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4462. A preliminary study of aerosolized recombinant human deoxyribonuclease I in the treatment of cystic fibrosis.
作者: R C Hubbard.;N G McElvaney.;P Birrer.;S Shak.;W W Robinson.;C Jolley.;M Wu.;M S Chernick.;R G Crystal.
来源: N Engl J Med. 1992年326卷12期812-5页 4463. A controlled trial of fluconazole or amphotericin B to prevent relapse of cryptococcal meningitis in patients with the acquired immunodeficiency syndrome. The NIAID AIDS Clinical Trials Group and Mycoses Study Group.
作者: W G Powderly.;M S Saag.;G A Cloud.;P Robinson.;R D Meyer.;J M Jacobson.;J R Graybill.;A M Sugar.;V J McAuliffe.;S E Follansbee.
来源: N Engl J Med. 1992年326卷12期793-8页
After primary treatment for cryptococcal meningitis, patients with the acquired immunodeficiency syndrome (AIDS) require some form of continued suppressive therapy to prevent relapse.
4464. Comparison of medical and surgical therapy for complicated gastroesophageal reflux disease in veterans. The Department of Veterans Affairs Gastroesophageal Reflux Disease Study Group.
Conventional medical treatment for gastroesophageal reflux disease involves life-style modifications and combination drug therapy, but few studies have included these features in their protocols. Antireflux surgery has seldom been studied prospectively, and there have been no trials comparing modern medical and surgical treatments for reflux disease.
4465. Carotid endarterectomy.4466. Allopurinol in the treatment of American cutaneous leishmaniasis.
Pentavalent antimony, the generally accepted treatment for leishmaniasis, is given parenterally, and it is expensive and not readily available in developing countries. An inexpensive, orally administered compound would be a substantial advance in treatment. Previous studies in vitro have shown synergism between allopurinol and pentavalent antimony in tissue-culture systems. We designed this clinical study to determine whether synergism could be demonstrated in patients.
4467. A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. The Optic Neuritis Study Group.
作者: R W Beck.;P A Cleary.;M M Anderson.;J L Keltner.;W T Shults.;D I Kaufman.;E G Buckley.;J J Corbett.;M J Kupersmith.;N R Miller.
来源: N Engl J Med. 1992年326卷9期581-8页
The use of corticosteroids to treat optic neuritis is controversial. At 15 clinical centers, we randomly assigned 457 patients with acute optic neuritis to receive oral prednisone (1 mg per kilogram of body weight per day) for 14 days; intravenous methylprednisolone (1 g per day) for 3 days, followed by oral prednisone (1 mg per kilogram per day) for 11 days; or oral placebo for 14 days. Visual function was assessed over a six-month follow-up period.
4470. A controlled trial in intensive care units of selective decontamination of the digestive tract with nonabsorbable antibiotics. The French Study Group on Selective Decontamination of the Digestive Tract.
Selective decontamination of the digestive tract with topical nonabsorbable antibiotics has been reported to prevent nosocomial infections in patients receiving mechanical ventilation, and the procedure is used widely in Europe. However, it is unclear whether selective decontamination improves survival.
4472. A randomized trial of prednisolone in patients with severe alcoholic hepatitis.
作者: M J Ramond.;T Poynard.;B Rueff.;P Mathurin.;C Théodore.;J C Chaput.;J P Benhamou.
来源: N Engl J Med. 1992年326卷8期507-12页
Controlled trials have yielded inconsistent results with regard to the efficacy of corticosteroids in the treatment of alcoholic hepatitis. Three meta-analyses suggest that they may be effective in patients with encephalopathy who have severe liver disease.
4473. Effects of concomitant cisplatin and radiotherapy on inoperable non-small-cell lung cancer.
作者: C Schaake-Koning.;W van den Bogaert.;O Dalesio.;J Festen.;J Hoogenhout.;P van Houtte.;A Kirkpatrick.;M Koolen.;B Maat.;A Nijs.
来源: N Engl J Med. 1992年326卷8期524-30页
Cisplatin (cis-diamminedichloroplatinum) has been reported to enhance the cell-killing effect of radiation, an effect whose intensity varies with the schedule of administration. We randomly assigned 331 patients with nonmetastatic inoperable non-small-cell lung cancer to one of three treatments: radiotherapy for two weeks (3 Gy given 10 times, in five fractions a week), followed by a three-week rest period and then radiotherapy for two more weeks (2.5 Gy given 10 times, five fractions a week); radiotherapy on the same schedule, combined with 30 mg of cisplatin per square meter of body-surface area, given on the first day of each treatment week; or radiotherapy on the same schedule, combined with 6 mg of cisplatin per square meter, given daily before radiotherapy.
4474. Streptozocin-doxorubicin, streptozocin-fluorouracil or chlorozotocin in the treatment of advanced islet-cell carcinoma.
作者: C G Moertel.;M Lefkopoulo.;S Lipsitz.;R G Hahn.;D Klaassen.
来源: N Engl J Med. 1992年326卷8期519-23页
The combination of streptozocin and fluorouracil has become the standard therapy for advanced islet-cell carcinoma. However, doxorubicin has also been shown to be active against this type of tumor, as has chlorozotocin, a drug that is structurally similar to streptozocin but less frequently causes vomiting.
4475. GM-1 ganglioside for spinal-cord injury.4478. 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.
4479. 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.
4480. 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.
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