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921.
Gregory Zuccaro Jr. MD Joel E. Richter MD Thomas W. Rice MD Edgar Achkar MD Kirk Easley MS Joyce Lewis RN Steven M. Gordon MD 《Gastrointestinal endoscopy》1998,48(6):568-573
Background: The incidence of bacteremia with organisms that may cause infective endocarditis after esophageal stricture dilation is unknown. There is disagreement among physicians regarding the need for antibiotic prophylaxis for patients with valvular heart disease undergoing dilation. Our aim was to determine the frequency and duration of bacteremia associated with esophageal stricture dilation. Methods: Blood cultures were obtained before and after stricture dilation in patients without valvular heart disease and in a control group of patients undergoing upper endoscopy without dilation. Results: A total of 103 patients undergoing dilation and 50 control patients were studied; 22 of 103 patients (21%) undergoing dilation had at least one post-procedure blood culture positive for viridans streptococcus, compared with 1 of 50 (2%) of control patients (p = 0.001). Blood cultures obtained 1 minute after stricture dilation were positive for viridans streptococcus in 19 of 81 (23%), in 16 of 96 (17%) 5 minutes post-dilation, and in 3 of 63 (5%) 20 to 30 minutes post-dilation. Of the 19 patients with viridans streptococcus bacteremia 1 minute after dilation, cultures were still positive in 14 of 19 (74%) at 5 minutes and in 2 of 19 (10%) 20 to 30 minutes post-dilation. Conclusions: These data support the use of antibiotic prophylaxis before esophageal stricture dilation for patients with valvular heart disease at risk for the development of infective endocarditis. (Gastrointest Endosc 1998;48:568-73.) 相似文献
922.
Gabor?Duray Sergio?Richter Johannes?Manegold Carsten?W.?Israel Gerian?Gr?nefeld Stefan?H.?HohnloserEmail author 《Journal of interventional cardiac electrophysiology》2005,14(3):169-173
Introduction: Implantable cardioverter-defibrillator (ICD) therapy has been shown to improve survival in patients with structural heart
disease and at high risk for life threatening ventricular arrhythmias. Whether elderly patients benefit from device therapy
in a similar way as younger patients is largely unknown.
Methods: We retrospectively analyzed data from 375 consecutive ICD recipients with structural heart disease. Patients were divided
into two groups, younger than 70 years at time of ICD implantation (group 1) or 70 years or older (group 2). Main outcome
measures were time to death from any cause and time from first appropriate ICD therapy to death.
Results: Group 1 and 2 patients were comparable with respect to clinical presentation and average follow-up duration. In the elderly
patient group, 78% received an ICD for secondary prevention versus 63% in group 1 (p = 0.007). During a mean follow-up period of 26.5 ± 18.1 months, there was no significant difference in overall mortality
among the two groups: 47 patients died, 34 (12.5%) of group 1 versus 13 (12.7%) of group 2. The average time to death was
28.4 ± 16.7 vs 30.4 ± 22.1 months after device implantation, respectively (p = ns). There was no difference in time from device implantation to first adequate ICD therapy and time from first appropriate
ICD therapy to death among the two groups (p = ns). Device associated complications were comparable in both groups.
Conclusions: Elderly ICD recipients had comparable survival rates and appropriate use of the ICD compared to younger individuals.
There was no external financial support of this study. 相似文献
923.
Sergio Richter Gabor Duray Gerian Gr?nefeld Carsten W Israel Stefan H Hohnloser 《Circulation journal》2005,69(6):625-629
Sudden cardiac death (SCD), presumably because of ventricular tachyarrhythmias, remains one of the major challenges of contemporary cardiology. Major randomized controlled trials conducted in patients with coronary artery disease (CAD) with the aim of primary prevention of SCD are providing insights. Several large-scale studies have demonstrated that treatment with beta-blockers, angiotensin-converting enzyme inhibitors, aldosterone antagonists, and statins results not only in a reduction in all-cause mortality but specifically also in SCD. On top of this optimized pharmacological therapy, implantable cardioverter-defibrillators (ICD) further decrease the risk of overall and SCD mortality in carefully selected patient groups. The sum of these trials indicates, however, that the benefit associated with ICD therapy is most prominent in patients with chronic stable CAD. In contrast, patients early after myocardial infarction derive less benefit from ICD treatment, presumably because of a high competing risk of non-arrhythmic cardiovascular death. Optimized pharmacological therapy, together with the ICD, can substantially improve the prognosis of high-risk CAD patients. 相似文献
924.
Pietro Leccese Yesim Ozguler Robin Christensen Sinem Nihal Esatoglu Dongsik Bang Bahram Bodaghi Aykut Ferhat Celik Farida Fortune Julien Gaudric Ahmet Gül Ina Kötter Alfred Mahr Robert J. Moots Jutta Richter David Saadoun Carlo Salvarani Francesco Scuderi Petros P. Sfikakis Gulen Hatemi 《Seminars in arthritis and rheumatism》2019,48(4):752-762
Objectives
The aim of this systematic review was to inform the update of European League Against Rheumatism (EULAR) Recommendations for the management of Behçet’s syndrome (BS), on the evidence for the treatment of skin, mucosa and joint involvement of BS.Methods
A systematic literature search, data extraction, statistical analyses and assessment of the quality of evidence were performed according to a pre-specified protocol using the PRISMA guidelines. Studies that assessed the efficacy of an intervention in comparison to an active comparator or placebo for oral ulcers, genital ulcers, papulopustular lesions, nodular lesions or arthritis were included. Where possible, risk ratios were calculated for binary outcomes and mean difference for continuous outcomes.Results
Among the 3927 references that were screened, 37 were included in the analyses. Twenty-seven of these assessed mucocutaneous and 17 assessed joint involvement. Twenty-one of these studies were randomised controlled trials (RCTs). RCTs with colchicine, azathioprine, interferon-alpha, thalidomide, etanercept and apremilast showed beneficial results with some differences according to lesion type and gender. These agents were generally well tolerated with few adverse events causing withdrawal from the study.Conclusions
RCTs comprised more than a half (21/37, 57%) of the sources included in the evidence synthesis related to skin, mucosa and joint involvement applicable for the EULAR Recommendations for the management of BS. Differences in the outcome measures that were used across the included studies often made it difficult to combine and compare the results. 相似文献925.
Endoscopic palliation of obstructive esophagogastric malignancy 总被引:1,自引:0,他引:1
J M Richter A D Hilgenberg M R Christensen D Logan D J Mathisen R H Schapiro P B Kelsey H C Grillo 《Gastrointestinal endoscopy》1988,34(6):454-458
To investigate the efficacy of alternative endoscopic palliative therapies for obstructive esophagogastric malignancy, the experience of 53 patients treated between 1979 and 1986 was analyzed. Forty-seven patients had placement of intraesophageal prostheses. Ten patients had prostheses placed after neodymium:YAG laser therapy. In four of these patients, prosthesis placement was planned as part of the initial therapy. Twelve patients initially received laser therapy. In six, recurrent tumor was treated with intraesophageal prostheses 3 to 24 weeks after laser treatment. Comparing neodymium:YAG laser therapy to placement of the prosthesis, both techniques provided similar improvement in dysphagia. Patients receiving prostheses required less additional treatment for dysphagia. Life table analysis comparing survival rates from diagnosis to death showed no difference. The palliation provided by prostheses and neodymium:YAG laser appears to be quite similar; however, the prosthesis seems to be more lasting and require fewer resources. 相似文献
926.
927.
Comparative morphology and paleobiology of Middle Pleistocene human remains from the Bau de l'Aubesier, Vaucluse, France
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Lebel S Trinkaus E Faure M Fernandez P Guérin C Richter D Mercier N Valladas H Wagner GA 《Proceedings of the National Academy of Sciences of the United States of America》2001,98(20):11097-11102
The discovery of later Middle Pleistocene human remains from the Bau de l'Aubesier, France reinforces an evolutionary model of the gradual accumulation of Neandertal-derived facial and dental features during the Middle Pleistocene of the northwestern Old World. The pronounced maxillary incisor beveling of Aubesier 4 helps to extend the antiquity of nondietary use of the anterior dentition. The interproximal "toothpick" groove on the Aubesier 10 molar increases the sample for these lesions. The pathological loss of the mandibular dentition of Aubesier 11 indicates advanced antemortem masticatory impairment, at a level previously undocumented before the Late Pleistocene. These remains support a view of later Middle Pleistocene humans able to support debilitated individuals despite the considerable use of their bodies to accomplish routine activities. 相似文献
928.
Cotter G Kaluski E Stangl K Pacher R Richter C Milo-Cotter O Perchenet L Kobrin I Kaplan S Rainisio M Frey A Neuhart E Vered Z Dingemanse J Torre-Amione G 《European journal of heart failure》2004,6(5):601-609
BACKGROUND: In previous studies (the RITZ project), tezosentan, an intravenous (i.v.)-balanced dual endothelin (ET-A/B) antagonist, in doses of 50 and 100 mg/h, improved the hemodynamics but not the clinical outcome of patients with acute heart failure (AHF). OBJECTIVE: To evaluate the effect of lower doses of tezosentan in patients with AHF. SUBJECTS AND METHODS: Included were 130 patients hospitalized due to AHF with dyspnea at rest, despite initial treatment, and were in need of hemodynamic monitoring with cardiac index (CI)<2.5 l/min/m(2) and wedge pressure > or = 20 mm Hg. Patients were randomized in a double-blind fashion to receive placebo or tezosentan: 0.2, 1, 5, or 25 mg/h for 24 h. RESULTS: The primary endpoint of the study, CI increase at 6 h of treatment, was significant in the 5 and 25 mg/h groups. Tezosentan induced a dose-dependent increase in CI and a decrease in wedge pressure, peaking after 3 h in the 5 and 25 mg/h groups. In the 1 mg/h group, this effect was smaller during the first 6 h and increased gradually, becoming significant at 24 h and beyond treatment discontinuation. There was no hemodynamic effect in the 0.2 mg/h arm. Type-B natriuretic peptide (BNP) decreased in the 1, 5, and 25 mg/h groups but not on placebo. Endothelin levels were significantly increased by the 5 and 25 mg/h groups but not in the lower (< or = 1 mg/h) tezosentan doses. Urine output decreased on the 25 mg/h dose. There was a trend towards improvement in patients' subjective dyspnea score and worsening heart failure events, mainly in the 1 mg/h group. CONCLUSIONS: In patients admitted with AHF, tezosentan doses of 1-25 mg/h are efficacious in improving the hemodynamics and reducing BNP. Tezosentan doses beyond 1 mg/h increased plasma endothelin levels and reduced urine output, probably limiting their clinical efficacy, as compared to tezosentan 1 mg/h. 相似文献
929.
Laser-assisted lead extraction: the European experience. 总被引:1,自引:0,他引:1
C Kennergren C A Bucknall C Butter R Charles J Fuhrer M Grosfeld R Tavernier T B Morgado P Mortensen V Paul P Richter T Schwartz F Wellens 《Europace : European pacing, arrhythmias, and cardiac electrophysiology》2007,9(8):651-656
AIMS: The aim of this study is to investigate the safety and effectiveness of Excimer laser-assisted lead extraction in Europe. The final European multi-centre study experience is presented. METHOD AND RESULTS: The Excimer is a cool cutting laser (50 degrees C) with a wavelength of 308 nm. The energy is emitted from the tip of a flexible sheath and is absorbed by proteins and lipids, 64% of the energy is absorbed at a tissue depth of 0.06 mm. The sheath is positioned over the lead, and the fibrosis surrounding the lead is vaporized while advancing the sheath without damaging other leads. From August 1996 to March 2001, 383 leads (170 atrial, 213 ventricular) in 292 patients (mean age 61.6 years, range 13-96) were extracted at 14 European centres. Mean implantation time was 74 months (3-358). Most frequent indications were pocket infection (26%), non-functional leads (21%), patient morbidity (21%), septicaemia or endocarditis (14%), erosion (5%), and lead interference (8%). Median extraction time was 15 min (1-300). Complete extraction was achieved in 90.9% of the leads and partial extraction in 3.4%. Extraction failed in 5.7% of the leads. Major complications = perforations caused 10/22 (3.4/5.7%) of the failures. Most partially extracted patients were considered clinically successful, as only minor lead parts without clinical significance were left. Femoral non-laser technique was used to remove 8/12 of the non-complication failures. The total complication rate, including five minor complications (1.7%), was 5.1%. No in-hospital mortality occurred. CONCLUSION: Pacing and implantable cardioverter-defibrillator leads can safely, effectively, and predictably be extracted. Open-heart extractions can be limited to special cases. The results indicate that the traditional policy of abandoning redundant leads, instead of removing them, may be obsolete in many patients. 相似文献
930.
The effect of altered gastric emptying on caffeine absorption (tablets; 366.1 mg) was studied in patients with gastric stasis or after Billroth II partial gastrectomy with adequate gastric emptying and in healthy subjects with slowed gastric emptying due to a fibre-free and a fibre-rich liquid test meal of an elemental diet, respectively. Compared with controls (n = 15), a significantly slowed caffeine absorption was found in gastric stasis (n = 8) by means of a lower absorption rate constant KA (0.018 +/- 0.007 vs. 0.122 +/- 0.110 min-1 in controls) and a prolonged peak time tmax (160 +/- 77 vs. 46 +/- 19 min). Similar results were obtained after a fibre-free and a fibre-rich liquid test meal, respectively (n = 8 and n = 8, respectively; KA 0.035 +/- 0.01 and 0.035 +/- 0.023 min-1, respectively; tmax 91 +/- 24 and 93 +/- 23 min, respectively vs. KA 0.10 +/- 0.06 min-1 and tmax 50 +/- 14 min in controls; n = 7). After B II with adequate gastric emptying (n = 11) the absorption rate was within the normal range. The significantly lower average of the peak concentration cmax and of the area under the serum concentration-time curve x elimination rate constant (AUC x KE) in gastric stasis (5.9 +/- 1.8 micrograms/ml and 8.9 +/- 3.2 mg/l, respectively) and after B II partial gastrectomy (8.8 +/- 2.6 micrograms/ml and 10.8 +/- 3.0 mg/l, respectively) compared with controls (17.7 +/- 9.4 micrograms/ml and 20.8 +/- 10.7 mg/l respectively) probably reflect reduced bioavailability, which is apparently unchanged after a liquid test meal. 相似文献