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3632. Effects of coronary risk reduction on the pattern of mortality.
Control of coronary risk factors is associated with lower age-specific risks, but people will then live longer, with increased exposure to the higher mortality rates of the elderly. Expected changes in pattern of mortality, based on the 15-year follow-up of men in the Whitehall study, have been calculated. Non-smokers live longer than smokers, but death (when it comes) is more likely to be due to heart attack and less likely to be due to cancer. By contrast a lower level of plasma cholesterol, which is also associated with longer life, is expected to reduce the lifetime risk of fatal heart attack, its place then being taken by a typical mixture of other causes of death.
3633. Hypothesis: Helicobacter pylori, urease, mucus, and gastric ulcer.
Ammonia, released in the gastric mucosa by the action of Helicobacter pylori urease on transuded plasma urea, curtails the biosynthesis of mucus and/or causes the mucus to be disassembled at the mucosal surface. These changes facilitate colonisation by H pylori and may promote gastric ulcer formation.
3635. Screening for cancer of the cervix in elderly women.
A substantial proportion of women aged over 65 years has not been screened for cancer of the cervix and women in this age group are not included in current screening programmes. This policy is not supported by evidence from the natural history of preinvasive lesions. Since older women present with late disease (and therefore have a poor survival) 5-year survival rates adjusted for stage were used to estimate the reduction in number of deaths in women aged 20 years or older (during a 5-year period) if opportunistic screening were to identify more cases of cervical cancer at an earlier stage. 353 lives would be saved and women older than 65 would benefit most, with a 63% improvement in 5-year mortality. Thus, there is no reason to exclude women aged over 65 years from screening for cancer of the cervix.
3636. Pathophysiology of angina.
The development and pathophysiology of myocardial ischaemia is a dynamic process in which increased myocardial oxygen demand or decreased coronary blood flow are not the sole determinants. Both these factors are inappropriately altered before, during, or after the onset of ischaemia, and a vicious cycle ensues. Drug therapy should be aimed at not only preventing the development of myocardial ischaemia but also at reversing the abnormal hormonal, metabolic, and haemodynamic effects.
3639. Liver transplantation for acute hepatic failure?
In the absence of definitive medical treatment for severe fulminant hepatic failure, liver transplantation may be appropriate in selected patients. However, uniform and easily applicable criteria for diagnosis of severity and analysis of results are needed to prevent unnecessary transplantation and to ensure that patients who may benefit are appropriately treated. Previous regimens for treatment of fulminant hepatic failure were often advocated, on the basis of data from historical controls, for several years until controlled trials failed to show any benefit. To obtain reliable information more rapidly than achieved before, a controlled trial between specialist liver transplant units is needed to establish the role of emergency hepatic transplantation in patients with fulminant hepatic failure.
3640. Use of cyclosporin in psoriasis.
作者: J D Bos.;M M Meinardi.;T van Joost.;F Heule.;A V Powles.;L Fry.
来源: Lancet. 1989年2卷8678-8679期1500-2页
In the treatment of severe psoriasis, cyclosporin may achieve improvement or remission at low doses, but relapse usually occurs on withdrawal of treatment. An initial dose of 3 mg/kg per day is recommended. Complete remission should not be the objective, and the role of long-term maintenance cyclosporin therapy is uncertain because of potential side-effects--especially nephrotoxicity, hypertension, and a predisposition to malignancy. Guidelines are proposed for the assessment of such treatment.
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