ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1995.tb02847.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1995.tb02848.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1995.tb02849.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1995.tb02850.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1995.tb02851.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractBackground:Directional coronary atherectomy is a percutaneous technique which extends the role of balloon angioplasty to bulky eccentric coronary lesions.Aims:To report the early experience, clinical results, complications and histopathological findings of directional coronary atherectomy (DCA) in proximal left anterior descending artery (LAD) stenosis.Methods:Study of 25 lesions in 24 patients on whom directional atherectomy was performed on the proximal LAD artery with the Simpson coronary atherectomy device.Results:Twenty‐five procedures were performed on 24 patients with stenosis in the proximal LAD artery. There were 21 males and three females with a mean age of 56.5 years. Sixteen patients presented with stable angina and eight with unstable angina. Eight patients had previous myocardial infarction (MI). Angiographic success was obtained in 24 of 25 lesions (96%). The mean lesion length was 13.1 ± 3.7 mm and the mean LAD artery diameter was 3.6 ± 0.5 mm. Minimal luminal diameter improved from 0.9 ± 0.4 mm to 3.0 ± 0.5 mm and the percentage diameter stenosis reduced from 75 ± 12% to 16 ± 9%. Complications included acute occlusion in one patient, non‐Q MI in three patients, local vascular complications in one patient and side‐branch loss in one patient. Histology demonstrated fibrous cap of atherosclerotic plaque in 100%, media and internal elastic lamina in 28% and intimal hyperplasia in 100% of restenotic lesions and 27% of native lesions. Restenosis rates in angiographically restudied patients was 27%. The mean minimal luminal diameter at follow‐up was 2.3 ± 0.9 mm and the mean percentage diameter stenosis was 35 ±21%.Conclusion:From this initial study, we conclude that DCA is an effective and safe procedure for the treatment of large proximal LAD lesions. DCA provides a large luminal diameter and a ‘smoother’ angiographic appearance compared to coronary angioplasty. Acute complication rates are low and restenosis rates were comparable with percutaneous transluminal coronary

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1995.tb02852.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractBackground:The histological criteria for the diagnosis of mild acute rejection in renal transplant biopsies have not been well defined.Aim:To ascertain the value of the Banff criteria for transplant biopsy reporting, particularly for the diagnosis of acute rejection, and the ‘borderline’ category.Methods:We compared two systems of histological assessment in 23 transplant biopsy specimens and compared histological diagnoses to separately defined clinical diagnoses. The histological criteria applied were those of the recently described Banff criteria which were compared with our traditional diagnostic method for each specimen.Results:We found the Banff diagnoses more closely related to the clinical outcome than the system of histological diagnosis that we had previously been using.Conclusions:We conclude that the Banff criteria more accurately reflect the clinical situat

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1995.tb02853.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractBackground:Scleroderma is a systemic rheumatic disorder seen in a wide range of clinical specialties.Aims:To establish the prevalence and mortality rates of scleroderma in South Australia (SA), to determine the relative frequency and characteristics of the three principal subsets (diffuse, limited and overlap), and to examine the role of nailfold capillaroscopy in subset identification and implied prognosis.Methods:Outpatient and discharge diagnostic indexes from five major teaching hospitals in SA were reviewed between February 1987 and November 1993. A total of 215 patients with scleroderma were identified. Case notes of 115 of these patients were reviewed in order to validate scleroderma diagnosis, and subset characteristics such as sex, mean age at diagnosis, extent of skin involvement, internal organ involvement and serology were analysed. Fifty‐two of these patients were then examined prospectively to confirm positive discharge diagnosis, and nailfold capillaroscopy was performed on these patients.Results:The point prevalence of scleroderma in SA for 1993 was estimated to be 208/106. This figure is a conservative estimate and is higher than most other reported series. The female to male ratio was 4:1. The majority of patients had limited disease with a ratio of 6:1:1.6 limitedvsdiffusevsoverlap. Systemic involvement excluding the oesophageal component in limited disease was found predominantly in the diffuse group. Autoimmune serology was positive in 90% of patients, with Scl‐70 being more common in diffuse scleroderma, anti‐centromere antibody (ACA) in the limited form and anti‐ribonucleoprotein (RNP) in the overlap form. Nailfold capillaroscopy was useful in predicting disease‐subtype as capillary dilatation was observed predominantly in limited disease, and capillary dropout in diffuse disease.Conclusions:Scleroderma is more common in SA than previously recognised. Limited disease is more common than diffuse or overlap disease, carries a better prognosis and is associated with ACA. Nailfold capillaroscopy is a useful tool in disease assessment and may provide useful diagnostic and prognostic in

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1995.tb02854.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractBackground:Alpha‐1‐antitrypsin deficiency is associated with a high risk for the development of emphysema, particularly for phenotype Pi ZZ, which is both deficient and an abnormal inhibitor of the powerful proteolytic enzyme, human neutrophil elastase. The rare variant PLowellis also expressed at abnormally low levels, but its anti‐elastase activity has not been described.Aim:To study the anti‐elastase activity of alpha‐1‐antitrypsin PLowdland compare it to the common M, S and Z proteins.Method:Alpha‐1‐antitrypsin from a female patient aged 75 years with the rare genotype PLoweUNullBcllinghamwas studied for its ability to inhibit human neutrophil elastase in a time dependent manner.Results:PLoweii has near normal function as an inhibitor of human neutrophil elastase with an association rate constant of 7.4 X 106M'V1at 25 °C, similar to that of M and S.Conclusion:Alpha‐1‐antitrypsin PLis associated with a severe deficiency of alpha‐1‐antitrypsin similar to Z, but unlike that protein it has near normal func

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1995.tb02855.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractBackground:There are conflicting reports about the effects of ACE inhibitors (ACEI) on insulin sensitivity and glycaemic control. Most studies have used a standard high dose of an ACEI but there have been no studies reported to establish whether any changes in glycaemic control or insulin sensitivity associated with ACEI are dose‐related.Aim:To examine the effect of increasing doses of enalapril on insulin sensitivity in normotensive non‐insulin dependent diabetic subjects.Methods:The effects of increasing doses of enalapril on insulin sensitivity in ten normotensive non‐insulin dependent diabetic subjects were measured, using the hyperinsulinaemic isoglycaemic clamp technique. Following a baseline study, enalapril was commenced at 5 mg daily and increased to 10 mg daily then 20 mg daily at 14 day intervals. Repeat studies were undertaken after 14 days at each dosage.Results:There was a significant dose‐related reduction of systolic blood pressure with enalapril. In contrast enalapril at 5‐20 mg daily produced no significant changes in insulin mediated glucose uptake (M‐value) or insulin sensitivity index (ISI).Conclusions:These findings indicate that in this insulin resistant population of normotensive non‐insulin dependent diabetics, angiotensin converting enzyme inhibition with enalapril has no significant effect on insulin mediated g

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1995.tb02856.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY