Upper gastrointestinal endoscopy with and without sedation: patients' opinions.
Upper gastrointestinal endoscopy with and without sedation: patients' opinions.
复制标题
使用和不使用镇静剂的上消化道内窥镜检查：患者的意见。
DOI：
10.1136/bmj.2.6026.20
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发表时间：
1976
影响因子：
--
通讯作者：
C. Hawkins
中科院分区：
文献类型：
--
作者：
A. Hoare;C. Hawkins
这些病例表明，HBIG只是延迟，并没有阻止明显的临床肝炎的出现。这证实并扩展了Seeff、aP、Grady和Lee的发现。”由于在我们的hbsag阴性病房没有第二次暴露的证据（意大利患者在护士扎伤自己三天后离开，并且两种临床病史完全相关），因此可以肯定地排除正常延迟的第二次暴露的假设。对晚发病例的解释似乎是，在使用HBIG时病毒已经存在，但只有当抗体浓度下降到病毒抗原可以产生的水平时，疾病的临床表现才会出现。如果暴露后4小时给予HBIG后未出现晚期病例，则延迟给予HBIG似乎至关重要；在我们的两个病例中，暴露后7小时给予HBIG，两人都出现了临床肝炎。这两个病例的临床演变与Seeff et aP和Grady and Lee的相同，尽管我们使用的HBIG是由瑞士红十字会提供的，滴度为1 4000而不是1 50万，并且一个月后没有重复治疗。尽管Seeff等人报道HBIG抑制活性抗体的产生，但我们的两名患者在临床发作几周后，血液中HBsAg已被清除。
These cases showed that HBIG only delayed and did not prevent the appearance of an overt clinical hepatitis. This confirms and extends the findings of Seeff et aP and Grady and Lee.' As there was no evidence of a second exposure in our HBsAg-negative unit (the Italian patient left three days after the nurses had pricked themselves and the two clinical histories were completely linked) the hypothesis of a second exposure with a normal delay can definitely be ruled out. The explanation for late onset cases seems to be that the virus is already established at the time of HBIG administration but that the clinical expression of the disease appears only when antibody concentrations fall to a level at which viral antigens can develop. It no late cases occur when HBIG is given four hours after exposure' delay in administration of HBIG seems critical; in our two cases HBIG was given seven hours after exposure and clinical hepatitis developed in both. The clinical evolution of those two cases was the same as in those of Seeff et aP and Grady and Lee,' although the HBIG we used, delivered by the Swiss Red Cross, had a titre of 1 4000 rather than one of 1 500 000, and treatment was not repeated one month later. Although Seeff et al reported that HBIG depresses active antibody production, HBsAg had cleared from the blood of our two patients a few weeks after the clinical episode.