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排序方式: 共有1006条查询结果,搜索用时 187 毫秒
1.
Stent placement for benign pancreatic diseases: correlation between ERCP findings and clinical response. 总被引:1,自引:0,他引:1
D J Gulliver S Edmunds M E Baker S Paine J Baillie P B Cotton R P Rice 《AJR. American journal of roentgenology》1992,159(4):751-755
OBJECTIVE. We performed a study to determine if the appearance of the pancreatic duct on ERCP before and after placement of pancreatic duct stents correlates with the therapeutic response in patients treated for impaired pancreatic drainage. MATERIALS AND METHODS. Findings in 29 consecutive patients with a variety of benign pancreatic diseases in whom pancreatic stents were placed and subsequently removed within a 3-year period were reviewed retrospectively. Early (1-5 days) and late (1-3 months) clinical outcomes after stent placement were assessed. These findings were correlated with a blinded interpretation of ERCP findings (Cambridge criteria were used) before and after stent placement. RESULTS. ERCP findings before stent placement were normal in 10 patients. At the end of stent therapy, ERCP showed changes associated with chronic pancreatitis in all 10; five had focal narrowing at the tip of the stent. Subsequent ERCP studies in five of these 10 patients showed that ductal changes induced by stents diminished after stent removal. Of the 19 patients with abnormal findings on ERCP at the time of stent placement, ERCP at the end of stent therapy showed some improvement in seven patients, no change in eight, and deterioration in four. Changes seen on ERCP had no statistically significant correlation with clinical outcome (p = .36). CONCLUSION. Our findings show that pancreatic duct stents can induce abnormalities on ERCP indicative of chronic pancreatitis. However, diminution of these abnormalities after stent removal in some patients suggests that these changes may be due to edema rather than to fibrosis. Ductal changes seen on ERCP are not a useful guide for determining the degree of response to pancreatic stents. 相似文献
2.
Thrombotic and bleeding complications of prosthetic heart valves 总被引:8,自引:0,他引:8
L H Edmunds 《The Annals of thoracic surgery》1987,44(4):430-445
A review of articles published since 1979 indicates that thrombotic and bleeding complications account for about 50% of valve-related complications in patients with bioprosthetic aortic and mitral valves and for approximately 75% of the complications in patients with mechanical valves. Although compromised by lack of standard definitions and by variability in reporting and follow-up, the data suggest that the linearized rate of both thrombotic and bleeding complications in patients with aortic bioprostheses is approximately half that for aortic mechanical prostheses (2% versus 4%), but is approximately equal for both bioprostheses and mechanical valves in the mitral position (approximately 4%), and for mechanical and bioprosthetic aortic and mitral valves in combination. However, linearized rates for fatal thrombotic and bleeding events are two to four times higher in patients with mechanical prostheses. The adequacy of warfarin anticoagulation is the most important factor affecting thrombotic and bleeding complications in patients with mechanical valves and over shadows the dubious importance of other phenomena such as atrial fibrillation and left atrial thrombus. Short-term warfarin anticoagulation or the use of long-term platelet inhibitors, or both, do not appear to reduce the incidence of thrombotic complications in patients with aortic bioprostheses but increase bleeding. For mitral bioprostheses, the postoperative use of warfarin for three months or aspirin indefinitely is as effective in preventing thromboembolism as long-term warfarin. Acute prosthetic valve endocarditis is associated with a 13 to 40% incidence of thrombotic complications. Likewise, the recurrence rate of cerebral emboli is high (20-30%) in patients with prosthetic valves who are not anticoagulated. Bioprostheses are strongly preferred for women who wish to bear children; fetal wastage occurs in 25 to 30% of pregnant women with mechanical heart valves who receive either warfarin or heparin, or a combination of the two. Heparin, however, greatly increases the risk of maternal bleeding. In children, the efficacy of platelet inhibitors without warfarin anticoagulation is unproven; nearly all serious strokes occur when warfarin is omitted; and permanent disability from warfarin-related bleeding is rare. All prosthetic cardiac valves initiate coagulation and affect the dynamic equilibrium between activated procoagulants and endogenous anticoagulants. Warfarin is the only available oral exogenous anticoagulant.(ABSTRACT TRUNCATED AT 400 WORDS) 相似文献
3.
Calciphylaxis – a topical overview 总被引:3,自引:0,他引:3
G Arseculeratne† AT Evans‡ SM Morley† 《Journal of the European Academy of Dermatology and Venereology》2006,20(5):493-502
'Calciphylaxis', a calcification syndrome associated with ischaemic cutaneous necrosis, is acquired naturally in humans in disease states. It is a life and limb-threatening complication, usually observed in patients with renal disease and secondary hyperparathyroidism, but known to occur in the absence of renal or parathyroid disease. The reported mortality rate, which ranges from 60-80%, relates to wound infection, sepsis and organ failure. It is a small-vessel vasculopathy, which is estimated to occur in about 4% of haemodialysis patients. Clinically, violaceous, reticulate areas of cutaneous necrosis and eschar may be evident, particularly in the extremities. In addition to the clinical picture, a raised calcium phosphorous product, an elevated parathyroid hormone level, radiographic evidence of vessel and soft-tissue calcification and the finding of mural calcification affecting small arteries and arterioles on histopathology help to confirm the diagnosis of this entity which generally has a poor prognosis. A high index of suspicion and an active multidisciplinary management approach, with rigorous attention to wound care and prevention of sepsis, are vital in the management of these patients. In this overview, we discuss the pathophysiology, clinical features and associations, risk factors, diagnosis and management issues relating to calciphylaxis. 相似文献
4.
5.
Fusion of the metarcarpophalangeal joint of the thumb is an accepted treatment in the management of instability or osteoarthritis following trauma to this joint. A review was made of the literature and 30 of the senior author's (RH) patients who had had this operation, in order to determine what effect the operation had on the pain in their thumb, any symptoms of instability, interference with work and daily activities, and strength in the hand. All of the patients achieved bony union and the average angle of fusion was 7.6 degrees of flexion. All of the patients were either satisfied or very satisfied with the results of the operation, and had an average increase of 6.3 points on a 12 point rating scale. However, 48% of patients had some mild intermittent pain and 43% complained of some difficulty with fine motor tasks. Twelve patients were able to attend for formal evaluation including the Jebson and Crawford Hand Function Tests which revealed some decrease in hand function in all of those tested. It was concluded that this method of arthrodesis of the metacarpophalangeal joint of the thumb gives reliable results, with high patient acceptance, but does not result in an entirely normal thumb or hand function. 相似文献
6.
Hepatic failure associated with imipramine therapy 总被引:1,自引:0,他引:1
Imipramine, a widely used antidepressant, has rarely been associated with hepatic abnormalities. In the majority of reported cases, hepatic effects have been transient and readily reversible on discontinuation of the drug. We cared for an 11-year-old boy with hepatic failure and massive cell necrosis which followed treatment with imipramine for enuresis. This therapy led to fulminant hepatic failure and subsequent liver transplantation. 相似文献
7.
New light on uveitis in ankylosing spondylitis 总被引:4,自引:0,他引:4
Inflammatory eye disease is well recognized in ankylosing spondylitis (AS) but the relationship between the uveitis and the spondyloarthropathy is poorly defined. The following conclusions may be drawn from a study of 1331 consecutive patients with AS: the prevalence of uveitis was 40% (535 subjects), almost half of whom had greater than 5 attacks. Family studies of sib pairs, concordant for AS, showed that uveitis occurred randomly with a concordance for uveitis/no uveitis of only 43%. A comparison of patients with (n = 535) and without (n = 796) uveitis showed no important differences. Analysis of potential trigger factors among 72 patients with recurrent disease revealed no seasonal, infective or other correlation. The removal of an intrauterine device from a woman with severe intractable bilateral uveitis was associated with remission of the eye disease. In summary, although genetic background determines susceptibility to uveitis the pattern of the disease suggests the possibility of random environmental triggers unrelated to the course of the underlying rheumatological disorder. 相似文献
8.
E B Savage S W Downing M B Ratcliffe M Fallert K B Gupta G S Tyson D K Bogen L H Edmunds 《The Journal of thoracic and cardiovascular surgery》1992,104(3):752-762
Anteroapical left ventricular aneurysms were produced in 23 sheep by coronary arterial ligation. Plication of the aneurysm does not change stroke volume or cardiac output and does not significantly change left ventricular oxygen consumption from the preoperative value of 5.1 +/- 2.6 ml/100 gm per minute. Plication, however, does increase left ventricular end-systolic elastance from 3.2 +/- 0.9 to 4.4 +/- 1.5 mm Hg/mm (p = 0.005). In nine of these sheep the midsagittal plane of the left ventricle was imaged by means of an array of sonomicrometry crystals before and after plication of the aneurysm. Regional wall stresses at end-systole and end-diastole and changes in diastolic function were calculated for anterior and posterior ventricular walls in the border zone adjacent to the aneurysm and in more basilar myocardium remote from the infarct. Plication significantly reduced end-systolic wall stresses and systolic stress integrals in the posterior border zone and remote myocardium, but it did not significantly change anterior wall systolic stresses or stress integrals. Plication also decreased diastolic stretching of border zone myocardium. Plication of anteroapical left ventricular aneurysm produced a shorter, more spherical ventricle and removed the dyskinetic segments but altered deformation (strain) in both circumferential and longitudinal directions. The changes in ventricular wall geometry and deformation provide an explanation for the increased ventricular end-systolic elastance and unchanged stroke volume observed after aneurysm plication. 相似文献
9.
H G French S W Burke J M Roberts C E Johnston T Whitecloud J O Edmunds 《Journal of pediatric orthopedics》1987,7(1):69-71
Six patients with upper cervical spine ossicles and Down syndrome from a study population of 184 are described. The average age was 20.6 years at the time of diagnosis. Three of the patients were involved in tumbling. Radiographic anatomy of the ossicles and the dens, as well as serial radiographs in three of the six patients, suggest that this represents an avulsion of the upper end of the dens rather than an occipital vertebrae, ossiculum terminale, or os odontoideum, as previously described. The authors advocate restriction of high-risk activities for all patients with Down syndrome. 相似文献
10.
Mutations in the retinal guanylate cyclase (RETGC-1) gene in dominant cone-rod dystrophy 总被引:3,自引:0,他引:3
Kelsell RE; Gregory-Evans K; Payne AM; Perrault I; Kaplan J; Yang RB; Garbers DL; Bird AC; Moore AT; Hunt DM 《Human molecular genetics》1998,7(7):1179-1184
The dominant cone-rod dystrophy gene CORD6 has previously been mapped to
within an 8 cM interval on chromosome 17p12-p13. The retinal- specific
guanylate cyclase gene (RETGC-1), which maps to within this genetic
interval and previously was implicated in Leber's congenital amaurosis, was
screened for mutations within this family and in a panel of small families
and individuals with various cone and cone- rod dystrophy phenotypes. A
missense mutation (E837D) was identified in affected members of the CORD6
family, as well as a second missense mutation (R838C) in three other
families with dominant cone-rod dystrophy. RETGC-1 is only the fourth gene
to be implicated in cone-rod dystrophy and this is the first report of
dominant mutations in this gene.
相似文献