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61.
Background: Sleep apnea is a frequent and unappreciated condition of morbidly obese patients. If unrecognized it could lead
to significant postoperative complications. A clinical tool to assess the severity of sleep apnea is not available.We prospectively
determined whether the Epworth Sleepiness Scale (ESS) or body mass index (BMI) predict the severity of sleep apnea in morbidly
obese patients. Methods: 66 consecutive patients evaluated for bariatric surgery from June to November 1999 were examined
and prospectively administered a health questionnaire including the ESS. Patients with an ESS ≥ 6 were referred for polysomnography
with calculation of Respiratory Disturbance Index (RDI). Sleep apnea was graded as mild (RDI 6-20), moderate (RDI 21-40) and
severe (RDI>40). Clinical variables such as BMI and ESS score were compared using regression analysis. Data are mean ± SEM.
Results: 4 men and 23 women (27/66) who scored >6 on the ESS completed a sleep study. Mean ESS was 13 ± 4.5. Sleep apnea was
mild in 13 patients, moderate in 7, severe in 6, and absent in 1. Mean age was 43 ± 9.5 years. BMI was 52 ± 10 kg/m2. Linear regression analysis did not demonstrate correlation between ESS score and severity of sleep apnea (r2=0.03, p>0.05). Multiple regression analysis demonstrated no correlation between BMI, patient snoring, and RDI score. Conclusions:
Sleep apnea is frequent in candidates screened for bariatric surgery. ESS is a useful tool to investigate daytime sleepiness
and other manifestations of sleep apnea. However, the ESS does not predict the severity of sleep apnea. Clinical suspicion
of sleep apnea should prompt polysomnography. 相似文献
62.
Perennial rhinitis: an analysis of skin testing, serum IgE, and blood and smear eosinophilia in 201 patients 总被引:3,自引:0,他引:3
N Mygind A Dirksen N J Johnsen B Weeke 《Clinical otolaryngology and allied sciences》1978,3(2):189-196
Allergen skin testing, eosinophil counting in blood and nasal smear and serum IgE determination were performed in patients with simple perennial rhinitis, and in patients with rhinitis and asthma. The results were compared with those obtained in normal controls. As a positive skin test was demonstrated in 40% of patients with simple rhinitis and in 88% of patients with rhinitis and asthma, skin testing is considered relevant in all patients with perennial rhinitis. While blood eosinophil count and serum IgE level were elevated in a fair proportion of asthmatic patients, only a few subjects with simple perennial rhinitis had an elevated level, and the diagnostic values of these tests is questionable. On the other hand, examination of a nasal smear for eosinophils could usually separate the patients from the controls. The study emphasizes the importance of making a distinction between simple perennial rhinitis and perennial rhinitis associated with other symptoms and diseases. 相似文献
63.
ReSllm6 Objectif Nos studes Precedentes out montrd une panne fonCtion de la greffe pulmonaire traitde Prdalablementper perfusion forcde retrograde et un stockage d froid inns ~. L' etude Prdsente a pour but de determiner l' effet de ~ surlefiot mngUin du poumon trait4 Prdalablement per perfusion retrograde forcde et un stockage d froid. met~. 12poumons donneurs canins out ate trait4s per perfusion r4tFograde de solution UW. Chez 6 animaux du grouch A, 250ng furent injectes dans l' artrdre… 相似文献
64.
65.
Siv H. Jacobsen Kirstine N. Bojsen-Møller Carsten Dirksen Nils B. Jørgensen Trine R. Clausen Birgitte S. Wulff Viggo B. Kristiansen Dorte Worm Dorte L. Hansen Jens J. Holst Gerrit van Hall Sten Madsbad 《Diabetologia》2013,56(10):2250-2254
Aims/hypothesis
Roux-en-Y gastric bypass surgery (RYGB) improves glucose tolerance in patients with type 2 diabetes, but also changes the glucose profile in response to a meal in glucose-tolerant individuals. We hypothesised that the driving force for the changed postprandial glucose profiles after RYGB is rapid entry of glucose into the systemic circulation due to modified gastrointestinal anatomy, causing hypersecretion of insulin and other hormones influencing glucose disappearance and endogenous glucose production.Methods
We determined glucose absorption and metabolism and the rate of lipolysis before and 3 months after RYGB in obese glucose-tolerant individuals using the double-tracer technique during a mixed meal.Results
After RYGB, the postprandial plasma glucose profile changed, with a higher peak glucose concentration followed by a faster return to lower than basal levels. These changes were brought about by changes in glucose kinetics: (1) a more rapid appearance of ingested glucose in the systemic circulation, and a concomitant increase in insulin and glucagon-like peptide-1 secretion; (2) postprandial glucose disappearance was maintained at a high rate for a longer time after RYGB. Endogenous glucose production was similar before and after surgery. Postoperative glucagon secretion increased and showed a biphasic response after RYGB. Adipose tissue basal rate of lipolysis was higher after RYGB.Conclusions/interpretation
A rapid rate of absorption of ingested glucose into the systemic circulation, followed by increased insulin secretion and glucose disappearance appears to drive the changes in the glucose profile observed after RYGB, while endogenous glucose production remains unchanged.Trial registration
ClinicalTrials.gov NCT01559792.Funding
The study was part of the UNIK program: Food, Fitness & Pharma for Health and Disease (see www.foodfitnesspharma.ku.dk). Funding was received from the Novo Nordisk foundation and the Strategic Research Counsel for the Capital Area and Danish Research Agency. The primary investigator received a PhD scholarship from the University of Copenhagen, which was one-third funded by Novo Nordisk. 相似文献66.
Stamatia Destounis MD Andrea Arieno BS Patricia A. Somerville MD Posy J. Seifert DO Philip Murphy MD Renee Morgan RT Melissa Skolny BA Sarah Hanson BA Wende Young MD 《Journal of ultrasound in medicine》2009,28(10):1337-1346
Objective. The purpose of this study was to assess the utility and efficacy of second‐look breast sonography in the evaluation of abnormalities identified on presurgical breast magnetic resonance imaging (MRI) examinations. Methods. A retrospective review was performed of 152 presurgical breast MRI examinations having 196 unsuspected abnormalities to identify findings that underwent subsequent breast sonography. Eligible examinations had a suspicious abnormality identified on presurgical MRI and documentation of the location and size of the finding on MRI and subsequent second‐look sonography. Fourteen examinations not meeting the criteria were excluded, with 182 abnormalities remaining. Patient medical records were reviewed. Results. Seventy percent (128 of 182) of breast MRI lesions were visible at second‐look sonography; 30% (54 of 182) were sonographically occult. Ninety‐five percent (121 of 128) of sonographically visible abnormalities underwent breast biopsy. Pathologic examinations of sampled sonographically visible lesions revealed 39 cancers, 9 high‐risk lesions, 72 benign lesions, and 1 lesion not specified at surgery; 23% (9 of 128) of cancers were in the contralateral breast. Fifty‐four lesions were sonographically occult. Needle biopsy was performed for 93% (50 of 54) of occult lesions, revealing 8 cancers, 1 high‐risk lesion, and 41 benign lesions; 3 of the benign lesions did not have sufficient pathologic specimens but were benign at follow‐up. Magnetic resonance imaging guidance was used in 86% (43 of 50) of these biopsies. One contralateral cancer was identified in the sonographically occult subset. Of the 182 lesions that underwent second‐look sonography, 20% (36 of 182) had a change in management. Conclusions. Second‐look sonography has value in the evaluation of abnormalities found on breast MRI. We found enhancements in 70% (128 of 182), yielding 39 cancers. 相似文献
67.
Sixty-five patients with severe alpha1-antitrypsin (AAT) deficiency (phenotype PiZ) were followed with spirometry at regular intervals of one year and a median
observation period of four years.
The annual decline in pulmonary function was adjusted for sex, age and height by division with the predicted normal pulmonary
function. The median decline in FEV1 was 1.9% predicted/year. The rate of decline was independent of age and pulmonary function, except for patients with FEV1 below 25% of predicted normal.
There was a tendency towards a slower median decline in FEV1 in exsmokers (1.7% predicted/year) compared to smokers (3.8% predicted/year) and never-smokers (3.7% predicted/year), however,
this difference was not significant (p > 0.1). At the time of diagnosis smokers and ex-smokers had a lower FEV1 (44 and 38% predicted) than never-smokers (85% predicted) (p < 0.02), and smokers and ex-smokers were generally younger (median age 44 and 42 years, respectively) than never smokers
(median age 55 years) (p > 0.1).
Our data indicate that smokers as well as nonsmokers with severe AAT deficiency are at risk of developing pulmonary emphysema.
The disease seems to appear later in nonsmokers, though once initiated it progresses at the same rate.
Presented at the Satellite Expert Meeting: α1-Antitrypsin Deficiency, Bürgenstock/Luzern, Switzerland, June 9–11, 1989. 相似文献
68.
Developing a custom computer program to simulate the uptake, distribution, and elimination of inhalational anesthetics allows the anesthesiologist to address specific problems, but extensive skills are required to translate the involved processes first into a set of mathematical equations and then into a satisfactory computer program. The first step is often facilitated by solutions offered in the literature. The second step demands computer proficiency that is often not available, but this problem can be obviated by means of a special-purpose simulation language (SPSL). We therefore constructed a model for closed-circuit inhalation anesthesia with the aid of the block-structured SPSL TUTSIM. Noticeable differences with previous models are that the linear, 14-compartment basic model does not assume a constant alveolar concentration and mimics circulation times through the use of blood pools. Advanced features of the SPSL were used to develop variants of the basic model to simulate feedback-controlled isoflurane administration, nitrous oxide uptake, and the impact of a nonlinearity by incorporating the effect of enflurane on cardiac output. Two variants were concatenated to form a multiple model showing the concentration and second-gas effects. The model was capable of reproducing the anesthetic uptake from previous experimental studies for nitrous oxide. After its validation for other anesthetic agents, the model can be used for clinical, teaching, and research purposes. The SPSL freed the authors from the problems associated with computer programming and allowed them to concentrate on the structure of the model. 相似文献
69.
Noncardiogenic pulmonary edema is a recognized but uncommon manifestation of type 2 decompression sickness. It typically occurs within 6 hours of a dive. Because the adult respiratory distress syndrome in this setting is believed to be due to microbubbles in the pulmonary vasculature, recompression in a hyperbaric chamber has been recommended as a form of therapy. A patient developed noncardiogenic pulmonary edema following a seawater dive to 75 feet. There was complete radiologic and clinical resolution within 5 hours of hyperbaric therapy. 相似文献
70.
Intraindividual variation and effect of learning in lung function examinations. A population study 总被引:1,自引:0,他引:1
S Groth A Dirksen H Dirksen N Rossing 《Bulletin européen de physiopathologie respiratoire》1986,22(1):35-42
The aims of this study were to analyse the influence of co-operation and instruction on inter-and intraindividual variations of normal lung function and to provide reference values for intraindividual variation. A sample of 125 non-smokers (age 30-70 yr) representative of the population of Copenhagen were studied with spirometry, complete and partial flow-volume curves, nitrogen washout volume, volume of trapped gas and transfer factor. The examination was repeated 0.5-6 months later for 112 of the individuals. Much of the variance observed at the first examination, i.e. interindividual variation, could be accounted for by the sex, age, height and weight of the individuals, whereas differences in individual motivation, social status, the ability of the technicians to instruct during the examination and interactions induced by the subject and the technician being of the same or of opposite sex were negligible. The intraindividual difference between the second and the first examinations were very small. Factors such as the subjects' sex, age, height, weight, social status, motivation, whether the examination was conducted by the same or a different technician at the two examinations, and whether the interval of time between the two examinations was short or long, were insignificant. It is concluded that while much of the interindividual variance of a lung function test is influenced by a variety of confounding factors, the intraindividual variation is not. Reference values for intraindividual variation are given. 相似文献