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J. Heidrich P. U. Heuschmann P. Kolominsky-Rabas A. G. Rudd C. D. A. Wolfe 《European journal of neurology》2007,14(3):255-261
Valid classification of stroke is essential to initiate effective acute management and early secondary prevention strategies. To accurately evaluate stroke subtype a number of diagnostic procedures have to be performed. This study sought to investigate variations in use of diagnostic procedures across selected European hospitals. First-ever stroke patients were sampled over a 1-year period through 11 hospital-based registers across 10 European countries. We defined a diagnostic standard for valid aetiological classification of ischemic stroke including brain imaging, vascular imaging and echocardiography. The impact of socio-demographic, clinical and structural characteristics on performance of the diagnostic standard was assessed using multivariate logistic regression analyses. A total of 1721 patients were included in the study. 83.1% received brain imaging, ranging from 32.8% to 100%. The diagnostic standard was performed in 40.4% of stroke patients, ranging from 0% to 77.2%. Patients with increasing age ( P < 0.001) and with more severe strokes ( P = 0.001) were less probably to receive the diagnostic standard. Patients treated in stroke units and neurological departments were more frequently investigated with the diagnostic standard ( P < 0.001). Less than half of hospitalized stroke patients across Europe underwent diagnostic procedures to allow for aetiological classification of stroke, which may hamper the initiation of effective early management and secondary prevention. 相似文献
3.
Johan Grunewald 《The clinical respiratory journal》2007,1(2):64-73
Introduction: Sarcoidosis is a granulomatous disorder of unknown aetiology, affecting young adults and frequently involving the lungs. Objective: The aim of the present review was to give an overview of the clinical aspects in sarcoidosis. Results: The majority of patients recover, but some develop a chronic disease that may result in fibrosis and respiratory failure. Besides the lungs, peripheral lymph nodes, the skin, the liver and the eyes are commonly affected as well. The genetic background, as well as environmental factors, is of importance for developing sarcoidosis. The incidence varies in different populations, in the Nordic countries approximately with 20/100 000 new patients yearly. Sarcoidosis is diagnosed when clinical and radiological findings are supported by histological evidence in the form of non‐caseating epithelioid cell granulomas, and when other causes of these features are excluded. Patients in need of treatment are usually treated with corticosteroids, topically or as oral steroids. A clinical effect of immunomodulatory drugs blocking tumour necrosis factor (TNF)α has been suggested from several case reports, while two controlled studies showed only minor effects; however, with a tendency to a more pronounced effect on patients with a more severe disease. The immune response in sarcoidosis, with a typical accumulation of CD4+ T‐cells to the lungs, indicate the existence of specific antigens in this disease. Recently, antigens derived from infectious agents such as Mycobacteria and Proprionibacterium acnes have come into focus. Lymphocyte populations with immunoregulatory functions have recently been investigated and seem to be dysfunctional in sarcoidosis, opening the possibility of developing new treatment strategies in this disease. Conclusion: Recent technical developments have provided better tools, enabling detailed and more thorough analyses of the inflammatory process in sarcoidosis. Please cite this paper as: Grunewald J. Clinical aspects and immune reactions in sarcoidosis. The Clinical Respiratory Journal 2007; 1:64–73. 相似文献
4.
Incidence of childhood diabetes mellitus in Yorkshire, northern England, is associated with nitrate in drinking water: an ecological analysis 总被引:7,自引:1,他引:6
R. C. Parslow P. A. McKinney G. R. Law A. Staines R. Williams H. J. Bodansky 《Diabetologia》1997,40(5):550-556
Summary The relationship between the incidence of childhood-onset insulin-dependent diabetes mellitus and levels of nitrate in drinking
water in the former Yorkshire Regional Health Authority was investigated by means of an ecological analysis. A population-based
register contributed 1797 0–16-year-olds diagnosed with diabetes between 1978 and 1994. Nitrate data were based on 9330 samples
of drinking water tested between 1990 and 1995 in 148 water supply zones, for which 1991 census small area statistics were
taken on population density, ethnicity and socio-economic status. Diabetes incidence was positively associated with raised
mean nitrate levels with a standardised incidence ratio of 115 in zones with greater than 14.85 mg · l–1 (χ2 = 26.81, 1 df, p < 0.001). Significant negative trends were found between standardised incidence ratios and proportion of non-whites in the
population (χ2 = 33.57, 1 df, p < 0.001), childhood population density (χ2 = 30.81, 1 df, p < 0.001) and the Townsend deprivation score (χ2 = 33.89, 1 df, p < 0.001). Poisson regression modelling, adjusting for the other factors, showed a significant increase in relative incidence
rate ratio from a baseline of 1 at nitrate levels below 3.22 mg · l–1 to 1.27 (95 % confidence interval 1.09,1.48) for mean nitrate levels above 14.85 mg · l–1. An association between higher nitrate levels in domestic drinking water and incidence of childhood diabetes has been demonstrated.
This was not explained by the ethnic composition of the population, population density or socioeconomic status. Nitrate in
drinking water may be a precursor of chemicals which are toxic to the pancreas. [Diabetologia (1997) 40: 550–556]
Received: 24 October 1996 and in revised form: 20 December 1996 相似文献
5.
Epidemiology and aetiology of basal cell carcinoma 总被引:1,自引:0,他引:1
6.
P. A. Gómez R. D. Lobato J. J. Rivas A. Cabrera R. Sarabia S. Castro M. Castañeda J. M. Cañizal 《Acta neurochirurgica》1989,101(1-2):35-41
Summary The authors review the literature on subarachnoid haemorrhage of unknown aetiology (SAHUE) and analyze a personal series of 212 patients diagnosed as SAHUE. These patients represent 30% of all cases of primary SAH admitted over a 14.5 year period.The age, sex, antecedents and initial clinical presentation of patients with SAHUE were indistinguishable from those of patients with subarachnoid haemorrhage due to ruptured aneurysm (SAHRA). However, the present series of SAHUE compare favourably with both a personal and a previously reported series of SAHRA insofar as clinical grade on admission (94% of patients in grades I–II of Botterell), presence of blood on CT (51%), vasospasm (5%), ischaemic deficits (3.3%), persistent hydrocephalus (3.5%), rebleeding (6%) and fatal result (3.9%) are concerned.The amount of blood on CT scan in our patients with SAHUE was associated with a significantly higher incidence of brain ischaemia and hydrocephalus but did not correlate with the Botterell grade on admission or final outcome, which were good in the majority of cases regardless of the presence or not of visible cisternal haemorrhage. The results of the present series confirm that the final prognosis of patients with primary SAH showing normal four-vessel cerebral angiography is essentially favourable. 相似文献
7.
Bernard A. MacLeod Roy McGroarty Roy H. Morton Michael J. A. Walker 《Journal canadien d'anesthésie》1989,36(3):289-294
The effect of halothane on arrhythmias induced by ischaemia was investigated in rats, isolated perfused rat hearts, and pigs. Responses to the occlusion of the left anterior descending coronary artery were determined in groups (n = 9) of chronically prepared rats treated with no halothane, 0.5, or 1.0 per cent halothane immediately after occlusion; in isolated rat hearts (n = 10) treated with no halothane, 0.5, 1.0, 2.0, or 4.0 per cent halothane for 15 min before and after occlusion; and 20–25 kg pigs (n = 11) anaesthetised with halothane or pentobarbital. The ECG, arrhythmias, blood pressure (BP), heart rate (HR) and extent of infarction were determined in each model. In pigs, left ventricular pressure, dp/dtmax and cardiac output were also measured. In chronically prepared rats, halothane anaesthesia started after occlusion was antiarrhythmic and decreased the incidence of ventricular fibrillation and resulting mortality. In isolated rat hearts, 0.5 or 1.0 per cent halothane had little effect on occlusion-induced arrhythmias. The highest concentration of halothane increased the incidence of ventricular fibrillation both before and after occlusion. Halothane decreased developed ventricular pressure in a dose-dependent manner. In acutely prepared pigs, halothane pre-treatment had no appreciable effect upon occlusion-induced arrhythmias when compared with pentobarbital anaesthesia. Thus, halothane is antiarrhythmic when treatment is initiated after occlusion in the rat but this action is not seen in isolated hearts or intact pigs. The antiarrhythmic action of halothane is, therefore, species and model dependent. 相似文献
8.
Cross-sectional areas and lactate dehydrogenase activity were determined of separate muscle fibres of mouse rectus femoris muscle in both ventral and dorsal parts of the muscle. The lactate dehydrogenase activity was measured quantitatively by microscope photometry using a tetrazolium staining in absence or presence of either vitamin K3 or phenazine methosulfate. If the observations are restricted to a relatively small area of the muscle cross section, one can distinguish categorically narrow ("red") and broad ("white) fibres with average values for cross sectional area and LDH content that depend on the part of the muscle chosen (higher LDH and smaller area in ventral part). However, if these data from the different parts or from the whole muscle are added together, no categorical distinction between the fibre types is allowed. On the basis of the observations a categorical division of muscle fibres within relatively large muscle areas or in a whole muscle is rather dubious. A relation is suggested between the subjective impression of different muscle fibre types in a field of observation with the number of motorunits present in that field. 相似文献
9.
Korppi M 《APMIS : acta pathologica, microbiologica, et immunologica Scandinavica》2002,110(7-8):515-522
Seven paediatric studies on community-acquired pneumonia with serological methods for both viruses and bacteria have been published, allowing the evaluation of concomitant multiple etiological findings. In these studies, dual viral infection has been present in 0-14%, dual bacterial infection likewise in 0-14%, and mixed viral-bacterial infection in 3-30% of the pneumonia cases. The results confirm former clinical observations that respiratory viruses often pave the way for airway-colonising bacteria. The measured frequency of multiple infections has been dependent on the available test panel, mainly on the tests used for pneumococcal aetiology. Mixed viral-bacterial infections have been especially common in young children under 2 years of age, reflecting the high frequency of respiratory syncytial virus infections and their tendency to induce bacterial co-infections. No microbe-specific viral-bacterial associations have been demonstrated. The clinical implications of mixed viral-bacterial infections, compared with viral infections alone or bacterial infections alone, have so far remained unresolved. Current guidelines recommend antibiotic therapy for all community-acquired pneumonia cases in children. 相似文献
10.
Marijke S. Labots-Vogelesang Doreth A. M. Teunissen Vivianne Kranenburg Antoine L. M. Lagro-Janssen 《The European journal of general practice》2021,27(1):19
BackgroundGeneral practitioners (GPs) encounter women suffering from premenstrual symptoms. Often women with premenstrual problems experience little understanding from GPs. Views of GPs will influence their approach to these women and their care. Insight into these views is lacking but could help in designing educational programmes for GPs.ObjectivesTo explore the views of Dutch GPs towards aetiology, diagnostic process, and preferred treatment of premenstrual symptoms.MethodsIn 2017, we conducted a qualitative, semi-structured, interview survey among 27 GPs, varying in age, gender, and practice setting.ResultsImportant themes emerged from the interviews: ‘no need for a symptom diary,’ ‘PMS defined as illness’ exclusively in case of disruption of normal functioning, and ‘symptomatic treatment’ as preferred approach. Most GPs considered PMS to be a physiological phenomenon, with taking history as an adequate diagnostic tool. Almost all GPs regarded a normal cyclical hormonal cycle as causal; many also mentioned the combination with personal sensitivity. Some pointed to a dividing line between physiological condition and illness if women could not function normally in daily life. Lastly, the approach GPs preferred was focussing on relieving symptoms of individual patients. In addition to explaining the hormonal cycle and lifestyle advice, all GPs advocated oral contraceptives, and if necessary psychological support. GPs expressed negative feelings about prescribing antidepressants.ConclusionGPs considered physiological changes and personal sensitivity as aetiological factors. We recommend more training to improve GPs knowledge and more insight into the burden of women with PMS. A symptom diary is an essential diagnostic tool for GPs. 相似文献