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4581. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer.
作者: .;Gregory T Wolf.;Susan Gross Fisher.;Waun Ki Hong.;Robert Hillman.;Monica Spaulding.;George E Laramore.;James W Endicott.;Kenneth McClatchey.;William G Henderson.
来源: N Engl J Med. 1991年324卷24期1685-90页
We performed a prospective, randomized study in patients with previously untreated advanced (Stage III or IV) laryngeal squamous carcinoma to compare the results of induction chemotherapy followed by definitive radiation therapy with those of conventional laryngectomy and postoperative radiation.
4582. A phase I evaluation of the safety and immunogenicity of vaccination with recombinant gp160 in patients with early human immunodeficiency virus infection. Military Medical Consortium for Applied Retroviral Research.
作者: R R Redfield.;D L Birx.;N Ketter.;E Tramont.;V Polonis.;C Davis.;J F Brundage.;G Smith.;S Johnson.;A Fowler.
来源: N Engl J Med. 1991年324卷24期1677-84页
Despite multiple antiviral humoral and cellular immune responses, infection with the human immunodeficiency virus (HIV) results in a progressively debilitating disease. We hypothesized that a more effective immune response could be generated by post-infection vaccination with HIV-specific antigens.
4583. Diagnosis and cure of the Wolff-Parkinson-White syndrome or paroxysmal supraventricular tachycardias during a single electrophysiologic test.
作者: H Calkins.;J Sousa.;R el-Atassi.;S Rosenheck.;M de Buitleir.;W H Kou.;A H Kadish.;J J Langberg.;F Morady.
来源: N Engl J Med. 1991年324卷23期1612-8页
We conducted this study to determine the feasibility of an abbreviated therapeutic approach to the Wolff-Parkinson-White syndrome or paroxysmal supraventricular tachycardia, in which the diagnosis is established and radiofrequency ablation carried out during a single electrophysiologic test.
4584. Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson-White syndrome) by radiofrequency current.
作者: W M Jackman.;X Z Wang.;K J Friday.;C A Roman.;K P Moulton.;K J Beckman.;J H McClelland.;N Twidale.;H A Hazlitt.;M I Prior.
来源: N Engl J Med. 1991年324卷23期1605-11页
Surgical or catheter ablation of accessory pathways by means of high-energy shocks serves as definitive therapy for patients with Wolff-Parkinson-White syndrome but has substantial associated morbidity and mortality. Radiofrequency current, an alternative energy source for ablation, produces smaller lesions without adverse effects remote from the site where current is delivered. We conducted this study to develop catheter techniques for delivering radiofrequency current to reduce morbidity and mortality associated with accessory-pathway ablation.
4586. A single intravenous infusion of gamma globulin as compared with four infusions in the treatment of acute Kawasaki syndrome.
作者: J W Newburger.;M Takahashi.;A S Beiser.;J C Burns.;J Bastian.;K J Chung.;S D Colan.;C E Duffy.;D R Fulton.;M P Glode.
来源: N Engl J Med. 1991年324卷23期1633-9页
Treatment of acute Kawasaki syndrome with a four-day course of intravenous gamma globulin, together with aspirin, has been demonstrated to be safe and effective in preventing coronary-artery lesions and reducing systemic inflammation. We hypothesized that therapy with a single, very high dose of gamma globulin would be at least as effective as the standard regimen.
4588. The beneficial effects of early dexamethasone administration in infants and children with bacterial meningitis.
作者: C M Odio.;I Faingezicht.;M Paris.;M Nassar.;A Baltodano.;J Rogers.;X Sáez-Llorens.;K D Olsen.;G H McCracken.
来源: N Engl J Med. 1991年324卷22期1525-31页
In experimental models of meningitis and in children with meningitis, dexamethasone has been shown to reduce meningeal inflammation and to improve the outcome of disease.
4589. A multicenter, controlled trial of ursodiol for the treatment of primary biliary cirrhosis. UDCA-PBC Study Group.
In primary biliary cirrhosis the hepatic lesions may result, at least in part, from the intracellular accumulation of potentially toxic endogenous bile acids. Preliminary work suggests that the administration of ursodiol (also called ursodeoxycholic acid), a hydrophilic bile acid without hepatotoxicity, leads to improvement in the condition of patients with primary biliary cirrhosis.
4590. Beta-adrenergic-antagonist drugs in the prevention of gastrointestinal bleeding in patients with cirrhosis and esophageal varices. An analysis of data and prognostic factors in 589 patients from four randomized clinical trials. Franco-Italian Multicenter Study Group.
作者: T Poynard.;P Calès.;L Pasta.;G Ideo.;J P Pascal.;L Pagliaro.;D Lebrec.
来源: N Engl J Med. 1991年324卷22期1532-8页
The value of beta-adrenergic-antagonist drug therapy for the prevention of initial episodes of gastrointestinal bleeding in patients with cirrhosis and esophageal varices is uncertain, both positive and negative study results having been reported.
4591. Replacement therapy for inherited enzyme deficiency--macrophage-targeted glucocerebrosidase for Gaucher's disease.
作者: N W Barton.;R O Brady.;J M Dambrosia.;A M Di Bisceglie.;S H Doppelt.;S C Hill.;H J Mankin.;G J Murray.;R I Parker.;C E Argoff.
来源: N Engl J Med. 1991年324卷21期1464-70页
Gaucher's disease, the most prevalent of the sphingolipid storage disorders, is caused by a deficiency of the enzyme glucocerebrosidase (glucosylceramidase). Enzyme replacement was proposed as a therapeutic strategy for this disorder in 1966. To assess the clinical effectiveness of this approach, we infused macrophage-targeted human placental glucocerebrosidase (60 IU per kilogram of body weight every 2 weeks for 9 to 12 months) into 12 patients with type 1 Gaucher's disease who had intact spleens. The frequency of infusions was increased to once a week in two patients (children) during part of the trial because they had clinically aggressive disease.
4592. Anti-B-cell monoclonal antibodies in the treatment of severe B-cell lymphoproliferative syndrome following bone marrow and organ transplantation.
作者: A Fischer.;S Blanche.;J Le Bidois.;P Bordigoni.;J L Garnier.;P Niaudet.;F Morinet.;F Le Deist.;A M Fischer.;C Griscelli.
来源: N Engl J Med. 1991年324卷21期1451-6页
The B-cell lymphoproliferative syndrome is an infrequent life-threatening complication of marrow or organ transplantation that is the consequence of profound immunosuppression. The results of treatment have been disappointing, although a small number of patients have been cured by chemoradiotherapy or antiviral agents after a reduction in the dosage of immunosuppressive therapy. We report here the results of treating this disorder with anti-B-cell antibodies.
4593. A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation.
The traditional predictors of the outcome of weaning from mechanical ventilation--minute ventilation (VE) and maximal inspiratory pressure (Plmax)--are frequently inaccurate. We developed two new indexes: the first quantitates rapid shallow breathing as the ratio of respiratory frequency to tidal volume (f/VT), and the second is termed CROP, because it integrates thoracic compliance, respiratory rate, arterial oxygenation, and Plmax.
4595. Treatment of aplastic anemia with antilymphocyte globulin and methylprednisolone with or without cyclosporine. The German Aplastic Anemia Study Group.
作者: N Frickhofen.;J P Kaltwasser.;H Schrezenmeier.;A Raghavachar.;H G Vogt.;F Herrmann.;M Freund.;P Meusers.;A Salama.;H Heimpel.
来源: N Engl J Med. 1991年324卷19期1297-304页
Immunosuppression is the most effective treatment for patients with aplastic anemia, except for bone marrow transplantation. The best results are achieved with antilymphocyte globulin or cyclosporine. Patients have been treated successfully with a combination of both agents, but there has been no controlled evaluation of its efficacy. We conducted a randomized, multicenter trial in 84 patients not eligible for bone marrow transplantation, comparing treatment with antilymphocyte globulin and methylprednisolone (41 patients--the control group) with antilymphocyte globulin, methylprednisolone, and cyclosporine (43 patients--the cyclosporine group).
4598. 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.
4599. 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.
4600. 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.
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