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4482. A controlled trial of a program for the active management of labor.
Over the past two decades, the rate of cesarean section in the United States has risen from 5 percent to 25 percent of deliveries, primarily because of the increased frequency of dystocia (arrest of labor). One strategy that has been proposed for increasing the rate of vaginal delivery is a program of active management of labor that encourages early amniotomy, early diagnosis of slow progress in labor, and the use of higher than usual doses of oxytocin; the efficacy and safety of this approach are uncertain, however.
4483. A comparison of nonionic, low-osmolality radiocontrast agents with ionic, high-osmolality agents during cardiac catheterization.
作者: B J Barrett.;P S Parfrey.;H M Vavasour.;F O'Dea.;G Kent.;E Stone.
来源: N Engl J Med. 1992年326卷7期431-6页
Nonionic, low-osmolality radiocontrast agents are used frequently because they are believed to be safer than ionic, high-osmolality agents, but they are also more expensive. We conducted a randomized trial to compare the incidence of adverse events after the administration of ionic, high-osmolality and of non-ionic, low-osmolality radiocontrast agents during cardiac angiography.
4484. Safety and cost effectiveness of high-osmolality as compared with low-osmolality contrast material in patients undergoing cardiac angiography.
作者: E P Steinberg.;R D Moore.;N R Powe.;R Gopalan.;A J Davidoff.;M Litt.;S Graziano.;J A Brinker.
来源: N Engl J Med. 1992年326卷7期425-30页
Low-osmolality contrast agents produce fewer hemodynamic and electrophysiologic alterations during cardiac angiography, but they are 20 times more expensive than high-osmolality contrast agents. In a randomized, double-blind trial comparing a nonionic low-osmolality contrast agent (Omnipaque 350) with a high-osmolality agent that does not avidly bind calcium (Hypaque 76) in 505 patients undergoing cardiac angiography, we determined the incidence of minor, mild, moderate, and severe adverse reactions, identified risk factors for such reactions, and evaluated the cost effectiveness of various strategies for the use of contrast material.
4485. A controlled trial of early versus late treatment with zidovudine in symptomatic human immunodeficiency virus infection. Results of the Veterans Affairs Cooperative Study.
作者: J D Hamilton.;P M Hartigan.;M S Simberkoff.;P L Day.;G R Diamond.;G M Dickinson.;G L Drusano.;M J Egorin.;W L George.;F M Gordin.
来源: N Engl J Med. 1992年326卷7期437-43页
Zidovudine is recommended for asymptomatic and early symptomatic human immunodeficiency virus (HIV) infection. The best time to initiate zidovudine treatment remains uncertain, however, and whether early treatment improves survival has not been established.
4487. Topical tretinoin (retinoic acid) treatment for liver spots associated with photodamage.
作者: E S Rafal.;C E Griffiths.;C M Ditre.;L J Finkel.;T A Hamilton.;C N Ellis.;J J Voorhees.
来源: N Engl J Med. 1992年326卷6期368-74页
The hyperpigmented lesions commonly called liver spots distress patients, in part because such lesions are associated with aging. We investigated their treatment with topical 0.1 percent tretinoin (retinoic acid).
4488. Treatment of postmenopausal osteoporosis with calcitriol or calcium.
Osteoporosis is a common problem whose management is controversial. To evaluate the efficacy and safety of calcitriol (1,25-dihydroxyvitamin D3) in the treatment of postmenopausal osteoporosis, we conducted a three-year prospective, multicenter, single-blind study in 622 women who had one or more vertebral compression fractures. The women were randomly assigned to receive treatment with calcitriol (0.25 micrograms twice a day) or supplemental calcium (1 g of elemental calcium daily) for three years. New vertebral fractures were detected by means of lateral roentgenography of the spine each year, and calcium absorption was measured in 392 of the women.
4490. Vaccination with gp160 in HIV.4492. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection.
作者: D C Classen.;R S Evans.;S L Pestotnik.;S D Horn.;R L Menlove.;J P Burke.
来源: N Engl J Med. 1992年326卷5期281-6页
Randomized, controlled trials have shown that prophylactic antibiotics are effective in preventing surgical-wound infections. However, it is uncertain how the timing of antibiotic administration affects the risk of surgical-wound infection in actual clinical practice.
4493. G-CSF for fever and neutropenia induced by chemotherapy.4494. G-CSF for fever and neutropenia induced by chemotherapy.4495. Mortality in patients with the acquired immunodeficiency syndrome treated with either foscarnet or ganciclovir for cytomegalovirus retinitis.
We performed a multicenter, randomized, unblinded clinical trial (the Foscarnet-Ganciclovir Cytomegalovirus Retinitis Trial) designed to compare ganciclovir with foscarnet in the treatment of cytomegalovirus retinitis in patients with the acquired immunodeficiency syndrome (AIDS). Of 234 patients, 127 were randomly assigned to ganciclovir and 107 to foscarnet; the study drugs were administered according to a common protocol at the 11 participating clinical centers. Antiretroviral therapy (with zidovudine, didanosine, or dideoxycytidine) was given as dictated by best medical judgment. The patients were followed for the progression of retinitis, visual loss, and death.
4498. Efficacy of low oral doses of iodized oil in the control of iodine deficiency in Zaire.
About one billion people worldwide are at risk for iodine deficiency. Despite existing programs of prophylaxis, the prevention of iodine deficiency is still a challenge throughout the developing world. We studied the efficacy of low doses of iodized oil in an area of severe iodine deficiency in Zaire.
4499. Comparison of amphotericin B with fluconazole in the treatment of acute AIDS-associated cryptococcal meningitis. The NIAID Mycoses Study Group and the AIDS Clinical Trials Group.
作者: M S Saag.;W G Powderly.;G A Cloud.;P Robinson.;M H Grieco.;P K Sharkey.;S E Thompson.;A M Sugar.;C U Tuazon.;J F Fisher.
来源: N Engl J Med. 1992年326卷2期83-9页
Intravenous amphotericin B, with or without flucytosine, is usually standard therapy for cryptococcal meningitis in patients with the acquired immunodeficiency syndrome (AIDS). Fluconazole, an oral triazole agent, represents a promising new approach to the treatment of cryptococcal disease.
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