摘要:

A total of 127 patients underwent combined coronary artery and valvular operations at our institutions, between 1984 and 1993. Ninety patients underwent coronary artery bypass grafting (CABG) and simultaneous aortic valve replacement (AV), 30 patients had CABG and mitral valve repair or replacement (MV) and 7 patients had CABG combined with a double-valve operation. An average of 2.7 bypasses were done (range 1-7). Preoperatively, 97 patients (76%) were categorized in the New York Heart Association (NYHA) functional class 3 or 4. There were 18 emergency operations and 10 reoperative procedures. In 31 patients (24%) the preoperative left ventricular ejection fraction was less than 40%. The overall hospital mortality rate was 11.8% (15/127). The mortality group (n = 15) was compared to the group of hospital survivors (n = 112) and the following parameters were found to be significant risk factors for perioperative mortality: age > 65 years (p < 0.05), insulin-dependent diabetes mellitus (p < 0.02), generalized arteriosclerosis (p < 0.01), preoperative NYHA functional classes 3 and 4 (p < 0.02) and double-valve procedures (p < 0.004). Long-term follow-up revealed a 5-year survival rate of 71.5% for CABG + AV and 62.5% for CABG + MV. The 5-year event-free survival rates were 52.6 and 53.4%, respectively. This study shows that, even in high-risk patients, combined valve repair/replacement and CABG surgery can be performed successfully with good, long-term results.

ISSN:1011-7571    

DOI:10.1159/000157374

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Using the ELISA technique, cytomegalovirus (CMV) IgG and IgM values were measured in the sera of 176 subjects who delivered healthy term infants and in the cord sera of their newborn babies. IgG was positive in 149 of 176 maternal sera and in 6 of 176 newborn cord sera. The subjects were classified into three socioeconomic levels: high, moderate and low. The distribution of IgG and IgM positivity among the three groups revealed significant differences (p < 0.05). The fetus and the placenta are affected during primary and reactive infections in pregnancy. The percentage of IgM-positive infants delivered by IgM-positive patients was found to be highly significant. CMV IgG is not always protective against reinfection. In our study, IgM was positive in 24 women in spite of IgG positivity. The distribution of CMV seropositivity was not significantly different with regard to age and parity. CMV infection is an important risk factor in pregnancy as it is the most frequent congenital and early postnatal infectious agent.

ISSN:1011-7571    

DOI:10.1159/000157375

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

In the pathogenesis of human lung diseases, much of the experimental evidence has indicated involvement of the neutrophil chemotactic factor interleukin-8 (IL-8). Since IL·-8 is secreted by alveolar capillary wall macrophages, local production of IL-8 may act as a mechanism for polymorphonuclear cell migration into lung tissues. In this study, the concentrations of IL-8 were measured by ELISA in plasma and bronchoalveolar lavage (BAL) fluid of 49 patients. The study was divided into three patient groups: group A, 17 with bacterial pneumonia (7 non-smokers and 10 smokers); group B, 23 with pulmonary tuberculosis (9 non-smokers and 14 smokers), and control group, 9 non-smokers. The concentration of ΓL-8 in BAL fluids was increased significantly in groups A and B (non-smokers and smokers) in comparison to the control group. In addition, there were significant differences between non-smokers versus smokers in IL-8 concentration in group A (non-smokers = 170.6 ± 32 versus smokers = 350 ± 89 pg/ml, p < 0.001) and group B (non-smokers = 146.6 ± 31 versus smokers = 305.5 ± 54 pg/ml, p < 0.001). No significant differences in plasma IL-8 concentration were observed in different patient groups (smokers and non-smokers). The present study suggests that the increased local production (BAL) of IL-8 is associated with lung diseases, such as bacterial pneumonia and pulmonary tuberculosis, and that smoking can increase IL-8 produ

ISSN:1011-7571    

DOI:10.1159/000157376

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Prostate specific antigen (PSA) is known to be the most sensitive marker available for monitoring the progression of prostate cancer and the response to therapy. PSA concentrations tend to increase with the advancing clinical stage of prostate cancer. To assess the role of PSA in detecting skeletal metastases, PSA levels were correlated retrospectively with 99mTc MDP bone scan findings in 35 known prostate cancer patients. The cutoff level was set at 10 ng/ml. Of the 35 bone scans, 24 demonstrated metastatic bone disease. Twenty of the 24 had serum PSA values of& < 10 ng/ml (13-800 ng/ml). Of the 11 patients with negative bone scans, 2 had PSA values& <10 ng/ml. The PSA level had a direct correlation with the incidence of positive bone scan (p& %lt; 0.001). The sensitivity of the marker was 83.3% and its specificity was 81.8%. Thus, serum PSA level is a useful biochemical tumor marker that can help in the assessment of skeletal metastases of prostate cancer patients during their follow-up. When used in combination with scintigraphic bone findings, a more accurate clinical picture of the patient is obtained.

ISSN:1011-7571    

DOI:10.1159/000157377

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

In this study we report 31 cases of femoral neck fractures treated by closed reduction and internal fixation using hook-pins (osteosynthesis). During the postoperative follow-up period 3 patients died and therefore were not included in the clinical and radiological analysis of this study. The average follow-up for the remaining 28 patients was 18 months. There were 11 (39%) non-displaced fractures (Garden 1 and 2) and 17 (60.7%) displaced fractures (Garden 3 and 4). There were no peri-operative or early post-operative complications. Incidence of non-union occurred in 6 patients (21%), and 3 patients (10.7%) underwent secondary arthroplasty surgery (1 hemiarthroplasty and 2 total hip replacements). We conclude that the use of hook-pins in the internal fixation of femoral neck fractures in general and in displaced fractures, in particular, is a safe and simple procedure with low peri-operative and post-operative morbidity even when performed on elderly patients.

ISSN:1011-7571    

DOI:10.1159/000157378

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Guinea worm transmission is targeted to be the first among the parasites to be eliminated globally. Chronic manifestations of the infection, however, are still likely to be seen over the next decade or two. When such patients present, especially in non-endemic countries, diagnosis may be problematical. We report a patient who presented with pain and swelling in the left lumbar region. On fine needle aspiration cytology, a provisional diagnosis of tumoral calcinosis was considered. However, on biopsy of the superficial lesion, a degenerated female Dracunculus medinensis was identified on the basis of the morphology of the adult worm and the larvae present in the body cavity. Although D. medinensis is likely to be a medical relic in the near future, attention is drawn to this case as the disease manifestations caused by the parasite are likely to still be encountered. Because of the bizarre presentations that may occur, a definitive diagnosis is essential for the prognosis of the patient as the infection caused by the worm may masquerade as a number of other clinical conditions.

ISSN:1011-7571    

DOI:10.1159/000157379

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

A 20-year-old female with protein C deficiency presented with a vaso-occlusive disorder, producing multiple cerebral infarcts and a clinical picture of pseudobulbar palsy with tetraparesis. Cerebral angiography showed a moyamoya-like appearance. Anticoagulation stabilized her condition with no further clinical deterioration.

ISSN:1011-7571    

DOI:10.1159/000157380

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

A patient with Guillain-Barré syndrome, who improved after initial treatment with plasma exchange, experienced a relapse of two functional grades 16 days after the completion of treatment. Subsequent treatment with a combination of plasma exchange and intravenous immunoglobulins led to a rapid clinical improvement. The patient experienced complete recovery within 2 months of the treatment

ISSN:1011-7571    

DOI:10.1159/000157381

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Qualitative data analysis has been increasingly employed in health care research in recent years. It is, however, still under criticism by positivist science as it is perceived as ‘soft’ science. Social scientists continue to debate the value of qualitative data analysis and its contribution to health care. This paper examines the role of qualitative data in health care, and in particular, its role in improving women’s h

ISSN:1011-7571    

DOI:10.1159/000157382

出版商:S. Karger AG    

年代:1996

数据来源: Karger

ISSN:1011-7571    

DOI:10.1159/000157383

出版商:S. Karger AG    

年代:1996

数据来源: Karger