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4421. Lack of efficacy of phenytoin in recessive dystrophic epidermolysis bullosa. Epidermolysis Bullosa Study Group.
Recessive dystrophic epidermolysis bullosa is an uncommon, severely disabling, heritable disorder characterized by abnormal fragility of the skin. Open trials have suggested that phenytoin is an effective treatment, and this therapy is now widely used.
4422. Reactivation of unstable angina after the discontinuation of heparin.
Heparin is an effective, widely used treatment for unstable angina. Among patients enrolled in a double-blind, randomized, placebo-controlled trial comparing intravenous heparin, aspirin, both treatments, and neither during the acute phase of unstable angina, we encountered patients in whom unstable angina was reactivated after heparin was discontinued.
4423. The effect of high doses of calcium-channel blockers on survival in primary pulmonary hypertension.
Primary pulmonary hypertension is a progressive, fatal disease of unknown cause. Vasodilator drugs have been used as a treatment, but their efficacy is uncertain.
4424. Diagnosis and staging of colonic tumors by conventional abdominal sonography as compared with hydrocolonic sonography.
Ultrasonic examination has become increasingly important in the diagnosis of diseases of the gastrointestinal tract. In neoplastic diseases of the large intestine, however, the diagnostic value of conventional transabdominal sonography is limited. The purpose of this investigation was to determine whether the evaluation and staging of colonic tumors would be improved by the retrograde instillation of water into the colon in a procedure called hydrocolonic sonography.
4425. The use of digoxin-specific Fab fragments for severe digitalis intoxication in children.
Because life-threatening digitalis intoxication is unusual in children, treatment with digoxin-specific-antibody Fab fragments (Fab) has rarely been reported. We describe the efficacy of Fab in the treatment of children with severe digitalis intoxication.
4426. Localization of pancreatic endocrine tumors by endoscopic ultrasonography.
作者: T Rösch.;C J Lightdale.;J F Botet.;G A Boyce.;M V Sivak.;K Yasuda.;N Heyder.;L Palazzo.;H Dancygier.;V Schusdziarra.
来源: N Engl J Med. 1992年326卷26期1721-6页
After a pancreatic endocrine tumor has been diagnosed on the basis of clinical signs and the results of laboratory tests, localization of the tumor by the usual imaging procedures fails in as many as 40 to 60 percent of patients. Endoscopic ultrasonography, a sensitive test for small carcinomas of the pancreas, might also be useful in patients with endocrine tumors of the pancreas that cannot be localized by conventional methods.
4428. The risk of stroke in patients with acute myocardial infarction after thrombolytic and antithrombotic treatment. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico II (GISSI-2), and The International Study Group.
作者: A P Maggioni.;M G Franzosi.;E Santoro.;H White.;F Van de Werf.;G Tognoni.
来源: N Engl J Med. 1992年327卷1期1-6页
Many trials in patients with acute myocardial infarction have demonstrated that thrombolytic therapy is not associated with an excessive risk of stroke, as compared with conventional treatment. However, the incidence of various forms of stroke in patients treated with different thrombolytic and antithrombotic regimens and the associated effect of risk factors for stroke are largely unknown.
4429. Renal transplantation in children. A report of the North American Pediatric Renal Transplant Cooperative Study.
Previous studies of renal transplantation in children have focused on the survival of grafts and patients. Little information is available about the cause of renal disease, the sources of donated organs, or children's growth after transplantation. The North American Pediatric Renal Transplant Cooperative Study was organized to identify the diseases that require transplantation and to analyze factors that affect the success of transplantation in children.
4430. Occurrence of ophthalmopathy after treatment for Graves' hyperthyroidism. The Thyroid Study Group.
作者: L Tallstedt.;G Lundell.;O Tørring.;G Wallin.;J G Ljunggren.;H Blomgren.;A Taube.
来源: N Engl J Med. 1992年326卷26期1733-8页
Ophthalmopathy caused by Graves' disease may first appear or worsen during or after treatment for hyperthyroidism. It is not known, however, whether choosing to treat hyperthyroidism with antithyroid drugs, iodine-131, or surgery affects the development or aggravation of Graves' ophthalmopathy.
4431. Synthetic surfactants in infants with respiratory distress syndrome.4432. Improvement in exercise performance by inhalation of methoxamine in patients with impaired left ventricular function.
作者: L Cabanes.;F Costes.;S Weber.;J Regnard.;C Benvenuti.;A Castaigne.;F Guerin.;A Lockhart.
来源: N Engl J Med. 1992年326卷25期1661-5页
Bronchial hyperresponsiveness to cholinergic stimuli such as the inhalation of methacholine is common in patients with impaired left ventricular function. Such hyperresponsiveness is best explained by cholinergic vasodilation of blood vessels in the small airways, with extravasation of plasma due to high left ventricular filling pressure. Because this vasodilation may be prevented by the inhalation of the vasoconstrictor agent methoxamine, we studied the effect of methoxamine on exercise performance in patients with chronic left ventricular dysfunction.
4434. Manipulating the immune system with immune globulin. The National Institute of Child Health and Human Development. Intravenous Immunoglobulin Study Group.
作者: L M Mofenson.;W T Shearer.;J Moye.;R Nugent.;A Willoughby.
来源: N Engl J Med. 1992年326卷24期1636-7; author reply 1637-8页 4437. Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus.
作者: A Herskovic.;K Martz.;M al-Sarraf.;L Leichman.;J Brindle.;V Vaitkevicius.;J Cooper.;R Byhardt.;L Davis.;B Emami.
来源: N Engl J Med. 1992年326卷24期1593-8页
The efficacy of conventional treatment with surgery and radiation for cancer of the esophagus is limited. The median survival is less than 10 months, and less than 10 percent of patients survive for 5 years. Recent studies have suggested that combined chemotherapy and radiation therapy may result in improved survival.
4438. Induction of labor as compared with serial antenatal monitoring in post-term pregnancy. A randomized controlled trial. The Canadian Multicenter Post-term Pregnancy Trial Group.
作者: M E Hannah.;W J Hannah.;J Hellmann.;S Hewson.;R Milner.;A Willan.
来源: N Engl J Med. 1992年326卷24期1587-92页
The rates of perinatal mortality and neonatal morbidity are higher for post-term pregnancies than for term pregnancies. It is not known, however, whether the induction of labor results in better outcomes than does serial fetal monitoring while awaiting spontaneous labor.
4439. Endoscopic biliary drainage for severe acute cholangitis.
作者: E C Lai.;F P Mok.;E S Tan.;C M Lo.;S T Fan.;K T You.;J Wong.
来源: N Engl J Med. 1992年326卷24期1582-6页
Emergency surgery for patients with severe acute cholangitis due to choledocholithiasis is associated with substantial morbidity and mortality. Because recent results suggested that emergency endoscopic drainage could improve the outcome of such patients, we undertook a prospective study to determine the role of this procedure as initial treatment.
4440. Magnetic resonance imaging of angiographically occult runoff vessels in peripheral arterial occlusive disease.
Bypass grafting to arteries of the lower leg has become standard surgical management of advanced peripheral vascular disease. Its success depends on identifying suitable distal vessels. Preoperative preparation includes imaging of the arteries of the lower leg, usually by conventional contrast arteriography. An alternative procedure, magnetic resonance (MR) angiography, has been successfully employed in patients with various cardiovascular diseases, but its possible value in patients with peripheral vascular disease has received little attention.
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