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11. |
Intermittent, Positive Pressure Ventilation-Dependent Right Bundle Branch Block |
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The American Journal of the Medical Sciences,
Volume 302,
Issue 6,
1991,
Page 380-381
JANINE PARKER,
BENNETT deBOISBLANC,
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摘要:
A 73-year-old man with severe chronic obstructive pulmonary disease and cor pulmonale developed an intermittent right bundle branch block (RBBB) during mechanical ventilation. The appearance and disappearance of his RBBB was temporally associated with each positive pressure breath. Intermittent RBBB is a previously undescribed complication of positive pressure ventilation.
ISSN:0002-9629
出版商:OVID
年代:1991
数据来源: OVID
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12. |
Disseminated Mycobacterium Gordonae Infection in a Nonimmunocompromised Host |
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The American Journal of the Medical Sciences,
Volume 302,
Issue 6,
1991,
Page 382-384
L N JARIKRE,
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摘要:
Mycobacterium gordonae is considered the least pathogenic of the Runyon Group II mycobacteria, although there are now welldocumented reports of infection varying from localized soft tissue infection to disseminated life threatening diseases. We report a 40-year-old Pakistani housewife, treated in childhood for tuberculosis, who presented with severe systemic illness, fever, ascites, hepatomegaly, persistent dysuria with sterile pyuria, pulmonary disease, and anorexia with weight loss. Liver biopsy histology showed multiple granulomata and multiple isolation of M. gordonae from sputum and urine, in keeping with disseminated mycobacterial infection. She had dramatic response to antituberculosis therapy with streptomycin, isoniazid, rifampicin, and pyrazinamide. No evidence existed for disturbed humoral or cellular immunity and HIV infection. This represents the fifth reported case of disseminated M. gordonae infection, the first from the Arabian Gulf. It was treated successfully with standard antituberculosis regimen.
ISSN:0002-9629
出版商:OVID
年代:1991
数据来源: OVID
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13. |
Initial Treatment of Pulmonary Edema: A Physiological Approach |
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The American Journal of the Medical Sciences,
Volume 302,
Issue 6,
1991,
Page 385-391
RONALD ALLISON,
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摘要:
An understanding of the physiological principles involved in lung fluid balance is useful in the initial treatment of pulmonary edema. Normally, a very small volume of fluid is filtered from the pulmonary vasculature into the interstitial space. This interstitial fluid enters the pulmonary lymphatics and is transferred to mediastinal lymphatics at an estimated rate of 20 ml/hr. Under abnormal circumstances, fluid filtration may occur at such a rapid rate that it overwhelms the lymphatics and interstitial space and results in alveolar flooding. This may occur as a result of increased pulmonary vascular pressure or increased vascular permeability. The two general goals of initial therapy are (1) to relieve hypoxemia and (2) to reduce pulmonary capillary pressure. Relieving hypoxemia may require the use of supplemental oxygen by nasal prongs or mask, continuous positive airway pressure (CPAP) mask, or even endotracheal intubation and mechanical ventilation. Measures to decrease preload and thereby reduce pulmonary capillary pressure include sitting the patient up, administering a loop diuretic or morphine intravenously, and in some circumstances using sublingual nitroglycerin. After initial treatment is underway, a search for and specific management of the underlying cause of pulmonary edema can proceed.
ISSN:0002-9629
出版商:OVID
年代:1991
数据来源: OVID
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14. |
Selegiline in the Treatment of Parkinson's Disease |
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The American Journal of the Medical Sciences,
Volume 302,
Issue 6,
1991,
Page 392-395
DEBORAH ROBIN,
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ISSN:0002-9629
出版商:OVID
年代:1991
数据来源: OVID
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15. |
Hepatitis B — Molecular Variants with Clinical Significance? |
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The American Journal of the Medical Sciences,
Volume 302,
Issue 6,
1991,
Page 396-403
JENNIFER CUTHBERT,
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摘要:
Mutations in the DNA of the hepatitis B virus have been discovered and they may have clinical significance. A single nucleotide substitution resulting in a premature stop codon in the pre-core region of the hepatitis B genome is the most common change. The premature stop codon prevents the synthesis of hepatitis B e antigen (HBeAg), a virally encoded protein normally secreted by hepatocytes. The mutant hepatitis B virus was initially discovered in patients who lacked HBeAg in the serum yet had high levels of hepatitis B viral DNA, a marker of active viral replication usually found in association with the continued presence of HBeAg. Other studies demonstrated that the mutant forms were observed with increasing frequency during the successful conversion from HBeAg positivity to anti-hepatitis B e antibody (anti-HBe) positivity. The mutant form of hepatitis B virus was not identified in patients with stable chronic hepatitis B who were positive for HBeAg or in any patients with uncomplicated acute hepatitis B, regardless of the presence of HBeAg or anti-HBe. However, mutant hepatitis B virus was detected in patients with fulminant hepatitis B who lacked both HBeAg and anti-HBe. The lack of HBeAg in the serum therefore may result in a more severe form of acute disease. Together with experimental animal studies of the normal role of HBeAg, these data suggest that serum HBeAg may be associated with immunologic tolerance, whereas clearance of or lack of HBeAg may be associated with an active immunologic response. Future studies are expected to clarify the role of mutant forms of hepatitis B virus in the natural history of hepatitis B infection.
ISSN:0002-9629
出版商:OVID
年代:1991
数据来源: OVID
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16. |
Index to Volume 302 |
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The American Journal of the Medical Sciences,
Volume 302,
Issue 6,
1991,
Page 404-409
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ISSN:0002-9629
出版商:OVID
年代:1991
数据来源: OVID
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