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4321. Prevention of the first occurrence of neural-tube defects by periconceptional vitamin supplementation.
The risk of recurrent neural-tube defects is decreased in women who take folic acid or multivitamins containing such during the periconceptional period. The extent to which folic acid supplementation can reduce the first occurrence of defects is not known.
4322. Treatment of preterm labor with the beta-adrenergic agonist ritodrine.4323. Treatment of preterm labor with the beta-adrenergic agonist ritodrine.4324. Treatment of preterm labor with the beta-adrenergic agonist ritodrine.4326. A noninvasive method of predicting pulmonary-capillary wedge pressure.
作者: K M McIntyre.;J A Vita.;C T Lambrew.;J Freeman.;J Loscalzo.
来源: N Engl J Med. 1992年327卷24期1715-20页
The noninvasive prediction of pulmonary-capillary wedge pressure (PCWP) is important for the recognition and treatment of a variety of cardiovascular disorders. The response of the arterial pressure to the Valsalva maneuver has been shown to correlate with the PCWP. We therefore devised a noninvasive method to measure this pressure response at the bedside and correlated these measurements with the PCWP measured directly with a pulmonary-artery catheter.
4327. A less costly regimen of alglucerase to treat Gaucher's disease.
作者: M L Figueroa.;B E Rosenbloom.;A C Kay.;P Garver.;D W Thurston.;J A Koziol.;T Gelbart.;E Beutler.
来源: N Engl J Med. 1992年327卷23期1632-6页
Alglucerase (Ceredase) provides effective enzyme-replacement treatment for patients with Gaucher's disease, but at the usually recommended dose of 60 U per kilogram of body weight every two weeks (130 U per kilogram per month), it costs $382,200 per year for a 70-kg patient. Theoretical considerations suggest that more frequent administration would be more efficient.
4328. Vitamin D3 and calcium to prevent hip fractures in elderly women.
作者: M C Chapuy.;M E Arlot.;F Duboeuf.;J Brun.;B Crouzet.;S Arnaud.;P D Delmas.;P J Meunier.
来源: N Engl J Med. 1992年327卷23期1637-42页
Hypovitaminosis D and a low calcium intake contribute to increased parathyroid function in elderly persons. Calcium and vitamin D supplements reduce this secondary hyperparathyroidism, but whether such supplements reduce the risk of hip fractures among elderly people is not known.
4329. Continued zidovudine or didanosine for human immunodeficiency virus infection.4333. A controlled clinical trial of dichloroacetate for treatment of lactic acidosis in adults. The Dichloroacetate-Lactic Acidosis Study Group.
作者: P W Stacpoole.;E C Wright.;T G Baumgartner.;R M Bersin.;S Buchalter.;S H Curry.;C A Duncan.;E M Harman.;G N Henderson.;S Jenkinson.
来源: N Engl J Med. 1992年327卷22期1564-9页
Mortality is very high in lactic acidosis, and there is no satisfactory treatment other than treatment of the underlying cause. Uncontrolled studies have suggested that dichloroacetate, which stimulates the oxidation of lactate to acetyl-coenzyme A and carbon dioxide, might reduce morbidity and improve survival among patients with this condition.
4334. Bilateral fetal mesencephalic grafting in two patients with parkinsonism induced by 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP).
作者: H Widner.;J Tetrud.;S Rehncrona.;B Snow.;P Brundin.;B Gustavii.;A Björklund.;O Lindvall.;J W Langston.
来源: N Engl J Med. 1992年327卷22期1556-63页
Intracerebral transplantation of fetal dopaminergic neurons is a promising new approach for the treatment of Parkinson's disease. Patients with parkinsonism induced by 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) have a relatively stable lesion limited to the nigrostriatal system, rendering them ideal candidates for transplantation. Improvement of motor function after neural grafting has previously been observed in nonhuman primates with MPTP-induced parkinsonism.
4335. Survival of implanted fetal dopamine cells and neurologic improvement 12 to 46 months after transplantation for Parkinson's disease.
作者: C R Freed.;R E Breeze.;N L Rosenberg.;S A Schneck.;E Kriek.;J X Qi.;T Lone.;Y B Zhang.;J A Snyder.;T H Wells.
来源: N Engl J Med. 1992年327卷22期1549-55页
Patients with Parkinson's disease tend to have a reduced response to levodopa after 5 to 20 years of therapy, with "on-off" fluctuations consisting of dyskinesia alternating with immobility. In an effort to modify the motor disability of advanced Parkinson's disease, we implanted embryonic mesencephalic tissue containing dopamine cells into the caudate and putamen of seven patients. Two patients received unilateral grafts in the caudate and the putamen on the side opposite the side with worse symptoms. Five patients received bilateral grafts implanted in the putamen only. In six of the seven patients, the fetal tissue was obtained from a single embryo with a gestational age of seven to eight weeks. The tissue was injected by means of 10 to 14 needle passes. There were no surgical complications. Four of the seven patients underwent immunosuppression with cyclosporine and prednisone.
4336. Unilateral transplantation of human fetal mesencephalic tissue into the caudate nucleus of patients with Parkinson's disease.
作者: D D Spencer.;R J Robbins.;F Naftolin.;K L Marek.;T Vollmer.;C Leranth.;R H Roth.;L H Price.;A Gjedde.;B S Bunney.
来源: N Engl J Med. 1992年327卷22期1541-8页
Parkinson's disease is characterized by the loss of midbrain dopamine neurons that innervate the caudate and the putamen. Studies in animals suggest that fetal dopaminergic neurons can survive transplantation and restore neurologic function. This report compares the clinical results in four case patients with severe Parkinson's disease who underwent stereotaxic implantation of human fetal ventral mesencephalic tissue in one caudate nucleus with the results in a control group of similar subjects assigned at random to a one-year delay in surgery.
4338. Acenocoumarol and heparin compared with acenocoumarol alone in the initial treatment of proximal-vein thrombosis.
作者: D P Brandjes.;H Heijboer.;H R Büller.;M de Rijk.;H Jagt.;J W ten Cate.
来源: N Engl J Med. 1992年327卷21期1485-9页
In most countries, heparin is used in the initial treatment of patients with deep-vein thrombosis. Well-designed studies establishing the efficacy of heparin therapy are lacking, however. Treatment with acenocoumarol alone, according to the hypothesis that high dosages of oral anticoagulants obviate the need for heparin, is considered an effective alternative in some countries.
4339. Effect of iron chelation therapy on recovery from deep coma in children with cerebral malaria.
作者: V Gordeuk.;P Thuma.;G Brittenham.;C McLaren.;D Parry.;A Backenstose.;G Biemba.;R Msiska.;L Holmes.;E McKinley.
来源: N Engl J Med. 1992年327卷21期1473-7页
Cerebral malaria is a severe complication of Plasmodium falciparum infection in children, with a mortality rate of 15 to 50 percent despite antimalarial therapy.
4340. Chemotherapy of advanced Hodgkin's disease with MOPP, ABVD, or MOPP alternating with ABVD.
作者: G P Canellos.;J R Anderson.;K J Propert.;N Nissen.;M R Cooper.;E S Henderson.;M R Green.;A Gottlieb.;B A Peterson.
来源: N Engl J Med. 1992年327卷21期1478-84页
MOPP (mechlorethamine, vincristine, procarbazine, and prednisone) has been the standard treatment for Hodgkin's disease for almost 20 years. In a randomized, multicenter trial, we compared three regimens of primary systemic therapy for newly diagnosed advanced Hodgkin's disease in Stages IIIA2, IIIB, and IVA or IVB: (1) MOPP alone given for 6 to 8 cycles, (2) MOPP alternating with ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) for 12 cycles, and (3) ABVD alone for 6 to 8 cycles. Patients in a first relapse after radiation therapy were eligible. No additional radiation therapy was given. Patients who did not have a complete response or who had a relapse with either MOPP alone or ABVD alone were switched to the opposite regimen.
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