ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1989.tb00242.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstractWe have evaluated a flexible warfarin dose induction protocol by monitoring its performance in 100 elderly inpatients.The protocol (designed by Fennerty et al., has two aims: (a) to move the prothrombin time (PT) ratio smoothly and quickly into its therapeutic range, and (b) to predict the steady‐state warfarin requirement from the PT ratio measured on the fourth treatment day.It proved simple to use and reasonably successful, since after four days, 67/100 patients had achieved a therapeutic level of PT ratio, nine exceeded the therapeutic range, and 24 remained sub‐therapeutic, while none had bled due to excessive anticoagulation. Maintenance dose prediction was tested by comparing the predicted and observed maintenance doses in patients within the ‘therapeutic range’ of PT ratio after various median times of treatment. After ten days, the observed dose was within 1 mg of that predicted in 65/86 patients (76%). This proportion became 57/77 (74%) after 18 days, and 49/79 (62%) after

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1989.tb00243.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1989.tb00244.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstractSeven children with steroid resistant nephrotic syndrome (focal segmental sclerosis in six, mesangial proliferation in one) were treated with Cyclosporin A for 12 weeks. Five of these children were also resistant to cyclophosphamide. All patients had normal renal function. Cyclosporin was started at 8mg/kg/day then increased until a trough blood level of 100–300 ng/ml (HPLC) was achieved. Three of the seven patients achieved complete remission, and the other four had a significant reduction in their proteinuria (p<0.05). In the three patients who achieved complete remission, relapse of proteinuria occurred within six weeks of ceasing Cyclosporin. All patients experienced some impairment in renal function with mean creatinine clearance decreasing from 12919 to 9113 ml/min/1.73m2(p<0.05). One child was subsequently treated with Cyclosporin for 12 months. He remains in remission with a repeat renal biopsy showing no evidence of nephrotoxicity.One other child with steroid sensitive minimal change nephrotic syndrome who had severe steroid toxicity was treated with a lower dose (5mg/kg/day) for 12 months. She remained in remission off steroids, but relapsed 16 weeks after Cyclosporin was ceased. A renal biopsy after 12 months showed no nephrotoxicity. Cyclosporin should be considered in steroid resistant nephrotic syndrome, and in children with minimal change disease who show signs of steroid toxicity and short remission period after cyclophosphamide. Serial renal biopsies are recommended with prolonged therap

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1989.tb00245.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstractThe progress of 41 Chinese patients with acromegaly treated with megavoltage radiotherapy was reviewed after a mean follow‐up of 4.5 (one‐ten) years. Nine received prior surgery. Radiotherapy was delivered by a 3‐field technique to a total of 4000–5000 cGy in 25 fractions. By life table analysis successful treatment of growth hormone (GH) hypersecretion, as defined by a mean GH concentration of 10 mu/L, could be expected in 6, 11, 26, 64 and 67% of the patients after one, two, five, eight and ten years respectively. Median intervals before achieving a mean GH level of 10 mu/L were 6.6 and 8.6 years following radiotherapy with the higher (4500–5000 cGy) and lower (4000 cGy) doses respectively, suggesting a tendency towards earlier response following radiotherapy with the higher dose. The prevalence of acquired hypopituitarism in patients followed up for over five years was 40% for gonadotrophins, 30% for TSH and 20% for ACTH deficiency respectively. In the majority of patients, acquired hypopituitarism was not apparent within five years after radiotherapy. No mortality or major side effects were noted following radiotherapy. In 34 patients on long‐term bromocriptine treatment, mean GH concentrations were normalised in 26.5% of patients. We conclude that with judicious selection of patients and use of adjunctive medical therapy, megavoltage radiotherapy remains a safe and satisfactory form of treatment for acromegaly especially if expert transphenoidal surgery is not readil

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1989.tb00246.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstractRecent advances in electronic engineering have allowed Doppler echocardiography to be presented in the form of a real‐time two‐dimensional image. The resulting image of blood flow has been described as a ‘non‐invasive angiogram’, but the analogy with angiography should not be pushed too far since the technical determinants of these images are entirely different. Nevertheless, the colour flow map does allow rapid and direct exclusion, detection and quantitation of regurgitant and stenotic lesions, and semi‐quantitative assessment of valvular regurgitation and shunts. To achieve optimum results, it is necessary to standardise recording procedure, to take account of patient variables which influence the image appearance and quality and to be aware of the possibility of artefact. As for all investigations, results which are not coherent with other echocardiographic data, with other investigations and with the clinical assessment should be subjected to particular scrutiny with the possibility of false diagno

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1989.tb00247.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1989.tb00248.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstractTo compare the diagnostic yield of magnetic resonance imaging (MRI) with computed tomography (CT) in posterior circulation infarction, we used proton MRI with a 0.3 Tesla magnet and a 3rd generation CT scanner in 25 patients. Age‐matched controls were compared in a blinded fashion. Seventeen patients (68%) showed relevant pathology on MRI not seen on CT, 11 with normal CT and six with more extensive lesions, chiefly in the brain stem.Evidence of abnormal vertebrobasilar blood flow was seen in 8/25 (32%) of patients, suggested by vascular high intensity signals on MRI. Two tissue and one flow abnormality were seen in the control group. MRI provides additional information concerning infarct site, extent and pathogenesis in posterior circulation infarctio

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1989.tb00249.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1989.tb00250.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstractSerum thymidine kinase (STK) levels have recently been used to detect tumour regression and progression in a number of hematological malignancies. In this study, patients with myeloma were monitored longitudinally for STK and several other potentially useful tumour markers to determine which laboratory parameters are the most useful for differentiating between stable and progressive disease. STK was determined by radioenzyme assay, lymphocyte surface markers were analysed by flowcytometry, plasma cell labelling index (LI) by immunofluorescence with anti BU‐1, serum B2‐microglobulin (SB2M) by radioimmunoassay and M proteins by radial immunodiffusion. Detailed multiparameter longitudinal investigations of 5 patients and ongoing studies of 70 other patients suggest that STK is a more reliable marker of progressive disease than either SB2M, LI, M‐protein or CD10 positive lymphocytes. A rise in STK during the emergence of progressive disease at least paralleled and usually preceded any change in the other parameters which often did not change at all. All samples from patients with progressive disease (n = 29) had a STK above the normal range (0–5U/I) whereas 76% of patients in clear stable disease had a STK within the normal range. All samples (n = 34) from patients with light chain isotype suppression (LCIS) had STK values of less than 12 U/L and 82% of samples (n = 33) from patients without LCIS had a STK above the normal range (0–5U/L). The correlation between STK and LI was r = 0.65;p<0.001 (n = 21). The radioenzyme assay for STK is simple, reproducible and a valuable tool for monitoring patients with myeloma and when used in conjunction with other clinical and laboratory investigations, aids in the separation of patients with stable myeloma from patients whose disease is pr

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1989.tb00251.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY