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Hartmann M van Es J Galjee MA van der Burgh PH de Bruin WI Said SA von Birgelen C 《Heart and vessels》2007,22(6):428-431
We present the case of a 44-year-old woman with acute coronary syndrome and multiple coronary artery–left ventricular microfistulae
at angiography. To evaluate the clinical significance of this observation and to obtain further insights into this rare disease,
the patient was further examined with echocardiography and both magnetic resonance imaging and single-photon emission computed
tomography, which showed considerable abnormalities. 相似文献
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Purposes
The purposes of this study are to investigate the usefulness of polygraphy (PG) in diagnosing obstructive sleep apnea (OSA) in sleepy/tired snorers compared to polysomnography (PSG) and, further, to search for suspected respiratory arousals in the PG.Methods
One hundred eighty-seven adults suffering from sleepiness/tiredness and snoring had undergone ambulant PG and were considered to be normal, using American Academy of Sleep Medicine’s 2007 hypopnea criteria A. After approximately 7 months, in-lab PSG was performed using hypopnea criteria B, where arousals are also recognized. Validated questionnaires (Hospital Anxiety and Depression Scale, self-rated general health) were answered. In a subgroup, the sensitivity and specificity were calculated for flow limitation index (FLI) and flattening index (FlatI) in PG compared with the respiratory distress index (RDI) in PSG.Results
Despite the normal PG, at PSG, the median RDI was 11.0 (range, 0–89.1). One hundred sixty-eight out of one hundred seventy-eight (90 %) were found to have at least mild OSA and 119/187 (64 %) with moderate–severe OSA according to the RDI values. The sensitivity and specificity were low (<70 %) for FLI and FlatI. Forty-nine percent of the patients rated anxiety at borderline or pathological levels, 35 % rated corresponding depression levels, and 45 % rated poor or fair general health.Conclusions
PG was insufficient to rule out OSA when the respiratory events were mainly associated with arousals. Almost half of these patients experience low general health and psychiatric problems. We recommend a full-night PSG when PG is “normal”, and patients have symptoms of snoring and sleepiness/tiredness. 相似文献4.
Objective
Gait speed is an important marker of health in adults and slows with aging. While knee osteoarthritis (OA) can result in difficulty walking, it is not known if radiographic knee OA (ROA) and/or knee pain are associated with a fast decline trajectory of gait speed over time.Methods
Gait speed trajectories were constructed using a multinomial modeling strategy from repeated 20‐meter walk tests measured annually over 4 years among participants from the Osteoarthritis Initiative, a prospective cohort study of adults ages 45–79 years at baseline with or at high risk of knee OA. We grouped participants into 4 knee OA categories (having neither ROA nor knee pain, ROA only, knee pain only, or symptomatic knee OA [ROA and pain]) and examined their association with trajectories of gait speed using a multivariable polytomous regression model adjusting for age and other potential confounders.Results
Of the 4,179 participants (mean ± SD age 61.1 ± 9.1 years, 57.6% women, mean ± SD body mass index 28.5 ± 4.8 kg/m2), 5% (n = 205) were in a fast decline trajectory, slowing at a rate of 2.75%/year. People with symptomatic knee OA had an almost 9‐fold risk (odds ratio 8.9; 95% confidence interval [95% CI] 3.1, 25.5) of being in a fast decline trajectory compared with those with neither pain nor ROA. Participants with knee pain had 4.5 times the odds of a fast decline (95% CI 1.4, 14.6), and those with ROA only had a slight but non–statistically significant increased risk.Conclusion
People with symptomatic knee OA have the highest risk of a fast decline trajectory of gait speed compared with people with ROA or pain alone. 相似文献5.
Prentice CR 《Haemostasis》1998,28(Z3):109-112
Chemoprophylaxis with subcutaneous low-molecular-weight heparin has been shown to reduce deep vein thrombosis detected by surrogate endpoints such as fibrinogen scanning and venography. However, there have been few trials which have assessed clinical endpoints attributed to fatal and non-fatal pulmonary embolism following surgery. As these clinical endpoints are rare, large-scale trials using vascular mortality, vascular morbidity and the incidence of haemorrhage as clinical endpoints need to be performed to assess the efficacy of chemical thromboprophylaxis. The benefit of using clinical endpoints against the risk of haemorrhage should also be evaluated. 相似文献
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In spite of the continuous growth of myocardial revascularisation techniques, stable angina remains an important clinical burden. In France, and based upon estimates from the European Society of Cardiology and from diverse epidemiological sources, 2 million people are likely to have stable angina. Though primary and secondary prevention are improving, this figure is likely to increase further, in particular because of the constant aging of the population (20% of patients more than 80 years of age have angina), but also because of the epidemics proportions that diabetes mellitus and obesity take. 相似文献
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Thilo Schwandner Michael H. Roblick Andreas Hecker Armand Brom Walter Kierer Winfried Padberg Markus Hirschburger 《International journal of colorectal disease》2009,24(12):1429-1434
Purpose
Widely differing surgical methods have been propagated to correct symptomatic rectocele. With transvaginal rectal repair (TVRR), we evaluate a method to reestablish the continuity of the rectal muscle wall, strengthen the weakened tunica muscularis, and restore normal rectal capacity and function. 相似文献10.
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J. Zimmerman 《Scandinavian journal of gastroenterology》2013,48(3):212-216
Background: This article presents a brief inventory for the diagnosis and monitoring of GORD symptoms. Methods: The inventory consists of five items pertaining to different aspects of GORD to be graded for frequency on a 5‐point Likert scale. It was validated on a consecutive group of GORD patients diagnosed either by endoscopy (n?=?25) or by 24‐h ambulatory pH monitoring (acid exposure time ≥5%; n?=?233) and control subjects (n?=?300). Results: Each of the inventory items was significantly associated with GORD (P?0.001). Factor analysis indicated that all items loaded on a single scale with a high reliability (Cronbach alpha 0.88). Each item was weighted by its respective odds ratio in favour of GORD and a total score for the scale was then calculated as the sum of weighted scores on the five individual items. Receiver‐operator (ROC) curve analysis implemented on a random sample comprising 67% of the group indicated that a total weighted score of 31.6 (percentage of the maximal possible weighted score) was 91% sensitive and 92% specific in the diagnosis of GORD. This score was then validated on the rest of the sample, where it correctly classified patients and controls with a sensitivity of 89% and specificity of 94%. The score proved stable on repeated administration in controls and in patients with stable symptoms, and decreased by 66% (P?0.001) after 1 month of treatment with omeprazole in patients who reported symptom relief. Conclusions: The scale described in this article is a brief, simple and accurate measure, for the diagnosis of GORD as well as for monitoring its symptoms. 相似文献
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Konstantinos P. Letsas MD FEHRA Konstantinos Vlachos MD Giulio Conte MD Michael Efremidis MD Takashi Nakashima MD Josselin Duchateau MD George Bazoukis MD Antonio Frontera MD Panagiotis Mililis MD Gary Tse MD Ghassen Cheniti MD Masateru Takigawa MD Thomas Pambrun MD Efstathia Prappa MD Frederic Sacher MD Nicolas Derval MD Antonios Sideris MD Angelo Auricchio MD Pierre Jais MD PhD Michel Haissaguerre MD Meleze Hocini MD 《Journal of cardiovascular electrophysiology》2021,32(11):2997-3007
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Small bowel bacterial overgrowth in symptomatic older people: can it be diagnosed earlier? 总被引:1,自引:0,他引:1
BACKGROUND/OBJECTIVES: In older people, small bowel bacterial overgrowth syndrome may be a common, but under-diagnosed, cause of diarrhoea and nutrient malabsorption. We aim to determine which clinical features and baseline laboratory investigations indicate a high likelihood of small bowel bacterial overgrowth as defined by a positive glucose breath test. METHODS: A retrospective analysis of records for all patients referred for glucose breath test over a 6-year period to a teaching hospital. RESULTS: Out of 197 referrals, 168 patient records were located and analysed (62 male, 106 female; median age 65). Patient characteristics predictive of a positive glucose breath test were: increasing age (p < 0.01), low serum vitamin B12 (p = 0.02), low serum albumin (p = 0.03), previous partial gastrectomy (p < 0.01), previous right hemi-colectomy (p < 0.01), presence of small bowel diverticulae (p = 0.01) and concurrent use of a proton pump inhibitor (p < 0.01). 52.5% (n = 21/40) of patients studied who were over 75 years old versus 21.8% (n = 28/128) of those under 75 years old had a positive glucose breath test (p < 0.01). The median time to diagnosis, from first hospital visit to positive glucose breath test, was 39 weeks. CONCLUSIONS: There is often a significant delay in diagnosis of small bowel bacterial overgrowth. We suggest that this diagnosis should be considered earlier in the investigative algorithm in older patients with indicative symptoms and a predisposing factor (including previous partial gastrectomy, previous right hemi-colectomy, small bowel diverticulae or use of a proton pump inhibitor) or concurring laboratory indices (low vitamin B12 or albumin). 相似文献
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