
conjugated oestrogen 0.625 mg, days 1-21, and medroxyprogesterone acetate
10 mg, days 12-21 (GnRHa group). Hirsutism was graded by the
Ferriman-Gallwey-Lorenzo (FGL) index and anagen hair shaft diameters and
serum luteinizing hormone (LH) and testosterone were assessed before and
every 3 months during and after treatment. All women were treated for 1
year with 1 year follow-up. At baseline hirsutism and endocrine patterns
were similar in all groups. After one year of treatment, hirsutism
decreased in all groups but the changes were greater (P <0.05) in the
CPA and GnRHa groups than in the Diane group. Serum LH and testosterone
were lowest in the GnRHa group. After withdrawal, hirsutism increased
rapidly in the Diane and CPA groups and after 6 months, FGL scores and hair
shaft diameters were similar to pretreatment values. In the GnRHa group,
hirsutism increased more gradually and after 1 year of withdrawal, FGL
scores and hair diameters were significantly (P <0.05) less than
pretreatment values. Serum LH and testosterone increased rapidly in all
three groups reaching pretreatment values by 6 months. These data suggest
equal efficacy of the GnRHa and the high dose CPA regimen for the treatment
of hirsutism in hyperandrogenic women. GnRHa with add-back treatment
appears to result in a longer remission of hirsutism in comparison with
CPA.
相似文献
9.
Maxillary sinusitis in adults: an evaluation of placebo-controlled double-blind trials 总被引:1,自引:0,他引:1
BACKGROUND: In general practice, acute sinusitis is frequently diagnosed
and treated with antibiotics. OBJECTIVE: This study aimed to determine the
evidence for the effectiveness of antibiotic treatment in acute maxillary
sinusitis in adults by assessing the methodological quality of
placebo-controlled double-blind randomized trials. METHOD: An evaluation by
four raters through a 35-item scoring-scale for internal and external
validity of all placebo-controlled double-blind randomized trials on acute
sinusitis found between January 1966 and July 1996. RESULTS: Eighty-five
trials were excluded because they were not placebo-controlled,
double-blind, randomized, or were carried out in patients with chronic
sinusitis or in children. The three remaining trials were performed in
different populations (one in general practice) between 1973 and 1978. Only
one study claimed superiority of antibiotic treatment. Different inclusion
criteria and major outcome measures were used by the authors. The
reliability of major outcome events was reported poorly or not at all and
in two studies outcome measures were clinically inappropriate. The studies
scored 30-62% of the maximum attainable score for internal validity and
10-20% for external validity. CONCLUSION: The effectiveness of antibiotic
treatment in acute maxillary sinusitis in a general practice population is
not based sufficiently on evidence.
相似文献
10.
M Burch L Lum M Elliott N Carter D Slater A Smith A Ationu 《British heart journal》1992,68(3):309-312
OBJECTIVE--To determine the changes in the endocrine mechanisms of fluid balance after cardiopulmonary bypass in children. DESIGN--Prospective study; analysis of numbered plasma samples performed blind with respect to clinical data. SETTING--Regional paediatric cardiothoracic unit. PATIENTS--Nine patients, median age 4, range 2 to 9 years, five males. Patients under the age of 1 year were excluded because of the frequent blood sampling involved. MAIN OUTCOME MEASURES--Plasma concentrations of atrial natriuretic peptide (ANP), arginine vasopressin, plasma renin activity, aldosterone, noradrenaline and adrenaline, and urinary concentrations of cyclic guanosine monophosphate (cGMP) as measured by radioimmunoassay. RESULTS--After 30 minutes of cardiopulmonary bypass plasma atrial natriuretic peptide (ANP) decreased from (mean (SEM)) 151 (71) pg/ml to 52 (44) pg/ml (NS), and urinary production of its second messenger cyclic guanosine monophosphate (cGMP) decreased from 1286 (600) pmol/ml to 151 (414) pmol (p < 0.05). Other plasma concentrations of hormones studied did not change significantly although arginine vasopressin, adrenaline, and noradrenaline increased whereas aldosterone and plasma renin activity decreased. After cardiopulmonary bypass stopped there was an immediate and significant rise in plasma ANP, but within the next 24 hours plasma ANP declined significantly (p < 0.05), decreasing from 294 (49) pg/ml to 64 (29) pg/ml at 22 hours. In the postoperative period there was a significant correlation between plasma ANP and both mean fluid balance (r = 0.96, p < 0.001) and mean urine output (r = 0.97, p < 0.001). Plasma aldosterone peaked (p < 0.05) at 22 hours after operation, and argine vasopressin peaked (p < 0.05) at two hours and then declined (p < 0.05) to a trough at 24 hours. Plasma renin activity, adrenaline, noradrenaline, and urinary cGMP concentrations, and mean central venous pressure did not change significantly in the postoperative period. CONCLUSION--The changes documented show the differing pattern of release of water balance hormones invoked by cardiopulmonary bypass. The central role of ANP is shown by its strong correlation with urinary output and its similarly strong relation to fluid balance. 相似文献