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101.
BACKGROUND: Gastroesophageal reflux has been implicated in otolaryngologic problems, particularly chronic hoarseness that cannot be attributed to other causes. PATIENTS AND METHODS: To study this relationship between gastroesophageal reflux and chronic hoarseness we used 24-h dual-site ambulatory pH-recordings in 68 patients with chronic hoarseness and laryngeal lesions suggestive of acid irritation. RESULTS: Thirty-eight patients (56%) had evidence of at least one esophago-pharyngeal reflux episode. The mean number of esophago-pharyngeal episodes was 6.7 +/- 12 within 24 hours (range: 1-34 episodes). The mean duration of these episodes was 201 +/- 28 seconds (range: 6 seconds-19.6 minutes). Most patients with esophago-pharyngeal reflux had no evidence of pathologic gastroesophageal reflux. Only 28.9% of the patients with esophago-pharyngeal reflux episodes also had pathologic gastroesophageal phageal reflux, whereas 23.3% of the patients without esophago-pharyngeal reflux had no gastroesophageal reflux disease. The esophago-pharyngeal reflux occurred mainly in the upright position. CONCLUSIONS: Occult esophago-pharyngeal reflux, predominantly in the upright position, appears to be common and severe in patients with chronic hoarseness. Gastroesophageal reflux may be an important factor in the pathogenesis of chronic hoarseness. The causative mechanisms are not clear. 相似文献
102.
The overall rate of complications after ileal pouch-anal anastomosis is 60%. This rate, however, includes complications such as bowel-obstruction and hernias. Pouch-related complications occur after ileal pouch-anal anastomosis with a frequency of 15-25%. In an analysis of the recent literature the main risk factors are: tension of the ileal pouch-anal anastomosis, anastomotic leakage, lack of protective ileostomy, preoperatively undiagnosed Crohn's disease and the experience of the surgeon. We classified pouch related-complications into (1) surgical complications (leakage, bleeding, pelvic sepsis, fistulas); (2) technical problems (long S-pouch spout, rectal cuff stenosis, etc.); (3) functional problems (anal sphincter insufficiency, night incontinence, hypermotility, evacuation disorders); (4) pouchitis; (5) pouch neoplasias. Pathogenesis, diagnostic features, and medical and surgical therapy are discussed in detail. In our own series of 11 pouch-redo operations we had 6 pouch fistulas (3 related to Crohn's disease, 3 postoperative fistulas), 3 wrongly constructed pouches, 1 chronic pouchitis and 1 long S-pouch spout. In 3 cases the pouch had to be excised completely. Two patients remained with a permanent ileostomy. In 6 patients the pouch could be preserved on long term. Due to the technical complexity, the need to understand pathophysiology and the need for a differentiated diagnostic procedure, this operation should be performed only in specialised centers. 相似文献
103.
TM Behr WS Becker RM Sharkey ME Juweid RM Dunn HJ Bair FG Wolf DM Goldenberg 《Canadian Metallurgical Quarterly》1996,37(5):829-833
The renal uptake of radiolabeled antibody fragments and peptides presents a problem in radioimmunodetection and therapy, compromising lesion sensitivity, especially with intracellularly-retained isotopes. Previously, we showed that cationic amino acids and their derivatives are capable of significantly reducing kidney uptake in animals. We report our initial clinical results of successful renal uptake reduction in five patients who underwent cancer radioimmunodetection with 99mTc-anti-CEA Fab' fragments. METHODS: The patients were infused with two liters of a commercially-available nutritive amino acid solution (containing approximately 2.25 g/liter lysine-glutamate and 2.50 g/liter arginine), whereas 75 control patients received the same volume of saline (quantification of organ and tumor kinetics from conjugate whole-body views by ROI technique). RESULTS: The renal uptake in the amino acid group was significantly lower (p<0.05) than in the control group (11.1 +/- 2.0% injected dose versus 17.7 +/- 7.0% injected dose at 24 hr postinjection), whereas the uptake of all other organs remained unaffected. Gel filtration chromatography of the urine taken from amino-acid-treated patients showed that a significantly higher amount of excreted activity was bound to intact Fab' (53% of excreted activity) in contrast to only less than 10% in the control group. CONCLUSION: The renal uptake of monoclonal antibody fragments in patients can be reduced significantly by amino acid infusion, even at considerably lower doses than those that were safe and effective in animals. As was found in animals, the mechanism seems to rely on an inhibition of the re-absorption of tubularly-filtered proteins by the proximal tubule cells. These results encourage further clinical trials to lower the renal uptake experienced in radioimmunodetection, as well as in therapeutic trials with antibody fragments and peptides. 相似文献
104.
EM Utens HJ Bieman FC Verhulst FJ Meijboom RA Erdman J Hess 《Canadian Metallurgical Quarterly》1998,19(4):647-651
Non-steroidal anti-inflammatory drugs inhibit constitutive (COX-1) and induced cyclooxygenase (COX-2), blocking prostaglandin production. We have compared the effects on nociceptive reflexes of meloxicam, which is COX-2 selective, with indomethacin, which is non-selective, using an in vitro spinal cord preparation. Cords were taken from naive rats, and from rats with carrageenan-induced hyperalgesia of one hindpaw. Reflex thresholds were lower in carrageenan preparations. Superfusion with meloxicam (10-100 microM) dose-dependently inhibited baseline reflexes and wind-up in normal and carrageenan preparations, whereas indomethacin (100-300 microM) had no effect. Thus meloxicam inhibits spinal reflexes, whereas indomethacin does not, despite its high affinity for both COX isoforms. We conclude that meloxicam has spinal antinociceptive actions which cannot be explained by the current concept of COX inhibition. 相似文献
105.
DJ van Veldhuisen S Genth-Zotz J Brouwer F Boomsma T Netzer AJ Man In 'T Veld YM Pinto KI Lie HJ Crijns 《Canadian Metallurgical Quarterly》1998,32(7):1811-1818
OBJECTIVES: To determine dose-related clinical and neurohumoral effects of angiotensin-converting enzyme (ACE) inhibitors in patients with chronic heart failure (CHF), we conducted a double-blind, placebo-controlled, randomized study of three doses (2.5 mg, 5 mg and 10 mg) of the long-acting ACE inhibitor imidapril. BACKGROUND: The ACE inhibitors have become a cornerstone in the treatment of CHF, but whether high doses are more effective than low doses has not been fully elucidated, nor have the mechanisms involved in such a dose-related effect. METHODS: In a parallel group comparison, the effects of three doses of imidapril were examined. We studied 244 patients with mild to moderate CHF (New York Heart Association class II-III: +/-80%/20%), who were stable on digoxin and diuretics. Patients were treated for 12 weeks, and the main end points were exercise capacity and plasma neurohormones. RESULTS: At baseline, the four treatment groups were well-matched for demographic variables. Of the 244 patients, 25 dropped out: 3 patients died, and 9 developed progressive CHF (3/182 patients on imidapril vs. 6/62 patients on placebo, p < 0.05). Exercise time increased 45 s in the 10-mg group (p = 0.02 vs. placebo), but it did not significantly change in the 5-mg (+16 s), and 2.5-mg (+11 s) imidapril group, compared to placebo (+3 s). Physical working capacity also increased in a dose-related manner. Plasma brain and atrial natriuretic peptide decreased (p < 0.05 for linear trend), while (nor)epinephrine, aldosterone and endothelin were not significantly affected. Renin increased in a dose-related manner, but plasma ACE activity was suppressed similarly (+/-60%) on all three doses. CONCLUSIONS: Already within 3 months after treatment initiation, high-dose ACE inhibition (with imidapril) is superior to low-dose. This is reflected by a more pronounced effect on exercise capacity and some of the neurohormones, but it does not appear to be related to the extent of suppression of plasma ACE. 相似文献
106.
GJ Jhon JE Hong HJ Yoon GI Rhyu YH Kim JS Yoo YS Chang 《Canadian Metallurgical Quarterly》1996,38(5):879-887
The presence of octoxynol from dried bear-bile was examined. Octoxynol was coextracted when glycolipids by Folch-Suzuki partition method. Octoxynol formed mixed-micelles with glycosphingolipids. The glycolipids were purified by DEAE-Sephadex A-25 column chromatography. The fractions containing mixed micelles were obtained from linear gradient solvent of 0.05M-0.5M ammonium acetate in methanol. HPLC ( Bondapak-NH(2) - linked to a Bondapak-C(18) column) chromatogram showed five peaks. Two possible structures for the fourth peak fraction were proposed as (CH(3))(3)C-CH(2)-C(CH(3))(2)-C(6)H(4)-OR and (CH(3))(3)C-C(CH(3))(2)-CH(2)-C(6)H(4)-OR by NMR spectroscopy. The structure was further confirmed by electrospray tandem mass spectrometry (ESI MS/MS). The spectrum showed a protonated molecule at m/z 559 and three different series of ions with mass difference of 44 were detected in the MS/MS spectrum. Therefore, the structure of the fourth peak fraction from HPLC was confirmed as octoxynol, (CH(3))(3)C-CH(2)-C(CH(3))(2)-C(6)H(4)-(OCH(2)-CH(2))n-OH, based on mass spectrometry and NMR spectroscopy. 相似文献
107.
AIMS: Five cases of primary gastrointestinal (GI) lymphoma (three in the stomach, one in the ileum (IPSID) and one in the colon) associated with localized AL amyloidosis were studied to identify morphological or immunohistochemical features which could explain the amyloid deposition. METHODS AND RESULTS: All the cases were low-grade marginal zone B-cell lymphomas; one case of gastric lymphoma and the IPSID also had a high-grade component. The lymphomas had a monoclonal plasma cell population, with different light and heavy-chain type expression in the five cases. Plasma cell differentiation was closely associated with the amyloid deposits. The latter were an incidental microscopic finding in one case, but produced tumoral masses in the other. CONCLUSIONS: The presence of amyloid in primary GI lymphoma is rare, but can have diagnostic value. In the present study, neither particular features of the lymphomatous proliferation nor specific agents are identified. Therefore, the factors predisposing to amyloid deposition require elucidation. 相似文献
108.
Selenium is a trace element which plays a vital role in many metabolic functions and in particular is an integral part of the antioxidant enzyme glutathione peroxidase. It may be involved in the prevention of a number of diseases including cardiovascular diseases and cancer, which are the main causes of death in Singapore with ethnic differences. The National University of Singapore Heart Study measured cardiovascular risk factors, including serum selenium, in a random of the general population aged 30 to 69 years from 1993 to 1995. Mean serum selenium was higher in Chinese (males 126 and females 119 micrograms/L) and Malays (males 122 and females 122 micrograms/L) than Indians (males 117 and females 115 micrograms/L). These levels (with an estimated mean of 122 micrograms/L in Singapore) are lower than those in the USA but higher than those in Western Europe. The proportions with serum selenium < 80 micrograms/L (classified as low values) were low, though highest in Indians (males 1.2% and females 1.2%), then Chinese (males 0.6% and females 1.3%) and then Malays (males 0.0% and females 0.0%), but the differences were not statistically significant. The overall estimate for the prevalence of low selenium in Singapore was 0.8%. It is concluded that levels of serum selenium in Singapore are satisfactory and no action with regard to dietary supplementation is needed. Serum selenium levels are slightly lower in Indians than in Chinese and Malays (probably due to a more vegetarian diet) and this may make a small contribution to Indians' higher rates of coronary heart disease compared to Chinese and Malays. 相似文献
109.
110.