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51.
Prognostic importance of automated ST-segment monitoring after coronary artery bypass graft surgery 总被引:1,自引:0,他引:1
A. Yazigi MD F. Richa S. Gebara F. Haddad G. Hayek M.-C. Antakly 《Acta anaesthesiologica Scandinavica》1998,42(5):532-535
Background : Automated ST-segment monitors are widely used in cardiac surgery units. The purpose of this study was to determine if cardiac morbidity and mortality, after CABG surgery, are predicted by ECG ST-segment changes on automated monitors.
Method : One hundred patients, who underwent CABG, were included in this prospective study. ST-segment deviations were recorded by an automated ST monitor, in the ICU, for 24 h after surgery. A reversible ST depression of more than 0.1 mV or a ST elevation of more than 0.2 mV and for at least 1 min were considered as significant episodes. Adverse cardiac outcomes were defined as: myocardial infarction (MI), severe left ventricular failure, ventricular fibrillation (VF) and cardiac-related death.
Results : Sixty patients (group 1) presented significant episodes of ST deviation (6δ5 episodes per patient). Forty patients (group 2) were free from ST changes. Eight patients from group 1 had postoperative adverse cardiac outcomes: 5 MI, 2 VF and 1 cardiac-related death. Patients from group 2 were all free from adverse cardiac outcomes. Automated ST-segment analysis during the first 24 h had a positive predictive value of 13% and a negative predictive value of 100%.
Conclusion : Automated ST analysis is a non-invasive, sensitive and very easy-to-use monitoring system to screen patients who may develop myocardial ischemia and cardiac complications after CABG surgery. 相似文献
Method : One hundred patients, who underwent CABG, were included in this prospective study. ST-segment deviations were recorded by an automated ST monitor, in the ICU, for 24 h after surgery. A reversible ST depression of more than 0.1 mV or a ST elevation of more than 0.2 mV and for at least 1 min were considered as significant episodes. Adverse cardiac outcomes were defined as: myocardial infarction (MI), severe left ventricular failure, ventricular fibrillation (VF) and cardiac-related death.
Results : Sixty patients (group 1) presented significant episodes of ST deviation (6δ5 episodes per patient). Forty patients (group 2) were free from ST changes. Eight patients from group 1 had postoperative adverse cardiac outcomes: 5 MI, 2 VF and 1 cardiac-related death. Patients from group 2 were all free from adverse cardiac outcomes. Automated ST-segment analysis during the first 24 h had a positive predictive value of 13% and a negative predictive value of 100%.
Conclusion : Automated ST analysis is a non-invasive, sensitive and very easy-to-use monitoring system to screen patients who may develop myocardial ischemia and cardiac complications after CABG surgery. 相似文献
52.
R Whit Hall Tiffany Wallace Huitt Richa Thapa D Keith Williams K J S Anand Edgar Garcia-Rill 《Clinical neurophysiology》2008,119(6):1281-1291
OBJECTIVE: Quantitative measures of pre-attentional, attentional and frontal lobe processes were compared to evaluate quantitative measures of these deficits in Ex-Preterm vs. Ex-Term adolescents. METHODS: We compared 43 Ex-Preterm with 26 Ex-Term adolescents using the P50 auditory potential, the Psychomotor Vigilance Task (PVT), a reaction time (RT) test, and Near Infrared Spectroscopy (NIRS). RESULTS: The mean amplitude (+/-SE) of the P50 amplitude was similar in the Ex-Preterm (1.8+/-1.4 microV) vs. Ex-Term adolescents (1.8+/-0.6 microV, df = 68, F = 0.05, p = 0.8), but the Ex-Preterm group showed a trimodal distribution in amplitude (High, 3.3+/-0.4 microV, df=42.25, F=19.2, p < 0.01; Medium, 1.7+/-0.1 microV, df = 39, F = 0.41, p = 0.53; Low, 0.7+/-0.1 microV, df = 40, F = 49.5, p < 0.01) suggested by statistically significant variance between populations (Kolmogorov-Kuiper test, df = 42.25, F = 5.4, p < 0.01). Mean RT was longer in Ex-Preterm (250+/-8 ms) vs. Ex-Term subjects (200+/-5 ms, df = 68, F = 18.8, p < 0.001). PVT lapses were increased in Ex-Preterm subjects, and varied inversely with P50 amplitude (Overall Mean 17+/-5 lapses, df = 67, F = 5.34, p < 0.05; Low P50 amplitude, 25+/-10, df = 40, F = 8.8, p < 0.01; Medium, 21+/-11, df = 38, F = 5.37, p < 0.05; High, 6+/-2, df = 39, F = 6.78, p < 0.01) vs. Ex-Term subjects (2+/-0.4 lapses, p < 0.01). NIRS levels did not differ statistically, but tended to correlate with P50 amplitude in the Ex-Preterm group. CONCLUSIONS: These findings suggest differential pre-attentional, attentional and frontal lobe dysfunction in Ex-Preterm adolescents. SIGNIFICANCE: These measures could provide a means to objectively assess differential dysregulation of arousal and attention in Ex-Preterm adolescents, allowing optimization of therapeutic designs. 相似文献
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Rupa Mehta MD R. Parker Ward MD FACC Sonal Chandra MD Richa Agarwal MD Kim Allan Williams MD FACC 《Journal of nuclear cardiology》2008,15(3):337-344
Background. The American College of Cardiology Foundation/American Society of Nuclear Cardiology appropriateness criteria (AC) were
created to guide responsible use of single photon emission computed tomography (SPECT). Clinical applicability of the AC has
not been evaluated.
Methods and Results. Indications for testing were determined in 1209 patients and categorized as having appropriate, uncertain, or inappropriate
indications; the specialty of the ordering physician was noted. There were 940 (80%) appropriate, 154 (13%) inappropriate,
and 79 (7%) uncertain tests; 36 tests were labeled “no category,” as these were ordered for indications not clearly addressed
in the AC. Inappropriate studies had more normal and lower summed stress scores, although there remained a high proportion
of abnormal SPECT studies in this group (26% of women and 50% of men). Women had lower summed stress scores and more normal
tests in the appropriate and inappropriate groups. Studies ordered by anesthesiologists for preoperative evaluation were more
likely to be deemed inappropriate than other specialty groups.
Conclusion. In evaluating the AC in a single-center academic setting, the majority of studies are appropriate, but a large proportion
of ordered SPECT studies were categorized as uncertain, inappropriate, or no category. Although the inappropriate studies
showed less ischemia than other groups, especially in women, a substantial portion of these studies (32%) were abnormal. 相似文献
55.
Kaushik P Cohen AJ Zuckerman SJ Vatsavai SR Pepper JS Banda VR Eason JD Loss GE Kaushik R 《The Annals of pharmacotherapy》2005,39(6):1124-1127
OBJECTIVE: To report a case of Miller Fisher syndrome (MFS), a variant of Guillain-Barre syndrome (GBS) necessitating the placement of a permanent cardiac pacemaker in a patient on tacrolimus after a cadaveric orthotopic liver transplantation. CASE SUMMARY: A 46-year-old African American male, who had been receiving tacrolimus 4 mg/day orally for the preceding 6 months, developed a Miller Fisher variant of GBS (severe ataxia, ophthalmoplegia, areflexia). He developed symptomatic sinus pauses requiring a cardiac pacemaker. He improved substantially after cessation of tacrolimus and initiation of intravenous immunoglobulin therapy. The patient was not rechallenged with tacrolimus due to the clinical/ethical gravity of this probable adverse effect. DISCUSSION: Although different types of neuropathies have been reported with the use of tacrolimus, to the best of our knowledge, this is the first case report of a Miller Fisher variant of GBS severe enough to cause dysautonomia requiring a cardiac pacemaker associated with the use of this drug. Causality assessment using the Naranjo probability scale revealed the adverse drug event was probable. CONCLUSIONS: Tacrolimus was probably associated with a Miller Fisher variant of GBS necessitating the placement of a permanent cardiac pacemaker in this patient. MFS needs to be considered a potentially life-threatening adverse effect of tacrolimus therapy. 相似文献
56.
Sharma Vishal Singh Anoop Gaur Mohita Rawat Deepti Yadav Anjali Rajan Kumar Chanchal Varma-Basil Mandira Lohiya Sheelu Khanna Vishal Khanna Ashwani Chaudhry Anil Singh Yogendra Misra Richa 《European journal of clinical microbiology & infectious diseases》2022,41(6):893-906
European Journal of Clinical Microbiology & Infectious Diseases - Precise and timely detection of tuberculosis (TB) is crucial to reduce transmission. This study aims to assess the accuracy of... 相似文献
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There have been few studies examining the outcome of schizophrenia in later life. Using five conceptual models, we test two
hypotheses with respect to range of outcomes among older schizophrenia outpatients and how they compare to their age peers
in the community. We operationalized five outcome measures from the following conceptual models: Remission, adapting criteria of Andreasen et al. (The American Journal of Psychiatry, 162:441–449, 2005); Recovery, adapting the criteria by Liberman et al. (International Review of Psychiatry, 14:256–272, 2002); Community Integration using the model of Wong and Solomon (Mental Health Services Research, 4:13–28, 2002); Subjective and Objective Successful Aging using the model of Rowe and Kahn (Science, 237:143–149, 1987). The schizophrenia (S) group consisted of 198 community-dwelling
persons aged 55 and over who developed schizophrenia before age 45 and a community comparison (CC) group (N = 113). Remission and recovery criteria were met by 49 and 17% of the S group, respectively. There were significant differences
between the S and CC groups in the distribution of community integration and successful aging scales: 41% of the CC group
met at least 10 of 12 criteria versus 23% of the S group on the Community Integration Scale; 19% of the CC group met all six
criteria vs. 2% of the S group on the Objective Successful Aging Scale; 27% of the CC group vs. 13% of the S group met all
six criteria on the Subjective Successful Aging Scale. Correlations among the five outcome measures ranged from r = .19 to .48 (median value: r = .26 or 7% shared variance). There is wide variability in outcome in later life depending on which measure is used. Rather
than one universal indicator, each measure offers a different perspective that can provide useful guidelines for researchers,
clinicians, and policy makers. 相似文献