Ist die infrainguinale Rekonstruktion der arteriellen Strombahn mit autologer Vene im Stadium der limitierenden Klaudikation gerechtfertigt?

Infrainguinal arterial reconstruction for intermittent claudication has been discouraged because of fear of bypass graft failure, significant perioperative complications, and limb loss. This may be worse than the natural history of the disease. In our study, we retrospectively evaluated all infrainguinal bypass procedures performed in the past 10 years.From October 1988 to December 1998, we performed 421 infrainguinal arterial reconstructions, 115 (27.2%) for debilitating claudication and 306 (72.8%) for critical ischemia in 410 patients. The average age was 73.2 years (range 20–86 years). There were significantly more diabetics with critical ischemia (183 versus 14, P=0.000). Other risk factors (smoking, hypertension, hyperlipidemia) were evenly distributed in both groups. Follow-up was scheduled in our vascular laboratory.The primary patency rates were 64.8% for intermittent claudication and 54.2% for critical ischemia at 7 years (P value not significant), and the primary assisted patency rates were 86.1% and 79.3%, respectively (P value not significant). There were 2 patients (1.7%) with limb loss in the follow-up period (3 and 5 years after operation, respectively). Both patients were diabetics, who had to be amputated with patent grafts because of progressive forefoot gangrene. The 30-day mortality rate was 0.8% (1 patient died on the second postoperative day due to cardiac failure).In our experience, patients with debilitating claudication have to be managed by a team of angiologists, radiologists, and vascular surgeons. The use of autologous vein, intraoperative angioscopy, and a scheduled follow-up program may be the cornerstones for excellent long-term results. These results justify operation in selected cases.     

Interactions of a history of migration with the course of pain disorder

OBJECTIVE: Previous studies indicate that sociocultural factors affect the course of pain disorder. We investigated the role of nationality as an indicator of cultural factors, and of the degree of inclusion (DI) in Swiss society as an indicator of the migration process on the course of pain disorder. METHOD: In a semiprospective case-control study, outcome was assessed after a 2-year follow-up in 57 patients treated for pain disorder by phone interview with the patients. One Swiss patient was matched with two Spanish or Italian patients living in Switzerland. Patients' appraisal of course of illness (PACI) and of current general health (PACGH) were assessed as the sum score of their ratings of general well-being, handicap in everyday life, work ability, mood and pain. Family physicians were also asked to rate patient's course of illness. DI in Swiss society was assessed according to type of work permit, age at immigration and fluency in the language of the receiving country. RESULTS: Swiss patients evaluated their PACI [H(1,56) = 4.30; P = .0038] and PACGH [H(1,56) = 9.04; P = .003)] more favourably than patients from Italy and Spain. This difference was confirmed by the family physician's evaluation of the course of illness. A similar difference in outcome was found in favour of foreign patients with a higher DI. CONCLUSION: These results indicate that, in addition to sociocultural factors, the DI affects the outcome of pain disorder in patients with a history of migration.     

替硝唑软膏的研制与临床应用

目的:研究替硝唑软膏,并应用于临床。方法:参照同类制剂,确定最优组方和制备方法,采用紫外分光光度法测定含量,用比较法进行临床疗效观察。结果:制剂制备简单,含量测定方法简便,结果可靠,经临床应用牙周炎、牙龈炎患者62例,总有效率95.3％。结论:本品是治疗牙周炎、牙龈炎的理想制剂,值得推广应用。     

Endovascular treatment of a post-traumatic thoracic false aneurysm in an adolescent. A case report

A 17 year old healthy young man suffered a motor-vehicle accident with severe polytrauma. During the rehabilitation a slight hypertension and a blood pressure difference of 30-40 mmHg between arms and legs was recognized. Mindful of a possible aortic lesion, an angio-magnetic resonance imaging (MRI) showed a 2.7x4.2 cm thoracic false aneurysm at the descending aorta. About 1 month after initial trauma, a Talent stent was implanted. The postinterventional period was uneventful. The patient was discharged on the 5th postoperative day.     

Hypopituitarism and neurodevelopmental abnormalities in relation to central nervous system structural defects in children with optic nerve hypoplasia

OBJECTIVE: Optic nerve hypoplasia (ONH) is a heterogeneous disease with variable findings of pituitary insufficiency, CNS and neurodevelopmental abnormalities. We characterized the spectrum of endocrinopathy in a cohort of children with ONH and attempted to correlate the presence of different midline CNS findings with the degree of hypopituitarism. The correlation of variable CNS abnormalities with the presence of a seizure disorder and neurodevelopmental delay was also examined. METHODS: Charts of 56 patients with ONH referred to our endocrine clinics between 1990 and 2000 were reviewed. Neurodevelopmental assessment was based on questionnaires sent to families during the study period. RESULTS: Forty-six patients (82%) had hypopituitarism, with growth hormone deficiency being the most common endocrinopathy. All patients with diabetes insipidus, hypocortisolism, and hypogonadotropin hypogonadism also had combined pituitary hormone deficiency. Evolving pituitary hormone deficiency was observed in two of 37 patients diagnosed with hypopituitarism in the first 3 years of life. No single midline CNS finding correlated with the presence of hypopituitarism or a seizure disorder. However, hydrocephalus or a seizure disorder was more commonly seen in patients with developmental delay. CONCLUSION: ONH is a heterogeneous disorder with possible multifactorial etiologies. All patients with this diagnosis deserve a comprehensive endocrine and neurodevelopmental evaluation.     

The effect of episodic anxiety on an in vitro fertilization and intracytoplasmic sperm injection treatment outcome: a pilot study

This study examines whether the inconsistent and contradictory findings from prospective studies on the effect of psychosocial factors on treatment outcome of in vitro fertilization (IVF) can be explained by the fact that no clear distinction has been made between acute and chronic emotional stress responses. Because chronicity is difficult to measure within the context of an IVF-procedure, the focus of the present study was on episodic anxiety. We compared its predictive value on treatment outcome after the second IVF and intracytoplasmic sperm injection (ICSI) with the predictive value of trait anxiety and acute anxiety. In a prospective study with 47 women who failed to conceive after the first IVF, state anxiety was measured both before and after the first IVF treatment. Episodic anxiety was operationalized as high state anxiety both before and after the first IVF treatment Student's t-test and logistic regression analysis were used to determine the predictive value of episodic anxiety compared with acute or trait anxiety. Women with episodic anxiety, but not those with high levels of trait or acute anxiety, were less likely to become pregnant after the second IVF/ICSI. The results suggest that future studies should differentiate between acute and chronic stress, when examining the effects of psychosocial factors on treatment outcome after a fertility treatment     

Lung function,asthma symptoms,and quality of life for children in public housing in Boston: a case-series analysis

Background  

Children in urban public housing are at high risk for asthma, given elevated environmental and social exposures and suboptimal medical care. For a multifactorial disease like asthma, design of intervention studies can be influenced by the relative prevalence of key risk factors. To better understand risk factors for asthma morbidity in the context of an environmental intervention study, we conducted a detailed baseline evaluation of 78 children (aged 4–17 years) from three public housing developments in Boston.