ISSN:0954-6820    

DOI:10.1046/j.1365-2796.1996.505833000.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

The essential n‐6 and n‐3 polyunsaturated fatty acids can prevent ischaemia‐induced ventricular fibrillation in rats, dogs and marmosets. In isolated neonatal rat cardiac myocytes, these have been shown to prevent tachyarrhythmias caused by elevated calcium concentrations, toxic levels of ouabain, a β‐adrenergic agent (isoproterenol), lysophosphatidylcholine and acylcarnitine. The antiarrhythmic effect is caused by a reduction in electrical excitability caused by partitioning of the free polyunsaturated fatty acids into the phospholipid cell membranes of the cardiac myocytes, which modulates membrane ion channels. Two clinical trials suggest they could prevent sudden cardiac death i

ISSN:0954-6820    

DOI:10.1046/j.1365-2796.1996.449803000.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective.The objectives of the Cost Effectiveness of Lipid Lowering (CELL) study were twofold: (i) to evaluate the effect on overall cardiovascular risk of two types of health care advice (‘usual’ and ‘intensive’) given in primary care, with or without pharmacological medication, with the target being to attain a moderate decrease in cholesterol; (ii) to evaluate the ritual of daily medication on compliance with the health care advice.Design.A prospective, double‐blind, randomized, controlled trial of 18 months' duration.Setting.The study was carried out in 32 health centres (out of a total of approximately 850) in Sweden.Subjects.In all, 681 subjects, aged 30–59 years, were randomized. They had at least two cardiovascular risk factors in addition to moderate primary hyperlipidaemia (total cholesterol of at least 6.50 mmol L‐1on three occasions measured by Reflotron, triglycerides less than 4.0 mmol L‐1and an LDL:HDL cholesterol ratio of more than 4.0). Most (87%) of the subjects were males; 626 subjects (92%) completed the 18‐month follow‐up.Intervention:Half the subjects were randomized to ‘intensive advice’ given in group sessions led by doctors and nurses in primary care. The other half received ‘usual advice’. In each of the two advice groups, one‐third received an active lipid‐lowering drug (pravastatin), one‐third placebo, and one‐third no drug at all. The tablets were titrated to achieve a 15% reduction in cholesterol.Main outcome measures.Changes in the overall Framingham risk score, and the development of adverse events in each group.Results.The change in Framingham risk score was significantly reduced only in subjects taking lipid‐lowering medication (together with intensive advice‐0.13; 95% CI ‐0.20,‐0.06, and together with usual advice ‐0.16; 95% CI ‐0.23,‐0.09). The other subjects receiving intensive advice tended to fare better than those on usual advice. Lifestyle was not influenced significantly over the study period. The ritual of daily medication did not affect the outcome.Conclusion.As expected, lipid‐lowering medication reduced serum cholesterol as well as overall cardiovascular risk in subjects with several risk factors for cardiovascular disease. There was no additive effect of intensive advice to these subjects. However, there was a meagre but significant effect of intensive advice in subjects not receiving active lipid‐lowering drugs. One explanation for this difference may be that those on active lipid‐lowering medication who had substantial drops in cholesterol might have felt less inclined to change their lifestyle compared with those on other treatment regimens who had less successful drops in cholesterol. There wa

ISSN:0954-6820    

DOI:10.1046/j.1365-2796.1996.492831000.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective.To evaluate the cost‐effectiveness of two types of advice (usual and intensive) to lower cardiovascular risk, with or without pharmacological medication aimed at lowering cholesterol levels.Design.Prospective, randomized, controlled clinical study of 18 months' duration.Setting.Thirty‐two primary health care centres in Sweden.Subjects.A total of 384 males, aged 30–59 years, with at least one cardiovascular risk factor in addition to moderate primary hyperlipidaemia; of these, 355 completed the 18‐month follow‐up.Interventions.Intensive advice consisted of group sessions led by a health care professional; the usual level of advice was given at follow‐up visits. The pharmacological intervention consisted of pravastatin. The goal was to achieve a 15% reduction in cholesterol.Main outcome measures.Cost per life‐year gained based on the change in serum cholesterol and the net intervention cost of the four treatment options.Results.The usual level of advice and intensive advice in combination with pharmacological treatment achieved no incremental effects and were not considered in the cost‐effectiveness analysis. The cost per life‐year gained of pharmacological treatment compared with intensive advice decreased. The cost per life‐year gained of pharmacological treatment compared with no treatment was about $61 000, if no adverse consequences on noncardiovascular mortality were assumed.Conclusions.According to the results of the CELL trial, intensive advice is not a cost‐effective strategy compared with lipid‐lowering drug treatment. However, it is also doubtful whether drug treatment as primary prevention is cost‐effective compared with no treatment in the s

ISSN:0954-6820    

DOI:10.1046/j.1365-2796.1996.491830000.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Inflammation of medium and small sized arteries caused by polyarteritis nodosa (PAN) sometimes causes acute and life threatening ischaemic intestinal complications. We report a case of PAN presenting with severe abdominal pain successfully treated with nitroglycerin.

ISSN:0954-6820    

DOI:10.1046/j.1365-2796.1996.446784000.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Pulmonary arteriovenous fistulas are uncommon abnormalities of capillary development which cause right to left shunting and, if not treated, may lead to severe neurological complications, including meningitis and brain abscess. Pulmonary arteriovenous fistulas are commonly a result of hereditary haemorrhagic telangiectasia (Rendu–Osler–Weber disease) and both conditions may be readily diagnosed by careful history taking and physical examination. Two cases of brain abscess associated with hereditary haemorrhagic telangiectasia, which remained unrecognized for many years, are reported. These cases emphasize the importance of early diagnosis and treatment of pulmonary arteriovenous fistula in preventing central nervous system infecti

ISSN:0954-6820    

DOI:10.1046/j.1365-2796.1996.471812000.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

The syndrome defined as ‘idiopathic CD4 lymphocytopenia’ (ICL) is a rare disease of unknown aetiology, often associated with severe depression of immune defences and the occurrence of opportunistic infections. A case is reported wherein a severe immunodeficiency syndrome with persistent idiopathic CD4+ lymphopenia developed in a woman suffering from systemic microscopic polyarteritis; no signs of HIV 1/2 or HTLV I/II infection were evident. The patient died of widespread opportunistic infections. The association of ICL with vasculitis has never been reported until now. A link between the two diseases cannot be ruled

ISSN:0954-6820    

DOI:10.1046/j.1365-2796.1996.447785000.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY