摘要:

PurposeExtrahepatic conditions can cause, exacerbate, or mimic hepatic encephalopathy in any patient with advanced liver disease, particularly in older persons. The aim of this study was to characterize the clinical features and frequency of extrahepatic conditions and the effect of therapeutic interventions upon the encephalopathy.DesignSurvey.SettingInner city community hospital.MethodsRetrospective chart review of 294 elderly patients (age 65–97) with liver disease and suspected hepatic encephalopathy, during a 15-year period, that included 188 men and 106 women.ResultsExtrahepatic conditions were found in 64 patients (22%); 29 (10%) patients had > 1 extrahepatic condition. Category and frequency of the extrahepatic conditions found in these 64 patients were as follows: urinary tract infection, 21 (33%); cellulitis/infected pressure ulcers, 16 (25%); pneumonia, 16 (25%); septicemia (with positive blood cultures), 10 (16%); silent myocardial infarction, 10 (16%); drug toxicity (nonsteroidal anti-inflammatory drugs, sedatives, hypnotics, antidiabetics), 6 (9%); meningitis, 6 (9%); head injury, 5 (8%); stroke, 5 (8%); and subdural hematoma, 5 (8%).ConclusionA significant proportion of elderly patients with liver disease and presumptive diagnosis of hepatic encephalopathy may have extrahepatic condition(s), and the treatment of the latter may improve clinical outcome of such patients. A high index of suspicion, low threshold of diagnostic measures, and prompt treatment of any associated extrahepatic condition are essential to prevent significant morbidity and mortality of these patients.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundMacrophage colony-stimulating factor (M-CSF) stimulates the proliferation and differentiation of placental trophoblasts and may regulate trophoblast invasion into the placental bed. M-CSF levels in peripheral blood show a significant increase in preeclampsia. Thus, the present study examined changes in blood levels of M-CSF before and after cesarean section and compared them between normotensive and preeclamptic pregnant women.MethodsPeripheral blood was collected before, 1 day after, and 10 days after cesarean section from 27 women, 12 of whom were preeclamptic pregnant patients with a mean blood pressure of 162/98 mm Hg and 15 were age- and gestational age-matched normotensive pregnant women (normotensive control subjects). Peripheral blood was also collected once from 15 age-matched healthy, normal cycling women (nonpregnant control subjects). M-CSF level was determined by the sandwich enzyme-linked immunosorbent assay (ELISA) method using 3 antibodies.ResultsIn normotensive and preeclamptic pregnancies, the M-CSF levels increased significantly (P< 0.01) 1 day after surgery but then decreased significantly (P< 0.01) at 10 days after surgery. Before and 1 day after surgery, the M-CSF levels were significantly higher (P< 0.01) in preeclamptic patients than in normotensive control subjects, but not at 10 days after surgery.ConclusionsThe blood M-CSF levels were significantly higher in preeclampsia than in normotensive pregnancies, before cesarean section. The M-CSF levels in the circulation at 1 day after surgery increased significantly. The increase was about 270 U/mL net and at similar levels in 2 groups. Thus, increases in M-CSF levels after cesarean section may occur via similar mechanisms in normotensive and preeclamptic pregnancies. The M-CSF level in normotensive pregnancies and preeclampsia decreased and returned to the normal level at 10 days after cesarean section.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Serum digoxin concentrations (SDC) have been used clinically since the early 1970s. Whereas the therapeutic range for SDC is frequently cited as either 0.8 to 2.0 ng/mL or 0.5 to 2.0 ng/mL, studies over the past decade suggest an upper limit of 1.0 ng/mL for treating heart failure. The same upper limit for SDC is suggested for patients with heart failure and atrial fibrillation with rapid ventricular response. Reducing the upper limit of the therapeutic range to 1.0 ng/mL on computerized and paper laboratory report forms may guide clinicians to avoid unnecessarily high SDC, thus minimizing risk of digoxin toxicity without sacrificing therapeutic benefit for heart failure.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Researchers have sought therapeutic applications for monoclonal antibodies since their development in 1975. However, murine-derived monoclonal antibodies may cause an immunogenic response in human patients, reducing their therapeutic efficacy. Chimeric and humanized antibodies have been developed that are less likely to provoke an immune reaction in human patients than are murine-derived antibodies. Antibody fragments, bispecific antibodies, and antibodies produced through the use of phage display systems and genetically modified plants and animals may aid researchers in developing new uses for monoclonal antibodies in the treatment of disease. Monoclonal antibodies may have a number of promising potential therapeutic applications in the treatment of asthma, autoimmune diseases, cancer, poisoning, septicemia, substance abuse, viral infections, and other diseases.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Although unconfirmed, the syndrome idiopathic intracranial hypertension (IIH), commonly seen in overweight 20- to 50-year-old women, has been proposed to have its origins in an endocrine-based disturbance of electrolytes. Herein we report on 2 women with IIH and primary aldosteronism (PAL). Aged 57 and 55 (patients 1 and 2), each had a longstanding history of mild-to-moderate arterial hypertension, recurrent hypokalemia, and headaches. They were found to have IIH at ages 51 and 45. PAL was diagnosed at ages 57 and 35, respectively, due to proven left adrenal adenoma in patient 1; and presumptive adrenal nodular hyperplasia in patient 2. This is the first report to appear in the English medical literature that describes an association between IIH and PAL. It raises the prospect that in some cases of IIH associated with arterial hypertension, an autonomous production of aldosterone should be considered.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Antibiotic resistance among viridans streptococci has increased withStreptococcus mitisbeing more resistant than other viridans species. In a case presented in this report, it is possible that antibiotic resistance contributed to an apparent failure of endocarditis prophylaxis. The patient had undergone periodontal surgery on 2 separate occasions and in both instances was administered 2 g of amoxicillin orally 1 hour before each procedure. He subsequently developed a subacute illness and had multiple blood cultures drawn that grewS mitiswith a minimum inhibitory concentration of 1.0 &mgr;g/mL for penicillin. Transesophageal echocardiogram provided further evidence of infective endocarditis with vegetations seen on the anterior leaflet of the mitral valve. Combination therapy with high-dose intravenous aqueous crystalline penicillin G and gentamicin sulfate for 4 weeks was curative. Clindamycin, rather than amoxicillin, has since been used as dental prophylaxis for subsequent procedures.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID