Quarterly Journal of Medicine最新文献_第6页

Hyperglycaemia and mortality from acute stroke. 高血糖与急性中风死亡率。

Quarterly Journal of Medicine Pub Date : 1994-04-01 DOI: 10.1097/00132586-199404000-00053

F. Tracey, V. Crawford, J. Lawson, K. Buchanan, R. Stout

{"title":"Hyperglycaemia and mortality from acute stroke.","authors":"F. Tracey, V. Crawford, J. Lawson, K. Buchanan, R. Stout","doi":"10.1097/00132586-199404000-00053","DOIUrl":"https://doi.org/10.1097/00132586-199404000-00053","url":null,"abstract":"Hyperglycaemia has been observed after acute stroke, and is associated with a poor prognosis. It is not known whether this is due to the stress response of the acute illness or whether hyperglycaemia is, in itself, harmful to ischaemic nervous tissue. Seventy-one patients admitted to hospital with acute stroke and no history of diabetes or other acute illness were recruited, and fasting blood sampling was carried out within 24 h of symptom onset, for plasma glucose and stress hormones and levels of haemoglobin A1c (HbA1c). Computerized tomography of the brain was carried out on 77% of the subjects. The subjects were followed up for 3 months or until death. Glucose levels were higher in subjects who died during the course of the study (p = 0.025), but this relationship became non-significant after age (p < 0.001) and cortisol (p = 0.001) levels were taken into account with multivariate analysis. The correlation between serum cortisol and the volume of the lesion on CT scan was also stronger than the relation of glucose with volume. Haemoglobin A1c had no relationship with either mortality or lesion volume. These findings suggest that the hyperglycaemia seen after an acute stroke is secondary to a stress response and they do not support the theory of hyperglycaemia being harmful to ischaemic nervous tissue. These findings have implications for the treatment of acute stroke with hypoglycaemic agents.","PeriodicalId":54520,"journal":{"name":"Quarterly Journal of Medicine","volume":"86 7 1","pages":"439-46"},"PeriodicalIF":0.0,"publicationDate":"1994-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/00132586-199404000-00053","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61643197","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: 37

New diagnoses for old diseases: dangers and distractions. 旧疾病的新诊断:危险和干扰。

Quarterly Journal of Medicine Pub Date : 1994-04-01

J M Pearce

引用次数: 0

Familial nephropathic systemic amyloidosis caused by apolipoprotein AI variant Arg26. 载脂蛋白AI变异Arg26引起的家族性肾病全身性淀粉样变性。

Quarterly Journal of Medicine Pub Date : 1994-03-01

D M Vigushin, J Gough, D Allan, A Alguacil, B Penner, N M Pettigrew, G Quinonez, K Bernstein, S E Booth, D R Booth

引用次数: 0

Left ventricular diastolic dysfunction. 左室舒张功能不全。

Quarterly Journal of Medicine Pub Date : 1994-03-01

P Clarkson, N M Wheeldon, T M Macdonald

引用次数: 0

Association of severe haemophilia A with osteoporosis: a densitometric and biochemical study. 严重血友病A与骨质疏松症的关系:一项密度和生化研究。

Quarterly Journal of Medicine Pub Date : 1994-03-01

S J Gallacher, C Deighan, A M Wallace, R A Cowan, W D Fraser, J A Fenner, G D Lowe, I T Boyle

{"title":"Association of severe haemophilia A with osteoporosis: a densitometric and biochemical study.","authors":"S J Gallacher, C Deighan, A M Wallace, R A Cowan, W D Fraser, J A Fenner, G D Lowe, I T Boyle","doi":"","DOIUrl":"","url":null,"abstract":"Following a femoral neck fracture and vertebral compression fractures in two patients with severe haemophilia A, bone density and turnover were measured in 19 males with severe haemophilia A (all HIV negative, 18/19 hepatitis C antibody positive) and in 19 age/sex matched controls. Bone density at the lumbar spine (L2-4), measured by dual energy X-ray absorptiometry, was significantly lower in the haemophiliac patients (HPs) at (mean +/- SEM) 1.109 +/- 0.042 g/cm2 vs. 1.234 +/- 0.027 in controls; p = 0.018. Femoral neck density was also lower at 0.877 +/- 0.034 g/cm2 (HPs) vs. 1.067 +/- 0.032; p < 0.0005. No significant differences were evident between the groups for serum calcium, parathyroid hormone, luteinizing hormone, follicle-stimulating hormone or 1,25 dihydroxyvitamin D3, nor for fasting urinary hydroxyproline, pyridinoline or deoxypyridinoline excretion. Serum total alkaline phosphatases was elevated in HPs at 200 +/- 10 U/l vs. 158 +/- 8; p = 0.004. Similarly, gamma-glutamyl transferase was elevated at 42 +/- 7 U/l (HPs) vs. 20 +/- 2; p = 0.007. Serum total testosterone and sex-hormone-binding globulin (SHBG) were higher in HPs at 26 +/- 2.5 nmol/l vs. 17.4 +/- 1.6 (p = 0.009) and 56 +/- 6 nmol/l vs. 27 +/- 3 (p = 0.0005), respectively. Free androgen index, however, was lower in HPs at 44 +/- 5 vs 69 +/- 7; p = 0.008. These results suggest significant osteopenia associated with haemophilia A. This may be partly due to liver dysfunction in HPs, but other factors, e.g. relative immobilization, may also be relevant.","PeriodicalId":54520,"journal":{"name":"Quarterly Journal of Medicine","volume":"87 3","pages":"181-6"},"PeriodicalIF":0.0,"publicationDate":"1994-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19198851","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

Outcome of treatment in young adults with phenylketonuria detected by routine neonatal screening between 1964 and 1971. 1964年至1971年间新生儿常规筛查发现的年轻苯丙酮尿症患者的治疗结果。

Quarterly Journal of Medicine Pub Date : 1994-03-01 DOI: 10.1093/OXFORDJOURNALS.QJMED.A068910

M. Beasley, P. Costello, I. Smith

{"title":"Outcome of treatment in young adults with phenylketonuria detected by routine neonatal screening between 1964 and 1971.","authors":"M. Beasley, P. Costello, I. Smith","doi":"10.1093/OXFORDJOURNALS.QJMED.A068910","DOIUrl":"https://doi.org/10.1093/OXFORDJOURNALS.QJMED.A068910","url":null,"abstract":"Intellectual status at 18 years is reported in 192 patients with phenylketonuria born in the UK between 1964 and 1971, together with their school progress. Mean IQs expressed as standard deviation scores (IQ-SDS) were significantly below estimated population norms, and showed a small decrease from 14 to 18 years of age (mean IQ-SDS -1.06 +/- 1.3 at 14 years and -1.28 +/- 1.07 at 18 years, t = 5.7, p < 0.0001). At 18 years, 27% of subjects had IQs over 2 SDs below the estimated population mean. IQ-SDS at 18 years, although significantly related to average phenylalanine control both between birth and 14 years, and between 14 and 18 years, was not independently related to either variable after allowing for IQ-SDS at 14 years. We conclude that general ability in young adults with early treated phenylketonuria, although reduced in comparison with their peers and closely related to phenylalanine control in early childhood, is not directly influenced by phenylalanine control in the four years preceding the 18th birthday. The apparent fall in IQ-SDS between 14 and 18 years may be due to methodological problems in the analysis of longitudinal IQ data without a control group, rather than providing evidence of intellectual decline.","PeriodicalId":54520,"journal":{"name":"Quarterly Journal of Medicine","volume":"87 3 1","pages":"155-60"},"PeriodicalIF":0.0,"publicationDate":"1994-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/OXFORDJOURNALS.QJMED.A068910","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61292555","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: 53

Classical versus non-renal Wegener's granulomatosis. 典型韦格纳肉芽肿与非肾性韦格纳肉芽肿。

Quarterly Journal of Medicine Pub Date : 1994-03-01

R A Luqmani, P A Bacon, M Beaman, D G Scott, P Emery, S J Lee, A J Howie, N Richards, J Michael, D Adu

{"title":"Classical versus non-renal Wegener's granulomatosis.","authors":"R A Luqmani, P A Bacon, M Beaman, D G Scott, P Emery, S J Lee, A J Howie, N Richards, J Michael, D Adu","doi":"","DOIUrl":"","url":null,"abstract":"We investigated whether 'limited' or 'non-renal' Wegener's granulomatosis (WG) differs from classical or 'renal' WG. Renal WG is characterized by necrotizing granulomatosis of the upper and or lower respiratory tract, accompanied by systemic vasculitis and focal segmental necrotizing glomerulonephritis. This last feature is absent in non-renal WG. In a prospective follow-up study of all identified cases presenting to a single teaching hospital, we reviewed 22 patients with non-renal WG, and compared their presentation and outcome with that of 28 patients with renal WG. Clinical and laboratory assessment of disease activity, frequency of death, relapse and end-stage renal disease were assessed. The two groups differed in clinical presentation, laboratory features and outcome. The group with non-renal WG had less cutaneous and pulmonary disease; the haemoglobin, white cell count and platelet count tended to be normal. Residual mortality was confined to the renal group. However, the groups shared many features, particularly their requirement for immunosuppressive therapy, since WG causes major tissue destruction regardless of whether it is a localized or widespread process. At the immunopathological level, the two groups appear to be part of a single disease spectrum. Importantly, the non-renal WG group may change the pattern of their disease to involve the kidney. Long-term follow-up of such patients is therefore essential.","PeriodicalId":54520,"journal":{"name":"Quarterly Journal of Medicine","volume":"87 3","pages":"161-7"},"PeriodicalIF":0.0,"publicationDate":"1994-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19198849","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

Acute encephalopathy: diagnosis and outcome in patients at a regional neurological unit. 急性脑病:诊断和结果的病人在区域神经单位。

Quarterly Journal of Medicine Pub Date : 1994-03-01 DOI: 10.1093/OXFORDJOURNALS.QJMED.A068912

L. Ginsberg, D. Compston

{"title":"Acute encephalopathy: diagnosis and outcome in patients at a regional neurological unit.","authors":"L. Ginsberg, D. Compston","doi":"10.1093/OXFORDJOURNALS.QJMED.A068912","DOIUrl":"https://doi.org/10.1093/OXFORDJOURNALS.QJMED.A068912","url":null,"abstract":"Sixty-five patients with a diagnosis of acute encephalitis or encephalopathy were discharged from a regional neurological unit over a 17-year period. Investigation during the acute illness, or subsequent clinical and laboratory observations, yielded a definite or probable diagnosis in 34 of these patients, including herpes simplex encephalitis (8 cases), encephalitis due to other identified viruses (7 cases), vascular disease (7 cases) and multiple sclerosis (4 cases). In these 34 patients, mortality relating to the presenting illness was 50% and a further 29% had significant long-term neurological morbidity. In the other 31 patients, no cause for the encephalopathy was identified, despite extensive investigation. These patients had an alteration in conscious state, often with recurrent seizures (45%), focal neurological signs (52%), pyrexia (65%), abnormal electroencephalogram (85%) and cerebrospinal fluid lymphocytosis (80%). During follow-up (6 months to 15 years) none had recurrent encephalopathy, and 65% eventually made a complete recovery, although delayed by seizures in 6% and psychiatric illness in 13%. The mortality in this group relating to the acute illness was 6%. Overall, nearly half the patients with a discharge diagnosis of acute encephalitis or encephalopathy had a good prognosis for recovery, following a monophasic illness of undetermined cause.","PeriodicalId":54520,"journal":{"name":"Quarterly Journal of Medicine","volume":"87 3 1","pages":"169-80"},"PeriodicalIF":0.0,"publicationDate":"1994-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/OXFORDJOURNALS.QJMED.A068912","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61292567","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: 9

Acute encephalopathy: diagnosis and outcome in patients at a regional neurological unit. 急性脑病:诊断和结果的病人在区域神经单位。

Quarterly Journal of Medicine Pub Date : 1994-03-01

L Ginsberg, D A Compston

{"title":"Acute encephalopathy: diagnosis and outcome in patients at a regional neurological unit.","authors":"L Ginsberg, D A Compston","doi":"","DOIUrl":"","url":null,"abstract":"Sixty-five patients with a diagnosis of acute encephalitis or encephalopathy were discharged from a regional neurological unit over a 17-year period. Investigation during the acute illness, or subsequent clinical and laboratory observations, yielded a definite or probable diagnosis in 34 of these patients, including herpes simplex encephalitis (8 cases), encephalitis due to other identified viruses (7 cases), vascular disease (7 cases) and multiple sclerosis (4 cases). In these 34 patients, mortality relating to the presenting illness was 50% and a further 29% had significant long-term neurological morbidity. In the other 31 patients, no cause for the encephalopathy was identified, despite extensive investigation. These patients had an alteration in conscious state, often with recurrent seizures (45%), focal neurological signs (52%), pyrexia (65%), abnormal electroencephalogram (85%) and cerebrospinal fluid lymphocytosis (80%). During follow-up (6 months to 15 years) none had recurrent encephalopathy, and 65% eventually made a complete recovery, although delayed by seizures in 6% and psychiatric illness in 13%. The mortality in this group relating to the acute illness was 6%. Overall, nearly half the patients with a discharge diagnosis of acute encephalitis or encephalopathy had a good prognosis for recovery, following a monophasic illness of undetermined cause.","PeriodicalId":54520,"journal":{"name":"Quarterly Journal of Medicine","volume":"87 3","pages":"169-80"},"PeriodicalIF":0.0,"publicationDate":"1994-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19198850","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

Familial nephropathic systemic amyloidosis caused by apolipoprotein AI variant Arg26. 载脂蛋白AI变异Arg26引起的家族性肾病全身性淀粉样变性。

Quarterly Journal of Medicine Pub Date : 1994-03-01 DOI: 10.1093/OXFORDJOURNALS.QJMED.A068909

D. Vigushin, J. Gough, D. Allan, A. Alguacil, B. Penner, N. Pettigrew, G. Quinonez, K. Bernstein, S. Booth, D. Booth

{"title":"Familial nephropathic systemic amyloidosis caused by apolipoprotein AI variant Arg26.","authors":"D. Vigushin, J. Gough, D. Allan, A. Alguacil, B. Penner, N. Pettigrew, G. Quinonez, K. Bernstein, S. Booth, D. Booth","doi":"10.1093/OXFORDJOURNALS.QJMED.A068909","DOIUrl":"https://doi.org/10.1093/OXFORDJOURNALS.QJMED.A068909","url":null,"abstract":"A point mutation in the apolipoprotein AI (apoAI) gene causing autosomal dominant non-neuropathic systemic amyloidosis is described in a previously unreported Canadian family of British origin with five affected individuals in three generations. Amyloid deposits in the renal biopsy from the proband, a 31-year-old female presenting with hypertension and renal failure, stained immunospecifically with antiserum to apoAI. The plasma of all family members with amyloidosis contained both wild-type apoAI and a variant bearing one additional positive charge. Sequencing of the apoAI gene demonstrated that the proband was a heterozygote for a single base substitution in exon 3, changing codon 26 from GGC(Gly) to CGC(Arg). Concordance of the mutant allele with the presence of variant plasma apoAI and clinical features of amyloidosis was demonstrated. This is the third family in which this amyloidotic mutation has been described, but the distribution of amyloid deposits and their clinical effects are clearly determined by other genetic and/or environmental factors.","PeriodicalId":54520,"journal":{"name":"Quarterly Journal of Medicine","volume":"87 3 1","pages":"149-54"},"PeriodicalIF":0.0,"publicationDate":"1994-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/OXFORDJOURNALS.QJMED.A068909","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61292442","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: 52