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81.
Endoscopic pancreatic and biliary manometry in pancreatic, biliary, and papillary disease, and after endoscopic sphincterotomy and surgical sphincteroplasty. 总被引:3,自引:3,他引:3 下载免费PDF全文
Endoscopic manometry was used to measure pancreatic duct, common bile duct, pancreatic duct sphincter and bile duct sphincter pressures in 43 healthy volunteers and 162 patients with a variety of papillary, pancreatic and biliary disorders. Common bile duct pressure was significantly raised after cholecystectomy, with common bile duct stones and papillary stenosis but pancreatic duct pressure only in papillary stenosis. After endoscopic sphincterotomy mean common bile duct pressure fell from 11.2 to 1.1 mmHg and pancreatic duct pressure from 18.0 to 11.2 mmHg. Distinct pancreatic duct sphincter and bile duct sphincter zones were identified as phasic pressures of 3-12 waves/minute on pull-through from pancreatic duct and common bile duct to duodenum. Pancreatic duct sphincter pressures were higher with common bile duct stones and stenosis whereas bile duct sphincter pressures were higher in pancreatitis and stenosis. Bile duct sphincter activity was present in 60% of patients after surgical sphincteroplasty but 21% of patients after endoscopic sphincterotomy. Endoscopic manometry facilitated the diagnosis of papillary stenosis, has allowed study of papillary pathophysiology and has shown a functional inter-relationship between the two sphincteric zones. 相似文献
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Lynsey C. Patrott B. App Sc Sp.Path Wilfred G. Selley F.D.S. F. C. S. T. Hon Wendy A. Brooks B.Sc. Penny C. Lethbridge S.R.N. Jessica J. Cole M.C.S.P. Frederick C. Flack Ph.D. Richard E. Ellis M.Phil. John H. Tripp F.R.C.P. M.D. 《Dysphagia》1992,7(4):209-219
Eighteen children with cerebral palsy in a special school, most of whom had feeding difficulties, were studied to compare
the diagnostic value of the Exeter Dysphagia Assessment Technique (EDAT) with an exhaustive clinical assessment undertaken
by a multidisciplinary team experienced in the diagnosis and treatment of dysphagia of neurological origin. Four feeding skills
were assessed by each method independently, viz. anticipation, intraoral sensory perception, oral-motor efficiency, and pharyngeal
triggering. Comparison of the two sets of results showed agreement in at least 78% of the assessed skills. The possible reasons
for the few discrepancies are discussed. The noninvasive EDAT equipment was easy to use with the children, who had a range
of type and severity of cerebral palsy. The test was undertaken in their familiar surroundings and took 15 to 20 min per child.
Interpretation of the results showed that EDAT provided a rapid, reliable diagnostic aid which assisted in the assessment
of the degree of feeding impairment within each of the four feeding skills tested.
The authors are very grateful for the financial support for this project which was provided partially by Action Research and
partially by the Northcott Devon Medical Foundation 相似文献
84.
Vascular remodeling and plaque composition between focal and diffuse coronary lesions assessed by intravascular ultrasound 总被引:4,自引:0,他引:4
Fujii K Mintz GS Kobayashi Y Carlier SG Takebayashi H Jacoboff D Yasuda T Moussa I Dangas G Mehran R Lansky AJ Reyes A Kreps E Collins M Stone GW Leon MB Moses JW 《The American journal of cardiology》2004,94(8):1067-1070
Coronary remodeling and plaque composition were compared between focal and diffuse coronary lesions. Negative remodeling and fibrous and calcified plaque compositions contribute to stenosis development in diffuse lesions more frequently than in focal lesions. 相似文献
85.
Ioanna Kosmidou Shmuel Chen A. Pieter Kappetein Patrick W. Serruys Bernard J. Gersh John D. Puskas David E. Kandzari David P. Taggart Marie-Claude Morice Paweł E. Buszman Andrzej Bochenek Erick Schampaert Pierre Pagé Joseph F. Sabik Thomas McAndrew Björn Redfors Ori Ben-Yehuda Gregg W. Stone 《Journal of the American College of Cardiology》2018,71(7):739-748
Background
There is limited information on the incidence and prognostic impact of new-onset atrial fibrillation (NOAF) following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for left main coronary artery disease (LMCAD).Objectives
This study sought to determine the incidence of NOAF following PCI and CABG for LMCAD and its effect on 3-year cardiovascular outcomes.Methods
In the EXCEL (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial, 1,905 patients with LMCAD and low or intermediate SYNTAX scores were randomized to PCI with everolimus-eluting stents versus CABG. Outcomes were analyzed according to the development of NOAF during the initial hospitalization following revascularization.Results
Among 1,812 patients without atrial fibrillation on presentation, NOAF developed at a mean of 2.7 ± 2.5 days after revascularization in 162 patients (8.9%), including 161 of 893 (18.0%) CABG-treated patients and 1 of 919 (0.1%) PCI-treated patients (p < 0.0001). Older age, greater body mass index, and reduced left ventricular ejection fraction were independent predictors of NOAF in patients undergoing CABG. Patients with versus without NOAF had a significantly longer duration of hospitalization, were more likely to be discharged on anticoagulant therapy, and had an increased 30-day rate of Thrombolysis In Myocardial Infarction major or minor bleeding (14.2% vs. 5.5%; p < 0.0001). By multivariable analysis, NOAF after CABG was an independent predictor of 3-year stroke (6.6% vs. 2.4%; adjusted hazard ratio [HR]: 4.19; 95% confidence interval [CI]: 1.74 to 10.11; p = 0.001), death (11.4% vs. 4.3%; adjusted HR: 3.02; 95% CI: 1.60 to 5.70; p = 0.0006), and the primary composite endpoint of death, MI, or stroke (22.6% vs. 12.8%; adjusted HR: 2.13; 95% CI: 1.39 to 3.25; p = 0.0004).Conclusions
In patients with LMCAD undergoing revascularization in the EXCEL trial, NOAF was common after CABG but extremely rare after PCI. The development of NOAF was strongly associated with subsequent death and stroke in CABG-treated patients. Further studies are warranted to determine whether prophylactic strategies to prevent or treat atrial fibrillation may improve prognosis in patients with LMCAD who are undergoing CABG. (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization [EXCEL]; NCT01205776) 相似文献86.
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Clodfelter RC Albanese MJ Baker G Domoto K Gui AL Khantzian EJ 《The American journal on addictions / American Academy of Psychiatrists in Alcoholism and Addictions》2003,12(5):448-454
This report describes the MICA (Mentally Ill Chemically Abusing) Program at the Tewksbury Hospital campus in Tewksbury, Massachusetts. Several campus facilities collaborate in the MICA Program. Through Expert Case Conferences, principles of integrated psychosocial treatment with dual diagnosis patients are demonstrated. An expert clinician focuses on the interplay between psychological pain, characterological traits, defenses, and the patient's drug of choice. Patients who have participated in the program have reported positive experiences. The staff reported that the program has resulted in facility improvement in assessment and treatment of complex dual diagnosis patients. 相似文献
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Contrast-induced nephropathy after percutaneous coronary interventions in relation to chronic kidney disease and hemodynamic variables 总被引:9,自引:0,他引:9
Dangas G Iakovou I Nikolsky E Aymong ED Mintz GS Kipshidze NN Lansky AJ Moussa I Stone GW Moses JW Leon MB Mehran R 《The American journal of cardiology》2005,95(1):13-19
We previously found that contrast-induced nephropathy (CIN) complicating percutaneous coronary intervention adversely affects patients with chronic kidney disease (CKD). Therefore, we further investigated whether the predictors and outcome of CIN after percutaneous coronary intervention differ among patients with versus without CKD. Among 7,230 consecutive patients, CIN (>or=25% or >or=0.5 mg/dl increase in preprocedure serum creatinine 48 hours after the procedure) developed in 381 of 1,980 patients (19.2%) with baseline CKD (estimated glomerular filtration rate [eGFR] <60 ml/min/1.73 m(2)) and in 688 of 5,250 patients (13.1%) without CKD. Decreased eGFRs, periprocedural hypotension, higher contrast media volumes, lower baseline hematocrit, diabetes, pulmonary edema at presentation, intra-aortic balloon pump use, and ejection fraction <40% were the most significant predictors of CIN in patients with CKD. Apart from intra-aortic balloon pump use, predictors of CIN in patients without CKD were the same as mentioned, plus older age and type of contrast media. Regardless of baseline renal function, CIN correlated with longer in-hospital stay and higher rates of in-hospital complications and 1-year mortality compared with patients without CIN. By multivariate analysis, CIN was 1 of the most powerful predictors of 1-year mortality in patients with preexisting CKD (odds ratio 2.37, 95% confidence interval 1.63 to 3.44) or preserved eGFR (odds ratio 1.78; 95% confidence interval 1.22 to 2.60). Thus, regardless of the presence of CKD, baseline characteristics and periprocedural hemodynamic parameters predict CIN, and this complication is associated with worse in-hospital and 1-year outcomes. 相似文献