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4521. The protective efficacy of polyvalent pneumococcal polysaccharide vaccine.
作者: E D Shapiro.;A T Berg.;R Austrian.;D Schroeder.;V Parcells.;A Margolis.;R K Adair.;J D Clemens.
来源: N Engl J Med. 1991年325卷21期1453-60页
Although the protective efficacy of pneumococcal polysaccharide vaccine has been demonstrated in randomized trials in young African gold miners, there has been controversy about its efficacy in older Americans at risk for serious pneumococcal infections. To assess the vaccine's protective efficacy against invasive pneumococcal infections, we conducted a hospital-based case-control study of the efficacy of pneumococcal vaccine in adults with a condition recognized to be an indication for receiving the vaccine.
4523. Plasma exchange in polyneuropathy associated with monoclonal gammopathy of undetermined significance.
作者: P J Dyck.;P A Low.;A J Windebank.;S S Jaradeh.;S Gosselin.;P Bourque.;B E Smith.;K M Kratz.;J L Karnes.;B A Evans.
来源: N Engl J Med. 1991年325卷21期1482-6页
Polyneuropathy associated with monoclonal gammopathy of undetermined significance (MGUS) has been treated with plasma exchange, intravenous immune globulin, and chemotherapy, but the effectiveness of these treatments remains uncertain.
4524. A comparison of single-dose cefixime with ceftriaxone as treatment for uncomplicated gonorrhea. The Gonorrhea Treatment Study Group.
作者: H H Handsfield.;W M McCormack.;E W Hook.;J M Douglas.;J M Covino.;M S Verdon.;C A Reichart.;J M Ehret.
来源: N Engl J Med. 1991年325卷19期1337-41页
Because of the widespread existence of Neisseria gonorrhoeae resistant to penicillin or tetracycline, ceftriaxone is now recommended for the treatment of gonorrhea. There is, however, a need for effective antibiotics that can be administered orally as an alternative to ceftriaxone, which requires intramuscular administration. Cefixime is an orally absorbed cephalosporin that is active against resistant gonococci and has pharmacokinetic activity suitable for single-dose administration.
4525. Calcium supplementation to prevent hypertensive disorders of pregnancy.
作者: J M Belizán.;J Villar.;L Gonzalez.;L Campodonico.;E Bergel.
来源: N Engl J Med. 1991年325卷20期1399-405页
Calcium supplementation has been reported to reduce blood pressure in pregnant and nonpregnant women. We undertook this prospective study to determine the effect of calcium supplementation on the incidence of hypertensive disorders of pregnancy (gestational hypertension and preeclampsia) and to determine the value of urinary calcium levels as a predictor of the response.
4528. Interrupted versus continuous chemotherapy in patients with metastatic breast cancer. The Piedmont Oncology Association.
作者: H B Muss.;L D Case.;F Richards.;D R White.;M R Cooper.;J M Cruz.;B L Powell.;C L Spurr.;R L Capizzi.
来源: N Engl J Med. 1991年325卷19期1342-8页
Chemotherapy for metastatic breast cancer is palliative, and the optimal duration of therapy is unknown. We designed a trial to determine whether continuous treatment is superior to stopping treatment after a brief induction period and resuming treatment when the disease progresses.
4529. A randomized trial of intravesical doxorubicin and immunotherapy with bacille Calmette-Guérin for transitional-cell carcinoma of the bladder.
作者: D L Lamm.;B A Blumenstein.;E D Crawford.;J E Montie.;P Scardino.;H B Grossman.;T H Stanisic.;J A Smith.;J Sullivan.;M F Sarosdy.
来源: N Engl J Med. 1991年325卷17期1205-9页
In carcinoma of the bladder, both intravesical chemotherapy and immunotherapy can induce tumor regression and reduce the rate of recurrence, but the relative merits of these two therapies are unclear. We conducted a multi-institutional study to address this question.
4530. Prevention of high-altitude pulmonary edema by nifedipine.
作者: P Bärtsch.;M Maggiorini.;M Ritter.;C Noti.;P Vock.;O Oelz.
来源: N Engl J Med. 1991年325卷18期1284-9页
Exaggerated pulmonary-artery pressure due to hypoxic vasoconstriction is considered an important pathogenetic factor in high-altitude pulmonary edema. We previously found that nifedipine lowered pulmonary-artery pressure and improved exercise performance, gas exchange, and the radiographic manifestations of disease in patients with high-altitude pulmonary edema. We therefore hypothesized that the prophylactic administration of nifedipine would prevent its recurrence.
4531. A comparison of two doses of aspirin (30 mg vs. 283 mg a day) in patients after a transient ischemic attack or minor ischemic stroke.
作者: .;Jan van Gijn.;Ale Algra.;Jaap Kappelle.;Peter J Koudstaal.;Anet van Latum.
来源: N Engl J Med. 1991年325卷18期1261-6页
Aspirin is known to improve the outcome of patients who have had a cerebral transient ischemic attack, but the optimal dose of aspirin remains uncertain. Experimental evidence indicates that 30 mg of aspirin daily alters platelet aggregation more favorably than the 300-mg dose currently used in patients after transient ischemic attack or minor ischemic stroke.
4533. Effects of postmenopausal estrogen replacement on the concentrations and metabolism of plasma lipoproteins.
作者: B W Walsh.;I Schiff.;B Rosner.;L Greenberg.;V Ravnikar.;F M Sacks.
来源: N Engl J Med. 1991年325卷17期1196-204页
Postmenopausal estrogen-replacement therapy may reduce the risk of cardiovascular disease, and this beneficial effect may be mediated in part by favorable changes in plasma lipid levels. However, the effects on plasma lipoprotein levels of postmenopausal estrogens in the low doses currently used have not been precisely quantified, and the mechanism of these effects is unknown.
4534. Prevention of postmenopausal osteoporosis. A comparative study of exercise, calcium supplementation, and hormone-replacement therapy.
作者: R L Prince.;M Smith.;I M Dick.;R I Price.;P G Webb.;N K Henderson.;M M Harris.
来源: N Engl J Med. 1991年325卷17期1189-95页
Osteoporosis among older women is a major public health problem. We studied the effects of three approaches to the prevention of osteoporosis in women with low bone density.
4535. Suppression of thromboxane A2 but not of systemic prostacyclin by controlled-release aspirin.
The antithrombotic efficacy of aspirin is attributed to its inhibition of the enzyme prostaglandin G/H synthase, which is necessary for the formation of thromboxane A2 in platelets. Thromboxane A2 is a potent vasoconstrictor and platelet agonist. However, the formation of prostacyclin by vascular endothelium also requires prostaglandin G/H synthase, and prostacyclin exerts opposite effects on platelet function and vascular tone. We wanted to see whether controlled-release aspirin would affect the formation of thromboxane A2 but not prostacyclin by reducing the aspirin concentration that reaches the posthepatic circulation.
4536. Analgesic effect of intraarticular morphine after arthroscopic knee surgery.
作者: C Stein.;K Comisel.;E Haimerl.;A Yassouridis.;K Lehrberger.;A Herz.;K Peter.
来源: N Engl J Med. 1991年325卷16期1123-6页
Opioids can produce potent antinociceptive effects by interacting with local opioid receptors in inflamed peripheral tissue. In this study we examined the analgesic effects of the intraarticular, as compared with intravenous, administration of morphine after arthroscopic knee surgery.
4537. Abnormal coronary vasoconstriction as a predictor of restenosis after successful coronary angioplasty in patients with unstable angina pectoris.
作者: D Ardissino.;P Barberis.;S De Servi.;P A Merlini.;E Bramucci.;C Falcone.;G Specchia.
来源: N Engl J Med. 1991年325卷15期1053-7页
High rates of restenosis after coronary angioplasty have been reported in patients with vasospastic angina. This study was designed to determine whether the occurrence of abnormal coronary vasoconstriction, detected by means of hyperventilation testing before angioplasty, influences the risk of restenosis after successful dilation.
4538. Petrosal sinus sampling with and without corticotropin-releasing hormone for the differential diagnosis of Cushing's syndrome.
作者: E H Oldfield.;J L Doppman.;L K Nieman.;G P Chrousos.;D L Miller.;D A Katz.;G B Cutler.;D L Loriaux.
来源: N Engl J Med. 1991年325卷13期897-905页
Measurement of adrenocorticotropin levels in plasma from the inferior petrosal sinuses of patients with Cushing's syndrome can distinguish adrenocorticotropin-secreting pituitary tumors (Cushing's disease) from other causes of the syndrome, principally ectopic adrenocorticotropin secretion from an occult tumor. However, it is unknown whether such measurement consistently identifies patients with Cushing's disease and whether testing with corticotropin-releasing hormone (CRH) enhances the value of the procedure.
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