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4261. Preventing bronchoconstriction in exercise-induced asthma with inhaled heparin.
We have previously reported that inhaled heparin prevents allergic bronchoconstriction in sheep and inhibits the anti-IgE-mediated release of histamine from mast cells in vitro. Since the release of such mediators has been implicated in exercise-induced asthma, we investigated whether inhaled heparin could also attenuate the bronchoconstrictor response in this disease.
4262. A controlled trial of diazepam administered during febrile illnesses to prevent recurrence of febrile seizures.
作者: N P Rosman.;T Colton.;J Labazzo.;P L Gilbert.;N B Gardella.;E M Kaye.;C Van Bennekom.;M R Winter.
来源: N Engl J Med. 1993年329卷2期79-84页
Phenobarbital, once widely prescribed to prevent febrile seizures, is now in disfavor because of its side effects and lack of efficacy. Diazepam, administered only during episodes of fever, may be a safe, effective agent to prevent the recurrence of febrile seizures.
4263. Mortality rates and risk factors for coronary disease in black as compared with white men and women.
作者: J E Keil.;S E Sutherland.;R G Knapp.;D T Lackland.;P C Gazes.;H A Tyroler.
来源: N Engl J Med. 1993年329卷2期73-8页
Currently recognized risk factors for coronary artery disease have been identified primarily from investigations of white populations. In this investigation, we estimated mortality rates for coronary disease and for any cause and identified risk factors for death from coronary disease among whites and blacks.
4265. Withdrawal of digoxin from patients with chronic heart failure treated with angiotensin-converting-enzyme inhibitors. RADIANCE Study.
作者: M Packer.;M Gheorghiade.;J B Young.;P J Costantini.;K F Adams.;R J Cody.;L K Smith.;L Van Voorhees.;L A Gourley.;M K Jolly.
来源: N Engl J Med. 1993年329卷1期1-7页
Although digoxin is effective in the treatment of patients with chronic heart failure who are receiving diuretic agents, it is not clear whether the drug has a role when patients are receiving angiotensin-converting-enzyme inhibitors, as is often the case in current practice.
4266. Effect on blood lipids of very high intakes of fiber in diets low in saturated fat and cholesterol.
作者: D J Jenkins.;T M Wolever.;A V Rao.;R A Hegele.;S J Mitchell.;T P Ransom.;D L Boctor.;P J Spadafora.;A L Jenkins.;C Mehling.
来源: N Engl J Med. 1993年329卷1期21-6页
It is known that soluble fiber in the diet can lower blood lipid levels. It is less certain, however, that eating foods with soluble fiber will further lower blood lipids when the intake of saturated fat and cholesterol has already been reduced to very low levels. Furthermore, the mechanism of the lipid-lowering effect of fiber has not been elucidated.
4267. Effect of dietary supplementation with very-long-chain n-3 fatty acids in patients with psoriasis.
作者: E Søyland.;J Funk.;G Rajka.;M Sandberg.;P Thune.;L Rustad.;S Helland.;K Middelfart.;S Odu.;E S Falk.
来源: N Engl J Med. 1993年328卷25期1812-6页
In several studies dietary fish oil has been found to have beneficial effect on psoriasis, but the results are contradictory and based mainly on open studies or studies of small numbers of patients.
4268. Efficacy of aerosolized tobramycin in patients with cystic fibrosis.
作者: B W Ramsey.;H L Dorkin.;J D Eisenberg.;R L Gibson.;I R Harwood.;R M Kravitz.;D V Schidlow.;R W Wilmott.;S J Astley.;M A McBurnie.
来源: N Engl J Med. 1993年328卷24期1740-6页
Direct aerosol delivery of aminoglycosides such as tobramycin to the lower airways of patients with cystic fibrosis may control infection with Pseudomonas aeruginosa and improve pulmonary function, with low systemic toxicity. We conducted a randomized crossover study to evaluate the safety and efficacy of aerosolized tobramycin in patients with cystic fibrosis and P. aeruginosa infections.
4269. Prevention of corticosteroid osteoporosis. A comparison of calcium, calcitriol, and calcitonin.
作者: P Sambrook.;J Birmingham.;P Kelly.;S Kempler.;T Nguyen.;N Pocock.;J Eisman.
来源: N Engl J Med. 1993年328卷24期1747-52页
Prolonged corticosteroid therapy increases the risk of osteoporosis and fracture. We studied whether corticosteroid-induced osteoporosis could be prevented by treatment with calcium, calcitriol (1,25-dihydroxyvitamin D3), and calcitonin.
4270. A controlled trial of bismuth subsalicylate in infants with acute watery diarrheal disease.
作者: D Figueroa-Quintanilla.;E Salazar-Lindo.;R B Sack.;R León-Barúa.;S Sarabia-Arce.;M Campos-Sánchez.;E Eyzaguirre-Maccan.
来源: N Engl J Med. 1993年328卷23期1653-8页
Bismuth subsalicylate is a common constituent of over-the-counter medications for diarrhea. However, it is uncertain whether bismuth offers any more benefit than standard oral rehydration therapy with early feeding.
4271. Radiotherapy after breast-preserving surgery in women with localized cancer of the breast.
作者: U Veronesi.;A Luini.;M Del Vecchio.;M Greco.;V Galimberti.;M Merson.;F Rilke.;V Sacchini.;R Saccozzi.;T Savio.
来源: N Engl J Med. 1993年328卷22期1587-91页
Conservative surgery and radiotherapy have become well-established treatments for breast cancer, and many trials in progress are attempting to define the most acceptable type of procedure. Between 1987 and 1989 we randomly assigned 567 women with small breast cancers (< 2.5 cm in diameter) to quadrantectomy followed by radiotherapy or to quadrantectomy without radiotherapy. All patients underwent total axillary dissection. The median follow-up period was 39 months (range, 28 to 54).
4272. Lumpectomy compared with lumpectomy and radiation therapy for the treatment of intraductal breast cancer.
作者: B Fisher.;J Costantino.;C Redmond.;E Fisher.;R Margolese.;N Dimitrov.;N Wolmark.;D L Wickerham.;M Deutsch.;L Ore.
来源: N Engl J Med. 1993年328卷22期1581-6页
Women with ductal carcinoma in situ have been treated both by lumpectomy and by lumpectomy followed by radiation therapy, but the benefit of combined therapy is uncertain. A group of 818 women with ductal carcinoma in situ were randomly assigned to undergo lumpectomy or lumpectomy followed by breast irradiation (50 Gy). Sufficient tissue was removed that the margins of the resected specimens were histologically tumor-free. The mean duration of follow-up was 43 months (range, 11 to 86). The principal end point of the study was event-free survival, as defined by the presence of no new ipsilateral or contralateral breast cancers, regional or distant metastases, or other cancers and by no deaths from causes other than cancer.
4273. Comparison of atovaquone (566C80) with trimethoprim-sulfamethoxazole to treat Pneumocystis carinii pneumonia in patients with AIDS.
作者: W Hughes.;G Leoung.;F Kramer.;S A Bozzette.;S Safrin.;P Frame.;N Clumeck.;H Masur.;D Lancaster.;C Chan.
来源: N Engl J Med. 1993年328卷21期1521-7页
Both trimethoprim-sulfamethoxazole and pentamidine are effective as treatments for Pneumocystis carinii pneumonia, but adverse effects frequently limit their use. Atovaquone (566C80) is a new hydroxynaphthoquinone with activity against P. carinii.
4274. Dapsone-pyrimethamine compared with aerosolized pentamidine as primary prophylaxis against Pneumocystis carinii pneumonia and toxoplasmosis in HIV infection. The PRIO Study Group.
作者: P M Girard.;R Landman.;C Gaudebout.;R Olivares.;A G Saimot.;P Jelazko.;C Gaudebout.;A Certain.;F Boué.;E Bouvet.
来源: N Engl J Med. 1993年328卷21期1514-20页
Pneumocystis carinii pneumonia and toxoplasmic encephalitis are frequent life-threatening opportunistic infections in patients with human immunodeficiency virus (HIV) infection. Primary prophylaxis against P. carinii pneumonia is now common, but there are few data on regimens for primary prophylaxis against toxoplasmosis.
4275. Topical tretinoin (retinoic acid) therapy for hyperpigmented lesions caused by inflammation of the skin in black patients.
作者: S M Bulengo-Ransby.;C E Griffiths.;C K Kimbrough-Green.;L J Finkel.;T A Hamilton.;C N Ellis.;J J Voorhees.
来源: N Engl J Med. 1993年328卷20期1438-43页
Irregular disfiguring skin hyperpigmentation due to inflammation may develop in black persons. We investigated the treatment of this hyperpigmentation with topical tretinoin (0.1 percent retinoic acid cream). Fifty-four subjects completed a 40-week randomized, double-blind, vehicle-controlled study. Twenty-four subjects applied tretinoin daily to the face, arms, or both areas, and 30 subjects applied vehicle cream. At base line and after 40 weeks of treatment, each subject's post-inflammatory hyperpigmented lesions and normal skin were assessed by clinical and colorimetric evaluations and by analysis of biopsy specimens.
4276. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study.
作者: J S Mandel.;J H Bond.;T R Church.;D C Snover.;G M Bradley.;L M Schuman.;F Ederer.
来源: N Engl J Med. 1993年328卷19期1365-71页
Although tests for occult blood in the feces are widely used to screen for colorectal cancers, there is no conclusive evidence that they reduce mortality from this cause. We evaluated a fecal occult-blood test in a randomized trial and documented its effectiveness.
4277. Blood transfusions and prognosis in colorectal cancer.
作者: O R Busch.;W C Hop.;M A Hoynck van Papendrecht.;R L Marquet.;J Jeekel.
来源: N Engl J Med. 1993年328卷19期1372-6页
Blood transfusions may adversely affect the prognosis of patients treated surgically for cancer, although definite proof of this adverse effect has not been reported.
4278. A comparison of outcomes in men 11 years after heart-valve replacement with a mechanical valve or bioprosthesis. Veterans Affairs Cooperative Study on Valvular Heart Disease.
作者: K E Hammermeister.;G K Sethi.;W G Henderson.;C Oprian.;T Kim.;S Rahimtoola.
来源: N Engl J Med. 1993年328卷18期1289-96页
Mechanical heart valves are durable but thrombogenic, and their use requires that the patient receive anticoagulants. In contrast, bioprosthetic valves are less thrombogenic, but they have limited durability because of tissue deterioration.
4279. Treatment of colonic and rectal adenomas with sulindac in familial adenomatous polyposis.
作者: F M Giardiello.;S R Hamilton.;A J Krush.;S Piantadosi.;L M Hylind.;P Celano.;S V Booker.;C R Robinson.;G J Offerhaus.
来源: N Engl J Med. 1993年328卷18期1313-6页
Familial adenomatous polyposis is an autosomal dominant disorder characterized by the formation of hundreds of colorectal adenomas and eventual colorectal cancer. Administration of the nonsteroidal antiinflammatory drug sulindac has been followed by regression of polyps in patients with this disorder, but no controlled trial of this drug in patients who have not had surgery has been reported.
4280. The efficacy of intensive dietary therapy alone or combined with lovastatin in outpatients with hypercholesterolemia.
作者: D B Hunninghake.;E A Stein.;C A Dujovne.;W S Harris.;E B Feldman.;V T Miller.;J A Tobert.;P M Laskarzewski.;E Quiter.;J Held.
来源: N Engl J Med. 1993年328卷17期1213-9页
A diet low in saturated fat and cholesterol is the standard initial treatment for hypercholesterolemia. However, little quantitative information is available about the efficacy of dietary therapy in clinical practice or about the combined effects of diet and drug therapy.
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