ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1988.tb02240.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Abstract:The noninvasive measurement of aortic valve area by use of the continuity equation has been proposed as an accurate method for determining the severity of aortic stenosis. In 32 patients (mean age 64±14 years) with proven aortic stenosis and without significant regurgitation, aortic valve areas derived by the Gorlin equation from cardiac catheterisation data were compared with valve areas calculated from the continuity equation using Doppler echocardiography.There was a close correlation between Doppler and catheter derived aortic valve areas (r = 0.87, SEE = 0.17 cm2). The interobseryer error for aortic valve area measurement in 20 patients was 9.0 ± 6.8%. The specificity of this method for critical aortic stenosis (aortic valve area less than 0.75 cm2) was 73% and the sensitivity 88%.We conclude that in an adult, predominantly elderly population with calcific aortic stenosis, this Doppler echocardiographic method is reproducible and can be used accurately to derive aortic valve are

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1988.tb02241.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1988.tb02242.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Abstract:A multivariate predictive model for early (six‐month) survival based on Cox's proportional‐hazards regression model was developed using data collected prospectively from 317 consecutive patients admitted with acute myocardial infarction to a coronary care unit (CCU). Of these, 63 (19.8%) died within the follow‐up period. Patients with cardiogenic shock were excluded from the study. Variables associated with survival were sought from clinical, historical, electrocardiographic and radiographic variables recorded at the time of admission. On multivariate analysis, a stepwise selection procedure identified four variables which described the probability of survival for the six‐month follow‐up. These were: age, upper lung crepitations, marginal and also definite radiographic cardio‐megaly on an anteroposterior radiograph. With this combination of clinical variables alone, using a survival probability partition value of 80%, the model had a sensitivity of 67% and a specificity of 75%. However, the model's predictive accuracy for death was 40%, compared to a predictive accuracy for survival of 90%. This clinical model is most useful for early discrimination of those patients at low risk of death within six months of CCU admission. Other predictive tests for premature death would need to exceed these discriminatory criteria to justify their cos

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1988.tb02243.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Abstract:A 22‐year‐old man developed severe encephalopathy, grand mal seizures and visual disturbance after combination chemotherapy with cisplatin, vinblastine and bleomycin for metastatic testicular carcinoma. After excluding treatable causes, only supportive management was given, and the symptoms and signs resolved over several months. We suggest a clinical syndrome of encephalopathy, seizures and visual disturbance represents a rare toxicity of cisplatin‐based therapy. Given the wide spread usage of cisplatin, this should be drawn once again to the attention of medical oncolo

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1988.tb02244.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Abstract:A 19‐year‐old woman with long‐standing sensorineural deafness, bilateral cataracts and mild clumsiness, presented with acute focal edema in the left temperoparieto‐occipital area which required surgical decompression as a life‐saving measure. Investigation revealed a persistent lactic acidemia and evidence of many ragged red fibres in a skeletal muscle biopsy specimen, suggesting a diagnosis of mitochondrial myopathy, encephalopathy, lactic acidosis and stroke‐like episodes (MELAS) syndrome. The patient developed two further stroke‐like episodes over a short period. One sibling died at the age of 14 years with a progressive neurological illness characterised by seizures, bilateral optic atrophy, ataxia, myoclonus and progressive dementia.The diagnosis of MELAS syndrome should be considered in young people presenting with stroke‐like episodes that fail to conform to a given vascular territory, particularly if they have longstanding minor neurological abnormalities or a family history of obscure early onset neurological disease.The different clinical pictures in the two affected siblings in this family suggest that MELAS syndrome is part of a spectrum of inherited mitochondrial cytopathies rather than a discrete

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1988.tb02245.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1988.tb02246.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Abstract:The rare occurrence of Wiskott‐Aldrich syndrome (WAS) in identical twin brothers without a preceding family history of the disease is described. Investigation into the nature of the lymphocyte abnormality in the surviving twin suggests that the frequency of T cell clone forming cells is markedly decreased. Further analysis of the T cell clones showed a deficiency of CD8 positive cytotoxic/suppressor cells. This alteration may be an underlying mechanism in the development of some of the clinical manifestations of W

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1988.tb02247.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1988.tb02248.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Abstract:We examined the efficacy of high dose glucocorticosteroids in two patients with Waldenstrom's macroglobulinemia resistant to other forms of therapy. Both patients demonstrated marked falls in total protein, paraprotein and viscosity levels, after only short periods on this regimen. There was no significant toxicity. We conclude that high dose dexamethasone may offer significant benefits in the treatment of Waldenstrom's macroglobulinemia.

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1988.tb02249.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY