Quarterly Journal of Medicine最新文献_第4页

Helicobacter pylori eradication in patients with peptic ulcer disease: clinical consequences and financial implications. 消化性溃疡患者的幽门螺杆菌根除:临床后果和经济意义。

Quarterly Journal of Medicine Pub Date : 1994-05-01 DOI: 10.1093/OXFORDJOURNALS.QJMED.A068928

K. Powell, G. Bell, G. Bolton, S. Burridge, A. Bowden, B. Rameh, L. Hart, P. Bradley, G. Harrison, P. Gant

{"title":"Helicobacter pylori eradication in patients with peptic ulcer disease: clinical consequences and financial implications.","authors":"K. Powell, G. Bell, G. Bolton, S. Burridge, A. Bowden, B. Rameh, L. Hart, P. Bradley, G. Harrison, P. Gant","doi":"10.1093/OXFORDJOURNALS.QJMED.A068928","DOIUrl":"https://doi.org/10.1093/OXFORDJOURNALS.QJMED.A068928","url":null,"abstract":"We assessed clinical consequences and financial implications of Helicobacter pylori eradication in 175 patients with peptic ulceration, of whom 106 had been free from H. pylori infection for a mean of 3.2 years, while 69 remained infected. We used quarterly questionnaires to examine consumption of ulcer-healing medication and antacids. In the 106 successfully treated patients, gastrointestinal haemorrhage as a complication of peptic ulcer complications during the 344 patient years after eradication (0.003 per patient year) was 18-fold lower than during the 912 patient years before eradication (0.056 per patient year). Of the H. pylori-negative patients, 12-18% used ulcer-healing medication during any one of the three-month periods of the survey, compared with 34-51% of the patients with residual H. pylori infection. The average cost of the ulcer-healing drugs consumed by the H. pylori-negative patients was 30.59 pounds during the 12 months of the survey, compared with 99.05 pounds for H. pylori-positive patients. Consumption of antacids was also lower in the H. pylori-negative group. Successful eradication of H. pylori significantly reduced the annual cost of ulcer-healing drugs consumed by the patients with ulcer disease. Maintenance of ulcer remission following successful eradication of H. pylori also significantly reduced ulcer complications.","PeriodicalId":54520,"journal":{"name":"Quarterly Journal of Medicine","volume":"87 5 1","pages":"283-90"},"PeriodicalIF":0.0,"publicationDate":"1994-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/OXFORDJOURNALS.QJMED.A068928","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61293381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 32

Helicobacter pylori eradication in patients with peptic ulcer disease: clinical consequences and financial implications. 消化性溃疡患者的幽门螺杆菌根除:临床后果和经济意义。

Quarterly Journal of Medicine Pub Date : 1994-05-01

K U Powell, G D Bell, G H Bolton, S M Burridge, A F Bowden, B Rameh, L Hart, P Bradley, G Harrison, P W Gant

{"title":"Helicobacter pylori eradication in patients with peptic ulcer disease: clinical consequences and financial implications.","authors":"K U Powell, G D Bell, G H Bolton, S M Burridge, A F Bowden, B Rameh, L Hart, P Bradley, G Harrison, P W Gant","doi":"","DOIUrl":"","url":null,"abstract":"We assessed clinical consequences and financial implications of Helicobacter pylori eradication in 175 patients with peptic ulceration, of whom 106 had been free from H. pylori infection for a mean of 3.2 years, while 69 remained infected. We used quarterly questionnaires to examine consumption of ulcer-healing medication and antacids. In the 106 successfully treated patients, gastrointestinal haemorrhage as a complication of peptic ulcer complications during the 344 patient years after eradication (0.003 per patient year) was 18-fold lower than during the 912 patient years before eradication (0.056 per patient year). Of the H. pylori-negative patients, 12-18% used ulcer-healing medication during any one of the three-month periods of the survey, compared with 34-51% of the patients with residual H. pylori infection. The average cost of the ulcer-healing drugs consumed by the H. pylori-negative patients was 30.59 pounds during the 12 months of the survey, compared with 99.05 pounds for H. pylori-positive patients. Consumption of antacids was also lower in the H. pylori-negative group. Successful eradication of H. pylori significantly reduced the annual cost of ulcer-healing drugs consumed by the patients with ulcer disease. Maintenance of ulcer remission following successful eradication of H. pylori also significantly reduced ulcer complications.","PeriodicalId":54520,"journal":{"name":"Quarterly Journal of Medicine","volume":"87 5","pages":"283-90"},"PeriodicalIF":0.0,"publicationDate":"1994-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"18938035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Hyperinsulinaemia in heart disease. 心脏病中的高胰岛素血症。

Quarterly Journal of Medicine Pub Date : 1994-05-01

D Hockaday

引用次数: 0

Severe and fatal mass attacks by 'killer' bees (Africanized honey bees--Apis mellifera scutellata) in Brazil: clinicopathological studies with measurement of serum venom concentrations. 巴西“杀人蜂”(非洲化蜜蜂——Apis mellifera scutellata)的严重和致命的大规模攻击:血清毒液浓度测量的临床病理研究。

Quarterly Journal of Medicine Pub Date : 1994-05-01

F O França, L A Benvenuti, H W Fan, D R Dos Santos, S H Hain, F R Picchi-Martins, J L Cardoso, A S Kamiguti, R D Theakston, D A Warrell

{"title":"Severe and fatal mass attacks by 'killer' bees (Africanized honey bees--Apis mellifera scutellata) in Brazil: clinicopathological studies with measurement of serum venom concentrations.","authors":"F O França, L A Benvenuti, H W Fan, D R Dos Santos, S H Hain, F R Picchi-Martins, J L Cardoso, A S Kamiguti, R D Theakston, D A Warrell","doi":"","DOIUrl":"","url":null,"abstract":"In São Paulo State, Brazil, five males, aged between 8 and 64 years, were attacked by 'Africanized' honey bees (Apis mellifera scutellata). The estimated number of stings received by each patient ranged from > 200 to > 1000. All five were transferred to intensive care units in São Paulo City. Clinical features included intravascular haemolysis, respiratory distress with ARDS, hepatic dysfunction, rhabdomyolysis (with myoglobinaemia and myoglobinuria), hypertension and myocardial damage (perhaps explained by release of endogenous catecholamines by venom phospholipase A2 and mellitin), shock, coma, acute renal failure and bleeding. Laboratory findings included gross neutrophil leucocytosis, elevated serum enzymes [AST, ALT, LDH, CPK (predominantly CPK-MM)] and creatinine. Clotting times were slightly prolonged. Despite treatment with antihistamines, corticosteroids, bronchodilators, vasodilators, bicarbonate, mannitol and mechanical ventilation, three of the patients died between 22 and 71 h after the attacks, with histopathological features of ARDS, hepatocellular necrosis, acute tubular necrosis, focal subendocardial necrosis and disseminated intravascular coagulation. Whole bee venom and phospholipase A2 (PLA2) antigen concentrations were measured in serum and urine for the first time, using enzyme immunoassay. High venom and PLA2 concentrations were detected in serum and urine for more than 50 h after the stings in two fatal cases, in one of which the total circulating unbound whole venom was estimated at 27 mg, one hour after the attack. An antivenom should be developed to treat the increasing numbers of victims of mass attacks by Africanized 'killer' bees in USA, Middle and South America.","PeriodicalId":54520,"journal":{"name":"Quarterly Journal of Medicine","volume":"87 5","pages":"269-82"},"PeriodicalIF":0.0,"publicationDate":"1994-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"18938034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Severe and fatal mass attacks by 'killer' bees (Africanized honey bees--Apis mellifera scutellata) in Brazil: clinicopathological studies with measurement of serum venom concentrations. 巴西“杀人蜂”(非洲化蜜蜂——Apis mellifera scutellata)的严重和致命的大规模攻击:血清毒液浓度测量的临床病理研究。

Quarterly Journal of Medicine Pub Date : 1994-05-01 DOI: 10.1093/OXFORDJOURNALS.QJMED.A068927

F. França, L. A. Benvenuti, H. Fan, D. D. dos Santos, S. H. Hain, F. R. Picchi-Martins, J. Cardoso, A. Kamiguti, R. Theakston, D. Warrell

{"title":"Severe and fatal mass attacks by 'killer' bees (Africanized honey bees--Apis mellifera scutellata) in Brazil: clinicopathological studies with measurement of serum venom concentrations.","authors":"F. França, L. A. Benvenuti, H. Fan, D. D. dos Santos, S. H. Hain, F. R. Picchi-Martins, J. Cardoso, A. Kamiguti, R. Theakston, D. Warrell","doi":"10.1093/OXFORDJOURNALS.QJMED.A068927","DOIUrl":"https://doi.org/10.1093/OXFORDJOURNALS.QJMED.A068927","url":null,"abstract":"In São Paulo State, Brazil, five males, aged between 8 and 64 years, were attacked by 'Africanized' honey bees (Apis mellifera scutellata). The estimated number of stings received by each patient ranged from > 200 to > 1000. All five were transferred to intensive care units in São Paulo City. Clinical features included intravascular haemolysis, respiratory distress with ARDS, hepatic dysfunction, rhabdomyolysis (with myoglobinaemia and myoglobinuria), hypertension and myocardial damage (perhaps explained by release of endogenous catecholamines by venom phospholipase A2 and mellitin), shock, coma, acute renal failure and bleeding. Laboratory findings included gross neutrophil leucocytosis, elevated serum enzymes [AST, ALT, LDH, CPK (predominantly CPK-MM)] and creatinine. Clotting times were slightly prolonged. Despite treatment with antihistamines, corticosteroids, bronchodilators, vasodilators, bicarbonate, mannitol and mechanical ventilation, three of the patients died between 22 and 71 h after the attacks, with histopathological features of ARDS, hepatocellular necrosis, acute tubular necrosis, focal subendocardial necrosis and disseminated intravascular coagulation. Whole bee venom and phospholipase A2 (PLA2) antigen concentrations were measured in serum and urine for the first time, using enzyme immunoassay. High venom and PLA2 concentrations were detected in serum and urine for more than 50 h after the stings in two fatal cases, in one of which the total circulating unbound whole venom was estimated at 27 mg, one hour after the attack. An antivenom should be developed to treat the increasing numbers of victims of mass attacks by Africanized 'killer' bees in USA, Middle and South America.","PeriodicalId":54520,"journal":{"name":"Quarterly Journal of Medicine","volume":"87 5 1","pages":"269-82"},"PeriodicalIF":0.0,"publicationDate":"1994-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/OXFORDJOURNALS.QJMED.A068927","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61293046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 159

DCCT: the ecstasy and the agony. DCCT:狂喜和痛苦。

Quarterly Journal of Medicine Pub Date : 1994-05-01 DOI: 10.1093/OXFORDJOURNALS.QJMED.A068932

P. Watkins

引用次数: 4

Hyperinsulinaemia in heart disease. 心脏病中的高胰岛素血症。

Quarterly Journal of Medicine Pub Date : 1994-05-01 DOI: 10.1093/OXFORDJOURNALS.QJMED.A068933

D. Hockaday

引用次数: 0

Clinical significance of anti-neutrophil cytoplasm antibodies detected by a standardized indirect immunofluorescence assay. 标准化间接免疫荧光法检测抗中性粒细胞细胞质抗体的临床意义。

Quarterly Journal of Medicine Pub Date : 1994-05-01 DOI: 10.1093/OXFORDJOURNALS.QJMED.A068929

A. Davenport, R. J. Lock, T. Wallington, T. Feest

{"title":"Clinical significance of anti-neutrophil cytoplasm antibodies detected by a standardized indirect immunofluorescence assay.","authors":"A. Davenport, R. J. Lock, T. Wallington, T. Feest","doi":"10.1093/OXFORDJOURNALS.QJMED.A068929","DOIUrl":"https://doi.org/10.1093/OXFORDJOURNALS.QJMED.A068929","url":null,"abstract":"We assessed the use of a standardized antineutrophil cytoplasm antibody (ANCA) test in diagnosing Wegener's granulomatosis (WG), microscopic polyarteritis (mPA) and systemic vasculitis (SV). All samples (n = 779) tested for ANCA at our laboratory were identified, and clinical information was obtained for 783/779 patients by questionnaire, and by visits where necessary. The combined prevalence of WG/mPA/SV was 123/738 (17%). The ANCA test was positive in 48/68 WG patients (71%; 38 cANCA, 10 pANCA), 22/43 mPA patients (51%; 12 cANCA, 10 pANCA) and 3/12 SV patients (25%). WG and mPA patients in remission had similar frequencies of positive ANCA to those with active disease. The sensitivity and specificity for WG (71% and 80%) and mPA (51% and 80%) were lower than previously reported. In this high-prevalence population, the overall (WG/mPA/SV) positive predictive value was only 40%, and the sensitivity 59%. Only 29% of positive tests were from patients with active disease. Overall, 78% of test results gave a 'true' prediction. On this basis, a diagnosis of necrotizing vasculitis (WG/mPA/SV) can be neither made nor refuted by ANCA test alone.","PeriodicalId":54520,"journal":{"name":"Quarterly Journal of Medicine","volume":"87 5 1","pages":"291-9"},"PeriodicalIF":0.0,"publicationDate":"1994-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/OXFORDJOURNALS.QJMED.A068929","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61293248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 41

Glucocorticoids and small babies. 糖皮质激素和小婴儿。

Quarterly Journal of Medicine Pub Date : 1994-05-01 DOI: 10.1093/OXFORDJOURNALS.QJMED.A068925

J. Seckl

引用次数: 80

DCCT: the ecstasy and the agony. DCCT:狂喜和痛苦。

Quarterly Journal of Medicine Pub Date : 1994-05-01

P J Watkins

引用次数: 0