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61.
Rebecca M. Dodson Amin Firoozmand Omar Hyder Vania Tacher David P. Cosgrove Nikhil Bhagat Joseph M. Herman Christopher L. Wolfgang Jean-Francois H. Geschwind Ihab R. Kamel Timothy M. Pawlik 《Journal of gastrointestinal surgery》2013,17(12):2123-2132
Background
Assessment of patient performance status is often subjective. Sarcopenia—measurement of muscle wasting—may be a more objective means to assess performance status and therefore mortality risk following intra-arterial therapy (IAT).Methods
Total psoas area (TPA) was measured on cross-sectional imaging in 216 patients undergoing IAT of hepatic malignancies between 2002 and 2012. Sarcopenia was defined as TPA in the lowest sex-specific quartile. Impact of sarcopenia was assessed relative to other clinicopathological factors.Results
Indications for IAT included hepatocellular carcinoma (51 %), intrahepatic cholangiocarcinoma (13 %), colorectal liver metastasis (7 %), or other metastatic disease (30 %). Median TPA among men (568 mm2/m2) was greater than women (413 mm2/m2). IAT involved conventional chemoembolization (54 %), drug-eluting beads (40 %), or yttrium-90 (6 %). Median tumor size was 5.8 cm; most patients had multiple lesions (74 %). Ninety-day mortality was 9.3 %; 3-year survival was 39 %. Factors associated with risk of death were tumor size (HR?=?1.84) and Child's score (HR?=?2.15) (all P?<?0.05). On multivariate analysis, sarcopenia remained independently associated with increased risk of death (lowest vs. highest TPA quartile, HR?=?1.84; P?=?0.04). Sarcopenic patients had a 3-year survival of 28 vs. 44 % for non-sarcopenic patients.Conclusions
Sarcopenia was an independent predictor of mortality following IAT with sarcopenic patients having a twofold increased risk of death. Sarcopenia is an objective measure of frailty that can help clinical decision-making regarding IAT for hepatic malignancies. 相似文献62.
63.
Amin Makni Mohamed Jouini Montassar Kacem Zoubeir Ben Safta 《World journal of emergency surgery : WJES》2012,7(1):1-4
Non-occlusive colonic ischaemia is a recognized albeit rare entity related to low blood flow within the visceral circulation and in most reported cases the right colon was affected. This is the second case report in the literature of extensive colonic necrosis following cardiac arrest and cardiopulmonary resuscitation (CPR). A 83-year-old Caucasian woman was admitted to our hospital due to a low energy hip fracture. On her way to the radiology department she sustained a cardiac arrest. CPR started immediately and was successful. A few hours later, the patient developed increasing abdominal distension and severe metabolic acidocis. An abdominal multidetector computed tomography (MDCT) scan was suggestive of intestinal ischaemia. At laparotomy, the terminal ileum was ischaemic and extensive colonic necrosis was found, sparing only the proximal third of the transverse colon. The rectum was also spared. The terminal ileum and the entire colon were resected and an end ileostomy was fashioned. Although the patient exhibited a transient improvement during the immediate postoperative period, she eventually died 24h later from multiple organ failure. Histology showed transmural colonic necrosis with no evidence of a thromboembolic process or vasculitis. Therefore, this entity was attributed to a low flow state within the intestinal circulation secondary to the cardiac arrest. 相似文献
64.
65.
Hassan AS Sakwa EM Nabwera HM Taegtmeyer MM Kimutai RM Sanders EJ Awuondo KK Mutinda MN Molyneux CS Berkley JA 《AIDS and behavior》2012,16(1):5-12
A cohort design was used to determine uptake and drop out of 213 HIV-exposed infants eligible for Early Infant Diagnosis (EID) of HIV. To explore service providers and care givers knowledge, attitudes and perceptions of the EID process, observations and in-depth interviews were conducted. 145 (68%) infants enrolled after 2 months of age. 139 (65%) dropped out before follow up to 18 months old. 60 (43%) drop outs occurred within 2 months of enrolment. Maternal factors associated with infant drop out were maternal loss to follow up (48 [68%] vs. 8 [20%], P < 0.001) and younger maternal age (27.2 vs. 30.1 years, P = 0.033). Service providers and caregivers had inadequate training, knowledge and understanding of EID. Poverty and lack of social support were challenges in accessing EID services. EID should be more closely aligned within PMTCT services, integrated with routine mother and child health (MCH) activities and its implementation more closely monitored. 相似文献
66.
Linda Broer Christina M. Lill Maaike Schuur Najaf Amin Johannes T. Roehr Lars Bertram John P. A. Ioannidis Cornelia M. van Duijn 《European journal of epidemiology》2013,28(2):131-138
Distinguishing true from false positive findings is a major challenge in human genetic epidemiology. Several strategies have been devised to facilitate this, including the positive predictive value (PPV) and a set of epidemiological criteria, known as the “Venice” criteria. The PPV measures the probability of a true association, given a statistically significant finding, while the Venice criteria grade the credibility based on the amount of evidence, consistency of replication and protection from bias. A vast majority of journals use significance thresholds to identify the true positive findings. We studied the effect of p value thresholds on the PPV and used the PPV and Venice criteria to define usable thresholds of statistical significance. Theoretical and empirical analyses of data published on AlzGene show that at a nominal p value threshold of 0.05 most “positive” findings will turn out to be false if the prior probability of association is below 0.10 even if the statistical power of the study is higher than 0.80. However, in underpowered studies (0.25) with a low prior probability of 1 × 10?3, a p value of 1 × 10?5 yields a high PPV (>96 %). Here we have shown that the p value threshold of 1 × 10?5 gives a very strong evidence of association in almost all studies. However, in the case of a very high prior probability of association (0.50) a p value threshold of 0.05 may be sufficient, while for studies with very low prior probability of association (1 × 10?4; genome-wide association studies for instance) 1 × 10?7 may serve as a useful threshold to declare significance. 相似文献
67.
Methotrexate[MTX] is commonly employed as the initial DMARD used for treatment of Rheumatoid arthritis[RA]. We aimed to contribute to the safety profile of MTX by assessing its cumulative effect on renal filtration. Fifty two RA adult females with normal base-line serum creatinine and GFR at the initial diagnosis of the disease were included. Group-1[G1] included 30 patients[mean age 40.4 ± 4.4 years] on MTX and NSAIDS, while 22 RA patients[mean age 38.5 ± 8.2 years] who received NSAIDs only served as the control group[G2]. Renal function was assessed by GFR-measurement using Technetium diethylenetriamine-pentaacetic acid[Tc-99 m-DTPA] at the point of the study time corresponding to disease duration. 21/30[70%] in G1 showed reduced GFR compared to 6/22[27.3%] in G2[P0.007] with 3.3 ± 0.5% annual reduction of GFR. Reduced GFR in G1 showed significant negative correlation with age[r = ?0.396, P = 0.005], MTX-cumulative dose[r = ?0.263, P = 0.049], MTX-intake duration[r = ?0.293, P = 0.031] and NSAID-intake duration[r = ?0.344, P = 0.014]. Low dose MTX has a slow cumulative effect on renal filtration manifested by GFR reduction over time that could be monitored by Tc-99 m DTPA. 相似文献
68.
IntroductionBehçet’s disease (BD) is an idiopathic multisystem disorder. Cardiac involvement[cardio-BD] occurs in 7–60% of BD patients. Technetium 99m-Methoxyisobutyl isonitrile (Tc-99m sestamibi) is a myocardial perfusion imaging agent that is used for evaluation of the coronary flow.Aim of the workTo evaluate the usefulness of Dipyridamole pharmacological stress test in conjunction with Tc-99m sestamibi cardiac gated single photon emission computed tomography (GSPECT) to investigate the prevalence of subclinical coronary endothelial dysfunction[SCED] in asymptomatic Egyptian BD patients; also to assess possibly associated clinical predictive variables.Patients and MethodsTwenty-five BD patients without overt cardiac involvement and fifteen healthy controls matched for age, BMI and sex were included. Database included full history, clinical examination, relevant laboratory tests, and Tc-99m sestamibi myocardial GSPECT with coronary angiography[CAG] in GSPECT positive cases. Disease activity was assessed using Behçet’s Disease Current Activity Form (BDCAF).ResultsSCED detected by reduced flow or left ventricular dysfunction (LVD) or both was found in 13/25[52%] of BD-patients[12 males and 1 female] vs. 1/15[6.7%] of controls[P < 0.0001] with normal CAG. Subjects with positive GSPECT had significantly older age[P = 0.01] and longer disease duration (P = 0.02) and were more frequently males (P < 0.0001) than those with negative GSPECT. No statistically significant differences between cases with negative and positive GSPECT were found regarding other clinical or laboratory parameters.ConclusionTc-99m sestamibi GSPECT could be a useful screening tool for detection of SCED in BD patients, so early prophylactic measures and therapy modifications could be considered. 相似文献
69.
Navin M. Amin 《Postgraduate medicine》2013,125(1):195-208
For additional diagnostic clues, Dr Morris recommends looking at the eyes. Many systemic diseases, including diabetes mellitus, thyroid disease, and AIDS, have characteristic ocular manifestations. These often can be seen with tools readily available to primary care physicians. This article sheds light on the role of ocular findings in the evaluation of systemic disease. 相似文献
70.
Mark L. Eberhard Gholamabbas Amin Ostovar Kote Chundu Dan Hobohm Iman Feiz-Erfan Blaine A. Mathison Henry S. Bishop Paul T. Cantey 《The American journal of tropical medicine and hygiene》2013,88(3):601-605
A 22-month-old girl presented with neck pain and stiffness and magnetic resonance imaging showed an extradural mass extending from C2 through the C4 level with moderate to severe compression of the cord. A left unilateral C2–C4 laminectomy was performed revealing an extradural rubbery tumor; a small biopsy was obtained. Examination of stained tissue revealed the presence of a parasitic worm that was identified as a gravid female Onchocerca lupi. A magnetic resonance imaging at 7 weeks follow-up showed a significantly decreased size of the enhancing lesion and the patient''s symptoms gradually resolved. This is the first report of zoonotic O. lupi in the United States. The parasite has been reported in dogs and cats in the western United States, and from people in four cases reported from Europe. A great deal more needs to be learned, including full host range and geographic distribution, before we fully understand O. lupi infections in animals and man. 相似文献