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51.
Alexander Richter Christian Schütz Michael Hauck Henry Halm 《European spine journal》2010,19(2):283-289
A number of interspinous process devices have recently been introduced to the lumbar spinal market as an alternative to conventional
surgical procedures in the treatment of symptomatic lumbar stenosis. One of those “dynamic” devices is the Coflex™ device
which has been already implanted worldwide more than 14,000 times. The aim of implanting this interspinous device is to unload
the facet joints, restore foraminal height and provide stability in order to improve the clinical outcome of surgery. Published
information is limited, and there are so far no data of comparison between the implant and traditional surgical approaches
such as laminotomy. The purpose of our prospective study is to evaluate the surgical outcome of decompressive surgery in comparison
to decompressive surgery and additional implantation of the Coflex™ interspinous Device. 60 patients who were all treated
in the Spine Center of Klinikum Neustadt, Germany for a one or two level symptomatic LSS with decompressive surgery were included.
Two groups were built. In Group one (UD) we treated 30 patients with decompression surgery alone and group two (CO) in 30
patients a Coflex™ device was additional implanted. Pre- and postoperatively disability and pain scores were measured using
the Oswestry disability index (ODI), the Roland–Morris score (RMS), the visual analogue scale (VAS) and the pain-free walking
distance (WD). Patients underwent postoperative assessments 3, 6 and 12 month including the above-mentioned scores as well
as patient satisfaction. In both groups we could see a significant improve (p < 0.001) in the clinical outcome assessed in the ODI, in the RMS for evaluation of back pain, in the VAS and in the pain-free
WD at all times of reinvestigation compared to base line. At 1-year follow up there were no statistically differences between
both groups in all ascertained parameters including patient satisfaction and subjective operation decision. Because there
is no current evidence of the efficacy of the Coflex™ device we need further data from randomized controlled studies for defining
the indications for theses procedures. To the best of our knowledge this is the first prospective controlled study which compares
surgical decompression of lumbar spinal stenosis with additional implanting of an interspinous Coflex™ device in the treatment
of symptomatic LSS. 相似文献
52.
Willem-Jan Flu Jan-Peter van Kuijk Sanne Hoeks Jeroen J. Bax Don Poldermans 《Current cardiology reports》2010,12(4):286-294
During noncardiac surgery, patients may be at risk for developing cardiac events, related to underlying coronary artery disease. Therefore, perioperative cardiac complications remain an area of clinical interest and concern in patients undergoing noncardiac surgery. Over the years, perioperative risk assessment has evolved significantly to detect surgical patients with myocardium at risk due the coronary artery disease. In addition, many efforts have been made to reduce the cardiac risk of patients undergoing noncardiac surgery. The present review article will focus on the definition of high cardiac risk surgery and will discuss patient-related cardiac risk factors. In addition, the preoperative cardiac tests available to detect patients with coronary artery disease and strategies to reduce perioperative cardiac risk, as recommended in most recent perioperative guidelines, will be outlined. 相似文献
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57.
Jan-Peter van Kuijk Willem-Jan Flu Michel Chonchol Jeroen J. Bax Hence J.M. Verhagen Don Poldermans 《Atherosclerosis》2010,210(2):596-601
Objective
Metabolic syndrome (MetSyn) is a well-known risk factor for cardiovascular (CV) disease in the general population; however, the additional predictive value for CV events in high-risk patients with peripheral arterial disease (PAD) is unknown. The aims of the current study were to assess and compare: (1) prevalence of MetSyn, and (2) predictive value of MetSyn for CV events, in patients with either occlusive or aneurysmatic PAD.Methods
We screened 2069 patients scheduled for lower occlusive arterial revascularization (n = 1031) or abdominal aortic aneurysm repair (n = 1038) for the presence of MetSyn. Adult Treatment Panel III report (ATP III) was used for defining MetSyn. Central obesity was defined as body-mass-index >30 kg/m2. Main outcomes were the occurrence of CV events and CV mortality during a median follow-up of 6 years (IQR 2–9 years).Results
Metabolic syndrome was diagnosed in 421 (41%) and 432 (42%) patients with occlusive and aneurysmatic PAD, respectively (p = 0.72). Patients with occlusive or aneurysmatic PAD and MetSyn had an increased risk for the development of CV events, when compared to patients without MetSyn (27% vs. 18% and 27% vs. 19%, p < 0.001, respectively). In occlusive and aneurysmatic PAD, MetSyn was independently associated with an increased risk of CV events (HR = 1.6; 95%CI 1.2–2.1 and HR = 1.4; 95%CI 1.1–1.8). No significant association between the presence of MetSyn and CV mortality was observed.Conclusions
Metabolic syndrome is highly prevalent in high-risk PAD patients. In occlusive and aneurysmatic PAD patients, MetSyn is an independent predictor of long-term CV events. 相似文献58.
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60.
Peters MJ Vis M van Halm VP Wolbink GJ Voskuyl AE Lems WF Dijkmans BA Twisk JW de Koning MH van de Stadt RJ Nurmohamed MT 《Annals of the rheumatic diseases》2007,66(7):958-961
OBJECTIVE: To evaluate the effects of infliximab and corticosteroid treatment on the lipid profile in patients with active rheumatoid arthritis (RA). METHODS: Infliximab infusions were given at weeks 0, 2, 6 and then every 8 weeks. Before each infusion, disease activity parameters (Disease Activity Index 28-Joint Score (DAS28)) C reactive protein (CRP) and lipid levels (total cholesterol, high-density lipoprotein (HDL)-cholesterol, triglycerides, apolipoprotein A1 (apo A1) and apolipoprotein B) were measured in 80 consecutive patients with RA, who completed the study period of 48 weeks. Longitudinal analyses were used to investigate (1) the course of lipid levels over a period of time and (2) the relationship between lipids, prednisone dose and disease activity. RESULTS: Infliximab treatment causes a significant reduction in disease activity and a concomitant decrease in prednisone dose. Although they initially improved significantly, all lipid levels had returned to baseline levels after 48 weeks, except for apo A1. Longitudinal analyses revealed significant yet opposite associations between lipid levels and disease activity and between lipid levels and prednisone dose. DAS28 improvement by 1 point was associated with an increase of 0.016 mmol/l (0.618 mg/dl) total cholesterol and 0.045 mmol/l (1.737 mg/dl) HDL-cholesterol. Reduction of 10 mg prednisone was associated with a decrease of 0.04 mmol/l (1.544 mg/dl) total cholesterol and 0.16 mmol/l (6.177 mg/dl) HDL-cholesterol. CONCLUSION: Overall, no changes in serum lipid levels were observed after 48 weeks of infliximab treatment. The initial beneficial effects of infliximab on the lipid profile, by means of a reduction of disease activity, are attenuated by a concomitant decrease in prednisone dose. 相似文献