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Christopher Learn MD Alistair Phillips MD Joanne Chisolm BSN MSN ACNP‐BC Sharon Hill MSN ACNP‐BC John Cheatham MD Peter Winch MD MBA Mark Galantowicz MD Ralf Holzer MD 《Congenital heart disease》2012,7(2):111-121
Introduction. Pulmonary atresia with ventricular septal defect (VSD) continues to be associated with significant morbidity and mortality, with significant institutional variation in therapeutic strategies. This study reports a single center experience utilizing an intensive transcatheter approach to promote pulmonary vascular growth. Methods. A retrospective analysis of 20 patients undergoing surgical and transcatheter treatment for pulmonary atresia with VSD between 2002 and 2010. Results. The median age at initial surgical palliation was 6.3 months (8 days to 2.5 years). Eleven patients (group 1) underwent initial surgical palliation without VSD closure and nine patients (group 2) underwent an initial complete repair with fenestrated or complete VSD closure. Group 1 had a smaller Nakata index (54 mm2/m2 vs. 134 mm2/m2, P= .04) and a smaller absolute native pulmonary artery diameter (2.7 mm vs. 4.5 mm, P= .01) than group 2. Intraoperative angiography was performed in 10 cases to evaluate if early transcatheter intervention was warranted. The median follow‐up during the study period was 2.3 years (1.6 months to 8.3 years). Of the 16 patients who survived the initial early postoperative period, 15 patients (94%) went on to receive surgical (n = 11) and/or interventional (n = 25) catheterization procedures. There was improvement in the mean Nakata index from the initial presurgical evaluation to the most recent catheterization data (38.4 mm2/m2 vs. 169.7 mm2/m2, P≤ .05). To date, two of 11 (18%) patients in group 1 ultimately underwent surgical VSD closure. Overall mortality was six of 20 (30%) with four deaths in group 1 and two deaths in group 2. There were no procedural deaths. Conclusions. Combining surgical unifocalization procedures with subsequent early and intensive catheter‐based pulmonary artery rehabilitation may improve vascular growth, ultimately rendering many patients suitable for fenestrated VSD closure. Risk stratification, including intraoperative exit angiography, is essential to determine the need for early transcatheter interventions. 相似文献
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Melinda L. Munang Catherine Browne Shaina Khanom Jason T. Evans E. Grace Smith Peter M. Hawkey Heinke Kunst Steven B. Welch Martin J. Dedicoat 《Emerging infectious diseases》2015,21(3):524-527
To determine if local transmission was responsible for rising tuberculosis incidence in a recently dispersed migrant community in Birmingham, UK, during 2004–2013, we conducted enhanced epidemiologic investigation of molecular clusters. This technique identified exact locations of social mixing and chains of apparent recent transmission, which can be helpful for directing resources. 相似文献
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Cardiovascular Disease,Mortality Risk,and Healthcare Costs by Lipoprotein(a) Levels According to Low‐density Lipoprotein Cholesterol Levels in Older High‐risk Adults 下载免费PDF全文
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LTC Edwin S. Beatrice MC Georg D. Frisch MBA 《Archives of environmental & occupational health》2013,68(5):322-326
The eyes of rhesus monkeys were exposed to argon (514.5 nm) and ruby (694.3 nm) laser irradiation using various retinal image diameters which were estimated by microphotometric techniques. The experimental design for both wavelengths produced image diameters of 40μ to 50μ for the “minimal” case and approximately 500μ to 1,000μ for the larger irradiance series employed. Extramacular retinal exposure sites were examined by ophthalmoscopic and histopathological techniques. Flat preparations of the pigmented epithelium and sensory layers of the retina were utilized in the confirmation of damage at low power levels. All data were statistically analyzed to establish trends, and results were compared for the wavelengths employed. Results indicate that retinal damage is primarily dependent on energy distribution as a function of image diameter and exposure duration. 相似文献
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Reports of uterine rupture following surgical abortion are rare but may result in hemorrhage, sepsis, and even death. In this unique case, we describe how a transabdominal pelvic ultrasound performed at the bedside by an emergency department physician identified uterine rupture with retained products of conception and led to an emergent laparotomy and hysterectomy. This case illustrates how bedside ultrasound may be used in patients presenting with abdominopelvic pain following surgical abortion to shorten the time to definitive treatment and ultimately lower the morbidity and mortality associated with a diagnosis of life-threatening uterine rupture. 相似文献