Objective: The purpose of this study was to compare perinatal outcomes among women with conservatively treated preterm premature rupture of membranes at 24 to 32 weeks of gestation in the presence or absence of vagina...Objective: The purpose of this study was to compare perinatal outcomes among women with conservatively treated preterm premature rupture of membranes at 24 to 32 weeks of gestation in the presence or absence of vaginal bleeding. Study design: This is a secondary analysis of 581 women with and without vaginal bleeding within 1 week of admission with preterm premature rupture of membranes at 24 to 32 weeks of gestation who were enrolled in a multicenter trial of antibiotic therapy during conservative treatment. The main outcome was latency to delivery. Other outcome variables included clinical abruptio placentae, amnionitis, perinatal death, severe intraventricular hemorrhage, and respiratory distress syndrome. Results: Outcome data were available for 581 patients (n = 50 with bleeding). Latency to delivery was not affected by the presence or absence of bleeding. In general, a history of bleeding was associated with higher frequencies of subsequently diagnosed abruptio placentae (12% vs 3.5% ; P = .01), perinatal death (16% vs 4.9% ; P = .006), intraventricular hemorrhage (14.3% vs 5.9% ; P = .03), and respiratory distress syndrome (69.4% vs 40.4% ; P < .0001), when compared with those women with nonbleeding events. Women with bleeding were less likely to be black (42% vs 60% ; P = .002) and had a lower mean gestational age at preterm premature rupture of membranes (27.6 vs 28.5 weeks; P = .02) when compared with white, Hispanic, and other. After an adjustment of data was made for potentially confounding factors, women with recent bleeding were more likely to be diagnosed with abruptio placentae at delivery (odds ratio, 2.8; 95% CI, 1.03-7.8; P = .04), and their infants were more likely to have respiratory distress syndrome (odds ratio, 3.1; 95% CI, 1.5-6.6; P = .004). Conclusion: Vaginal bleeding before preterm premature rupture of membranes is associated with increased rates of neonatal respiratory distress syndrome and abruptio placentae, but not with reduced latency to delivery.展开更多
晚发性维生素 K 缺乏所致婴儿颅内出血,临床少见,易误诊,病死率较高,近年才被重视。现将我科遇治四例报告如下。例1,男,2月。因呕吐,面色苍白3天,皮肤淤斑2天,抽搐6次,于85年8月入院。患儿为母乳喂养,未加辅食。既往无外伤及出血史。体...晚发性维生素 K 缺乏所致婴儿颅内出血,临床少见,易误诊,病死率较高,近年才被重视。现将我科遇治四例报告如下。例1,男,2月。因呕吐,面色苍白3天,皮肤淤斑2天,抽搐6次,于85年8月入院。患儿为母乳喂养,未加辅食。既往无外伤及出血史。体检:体温38.3℃,神清,胸部皮肤有1×1cm 的淤斑2个,背部有一2×2cm 的血肿。前胸隆起,颈无抵抗,心肺未见异常,肝肋下1.5cm,脾未扪及。克氏征（一）。血红蛋白63g/L红细胞2.03×10<sup>12</sup>/L,白细胞10.9×10<sup>9</sup>L,血小板272×10<sup>9</sup>/L,凝血时间4分30秒,脑脊液血性。例2,男,3月。因发烧、呕吐。展开更多
BACKGROUND: Concurrent therapy with a proton-pump inhibitor is a standard treatment for patients receiving aspirin who are at risk for ulcer. Current U.S. guidelines also recommend clopidrogel for patients who have ma...BACKGROUND: Concurrent therapy with a proton-pump inhibitor is a standard treatment for patients receiving aspirin who are at risk for ulcer. Current U.S. guidelines also recommend clopidrogel for patients who have major gastrointestinal intolerance of aspirin. We compared clopidogrel with aspirin plus esomeprazole for the prevention of recurrent bleeding from ulcers in high-risk patients. METHODS: We studied patients who took aspirin to prevent vascular diseases and who presented with ulcer bleeding. After the ulcers had healed, we randomly assigned patients who were negative for Helicobacter pylori to receive either 75 mg of clopidogrel daily plus esomeprazole placebo twice daily or 80 mg of aspirin daily plus 20 mg of esomeprazole twice daily for 12 months. The end point was recurrent ulcer bleeding. RESULTS: We enrolled 320 patients (161 patients assigned to receive clopidogrel and 159 to receive aspirin plus esomeprazole). Recurrent ulcer bleeding occurred in 13 patients receiving clopidogrel and 1 receiving aspirin plus esomeprazole. The cumulative incidence of recurrent bleeding during the 12-month period was 8.6 percent (95 percent confidence interval, 4.1 to 13.1 percent) among patients who received clopidogrel and 0.7 percent (95 percent confidence interval, 0 to 2.0 percent) among those who received aspirin plus esomeprazole (difference, 7.9 percentage points; 95 percent confidence interval for the difference, 3.4 to 12.4; P=0.001). CONCLUSIONS: Among patients with a history of aspirin-induced ulcer bleeding whose ulcers had healed before they received the study treatment, aspirin plus esomeprazole was superior to clopidogrel in the prevention of recurrent ulcer bleeding. Our finding does not support the current recommendation that patients with major gastrointestinal intolerance of aspirin be given clopidogrel.展开更多
体外循环心内直视手术后并发尿崩症,同内文献未见报道。我院新近一例房间隔缺损修补术后并发尿崩症,现报告如下:患者女性,39岁,发现心脏杂者16年,既往无多尿,多饮及产后大出血史。查体:血压12/8Kpa（90/60mmHg）,胸骨左缘2—3肋间闻及3...体外循环心内直视手术后并发尿崩症,同内文献未见报道。我院新近一例房间隔缺损修补术后并发尿崩症,现报告如下:患者女性,39岁,发现心脏杂者16年,既往无多尿,多饮及产后大出血史。查体:血压12/8Kpa（90/60mmHg）,胸骨左缘2—3肋间闻及3/Ⅵ收缩期杂音,P<sub>2</sub>亢进。二维超声心动图及 X 线胸片均提示房间隔缺损,术前糖尿（一）,血肌酐及尿素氮均正常。1991年4月在体外循环下行房间隔修补术,术中平均动脉压8—13Kpa（60—100mmHg）,术后即出现多尿,达10960ml/24小时,比重低（1.004—1.006）。展开更多
文摘Objective: The purpose of this study was to compare perinatal outcomes among women with conservatively treated preterm premature rupture of membranes at 24 to 32 weeks of gestation in the presence or absence of vaginal bleeding. Study design: This is a secondary analysis of 581 women with and without vaginal bleeding within 1 week of admission with preterm premature rupture of membranes at 24 to 32 weeks of gestation who were enrolled in a multicenter trial of antibiotic therapy during conservative treatment. The main outcome was latency to delivery. Other outcome variables included clinical abruptio placentae, amnionitis, perinatal death, severe intraventricular hemorrhage, and respiratory distress syndrome. Results: Outcome data were available for 581 patients (n = 50 with bleeding). Latency to delivery was not affected by the presence or absence of bleeding. In general, a history of bleeding was associated with higher frequencies of subsequently diagnosed abruptio placentae (12% vs 3.5% ; P = .01), perinatal death (16% vs 4.9% ; P = .006), intraventricular hemorrhage (14.3% vs 5.9% ; P = .03), and respiratory distress syndrome (69.4% vs 40.4% ; P < .0001), when compared with those women with nonbleeding events. Women with bleeding were less likely to be black (42% vs 60% ; P = .002) and had a lower mean gestational age at preterm premature rupture of membranes (27.6 vs 28.5 weeks; P = .02) when compared with white, Hispanic, and other. After an adjustment of data was made for potentially confounding factors, women with recent bleeding were more likely to be diagnosed with abruptio placentae at delivery (odds ratio, 2.8; 95% CI, 1.03-7.8; P = .04), and their infants were more likely to have respiratory distress syndrome (odds ratio, 3.1; 95% CI, 1.5-6.6; P = .004). Conclusion: Vaginal bleeding before preterm premature rupture of membranes is associated with increased rates of neonatal respiratory distress syndrome and abruptio placentae, but not with reduced latency to delivery.
文摘晚发性维生素 K 缺乏所致婴儿颅内出血,临床少见,易误诊,病死率较高,近年才被重视。现将我科遇治四例报告如下。例1,男,2月。因呕吐,面色苍白3天,皮肤淤斑2天,抽搐6次,于85年8月入院。患儿为母乳喂养,未加辅食。既往无外伤及出血史。体检:体温38.3℃,神清,胸部皮肤有1×1cm 的淤斑2个,背部有一2×2cm 的血肿。前胸隆起,颈无抵抗,心肺未见异常,肝肋下1.5cm,脾未扪及。克氏征（一）。血红蛋白63g/L红细胞2.03×10<sup>12</sup>/L,白细胞10.9×10<sup>9</sup>L,血小板272×10<sup>9</sup>/L,凝血时间4分30秒,脑脊液血性。例2,男,3月。因发烧、呕吐。
文摘BACKGROUND: Concurrent therapy with a proton-pump inhibitor is a standard treatment for patients receiving aspirin who are at risk for ulcer. Current U.S. guidelines also recommend clopidrogel for patients who have major gastrointestinal intolerance of aspirin. We compared clopidogrel with aspirin plus esomeprazole for the prevention of recurrent bleeding from ulcers in high-risk patients. METHODS: We studied patients who took aspirin to prevent vascular diseases and who presented with ulcer bleeding. After the ulcers had healed, we randomly assigned patients who were negative for Helicobacter pylori to receive either 75 mg of clopidogrel daily plus esomeprazole placebo twice daily or 80 mg of aspirin daily plus 20 mg of esomeprazole twice daily for 12 months. The end point was recurrent ulcer bleeding. RESULTS: We enrolled 320 patients (161 patients assigned to receive clopidogrel and 159 to receive aspirin plus esomeprazole). Recurrent ulcer bleeding occurred in 13 patients receiving clopidogrel and 1 receiving aspirin plus esomeprazole. The cumulative incidence of recurrent bleeding during the 12-month period was 8.6 percent (95 percent confidence interval, 4.1 to 13.1 percent) among patients who received clopidogrel and 0.7 percent (95 percent confidence interval, 0 to 2.0 percent) among those who received aspirin plus esomeprazole (difference, 7.9 percentage points; 95 percent confidence interval for the difference, 3.4 to 12.4; P=0.001). CONCLUSIONS: Among patients with a history of aspirin-induced ulcer bleeding whose ulcers had healed before they received the study treatment, aspirin plus esomeprazole was superior to clopidogrel in the prevention of recurrent ulcer bleeding. Our finding does not support the current recommendation that patients with major gastrointestinal intolerance of aspirin be given clopidogrel.
文摘体外循环心内直视手术后并发尿崩症,同内文献未见报道。我院新近一例房间隔缺损修补术后并发尿崩症,现报告如下:患者女性,39岁,发现心脏杂者16年,既往无多尿,多饮及产后大出血史。查体:血压12/8Kpa（90/60mmHg）,胸骨左缘2—3肋间闻及3/Ⅵ收缩期杂音,P<sub>2</sub>亢进。二维超声心动图及 X 线胸片均提示房间隔缺损,术前糖尿（一）,血肌酐及尿素氮均正常。1991年4月在体外循环下行房间隔修补术,术中平均动脉压8—13Kpa（60—100mmHg）,术后即出现多尿,达10960ml/24小时,比重低（1.004—1.006）。
