摘要:

ABSTRACT: The concept of hypothyroid heart disease remains controversial. Although hemodynamic abnormalities have been describecd, the presence of underlying abnormal cardiac structures has not been confirmed. The authors studied 20 hypothyroid patients using M-mode echocardiography before and after 1-thyroxine therapy. Fifteen additional hypothyroid patients were studied using two-dinensional echocardiography to confirm the data of the first study. The findings were the same in both studies: during hypothyroidism, the interventricular septum is thickened, the ratio of septal thickness to left ventricular posterior wall thickening is increased, the right ventricular wall is thickened, regional wall motion of interventricular septum and right ventricular wall is decreased, and global function of the left ventricle is decreased. These findings are reversed with 1-thyroxine therapy; they occur within 6 months of the development of hypothyroidism, but appear unrelated to elevated TSH levels. Whether the thickened interventricular septum and right ventricular wall represent true muscular hypertrophy requires further elucidation. Nevertheless, these data demonstrate the existence of a hypothyroid cardiomyopathy.

ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

ABSTRACT: Insulin requirements, C-peptide levels, and serum lipids have been assessed in 12 obese, insulin-requiring (>60 U/day) patients with type II diabetes mellitus, in a randomized crossover fashion with two treatment regiments: NPH alone and combined NPH and tolazamide, over a period of 3 months each, with maintenance of weight and glycemic control (HgA1. 2hpp amd mean 24h glucose profile) at comparable levels. Serum cholesterol improved in both groups compared to their respective baseline values (p<0.05). In addition, serum triglyceride was lower (p<0.05) in the combined therapy as compared with NPH alone therapy. Insulin requirements were decreased by 23% (p<0.002) in the combined therapy group, without significant change in weight, glycemic control, or C-peptide levels. However, C-peptide increments in the combined therapy group were significantly higher than the baseline by 70% (p<0.02). NPH plus tolazamide therapy as compared with NPH alone (1) lowers insulin requirement in obese, type II diabetic women without significant alteration in glycemic control, possibly by an increased tissue sensitivity to insulin, and (2) decreases serum triglyceride levels.

ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

ABSTRACT: Surgically removed normal and tumorous pituitary tissues from a prolactinoma patient were analyzed by western blot techniques for PRL and Gh variants. Criteria for identification were the Rfof the bands within the gel, immunologic crossreactivity to specific antisera, and structural verfification by tyrosine peptide mapping of individual bands from the gel. The authrors found the tumor-tissue to be characterized by the presence of a PRL band greater in concentration than in the normal tissue and the virtual absence of a GH band. Immunoblotting of the electrophoretically resolved proteins form both types of tissues revealed several new bands corssreactive with human PRL and GH antibodies. Some of the new bands were of Mfgreater than the monomeric PRL and GH and others were of lower MfRelative to two of the low mobility MfPRL-immunoreactive bands designated as 16K and 8K corresponded to the Rfof the two fragments of cleaved PRL, which suggested that cleaved PRL occurred naturally in the human pituitary gland. The most conspicuous of the new PRL-immunoreactive bands, a 25,000 Mfprotein migrating slightly behind PRL, displayed strong crossreactivity to hPRL antibodies and was present in greater concentration in the prolactinoma tissue than in the normal tissue. These properties suggested that it was related to hPRL and perhaps represented its glycosylated variant. However, its tyrosine peptide map did not resemble that of hPRL. Thus, it is not clear whether it represented GhPRL or a new pituitary protein that cross-reacts with hPRL antibodies. In addition, two other bands of low Mfdesignated as unknown 1 and unknown 2, reacted with hPRL antibodies. Immunostaining with hGH antibodies revealed the 20K-hGH variant, the Mf, fragment of cleaved hGH, and a pair of new bands immediately behind GH that could represent glycosylated hGH-possibly a product of Seebrug's variant hGH gene. Both PRL and GH antibodies elicited numerous bands of high Mfby the technique employed, far more than ever observed by Sephadex chromatography. The nature of the high Mfbands remians unknown. Further characterization of these new PRL- and GH-immunoreactive proteins might help in the understanidng of the multiple physiologic functions of PRL and GH in man.

ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

ABSTRACT: Despite the widespread application of endoscopy in acute upper gastrointestinal bleeding, there is little evidence of improved survival among those who undergo the procedure. To select high-risk patients who might benefit most from diagnostic and therapeutic endoscopy, the authors developed and valiadated a scoring system based on prognostic indicators of increased mortality. The scoring system was developed from the best clinical predictors of mortality, determined in a prospective study of consecutive bleeding patients. The model was then tested in a prospective validation phase at three hospitals. Three main factors in the model predict mortality: (1) bleeding, including hematochezia, drop in hematocrit of 5%, short duration of bleeding, absence of melena, and hypotension; (2) liver disease, mainifested by prolonged prothrombin time and encephalopathy; and (3) renal disease. Patients determined to be at high risk for death using the scring system might be candidates for aggressive management and for therapeutiv endoscopy.

ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

ABSTRACT: Adjuvant chemotherapy for microscopic disease following eradication of clinically detectable lesions by primary surgery and/or radiotherapy is of documented benefit for some oncology patients. However, for many primary cancers efficacy is limited to specific subgroups of patients or has demonstrated no advantage over primary thereapy alone. The rationale for adjuvant chemotherapy and results of selected trials are reviewed. In patients for whom adjuvant therapy is of demonstrated benefit, further trials aimed at delineation of patient selection factors, optimal chemotherapy regimens and schedules, and duration of therapy are needed; progress in adjuvant treatment of other subgroups may require development of more effective antineoplastic drugs, in addition to exploration of these factors.

ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

ABSTRACT: A patient with the acquired immunodeficiency syndrome (AIDS) had tuberculosis present as an endobronchial mass simulating bronchogenic carcinoma. Endobronchial tuberculosis may be another unusual manifestation of tuberculosis in patients with AIDs. This manifestation of tuberculosis may be missed unless there is a high degree os suspicion. Proper cultures and biopsy speciments should be taken from sites where endobronchial abnormalities are noted in patients at risk for AIDS.

ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

ABSTRACT: Pneumonias in adults due to mycoplasma, chlamydiae, and viruses are a common clinical problem. These micro-organisms contribute to the etiologies in 6–35% of all cases of pneumonia and are the sole pathogens in 1–17% of hospitalized cases. Important trends and dvelopments in the field include (1) the emergence of a Chlamydia psittaci strain (TWAR) that is passaged from human to human, causes a mycoplasma-like illness, and that is relatively resistant to erythromycin, (2) the recognition of respiratory syscytical virus as a pathogen in nursing home outbreaks and in immunosuppressed adults, (3) the continuing high lethality of fully developed influenza pneumonia, (4) the efficacy of acyclovir and adenine arabinoside in limiting the complications of varicells-zoster virus infections, and (5) the increasing frequency of pneumonia caused by cytomegalovirus and the severity of this disorder in highly immunosuppressed patients. Developments in the rapid diagnosis and therapy of respiratory syncytial virus infections with an aerosolized antiviral drug in children may pave the way for comparable advances in difficult pneumonias in adult patients.

ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID