RESUMEN
AIMS: This randomized, double-blind, placebo-controlled, parallel-group study evaluated the safety and efficacy of ezetimibe 10 mg/day in patients with primary hypercholesterolemia. METHODS AND RESULTS: Following dietary stabilization, a 2-12-week washout period, and a 4-week, single-blind, placebo lead-in period, 827 patients with baseline low-density lipoprotein cholesterol (LDL-C) > or =3.36 mmol/l (130 mg/dl) to < or =6.47 mmol/l (250 mg/dl) and triglycerides < or =3.95 mmol/l (350 mg/dl) were randomized 3:1 to receive ezetimibe 10 mg or placebo orally once daily in the morning for 12 weeks. The primary efficacy endpoint was percentage reduction in direct plasma LDL-C. Ezetimibe reduced direct LDL-C by a mean of 17.7% from baseline to endpoint, compared with an increase of 0.8% with placebo (P<0.01). Response to ezetimibe was generally consistent across all subgroups analyzed. Ezetimibe also significantly improved levels of plasma total cholesterol, apolipoprotein B, high-density lipoprotein(2)-cholesterol and lipoprotein(a), and elicited a trend toward lower triglyceride levels. Ezetimibe did not alter the serum concentrations of lipid-soluble vitamins or significantly affect baseline or stimulated cortisol production. Ezetimibe was well tolerated, with a safety profile similar to that of placebo. CONCLUSIONS: Ezetimibe, which significantly reduces LDL-C and favorably affects other lipid variables, may provide a well tolerated and effective new option for lipid management in the future.
Asunto(s)
Anticolesterolemiantes/uso terapéutico , Azetidinas/uso terapéutico , Hipercolesterolemia/tratamiento farmacológico , Adulto , Anciano , LDL-Colesterol/sangre , Cosintropina/sangre , Método Doble Ciego , Ezetimiba , Femenino , Humanos , Hipercolesterolemia/sangre , Masculino , Persona de Mediana Edad , Método Simple Ciego , Triglicéridos/sangre , Vitaminas/sangreRESUMEN
BACKGROUND/PURPOSE: The current study enrolled 113 patients with esophageal atresia (EA) accompanying tracheoesophageal fistula (TEF) (Vogt type IIIb) who were treated at the Central Hospital St. Jürgen Strasse, Department of Pediatric Surgery in Bremen, Germany between 1978 and 1997. METHODS: These EA patients were classified into patients preoperatively complicated by respiratory distress syndrome (RDS) or pneumonia and those without complications. In each group, risk factors were classified according to the risk classification described by Spitz et al, and the prognoses and therapeutic problems were evaluated. Based on these results, a new preoperative risk classification consisting of risk factors described by Spitz et al supplemented with RDS and pneumonia was evaluated. RESULTS: When the prognoses of EA were evaluated, the survival rate was markedly decreased when RDS or pneumonia alone or more than 2 of 3 factors including major cardiac anomalies and low birth weight were present as preoperative risk factors. Concerning therapeutic problems, the necessity of treatment with delayed primary repair tended to increase when RDS or pneumonia was present as risk factors. However, it was suggested that secure and safe blockage of TEF was still difficult during the initial surgery. CONCLUSIONS: During selection of therapeutic strategies for EA, RDS and pneumonia are still considered to be essential as preoperative risk factors for EA. Our new preoperative risk classification consisting of risk factors described by Spitz et al supplemented with RDS and pneumonia appears to clearly reflect the prognoses and therapeutic problems of EA.
Asunto(s)
Atresia Esofágica/cirugía , Niño , Atresia Esofágica/mortalidad , Alemania , Humanos , Pronóstico , Medición de Riesgo , Factores de Riesgo , Análisis de SupervivenciaRESUMEN
A 22-year-old male presented with a brief history of progressive encephalopathy. One week previously, he had developed an upper respiratory infection that resolved spontaneously and was followed by intractable vomiting. He had taken salicylates for several days during the viral syndrome. The diagnosis of Reye's syndrome was confirmed by hepatic histology. Aggressive conservative management was followed by complete metabolic and neurological recovery. There are fewer than 10 reported cases of Reye's syndrome in adults but this disease may be more common than is generally suspected. The diagnosis should be considered in patients presenting with emesis and obtundation, who have recently had a viral illness and exhibit elevated blood ammonia and transaminases with normal cerebrospinal fluid. Confirmation is achieved by liver biopsy. Therapy is directed toward aggressive reduction of increased intracranial pressure.