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1.
Cheng-Ying Chiu Robert Hättasch Damaris Praeger Fabian Knebel Karl Stangl Ivan Diaz Ramirez Henryk Dreger 《Heart & lung : the journal of critical care》2018,47(3):250-252
Introduction
Percutaneous mechanical circulatory support systems have increasingly been adopted as a bail out strategy in patients with cardiogenic shock. Since studies showed mostly mixed results, however, the use of support systems remains a case by case decision.Case
Here, we report on a case of therapy-refractory cardiogenic shock due to acute myocardial infarction treated with percutaneous right and left ventricular assist devices (Impella RP and CP).Conclusion
Due to myocardial stunning, even patients with fulminant cardiogenic shock have the potential for full recovery. In the present case, we demonstrate the feasibility of biventricular Impella support in therapy-refractory cardiogenic shock facilitating bridge to recovery. 相似文献2.
Women With Cardiogenic Shock Derive Greater Benefit From Early Mechanical Circulatory Support: An Update From the cVAD Registry 
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下载免费PDF全文 Susan M. Joseph M.D. Meredith A. Brisco M.D. M.S.C.E. F.A.C.C. Monica Colvin M.D. M.S. F.A.H.A. Kathleen L. Grady Ph.D R.N. M.S. F.A.A.N. Mary Norine Walsh M.D. F.A.C.C. Jennifer L. Cook M.D. F.A.H.A. for the genVAD Working Group 《Journal of interventional cardiology》2016,29(3):248-256
Objectives
The aim of this analysis was to assess survival differences between men and women supported with Impella 2.5 (Abiomed Inc., Danvers) in the setting of acute myocardial infarction (AMI) complicated by cardiogenic shock (CS).Background
Data on sex differences in outcomes of CS with mechanical circulatory support are sparse.Methods
Patients enrolled in the cVAD Registry who underwent percutaneous coronary intervention (PCI) and Impella 2.5 support for CS complicating an AMI were included. Differences between men and women were examined.Results
In total, 180 patients were analyzed. Women (n = 49, 27.2%) were older (71.0 ± 12.8 years vs 63.8 ± 13.0, P = 0.001), smaller (BSA 1.82 ± 0.22 vs 2.04 ± 0.24 m2, P < 0.001), and had a higher STS mortality risk score than men (27.9 ± 17.0 vs. 20.8 ± 16.8 P = 0.01). There was no difference in survival to discharge (P = 0.3). Patients receiving the Impella 2.5 pre‐PCI had significantly lower inpatient mortality than those who received support post‐PCI (P = 0.003). However, the magnitude of the survival benefit was significantly greater in women who received the Impella pre‐PCI as compared to men. Overall, 68.8% of women survived with pre‐PCI Impella 2.5 versus 24.2% post‐PCI (P = 0.005) whereas 54.2% of men survived with pre‐PCI Impella 2.5 versus 40.3% post‐PCI (P = 0.1, p‐interaction = 0.07). No differences in timing to intervention were found between men and women.Conclusions
Early initiation of hemodynamic support prior to PCI with Impella 2.5, in the setting of AMI complicated by CS, was associated with a greater survival benefit to hospital discharge in women compared to men, despite a higher predicted risk of mortality and a greater revascularization failure rate for women. (J Interven Cardiol 2016;29:248–256)3.
Syed S. Mahmood Michael G. Fradley Justine V. Cohen Anju Nohria Kerry L. Reynolds Lucie M. Heinzerling Ryan J. Sullivan Rongras Damrongwatanasuk Carol L. Chen Dipti Gupta Michael C. Kirchberger Magid Awadalla Malek Z.O. Hassan Javid J. Moslehi Sachin P. Shah Sarju Ganatra Paaladinesh Thavendiranathan Donald P. Lawrence Tomas G. Neilan 《Journal of the American College of Cardiology》2018,71(16):1755-1764
Background
Myocarditis is an uncommon, but potentially fatal, toxicity of immune checkpoint inhibitors (ICI). Myocarditis after ICI has not been well characterized.Objectives
The authors sought to understand the presentation and clinical course of ICI-associated myocarditis.Methods
After observation of sporadic ICI-associated myocarditis cases, the authors created a multicenter registry with 8 sites. From November 2013 to July 2017, there were 35 patients with ICI-associated myocarditis, who were compared to a random sample of 105 ICI-treated patients without myocarditis. Covariates of interest were extracted from medical records including the occurrence of major adverse cardiac events (MACE), defined as the composite of cardiovascular death, cardiogenic shock, cardiac arrest, and hemodynamically significant complete heart block.Results
The prevalence of myocarditis was 1.14% with a median time of onset of 34 days after starting ICI (interquartile range: 21 to 75 days). Cases were 65 ± 13 years of age, 29% were female, and 54% had no other immune-related side effects. Relative to controls, combination ICI (34% vs. 2%; p < 0.001) and diabetes (34% vs. 13%; p = 0.01) were more common in cases. Over 102 days (interquartile range: 62 to 214 days) of median follow-up, 16 (46%) developed MACE; 38% of MACE occurred with normal ejection fraction. There was a 4-fold increased risk of MACE with troponin T of ≥1.5 ng/ml (hazard ratio: 4.0; 95% confidence interval: 1.5 to 10.9; p = 0.003). Steroids were administered in 89%, and lower steroids doses were associated with higher residual troponin and higher MACE rates.Conclusions
Myocarditis after ICI therapy may be more common than appreciated, occurs early after starting treatment, has a malignant course, and responds to higher steroid doses. 相似文献4.
The Use of Impella 2.5 in Severe Refractory Cardiogenic Shock Complicating an Acute Myocardial Infarction 下载免费PDF全文
下载免费PDF全文 FREDERIC CASASSUS M.D. JEROME CORRE M.D. LIONEL LEROUX M.D. Ph.D. PIERRE CHEVALEREAU M.D. AURELIE FRESSELINAT Ph.D. BENJAMIN SEGUY M.D. JOACHIM CALDERON M.D. PIERRE COSTE M.D. Ph.D. ALEXANDRE OUATTARA M.D. Ph.D. XAVIER ROQUES M.D. Ph.D LAURENT BARANDON M.D. Ph.D 《Journal of interventional cardiology》2015,28(1):41-50
Objectives
To investigate the outcome of patients with acute myocardial infarction (AMI) complicated by refractory cardiogenic shock (CS) who underwent mechanical circulatory support with Impella 2.5.Background
AMI complicated by CS remains a highly fatal condition. A potent and minimally invasive left ventricular assist device might improve patient outcomes.Methods
We analyzed the procedural characteristics and outcomes of 22 consecutive patients who underwent, between July 2008 and December 2012, a percutaneous coronary intervention and Impella 2.5 support for AMI complicated by CS refractory to first‐line therapy with inotropes and/or Intra‐aortic balloon pump.Results
In this analysis, patients were relatively young with a mean age of 57.9 ± 11.6 year old and 59.1% were male. The majority of patients (77.3%) were admitted in CS and 40.9% sustained cardiac arrest prior to admission. Hemodynamics improved significantly upon initiation of support, end‐organ and tissue perfusion improved subsequently demonstrated by a significant decrease in lactate levels from 6.37 ± 5.3 mmol/L to 2.41 ± 2.1 mmo/L, (P = 0.008) after 2 days of support. Thirteen (59.1%) patients were successfully weaned‐off Impella 2.5 and 4 (18.2%) were transitioned to another device. We observed a functional recovery of the left ventricle when compared to baseline (43 ± 10% vs. 27 ± 9%, P < 0.0001). The survival rate at 6 months and 1 year was 59.1% and 54.5%, respectively.Conclusion
Impella 2.5 was initiated as a last resort therapy to support very sick patients with refractory CS after failed conventional therapy. The use of the device yielded favorable short and mid‐term survival results with recovery being the most frequently observed outcome. (J Interven Cardiol 2015;28:41–50)5.
Purpose of Review
This review aims to discuss the role of ECMO in the treatment of cardiogenic shock in heart failure.Recent Findings
Trials done previously have shown that IABP does not improve survival in cardiogenic shock compared to medical treatment, and that neither Impella 2.5 nor TandemHeart improves survival compared to IABP. The “IMPRESS in severe shock” trial compared Impella CP with IABP and found no difference in survival. A meta-analysis of cohort studies comparing ECMO with IABP showed 33% improved 30-day survival with ECMO (risk difference 33%; 95% CI 14–52%; p =?0.0008; NNT 3).Summary
ECMO is indicated in medically refractory cardiogenic shock. ECMO can be considered in cardiogenic shock patients with estimated mortality of more than 50%. ECMO is probably the MCS of choice in cardiogenic shock with; biventricular failure, respiratory failure, life-threatening arrhythmias and cardiac arrest.6.
Vikas Singh Rodrigo Mendirichaga Ignacio Inglessis-Azuaje Igor F. Palacios William W. O’Neill 《Current treatment options in cardiovascular medicine》2018,20(6):44
Purpose of review
The goal of this review is to discuss the effects of Impella (Abiomed, Danvers, MA), to support in the hemodynamics of patients with severe aortic stenosis, and to explore the clinical scenarios in which the use of Impella may be beneficial in this setting.Recent findings
The management of patients with severe aortic stenosis who go on to develop left ventricular failure and cardiogenic shock remains an important clinical challenge associated with increased morbidity and mortality.Summary
Once considered a relative contraindication, the use of Impella in severe aortic stenosis has now been proven feasible and demonstrated promising results in selected high-risk patients. The use of Impella to provide hemodynamic support maybe considered in patients with aortic stenosis in cardiogenic shock or those with severe left ventricular dysfunction and CAD who require high-risk PCI and or balloon aortic valvuloplasty. Impella is also an attractive option in selected cases of hemodynamic collapse during TAVR.7.
Background
Calculated estimates of plasma volume (PV) have been developed with the use of hemoglobin/hematocrit-body weight–based methods. The accuracy of such formula-derived values has not been thoroughly evaluated. The objective of this analysis was to compare the calculated estimate and a quantitative measure of PV in patients with chronic heart failure (HF).Methods and Results
PV was measured with the use of a standardized computer-based indicator-dilution–labeled albumin technique in 110 patients with clinically stable chronic HF and correlated with paired Kaplan-Hakim (K-H) and Strauss formula estimates of PV. The K-H formula underestimated (3.4 ± 0.7 L) and the Strauss formula overestimated (5.3 ± 1.5 L) PV relative to the measured volume (4.3 ± 1.1 L). Calculated PV was only moderately correlated with measured PV by the K-H formula (r?=?0.64; P < .001) and weakly by the Strauss formula (r?=?0.285; P?=?.003). Strauss formula estimates of change (%) in PV were also poorly correlated with paired measured changes in PV (r?=?0.162; P?=?.999; n?=?40).Conclusions
Calculated estimates of PV demonstrate limited association with measured volumes. These findings indicate that although formula-based estimates of PV have been shown to have prognostic value, they are limited in their reliability for volume management in patients with chronic HF. 相似文献8.
Qing Cao Cheng-Bo Yu Shi-Gui Yang Hong-Cui Cao Ping Chen Min Deng Lan-Juan Li 《Hepatobiliary & pancreatic diseases international : HBPD INT》2018,17(1):9-16
Background: Minimal hepatic encephalopathy(MHE) is an early and reversible form of hepatic encephalopathy. The documentations on the treatment with probiotics are inconsistent. The present meta-analysis was to verify the role of probiotics in the treatment of cirrhotic patients with MHE.Data sources: Seven electronic databases were searched for relevant randomized controlled trials(RCTs)published until July 2015. The effects of probiotics on serum ammonia, endotoxin, and MHE were evaluated.Results: A total of 14 RCTs(combined n = 1132) were included in the meta-analysis. When probiotics were compared to placebo or no treatment, probiotics were more likely to reduce values in the number connection test(NCT; week 4: MD =-30.25, 95% CI:-49.85 to-10.66), improve MHE(week 4: OR = 0.18,95% CI: 0.07 to 0.47; week 12: OR = 0.15, 95% CI: 0.07 to 0.32), and prevent overt HE progression(week4: OR = 0.22, 95% CI: 0.07 to 0.67) in patients with liver cirrhosis. When probiotics was compared to lactulose, probiotics tended to reduce serum ammonia levels(week 4: MD =-0.33 μmol/L, 95% CI:-5.39 to 4.74; week 8: MD = 6.22 μmol/L, 95% CI:-24.04 to 36.48), decrease NCT(week 8: MD = 3.93, 95% CI:-0.72 to 8.58), improve MHE(week 4: OR = 0.93, 95% CI: 0.45 to 1.91; week 12: OR = 0.73, 95% CI: 0.35 to 1.51) and prevent the development of overt HE(week 4: OR = 0.96, 95% CI: 0.17 to 5.44; week 12:OR = 2.7, 95% CI: 0.50 to 14.64) in patients with liver cirrhosis. However, lactulose appears to be more effective in reducing NCT values as compared to probiotics(week 4: MD = 6.7, 95% CI: 0.58 to 12.82).Conclusion: Probiotics can decrease serum ammonia and endotoxin levels, improve MHE, and prevent overt HE development in patients with liver cirrhosis. 相似文献
9.
Ehimare Akhabue Jacob B. Pierce Laura J. Davidson Stuart B. Prenner Raja K. Mutharasan Jyothy J. Puthumana Sanjiv J. Shah Allen S. Anderson James D. Thomas 《Journal of cardiac failure》2018,24(9):614-617
Background
Rehospitalization for heart failure (HF) is common, and subclinical congestion may be present at discharge. Larger inferior vena cava (IVC) size and lower collapsibility at discharge assessed via bedside ultrasound are predictive of rehospitalization; however, the utility of IVC assessment with the use of pocket-carried ultrasound (PCUS) during the transition from discharge to the posthospitalization follow-up visit (FU) has not been investigated.Methods and Results
IVCmax and IVCmin were measured with the use of PCUS, and the collapsibility index (IVCCI?=?[IVCmax???IVCmin]/IVCmax) was determined. The primary outcome was 90-day rehospitalization or death. We prospectively enrolled 49 adults (71 ± 13 years of age, 51% male, 47% black, 43% preserved ejection fraction) hospitalized for HF. Nineteen patients (39%) experienced the outcome. Within the rehospitalized group, discharge and FU mean IVCmax were both >2.1 cm (2.2 ± 0.5 and 2.2 ± 0.7) and IVCCIs <50% (44 ± 20% and 45 ± 24%). Within those not rehospitalized, FU IVCmax was ≤2.1 cm (2.1 ± 0.6 and 1.9 ± 0.6; P?=?.038) and IVCCI >50% at both time points (55 ± 25% and 62 ± 19%; P?=?NS). FU IVCCI below an optimal cutoff of 42% had modest discrimination alone (c-statistic?=?0.73). FU IVCCI <42% was associated with a greater hazard of the outcome independent of admission log B-type natriuretic peptide (adjusted hazard ratio?=?6.8; 95% confidence interval 2.4–19.0; P < .001).Conclusions
Posthospitalization IVCCI assessment with PCUS predicts HF rehospitalization and may identify patients in need of intervention. 相似文献10.
Brittany O. Dulmage Lisa Akintilo Leah J. Welty Matthew M. Davis Maria Colavincenzo Shuai Xu 《The American journal of medicine》2018,131(9):1130-1134.e6
IMPORTANCE
Residency applicants often use social media to discuss the positive and negative features of prospective training programs. An examination of the content discussed by applicants could provide guidance for how a medical education faculty can better engage with prospective trainees and adapt to meet the educational expectations of a new generation of digital-native physicians.OBJECTIVE
The objective was to identify unstructured social media data submitted by residency applicants and categorize positive and negative statements to determine key themes.DESIGN
The study design was qualitative analysis of a retrospective cohort.SETTING
Publicly available datasets were used.PARTICIPANTS
The participants were anonymized medical trainees applying to residency training positions in 9 specialties—dermatology, general surgery, internal medicine, obstetrics/gynecology, plastic surgery, otolaryngology, physical medicine and rehabilitation, pediatrics, and radiology—from 2007 to 2017.MAIN OUTCOMES AND MEASURES
After we developed a standardized coding scheme that broke comments down into major features, themes, and subthemes, all unstructured comments were coded by two independent researchers. Positive and negative comments were coded separately. Frequency counts and percentages were recorded for each identified feature, theme, and subtheme. The percent positive and negative comments by specialty were also calculated.RESULTS
: Of the 6314 comments identified, 4541 were positive and 1773 were negative. Institution was the most commonly cited major feature in both the positive (n?=?767 [17%]) and negative (n?=?827 [47%]) comments. Geography was the most cited theme, and City, Cost of Living, and Commute were commonly cited subthemes. Training was the next most cited major feature in both positive (n?=?1005 [22%]) and negative (n?=?291 [16%]) comments, with Clinical Training being more commonly cited compared to Research Opportunities. Overall, 72% of comments from all were positive; however, the percent of comments that were positive comments varied significantly across the 9 specialties. Pediatrics (65%), dermatology (66%), and internal medicine (68%) applicants were more likely to express negative comments compared with the global average, but physical medicine and rehabilitation (85%), radiology (82%), otolaryngology (81%), and plastic surgery (80%) applicants were more likely to express positive comments.CONCLUSIONS AND RELEVANCE
This qualitative analysis of positive and negative themes as posted by applicants in recent matching years is the first and provides new detailed insights into the motivations and desires of trainees. 相似文献11.
Leo I. Amodu Jamil Alexis Aron Soleiman Meredith Akerman Poppy Addison Toni Iurcotta Horacio L. Rodriguez Rilo 《Hepatobiliary & pancreatic diseases international : HBPD INT》2018,17(3):269-274
Background: Pancreatectomies have been identified as procedures with an increased risk of readmission.In surgical patients, readmissions within 30 days of discharge are usually procedure-related. We sought to determine predictors of 30-day readmission following pancreatic resections in a large healthcare system.Methods: We retrospectively collected information from the records of 383 patients who underwent pancreatic resections from 2004–2013. To find the predictors of readmission in the 30 days after discharge,we performed a univariate screen of possible variables using the Fisher's exact test for categorical variables and the Mann–Whitney U test for continuous variables. Multivariate analysis was used to determine the independent factors.Results: Fifty-eight(15.1%) patients were readmitted within 30 days of discharge. Of the patients readmitted, the most common diagnoses at readmission were sepsis(17.2%), and dehydration(8.6%). Multivariate logistic regression found that the development of intra-abdominal fluid collections(OR = 5.32, P 0.0001),new thromboembolic events(OR = 4.08, P = 0.016), and pre-operative BMI(OR = 1.06, P = 0.040) were independent risk factors of readmission within 30 days of discharge.Conclusion: Our data demonstrate that factors predictive of 30-day readmission are a combination of patient characteristics and the development of post-operative complications. Targeted interventions may be used to reduce the risk of readmission. 相似文献
12.
SHEILA L. Klassen ROBERT J.H. MILLER ROBIN HAO J. WAYNE WARNICA NOWELL M. FINE MAHENDRA CARPEN DEBRA L. ISAAC 《Journal of cardiac failure》2018,24(12):835-841
Background
Guyana is a small developing country with a high burden of cardiovascular disease and extensive barriers to optimal care delivery. We investigated the effectiveness of a newly established multidisciplinary inpatient cardiology service in this setting.Methods
We performed an interrupted time-series cohort study of heart failure (HF) patients admitted to the Georgetown Public Hospital Corporation from January to December 2015 and July 2016 to December 2017. The primary outcome was discharge on guideline-directed medical therapy (GDMT). Secondary outcomes included length of hospitalization and all-cause mortality.Results
We identified 740 patients, 347 (46.9%) of whom were admitted after service implementation. The postimplementation cohort was more likely to be discharged on a beta-blocker (66.6% vs 41.7%; P < .01) and mineralocorticoid receptor antagonist (31.7% vs 15.3%; P?=?.01). They were also more likely to undergo echocardiography (60.8% vs 40.5%; P < .01) and chest x-rays (70.6% vs 46.6%; P < .01). Hospitalization length (10.0 ± 13.1 vs 9.8 ± 10.1 days) and readmissions within 90 days (19.0% vs 19.1%) were not significantly different. There were fewer deaths in the postimplementation cohort compared with the preimplementation cohort (12/347 vs 28/393).Conclusions
Establishment of a multidisciplinary inpatient cardiology service demonstrated increased adherence to GDMT without extending length of hospitalization. 相似文献13.
Taya Irizarry Matthew Allen Brian P. Suffoletto Julian Einhorn Lora E. Burke Thomas W. Kamarck Bruce L. Rollman Matthew F. Muldoon 《The American journal of medicine》2018,131(9):1125.e1-1125.e8
Background
Uncontrolled hypertension constitutes a significant challenge throughout the world. Blood pressure measurement by patients is informative for both patients and providers but is rarely performed systematically, thereby reducing its utility. Mobile phones can be used to efficiently prompt individuals to measure blood pressure and automate data management while avoiding technology barriers to widespread adoption. Presented is the design and pilot test results of MyBP, an automated texting intervention to support blood pressure self-monitoring and patient self-management.Methods
Three sequential phases are described: (1) stakeholders’ needs assessment, (2) preliminary design pilot (n?=?10), and (3) a 6-week pilot of the redesigned comprehensive program with hypertensive patients (n?=?43) recruited from 3 clinical sites (Emergency Department, Primary Care, Hypertension Center). Outcomes of interest included participant adherence, perceived importance of blood pressure monitoring, and healthy behavior change.Results
Median adherence to MyBP prompts over 6 weeks was 79% (72% emergency department, 84% primary care, and 96% hypertension center, H[2] = 5.56, P = .06). Adherence did not vary by age, sex, education, or baseline use of texting but was lowest among patients recruited from the emergency department (χ[2]2?=?6.66, P = .04). In the exit survey, MyBP was associated with increased importance of blood pressure self-monitoring and particularly motivated primary care and emergency department groups to improve dietary habits, increase daily physical activity, and focus on stress reduction. The majority of participants (88%) indicated interest in using the program for 6 months.Conclusions
Automated mobile-phone–based blood pressure self-monitoring using MyBP is feasible, acceptable, and scalable, and may improve self-management and support clinical care. 相似文献14.
Ya Wen Shi-Fang Peng Lei Fu Xiao-Yu Fu Da-Xian Wu Bing-Jie Liu De-Ming Tan Yi Ouyang 《Hepatobiliary & pancreatic diseases international : HBPD INT》2018,17(2):126-132
Background: Hepatitis B virus(HBV)-associated acute-on-chronic liver failure(HBV-ACLF) is a lifethreatening condition and its exact pathophysiology and progression remain unclear. The present study aimed to assess the role of serum mi RNAs in the evaluation of HBV-ACLF and to develop a model to predict the outcomes for ACLF.Methods: Serum was collected from 41 chronic hepatitis B and 55 HBV-ACLF patients in addition to30 chronic asymptomatic HBV carriers as controls. The mi RNAs expressions were measured by real-time quantitative PCR(q-PCR). Statistical analyses were conducted to assess the ability of differentially expressed mi RNAs and other prognostic factors in identifying ACLF prognosis and to develop a new predictive model.Results: Real-time q-PCR indicated that serum miR-146 a-5 p, mi R-122-3 p and mi R-328-3 p levels were significantly upregulated in ACLF patients compared to chronic hepatitis B and chronic asymptomatic HBV carriers patients. In addition, multivariate regression analyses indicated that Na+, INR, gastrointestinal bleeding and mi R-122-3 p are all independent factors that are reliable and sensitive to the prognosis of HBV-ACLF. Therefore, we developed a new model for the prediction of HBV-ACLF disease state: Y = 0.402 × Na+-1.72 × INR-4.963 × gastrointestinal bleeding(Yes = 0; No = 1)-0.278 ×(mi R-122-3 p) + 50.449. The predictive accuracy of the model was 95.3% and the area under the receiver operating characteristic curve(AUROC) was 0.847.Conclusions: Expression levels of these mi RNAs(miR-146 a-5 p, mi R-122-3 p and mi R-328-3 p) positively correlate with the severity of liver inflammation in patients with ACLF and may be useful to predict HBV-ACLF severity. 相似文献
15.
Jin Jeon Sung Uk Lim Chang-Hwan Park Chung-Hwan Jun Seon-Young Park Jong-Sun Rew 《Hepatobiliary & pancreatic diseases international : HBPD INT》2018,17(3):251-256
Background: Little information is available about the relationship between restoration of common bile duct(CBD) diameter after endoscopic stone retraction and recurrence of CBD stones in elderly patients.The present study was to determine whether restoration of CBD diameter is a preventive factor for CBD stone recurrence in elderly patients who underwent endoscopic retrograde cholangiopancreatography(ERCP).Methods: From January 2006 to December 2010, 238 patients underwent the first and the second session of ERCP for the removal of CBD stones. Among them, 173 were over 65 years old. These patients were divided into recurrent group and non-recurrent group. Restoration of CBD diameter and patients' characteristics were compared.Results: There was no statistical difference in patients' characteristics, associated diseases, or ERCP-related complications between the two groups. Reduction of CBD diameter was significantly larger in the nonrecurrent group(2.7 ± 1.7 mm) compared to that in the recurrent group(1.4 ± 2.3 mm, P = 0.002). The proportion of patients with restoration of CBD diameter were significantly lower in the recurrent group(6/42, 14.3%) compared with that in the non-recurrent group(67/131, 51.1%)(P 0.01).Conclusions: There is an inverse relationship between restoration of CBD diameter and CBD stone recurrence. Therefore, patients without restoration of CBD diameter within 2 weeks after endoscopic stone removal should be monitored more frequently. 相似文献
16.
Benjamin Brenner Behnood Bikdeli Inna Tzoran Olga Madridano Raquel López-Reyes José María Suriñach Ángeles Blanco-Molina Antonella Tufano Juan José López Núñez Javier Trujillo-Santos Manuel Monreal 《The American journal of medicine》2018,131(9):1095-1103
Background
Venous thromboembolism is common in patients with malignancies, affecting up to 10% of this patient population. The association between arterial ischemic events and venous thromboembolism also has been established. However, the influence of arterial ischemic events on outcomes in cancer patients with venous thromboembolism has not been fully determined.Methods
The current study analyzed clinical characteristics, time course, risk factors, incidence and severity of venous thromboembolism recurrences, arterial ischemic events and major bleeding in 5717 patients with active cancer and venous thromboembolism recruited into RIETE (multi-center prospective registry of patients with objectively confirmed venous thromboembolism).Results
During the anticoagulation course (median 7.3 months), 499 (8.7%) patients developed venous thromboembolism recurrences, 63 (1.1%) developed arterial events, and 346 (6.1%) suffered from major bleeding. Overall, major bleeding and arterial events appeared earlier (median 35 and 36 days, respectively) than venous thromboembolism recurrences (median 97 days). Thirty-day mortality rates after each event were: 20% after recurrent pulmonary embolism, 13% after recurrent deep vein thrombosis, 41% after major bleeding, 40% after myocardial infarction, 64% after ischemic stroke, and 83% after lower limb amputation. Bleeding was the leading cause of death (67 fatal bleeds), whereas cumulative mortality due to arterial ischemic events (n?=?27) was similar to that related to pulmonary embolism recurrences (n?=?26).Conclusions
In this study, arterial ischemic events and major bleeding appeared early after venous thromboembolism in patients with active cancer and were among frequent causes of their deaths. The risk and severity of arterial events need to be considered in this clinical setting. 相似文献17.
Jung Wan Choe Hyo Jung Kim Jae Seon Kim Jaehyung Cha Moon Kyung Joo Beom Jae Lee Jong-Jae Park Young-Tae Bak 《Hepatobiliary & pancreatic diseases international : HBPD INT》2018,17(3):263-268
Background: Generally, carbohydrate antigen 19–9(CA 19–9) is not useful for screening pancreatic cancer in the asymptomatic general population. This study aimed to evaluate the utility of CA 19–9 level as a screening indicator of pancreatic cancer in asymptomatic patients with new-onset diabetes.Methods: We retrospectively reviewed the medical records of patients who visited our health promotion center for health check-ups without cancer related symptoms from January 2005 to January 2014, and were newly diagnosed with diabetes mellitus(DM) within 2 years before their visit.Results: Of the 5111 asymptomatic patients with new-onset DM(2 years) selected for analyses, 87(1.7%) eventually developed pancreatic cancer after the health check-up. In the subgroup of 322 patients with high total bilirubin levels(1.7 mg/d L) at the screening time, 42(73.7%) of 57 patients with high CA19–9 levels(37 IU/m L) had been diagnosed as pancreatic cancer during follow-up period and 12(4.5%)of 265 patients with normal CA 19–9 levels had finally developed pancreatic cancer(OR = 16.3). In the subgroup of 4789 patients with normal bilirubin levels, pancreatic cancer had been detected in 20(3.8%)of 522 patients with high CA 19–9 level, while only 13(0.3%) in 4267 patients with normal CA 19–9 levels(OR = 12.6), respectively.Conclusion: CA 19–9 levels after a diagnosis of new-onset DM could be a useful biomarker of pancreatic cancer, especially in patients with high serum bilirubin. 相似文献
18.
Stefano Francesco Crinò Maria Cristina Conti Bellocchi Laura Bernardoni Erminia Manfrin Alice Parisi Antonio Amodio Nicolò De Pretis Luca Frulloni Armando Gabbrielli 《Hepatobiliary & pancreatic diseases international : HBPD INT》2018,17(1):70-74
Background: Early detection of small solid pancreatic lesions is increasingly common. To date, few and contradictory data have been published about the relationship between lesion size and endoscopic ultrasound-guided fine needle aspiration(EUS-FNA) diagnostic yield. The aim of this study was to assess the relation between the size of solid pancreatic lesions and the diagnostic yield of EUS-FNA using a 25-gauge needle in a center without available rapid on-site evaluation.Methods: In the retrospective cohort study, we selected patients who underwent EUS-FNA for solid pancreatic lesions with a 25-gauge needle from October 2014 to October 2015. Patients were divided into three groups(≤15 mm, 16–25 mm and 25 mm), and the outcomes were compared.Results: We analyzed 163 patients. Overall adequacy, sensitivity, specificity and accuracy were 85.2%,81.8%, 93.7%, and 80.4%, respectively. When stratified by size, the sensitivity and accuracy correlated with size(P = 0.016 and P = 0.042, respectively). Multivariate analysis showed that lesion size was the only independent factor(P = 0.019, OR = 4.76) affecting accuracy. The role of size as an independent factor affecting accuracy was confirmed in a separate multivariate analysis, where size was included in the model as a covariate(P = 0.018, OR = 1.08).Conclusion: Our study demonstrates that, in the absence of rapid on-site evaluation, mass size affects the accuracy of EUS-FNA of solid pancreatic lesions. 相似文献
19.
Shu-Fen Su Ying-Chin Liao Meng-Shan Wu 《Heart & lung : the journal of critical care》2018,47(6):576-583
Background
Transfemoral percutaneous coronary intervention (PCI) requires strict bed rest, causing pain and discomfort in patients. However, no studies have investigated this issue.Objectives
To investigate the predictors of discomfort in transfemoral PCI patients.Methods
A cross-sectional sample of 110 patients from two coronary care units completed questionnaires on demographic and clinical characteristics, visual analogue pain scale, and discomfort.Results
Eight factors predicted overall discomfort: physiologic pain, physiological discomfort, psychological discomfort, analgesic use after sheath removal, hemostasis method, and bed rest duration. Psychological discomfort was associated with age, chronic obstructive pulmonary disease, analgesic use after sheath removal, successful hemostasis, and hematoma >5 cm. A hierarchical regression model explained 70.5% of the variance in overall discomfort.Conclusions
Age and physiologic pain are major predictors of overall discomfort, especially in patients aged <60 years having high pain sensitivity. Critical care providers should note patients’ physiological and psychological issues throughout the PCI process. 相似文献20.
Matthew S. Delfiner Colleen Nofi Ying Li A. Martin Gerdes Youhua Zhang 《Journal of cardiac failure》2018,24(7):460-469