British Medical Journal最新文献_第4页

Chemotherapy in pancreatic cancer: results of a controlled, prospective, randomised, multicentre trial. 胰腺癌的化疗:一项对照、前瞻性、随机、多中心试验的结果。

1区医学 Q1 MEDICINE, GENERAL & INTERNAL

British Medical Journal

Pub Date : 1980-12-13 DOI: 10.1136/bmj.281.6255.1589

C N Mallinson, M O Rake, J B Cocking, C A Fox, M T Cwynarski, B L Diffey, G A Jackson, J Hanley, V J Wass

Forty patients with inoperable pancreatic cancer were included in a prospective, randomised, controlled trial of multiple chemotherapy. The survival of 19 untreated control patients was compared with that of 21 patients who received an initiation course of intravenous fluorouracil, cyclophosphamide, methotrexate, and vincristine given over five days followed by intravenous fluorouracil and mitomycin given over three or five days at six-week intervals thereafter. Median survival in treated patients was 44 weeks, which was significantly longer than the nine weeks seen in controls. In patients without metastases median survival was 48 weeks in the treated group and 12 weeks in controls. In patients with metastases it was 30 weeks in treated patients and seven weeks in controls. The treatment was well tolerated and seemed to confer a significant prolongation of survival, comparing favourably with previous reports of chemotherapy with or without radiotherapy. If the results are confirmed this regimen may be useful in district general hospital practice.

40例不能手术的胰腺癌患者纳入了一项前瞻性、随机、对照的多重化疗试验。19名未接受治疗的对照组患者的生存与21名接受5天静脉注射氟尿嘧啶、环磷酰胺、甲氨蝶呤和长春新碱的患者的生存进行比较，随后每隔6周静脉注射氟尿嘧啶和丝裂霉素3天或5天。治疗组患者的中位生存期为44周，明显长于对照组的9周。在无转移的患者中，治疗组的中位生存期为48周，对照组为12周。在转移患者中，治疗组为30周，对照组为7周。与以前的化疗合并或不合并放疗的报道相比，该治疗耐受性良好，似乎能显著延长生存期。如果结果得到证实，该方案可用于地区综合医院的实践。

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引用次数: 242

Renal aneurysms in rejected renal transplants. 肾移植排斥反应中的肾动脉瘤。

1区医学 Q1 MEDICINE, GENERAL & INTERNAL

British Medical Journal

Pub Date : 1980-12-13 DOI: 10.1136/bmj.281.6255.1640-d

A P Hemingway, D J Allison

SIR,-Dr E S Steiner and others (8 November, p 1237) have offered a very succinct paper examining the outcome of very low birthweight infants who did not require "special or intensive" care. I am unable to agree with their conclusions and am saddened by their hostility towards intensive perinatal care. Clearly none of their infants required intensive care intervention and those that did died. Thus a population of "well babies" remained, of whom only 52% were normal at school age. Surely these results are disastrous and must indicate that more intensive care facilities are required at this unit. A more useful comparison would be a similar population at University College Hospital or Hammersmith Hospital-that is, very low birthweight infants who did not require intensive therapy after birth and who were managed by minimal handling only. The figures quoted from these other units included babies ventilated for hyaline membrane disease. I would be. very interested to learn whether Dr Pamela Davies at Hammersmith Hospital has been able to differentiate non-ventilated very low birthweight infants in her follow-up studies. G J REYNOLDS

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引用次数: 4

Atrial myxomas. 心房粘液瘤。

1区医学 Q1 MEDICINE, GENERAL & INTERNAL

British Medical Journal

Pub Date : 1980-12-13

引用次数: 0

Is low-level lead pollution dangerous? 低水平的铅污染危险吗?

1区医学 Q1 MEDICINE, GENERAL & INTERNAL

British Medical Journal

Pub Date : 1980-12-13 DOI: 10.1136/bmj.281.6255.1622

D Gloag

Present-day Americans are said to have about 500 times more lead in their skeletons than Peruvians of 1800 years ago.1 Lead pollution has become widespread in developed countries, especially from the use of lead in industry and in petrol and from its contamination of canned foods and some water. Never theless, lead poisoning, which was first described by the Greek physician poet Nikander in the second century BC,2 is very rare, being associated with high blood concentrations over 3-9 pimol/1 (80 (xg/100 ml), or occasionally over 2-9 (xmol/1 (60 (xg/100 ml.). The current debate centres on whether concentrations usually considered safe?under 1-9 pimol/1 (40 (xg/100 ml)?may in fact cause subtle neurological and behavioural abnormalities.

引用次数: 25

Comparison of neonatal management methods for very low birthweight babies. 极低出生体重儿新生儿管理方法比较。

1区医学 Q1 MEDICINE, GENERAL & INTERNAL

British Medical Journal

Pub Date : 1980-12-13 DOI: 10.1136/bmj.281.6255.1640

G J Reynolds

SIR,-Dr E S Steiner and others (8 November, p 1237) have offered a very succinct paper examining the outcome of very low birthweight infants who did not require "special or intensive" care. I am unable to agree with their conclusions and am saddened by their hostility towards intensive perinatal care. Clearly none of their infants required intensive care intervention and those that did died. Thus a population of "well babies" remained, of whom only 52% were normal at school age. Surely these results are disastrous and must indicate that more intensive care facilities are required at this unit. A more useful comparison would be a similar population at University College Hospital or Hammersmith Hospital-that is, very low birthweight infants who did not require intensive therapy after birth and who were managed by minimal handling only. The figures quoted from these other units included babies ventilated for hyaline membrane disease. I would be. very interested to learn whether Dr Pamela Davies at Hammersmith Hospital has been able to differentiate non-ventilated very low birthweight infants in her follow-up studies. G J REYNOLDS

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引用次数: 2

Fulminant Streptococcus pyogenes infection. 暴发性化脓性链球菌感染。

1区医学 Q1 MEDICINE, GENERAL & INTERNAL

British Medical Journal

Pub Date : 1980-12-13 DOI: 10.1136/bmj.281.6255.1639-d

P J Redding

SIR,-I find myself in a strange position with regard to the current brain death debate. I am a doctor and also chairman of the Association of Community Health Councils. From where I am I think that I really can see both sides. I would like to suggest that the BMA (or the colleges) approach the BBC and apply to do an Openi Door programme under its community access scheme. No doubt the application could be backed up by the suggestion that the programme could be made available to medical schools, postgraduate centres, and patient and community groups as part of continuing education about transplants. This basis for action would avoid the problems of editorial freedom and allow the profession to produce its version of a balanced programme. I would obviously press the case for the involvement of patients and community interests in the making of the programme. Of course, these programmes are not transmitted at peak times but at least the resources of the BBC would be seen to be available. It might even be that some part of the BBC current affairs machine chose to feature parts of the programme at a peak time-subject, of course, to editorial judgments, news value, and so on. Editorial freedom is one of those things, like clinical freedom, that we all have to be prepared to die for; the pity at the moment is that it is only those with chronic renal failure who are having actually to make the sacrifice. I offer my admittedly naive suggestion as a way in which both the profession and the media could work together and climb up out of this mess rather than wait for either to climb down.

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引用次数: 7

Is coeliac disease underdiagnosed? 乳糜泻诊断不足吗?

1区医学 Q1 MEDICINE, GENERAL & INTERNAL

British Medical Journal

Pub Date : 1980-12-13 DOI: 10.1136/bmj.281.6255.1637

E Rifkind, A Busuttil, A Ferguson

引用次数: 2

Psychiatric morbidity and physical toxicity associated with adjuvant chemotherapy. 与辅助化疗相关的精神疾病和物理毒性。

1区医学 Q1 MEDICINE, GENERAL & INTERNAL

British Medical Journal

Pub Date : 1980-12-13 DOI: 10.1136/bmj.281.6255.1641-a

A F Cooper, A V Hughson, C S McArdle, A R Russell, D C Smith

seven kidneys (5 %), however, showed severe arterial beading of the type previously reported in rejectionl 2; and in another nine kidneys (7 %) there were irregularities in the small renal arteries ranging from minor variations in vessel calibre and course to obvious segments of constriction or dilatation with abrupt terminations to the vessels. All the transplanted kidneys demonstrating these vascular abnormalities were undergoing rejection. One of the patients in whom aneurysms were demonstrated had arteriography of the transplanted kidney performed on two occasions; the first arteriogram showed normal intrarenal vessels, the second study one year later showed multiple small aneurysms which had developed during the course of rejection of the kidney. There was considerable overlap between the different types of arteriographic abnormality seen in rejecting transplant kidneys; the 20 kidneys comprising the three groups described above demonstrated a spectrum of vascular changes ranging from mild variations in vessel calibre at one extreme to multiple aneurysms at the other. In summary, multiple intrarenal aneurysms or severe preaneurysmal beading were demonstrated in 8 % of 136 arteriograms performed on malfunctioning transplanted kidneys. In a total series of 918 renal arteriograms rejection of a transplant was second only to polyarteritis nodosa as a cause of this type of aneurysm. Many causes of renal aneurysm are known,3 but the aneurysms seen in transplant rejection are most similar in their arteriographic appearance to those occurring in polyarteritis nodosa3 or drug abuse.4

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引用次数: 6

Long-term effects following administration of massive doses of stilboestrol and ethisterone to pregnant diabetics. 妊娠糖尿病患者服用大剂量雌甾酮和乙司酮后的长期影响。

1区医学 Q1 MEDICINE, GENERAL & INTERNAL

British Medical Journal

Pub Date : 1980-12-13 DOI: 10.1136/bmj.281.6255.1638-a

G Lane, N Siddle, M Whitehead

引用次数: 0

Kidney biopsy. 肾活检

1区医学 Q1 MEDICINE, GENERAL & INTERNAL

British Medical Journal

Pub Date : 1980-12-13 DOI: 10.1136/bmj.281.6255.1640-c

M S Knapp, R P Burden, D H Rose, P Davies

引用次数: 0