ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Atovaquone is a new hydroxy-napthoquinone antiprotozoal agent active againstPneumocystis cariniiin vitro and in animal models. The authors report an experience using atovaquone to treat 25 patients with mild to moderateP. cariniipneumonia. Eligible patients were treated for 21 days with 750 mg of atovaquone orally three times daily. Prednisone was added when the P(A-a)O2gradient was between 35–45 mm Hg. Patients were treated under three treatment protocols. Patients in Group 1 participated in one of two randomized comparative drug trials, designed for patients with and without sulfonamide intolerance. Six of seven patients successfully completed treatment, and one patient discontinued treatment because of an adverse reaction (>5 times baseline increase in transaminase level). Patients in Group 2 were treated with atovaquone for mild to moderateP. cariniipneumonia under a treatment Investigational New Drug protocol because of prior sulfonamide reactions. Fifteen of these 18 patients successfully completed treatment; one died from other complications during treatment and two discontinued treatment for adverse reactions (>5 times baseline increase in transaminase levels, and a diffuse rash). Serum transaminase levels returned to normal at the end of treatment in all patients with elevated levels. All patients demonstrated clinical resolution of their pneumonia and improvement of pretreatment hypoxemia (Group 1: pretreatment PaO2= 82 ± 14 mm Hg, posttreatment PaO2= 92 ± 9 mm Hg). Overall, 21 (84%) of 25 patients successfully finished therapy without significant adverse reactions. Atovaquone appears to be an effective and well-tolerated oral treatment for mild to moderateP. cariniipneumonia. The main toxicities appear to be a reversible serum transaminase rise and a nondesquamating rash. Currently, atovaquone should be considered as an alternative therapy for intolerant patients or as salvage therapy.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The authors assess prevalence of anemia in a population of patients anticipating radiation therapy. They also characterize the anemia and determine its relationship to stage, inflammation, and mortality. Blood counts were recorded for 81 of 103 patients surveyed during August 1988. When available, iron studies were used to characterize anemia. Stage, treatment, and 3-year mortality were obtained from tumor registry data. Many patients had anemia of chronic disorders. Therefore, 16 adults with solid tumors anticipating radiation therapy were evaluated with complete blood counts, iron studies, chemistries, erythropoietin, and measures of inflammation. Of 81 patients, more than half were anemic. Thirteen of 17 patients with anemia and with iron studies had anemia of chronic disorders. Two-thirds of patients with anemia had advanced cancer, versus one third of patients without anemia. Twice as many patients with anemia compared with those without anemia died within 3 years. Of 16 patients studied intensively, 4 had anemia, advanced cancer, and died within 6 months, whereas all 12 patients without anemia lived longer. The 4 patients with anemia had an elevated iron index (7.95), erythrocyte sedimentation rate (86 mm per hour), and C-reactive protein (4.48 mg/dL) versus those of 12 patients without anemia and 10 volunteers. Erythropoietin levels were not different significantly among groups. Anemia indicated a poor prognosis during and before radiotherapy, and anemia of chronic disorders was associated with advanced cancer and a short survival rate.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Beta-carotene in doses of up to 300 mg daily raises high-density lipoprotein cholesterol levels within 2 to 4 weeks in healthy subjects. The authors, in this study, investigate the short-term effects of high-dose beta-carotene upon serum lipids, lipoproteins, and selected sex steroid hormones in 59 adult patients with Type IIa or IIb hyperlipidemia and 36 healthy subjects. Volunteers took beta-carotene (300 mg) or wheat germ oil capsules daily for 30 days. Lipids were measured on days 1, 14, 21, and 30. Betacarotene, retinol, free and total testosterone, and estradiol levels were measured on days 1 and 30. Total high-density lipoprotein cholesterol levels increased 10% (p < 0.01) over baseline in all groups by day 14 but returned to baseline by day 30. Total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels transiently increased between days 14 and 21 by up to 9%, 8%, and 20%, respectively, only in the patients with hyperlipidemia treated with beta-carotene, but returned to baseline on day 30. Apolipoproteins A and B were unchanged. Despite 20-fold increases of plasma beta-carotene levels there, were no reports of carotenodermia and no alteration in sex steroid hormones, retinol levels, hepatic transaminases, or persistent changes in serum lipids that were attributable to beta-carotene.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Because of a newly developed model of esophageal perfusion in humans, the authors could study the role of esophago—salivary reflex in salivary neutral and acidic mucin output. The basal rate of neutral mucin output was 0.24 ± 0.06 mg per minute. Placement of intraesophageal tubing and inflation of balloons resulted in a highly significant increase in salivary mucin output (2.10 ± 0.22 mg per minute; p < 0.00001). However, implementation of esophageal perfusion with saline resulted in a significant decline of salivary mucin output (1.28 ± 0.10 mg/mL NaCl4 versus 2.08 ± 0.24 mg/mL NaCl1; p < 0.001). Esophageal perfusion with hydrochloric acid prevented the decline of salivary mucin output observed during perfusion with saline, whereas infusion of hydrochloric acid/pepsin resulted in a significant enhancement of salivary mucin output (2.89 ± 0.31 mg per minute; p < 0.01). Therefore, mechanical and chemical stimulations resulted in an overall 9-fold and 12-fold increase in the rate of salivary mucin output over the basal value, respectively. The basal rate of acidic mucin secretion was 0.26 ± 0.06 mg per minute. After placement of intraesophageal tubing, inflation of balloons, perfusion hydrochloric acid, or hydrochloric acid—pepsin solution, a significant enhancement in the rate of salivary acidic mucin output, similar to that observed during measurement of neutral mucin, was observed. Therefore, during mechanical and chemical stimulation, the rate of salivary acidic mucin output increased 7.3-fold and 11.1-fold over the basal value, respectively. A significant increase of salivary mucin output, especially under the impact of esophageal stimulation with acid and pepsin, indicates that mucin may play an important role in esophageal preepithelial defense mechanisms.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The detrimental health effects of cigarette smoking, including the increased risk of cancer, cardiovascular disorders, and pulmonary diseases, are well established. Although most smokers express a desire to quit, 46 million Americans continue to smoke because of the nicotine addiction associated with the habit. The author, in this paper, describes the magnitude of the health risks related to various forms of tobacco use and proposes that smokeless tobacco be recommended as a cigarette substitute by persons who cannot stop smoking. This proposal is made because smokeless tobacco is associated with far fewer and considerably less serious health consequences than is smoking. Of primary concern is oral cancer, the annual incidence of which is estimated at 26 cases per 100,000 smokeless tobacco users. If all American smokers used smokeless tobacco instead, this would result in 12,000 cases of oral cancer per year. This is only 1/20 of all smoking-related cancers, less than 1/10 of smoking-related lung cancers, and less than half the number of oral cancers now attributed to smoking. A public health policy that recognizes smokeless tobacco as an alternative to smoking would benefit individuals confronted with the unsatisfactory options of abstinence or continuing to smoke.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The authors report a case of hypo-pituitarism in a 28-year-old woman who appeared to develop this in conjunction with a pregnancy 4 years previously. The patient had clear-cut evidence of secondary hypoadrenalism and secondary hypothyroidism. A magnetic resonance imaging scan revealed a partially empty sella of normal size. The patient had no prior evidence of peripartum hypotension or other obstetrical catastrophe. Her only recognizable risk factor was the presence of sickle cell trait. The authors speculate that her sickle trait predisposed her to develop pituitary infarction during her first pregnancy. The authors also review three previous cases linking sickle cell syndromes with hypopituitarism and suggest that this case further supports the concept that sickle cell syndromes can predispose affected individuals to pituitary infarction and ultimately to subsequent hypopituitarism.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Divalproex sodium (DVS; Depakote) is a commonly used antiepileptic agent that increases the levels of gamma aminobutyric acid. Spasticity from different causes may be due to a deficiency of inhibitory transmitters like gamma aminobutyric acid or an excess of excitatory neurotransmitters. Spasticity also may be accompanied by pain. The authors administered DVS orally for pain and spasticity in three patients with a history of spinal cord injury and one patient with a history of head injury. Three patients had marked improvement in spasticity and pain. One patient, who had some symptomatic improvement in spasticity, could not tolerate DVS because of gastric irritation. In contrast to the side effects of sedation and increased motor weakness associated with antispasticity drugs commonly used, no such side effects were detected with DVS. It is suggested that a possible enhancement by DVS of gamma aminobutyric acid-ergic postsynaptic inhibition of motor reflex arc in the spinal cord may represent a new non-sedating, management approach for spasticity as a result of traumatic spinal cord and head injuries.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The incidence of perioperative myocardial infarction with noncardiac surgery varies by the type of procedure and the prevalence of coronary atherosclerosis in the study population. Incidence is 1% with minor procedures and may exceed 10% with vascular operations. The case fatality rate continues to be 30% to 50%. Pathogenesis is not understood completely. Diagnosis is sometimes problematic, because less than 50% of patients complain of chest pain. In addition, a high frequency of notable but apparently innocent postoperative electrocardiograph changes limits the diagnostic use of the electrocardiogram. Fortunately, the creatine kinase MB isoenzyme retains its sensitivity and specificity for acute infarction in perioperative patients. Different approaches to pre-operative risk assessment have been developed, including a summative cardiac risk index and a stratification system based on the likelihood that the most powerful risk factor (coronary artery disease) is present. Although many interventions have been recommended to lower perceived risk, none has been tested in a randomized controlled trial, and their comparative efficacy and safety is unknown.

ISSN:0002-9629    

出版商:OVID    

年代:1994

数据来源: OVID