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4602. Ruling out acute myocardial infarction. A prospective multicenter validation of a 12-hour strategy for patients at low risk.
作者: T H Lee.;G Juarez.;E F Cook.;M C Weisberg.;G W Rouan.;D A Brand.;L Goldman.
来源: N Engl J Med. 1991年324卷18期1239-46页
Although previous investigations have suggested that 24 hours is required to exclude acute myocardial infarction in patients who are admitted to a coronary care unit for the evaluation of acute chest pain, we hypothesized that a 12-hour period might be adequate for patients with a low probability of infarction at the time of admission.
4603. A randomized clinical study of a calcium-entry blocker (lidoflazine) in the treatment of comatose survivors of cardiac arrest.
Abnormalities of cellular calcium homeostasis have been implicated in the pathophysiology of postischemic encephalopathy. Calcium-entry-blocking drugs inhibit the influx of calcium into cells and have been shown to mitigate postischemic encephalopathy in animal models.
4604. Lack of effect of induced menses on symptoms in women with premenstrual syndrome.
作者: P J Schmidt.;L K Nieman.;G N Grover.;K L Muller.;G R Merriam.;D R Rubinow.
来源: N Engl J Med. 1991年324卷17期1174-9页
No physiologic abnormality of the luteal phase has been consistently demonstrated in women with premenstrual syndrome (PMS). Using the progesterone antagonist mifepristone, we truncated the late luteal phase of the menstrual cycle in a blinded fashion to evaluate the relation of the events of the late luteal phase to the symptoms of PMS.
4605. Measurement of prostate-specific antigen in serum as a screening test for prostate cancer.
作者: W J Catalona.;D S Smith.;T L Ratliff.;K M Dodds.;D E Coplen.;J J Yuan.;J A Petros.;G L Andriole.
来源: N Engl J Med. 1991年324卷17期1156-61页
Prostate-specific antigen (PSA) is secreted exclusively by prostatic epithelial cells, and its serum concentration is increased in men with prostatic disease, including cancer. We evaluated its usefulness in the detection and staging of prostate cancer.
4607. A controlled study of inhaled pentamidine for primary prevention of Pneumocystis carinii pneumonia.
作者: B Hirschel.;A Lazzarin.;P Chopard.;M Opravil.;H J Furrer.;S Rüttimann.;P Vernazza.;J P Chave.;F Ancarani.;V Gabriel.
来源: N Engl J Med. 1991年324卷16期1079-83页
Current recommendations for prophylaxis of Pneumocystis carinii pneumonia (PCP) are based on data from patients who have had at least one episode of PCP (secondary prevention). We designed a study to determine the efficacy and side effects of inhaled pentamidine in the primary prevention of PCP.
4609. A prospective analysis of 1518 laparoscopic cholecystectomies.
The Southern Surgeons Club conducted a prospective study of 1518 patients who underwent laparoscopic cholecystectomy for treatment of gallbladder disease in order to evaluate the safety of this procedure.
4610. Detection of circulating candida enolase by immunoassay in patients with cancer and invasive candidiasis.
作者: T J Walsh.;J W Hathorn.;J D Sobel.;W G Merz.;V Sanchez.;S M Maret.;H R Buckley.;M A Pfaller.;R Schaufele.;C Sliva.
来源: N Engl J Med. 1991年324卷15期1026-31页
Invasive candidiasis is a major nosocomial infection that is difficult to diagnose. Few biochemically defined markers of invasive candidiasis are known. Initial findings suggested that the presence of candida enolase in the blood may be a novel marker for invasive candidiasis.
4611. Diagnosis of magnesium-induced diarrhea.
There is no specific method of diagnosing magnesium-induced diarrhea. Therefore, the frequency and clinical importance of diarrhea caused by magnesium are unknown. The purposes of this study were to establish a method for diagnosing magnesium-induced diarrhea and to apply it to patients with chronic diarrhea.
4612. A randomized, controlled trial of prophylactic ganciclovir for cytomegalovirus pulmonary infection in recipients of allogeneic bone marrow transplants; The City of Hope-Stanford-Syntex CMV Study Group.
作者: G M Schmidt.;D A Horak.;J C Niland.;S R Duncan.;S J Forman.;J A Zaia.
来源: N Engl J Med. 1991年324卷15期1005-11页
Cytomegalovirus (CMV)-associated interstitial pneumonia is a major cause of death after allogeneic bone marrow transplantation. We conducted a controlled trial of ganciclovir in recipients of bone marrow transplants who had asymptomatic pulmonary CMV infection. We also sought to identify risk factors for the development of CMV interstitial pneumonia.
4614. Administration of thyroxine in treated Graves' disease. Effects on the level of antibodies to thyroid-stimulating hormone receptors and on the risk of recurrence of hyperthyroidism.
作者: K Hashizume.;K Ichikawa.;A Sakurai.;S Suzuki.;T Takeda.;M Kobayashi.;T Miyamoto.;M Arai.;T Nagasawa.
来源: N Engl J Med. 1991年324卷14期947-53页
Antibodies to thyroid-stimulating hormone (TSH) receptors that stimulate the thyroid gland cause hyperthyroidism in patients with Graves' disease, and their production during antithyroid drug treatment is an important determinant of the course of the disease. One factor that might contribute to the persistent production of antibodies to TSH receptors is stimulation of the release of thyroid antigens by TSH during antithyroid drug therapy. We therefore studied the effect of the suppression of TSH secretion by thyroxine on the levels of antibodies to TSH receptors after thyroid hormone secretion had been normalized by methimazole.
4615. A comparison of surfactant as immediate prophylaxis and as rescue therapy in newborns of less than 30 weeks' gestation.
作者: J W Kendig.;R H Notter.;C Cox.;L J Reubens.;J M Davis.;W M Maniscalco.;R A Sinkin.;A Bartoletti.;H S Dweck.;M J Horgan.
来源: N Engl J Med. 1991年324卷13期865-71页
Exogenous pulmonary surfactants are administered into the trachea either to prevent respiratory distress syndrome in premature infants or to treat it. In a randomized, multicenter trial, we compared the results of surfactant therapy initiated as prophylaxis with the results of rescue therapy with surfactant.
4616. Effect of a short course of prednisone in the prevention of early relapse after the emergency room treatment of acute asthma.
Relapse after the treatment of acute asthma in the emergency room is common (occurring in 25 to 30 percent of cases) and is not accurately predicted by any available measurements. We studied the usefulness of prednisone in reducing this high rate of relapse.
4617. Mortality and morbidity in patients receiving encainide, flecainide, or placebo. The Cardiac Arrhythmia Suppression Trial.
作者: D S Echt.;P R Liebson.;L B Mitchell.;R W Peters.;D Obias-Manno.;A H Barker.;D Arensberg.;A Baker.;L Friedman.;H L Greene.
来源: N Engl J Med. 1991年324卷12期781-8页
In the Cardiac Arrhythmia Suppression Trial, designed to test the hypothesis that suppression of ventricular ectopy after a myocardial infarction reduces the incidence of sudden death, patients in whom ventricular ectopy could be suppressed with encainide, flecainide, or moricizine were randomly assigned to receive either active drug or placebo. The use of encainide and flecainide was discontinued because of excess mortality. We examined the mortality and morbidity after randomization to encainide or flecainide or their respective placebo.
4618. Effective surgical adjuvant therapy for high-risk rectal carcinoma.
作者: J E Krook.;C G Moertel.;L L Gunderson.;H S Wieand.;R T Collins.;R W Beart.;T P Kubista.;M A Poon.;W C Meyers.;J A Mailliard.
来源: N Engl J Med. 1991年324卷11期709-15页
Radiation therapy as an adjunct to surgery for rectal cancer has been shown to reduce local recurrence but has not improved survival. In a previous study, combined radiation and chemotherapy improved survival significantly as compared with surgery alone, but not as compared with adjuvant radiation, which many regard as standard therapy. We designed a combination regimen to optimize the contribution of chemotherapy, decrease recurrence, and improve survival as compared with adjuvant radiation alone.
4619. High-dose intramuscular triamcinolone in severe, chronic, life-threatening asthma.
作者: R G Ogirala.;T K Aldrich.;D J Prezant.;M J Sinnett.;J B Enden.;M H Williams.
来源: N Engl J Med. 1991年324卷9期585-9页
Despite oral corticosteroid therapy, some patients with asthma have frequent exacerbations requiring emergency room visits, hospitalization, and occasionally, mechanical ventilation. We compared the effects of high-dose intramuscular triamcinolone with oral prednisone in patients with severe chronic asthma.
4620. A placebo-controlled trial of maintenance therapy with fluconazole after treatment of cryptococcal meningitis in the acquired immunodeficiency syndrome. California Collaborative Treatment Group.
作者: S A Bozzette.;R A Larsen.;J Chiu.;M A Leal.;J Jacobsen.;P Rothman.;P Robinson.;G Gilbert.;J A McCutchan.;J Tilles.
来源: N Engl J Med. 1991年324卷9期580-4页
In patients with the acquired immunodeficiency syndrome (AIDS), the rate of relapse after primary treatment for cryptococcal meningitis remains high. We conducted a controlled, double-blind trial to evaluate the efficacy of maintenance therapy with fluconazole. At entry into the study, all participants had sterile cultures of cerebrospinal fluid, blood, and urine after following a standardized course of therapy for culture-proved cryptococcal meningitis. The patients were randomly assigned to take either fluconazole or placebo as maintenance therapy. The dose of fluconazole was 100 mg daily in the first phase of study and 200 mg daily in the second phase.
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