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581.
Haemodynamic parameters predicting variceal haemorrhage and survival in alcoholic cirrhosis 总被引:1,自引:0,他引:1
Stanley AJ; Robinson I; Forrest EH; Jones AL; Hayes PC 《QJM : monthly journal of the Association of Physicians》1998,91(1):19-25
The relationship between the various haemodynamic abnormalities observed in
cirrhosis and their prognostic value remains unclear. We report
haemodynamic measurements on 96 patients with alcoholic cirrhosis (mean
Childs-Pugh Score, CPS, 9.0 +/- 0.2, mean age 55.6 +/- 1.0 years) and
assess their value in predicting variceal bleeding and death during a mean
follow-up of 19.3 +/- 1.5 months. Baseline CPS correlated with hepatic
venous pressure gradient (HVPG) (p = 0.001), azygos blood flow (p <
0.05), cardiac index (p < 0.05), and inversely with mean arterial
pressure (p < 0.01) and systemic vascular resistance index (p <
0.05). Renal blood flow was not related to any haemodynamic parameter or
CPS. Thirty-eight patients died during follow-up, and 16 had a variceal
bleed. Death (p = 0.001) and variceal bleeding (p < 0.05) were more
likely in patients with HVPG > 16 mmHg than in those with HVPG < 16
mmHg, and variceal bleeding was more likely in patients with HVPG > 12
mmHg (vs. HVPG < 12 mmHg, p < 0.05). HVPG also predicted death and
variceal haemorrhage on univariate and multivariate analyses. No other
haemodynamic parameter predicted death or bleeding. In alcoholic cirrhosis,
severity of liver disease is related to HVPG, collateral blood flow and
degree of systemic circulatory abnormalities. HVPG is a useful predictor of
survival and variceal bleeding in these patients.
相似文献
582.
SUMMARY Anterior mediastinal tumours have been reported that initially presented with signs suggestive of cardiac disease. The widespread availability of two-dimensional echocardiography has demonstrated that, in the majority of cases, right ventricular compression is the major cardiac complication of such masses. We report two cases of mediastinal lymphoma that presented with chest pain and signs of right ventricular outflow obstruction. 相似文献
583.
584.
Toward standardization of care: The feeding readiness assessment after congenital cardiac surgery
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Daniel E. Ehrmann MD MS Matthew Mulvahill MS Shaunda Harendt MS CCC‐SLP BCS‐S Jessica Church CPNP‐AC/PC Amy Stimmler CPNP‐PC Piyagarnt Vichayavilas MS RD CNSC Sanja Batz OTR/L Jennifer Rodgers OTR/L Michael DiMaria MD James Jaggers MD Cindy Barrett MD MPH Jon Kaufman MD 《Congenital heart disease》2018,13(1):31-37
Background
Feeding practices after neonatal and congenital heart surgery are complicated and variable, which may be associated with prolonged hospitalization length of stay (LOS). Systematic assessment of feeding skills after cardiac surgery may earlier identify those likely to have protracted feeding difficulties, which may promote standardization of care.Methods
Neonates and infants ≤3 months old admitted for their first cardiac surgery were retrospectively identified during a 1‐year period at a single center. A systematic feeding readiness assessment (FRA) was utilized to score infant feeding skills. FRA scores were assigned immediately prior to surgery and 1, 2, and 3 weeks after surgery. FRA scores were analyzed individually and in combination as predictors of gastrostomy tube (GT) placement prior to hospital discharge by logistic regression.Results
Eighty‐six patients met inclusion criteria and 69 patients had complete data to be included in the final model. The mean age of admit was five days and 51% were male. Forty‐six percent had single ventricle physiology. Twenty‐nine (42%) underwent GT placement. The model containing both immediate presurgical and 1‐week postoperative FRA scores was of highest utility in predicting discharge with GT (intercept odds = 10.9, P = .0002; sensitivity 69%, specificity 93%, AUC 0.913). The false positive rate was 7.5%.Conclusions
In this analysis, systematic and standardized measurements of feeding readiness employed immediately before and one week after congenital cardiac surgery predicted need for GT placement prior to hospital discharge. The FRA score may be used to risk stratify patients based on likelihood of prolonged feeding difficulties, which may further improve standardization of care. 相似文献585.
Remi Stevelink Maurits WCB. Sanders Maarten P. Tuinman Eva H. Brilstra Bobby PC. Koeleman Floor E. Jansen Kees PJ. Braun 《Epileptic Disord》2018,20(2):99-115
Aims. In recent years, many different DNA mutations underlying the development of refractory epilepsy have been discovered. However, genetic diagnostics are still not routinely performed during presurgical evaluation and reports on epilepsy surgery outcome for patients with genetic refractory epilepsy are limited. We aimed to create an overview of the literature on seizure outcome following epilepsy surgery in patients with different genetic causes of refractory epilepsy. Methods. We systematically searched PubMed and Embase prior to January 2017 and included studies describing treatment outcome following epilepsy surgery in patients with genetic causes of epilepsy. We excluded studies in which patients were described with epilepsy due to Tuberous Sclerosis Complex or Sturge‐Weber syndrome (since this extensive body of research has recently been described elsewhere) and articles in which surgery was aimed to be palliative. Results. We identified 24 eligible articles, comprising a total of 82 patients who had undergone surgery for (mainly childhood‐onset) refractory epilepsy due to 15 different underlying genetic causes. The success rate of surgery varied widely across these different genetic causes. Surgery was almost never effective in patients with epilepsy due to mutations in genes involved in channel function and synaptic transmission, whereas surgery was significantly more successful regarding seizure control in patients with epilepsy due to mutations in the mTOR pathway. Patients with a lesion on MRI tended to have higher seizure freedom rates than those who were MRI‐negative. Conclusion. Although the evidence is still scarce, this systematic review suggests that studying genetic variations in patients with refractory epilepsy could help guide the selection of surgical candidates. 相似文献
586.