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111.
Incremental value of live/real time three‐dimensional transesophageal echocardiography in the assessment of ventricular septal rupture following acute myocardial infarction 下载免费PDF全文
Mohammed J. Arisha MD Ming C. Hsiung MD Navin C. Nanda MD Bulur Serkan MD Amier Ahmad MD Ahmed Elkaryoni MD Mahmoud Elsayed MD Leilani Adana MD Shravan Turaga MD Emel Guler MD Nermina Alagic MD 《Echocardiography (Mount Kisco, N.Y.)》2017,34(11):1680-1686
Ventricular septal rupture is a serious complication following acute myocardial infarctions and is associated with a significant mortality rate. Classically, two‐dimensional transthoracic echocardiography has been used to diagnose this complication and visualize its location. Two‐dimensional transesophageal echocardiography has supplemented the transthoracic approach by providing more accurate assessment of the defect size and in guiding closure both percutaneously and intraoperatively. This modality, however, is limited to two‐dimensional views only, and a greater breadth of information is instead available through the use of three‐dimensional transesophageal echocardiography. We present a series of 11 patients in which live/real time three‐dimensional transesophageal echocardiography offered incremental benefits over two‐dimensional imaging alone. 相似文献
112.
BackgroundIntravenous drug use is becoming an increasing problem in today’s society causing an enormous socio-economic burden. Any intravenous injection will carry a risk of vascular injury. However, this risk will be significantly increased with repeated injections. With ongoing injection drug misuse, individuals are at risk of serious complex vascular injuries that can masquerade as simple illnesses.MethodsA comprehensive Medline search was conducted to identify key articles related to vascular injuries in intravenous drug users (IVDUs).ResultsNumerous arterial and venous injuries have been described as a result of intravenous drug use. This article reviews the literature to identify appropriate management of the peripheral vascular injuries encountered more and more often in this group of patients. Recommendations for investigation and treatment are made.ConclusionIntravenous drug users are notoriously difficult to treat and present late in the course of their illnesses. Despite management problems, it is important to have a high index of suspicion for serious vascular problems. Education and awareness of both patients and health care professionals may lead to earlier diagnosis and treatment of these conditions which carry significant morbidity and mortality. 相似文献
113.
Hamada M. M. Sayed Ahmed Mahmoud Youssef Youssef M. Mosaad 《Clinical rheumatology》2010,29(11):1237-1243
Rheumatoid arthritis (RA) patients have increased mortality largely as a result of cardiovascular diseases (CVD) that cannot
be explained by traditional risk factors, suggesting that systemic inflammation may accelerate atherosclerosis. We investigated
the presence of subclinical atherosclerosis in early RA (<12 months) and the possible association of RA-related risk factors.
Forty patients with early RA and 40 controls matched for age, sex, and traditional risk factors for CVD were selected. Carotid
US examination, assay of lipogram, C-reactive protein (CRP), and oxidized low-density lipoprotein antibodies (OxLDL-ab) were
done. RA patients had significantly higher carotid intima-media thickness (cIMT) values and more plaque than the control (P < 0.001 and P = 0.0122, respectively). CRP and OxLDL-ab were significantly higher in RA patients than controls. Traditional risk factors
and RA-related risk factors (disease duration, DAS-28, duration of treatment with steroids, erythrocyte sedimentation rate,
and CRP) as well as OxLDL and cIMT were significantly higher in RA with plaques compared to those without plaques. Regression
analysis identified the age of patients, CRP, and OxLDL-ab as an independent risk factor associated with the presence of atherosclerosis.
Conclusion: there is increased prevalence of carotid plaques in patients with recent-onset RA compared to matched controls.
The accelerated atherosclerosis is predicted by age, CRP, and oxLDL-ab. The association of plaques with elevated CRP and OxLDL-ab
support the hypothesis that chronic systemic autoimmune inflammatory process is probably a driving force for premature atherosclerosis. 相似文献
114.
115.
Soliman AT Al Khalaf F Alhemaidi N Al Ali M Al Zyoud M Yakoot K 《Metabolism: clinical and experimental》2008,57(1):95-102
The objective of the study was to determine the degree of linear growth retardation of patients with vitamin D deficiency rickets at presentation and the magnitude of catch-up growth in relation to their calcium (Ca) homeostasis and hormones affecting it before and after treatment. This prospective study recorded the anthropometric data and measured the circulating 25-hydroxy vitamin D (25-OH-D), insulin-like growth factor I (IGF-I), parathyroid hormone, Ca, phosphate, and alkaline phosphatase concentrations in 46 infants and children with nutritional (vitamin D deficiency) rickets before and 6 months or more after treatment with one intramuscular injection of vitamin D3 megadose (300000 IU). Forty normal age- and sex-matched children were included as controls for the auxological data. At presentation, patients' mean age = 13.1 +/- 1.1 months, length standard deviation scores (LSDS) = -1.5 +/- 0.2, and body mass index = 16.3 +/- 0.85. They were significantly shorter and had markedly lower growth velocity standard deviation scores (GVSDS) compared with normal controls (LSDS = 0.25 +/- 0.18 and 0.31 +/- 0.22, respectively). Six months after treatment, the LSDS increased significantly in patients to -0.45 +/- 0.13, with a significantly increased GVSDS (2.76 +/- 0.45) and body mass index (16.9 +/- 0.65). They were still shorter but with significantly higher GVSDS compared with normal controls. Serum Ca and phosphate concentrations increased from 2.07 +/- 0.25 and 1.23 +/- 0.24 mmol/L, respectively, before treatment to 2.44 +/- 0.2 and 1.94 +/- 0.2 mmol/L, respectively, after treatment. Serum alkaline phosphatase and parathyroid hormone concentrations decreased from 1183 +/- 219 U/L and 294 +/- 87 pg/mL, respectively, before treatment to 334 +/- 75 U/L and 35.2 +/- 15.2 pg/mL, respectively, after treatment. The 25-OH-D level increased from 4.5 +/- 0.56 ng/mL before treatment to 44.5 +/- 3.7 ng/mL after treatment. Circulating concentrations of IGF-I increased significantly after treatment (52.2 +/- 18.9 ng/mL) vs before treatment (26.6 +/- 12.8 ng/mL). The 25-OH-D concentrations were correlated significantly with the IGF-I levels before and after treatment (r = 0.603 and r = 0.59, respectively; P < .001). The GVSDS after treatment was correlated with the increase of IGF-I and 25-OH-D levels (r = 0.325 and r= 0.314, respectively; P < .01). These data denote that the accelerated linear growth after treatment of nutritional vitamin D deficiency is mediated through activation of the growth hormone/IGF-I system and suggests an important role of vitamin D as a link between the proliferating cartilage cells of the growth plate and growth hormone/IGF-I secretion. Three different sequential stages of vitamin D deficiency can be recognized according to the clinical/radiological, biochemical, and hormonal data of patients at presentation. 相似文献
116.
Significance of matrix metalloproteinase 9 and CD34 expressions in esophageal carcinoma: correlation with DNA content 总被引:2,自引:0,他引:2
El-Kenawy Ael-M Lotfy M El-Kott A El-Shahat M 《Journal of clinical gastroenterology》2005,39(9):791-794
BACKGROUND: Esophageal carcinoma is common in many countries, and it is characterized by poor prognosis and rapid clinical progression with a high frequency of lymph node metastasis and recurrence. The present study was carried out to evaluate the correlation between vascular endothelial cell marker (CD34), matrix metalloproteinase type 9 (MMP9), and DNA content in esophageal carcinoma. METHODS: A total of 38 patients were classified with histopathologic examination as 8 cases with adenocarcinoma, 24 cases with squamous cell carcinoma, and the last 6 cases with undifferentiated carcinoma. The obtained results of the patient group were compared with the results of 6 cases with proven normal esophageal mucosa as a control group. The samples of patients and controls were subjected to immunohistochemical evaluation of CD34 and MMP9 expression along with DNA index determination using flow cytometry. RESULTS: There was a significant difference between patients and normal cases in DNA index, CD34, and MMP9 pattern (P = 0.003, <0.001, and 0.002, respectively). DNA index was positively correlated with MMP9 (r = 0.574, P < 0.001) and with CD34 (r = 0.562, P < 0.001). MMP9 was correlated with CD34 (r = 0.55, P < 0.001). A significant difference was found in both microvessel density and MMP9 expression with respect to tumor grade and stage. The microvessel density in patients with highly positive staining for MMP9 was higher than in those with negative and weak staining for MMP9 (P = 0.002). CONCLUSION: The analysis of DNA content along with detection of CD34 and MMP9 in esophageal cancer can successfully differentiate the different pathologic lesions and hence can be used powerfully in disease prognosis reflecting valuable information about the aggressiveness and activity of those lesions. 相似文献
117.
The relative contribution of transcytosis vs. large pore transport to the passage of macromolecules across microvascular endothelia has been a controversial issue for nearly half a century. To separate transcytosis from 'porous' transport, the transcytosis inhibitors N-ethylmaleimide (NEM) and filipin have been tested in in situ or ex vivo perfused organs with highly conflicting results. In continually weighed isolated perfused organs, where measurements of pre- and post-capillary resistances, capillary pressure and capillary filtration coefficients can be repeatedly performed, high doses of NEM and filipin increased the bulk transport of macromolecules from blood to tissue, despite producing vasoconstriction. By contrast, in in situ perfused organs, marked reductions in the tissue uptake of albumin tracer have been observed after NEM and filipin. When tissue cooling has been employed as a means of inhibiting (active) transcytosis, results have invariably shown a low cooling sensitivity of albumin transport, compatible with passive transendothelial passage of albumin. This observation is further strengthened by the commonly observed dependence of albumin transport upon the capillary pressure and the rate of transcapillary convection. For low-density lipoprotein (LDL), a cooling-sensitive, non-selective transport component has been discovered, which may be represented by filtration through paracellular gaps, lateral diffusion through transendothelial channels formed by fused vesicles, or by transcytosis. From a physiological standpoint there is little evidence supporting active transendothelial transport of most plasma macromolecules. This seems to be supported by studies on caveolin-1-deficient mice lacking plasmalemmal vesicles (caveolae), in which there are no obvious abnormalities in the transendothelial transport of albumin, immunoglobulins or lipoproteins. Nevertheless, specific transport in peripheral capillaries of several hormones and other specific substances, similar to that existing across the blood-brain barrier, still remains as a possibility. 相似文献
118.
Hekmat M Rafieyian S Foroughi M Majidi Tehrani MM Beheshti Monfared M Hassantash SA 《Asian cardiovascular & thoracic annals》2005,13(4):307-310
Coronary artery anomalies are common among patients with tetralogy of Fallot. One hundred and thirty-five patients (80 males and 55 females) with tetralogy of Fallot who underwent repair between 1995 and 2002 were studied to determine the incidence of coronary anomalies in Iranian patients. Eight (5.9%) patients (4 males and 4 females) had a surgically relevant coronary artery anomaly: single coronary ostium in 5, origin of the left anterior descending artery from the right coronary artery in 2, and origin of the right coronary artery from the left coronary artery in 1. The surgical technique in 3 of these patients was repair of the ventricular septal defect with a transverse incision on the right ventricle, without damage to the coronary arteries. In another patient, an allograft aortic valve cylinder was inserted. In the other 4 patients with a single coronary ostium, placement of a limited transannular patch was adequate. Consideration of these anomalies during primary repair could decrease the risk of operation in such patients. However, it seems that the presence of anomalous coronary arteries does not affect incremental risk after surgical repair. 相似文献
119.
Clinical and laboratory characteristics in septic arthritis patients with and without isolated germs
Hana Sahli Asma Bachali Rawdha Tekaya Aicha Ben Tekaya Rim Khalfallah Olfa Saidane Ines Mahmoud Leila Abdelmoula 《The Egyptian Rheumatologist》2018,40(4):269-272
Background
The management of septic arthritis without bacteriological evidence is not well codified.Aim of the work
To compare the features of septic arthritis with and without isolated germs.Patients and Methods
This is a retrospective study including all patients with septic arthritis, discharged from the Rheumatology Department of Charles Nicolle Hospital, Tunisia over a period of 17?years [1998–2014]. The epidemiological and clinical data were evaluated. Patients were grouped according to the presence and absence of isolated germs.Results
Fifty-nine septic arthritis patients were collected with an average of 3.5?cases/year. The mean age of the patients was 54.6?±?19?years [15–95] without sex predominance: 28 were male and 31 were female. At least one risk factor for SA was founded in 41 patients (69.5%). It was monoarticular in 50 cases (84.7%), oligoarticular in 6 (10.2%) and polyarticular in 3 (5.1%). The knee was the most often affected (49.2%). Germ was isolated in cultures and/or synovial fluids in 27 patients (45.8%). The age tended to be older in those with isolated germs and the elderly were more frequently infected compared to the non-elderly (51.8% versus 21.9%) (p?=?.01). The synovial fluid analysis, clinical and laboratory characteristics were comparable but the functional disability was significant higher in those without isolated germs (p?=?.024). Sternoclavicular joint was more common in patients with isolated germs (p?=?.016). There was no difference between the two groups regarding the course of the infection.Conclusion
Patients with isolated and non-isolated germs have similar epidemiologic, clinical, biological and radiological characteristics. 相似文献120.
Tag LM Ezz-Eldeen AM Mahmoud MS Rashed HA Noaman HA 《The Egyptian journal of immunology / Egyptian Association of Immunologists》2004,11(2):121-132
Immune thrombocytopenic purpura (ITP) is an acquired disease in which autoantibodies to platelets cause their sequestration and destruction by mononuclear macrophages, principally in the spleen. While most children with the disease experience a relatively short and benign clinical course, ITP in adults often lasts more than 6 months (chronic ITP) and is resistant to conventional treatment (corticosteroids, intravenous immunoglobulin, or splenectomy). This work was done to study the immunological difference between acute and chronic ITP, the effect of treatment on the studied immunological parameters, and to evaluate the role of prednisone therapy in chronic ITP. The study included 49 patients, twenty-three children with acute ITP, and twenty-six with chronic ITP. After taking the history, clinical examination was performed for all patients and control subjects. Laboratory investigations included complete blood count, bone marrow aspirate examination (patients), direct and indirect Coombs' test, antinuclear antibodies, lymphocyte phenotyping, cytokine (IL-2, IFN-gamma, and IL-6) measurement, and platelet antibodies by immunofluorescence. Results showed that acute ITP is more prevalent in preschool children and its relapse is lower when steroids are used for treatment. Platelet counts were significantly elevated in both acute and chronic ITP, especially with good response to steroids. Also, CD4 and CD4/CD8 were significantly reduced in chronic ITP with good response to therapy. Both IL-2 and IFN-gamma were significantly increased in chronic ITP when compared to acute ITP or control. Platelet associated IgM was detected more in acute than in chronic ITP, while IgG was equally detectable in both cases. This work shows that IL-2 is a good prognostic factor in chronic ITP and steroids are important for its treatment. It also shows that platelet associated IgG is a good monitoring parameter for response to treatment. 相似文献