ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1990.tb01281.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractPrognostic models in primary biliary cirrhosis have been validated for large population groups but the predictive value for individual patients has not been tested. We used data from ten deceased patients with primary biliary cirrhosis to test three prognostic models: the Shapiro model (bilirubin); the Christensen model (age, bilirubin, albumin, presence of cirrhosis or cholestasis, azathioprine treatment); and the Dickson model (age, bilirubin, albumin, prothrombin time, oedema). The predictive value of each model for individual patients was determined by assessing whether it would have accurately predicted appropriate timing of liver transplantation in patients prior to death. The Dickson model predicted that four of nine cases would have been considered for liver transplantation one year before death and one of seven cases two years before death. The Christensen model predicted that this procedure would have been considered in three of seven cases two years before death. The Shapiro model was demonstrated to be the least predictive of the three tested. Although none of the three models assessed was found to accurately predict survival, no model predicted a worse survival than actually occurred. Liver transplantation is indicated in those cases with a poor predicted survival

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1990.tb01282.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1990.tb01283.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractPost transfusion purpura in a DR3, DRw52 positive, P1A1negative woman rapidly responded to high‐dose intravenous gammaglobulin therapy. Using the platelet immunofluorescence test (PIFT) high titre IgG and IgM alloantibodies were detected in the patient's acute serum. These alloantibodies had P1A1specificity and the patient's serum produced a broad, 100 kDa band on Western Blot with P1A1positive platelets. Acute phase serum also contained an IgG antibody which reacted in the PIFT with the patient's own platelets, and P1A1negative platelets. When tested by Western Blot with P1A1negative and Glanzmann's Thrombasthenia platelets, the acute serum produced bands at 180 and 200 kDa. The autoreactive antibody was not detected once the platelet count returned to normal. These findings provide evidence for the hypothesis that the mechanism of autologous platelet destruction in PTP is autoimmun

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1990.tb01284.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1990.tb01285.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractTwo methods of eliciting the ankle jerk have been compared. One, the traditional method, involved tapping the Achilles tendon (the tendon tap); the other (the plantar tap) involved tapping the sole of the foot. The study was done on 110 inpatients in the medical wards of a teaching hospital.The results showed an 89% agreement between the two methods. The extent of agreement was unrelated to the level of experience of the examiner. Forty three per cent of patients favoured the plantar tap method; 14% the tendon tap. The plantar tap method of eliciting the ankle jerk is an acceptable alternative to the traditional method.

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1990.tb01286.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1990.tb01287.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractIn a two year period 44 endobronchial resections using the Neodymium‐YAG laser have been performed in 28 patients. The majority of cases had either bronchogenic carcinoma (57%) or metastatic carcinoma (18%) involving the bronchial tree. Adenoid cystic carcinoma, benign tumours, lymphoma, tracheal papillomatosis, Wegener's granulomatosis and benign stricture comprised the other cases. Rigid bronchoscopy and general anaesthesia were used in the majority. Symptomatic improvement of dyspnoea when relief of bronchial obstruction occurred was marked in ten of 17 cases, moderate in four and absent in three. Haemoptysis was markedly improved in two of three cases and obstructive pneumonias resolved in one of two cases. Significant respiratory function improvement was observed in Raw(most sensitive), FEV1, FVC and TLC. Laser treatment restored the lumen to normal calibre in 52% (including all patients with tracheal lesions), to greater than half normal in 28% and to less than half normal in 20% of cases. Re‐expansion of a collapsed lung or lobe occurred in seven of eight patients. In six of these patients laser treatment was the initial therapy resulting in immediate re‐expansion and symptomatic relief prior to further therapy. In patients with bronchogenic carcinoma the mean time to retreatment or death was 72 days. For metastatic carcinoma this was 60 days. Two early deaths (3 hours, 36 hours) due to respiratory failure occurred in patients with very severe bilateral bronchial obstruction too advanced for effective clearance. Other complications included laryngeal oedema requiring prolonged intubation (1), bronchospasm (1), atrial fibrillation (1), and acute pulmonary oedema (1). Laser treatment provides effective palliation for bronchial obstruction and haemoptysis in selected proximal endobronchial ca

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1990.tb01288.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractEpidemiologists have not identified high risk groups nor the entire spectrum of heart disease, especially the subclinical forms underlying nonvalvular atrial fibrillation (NVAF) predisposing to cardioembolic (CE) stroke. We analysed 36 cases of ‘isolated’ NVAF among 106 consecutive cases of CE stroke after excluding cases of AF associated with valvular disease, myocardial infarcts, ischaemic and other cardio‐myopathies (34 cases). This revealed echocardiographic left ventricular hypertrophy (LV mass index 136 ± 25 g, vs normal 68 ± 12 gp<0.001), enlarged left atria (left atrial area 27.4 ± 3.6 cm2vs normal 14.3 ± 1.6 cm2p<0.001), normal systolic function and formed the largest group associated with CE stroke (34%), mean age 72.6 years – Study Group D. Eighty nine per cent had known or undetected hypertension compared to 60% in matched controls (x2= 8.3 df= 1p<0.01), and hypertension remained the predominant risk factor for left ventricular hypertrophy (LVH). Although all had echocardiographic LVH, 60% had neither electrocardiographs LVH nor cardiomegaly on chest X‐ray. Hence usual epidemiologic methods may fail to detect these cases. Hypertensive heart disease is known to predispose to left atrial enlargement and AF. Progressive atrial enlargement is associated with increasing risk of embolie stroke.We conclude that NVAF associated with hypertensive heart disease forms a major component of the spectrum of heart disease associated with NVAF predisposing to CE stroke. Detection and treatment of hypertension to prevent or reverse LVH and atrial enlargement should be an important preve

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1990.tb01289.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

AbstractElectrical ablation of a posteroseptal accessory pathway by delivery of direct current electrical energy at the coronary sinus ostium was attempted in six patients.As a result of 12 procedures in these six patients, the posteroseptal accessory pathway was successfully ablated in one patient. Retrograde conduction only was affected in a further three patients, abolishing paroxysmal supraventricular tachycardia in two and reducing the tachycardia rate in one. One of the six patients developed coronary sinus perforation requiring prompt pericardial aspiration.The procedure is complicated, time consuming, of limited efficacy and coronary sinus perforation is a significant risk. Surgery remains the preferred option as a curative procedure for arrhythmias due to posteroseptal accessory pathway.

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1990.tb01290.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY