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3701. A double-blind comparison of empirical oral and intravenous antibiotic therapy for low-risk febrile patients with neutropenia during cancer chemotherapy.
作者: A Freifeld.;D Marchigiani.;T Walsh.;S Chanock.;L Lewis.;J Hiemenz.;S Hiemenz.;J E Hicks.;V Gill.;S M Steinberg.;P A Pizzo.
来源: N Engl J Med. 1999年341卷5期305-11页
Among patients with fever and neutropenia during chemotherapy for cancer who have a low risk of complications, oral administration of empirical broad-spectrum antibiotics may be an acceptable alternative to intravenous treatment.
3702. Neostigmine for the treatment of acute colonic pseudo-obstruction.
Acute colonic pseudo-obstruction -- that is, massive dilation of the colon without mechanical obstruction -- may develop after surgery or severe illness. Although it may resolve with conservative therapy, colonoscopic decompression is sometimes needed to prevent ischemia and perforation of the bowel. Uncontrolled studies have suggested that neostigmine, may be an effective treatment.
3703. Aggressive lipid-lowering therapy compared with angioplasty in stable coronary artery disease. Atorvastatin versus Revascularization Treatment Investigators.
作者: B Pitt.;D Waters.;W V Brown.;A J van Boven.;L Schwartz.;L M Title.;D Eisenberg.;L Shurzinske.;L S McCormick.
来源: N Engl J Med. 1999年341卷2期70-6页
Percutaneous coronary revascularization is widely used in improving symptoms and exercise performance in patients with ischemic heart disease and stable angina pectoris. In this study, we compared percutaneous coronary revascularization with lipid-lowering treatment for reducing the incidence of ischemic events.
3704. A comparison of injections of botulinum toxin and topical nitroglycerin ointment for the treatment of chronic anal fissure.
作者: G Brisinda.;G Maria.;A R Bentivoglio.;E Cassetta.;D Gui.;A Albanese.
来源: N Engl J Med. 1999年341卷2期65-9页
Lateral internal sphincterotomy, the most common treatment for chronic anal fissure, may cause permanent injury to the anal sphincter, which can lead to fecal incontinence. We compared two nonsurgical treatments that avert the risk of fecal incontinence. We randomly assigned 50 adults with symptomatic chronic posterior anal fissures to receive treatment with either a total of 20 U of botulinum toxin injected into the internal anal sphincter on each side of the anterior midline or 0.2 percent nitroglycerin ointment applied twice daily for six weeks.
3705. Vitamin A supplementation for extremely-low-birth-weight infants. National Institute of Child Health and Human Development Neonatal Research Network.
作者: J E Tyson.;L L Wright.;W Oh.;K A Kennedy.;L Mele.;R A Ehrenkranz.;B J Stoll.;J A Lemons.;D K Stevenson.;C R Bauer.;S B Korones.;A A Fanaroff.
来源: N Engl J Med. 1999年340卷25期1962-8页
Vitamin A supplementation may reduce the risk of chronic lung disease and sepsis in extremely-low-birth-weight infants. The results of our pilot study suggested that a dose of 5000 IU administered intramuscularly three times per week for four weeks was more effective than the lower doses given in past trials.
3706. Long-term treatment with inhaled budesonide in persons with mild chronic obstructive pulmonary disease who continue smoking. European Respiratory Society Study on Chronic Obstructive Pulmonary Disease.
作者: R A Pauwels.;C G Löfdahl.;L A Laitinen.;J P Schouten.;D S Postma.;N B Pride.;S V Ohlsson.
来源: N Engl J Med. 1999年340卷25期1948-53页
Although patients with chronic obstructive pulmonary disease (COPD) should stop smoking, some do not. In a double-blind, placebo-controlled study, we evaluated the effect of the inhaled glucocorticoid budesonide in patients with mild COPD who continued smoking. After a six-month run-in period, we randomly assigned 1277 subjects (mean age, 52 years; mean forced expiratory volume in one second [FEV1], 77 percent of the predicted value; 73 percent men) to twice-daily treatment with 400 microg of budesonide or placebo, inhaled from a dry-powder inhaler, for three years.
3707. Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease. Department of Veterans Affairs Cooperative Study Group.
作者: D E Niewoehner.;M L Erbland.;R H Deupree.;D Collins.;N J Gross.;R W Light.;P Anderson.;N A Morgan.
来源: N Engl J Med. 1999年340卷25期1941-7页
Although their clinical efficacy is unclear and they may cause serious adverse effects, systemic glucocorticoids are a standard treatment for patients hospitalized with exacerbations of chronic obstructive pulmonary disease (COPD). We conducted a double-blind, randomized trial of systemic glucocorticoids (given for two or eight weeks) or placebo in addition to other therapies, for exacerbations of COPD. Most other care was standardized over the six-month period of follow-up. The primary end point was treatment failure, defined as death from any cause or the need for intubation and mechanical ventilation, readmission to the hospital for COPD, or intensification of drug therapy.
3708. Effects of different forms of dietary hydrogenated fats on serum lipoprotein cholesterol levels.
Metabolic studies suggest that fatty acids containing at least one double bond in the trans configuration, which are found in hydrogenated fat, have a detrimental effect on serum lipoprotein cholesterol levels as compared with unsaturated fatty acids containing double bonds only in the cis configuration. We compared the effects of diets with a broad range of trans fatty acids on serum lipoprotein cholesterol levels.
3709. Prevention of implantable-defibrillator shocks by treatment with sotalol. d,l-Sotalol Implantable Cardioverter-Defibrillator Study Group.
作者: A Pacifico.;S H Hohnloser.;J H Williams.;B Tao.;S Saksena.;P D Henry.;E N Prystowsky.
来源: N Engl J Med. 1999年340卷24期1855-62页
Patients with implantable cardioverter-defibrillators often receive adjunctive antiarrhythmic therapy to prevent frequent shocks. We tested the efficacy and safety of sotalol, a beta-blocker with class III antiarrhythmic effects, for this purpose.
3710. Facilitating transthoracic cardioversion of atrial fibrillation with ibutilide pretreatment.
作者: H Oral.;J J Souza.;G F Michaud.;B P Knight.;R Goyal.;S A Strickberger.;F Morady.
来源: N Engl J Med. 1999年340卷24期1849-54页
Atrial fibrillation cannot always be converted to sinus rhythm by transthoracic electrical cardioversion. We examined the effect of ibutilide, a class III antiarrhythmic agent, on the energy requirement for atrial defibrillation and assessed the value of this agent in facilitating cardioversion in patients with atrial fibrillation that is resistant to conventional transthoracic cardioversion.
3711. Effects of tissue plasminogen activator for acute ischemic stroke at one year. National Institute of Neurological Disorders and Stroke Recombinant Tissue Plasminogen Activator Stroke Study Group.
作者: T G Kwiatkowski.;R B Libman.;M Frankel.;B C Tilley.;L B Morgenstern.;M Lu.;J P Broderick.;C A Lewandowski.;J R Marler.;S R Levine.;T Brott.
来源: N Engl J Med. 1999年340卷23期1781-7页
In 1995, the two-part National Institute of Neurological Disorders and Stroke (NINDS) Recombinant Tissue Plasminogen Activator Stroke Trial found that patients who were treated with tissue plasminogen activator (t-PA) within three hours after the onset of symptoms of acute ischemic stroke were at least 30 percent more likely than patients given placebo to have minimal or no disability three months after the stroke. It was unknown, however, whether the benefit would be sustained for longer periods.
3712. Transplantation of anergic histoincompatible bone marrow allografts.
作者: E C Guinan.;V A Boussiotis.;D Neuberg.;L L Brennan.;N Hirano.;L M Nadler.;J G Gribben.
来源: N Engl J Med. 1999年340卷22期1704-14页
Successful allogeneic bone marrow transplantation relies on global immunosuppression or elimination of T cells. In contrast, the induction of anergy can inactivate specific sets of alloreactive T cells in the donor marrow. Previous work has shown that anergy can be induced by blocking the interaction of the B7 molecule on the surface of antigen-presenting cells with the CD28 molecule on the surface of T cells, thus preventing key signaling events essential for the activation of T cells. To investigate the feasibility of this approach with respect to transplantation of histoincompatible bone marrow, we undertook a clinical trial of ex vivo induction of anergy in T cells present in donor marrow to recipient alloantigens.
3713. Treatment of severe ocular-surface disorders with corneal epithelial stem-cell transplantation.
作者: K Tsubota.;Y Satake.;M Kaido.;N Shinozaki.;S Shimmura.;H Bissen-Miyajima.;J Shimazaki.
来源: N Engl J Med. 1999年340卷22期1697-703页
Conditions that destroy the limbal area of the peripheral cornea, such as the Stevens-Johnson syndrome, ocular pemphigoid, and chemical and thermal injuries, can deplete stem cells of the corneal epithelium. The result is scarring and opacification of the normally clear cornea. Standard corneal transplantation cannot treat this form of functional blindness.
3714. Benefit of abciximab in patients with refractory unstable angina in relation to serum troponin T levels. c7E3 Fab Antiplatelet Therapy in Unstable Refractory Angina (CAPTURE) Study Investigators.
作者: C W Hamm.;C Heeschen.;B Goldmann.;A Vahanian.;J Adgey.;C M Miguel.;W Rutsch.;J Berger.;J Kootstra.;M L Simoons.
来源: N Engl J Med. 1999年340卷21期1623-9页
In patients with refractory unstable angina, the platelet glycoprotein IIb/IIIa-receptor antibody abciximab reduces the incidence of cardiac events before and during coronary angioplasty. We investigated whether serum troponin T levels identify patients most likely to benefit from therapy with this drug.
3715. Persistence of HIV-1 transcription in peripheral-blood mononuclear cells in patients receiving potent antiretroviral therapy.
作者: M R Furtado.;D S Callaway.;J P Phair.;K J Kunstman.;J L Stanton.;C A Macken.;A S Perelson.;S M Wolinsky.
来源: N Engl J Med. 1999年340卷21期1614-22页
Although potent antiretroviral therapy can control infection with human immunodeficiency virus type 1 (HIV-1), a long-lived reservoir of infectious virus persists in CD4+ T cells. We investigated this viral reservoir by measuring the levels of cell-associated viral DNA and messenger RNA (mRNA) that are essential for HIV-1 replication. Approximately every 6 months, we obtained samples of peripheral-blood mononuclear cells from five men with long-standing HIV-1 infection who had had undetectable levels of plasma HIV-1 RNA for 20 months or more during treatment with potent antiretroviral drugs.
3716. Quantifying residual HIV-1 replication in patients receiving combination antiretroviral therapy.
作者: L Zhang.;B Ramratnam.;K Tenner-Racz.;Y He.;M Vesanen.;S Lewin.;A Talal.;P Racz.;A S Perelson.;B T Korber.;M Markowitz.;D D Ho.
来源: N Engl J Med. 1999年340卷21期1605-13页
In patients infected with human immunodeficiency virus type 1 (HIV-1), combination antiretroviral therapy can result in sustained suppression of plasma levels of the virus. However, replication-competent virus can still be recovered from latently infected resting memory CD4 lymphocytes; this finding raises serious doubts about whether antiviral treatment can eradicate HIV-1.
3717. Endovascular stent-graft placement for the treatment of acute aortic dissection.
作者: M D Dake.;N Kato.;R S Mitchell.;C P Semba.;M K Razavi.;T Shimono.;T Hirano.;K Takeda.;I Yada.;D C Miller.
来源: N Engl J Med. 1999年340卷20期1546-52页
The standard treatment for acute aortic dissection is either surgical or medical therapy, depending on the morphologic features of the lesion and any associated complications. Irrespective of the form of treatment, the associated mortality and morbidity are considerable.
3718. Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement.
作者: C A Nienaber.;R Fattori.;G Lund.;C Dieckmann.;W Wolf.;Y von Kodolitsch.;V Nicolas.;A Pierangeli.
来源: N Engl J Med. 1999年340卷20期1539-45页
The treatment of thoracic aortic dissection is guided by prognostic and anatomical information. Proximal dissection requires surgery, but the appropriate treatment of distal thoracic aortic dissection has not been determined, because surgery has failed to improve the prognosis.
3719. Ultrasound therapy for calcific tendinitis of the shoulder.
作者: G R Ebenbichler.;C B Erdogmus.;K L Resch.;M A Funovics.;F Kainberger.;G Barisani.;M Aringer.;P Nicolakis.;G F Wiesinger.;M Baghestanian.;E Preisinger.;V Fialka-Moser.
来源: N Engl J Med. 1999年340卷20期1533-8页
Although ultrasound therapy is used to treat calcific tendinitis of the shoulder, its efficacy has not been rigorously evaluated. We conducted a randomized, double-blind comparison of ultrasonography and sham insonation in patients with symptomatic calcific tendinitis verified by radiography. Patients were assigned to receive 24 15-minute sessions of either pulsed ultrasound (frequency, 0.89 MHz; intensity, 2.5 W per square centimeter; pulsed mode, 1:4) or an indistinguishable sham treatment to the area over the calcification. The first 15 treatments were given daily (five times per week), and the remainder were given three times a week for three weeks. Randomization was conducted according to shoulders rather than patients, so a patient with bilateral tendinitis might receive either or both therapies.
3720. Valacyclovir for the prevention of cytomegalovirus disease after renal transplantation. International Valacyclovir Cytomegalovirus Prophylaxis Transplantation Study Group.
作者: D Lowance.;H H Neumayer.;C M Legendre.;J P Squifflet.;J Kovarik.;P J Brennan.;D Norman.;R Mendez.;M R Keating.;G L Coggon.;A Crisp.;I C Lee.
来源: N Engl J Med. 1999年340卷19期1462-70页
Cytomegalovirus (CMV) disease is a major complication of organ transplantation. We hypothesized that prophylactic treatment with valacyclovir would reduce the risk of CMV disease.
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