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101.
Simon Hsu Dena E. Rifkin Michael H. Criqui Natalie C. Suder Pranav Garimella Charles Ginsberg Antoinette M. Marasco Belinda J. McQuaide Emma J. Barinas-Mitchell Matthew A. Allison Christina L. Wassel Joachim H. Ix 《Journal of vascular surgery》2018,67(6):1855-1863.e1
Background
Chronic kidney disease (CKD) is strongly associated with peripheral artery disease (PAD). Detection of subclinical PAD may allow early interventions for or prevention of PAD in persons with CKD. Whether the presence of atherosclerotic plaque and femoral intima-media thickness (IMT) are associated with kidney function is unknown.Methods
We performed a cross-sectional observational study of 1029 community-living adults. We measured superficial and common femoral artery IMT and atherosclerotic plaque presence by ultrasound. Estimated glomerular filtration rate (eGFR; continuous) and eGFR <60 mL/min/1.73 m2 (binary) were evaluated as outcomes.Results
Mean age was 70 ± 10 years, mean eGFR was 78 ± 17 mL/min/1.73 m2, and 156 (15%) individuals had eGFR <60 mL/min/1.73 m2; 260 (25%) had femoral artery plaque. In models adjusted for demographics and cardiovascular risk factors, individuals with femoral artery plaque had mean eGFR approximately 3.0 (95% confidence interval, ?5.3 to ?0.8) mL/min/1.73 m2 lower than those without plaque (P < .01). The presence of plaque was also associated with a 1.7-fold higher odds of eGFR <60 mL/min/1.73 m2 (95% confidence interval, 1.1-2.8; P < .02). Associations were similar in persons with normal ankle-brachial index. The directions of associations were similar for femoral IMT measures with eGFR and CKD but were rendered no longer statistically significant with adjustment for demographic variables and cardiovascular disease risk factors.Conclusions
Femoral artery plaque is significantly associated with CKD prevalence in community-living individuals, even among those with normal ankle-brachial index. Femoral artery ultrasound may allow evaluation of relationships and risk factors linking PAD and kidney disease earlier in its course. 相似文献102.
Grace J. Wang Benjamin M. Jackson Paul J. Foley Scott M. Damrauer Philip P. Goodney Rachel R. Kelz Christopher Wirtalla Ronald M. Fairman 《Journal of vascular surgery》2018,67(6):1649-1658
Objective
The advent of endovascular repair for both thoracic aortic aneurysm and type B dissection has transformed the management of these disease processes. This study was undertaken to better define, compare, and contrast the national trends in hospital admissions, invasive treatments, and inpatient mortality of patients with thoracic aortic aneurysm and type B dissection in the National Inpatient Sample.Methods
The cohort was derived from International Classification of Diseases, Ninth Revision diagnosis codes for thoracic aortic dissection and thoracic aortic or thoracoabdominal aortic aneurysm. Patients receiving type A dissection or ascending aortic repair during their index admission were excluded using International Classification of Diseases, Ninth Revision procedure codes. A total of 155,187 patients were available for analysis from 2000 to 2012.Results
Admissions for thoracic aortic aneurysm outnumbered the admissions for type B dissection (69.8% vs 30.2%; P < .001), and the number of admissions for aneurysm grew more rapidly during this time (132% vs 63%; P < .001). Thoracic endovascular aortic repair (TEVAR) for aneurysm experienced an increase in 2005, concordant with Food and Drug Administration approval of TEVAR for thoracic aortic aneurysm indication, then superseded open repair for thoracic aortic aneurysm from 2006 onward. Despite this, the rate of thoracic aortic aneurysm repair has remained relatively stable over time. TEVAR for dissection increased in 2006, superseded open repair in 2010, and continues to account for 50.5% of all dissection repairs. Overall, the number of type B dissection repairs has increased (P < .001), over and above the increase in number of admissions for type B dissection. Despite the increased trends of utilization of TEVAR for both aneurysm and type B dissection, the overall in-hospital mortality rate among patients admitted for either disease state has decreased steadily over time (P < .001).Conclusions
Whereas admissions for thoracic aortic aneurysm disease have increased over time, the rate of aneurysm repair has been stable, although TEVAR has supplanted a proportion of open repairs. In contrast, whereas admissions for type B dissection have experienced a more modest increase, there has been a disproportionate increase in type B dissection repair, largely due to increased use of TEVAR. These results show embracing of endovascular technology for dissection through expansion of indication. Despite the increase in rate of repair for type B dissection, inpatient mortality rate was reduced in both aneurysm and dissection patients, influenced by appropriate selection of patients for intervention. 相似文献103.
Ruhani Nanavati Patrick Jasinski Demetri Adrahtas Antonios Gasparis Nicos Labropoulos 《Journal of vascular surgery》2018,67(2):536-541
Objective
Previous studies of men suggested that patients with varicocele may be leaner than the normal population. No such work exists in women with pelvic congestion syndrome (PCS). This study evaluated the correlation between body mass index (BMI) and PCS.Methods
A case-control study at a single institution was performed of women who had the objective diagnosis of PCS. Data were prospectively collected for 100 consecutive patients with PCS. BMI was calculated for every patient and categorized into normal weight (BMI <25), overweight (BMI 25-29.9), and obese (BMI >30). Diagnosis of PCS was made by ultrasound and venography. Mean BMI was compared with that of the general female population of the United States from 1999 to 2002. Furthermore, analyses included comparison of patients with and without ovarian vein dilation and pelvic varices.Results
There were 100 women with a median age of 44 years (range, 24-73 years). The mean BMI of the study group was 25 ± 5.6 kg/m2. The cohort was categorized into 59 women with normal BMI, 23 overweight women, and 18 obese women. The study cohort's BMI was less than that of the general U.S. female population (P = .02). The majority of the study group were white with lower BMI (P < .0001). Leg varicosities were more prevalent in obese patients (100% obese vs 81% normal BMI; P = .01). Patients with ovarian vein dilation had significantly lower BMI (24.1 ± 5.6 kg/m2 and 26.7 ± 5.4 kg/m2; P = .036). No differences were identified for pelvic varices or reflux.Conclusions
Women with PCS are more likely to have a normal BMI with ovarian vein dilation compared with obese women, who are more frequently affected by leg varicosities. 相似文献104.
105.
D.-L. Wan M.-X. Li L. Bao L.-L. Zhang L. Zhang Q.-Y. Chen S.-Z. Lin 《Transplantation proceedings》2018,50(3):925-929
Background
With the continuous improvement of liver transplantation technology, the survival rate of liver transplantation has been improved, but recurrent or de novo malignancy remains one of the major factors affecting the long-term survival of liver transplant recipients.Case Report
A 45-year-old Chinese man had a plastic biliary stent placed on account of biliary anastomotic stenosis after 3 years of piggyback liver transplantation. He came to our hospital because of recurrent fever and jaundice for 2 weeks, and his carcinoembryonic antigen-199 had increased. The patient's duodenal papillary was cauliflower-like at endoscopic retrograde cholangiopancreatography to replace the biliary stent. He was initially suspected of having duodenal papillary carcinoma after liver transplantation. However, the pathology from endoscopic retrograde cholangiopancreatography and endoscopic ultrasound-guided biopsy showed inflammation. While awaiting the result of biopsy, his CA-199 decreased significantly after anti-infection and symptomatic treatment. The patient was diagnosed with biliary anastomotic stenosis and duodenal papillitis. He was discharged uneventfully; to date, there is no evidence of malignant tumor.Conclusions
We report this case to provide helpful information to clinicians about the management of the duodenal papilla cauliflower-like neoplasm after liver transplantation, which should be considered as inflammatory first. Perhaps our view can avoid the risk of bringing an excessive medical treatment and unnecessary economic burden to patients and their families. 相似文献106.
107.
慢性肾脏病主要临床表现为血尿、蛋白尿、水肿及肾功能损害等。在现代医学积极治疗的情况下,肾脏疾病的患病率及病死率仍然就高,中医药独具特色的辨证论治在治疗慢性肾脏病方面有着较好的疗效。杨洪涛教授认为,慢性肾脏病病程日久,病机总属本虚标实,虚实夹杂。杨师临证时精于辨证,在治疗慢性肾脏病时注重健脾补肾,屡获良效。 相似文献
108.
糖尿病性视网膜病变是糖尿病常见的微血管并发症之一,目前现代医学治疗以控制血糖、血压、血脂、改善微循环等基础治疗方法为主,严重者采取激光光凝、手术或局部糖皮质激素治疗。中医药辅助治疗在减少潜在致盲并发症的发生率,延缓病情进展等方面具有独特的疗效。魏子孝教授参考眼底检查抓住患者“主证”,运用中医药理论辨治糖尿病性视网膜病变,主要针对非急性眼底出血糖尿病性视网膜病变。治疗上注重整体与眼部微观辨证相结合,以滋补肝肾、养血明目为基础,佐以化痰祛瘀、活血利水等祛邪通络之法;注意起居调护,如疏肝理气、润肠通便药物的应用,以避免眼底再次出血,临床效果明显。 相似文献
109.
110.
One hundred patients, referred for the management of intractable pain, completed a 52-item Illness Behaviour Questionnaire (IBQ). Responses were scored on 7 scales: general hypochondriasis, disease conviction, psychological versus somatic perception of illness, affective inhibition, affective disturbance, denial, and irritability. IBQ scale profiles were subjected to numerical analysis and 6 taxonomic clusters were identified. Patients in groups 1-3 were characterized by a relatively non-neurotic, reality-oriented attitude to illness, as indicated by low scores on the first three scales. Patients in groups 4-6 manifested greater evidence of 'abnormal illness behaviour', and presented syndromes resembling 'hysteria', 'conversion reaction', and 'hypothchondriasis' respectively. 相似文献